Codeine deaths claim ‘doesn’t stack up’: Fact Check

RMIT ABC Fact Check has concluded Minister Hunt’s claim that making codeine prescription-only would save 100 lives a year doesn’t stack up to evidence

In a move that is sure to reignite the codeine upschedule debate, RMIT ABC Fact Check has examined the evidence behind Health Minister Greg Hunt’s claim that making codeine prescription-only would save 100 lives a year.

“Mr Hunt’s claim doesn’t stack up,” the Fact Check team concludes.

“There has not been any recent data to suggest that 100 Australians are dying every year from over-the-counter codeine products.

“The latest available data was published in a 2015 study covering 2000 to 2013, which showed that on average about 100 Australians were dying a year from all codeine products, both over-the-counter and prescription.”

RMIT ABC Fact Check points out Mr Hunt’s claim comes from a TGA estimate, which is based on an assumption that an increasing death rate seen in the early years of that research would have continued in the time since then.

“This is not accepted by experts consulted by Fact Check,” it says.

Experts contacted by Fact Check pointed to a 2015 study, ‘Trends and characteristics of accidental and intentional codeine overdose deaths in Australia’, which found there were 1437 deaths linked to codeine, both prescription and over-the-counter products, between 2000 and 2013.

This amounts to an average of around 103 deaths per year.

“In any case the study was unable to determine the source of the codeine involved in 60% of the deaths,” said the Fact Check team.

“In the 40% where the source could be determined, over-the-counter products were involved in 40% of cases.

“That means over-the-counter codeine was only conclusively found in 16% of all the deaths reported in the study, or 16% on average.

“It appears that Mr Hunt and the Therapeutic Goods Administration have used the study’s findings to assume that over-the-counter products were involved in 40% of all codeine-related deaths.”

Image credit: ABC News
Image credit: ABC News

Fact Check is funded jointly by RMIT University and the ABC, and works to determine the accuracy of claims by politicians, public figures, advocacy groups and institutions engaged in the public debate.

The team’s verdict provides vindication for the anti-upschedule team, which has been persistently adamant that the claim was wrong.

“I am not aware of any study or data which backs up this claim – which is misleading, defamatory to pharmacists and must stop,” Pharmacy Guild NSW Branch president David Heffernan said in January.

“If there is any data to back up such an overblown claim, those making the claims should produce it – but I doubt that they can because I do not believe it exists,” he said.

University of Sydney’s Professor Peter Carroll countered the claim, saying he disputed the 100 deaths a year statistic and that the “vast majority” of people used low-dose codeine safely and appropriately for acute pain.

“In the debate regarding the upscheduling of low dose OTC codeine-containing products I had a number of conversations and email contacts with Mr Hunt where I advised him that I believed his claim was inaccurate, and that he had been misled by the TGA,” Professor Carroll told AJP.

Professor Carroll says the majority of the data referred to in the TGA’s claim was collected before codeine products were made Schedule 3 (May 2010), and no data was collected after the introduction of MedsASSIST (February 2016).

“They give no figures for the past four years, and include data collected a decade or more ago,” he says.

“It seems meaningless to quote any figure as to the best of my knowledge there is no evidence to show what the current figure actually is.”

Professor Carroll believes Minister Hunt and the TGA should “publicly admit that they were using outdated data” on which they based their codeine claims.

See the full verdict here.

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  1. Debbie Rigby

    Surely one preventable death is too many…

    Too much use of evidence to support an opinion.

    • Glen Bayer

      While I agree that codeine is a bit crap, and the upscheduling should help with reducing diversion/abuse and associated harms, I think we need to be careful if we start picking and choosing to accept evidence only when it suits our preferred agenda. The “for” argument in the codeine case were pretty happy to accept the study data (ie evidence) as presented to support the rescheduling.

    • Jarrod McMaugh

      the question – as it has been all along – is whether it will save lives.

      There has been plenty of evidence on the dangers of codeine, but this evidence is not very clear on the source of codeine. Even when people have had access to OTC-strength codeine products, there is documented evidence that these strengths have been prescribed in large quantities.

      What’s really disappointing is that the particular study being relied on here is a very good study, but it is being asked to hold up a conclusion that it is not powered to provide, since it cannot identify they source of the codeine causing the deaths in question.

      So, if access to codeine in high volumes cannot be equivocally tied to OTC access – and the other pillars of harm minimisation are not being addressed soon (ORT access & infrastructure, RTPM access, Pain management infrastructure) – then will this actually save any lives? In other words, has the change actually reduced the capacity of people to get codeine from sources that they were accessing in dangerous quantities before?

      The answer so far seems to be no…. especially since most people are being prescribed high volumes or higher strengths (not helped by the non-availability of lower strengths).

      It was pointed out multiple times by plenty of people that the “100 deaths” associated with codeine could not be linked to OTC access. It is very clear that these numbers are inflated….. yet it was the will of the TGA and the health minister that these medications be re-scheduled, so the veracity of the 100 deaths was never addressed by anyone on the side of the argument calling for schedule change.

      Now, I can see the value in going along with TGA and the health minister on an issue that they want addressed, especially if the intent is to improve health or save lives… but to rely on data that is so readily disproven undermines the argument, weakens the resolve of people who can see through the misrepresented data, and creates a conflict where none needed to exist. I for one am a proponent for harm minimisation, but I cannot support the use of data that is clearly being given more weight than it should hold based just so it can achieve a political end-point.

      Yes, one preventable death is too many…. but lets have evidence (reliable evidence) that shows that the deaths will be prevented by the measures taken.

    • Willy the chemist

      What a load of …excuses. This is such a weak argument, it’s not only bias but it’s a fallacy.
      In the same vein, we should reintroduce The great prohibition.

      You on the other hand selectively used the result of studies to support your biased opinion. It’s not being objective.

    • Mr Bighead

      Alcohol kills 15 people every day, 5500 people a year, in Australia. What’s you point Debbie?

  2. Amandarose

    I do worry we take people’s autonomy when we legislate to “save lives”.
    I personally believe people are entitled to their addictions and the legislation should be towards avoiding exploitation and promoting addictive substances.
    The reality is alcohol causes way more deaths then codeine yet we respect and even glorify alcohol.
    Addiction is a disease we can offer support for but we cannot force people to live the way we think they should.
    Having said all that I don’t miss the charade of codeine sales at all where everyone knows their lines and we all pretend it’s normal.

  3. Toby

    Most of the anti-OTC-anything (eg Codeine) arguments come from people who have jobs which do not involve providing actual OTC pharmaceutical products to help the public. Non-supply jobs include paid chatterers (politicians, some holier-than-thou consultant pharmacists) , public servants (eg some public servants, some hospital pharmacists, some academic pharmacists). Note that most of the anti- supply-to-help-the-public arguments do not involve restricting doctors in any way, and avoid addressing any evidence showing that doctors are not monitoring supply to the same high standard that pharmacists have done.

    • Russell Smith

      Any idea when the “ongoing national survey of lives saved by funded do-gooders” will be published? Might be interesting to find out how many lives were not, not saved. But then that wd disprove the chatterers and public servants opinions and false facts! Bet there’s no funding now that prohibition is a done deal. Then after all the do-gooders are finished interfering in natural selection, in every facet of our lives, what is going to be left to die of or from?

      • Toby

        What will we die from, Russell? Boredom and pointlessness – but I think the system will decline, under the increasingly top-heavy weight of its own pomposity before that point. Then we will start again with some common sense.

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