Would codeine be listed today?

paracetamol challenge: blister pack with one tablet separate

Codeine might not even be approved for use if it was introduced today, one doctor says

“I think if codeine was invented next week, it might struggle to get listed,” says Dr Michael Gannon, national president of the Australian Medical Association.

Speaking to ABC Radio Melbourne’s Susan Carland following the call by NSW Nationals leader John Barilaro for a reassessment of the codeine upschedule, Dr Gannon said that “When we look at the harms it causes and its ineffectiveness at low doses, it might struggle to get on the formulary today.

“At low doses it’s no better than the standalone agents like paracetamol and anti-inflammatory, and at high doses it is increasingly a drug of abuse.

“I’m not interested in GPs, other specialists, prescribing yet more and more codeine,” he said.

“The more we know about this drug, the more we realise that we should be looking for more effective and safer alternatives.”

Dr Gannon also told Ms Carland that “Panadeine is no more effective than plain paracetamol”.

“The preparations containing codeine and an anti-inflammatory are no more effective than the anti-inflammatory on its own,” he said.

Writing in the Medical Observer, Dr Jennifer Pilgrim, head of the drug harm prevention unit of Victorian Institute of Forensic Medicine, also said that given the harms caused by addiction and high-dose exposure to ibuprofen or paracetamol in codeine-containing products, there would need to be “good evidence of substantial benefit to warrant such serious harm and loss of life”.

She also said that there was no conclusive evidence of a benefit for these products compared to non-opioid analgesics.

“New OTC combination analgesics (ibuprofen/paracetamol) provide better analgesia than OTC CCAs, without the risk of opiate addiction,” she writes.

University of Sydney’s Peter Carroll wrote last week that he believes the push to switch to these combinations, however, was “incorrect and potentially dangerous” as ibuprofen is problematic for patients with high blood pressure, heart failure or renal impairment, among other ailments.

Guild Victorian Branch president Anthony Tassone told commenters on AJP’s coverage of Mr Barilaro’s statement that 71% of codeine users plan to visit their GP for continued access to the drug after 1 February next year.

“The majority of this group (70%) indicated they will not even consider alternative analgesics that will remain available over-the-counter,” Mr Tassone wrote.

“Such sentiments at the grassroots level are important and should be considered as part of this ongoing debate and discussion.”

He called on pharmacists “not be so dismissive of actual patients concerns about the impact on their own pain management by a decision that they had little control over”.

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