Codeine makes headlines as pharmacists warn of trouble ahead

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Pharmacists are taking to mainstream media outlets both large and small to express their opinions on the upcoming codeine changes

Several pharmacists around the country have given interviews to state and local newspapers, warning Australians that the codeine upschedule is on its way; more than a few have used mainstream media as an outlet to express their dissatisfaction with the decision.

Many of the latter are still hoping for the Guild’s proposed exception protocol, which would see pharmacists still able to dispense the products without a prescription under certain circumstances.

Thurgoona pharmacist Simon Horsfall wrote to the Border Mail to warn that “if the proposed change goes ahead I believe it will force some in our community to suffer unnecessary pain because if they wish to use the products they will have to get a doctor’s appointment”.

In his letter he urged state MPs to encourage NSW Health Minister Brad Hazzard to implement the “prescription – except when” protocol, and urged pharmacists to contact Mr Hazzard’s office.

“The decision to make the products available only on prescription can be changed as the NSW Health Minister, Brad Hazzard, can regulate to allow pharmacists to give people in acute pain a limited three-day supply in conjunction with mandating real-time monitoring that is already in place in the majority of pharmacies,” he wrote.

“This would allow pharmacists to identify and help those people who may be misusing the products, while at the same time allowing the vast majority of people who use the products appropriately and safely for the short-term treatment of acute pain continued access to the products without a prescription.”

At the time of writing a reader poll published alongside the letter had 72% of respondents (93 votes) choosing the “No… this is a dumb decision that punishes the vast majority of people who do nothing wrong” option, while another 26% (33 votes) responded with, “No. It’s another example of the nanny state approach”.

Only three readers had selected “Yes, because of the minority of people who abuse it”.

Judy Plunkett, a branch committee member with the Pharmacy Guild’s NSW Branch, has appeared in the Port Macquarie News stating that the upschedule will mean “congestion at doctors’ surgeries and a crowded A&E” from February 1.

“This will see upward pressure on Medicare, increased costs to patients where your doctor does not bulk bill and more of the so-called doctor and pharmacy shopping,” she said.

Ms Plunkett criticised “misinformation” being circulated by stakeholders including doctors, which attempts to discredit pharmacists who do not support the upschedule.

“I’ve been told that pharmacists oppose this move because it will cost them money,” she said. “On the contrary, we are likely to get more money because the patient will still require the prescription to be filled out.

“The other myth is the number of deaths associated with over-the-counter codeine-containing medicines. It is minimal.”

Perth Now says that “desperate customers are reportedly stockpiling” low-dose codeine products, quoting Pharmacy Guild WA Branch president, Andrew Ngeow, who said he has heard anecdotal reports that this is occurring.

“People are actually scared and they are desperate because they are wondering come February 1 what are they going to do,” Mr Ngeow said.

He said that “no-one is proposing a strong solution” for people who require pain management but for whom ibuprofen or paracetamol might not be appropriate.

Hunter Valley pharmacist John Jones told the Newcastle Herald that a better solution would be to make MedsASSIST mandatory, like Project Stop, as there will be no way to track codeine sales after 1 February.

“At the moment, there is no way for GPs to monitor someone’s opiate use. So you can go and see three different prescribers, get three different prescriptions, and present to three different pharmacies, and no one has any idea,” he said.

In the same article, the University of Sydney’s Peter Carroll called the upschedule “a silly solution”.

Professor Carroll had previously penned a piece for the Daily Telegraph in which he criticised the upschedule and warned of lack of timely access to pain management, as well as the possibility that patients could be prescribed a higher strength codeine product by GPs.

The Bega District News quotes an unnamed locum who warns that alternatives such as ibuprofen could spell trouble for people using it for pain relief.

“Nurofen can elevate blood pressure, irritate the stomach causing ulcers, and led to the retention of fluid around the kidneys,” she said.

She said she had not witnessed codeine dependence and “pharmacists are educated enough to handle conservative doses of codeine”.

In the Namoi Valley Independent, Gunnedah pharmacist Karen Carter warned that the pharmacy may have to send patients to the hospital for pain relief on weekends.

Peter Lee from Warnnambool told The Standard that there may be a shortage of the medicines following the upschedule. He said pharmaceutical suppliers have indicated that they would be cautious when supplying pharmacies due to an expected drop in sales once the change is implemented.

Meanwhile Adrian Ebbern has told the Tenterfield Star that the upschedule will not be as daunting as it may appear.

“I know just about every customer who walks in here by name,” he told the Star. “The vast majority who are taking these medications containing codeine are also in regular contact with their doctor, so obtaining a script shouldn’t be an issue.”

He encouraged readers to talk to their pharmacist first about alternatives including OTC NSAIDs, paracetamol and non-pharmaceutical options.

“At the end of the day, both the pharmacist and the doctor are after the best health outcome for the person,” Mr Ebbern said.

“It will be the same as it’s always been. If we can’t treat a condition with over-the-counter products, we’ll refer you to a doctor.”

And in the Canberra Times Magna Sadkowsky said that the looming upschedule had offered a good opportunity to discuss pain management with patients, though some patients had not reacted well to the news.

She said she hadn’t seen evidence of stockpiling, but customers might buy codeine-containing OTCs while they still can “just in case”.

“We actually get a very mixed response, some people who are very passionate with their frustration and anger that this is happening because they feel they are managing their pain in the best way,” Ms Sadkowsky said.

“[Recently] we had a really upset lady who said it would cost her a lot out of pocket to see her doctor and it is hard to get in to see her doctor.”

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