Codeine: the fallout


Australians have been warned they may have to pay more for low-dose codeine now it’s on script… and pharmacists are cast as the culprits

In a Herald Sun article this week, News Corp national health reporter Sue Dunlevy has examined the codeine upschedule and highlighted the issue of cost to patients.

“Now the pills are prescription only, chemists will be able to charge a dispensing fee for supplying the drugs that will raise their price,” wrote Ms Dunlevy, who has written a number of articles critical of pharmacists and dispensing fees in the past.

“The dispensing fee for PBS medicines is around $7 per pack but chemists can decide to set their own dispensing fee for private scripts, some may not charge one at all.”

The article does point out that formerly-S3 codeine will not be PBS subsidised.

One pharmacist told the AJP of his surprise when he went to order Nurofen Plus with the new Prescription Only packaging – and how the price change affected his ordering decision.

“They used to charge us $6.91 for a pack and it cost us $17.95 – it went up $11! I’d have thought RB would be a bit more cautious about tripling the price overnight,” he said.

“The thing is, there’s a big difference in what the public are going to pay for it. Forget about the fact that they may have to see the doctor and pay a copayment and wait to see them – in addition there’s this tripling in the cost price to pharmacies.

“It’s important [for us as pharmacists] to get it out there that because it’s prescription, the price will have gone up. It’s not necessarily because pharmacies are hiking it up, but because we’re being charged this ridiculous amount.”

He says he suspects that when generics come out with Prescription Only packaging brand prices may drop.

“We still ordered, but instead of a dozen we got three, because I think there’ll be some resistance from patients to paying that.”

Pharmacy Guild Victorian branch president Anthony Tassone told the AJP that many patients were already frustrated with the upschedule, concerned about the time needed to visit a GP as well as out-of-pocket costs; the increased cost of the product itself will likely not help.

“It’s a concern to some of our members that the public may perceive that this has been instigated by pharmacists themselves, when it hasn’t – there’s been an increased cost at the manufacturer level,” he said.

Pharmacy fallout

A backlash from patients angry that they can no longer access codeine over the counter has been expected by the pharmacy sector.

NSW Health Minister Brad Hazzard spoke on 2GB and asked the public not to take their anger out on pharmacists, as the decision was made by the TGA, not pharmacy – a comment which prompted NSW Guild president David Heffernan to call the Minister’s office and thank him on behalf of pharmacists.

AJP spoke to several pharmacists, several of whom had done their best to advise of the upschedule ahead of time, and thus did not have to deal with angry patients.

Others spoke of consumer anger – but generally, this had occurred before the measure was implemented.

Elise Apolloni from the Wanniassa Capital Chemist in the ACT told the AJP that the pharmacy had served one patient who “honestly didn’t know about the change and used OTC codeine infrequently”.

This patient had been prescribed a stronger variant in the past but preferred OTC codeine-containing analgesia as they did not like the strength of the prescription product.

“They were very civilised and understood, and we arranged an appointment with their GP for them,” Ms Apolloni said.

“We did spend many many months preparing our community for this and have been dispensing a reasonable amount of codeine medicines since December anyway because of the awareness raising.”

Several pharmacists spoke of the “frenzy” on the last day of January as patients attempted to stockpile.

“There was a guy coming in to try and get it – he knew it was finally up and he wanted two packs of codeine, but we would only give him one,” said Tim Rudd, of the Capital Chemist Ulladulla, NSW.

“He got quite aggressive and tried to intimidate the staff to get a second box.

“Then the lovely gentleman decided to knock a few things off the shelves and knock our Thermoskin mannequin into the street.

“Pharmacy will probably get a bit more of this as withdrawals kick in. I’m on the lookout, I’ve got a feeling he won’t be the last. But we’re at the coalface, and we just have to deal with it and try to triage these people as best we can.”

Angelo Pricolo from the Tambassis Pharmacy in Brunswick, Victoria said that on the last day of January, it was as though the “penny dropped” for a number of patients.

“Most we couldn’t help, and there was a little bit of frustration because people legitimately thought they’d gotten in before the change,” he said.

He also warned that some health professionals do not have a good understanding of the upschedule, and that this has not been helped by mainstream media reports which have confused which products were subject to the change.

A Fairfax article, for example, mistakenly referred to a “ban on pharmacists supplying medications like Panadeine Forte and Nurofen Plus”.

“We had a couple of allied health professionals, like nurses, ringing today [February 1],” Mr Pricolo said.

“One in particular wanted to know if we had any Panadeine Forte, because she thought it might be hard to get.

“People don’t really understand the new landscape.”

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6 Comments

  1. Philip Smith
    03/02/2018

    I now wonder how many will turn to street drugs for their pain relief?
    How much does Marijuana cost on the street?
    Take into account easy of access, time to acquire and cost.
    Which one wins?
    Pain relief on script or illegal drugs?
    Sounds like a PHD paper! 🙂

  2. lilacsigil
    03/02/2018

    It’s extremely frustrating that the patients who did the right thing and got sorted with a prescription are now unable to get their medication because we’re completely out of stock of all low-dose codeine with no ETA on the horizon!

  3. JimT
    03/02/2018

    can’t wait till medicinal marijuana becomes common place for pain relief

  4. chris
    03/02/2018

    Like taxes on cigarettes, does anyone thing there is a collusion in jacking up the price so it is less appealing. Conspiracy theory Number one.

  5. Tim Hewitt
    04/02/2018

    From what I’ve seen over the years, most codeine ‘addicts/abusers’ are rarely ‘users’ of codeine alone, and almost always have supplied themselves via multiple channels .. ie OTC and on script.. why buy OTC when you can get 240+ panadeine forte on a script at a fraction of the cost ?? ( via a willing prescriber ).. my feeling is that the ‘hole’ that OTC codeine filled for such people will be filled by other means of convenient relief like cheap booze or other drugs st hand .. the real test is to see if the medical profession has the bottle to really tackle the problem of their patients using drugs to dull the ‘pain of life’, or continue to fill them up with ‘mind benders’ etc and shunt then out the door…

  6. ChristR
    04/02/2018

    As someone who is soon to undergo surgery #8 in seven years on my knees, I am grateful for the pain relief in the form of Endone while in hospital, but as I recovered, the low dose codeine pain relief available from my chemist has been invaluable. I am also very, very grateful for the tireless advice and help I have had from my chemist on pain management. He and she was always available, not so with my GP. Now, I will be unnecessarily forced to join the queue to see my doctor, if in fact I can get an appointment at all.

    So, Greg Hunt, run that by me again. Exactly how many deaths were caused by over-the-counter low dose codeine pain relief? What was that you said? One or two! Wow! And the 150 or so deaths were caused by prescription medication? Stop mumbling man, I’m nearly 70 and my hearing, well, it ain’t what it used to be! I take that as a yes! And why did you not involve the wide network of chemists across this nation to stop this abuse at the coalface? (He’s whispering now.) Oh! Too simple you say and besides you needed to appease your mates in the AMA. Oh! I see!

    Sit back folks and watch doctors’ waiting rooms fill to overcapacity so that we are forced to go to our hospital ER for basic pain relief, that is if we can get in the door because the queues will be already forming up outside. Better take a chair and a brolly! Once again, the majority of us who do the right thing are penalised because of the few.

    PS … In The Advertiser Friday 2 Feb under the headline Codeine’s Dark Web Sales Surge, Greg Hunt’s office is quoted as saying, “evidence of the Illegal trade of codeine highlights why action needed to be taken.” They really are treating us as fools!

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