Docs ‘missing the point’ on codeine harms

The Guild has told doctors to “get real” about tackling the harms caused by opioid misuse

Guild president George Tambassis was responding to today’s RACP statement on codeine, criticising it for its lack of focus on doctor shopping and real-time monitoring.

The Royal Australasian College of Physicians today reaffirmed its support for the 1 February 2018 upscheduling of low-dose codeine to Prescription Only.

“Codeine addiction has become a major public health issue and we believe that the TGA’s decision to place greater restrictions around the sale of medicines containing codeine is based on good medical evidence,” RACP President Dr Catherine Yelland said.

“Australia is one of the few countries where codeine products can be bought over the counter. In most of Europe, the United Arab Emirates and Japan these medicines can only be sold with a prescription.

“We believe these changes, which are being led by the TGA, are proportional to the problem that has emerged and align with the approach taken by other jurisdictions.”

Dr Yelland cited data which shows that more than 6.3 million Australians aged 14 or older use OTC codeine-containing analgesics each year.

She cites “many reports” of misuse, addiction and secondary harm.

Meanwhile, president of the Chapter of Addiction Medicine, A/Prof Adrian Reynolds, said the harms caused by codeine addiction are significant.

“Addiction is a serious medical condition which should be avoided at all costs,” A/Prof Reynolds said.

“Addiction specialists have seen the number of patients with addiction to over the counter codeine grow at an alarming rate.

“People with persistent pain should talk to their doctor to develop an appropriate treatment plan. This may include a referral to see a pain specialist or pain management clinic to manage their condition on an ongoing basis.”

But the Pharmacy Guild says that the RACP is “missing the point” when it comes to codeine misuse.

RACP’s statement is remarkable for its omission of any reference to the need for real-time recording and reporting of prescription drugs of concern, it says.

George Tambassis said that throughout the entire debate over the upscheduling of medicines containing codeine, doctor groups have avoided addressing the issue of real-time recording and reporting.

“According to the Penington Institute, between 2008 and 2014 Australia experienced an 87% increase in prescription opioid deaths, with the increase in rural regional Australia a shocking 148%,” Mr Tambassis said.

He cited data from the Bureau of Statistics released this week which showed almost 70% of drug-related deaths in Australia in 2016 were a result of prescription drug abuse.

The ABS data showed that a person dying from a drug-induced death in 2016 was most likely to be a middle-aged man, living outside a capital city, misusing prescription drugs such as benzodiazepines or oxycodone and taking several medications at once.

“Despite this the medical profession has done little or nothing to bring about a national real time recording and reporting system,” Mr Tambassis said.

Mr Tambassis said the Pharmacy Guild recognises the reality that some patients misuse over-the-counter medicines containing codeine, which was why it introduced the MedsASSIST system in 2016 to record and report on usage.

“So far more than 4,000 pharmacies—or more than 70% of all PBS-approved pharmacies—are voluntarily using MedsASSIST,” Mr Tambassis said.

Around 9 million transactions have been recorded by MedsASSIST, with a sharp reduction in codeine sales, and referrals of thousands of patients for further pain management.

“There is no dispute that overuse and dependence on these codeine containing medicines can cause harm or fatalities. The question is how best to address it—and shifting medicines to prescription only is demonstrably a flawed solution,” Mr Tambassis said.

The Guild is proposing a limited exception to the upscheduling of these medicines to allow pharmacists to supply them under strict protocols and with mandatory real time recording, for the benefit and pain relief of patients using the medicines safely and appropriately.

It says that in contrast, doctors want to shift to a prescription-only regime with no monitoring and a demonstrated track record of doctor shopping, abuse and harm.   

 “Doctors need to embrace real time reporting and recording of prescription drugs so that we can reduce the horrendous number of deaths from drugs prescribe by doctors,” Mr Tambassis said.

“Let’s get real about our commitment to protecting Australians from opioid misuse.

 “Increasing prescriptions without a real time recording and reporting system can only exacerbate the problem.”


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