Doctor mag, Guild in codeine stoush


doctor wearing boxing glove

A story in Australian Doctor claims the Guild plans to ignore the schedule of codeine next year

A Pharmacy Guild spokesperson has condemned the article, which claims the Guild is confident that it will succeed in establishing a “schedule 3.5”.

Paul Smith and Antony Scholefield write in the doctor’s magazine this week that “the TGA may be the last word on patient safety but its decrees don’t matter much if you are the Pharmacy Guild of Australia”.

“It has emerged that the Guild has written to its 4000-plus members telling them not to worry about the impact of the ban (and the potential loss of $145 million in codeine sales) when it comes into force next year,” the two write.

“The reason? It is going to ignore the TGA scheduling drug system, and lobby state and territory governments to change poison and drug regulations so that patients can buy ‘prescription-only’ codeine without a prescription.”

The article claims that the Guild is “already wining and dining state ministers and is confident of success”.

“It has also urged pharmacists to tell patients the Guild was working on ways to get around the TGA’s OTC codeine ban,” it says.

A spokesperson for the Guild today slammed the article.

“What a load of provocative and ill-informed nonsense from AusDoc,” the spokesperson told the AJP.

“We expect doctor-centric propaganda from that publication, but it usually manages to avoid outright errors of fact.

“The Guild has not written to our Members telling them ‘not to worry about the ban (sic)’. The Guild is not ‘going to ignore the TGA scheduling drug system’ – and it is irresponsible of AusDoc to suggest we would do so.

“Our advocacy for an exception to the scheduling in certain circumstances under strict protocols, with mandatory national real time recording is an appropriate and responsible solution.

“Having invested in the development and roll out of MedsASSIST, the Guild is still waiting for any doctor group to invest in real time recording to address rampant doctor shopping of prescription medicines.”

The article did get one thing right, the spokesperson says.

Mr Smith and Mr Scholefield wrote that the TGA “should be alarmed” at the Guild’s activities, but that “publicly, it is playing with a straight bat”.

It quoted a TGA spokesperson who said that “while states and territories have consistently indicated a desire for a uniform approach to medicines scheduling regulations, it is within the remit of individual jurisdictions to decide to vary a scheduling decision, or provide particular exemptions”.

The Guild spokesperson told the AJP that “the TGA spokesperson quoted in the AusDoc article is absolutely right about the capacity for the States and Territories to consider these issues”.

Pharmacists including Guild Victorian branch president Anthony Tassone also took to Twitter to defend pharmacy after the RACGP’s Dr Evan Ackermann tweeted a link to the Australian Doctor piece.

The article followed the publication in AJP of this open letter by Pharmacy Guild executive director David Quilty, in which he clarified the Guild’s position on codeine and discussed its concerns about the drug’s upscheduling in the then absence of other safety measures such as a national prescription real-time monitoring system.

Such a system was announced late last week by Health Minister Greg Hunt at the Pharmaceutical Society’s flagship conference, PSA17. The rollout is expected to be completed nationwide by the end of 2018.

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21 Comments

  1. Philip Smith
    03/08/2017

    People’s pain issues are not going to disappear overnight.
    So they will either adjust to taking OTC products like Panadol, Nurofen or find the new combo’s work for them, or the S3 Voltaren.
    Otherwise they will go to the doctor and be prescribed pain relief medication which they have to come to a pharmacy for to get dispensed.
    The biggest loser is going to be the MBS with a spike in short consults for the GP’s to be handing out Panadeine Forte.

    • Jarrod McMaugh
      03/08/2017

      I would like to Know if anyone doing an honors thesis or higher is considering a project looking at the incidence of gastric ulceration before and after codeine OTC deletion…

  2. Ron Batagol
    03/08/2017

    You’d have to be very short-sighted to think that any Pharmacy pressure groups would be acting in a way that threatened the National SUSMP system-(and I’m sure they are not!) And let’s face it-OTC Codeine is now dead in the water for all the well-established reasons that other countries have it on script-only. Pharnacists can best help patients with best practice advice on available products-benefits and cautions, and in playing an active role in real-time monitoring utilising their recent experience in preparing for that emerging role, regardless of the schedule of Codeine products!

  3. Toby
    04/08/2017

    Typical Guild: too little, too late. The Guild is only just now aggressively pushing the arguments, that I made for OTC Codeine, BEFORE the delegate (whose name seems to be a big secret) set his final decision in concrete. Too late now. Good luck though – we’ll need it.

  4. Ronky
    08/08/2017

    The Guild should be helping pharmacists talk to patients NOW to prepare them for the post 1/2/18 world, getting them onto alternative products/treatments or to go to the doctor NOW. Instead of doing a massive dummy spit and trying to undermine the effect of the nationally agreed scheduling of medicines. This decision has been subject to the longest and most thorough consideration of evidence for and against of any scheduling decision in history. Time to accept the umpire’s decision and get on with the game, abiding by the new rule.

    • Jarrod McMaugh
      08/08/2017

      You make it sound like they aren’t doing that already.

      • Andrew
        08/08/2017

        Are they?

        It’s a looming public health disaster and the best they can do is ask for a scheduling exception for dental pain.. At the very least use some of their lobbying power to ask for defined D&A pathways for the cohort of chronic (ie. against indication) users who make up the bulk of purchases the TGA report identified.

        • Jarrod McMaugh
          08/08/2017

          Andrew, I can’t speak for the Guild specifically since I am a member, not part of their executive, but I can tell you that I have seen training modules available provided by them for pharmacists and staff; including as part of the medsassist platform.

          I can also say that there is work being done in this area from the PSA.

          As for lobbying for dependence and addiction pathways….. you are kidding aren’t you?

          At least here in Victoria we have been pushing for this for decades. There is constant lobbying by pharmacy groups to have an increase in the number of harm minimisation prescribers; there is constant lobbying by pharmacy groups for increases in the number of specialists who deal with chronic pain, addiction, or both; there is constant lobbying by pharmacy groups for the ability of pharmacists to have a greater role in harm minimisation.

          There is little outcome; not for lack of trying.

          When medical groups see all arguments regarding codeine as being driven by money, we have a problem. I have stated point blank to prescribers that scheduling alone will not fix the issue, and their response is that I’m trying to protect my own income…… a strange conclusion to jump to when I have not once said to these doctors that codeine should remains schedule 3. They are deaf to the concerns of pharmacists on this matter.

          When you have the likes of Evan Ackermann who has gone on record publicly stating that there is no need for real time monitoring, that there isn’t a trend among prescribers showing an increase in the use of opioids, and that concern raised by pharmacists is unprofessional and driven by money, then you can understand why I am extremely concerned and frustrated with the impending public health disaster.

          I can’t say this strongly enough Andrew – the Guild, the PSA, and all health care professionals who work in the area of addiction and dependence are very aware that there is a major crisis about to hit our health system. If you think that the focus is in one area only, then you are very much mistaken.

          • Andrew
            08/08/2017

            What are your thoughts on this transition being managed by the DoH?

          • Jarrod McMaugh
            10/08/2017

            Not positive.

            There’s a lot more that they should be doing. At the moment the advice on the TGA website is to talk to your doctor or pharmacist. That’s not exactly “handling” the issue

          • Ronky
            09/08/2017

            You do realise that the PSA and the Guild are totally separate (and often mutually hostile) organisations, don’t you? Sure the PSA is generally being constructive, but as far as I can see the Guild has done nothing but pay lip-service or “me-too” ism to the idea of working to embrace the new codeine scheduling environment. And whatever little the Guild has done is made ineffective and worthless by its desperate lobbying of politicians to try to get them to overrule the medicines experts and undercut, delay, defer, or destroy the effectiveness of the rescheduling decision which is an important public health measure. Leading the more gullible of their members to think that there is a real possibility that this might happen, so they don’t bother to change anything in the way their pharmacies deal with patients seeking codeine.

          • Jarrod McMaugh
            09/08/2017

            Ronky, I’m a state representative for the PSA (VP in Victoria), and I’m also a member of the Guild.

            Not once have I had a hostile interaction with the Guild. At an advocacy level, I’ve worked on many projects where cooperation between the Guild and PSA was effective and positive.

            With regards to your assessment on the Guild’s position on codeine – I can only say that I disagree with you. I can’t say you are wrong, since nothing you’ve said is factual, but as an opinion, I disagree with it.

          • Ronky
            09/08/2017

            “NOTHING” I’ve said is factual? Wow. You can’t have been involved with the Guild and the PSA very long if you think they’re always lovey-dovey to each other. It’s only a couple of years ago that they were virtually at war with each other. Look up the archives of this magazine if you can’t take off your rose coloured glasses long enough to believe it.

          • Jarrod McMaugh
            10/08/2017

            Everything you’ve said is an opinion.

            I didn’t say it was wrong it right, just that it’s not facts.

          • Ronky
            10/08/2017

            Really? e.g. I said the Guild is “lobbying politicians to try to get them to overrule the medicines experts and undercut, delay, defer, or destroy the effectiveness of the rescheduling decision”. That is an objective fact, not an opinion. The Guild even boasted in this very magazine about the fact that they are doing this.

          • Jarrod McMaugh
            10/08/2017

            It is a fact that they are lobbying politicians.

            What you said was that this is a waste of time.

            Thats an opinion. Not factual.

          • Ronky
            11/08/2017

            Thanks, so you admit that at least one thing I said was factual. Try not to make such sweeping statements in future.

          • Jarrod McMaugh
            11/08/2017

            Nothing I’ve said has contradicted anything else I said previously.

            Your first response here was 100% opinion.

          • Ronky
            14/08/2017

            Your false claim “nothing you’ve said is factual” was in response to my second response here. But in any case in my first response I stated objective facts such as “This decision has been subject to the longest and most thorough consideration of evidence for and against of any scheduling decision in history.”
            It’s not a good look to make a false accusation and then try to weasel out when its falsity is pointed out.

          • Jarrod McMaugh
            14/08/2017

            Peter, you can say that I’m making false claims all you like, or that I am weaseling out of what I’ve said, but that doesn’t change anything – it just makes you look belligerent.

            Your first post
            “The Guild should be helping pharmacists talk to patients NOW…” – opinion
            “Instead of doing a massive dummy spit and trying to undermine the effect of the nationally agreed scheduling of medicines.” – opinion

            “This decision has been subject to the longest and most thorough consideration of evidence for and against of any scheduling decision in history.” – presented as if fact, but there is nothing to back this up – yet again opinoin

            “Time to accept the umpire’s decision and get on with the game, abiding by the new rule.” – opinion

            Your second post
            “You do realise that the PSA and the Guild are totally separate (and often mutually hostile) organisations, don’t you?” – this was a fact, but your parenthetical addition reverts it to opinion

            “Sure the PSA is generally being constructive, but as far as I can see the Guild has done nothing but pay lip-service or “me-too” ism to the idea of working to embrace the new codeine scheduling environment.” – opinion

            “And whatever little the Guild has done is made ineffective and worthless by its desperate lobbying of politicians to try to get them to overrule the medicines experts and undercut, delay, defer, or destroy the effectiveness of the rescheduling decision which is an important public health measure.” – opinion

            “Leading the more gullible of their members to think that there is a real possibility that this might happen, so they don’t bother to change anything in the way their pharmacies deal with patients seeking codeine.” That’s opinion.

            Do you see where this is going Peter?

        • Anthony Tassone
          08/08/2017

          Hi Andrew

          The Guild is committed to working closely with the Pharmaceutical Society of Australia (PSA), in taking these issues forward and to engaging with other stakeholders such as Pain Australia to maximise the effectiveness of our advocacy to government and the communication and support for the large number of affected patients and community pharmacists charged with managing this transition.

          The Guild has already developed a range of support materials that include flyers and support documents for pharmacists to use in discussions with patients and their carers about the scheduling changes.

          A checklist to prepare the pharmacy for the transition to up-scheduling along with support documents to talk about pain-management with patients.

          There are also template letters to use in discussions with local health providers to fully inform them of the upcoming scheduling changes.

          The above resources are a Guild member only benefit.

          Online learning and development resources for pharmacy staff are currently in production around the upcoming codeine scheduling change.

          Guild members have been informed of these support resources and the work being undertaken.

          Anthony Tassone
          President, Pharmacy Guild of Australia (Victoria Branch)

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