Codeine conversation highlights opioid trouble


AMA President Dr Michael Gannon.

The Pharmacy Guild’s advocacy has shone a light on the extent of codeine misuse, says AMA chief

Doctor groups today welcomed the upschedule of low-dose codeine, with AMA president Dr Michael Gannon declaring that the Guild stood alone on its opposition to the measure.

Federal Health Minister Greg Hunt made an announcement on 1 February announcing the implementation of the upschedule, stating that “consumers will not be disadvantaged by this change”.

“Codeine is an opioid drug that can cause opioid tolerance, dependence, toxicity and in high doses, death,” the Minister said.

“Many people also develop severe health issues due to use and misuse of over the counter products containing codeine including liver damage, stomach ulceration, and respiratory depression.

“Each year, low dose codeine products are a factor in the death of more than 100 Australians.”

This figure has been disputed by several stakeholders including NSW Guild president David Heffernan and pharmacy academic Professor Peter Carroll.

“Research shows that around half a million Australians are misusing over-the-counter products containing codeine, with many people becoming dependent on it, contributing to serious health complications,” Mr Hunt said.

Dr Gannon told Sky News’ Laura Jayes that “the Pharmacy Guild stands alone in their opposition to this change, and we’ve seen a lot of mythology out there. The important message for people who have always required a prescription for higher doses of codeine, nothing’s changed”.

“Now, we’ll have more to say about that. This is a drug that is causing more harm than good in our community, and ideally over time we’ll see fewer and fewer prescriptions for opioids.

“But for the lower doses of codeine that this change affects, it’s very important to deliver the message to people that there’s very clear scientific evidence that the low dose codeine-containing preparations are no more effective than the paracetamol or the anti-inflammatory alone.

“That’s the message that should be delivered to a patient presenting to a community pharmacy today or in coming weeks: here’s some paracetamol, here’s some ibuprofen—it’s every bit as effective, and it’s a lot safer.”

Dr Gannon said that if anything good had come of the public discourse around codeine, it was that there was recognition something needed to be done about opioids more generally.

“Codeine is very much yesterday’s drug, it would not be licensed if it was invented next week. But we need to look carefully at our prescription of other opioids and really look carefully at non-pharmacological approaches to chronic pain,” he said.

“If anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.”

AMA vice president Dr Tony Bartone spoke to 2GB’s Alan Jones, who expressed concern about doctor shopping now that MedsASSIST has been wound up.

“Whenever there’s a rule or a law, Tony, someone’s always going to try and get around it, aren’t they?” Mr Jones asked. “So what about the issue of doctor shopping to obtain a prescription?

“Will the doctor give me a prescription? I walk in and I say, ‘look, I’m sorry doctor, I’ve just been driving, I’ve parked my car; I’ve got dreadful pain. I know that I’m unable to get X—can you give me a prescription—I’ve just got this dreadful pain?’ And I go two suburbs down, I do the same thing and I go two suburbs down, do the next thing.

“No doctor’s not going to give me a prescription, because he thinks ‘this bloke will sue me if I don’t give the stuff and the pain leaves some kind of permanent impairment’, and this is this doctor shopping, isn’t it?”

Dr Bartone replied that the upschedule was “about reducing the level of codeine in the community. It’s not about switching the source or supply of codeine in the community.

“So ultimately, there might be those prescriptions for codeine for people who really do require it, and we know that outside of cancer pain, there’s really no significant indication for long-term codeine.”

Doctor groups including the RACGP, United General Practice Australia and AMA welcomed the upschedule’s implementation.

The RACGP encouraged patients who are apprehensive about the change to talk to their GP, with president Dr Bastian Seidel suggesting they should use the upschedule as a reminder to find a safer alternative for managing their pain.

“If patients find they feel particularly anxious about the upcoming change perhaps that is a sign it is time they seek alternatives for pain relief,” Dr Seidel said.

“There are many alternatives that provide just as much pain relief in a much safer way.

“Evidence shows that over the counter medicines containing codeine provide little additional benefit in pain relief in comparison to other similar medicines without codeine,” Dr Seidel said.

“Codeine is dangerous and the situation in Australia was leading to severe health outcomes.

“Over 150 codeine related deaths in Australia every year is completely unacceptable.

“If your GP believes codeine is appropriate for you, then codeine is still a viable treatment option.

“But patients cannot self-medicate with it anymore.”

 

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