Doctors will prescribe less codeine: Gannon

Seeking an exemption from prescription for codeine-containing products is heading into “dangerous territory,” says AMA chief

And it’s likely doctors will prescribe less codeine and at lower doses after the 1 February 2018 upschedule, AMA president Dr Michael Gannon told reporters.

“Not only have we told the Minister we support the TGA’s decision, we are also telling the State and Territory Health Ministers that we do not want to see exemptions from this,” Dr Gannon told a Press Club Q&A.

“That’s wading into very, very dangerous territory, when the independent regulator looking at scientific evidence is overrun by an industry that has a different view.

“And what I would expect to see in line with the evidence is not only will doctors prescribing less and less 4mg, 8mg, 15mg tablets, but prescribing less 30mg tablets.

“The truth is the evidence shows there are much more effective analgesics that my members should be prescribing.”

Dr Gannon told reporters that the upscheduling was not a “unilateral AMA statement” following a question as to whether encouraging the regulatory change had been a bid to bring patients into GP surgeries and thus increase doctors’ incomes.

“This is very much the AMA supporting the Therapeutic Goods Administration, the TGA, in their independent science-based analysis of the issues,” he said.

“Now, many people might not know that there’s already 25 countries where codeine requires a prescription.

“Many people might not know that the science tells us that we all metabolise codeine very differently. So for a significant minority of us, we metabolise it in a way that is extremely potent, every bit as powerful as morphine, and is a common cause of death from opioid overdose. In Australia, more common than heroin overdose.

“In the United States, less common than heroin overdose, but very much the gateway drug to 140 deaths a day in that country from opioid overdose.

“There’s another group of individuals that metabolise codeine in a way that it is entirely ineffective and it has no additional analgesic effect over plain paracetamol or a plain anti-inflammatory.”

A spokesperson from the Pharmacy Guild, however, pointed out that “the AMA still has nothing to say on the absence of any real time recording for codeine products that may be prescribed beyond February next year”.

“Speculating that doctors may veer away from codeine doesn’t really help,” the spokesperson told the AJP.

“While not seeking to reverse the upscheduling decision, the Guild believes it makes sense for there to be an exception, whereby pharmacists that have received additional codeine related training could in defined circumstances supply up to an agreed quantity of these medicines to patients for the temporary relief of acute pain, with a requirement to adhere to a strict protocol and use a mandatory national real time monitoring system like MedsASSIST.”                            

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  1. Philip Smith

    It will be interesting to see the stats on it all.
    Keep these quotes handy.
    In Feb 2019 we can see if opioid related deaths have decreased or increased.

    • Karalyn Huxhagen

      It will take a long time for those stats to become available and who will collect the stats and grade them correctly? Coroner court? Grading stats for opioid deaths does not always define the actual opioid that MAY have contributed to the death.

  2. Karalyn Huxhagen

    I am drawn back to the statement from Pain Australia ‘ The Government now needs a plan to help people with addiction to codeine or recommendations for referral to pain services for people misusing codeine.’ Do you know how many pain clinics in Australia have addiction specialists attached to them? Not very many. Do you know how many GPs have advanced training in addiction? Not a lot in the big stats of GPs in Aus.

    Let us stop pissing in the wind at who has the most skin in the game when 1st February comes around and start working on some collaborative models of how everyone can assist the patient with pain and the patient with addiction to codeine.

    there is a lot of work to be completed quickly

    • Amandarose

      The Methadone doctors are great with Codeine addicts. Our local one uses Suboxone and has had great success with patients approached in the pharmacy with concern for overuse.

    • Jarrod McMaugh

      I agree with you Karalyn

      I realise I’m pretty abrasive on social media, but I’ve raised this issue with a number of GPs online and the response has been ….. disappointing. It seems that any pharmacist who raises the issue of prescribers not being prepared are treated as if the only concern is lost sales.

  3. United we stand

    Has anyone looked at the possible dangers pharmacies will face once these ppl start going through withdrawal and start abusing pharmacy staff when they realise they can’t get it.

    • Debbie Rigby

      We need to start the conversation now with people whom you know or suspect are dependent on OTC codeine products.

  4. Amandarose

    It goes two ways in my area- Doctors refusing to prescribe any pain relief at all- treating everyone like an addict as they are yet to understand the culture in Australia and how to tell a seeker from someone in genuine pain. This has lead to severe illnesses like rheumatoid arthritis being overlooked.

    Then there is the OTT prescribers- Durogesic for sore ribs in opiate nieve patients.

    I do think recording sales is the best option no matter who is prescribing it- the GP or pharmacist and anyone who uses a certain amount in a given period should be under the care of a pain specialist.

    I also wonder if some of the more effective drugs like Mersyndol ( it is great for tension head ache) could not be replaced with a version without codeine. I bet the sedation from the antihistamine is the main beneficial ingredient anyway.

    Addicted patients will find replacements. My bet is silly levels of Quetiapine for sleep (the most over prescribed and harmful drug in my area – making otherwise ok people fat and ending up on other mess). Lyrica has become highly abused locally. Restavit and Phenergan will certainly become a hit with those that want sedation. At least these all seem safer then paracetamol poisoning

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