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.”