Five ways to respond to unhappy codeine customers

NPS MedicineWise has released new guidance for pharmacists on the codeine upschedule, focusing on five consumer concerns

Drawing on the most common complaints and questions aired on social media about the upschedule, NPS MedicineWise put together a short video for pharmacists presented by Advanced Practice Pharmacist and NPS MedicineWise Board member Debbie Rigby.

The five key points represented by social media posts outlined in the video are:

“Panadol and Nurofen alone do not touch my pain… Ridiculous!!!!”

Ms Rigby says that pharmacists’ role is to help patients understand that OTC codeine-containing products provide very little additional pain relief, but are associated with safety issues.

“I can’t wait to go and get a script every time I need something stronger than paracetamol or ibuprofen for period pain. What a terrible use of my GP’s already limited time and Medicare’s funding…”

Pharmacists can expect many questions about acute pain situations such as period pain, dental pain, migraine and headache, Ms Rigby says.

“We need to help them understand that codeine combination products are not first line therapy for any of those conditions, and that we have alternate drugs available over the counter in the pharmacy that are safer and more effective, as well as non-drug strategies like heat packs and ice packs.”

“To those who say codeine doesn’t help chronic pain, do you even know what it’s like to have chronic pain??!”

“Opioids like codeine have very limited evidence in the management of chronic persistent pain,” Ms Rigby says.

“I think our role in the pharmacy is to have the conversation with patients to help them understand the biopsychosocial model of chronic pain and to shift their expectations towards improving their function rather than expecting a cure of their pain.”

“Annoyed customer…this will take more time out of our busy schedules and more money out of our pockets on pain relief thanks to those who abuse it.”

Ms Rigby says it is important for pharmacists to help people understand that codeine is highly addictive and that tolerance and dependence can develop swiftly.

Many people are self-diagnosing and self-treating with OTC codeine, she says.

She encourages pharmacists to reassure patients with this concern that there are alternative medicines still available OTC from pharmacy and that codeine will still be available on script from GPs.

“So just because you react badly to it, no-one else should have easy access to this medication? Get real.”

Ms Rigby highlights that codeine is a prodrug and that 10% of the Caucasian population are poor metabolisers and will not receive pain relief benefits from taking it.

Meanwhile 30% of the African population are ultra-fast metabolisers and more likely to experience harm.

The upscheduling of low-dose codeine should be viewed as a public health issue, she says.


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1 Comment

  1. Ron Batagol

    Well summarised Debbie.
    Furthermore, who better than a pharmacist to advise on pain relief options?
    This of course includes counselling and advice regarding appropriate use of NSAIDs, if not medically-contraindicated, whilst taking into account the
    patient’s underlying medication and therapeutic needs.

    However, as written and advocated recently, ( see AJP Daily opinion piece 11/1/18-“A side-effect to the
    up-schedule” at ) , if Ibuprofen continues to remain available for sale in supermarkets and other outlets, as it has been since 2003, consumers who may have been purchasing Codeine products from pharmacies, may, in line with the
    Australian community trend identified in a recent study, increasingly seek to self-select and purchase Ibuprofen products from supermarkets as an alternative
    to codeine, without utilising the professional advice and guidance of a pharmacist.
    In so doing, these people may be unwittingly at risk due to changes in prescribing patterns for antihypertensive medications, including renal “triple whammy”effects ,( where 2 of the 3 interacting medications are often prescribed as a combination tablet!).

    Therefore, for community pharmacists to be able to play their role as first-stop ”pain- counselling facilities, we urgently need the appropriate legislative change to pharmacy-only supply of Ibuprofen,so as to try to ensure that patients who may be at a greater risk of adverse outcomes from using Ibuprofen, are in a position to
    minimise that risk by seeking professional advice and guidance from their community pharmacist!

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