Guild predicted codeine outcome: Heffernan

codeine tabsules spill from orange pill bottle

Pharmacy Guild NSW president David Heffernan claims there may have been a “reframing of the truth” around the codeine upscheduling

In his President’s Address in the latest NSW Guild newsletter, Mr Heffernan writes that he found a recent special ABC report “fascinating”.

The report concerned research reported on in March by the AJP, in which Associate Professor Suzanne Nielsen, Deputy Director of the Monash Addiction Research Centre at Monash University, found that there was no evidence of increased codeine prescribing or increased prescribing of S4 or S8 opioids following the 1 February 2018 upschedule of low-dose codeine.

A/Prof Nielsen presented the data at the International Medicine in Addiction Conference in Melbourne in March and also appeared on an episode of the ABC’s 7.30 Report, where she discussed the issue.

She later told the AJP that opioid use in Australia was now “trending down” and “seemed to have turned a corner”.

The codeine upschedule did not explain all of this reduction, but was a part of the puzzle.

Her findings were questioned at the time by Anthony Tassone, the Guild’s Victorian branch president, said PBS dispensing data showed an increase in the number of scripts for 30mg codeine since the upschedule.

Now, Mr Heffernan writes that “Fact, the codeine upscheduling decision has delivered, as we predicted, an increase in higher dose prescriptions (11% in 12 months) according to PBS data”.

“In other words, 11% increase in PBS scripts only, excluding private scripts, for higher dose codeine has occurred since the upscheduling from February 18.

“This includes the months of reported stockpiling. Further, if one was to track PBS data on 30mg dose codeine over the last five years, they will find prescriptions for 30mg PBS codeine containing prescriptions were tracking down, further emphasising the impact of the re-scheduling.

“There appears to be a reframing of the truth around the codeine upscheduling.”

Mr Heffernan writes that “regardless of the spin,” the increased prescribing of 30mg codeine underlines the urgent need for a real time monitoring system in NSW.

“The Victorian experience has been an outright success and is being rolled out across the state this month,” he writes.

“The Branch will continue its advocacy of a RTPM as the vital tool in addressing the looming opioid crisis.”

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  1. Debbie Rigby

    Data presented recently at the Australian Pain Conference provides a clearer picture of codeine prescribing – soon to be published. Need to look at all the data not just a snapshot comparing one month to another.

  2. Andrew

    >>>>”Fact, the codeine upscheduling decision has delivered, as we predicted, an increase in higher dose prescriptions (11% in 12 months) according to PBS data”.

    This is a good thing, right? From a QuM perspective patients are moving from the ineffective lower-doses to the empirical higher doses. That’s a win.

    • Debbie Rigby

      The data discussed by Suzie Nielson was over a three-year period—two years before the upschedule of codeine, and the year following. This longitudinal data showed no evidence of increased codeine prescribing or increased prescribing of S4 or S8 opioids over that period. The Guild spokesperson was comparing one month’s usage to the previous year, which did show an increase – cherry-picking data to prove a position. As I said in another post, robust data will be published soon.

      • Jarrod McMaugh

        One thing we have to be mindful of is that the data that Dr Nielson was able to use is PBS data, which does not show fluctuations in private dispensing. This has some impact on the ability of this data to be used to discuss total opioid use.

        Interested in knowing about the data you are mentioning that will be published soon – hopefully it has been able to access all dispensing data.

      • Anthony Tassone


        The Guild spokesperson was referring to data since the upscheduling of codeine in February 2018, and compares a given month year-on-year.

        The trend of > 10% of prescribing of 30mg codeine under the PBS was not only seen for one month but for most if not all months since the upscheduling took place.

        This is taken from the Department of Health’s own PBS dataset.

        This does not include prescriptions that have been dispensed as non-PBS/private.

        The data wasn’t cherry picked to demonstrate a position, but merely stating what had actually happened in that regard.

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

  3. Debbie Rigby

    TGA media release today shows a significant decrease in the amount of codeine based on pharmaceutical industry sales data. The data showed that the total number of codeine-containing products supplied in Australia during 2018 was approximately 50 per cent lower than the average total supplied in the previous four years (17.1 million packs in 2018 compared to an average of 34.7 million per year from 2014-2017).

    The TGA also looked in detail at the supply of high-strength (30 mg codeine) Schedule 4 codeine-containing medicines. Between February and December 2018, there was no statistical difference in the supply of high-strength 30 mg Schedule 4 codeine.

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