Health Ministers worried about upschedule consequences

David Heffernan and John Barilaro
David Heffernan and John Barilaro.

State and Territory Health Ministers have answered a call to address the codeine upschedule

In a move commended by the Pharmacy Guild, all State and Territory Health Ministers – bar South Australia’s new Minister, Peter Malinauskas – have put their names to a letter calling for the Federal Minister to address their concerns.

The Ministers say all jurisdictions are committed to reducing the impact of inappropriate use and misuse of medicines, as well as overdoses of all kinds, but they have concerns about “unintended consequences” of the upschedule.

“In particular, given codeine products are widely used across the community by people to manage a range of health issues, including pain, stakeholders are concerned about the impact a large increase in the number of people requiring access to General Practitioners (GPs) for prescriptions will mean for the primary care system,” the Ministers write.

“There is concern that this will be felt particularly acutely in rural and regional areas where access to GPs is already low, and that some people managing chronic conditions with codeine medications will deteriorate as they abandon medication due to the out-of-pocket costs associated with accessing GPs for their prescription.

“We would welcome the Commonwealth working with stakeholders to address these issues, ahead of the rapidly approaching implementation of the proposed change in scheduling.”

“In this regard, we respectfully put that any action occur at the Commonwealth level to prevent variation in prescribing and dispensing practices.”

A number of mainstream media outlets reported on the issue over the weekend. NSW Health Minister Brad Hazzard told the Daily Telegraph that he is worried patients will face a rise in GP costs.

He said the Guild’s “Prescription – except when” model would be “making what is currently a blanket ban into something that still has element of protection against overuse of codeine but provides a balance that reflects a very large and diverse continent with very limited medical services in many areas”.

Cameron Dick, Queensland Health Minister, told TEN Eyewitness News that “the greatest concern to state and territory health ministers is access to this medication particularly in regional rural and remote areas”.

The move follows a call by NSW Deputy Premier and Nationals Leader John Barilaro, who urged the Ministers last week to consider undoing or adapting the move to schedule low-dose codeine to prescription-only.

“A reverse would be great, or a compromise position, which I know the Pharmacy Guild have been looking to,” Mr Barilaro said at the Harden Pharmacy.

The Guild has not called for a reversal of the decision – though other stakeholders such as the University of Sydney’s Professor Peter Carroll have – but it has come out in support of the State and Territory Health Ministers’ action in writing to Mr Hunt.

The National President of the Pharmacy Guild, George Tambassis, said that the Ministers are “justifiably” concerned that the upscheduling will “clog up” doctors’ practices and emergency departments, leaving patients with temporary acute pain such as headache, toothache and menstrual pain without timely access to treatment.

“The State and Territory Health Ministers have rightly pointed out in their letter to the Federal Minister that this will be particularly problematic in rural and regional areas where GP access is often spasmodic and non-existent after hours,” Mr Tambassis said.

He also expressed concern about the lack of real time monitoring and other measures to deal with “doctor shopping” following the upschedule. The Guild has repeatedly called for these issues to be addressed.

“While the Guild and the Pharmaceutical Society of Australia are not seeking to overturn the TGA decision to up-schedule these medicines to prescription-only, we are asking governments to support a common sense exception whereby pharmacists could supply these medicines for the temporary treatment of acute (not chronic) pain under a strict protocol with extra training and a mandatory requirement for electronic real time monitoring to identify non-legitimate misuse,” he says.

He said MedsASSIST had “very significantly” reduced the number of codeine purchases and helped pharmacists support at-risk users.

Mr Tambassis pointed out that the AMA had previously embraced such an approach in its May 2015 submission to the TGA, in which the AMA suggested a Project Stop-like solution.

“Unfortunately, doctors have no such real time monitoring system in place in any mainland State or Territory to provide visibility of patients who are doctor shopping for codeine.”

Doctor groups responded with anger to the call by Mr Barilaro last week, with the AMA accusing the Pharmacy Guild of being “sneaky” and attempting to undermine the TGA.

AMA President Dr Michael Gannon told ABC Radio Melbourne’s Susan Carland on Friday that the Guild was “wrong on this” and “being a bit too cute for my liking” over the prescription – except when model.

“We will continue to make the case that this was a good decision, it’s long overdue,” he said.

“Codeine is a harmful drug. And do you know what? It’s not even that good a painkiller, there are better alternatives.”

George Tambassis called for an end to the standoff between doctors and pharmacists, asking doctors to “engage constructively to find a solution that is in the interests of patients and the broader health system”.

You may be interested in:

Doctors erupt over Nats codeine announcement

Nats call to reverse or compromise codeine decision

Why upscheduling codeine won’t solve any problem

The pill epidemic

Docs missing the point on codeine harms

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