Hospital pharmacy backs upschedule

The Society of Hospital Pharmacists has sided with medical groups in their stance on the regulatory decision

Last week, all State and Territory Health Ministers except for South Australia’s new Minister, Peter Malinauskas, put their names to a letter calling for the Federal Minister to address concerns about the codeine upschedule.

Medical and health consumer advocates responded by publishing an open letter to State and Territory Health Ministers this week, calling on them to uphold the TGA regulatory decision to make codeine prescription-only.

The letter, signed by the Royal Australian College of General Practitioners, Royal Australasian College of Physicians, Consumers Health Forum of Australia, Rural Doctors Association of Australia and Painaustralia, reiterated key findings from the TGA’s review on codeine.

These findings included that codeine is not effective for treatment of chronic (long-term) pain, and that there are serious risks of harm associated with its use.

Now the SHPA has joined the ranks, for the first time publicly expressing its support for the upschedule.

Chief Executive Kristin Michaels says the SHPA strongly backs the stance in the open letter.

“As a regulatory decision based on robust evidence, empowering pharmacists and clinicians to provide better quality patient care, SHPA has long welcomed the TGA’s recommendation to upschedule codeine-containing medicines as prescription-only,” Ms Michaels tells AJP.

“On behalf of our members who provide treatment to patients with chronic and acute pain, as well as opioid misuse and dependence in both primary and acute settings, SHPA supports all government initiatives that prioritise patient safety.

“SHPA proudly remains the first and only pharmacy organisation to advocate against the use of medicines with sub-therapeutic doses of codeine for mild to moderate pain, as part of our five Choosing Wisely Australia recommendations.”

SHPA’s Choosing Wisely recommendation is based on evidence that doses of codeine less than 30 mg every six hours are no more effective than paracetamol or an NSAID alone.

“Therefore, combination products that contain low dose codeine should not be recommended for mild to moderate pain,” says the SHPA.

Meanwhile the Pharmacy Guild has questioned how doctors will be able to manage the predicted influx in patients following the upschedule.

“How will already overstretched doctors manage this increase in demand, including in regional and rural areas and elsewhere where there are already long wait times to see a GP?” it asks.

Some pharmacy academics have also expressed concerns.

Professor Peter Carroll, from the University of Sydney’s Discipline of Pharmacology and the University of Notre Dame’s School of Medicine, says the TGA’s decision “will merely force these people to visit a GP, where there is no Australia wide real time monitoring of prescriptions for codeine-containing analgesics,” he says.

“This has the potential to allow people to ‘doctor shop’ and visit numerous GP practices to obtain multiple prescriptions.”

The evidence relating to opioid misuse and death reveals it is mostly prescription opioids that are contributing to the problem, he adds.

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