Keeping to the script


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Don’t fall back on opioids or codeine combination products after Feb 1 rescheduling deadline, prescribers warned, as AMA boss says stockpiling is not a concern

Australian prescribers have been warned that they should be wary of what they offer patients who have been heavily using codeine-containing analgesics after the drugs are upscheduled on 1 February.

In a letter to the editor of the Medical Journal of Australia (MJA), a group of specialists say practitioners need to prepare for the forthcoming reschedule to avoid substituting OTC codeine containing analgesics with potentially even more harmful medications.

The authors, forensic medicine and pain specialists from Monash University and the University of WA, said “practitioners need… to avoid substituting OTC CCAs with either prescription opioid analgesics or prescribing a codeine-paracetamol combination”.

The latter may cause paracetamol hepatotoxicity, they said.

“In addition, practitioners should treat codeine dependence by referral, opioid replacement therapy or medicated withdrawal with follow-up,” they added.

“Medical practitioners should consider OTC CCA misuse in patients presenting with non-steroidal anti-inflammatory drug-related or paracetamol-related morbidity, as many patients do not disclose their misuse, therefore creating a failure to recognised the underlying cause of the present complaint.”

Meanwhile, AMA national president Dr Michael Gannon has told the ABC 24 news channel that he wasn’t worried about patients stockpiling codeine in the face of an “overdue” regulatory change.

When asked in early January about reports of patients stockpiling codeine containing medications and of some pharmacies already being out of these products as a consequence, he said: “I’m not concerned about those reports to the extent that there is now an opportunity, maybe before 1 February, for those people to get a better medication”.

“If they’ve got chronic pain, codeine is not the drug,” he said. “If they’re getting acute pain, there’s an opportunity for pharmacists to educate the patients that there are better options”.

“It’s not as if we’re leading the world on this change. Something like 25 countries around the world did this years ago, some more than a decade ago,” Dr Gannon said.

“It’s an overdue change and we fully support the TGA and the Minister on their move.”

 

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