Negotiation or confrontation?

codeine tabsules spill from orange pill bottle

Guild strives to work for a new model for non-script codeine dispensing as profession takes the fight to pollies’ offices

The Pharmacy Guild of Australia says it is working on a model that would see certain limited circumstances in which patients could continue accessing codeine-containing medicines directly through community pharmacies without a prescription.

In the latest edition of its newsletter Forefront, the Guild outlined its new ‘Prescription – except when’ model that would see continued non-prescription dispensing of these products.

Examples it cites are in cases such as severe toothache where a dentist’s surgery is not open, after hours or in rural areas without services.

The Guild is “actively exploring the best way to bring this about as soon as possible”, the newsletter said, noting the Federal, State and Territory regulatory hurdles that will need to be cleared.

Pharmacy representatives have been active in meeting State and Federal Ministers and politicians, as well as stakeholders, to inform them of the ‘Prescription – except when’ proposal, the Guild says,  while also highlighting the problems envisaged from 1 February 2018 when medicines containing codeine are upscheduled, and what we are doing to try to minimise for patients the impact of those potential problems.

It is working with the PSA and other stakeholders to develop a protocol around this model and the pharmacist training associated with it.

Pharmacists also are encouraged to inform patients about the ‘Prescription – except when’ model and the vital role of the MedsASSIST real time recording clinical support tool.

One PSA branch has gone public to tell its members that codeine rescheduling is “not the answer” and would burden millions of Australians.

Professor Peter Carroll, president of the NSW PSA said forcing people to visit a GP to get a prescription in order to still use the products will be problematic, as many will not be able to get an immediate appointment and, because of the rescheduling, will be forced to suffer unnecessary pain.

This will be particularly so in regional parts of Australia where there is a shortage of GP access, he said.

Professor Carroll said the NSW Branch believes that low dose codeine-containing analgesics must remain an OTC therapeutic option for the management of acute, short term pain.

“Community pharmacists have the knowledge base and competence to counsel patients regarding the effective and safe use of these products, and the vast majority of patients who use the products do so safely and appropriately for short-term use, and are at no risk of becoming dependent on codeine,” he said.

The NSW Branch Committee has communicated its’ views to the PSA National Board, and says it has “resolved to immediately pursue an advocacy strategy designed to inform NSW politicians and the NSW Health Minister of these issues in order to try and have the rescheduling of codeine-containing products delayed, or not implemented at all”.

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  1. Debbie Rigby

    Not sure “severe toothache where a dentist’s surgery is not open, after hours or in rural areas without services” is the best example. Toothache usually has an inflammatory component, so OTC ibuprofen/paracetamol could be a more appropriate choice. In addition, ibuprofen/paracetamol has been shown to be more effective than OTC paracetamol/codeine combination products. Obviously ibuprofen has safety issues in some patient groups, but in recommended doses is unlikely to cause harm over 1-2 days.

    • Andaroo

      Good point. Just like ibuprofen / codeine in combination

  2. Andrew

    There’s already a ‘Prescription – except when’ model – it was called Pharmacist Only and was so poorly executed that community harms necessitated up scheduling.

    This is nothing more than an attempt to protect a significant (6-8%) revenue source for pharmacies. Either you care about public health or you don’t, and with this and numerous other guild movements they have again demonstrated that clearly they don’t.

  3. Hany Aita

    I think it’s another silly desperate try to rescue some revenues lost from up scheduling of codeine without any consideration to what suits patients more. Yes many patients are not abusing but many are delaying doctor’s visit for months and sometimes years because they have access to codeine products. I see many patients who are getting 3-5 large packs a month and when counseling they have some sort of regular pain for more than 3 months which means some sort of chronic pain. Not to mention other conditions like painkillers induced migraines. Wouldn’t it be easier to talk early to doctor and get some sort of proper diagnosis and proper management plan. It will save lots of money in the future and improve patients’ quality of life. I really hope the guild will get over this and focus on more important things.

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