Next year’s codeine behaviour forecast

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New figures show many will still see pharmacy as their first port of call for pain relief after codeine is upscheduled

New research from Sanofi Consumer Healthcare investigated the likely impact of the upcoming regulatory changes, following the TGA’s decision to upschedule low-dose codeine to prescription only.

A significant number— 45%—will still head straight to their pharmacy to seek pain relief in the first instance following 1 February 2018, the research found.

It also revealed that 43% of those who currently purchase OTC codeine-containing analgesics will switch to a paracetamol and ibuprofen combination after the changes come into effect.

Another 28% of codeine customers instead plan to approach their GP for a product containing a higher dose of codeine.

However, the research also shows GPs would be more likely to prescribe the same codeine strength that previously worked for the patient when they were purchasing it over the counter.

The majority of GPs surveyed said they would prefer to prescribe smaller pack sizes of low-dose codeine (20-24 tablets) over a larger one (36-40 tablets).

Half said they would not write repeat codeine scripts.

Patients demonstrated a loyalty to brand name rather than doses or active ingredients, the research found.

“People who are in pain will seek help from an expert and, while some will visit their GP, a large number of people will still visit their local pharmacy first,” says Sanofi Consumer Healthcare general manager Brett Charlton.

“It’s critical that pharmacy be equipped to provide support, advice and relief to those people.”

The research was released to coincide with the introduction of Sanofi’s paracetamol/ibuprofen combination, Mersynofen.

Sanofi also confirmed that it will not discontinue its current codeine-containing range of Mersyndol, Prodeine and ProdeineXtra.

From 1 February 2018, these products will move to prescription only.

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  1. Debbie Rigby

    I think this survey is interesting and shows consumer’s support of a pharmacist’s advice and products which continue to be available OTC. NSAIDs and ibuprofen/paracetamol are not appropriate for all, but the majority of people can safely take them for a few days for acute pain.
    NSAIDs and opioids (incl codeine and tramadol) should not be used for long-term management of chronic pain.

    See my LinkedIn article

    • Yes, Debbie, I completely agree. This is a unique opportunity for pharmacists to continue to work with their patients and help evaluate their pain relief needs, in the light of what will be available OTC. Pharmacists are well aware of the precautions regarding Paracetamol and NSAIDs and combinations, and to give advice accordingly.

    • Jarrod McMaugh

      Not to mention that sometimes, pain may need to be endured. Even with acute treatment, pain wont be cured, and sometimes it is incompletely reduced by analgesics.

      The headache I’ve had for three days courtesy of a viral infection is testimony to that

    • Andaroo

      I think this survey is about as useful as a tits on a bull. Its about 90% marketing exercise and 10% justification of someones marketing job at sanofi.
      This poses no reflection of my sentiments on the scheduling issue, but just on the likely usefulness of this exercise in promotional self-flagellation

  2. Karalyn Huxhagen

    The diversity of type of patient requesting codeine containing products will make the GPs workload a lot heavier. Currently the GP Superclinic where I work are prescribing a lot of codeine for viral cough.

    My large concern is where will the habitual users of codeine move to? Illicit drugs may be more affordable than a GP consult? If their codeine is an addiction will they move to another substance e.g. ICE, THC, alcohol?

    we are already having the police called to the surgery when GPs refuse to prescribe what is asked for. How will GP surgeries cope with the avalanche of codeine seeking patients.

    • Anthony Tassone

      You raise a number of very valid points Karalyn.

      There’s not only the question of how GP’s will cope with an increase in patient load seeking codeine containing analgesia, but how will this be monitored?

      The only state or territory who has indicated a firm intent to capture Schedule 4 medicines (including codeine) beyond Schedule 8 medicines as part of a Real Time Prescription Monitoring system is Victoria (when the system begins to roll out in 2018).

      This has been a position strongly advocated for by both the Guild and PSA working collaboratively.

      Further details below:

      What is also important to note that as part of the Real Time Prescription Monitoring policy of the Victorian government there is not only consideration for workforce training but also for funding of drug addiction counseling and treatment (further details below):

      It is essential that we consider a broad solution to issues of drug misuse that include; mandatory real time monitoring, workforce training and drug addiction counseling and treatment.

      Up scheduling alone will not be successful in resolving these concerns – and will add further cost burden to an already stretched health system due to the vast majority of patients who use these products and do not misuse them and use them safely.

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

      • Deborah Taylor

        And more when people turn to other drugs for relief and find they now have an addiction worse or more health issues.

        Most people do the right thing and are being punished due to a few.
        Many people have chronic pain and try to get by on lesser drugs like codiene. How many will now end up on more potent drugs. I know I will. No point trying to get off oxy to save going to the doctors every 2 weeks and being stuck in one area due to prescribing laws. Now I would have to go through the same for codiene?
        It was bad enough when due to high metabilism my 3 doses I needed a day was cut down to 2. Ive spent the last year in pain in bed with no help. Suicide is the next step. Just to stop the pain

  3. Andrew Kelly

    Why will 43% of combination product users wait until upscheduling before trying a paracetamol and ibuprofen combination? Have they not been convinced of it’s benefits/advantages? Are they giving researchers an answer they want to hear? Just seems like a high proportion to me.

    • Deborah Taylor

      Most people take both now. Doesnt mean it works

  4. Deborah Taylor

    Between the cost of a doctors appointment then the script most paitents will turn to the black market for help due to cost alone or worse alcohol for relief..
    Those addicted cant get any help now so can only see another health crisis coming.
    People needing more time off work as they need to get to a doctor if they can the week they need pain relief while waiting an appointment. Instead of just dropping into the chemist. Many women rely on codiene for period pain.
    Unfortunately I can see a big rise in crime and mental health.

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