‘Nobody has developed a relationship with me.’

35380730 - lonely sad woman in distress

Pharmacists “defensive and antagonistic” about gatekeeping codeine, says chronic pain sufferer

Chronic pain sufferer Jackie has been sent home after surgery without pain relief, threatened with police removal and had to go online herself to research why pharmacists were suddenly refusing to sell her Nurofen Plus since the MedsASSIST tool began to roll out earlier this year, she told the AJP.

Last week, the AJP reported that some health stakeholders had been concerned, prior to its implementation, that MedsASSIST would be used as a policing tool – used to simply refuse sale of codeine-containing over-the-counter analgesics, rather than as a means of monitoring codeine use and a way to open up conversations about misuse and pain management.

Jackie (not her real name) says that some pharmacies are doing just that.

“Nobody has ‘developed a relationship’ with me, or done anything to help, or provided a safe/effective alternative,” she told the AJP.

“Oftentimes a pharmacist does not even come out from behind the back counter to talk to me, so I cannot always understand what they are saying, and either the assistant has to relay messages or goes to serve someone else.”

Jackie’s medical history is complex. As well as having chronic hemiplegic migraines, scoliosis, pelvic and knee pain, carpal tunnel syndrome affecting one wrist and PTSD, she has a communication disorder which means she needs to communicate in writing – often difficult due to the pain in her wrist.

Jackie says that lack of collaboration or even communication between members of her management team is part of the problem, with her pain specialist advising her to ask her GP to prescribe codeine, her GP advising her instead to buy it over the counter, and her psychiatrist, with whom she has the closest relationship, feeling that prescribing analgesia is not his job. She says her GP’s surgery has “a blanket policy against prescribing anything that may become addictive”.

And to date no pharmacist has been willing to step in to fill that communication gap, she says.

“I have been called stupid, been threatened with police and ambulance if I do not leave. I have been told ‘you won’t like rehab so you can’t have it’.

“I once tried to explain to a pharmacist that I had just had surgery and was on my way home to rest for a few days, and she refused service, saying, “We’re open every day, you can just come back tomorrow’.

“I have, however, been told things like, ‘It’s too soon, I don’t want to give it to you,’ and been sent away with nothing; ‘It’s a new government thing so I can’t give it to you,’ and ‘you have to see a doctor’.”

In June, the Pharmacy Guild issued a reminder to pharmacists that codeine recording is not mandatory or expected by Government.

Being told to see a doctor is particularly frustrating given she is already seeing several, including the pain specialist, Jackie says.

“All these lead me to believe that somewhere in the implementation of this system, pharmacists received no training on how to assess patients’ needs (not a single one has bothered to recommend anything else, let alone find out why I am taking it specifically), or how to explain the system to people,” she says.

“While Britney may be classed an outlier, my experiences are forcing me to behave like that in order to get medication I need in order to minimise my pain.

“I am no longer able to plan a week at home to rest as I am not allowed to get a packet in advance of the previous one running out, so my general pain levels are higher as I have to travel more often, which is incredibly hard for me,” Jackie told the AJP. “’We’re open every day, you can just come back tomorrow,’ is another thing I have heard.”

Some pharmacists have become “defensive and antagonistic,” she says. In many cases, the sale refusal goes through an assistant instead.

“There isn’t a willingness to create that dialogue—things like, ‘You need to see a doctor’ are rather pointless for me, because I am already seeing doctors, but they also are not questions, and no dialogue is created.

“’You were last given some six days ago, can you tell me why you need more?’ at least indicates that the pharmacist is seeing a person and is willing to work with them.”

Jackie told the AJP that she would appreciate access to a quick but thorough explanation of the MedsASSIST tool, possibly as a pamphlet, as she feels consumers have not been given an adequate explanation as to why some pharmacists are denying OTC codeine sales.

“People don’t actually understand that the information is being kept or shared, and are then being flat out denied and forced to leave with no pain relief at all without understanding why,” she says.

“If the pharmacist recognises me and has concerns, they can then come out and talk to me, asking questions more like ‘What else have you tried?’ and ‘Are you seeing a doctor?’.

“I can answer those questions by saying I have had bad reactions with other medications, and that I am currently being supervised by both my GP and my psychiatrist, who are working with me on finding a better solution but in the meantime, this is the best we can do. 

“Apparently, there is capacity for a note to be put in the system, so if a pharmacist had a conversation with me as above, and did take the time to sit with me so I could explain my situation, a note saying that could be put there, at the top, to save that time for everyone else.

“If a pharmacist took that time and then said, ‘We are now using a system that records how many times you buy this medication, because you’ve talked with me and I can see you understand the risks and are trying to find a better solution and seeing a doctor, I’ll put a note on there that says I’ve talked with you, so next time you come in we won’t have to do this again, but if you start to need more than what you’re taking now we’ll revisit it,’ they would basically get my business for life.”


Related reads

‘Codeine road trips’ less likely, but there’s still a way to go

MedsASSIST ‘not just about saying no’

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  1. Peter Crothers

    “Jackie says that lack of collaboration or even communication between members of her management team is part of the problem, with her pain specialist advising her to ask her GP to prescribe codeine, her GP advising her instead to buy it over the counter, and her psychiatrist, with whom she has the closest relationship, feeling that prescribing analgesia is not his job.” This sentence says as much about what is wrong with pain management in Australia as anything I’ve ever read. It’s a great pity that no pharmacist has reached out to Jackie and . . . it’s not hard to see why. A Clinical Intervention like this can go on for months and months and requires real skills – skills that not all of us have. I’ve had patients like this that I have reached out to and formed a relationship and in some cases achieved really worthwhile clinical outcomes: no doubt it can be very professionally rewarding. It is however, totally un-remunerated work that can also become extremely personally demanding.

  2. Jessica Jackson

    Ask for a private script from your GP for OTC codeine products. Go to the same pharmacy every time, don’t go to a discount pharmacy. If you have that many conditions, your pharmacist is definitely going to remember you if you come in every month for repeat prescriptions. If not change pharmacies.

  3. Peter Dishington

    This is a beat-up. I hope it’s not in a public forum. It’s hard to see Nurofen Plus being the most appropriate medication for this lady – or codeine for that matter. What she’s requesting is well outside temporary relief and she’s obviously making a scene in pharmacies who have to threaten to call police. Putting a note in the computer doesn’t make it appropriate to supply long-term without her doctor’s approval. I reckon she makes a scene at the doctor and the psychiatrist as well. They won’t give her a script because they don’t think she should be on it.
    For me this shows the system is working!

    • David Haworth

      I agree. I’d Like to know where AJP got this story. Did an AJP reporter talk to Jackie or did she contact them.

    • Jordan

      The article may be a mess but if someone isn’t getting the right treatment and all a pharmacist does is kick them out instead of saying ‘try this other thing that isn’t evil’, then the system isn’t working at all.

  4. James Lawson

    A pharmacist is a medical professional, and thus expected to prescribe treatments within the guidelines of best practise.

    Fact: Codeine combination products have a lack of evidence to support their effectiveness for chronic pain management
    Fact: Codeine combination products are approved for use for a maximum of three days treatment for the temporary relief of moderate to severe pain

    Outside of these guidelines, a pharmacist must refer the patient a practitioner qualified to treat chronic pain. If the patient’s physician fails to address their chronic pain adequately, a pharmacist is not qualified to assume the role of a GP in this pain management. A pharmacist can still recommend lifestyle modifications such as physiotherapy, massage therapy and TENS devices, as well as relaxation techniques or discussion with their psychologist on coping mechanisms.

    Regular supply of codeine combination analgesics is not currently supported by treatment guidelines.

    References: Guidance for provision of a Pharmacist Only medicine Combination analgesics containing codeine, Australian Pharmaceutical Formulary and Handbook, 23rd edition, Pharmaceutical Society of Australia, 2015

  5. GAPS

    Jackie is under a Pain Specialist who refuses to write a letter confirming therapy? Pain Specialist wants long-term use of subtherapeutic codeine? No discharge pain relief issued from a hospital after surgery?

    Plenty of gaps in this story……

  6. Russell Smith

    Is it just on my computer screen, or is this like and share crap on the LHS of everyone’s computer screen and interfering with reading the article in question?

    • Sheshtyn Paola

      Hi Russell,
      We have had this feedback once before. Apparently it’s related to your browser – could you please check whether you have updated your browser to the latest version?
      That should hopefully fix the problem. Let us know.
      Kind regards,
      Sheshtyn (Journalist, AJP)

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