NSW Guild stands firm on codeine exception

David Heffernan and John Barilaro
David Heffernan and John Barilaro.

Australia is in a “peculiar” situation where public sentiment opposes policy when it comes to codeine, says NSW Guild president David Heffernan

In the NSW Guild eBulletin Mr Heffernan writes that the NSW branch is remaining firm on its position towards codeine: that pharmacists are appropriately qualified to supply codeine for acute pain in short-term supply, supported by a real-time monitoring system and under a strict protocol.

He outlines six reasons why he says the branch holds firm to this position:

  1. “The vast majority of people who require these medicines for temporary acute conditions are at low risk of becoming dependent on codeine,” he says.
  2. Driving thousands of Australians to present at GP surgeries is an unnecessary burden on the health system as well as patients’ hip pockets.
  3. Because visiting a GP is a significant barrier for many people, it may leave them in “unnecessary pain”. “Further to this, having to see a doctor will see a spike in sick days as people are rendered unfit for work.”
  4. “Alternative analgesics like ibuprofen are not a safe alternative for a very large portion of our population,” Mr Heffernan writes.
  5. He says there is no evidence that making low-dose codeine prescription only will reduce the potential for abuse, and that it may be that problems of addiction increase.
  6. “A mandated real-time monitoring system, across all schedules, will make pharmacists and GPs more accountable, and identify and eliminate the risk of addiction,” Mr Heffernan writes. “Real-time monitoring is already in place for pseudoephedrine and has been shown to be successful.”

“Currently we are in a peculiar situation where the public, through social media, talkback radio and other media, are clearly against the TGA decision,” Mr Heffernan writes.

“Both state and federal MPs have publicly and privately expressed their disapproval, and State Health Ministers have expressed their concerns to the Federal Health Minister.

“NSW Health Minister the Hon Brad Hazzard MP has publically stated that there ought to be a ‘nuanced’ provision for pharmacists to continue to supply codeine-containing products without having to go to the doctor.”

Mr Heffernan also suggests that the chief pharmacists, “briefed by the TGA” may be the ones standing in the way of the proposed acute pain exception.

“Many pharmacists have expressed their concerns to me about the inaccuracies in the TGA regulation impact study and the inappropriateness of promoting ibuprofen and paracetamol combinations as a universal substitute for codeine containing products,” he writes.

“As February 1 approaches, many pharmacists will be challenged as they grapple with opioid addiction in the community without a real-time monitoring system.

“At the frontline, it is important that we get the best outcomes for our patients.”

Mr Heffernan and PSA NSW president Professor Peter Carroll have written to the state’s chief pharmacist outlining their concerns, and Mr Heffernan says they “await a reply that will legitimise the February 1st 2018 decision”.

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  1. Debbie Rigby

    “Alternative analgesics like ibuprofen are not a safe alternative for a very large portion of our population,” Mr Heffernan writes.“
    One or two doses of Ibuprofen for treatment of acute pain is unlikely to cause harm in the majority of people #EBM not #fakenews

    Will pharmacists now stop selling OTC NSAIDs as they “not a safe … for a very large portion of our population”? This is not an accurate statement.

    • Jarrod McMaugh

      I don’t think that was David’s point.

      For people who have minor pain, they currently have two pharmacological options (in addition to non-pharmacological options) …. Paracetamol or NSAID. Either one is fine so if you can’t have an NSAID you have an option.

      For stronger pain, there will be one option without prescription, which contains both paracetamol and ibuprofen. For those people who have a contraindication for NSAIDs, there isn’t an option for stronger pain. As a member of Nuromol’s advisory group, you’re aware of the limitations of these combination products.

      And yes, “One or two doses of Ibuprofen for treatment of acute pain is unlikely to cause harm in the majority of people” – this is true. The same is applicable to codeine.

      What we need is a complete solution, not piecemeal policy that will cause more disruption in the short term. This is the primary focus of the NSW Guild’s media release. It’s also the position of the PSA.

      • Karalyn Huxhagen

        Agreed that this is a small piece of the overall problem of minimal ability to provide effective pain management to every patient. I am not in favour of having pharmacists decide who can access the alternative codeine supply route as this does not fix the bigger issue. Pharmacy does not have a great track record of following the structured prescribing for choramphenicol so let us not be delusional about what will happen with codeine.

        I cannot get my head around how real time monitoring will assist me working in a small pharmacy in rural Australia. Can someone enlighten me on the benefit to the pcist faced with the aggressive codeine seeking customer?

        • Jarrod McMaugh

          I can’t disagree with your response Karalyn. This again goes to the issue that TGA made a decision to do 1 thing to “resolve” codeine, when clearly 5 things were needed.

          Now we’re in a position where we don’t have anything else in place, impending change, and no guidance from TGA.

        • Philip Smith

          I think it shows the failure of the S3 system as a whole.
          My reflection is from a NSW perspective, but we do not have to record names, most interaction are a “had it before?” head nod from pharmacist as assistant hands out.
          The pharmacy makes money when a product is sold, not on the time discussing conditions with patients. So why talk when you could be selling 3-4 more things in that time or check scripts? This is the ultimate failure.

          If we had a system of recording (linked to patient eHealth) and payment for service not product, I believe we would not be facing this problem.
          If you don’t have a private room and computer in there to record all S3s become script only (like mail order).

          Rant over (for now). 🙂

  2. 27/12/2017

    I am not agree with that. Quality medication is not harmful. the basic purpose of codeine medication is used to relief from any types injury pain. when you use any medication properly then you cannot face any problem. for further information visit this link.

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