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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