OTC codeine death claims ‘must stop’

codeine tabsules spill from orange pill bottle

Pharmacy Guild NSW Branch president David Heffernan has hit out at recent claims about deaths associated with OTC codeine, saying they defame pharmacists

In a message to NSW Guild members, Mr Heffernan is highly critical of media statements including those made recently by federal Health Minister Greg Hunt, TGA officials and doctor group representatives on the issue of OTC codeine.

Of particular concern is the claim that OTC codeine combination medicines have caused 100 deaths a year, he says.

“I am not aware of any study or data which backs up this claim – which is misleading, defamatory to pharmacists and must stop,” Mr Heffernan writes.

“If there is any data to back up such an overblown claim, those making the claims should produce it – but I doubt that they can because I do not believe it exists.”

Mr Heffernan says that the Pharmacy Guild is not denying the harms caused by codeine, and that even one death is too many.

However, he says that citing codeine death statistics in the context of low-dose OTC preparations is “entirely perverse” because most such deaths are attributable to abuse of prescription codeine.

“In the circumstances, citing those deaths as a justification for removing over the counter codeine is not only false, but perverse,” he writes.

Mr Heffernan notes that the “vast majority” of drug deaths involving opioids occur in a polypharmacy setting, with victims ingesting drugs including morphine, oxycodone, fentanyl, benzodiazepines, ibuprofen, paracetamol, codeine and/or alcohol.

“In instances such as these, the death is caused by the collective action of many of the drugs the person has taken,” he says.

“Where codeine was thought to be the sole cause of the death, the number of people dying each year in Australia is under 25, and this number includes deaths from both over the counter and prescription codeine products.”

He also points out that on occasion data cited to support the upschedule predates MedsASSIST.

“The figures quoted appear to be data manipulated from National Coronial Information System for the period 2007 to 2011, and the Roxburgh study 2000-2013, where, for the majority of the time codeine was Schedule 2 and none of the data collected was with real-time monitoring.

“We understand that Greg Hunt is not a pharmacist, yet disturbingly he appears to be reliant on data manipulated from his bureaucracy.

 “Defamatory media implying pharmacy has been negligent in its responsibilities must be called out and stopped.”

Mr Heffernan told the AJP that “turf wars” between doctor groups and pharmacy were unproductive and called on GP groups to support real-time monitoring of codeine-containing medicines following the upschedule.

“In the real world, pharmacists and GPs have a constructive and friendly relationship with each other,” he says.

“These doctor groups are at risk of doing serious damage to that relationship with their continued false representation of pharmacy, and their continued lack of acknowledgement of the genuine approach by the Guild to work on the problem that we identified and paid for ourselves, with MedsASSIST.

“MedsASSIST not only identified problem users with OTC products but also problem users of prescription opioids.

“Pharmacists know that problem users of OTC codeine generally came from prescription opioid abuse, and after February 1 pharmacy will grapple with the challenges of helping patients with addiction problems without a real time monitoring system.”

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