Panadol Osteo decision could shift patients to opioids

Stakeholders have expressed disappointment in the PBAC’s restatement of its decision to delist Panadol Osteo, and concerns that patients may turn to stronger alternatives to manage their pain.

The PBAC says it assessed the issues raised in correspondence from stakeholders including the Pharmacy Guild and Painaustralia, but did not consider that there was any basis to revisit its earlier recommendations.

Painaustralia CEO Lesley Brydon told the AJP today that the organisation received no official advice about the decision to stick by the delisting, only an email last Friday that acknowledged its correspondence and contained a link to the March outcomes on the PBAC’s website.

“The decision will be disappointing for many people who regularly take Panadol Osteo as the first line treatment for osteoarthritis,” Brydon told the AJP.

“It is generally regarded as the least harmful option for people with chronic pain.”

She warns that the decision could have significant consequences down the track.

“If reducing costs in the health budget is the intention, then this could well be counterproductive,” she says. “The move may cause a shift towards more harmful alternatives.

“It is quite likely that patients, especially those on a concession, will turn to other PBS subsidised medication, including the low dose opioids.

“There is already widespread concern about the over-prescribing of opioids especially in lower socio-economic communities.”

The Australian Atlas of Healthcare Variation recently showed that the number of prescriptions for opioids was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate.

Residents in parts of western NSW, western Victoria, rural areas of South Australia, some coastal regions of Queensland and the central highlands of Tasmania, were being prescribed opioids at rates of between 78,731 to 110,172 per 100,000 people.

This was in contrast with very different prescribing rates in areas of higher socioeconomic status and in major cities, including Sydney’s north shore and Melbourne’s eastern suburbs: much lower at 10,945 to 34,416 per 100,000 people.

“I understand the ACCC is currently investigating the manufacturer in relation to pricing issues… cost will certainly influence people to seek out more affordable options,” says Brydon.

The Guild wrote to the PBAC and Health Minister Sussan Ley in December and January raising its concerns about the delisting, including Quality Use of Medicine issues. Painaustralia and the Consumers Health Forum also raised concerns about the clinical and financial implications of delisting Panadol Osteo.

“We remain concerned that many sufferers of osteoarthritis will face an additional cost burden for their preferred medicine as they replace supplies purchased before I January,” says a spokesperson for the Pharmacy Guild.

In a media release earlier this year, Painaustralia said the cost of standard treatment with Panadol Osteo on the PBS (2 packs) for a patient on a concession card was $7.52 a month. This equated to $90.24 a year, less if the patient reached their Safety Net during the year.

Following the delisting the price increased to up to $14 a month for two packs off prescription, equating to $168 a year for these patients, as well as no longer contributing to their Safety Net eligibility.

But the PBAC says that as paracetamol 665mg tablets contain the same active ingredient as the 500mg immediate release form of paracetamol, six paracetamol modified release 665mg tablets are therapeutically equivalent to eight paracetamol 500mg tablets, which are less expensive.

“Panadol Osteo is possibly a more convenient form of paracetamol due to the less frequent dosing; it is generally taken three times per day whereas the 500 mg product is generally taken four times per day,” the PBAC noted.

“However, the 500 mg immediate release tablet is significantly less expensive than Panadol Osteo – a box of 100 tablets can be bought for as little as $2.

“The price at which Panadol Osteo is sold in pharmacy will now depend on a number of factors, including the choices made by GSK on de-listing its product from the PBS entirely.

“Further, the OTC price for all medicines varies widely from pharmacy to pharmacy. Anecdotally, Panadol Osteo is available at some pharmacies for $7.50 for 2 boxes, but does cost more than that at other pharmacies.

“A consideration of availability at a particular price OTC in pharmacy compared with the co-payment amount was not previously adopted by the PBAC.”

AJP reader Richard Lord echoed Brydon’s concerns that patients could be worse off if Panadol Osteo remains delisted.

“Osteoarthritis affects 60% of those over 65 years old and good pain management requires a baseline dose of two paracetamol tablets three times a day together with stronger opioid analgesics up to twice a day,” he wrote on an earlier AJP story on the subject.

“One complements the other and if you take away the paracetamol then the patient takes more opioid for pain relief with more side effects and health risks.”

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  1. Debbie Rigby

    I repeat my earlier comment: opioids are not an alternative to paracetamol for the treatment of osteoarthritis.
    Pharmacists should talk with consumers about effective pain relief options for OA including non-drug treatment, weight loss and exercise within limits.

    • John Cook

      I thought this reply by Felicity Veal UTAS to the BMJ article last year neatly summed up the issues.

      Interesting to read through the responses by other experts too

      CCBYNC Open access
      Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials
      BMJ 2015; 350 doi: (Published 31 March 2015)
      Cite this as: BMJ 2015;350:h1225

      Items per page Apply
      Re: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials
      Rather than suggesting paracetamol is ineffective in the management of back pain, would it not be more therapeutically applicable to say that paracetamol is just as effective as a placebo? To suggest otherwise is to imply that a placebo has no intrinsic therapeutic utility in the management of patients experiencing non-specific low back pain…

      Edited: Please use excerpts and links rather than full articles, for copyright reasons.

      • Sweet-William Synchronicity

        ~ ~
        ° °
        = funnily enough. I only discovered, Osteomol just b4 X’más via a mates Mum with Osteo Arthritis & Leukemia. I’m in my 2nd year Suffering more greately from Recital Cancer. I’ve been relying solely on China Med Pain-Less which hath no side effects! But was costing me too much on my pension
        I recently tried Panadol Osteo which caused me to bleed slightly and Stopped. My GP constantly prescribes me with Opiates. She said at my stage of cancer, that I ort not be concerned about Addiction or Withdraw. It’s about Quality Of Life From My Point Of View. She assured me Tramado 200mg was not an Opiate. Being off balance nausea vomiting sleeping half the day 15 hrs of itching per pill. Why is it OK for doctors to lie?
        I Believe ~ Osteomol works very well for numbing the pain, better than anything for $6 over the counter. A friend recently brought me 3 Pain Cookies from a street vendor in Nimbin. Released me from pain for a full 8 hours with No Side Effects. My first experience of illegal THC medicinal cannabis. Why does everything have to come from a pharmaceutical company. When it’s about relief for we in severe pain or told were dying ~

  2. Mohammad

    Good morning. This is the worst piece of sensationalist journalism, if it can be called journalism. Is AJP owned by Fox news? Or is it just a mouthpiece for the fat cat Pharmacy Guild and its “stakeholders”?
    How about we get reports on the facts and latest research: that paracetamol is no more effective than placebo; or that this “relatively safe” drug was responsible for 5% of drug related deaths between 1997-2005; in a 2013 it was reported to be the most commonly misused OTC analgesic in Australia (check NPS for references).

    Or writing about how Panadol Osteo was quick and easy money for the pharmacy owners and now they are having a good old fashioned whinge.

    What about the obsurd idea that patients are going to go to opiods? Will they magically generate their own scripts or will doctors malleciously prescribe opiates? Maybe they’ll be hitting up their local heroine dealer now that our saviour Panadol Osteo is gone.

    Why not encourage non-pharmacological methods for pain management in osteroarthritis: hot and cold packs, muscular strengthening exercise programs, increased mobility, weight loss and the list goes on (check UptoDate for reference)
    Lower SES is mentioned but what about the common comorbidites these patient exhibit that contributes to poor pain management in osteroarthritis? Depression and pain perception? Low tolerance for pain? Obesity? Lack of any physical activity or mobility?

    Having a daily mailing list doesn’t mean you have to fill it with subpar articles reporting essentially nothing but opinions, no facts, just fear mongering. Will you be trying to convince us to invade Iran next?

    • SHANOA

      hey, don’t speak for me darling… I have suffered Oesteoarthristis for about 10yrs..obviously, your not a sufferer… not one mention that Oesteoarthristis can be in a persons BACK…from L1/L2 – L5-S1, caused from Degenerative Disc Disease/bone spurs/Sciatica. You think you know it all?.. here ya go, I’m 54yrs old, didn’t start taking medication for pain until this year, suffered depression way way before that because of NARCISTIC ABUSIVE MALES.. I managed my pain all those years without medication, because ive had five kids and can tolerate immense pain… bet you couldn’t. The only thing that takes away a severe Sciatica attack is CODIENE >> OPIODS >>> MORPHINE. You may have read all the side effects dear, but really lol…. GUESS YOU MISSED THAT OESTEO MEDS CAN RUIN YOUR LIVER EVENTUALLY… and why its not recommended YOUNG PEOPLE take them for long periods of time. COUGH! KNOW WHAT YOUR SPEAKING ABOUT AND DONT INSULT OTHERS THAT HAVE DONE RESEARCH BEFORE HAND WHICH IS ALL OVER THE NET ANYWAY.

  3. United we stand

    There’s so much misinformation in this article it’s mind boggling.

    Paracetamol 665mg Sr tablets are still on PBS. It’s called Osteomol. PBAC only took the original brand off PBS.

    Patient can still access their medication for $5.20 as before.

    Lets hope a community pharmacist didn’t write this article ??

    • David Newby

      While the Osteomol brand is still listed, it is only available to patients on Repat, Palliative Care patients, and those that identify as Aboriginal or Torres Strait Islander. Therefore it is not available for the majority of patients on the PBS.

  4. M M

    Panadol Osteo and its generics should be taken off the market. Three times a day dosing vs the conventional four times a day dosing doesnt make much difference, it is a marketing game. If I were a regulator, I would never list such a product.

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