Doctors have taken to mainstream media to claim that codeine addicts are stockpiling – and pharmacists are letting them
Pharmacy leaders have described as a “beat-up” the suggestion that pharmacists are aiding codeine patients to stock up on low-dose codeine medicines ahead of the 1 February 2018 upschedule.
Australian Medical Association Queensland spokesperson Dr Richard Kidd told the Courier-Mail that there is “anecdotal evidence from some pharmacies” which indicate that stockpiling is already happening.
“That’s potentially tragic because, in the course of stockpiling, people who have got dependency issues are going to have ready access to taking even more than they should,” Dr Kidd said.
“There is a greater risk over the next few months that people may well accidentally overdose if they have more codeine-containing compounds at home.”
One commenter on the Courier-Mail article wrote that, “I have actually been advised by pharmacists to stock up prior to the laws coming in”.
Channel Nine reported that Dr Kean-Seng Lim, AMA NSW vice-president, says people are “buying in bulk,” with some using an online marketplace to find people who will visit pharmacies for them and purchase the items.
The Nine article quotes Balmain pharmacist Caroline Diamantis, who says regular codeine-seeking customers are “buying more than ever” and upon learning of the upschedule, make comments such as “well, I should buy a few boxes”.
She warns that the upschedule will not deter people who misuse codeine.
David Heffernan, president of the Pharmacy Guild – NSW branch, told the AJP that the stories are a “beat-up” and that following the upschedule, it will be more difficult to track inappropriate use of codeine-containing products.
“MedsASSIST was designed to make pharmacists accountable, and the Government wants to get rid of it on February 1,” he says.
“It’s the most advanced system for identifying problem patients and opioid addiction in Australia at the moment, and it will cease to exist on February 1.”
Pharmacists will be placed in a difficult position post-upschedule if they feel that a doctor is inappropriately prescribing codeine medicines, he says, as without MedsASSIST to track purchases they will not be able to obtain a true picture of that patient’s opioid using history.
Dr Shane Jackson, national president of the PSA, told the AJP that the insinuation that pharmacists are encouraging or allowing stockpiling are “patently false”.
“Certainly we’ve heard the stories about people stockpiling, and that raises the issue of the need for mandatory real time recording of all high-risk drugs, especially opioids,” he says.
“That needs to be done as a matter of priority. It’s on a number of government agendas, but it does highlight that people can potentially do this, because we don’t have the ability to monitor it between pharmacists and between doctors.”
Anyone who actually is stockpiling is likely to be visiting multiple pharmacies, rather than buying up at a single pharmacy, he says.
“And that’s what we’re trying to manage, and that’s why this would have been better with real time recording.”
The articles follow a piece on the ABC’s Law Report, which highlighted the fact that of opioid deaths, overdoses from prescription opioids significantly outnumber deaths from heroin.
Suzanne Nielsen from the National Drug and Alcohol Research Centre at UNSW told Damien Carrick that “with opioid-related deaths, the majority now are comprised of deaths that are attributed to pharmaceutical opioids, so pain medications that people are familiar with, so 70% of those deaths”.
“That’s actually a flip from 10 or 15 years ago when the majority of opioid related deaths were attributed to heroin,” she said.
Dr Matthew Frei, head of clinical services at the Turning Point Alcohol and Drug Centre, pointed out that “I’m sorry to say, it’s individual doctor prescribing that’s the issue, and not all of the deaths…in fact most of the deaths don’t seem to be doctor shoppers.”
Dr Jackson encouraged pharmacists to talk to their patients now about how they plan to manage pain – or addiction issues – post February 1.
“We need to turn our attention to making sure that people know this changes is occurring, and that they need to have a plan,” he says.
“If they’ve been using these medicines for chronic pain – which they shouldn’t have been – they need to discuss it with their pharmacist and potentially referred on to their GP to assess whether the use of that medication is appropriate in the long term, which it probably isn’t.”