In line with moves to promote physiotherapy as an alternative to opioids, the TGA has produced advice for physios

The RACGP has encouraged GPs to refer patients to physiotherapists as an alternative to prescribing codeine, following the 1 February upschedule of low-dose codeine-containing preparations.

The TGA has issued a fact sheet for physiotherapists in which it says they should be prepared to discuss the changes with patients “who may desire, but can no longer access, codeine-containing medicines”.

“There is high-quality evidence from a systematic review (which includes 14 randomised controlled trials) that over-the-counter codeine-containing medicines offer modest pain relief (around 12 points on a 100-point pain scale) in the immediate term (three hours post ingestion) when compared to placebo,” the fact sheet states.

“However, the same review also shows that these products offer little additional pain relief compared with other medicines without codeine.”

The TGA is asking physios to “show empathy” as “some people may express feelings of frustration as a result of being referred to a physiotherapist”.

“This may be due to past positive experiences with intermittent use of codeine,” it says.

Physios are also being asked to perform a focused and comprehensive clinical assessment; to provide reassurance regarding pain; to discuss and implement management plans and monitor outcomes.

Last year AMA chief Dr Michael Gannon foreshadowed that doctors would prescribe less codeine and at lower doses after the upschedule.

And last week Advantage Pharmacy CEO Steven Kastrinakis told the AJP that low-dose codeine sales have plummeted now the preparations are Prescription Only, with one pharmacy in the group reporting that it had sold only eight boxes of the medicines in the first three weeks of February – down from 10 to 12 a day.

Scripts for the stronger Panadeine Forte were on the rise, however, he warned.