Most pharmacists intend to keep using MedsASSIST between now and February 2018, an AJP poll has found
MedsASSIST may not have stopped the TGA from deciding to upschedule OTC preparations containing codeine… but it appears most pharmacies have no intention of abandoning it.
At the time of writing, our poll has found only 10% of respondents plan to stop using MedsASSIST before 1 February 2018 – the date codeine products are set to become prescription-only.
Another 15% say they had already stopped using MedsASSIST after the December announcement; 9% say they didn’t use MedsASSIST anyway.
But that leaves 63% of users who plan to keep the system up and running in their pharmacies: to help people who misuse codeine (26% of respondents), as a “great decision-making tool” (22%), because its use supports the profession’s credibility (7%) or in the hope that the decision can still be appealed (8%).
Former Pharmacist of the Year and member of the NSW Poisons Advisory Committee Nick Logan told the AJP that he encourages pharmacists to keep using the system.
“I personally would encourage people to keep using it specifically from a Quality Use of Medicines point of view, and because I think the public are on our side with this,” Mr Logan argues.
He says he was surprised at how well MedsASSIST was accepted by people using OTC codeine-containing preparations appropriately, and how it helped them be more open with pharmacists about their pain experience.
“It’s improved professional interactions significantly, and I think consumers got used to it very quickly, rather than being annoyed by it.
“It gives the profession validity, and the data is absolutely invaluable when it comes to building a case for professional services in pharmacy,” Mr Logan says. “So it would be a real shame if people turned their backs on it.”
There is a strong possibility that people, including some who may currently be using the medicines appropriately, will attempt to shore up a stockpile of codeine before the 1 February deadline, Mr Logan warns.
“You’d be inspecting the product for expiry dates and trying to get as much backup as you could,” he says. “I absolutely believe people will stockpile.”
Continuing to use MedsASSIST may help prevent this, he says.
Mr Logan also warns that upscheduling codeine-containing products will not solve the problem of misuse.
“Doctors don’t have any real-time monitoring system Australia-wide for codeine, so MedsASSIST was the best available option for solving the problem,” he says.
“And there’s good evidence that doctors won’t prescribe 15mg codeine-containing medicines, they’ll go straight to prescribing 30mg per tablet. The data shows 60% of codeine traceable deaths were from prescribed codeine, not codeine bought OTC from pharmacies.
“People who transfer to prescribed codeine are also likely to get a bigger quantity. They’ll say, ‘I don’t want to come back every month to see you, can you give me 100?’
“I’m not arguing that there’s not a problem with codeine addiction, but I don’t think upscheduling is the answer, or the end of the discussion.
“There’s so many good things they could have done alongside MedsASSIST: reduced quantities in smaller pack sizes with very clear labelling about the risk of addiction.
“We could have even set limits on how many boxes people can take overall, legislate MedsASSIST so that it happened in every pharmacy, and that way you would have had a clearly definable stage at which people would need to be referred for more intensive pain management.”