Real time monitoring best chance to curb codeine misuse

ASMI and the Pharmacy Guild say real-time monitoring of OTC codeine containing analgesics, in addition to a range of other targeted measures including mandatory warning statements, reducing pack sizes and educational materials, provides the best chance to curb potential misuse.

This was in response to a report published in Addiction titled “Codeine Misuse in Australia”.

ASMI welcomed the new report, as it says there is a need for more data on the topic.

“This new report would have provided additional useful insights if the authors had separately examined the prescription and OTC products (instead of pooling them), because it has been reported that misuse and abuse of prescription opiate and psychoactive drugs have escalated significantly over the past several years,” says Steve Scarff, ASMI Director Regulatory and Scientific Affairs.

The study authors themselves acknowledge that a real-time monitoring system could be an alternative to re-scheduling and ASMI says it supports this view.

ASMI and the Pharmacy Guild of Australia have been working together to develop and refine the real-time monitoring system (MedsASSIST).

The system has been trialled in community pharmacy and is currently being implemented nationally.

Information entered into the system is linked in real time, says ASMI, allowing pharmacists to accurately identify consumers who purchase OTC codeine analgesics at multiple pharmacies.

Pharmacists are prompted to provide these consumers with information and advice to assist those who may be having problems with chronic pain, dependence or misuse, and refer them to their GP or pain clinic as appropriate.

The benefits of a real-time monitoring system will therefore be two-fold, the organisation says.

First, the system will assist pharmacists in providing appropriate advice to consumers. Second, the system will generate objective data on the potential misuse of OTC codeine containing analgesics.

“We believe real-time recording provides a useful counselling tool for pharmacists to ensure the quality use of these medicines and to identify problem use,” says Scarff.

The Guild also noted the findings of the published study, reinforcing the need for more measures to ensure codeine products are used safely and effectively.

“That’s why the Guild has developed MedsASSIST—a real time recording and monitoring system which will aid pharmacists in assessing the clinical advisability of supplying codeine products,” a spokesperson for the Guild told the AJP.

The Guild is encouraging all pharmacies across Australia to implement the important clinical aid.

“Additionally, the Guild proposes smaller pack sizes, stronger labelling and a program of education for consumers and for pharmacists,” the spokesperson says.

“We believe these measures will be more effective and appropriate than making the products prescription only.”

The TGA is expected to make a final decision on the possible rescheduling to prescription-only of codeine-containing medicines after June.


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