Rural doctors have weighed in on the codeine debate, saying they strongly support the TGA’s decision to upschedule

The Rural Doctors Association of Australia makes a point of calling for a real-time monitoring system, an issue which the Pharmacy Guild has said other doctor groups have not stressed enough.

“RDAA is calling on the Federal Government to continue to back the TGA’s decision, despite pressure from the Pharmacy Guild to make exemptions to the requirement for a prescription,” RDAA president Dr Ewen McPhee says.

“The TGA’s decision has very clearly been made in the best interests of patient safety, and it has been made with extensive consultation from medicines experts.”

RDAA says it sees the upschedule as the “critical” first stage of a two-stage process to improve patient safety where codeine is concerned.

“The implementation of a compulsory and legislated national Real Time Prescription Monitoring system – enabling doctors and pharmacists to track prescriptions for individual patients in real time – is the crucial second stage that should be introduced as soon as possible.”

Dr McPhee says that patients in rural and remote communities have particular difficulty getting treatment for addiction, including medication addiction.

He queried some of the points the Pharmacy Guild has made when discussing its “Prescription – except when” model.

NSW Nationals leader John Barilaro called on Australia’s health ministers last week to push for a reversal or compromise (prescription – except when) on the upschedule, from the Harden Pharmacy in the south-west slopes of NSW.

The small rural town is frequently without a doctor, a fact highlighted by Mr Barilaro in his comments. The NSW Guild’s new president David Heffernan was on hand to explain the compromise model at the time.

But Dr McPhee says that the RDAA had noted “with interest” comments made by the Guild that prescription-only codeine would be a problem for residents of rural towns due to difficulty accessing GP services, particularly after hours.

“What the Guild fails to mention, however, is that in many rural towns, pharmacies do not work extended trading hours anyway,” Dr McPhee says.

“The Guild also argues that, in towns where there is no doctor or a doctor shortage, patients may not be able to access codeine for temporary acute pain associated with conditions like headache, toothache or period pain.

“We would hope that the Guild supports the need to put the safety of rural patients at the highest level – we believe that, on balance, it is more important that rural patients are properly assessed by a trained doctor for their condition, before they are given codeine for a condition that may not require it.

“In many cases, there may be more appropriate and just as effective alternative medicines with lower risk for the patient.”

Dr McPhee says most rural and remote patients would want to see their GP before taking more significant pain medication.

“And in a large number of remote towns, the GP also dispenses medication as there is no local pharmacy.”

He says that to date the RDAA has not been consulted on “prescription – except when” protocols by the Guild and how they would apply in rural and remote communities, though the Association had previously met with the Guild to understand the model.

A spokesperson for the Pharmacy Guild told the AJP that “The Guild is open to consultation with any doctor group on the best way forward to ensure safe appropriate access for patients is maintained, with limited quantities, real time recording and clinical protocols.

“Our focus is on providing a common sense solution for appropriate and safe use of these medicines, especially in rural and regional areas where doctor access may be reduced.”