What you said: Codeine goes S4

A roundup of thought-provoking comments regarding the TGA’s decision to upschedule products containing codeine

There weren’t many positive comments. Pharmacy veteran Ron Batagol said: “This decision by TGA is long overdue, and simply follows a worldwide trend to restrict the unrestricted availability of Codeine.”

“Upscheduling of barbiturates 25 or 30 years ago got rid of them as drugs of choice for sleeping – now replaced by benzos such as Temazepam – a lesser evil. Maybe codeine based meds will go the same way as barbiturates in another quarter century!” commented Philippe.

More than anything, readers voiced concerns about MedsASSIST and the implementation of a real-time monitoring system.

“Prescription codeine without real-time monitoring and prescriber accountability will further the codeine burden. GPs are inadequately qualified to manage chronic pain despite having a full clinical picture,” said Michael Post.

“My stance on this has always been that schedule change or not, there is no solution without RTPM as part of the strategy. This isn’t going to fix the issue, it will just transport the problem more directly into the doctor’s offices, while still maintaining the problem in pharmacy (since all supply must come through pharmacy),” added Jarrod McMaugh.

“The decision on whether to schedule or not isn’t in itself a good or bad decision – the issue is that it doesn’t address the problem. This is a band-aid that will create large costs for Medicare.”

And David Haworth also brought up the issue. “The worry now for me is the pharmacies using MedsAssist will stop using it. A big mistake. A codeine seeker will cotton on to Dr Shopping and multiple scripts and multiple repeats. This I have already seen out west. Doctors can’t monitor this but MedsAssist has a chance. These patient already Pharmacy shop and the next extension is Dr Shopping.”

“So now people misusing codeine products will have to doctor shop as well as pharmacy shop. What we really need, if privacy laws can be worked around, is a real time patient medication supply history that health professionals – not just pharmacists – can access,” PharmOwner said.

Many people were not happy with the decision and were not afraid to say so.

“Terrible decision by the TGA. If a patient has been overdosing on codeine, and all of the codeine products on S2/S3 are sold as combinations, surely these patients are overdosing on paracetamol or NSAIDs also,” said Raymond Li.

“An illogical decision given that the majority of traceable codeine-related deaths are from prescribed codeine,” argued Nicholas Logan.

medication pills drugs
Codeine-containing OTC medicines will be upscheduled from 1 February 2018, the TGA announced on Tuesday.

“This is not the right decision,” said one pharmacy retail manager. “The pressure on our already drowning healthcare system will be insurmountable!  Medsassist has not been in practice long enough. This decision is far too hasty.”

“The other very serious but unmentioned impact is the bottom line! Codeine makes up 5 out of 10 of the top OTC lines in our pharmacy.”

Another pharmacy retail manager said: “I’ve been in contact with my other health professional friends this morning. Doctor is happy, nurse is happy, pharmacist unhappy….so many different things to consider, lots of changes to me made.

“I suppose we can try and look at this positively from one of the many perspectives. Given that the decision doesn’t come into action until 2018 and we know about it now, it gives us time to educate our customers, and encourage customers, especially those that we feel may not have been managing their pain effectively to seek doctors advice for alternate options.

“Also Maxigesic and Nuromol will become the best option (which we all know is clinically proven to be more effective that codeine combinations anyway) and easier to sell to the customer. Trying to be positive, although I do worry about the backlash or potential violence that pharmacies could face from certain people who will not understand that the decision was out of our hands.”

And even a patient commented on the AJP story sharing their concerns.

“From a patient perspective, I think the new decision has positives and negatives. I cant afford to see the gp as well as I am currently studying full time. I think the current rules are ok where we have to provide our drivers license. I disagree with the new regulations of no sale at all. I cant afford pay anymore money to see anymore doctors every 6 weeks. I understand misuse is an issue but that will always be the case with anything. Thank god I am leaving this crapy country soon. Its definitely going downhill quick. I am sick of the over regulations!!” said Jane Palmer.

PPA’s Matt Harris argued that the Guild played a role in the decision as pharmacy’s largest lobby group.

“Surely the Pharmacy Guild can’t be that surprised at the govt’s decision to upschedule codeine?” he wrote on social media.

“The Guild needs to accept its role in the government’s decision to up-schedule codeine. You can’t preside over a system that has seen pharmacists’ workloads increase, the rise of a discount model, and appalling low pay and expect that there won’t be any consequences.”

Many large organisations also put forward their views on the issue. Read more here:

Guild responds to codeine decision

ASMI on codeine

PSA on decision

RACGP and NPS MedicineWise respond to upscheduling decision

Reasons for upscheduling: TGA

You can also participate in our forum on the issue.

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