Shock and disappointment at MedsASSIST demise


codeine tabsules spill from orange pill bottle

Pharmacists across Australia are expressing disappointment at the discontinuation of MedsASSIST, amid fears of stockpiling

The Guild has announced that the decision-making tool will be wound up at 10pm on Thursday, March 30.

MedsASSIST was rendered obsolete by the TGA’s decision to upschedule codeine-containing OTC preparations to prescription only, the Guild says.

GSK has already announced that it will discontinue its OTC codeine, including Panadeine, in the lead-up to the upschedule.

Researcher and pharmacist Penelope Wood, a pharmacotherapy clinical adviser at Western Victoria Primary Health Network in Geelong, says that the end of MedsASSIST is “disappointing… it’s going to put a lot of pressure back on the pharmacist again, because there’s no way to monitor this”.

Wood and colleagues recently published the results of a study in which shoppers attended pharmacies requesting Nurofen Plus, with two differing scenarios (one new to the drug, one a regular user). These visits took place before MedsASSIST was rolled out.

A pharmacist was involved (directly or indirectly) in only 77% of visits, the researchers found, and adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits.

Safety was established in 17% of visits, as was adequate counselling. 24% of product requests were refused due to lack of photo ID, but alternatives were generally not suggested.

The end of MedsASSIST will likely see a reversion to pharmacies attempting to use their own methods of identifying problem codeine users, Ms Wood warns, and possibly the inadequate use of S3 protocols as seen in the study.

“That was the beauty of MedsASSIST. You could see a pattern, and have more clout to your discussion.”

“Back then, people were trying to use Project Stop, which of course isn’t made for codeine, and recording purchases in their own dispensing system, so they would at least have a record for when that patient came back,” Ms Wood tells the AJP.

“A lot were using this more as a policing protocol, rather than with an ideal of, ‘Let’s help these patients’.”

Informal recording systems for codeine purchases can help, but are flawed particularly when a pharmacy employs several different pharmacists, she says, and don’t help address issues around pharmacy shopping.

She says she has concerns that the end of MedsASSIST will make it easier for consumers, including people who do not necessarily use codeine inappropriately, to stockpile the drug before the 1 February 2018 deadline for upscheduling.

“I’ve even heard colleagues or random people saying, ‘I use it for back pain occasionally, and if it won’t be available I’ll have to buy it up’,” she says. “These are educated people and people who use it properly, so I can only imagine what people who depend on it will try to do.

“These medicines do usually have long expiry dates, but after that deadline if there’s a box sitting right there in the cupboard past its date, and somebody is having a bad night, there’s an inherent risk that they’ll take it anyway.”

Karalyn Huxhagen, 2010 pharmacist of the year and a specialist in pain management, says that pharmacists should continue to attempt to identify problem users, but that the end of MedsASSIST may undermine their attempts to do so.

“It’s harder when all you see is a one-off request,” she says. “That was the beauty of MedsASSIST. You could see a pattern, and have more clout to your discussion.

“Without it, they can fob you off and say it’s just a one-off, and you don’t have that long list in front of you. You had more ammunition when you said, ‘I’m not going to give you any more until we discuss what you’re doing and how we can help’.”

She urges pharmacists to bookmark and continue to use resources provided by MedsASSIST, such as the pain diary from NPS MedicineWise and the Pain Australia FAQ.

“We don’t have enough pain specialists, or pain management clinics, but there are resources that patients don’t always know exist. And as a pharmacist I would keep going with the conversations: ‘What is your pain? Why do you have to have codeine, what is it codeine does?’ and have that conversation about the fact that there are better ways to manage the pain.”

 

Shock on social media

Several AJP readers have expressed disappointment with the demise of MedsASSIST.

“Legislated, real-time recording goes up in a puff of smoke. It’s a real shame,” Nick Logan writes. “MedsASSIST was the only available solution to the problem. Thwarted by illogical up-scheduling.”

Amin-Reza Javanmard says that “I for one would like to thank the Guild for having the balls to implement a system like this off their own bat and the pharmacies who used the platform as an example of best practice and prob patients above profit.

“It has helped me detect a case of pancreatic cancer and a help a number of patients with chronic pain and substance abuse issues. To the pharmacies who chose not to use the system, I hope your greed is punished by the pharmacy board… although I won’t hold my breath.”

Not everyone was happy with the Guild over the decision, however. “Shame Guild, shame,” writes PharmOwner. “Thanks for pulling the rug out from under our feet. MedsAssist WAS a useful tool in detecting patients with codeine issues even though not every pharmacy used it.”

Victorian Guild president Anthony Tassone responded that there were a number of considerations behind the decision to close MedsASSIST.

“Whilst all posters are entitled to their opinion, to read some posts state their view that the Guild is ‘disgraceful’ and ‘shame on them’ perhaps does not take into account a number of considerations that were behind this decision,” says Mr Tassone.

“The absence of legislation making real-time recording of codeine compulsory has not only rendered the system less than effective because of partial coverage, it has also resulted in privacy concerns arising from complaints by some consumers. These could have and should have been addressed through legislation to mandate the use of a real-time monitoring system for supply of codeine.”

Pharmacists also took to the Guild’s Facebook page to express their frustration.

“Super disappointing to see it being discontinued,” writes one pharmacist. “Such a valuable resource that we have been crying for for years and then at the drop of a hat. Gone. I’m genuinely extremely frustrated at this decision.”

The Guild’s Amanda Galbraith responded: “Sadly, if the TGA requires up scheduling, then there is no way to justify the ongoing costs of this platform, that we all hoped would ensure that appropriate clinical use could continue.

“We are still negotiating with Government ways to continue to provide codeine for acute patients.”

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