As the codeine wars continue, the hospital pharmacy society has reiterated its support for reducing the availability of codeine-containing medicines

Late last week, Commonwealth Chief Medical Officer Professor Brendon Murphy put out a statement saying paracetamol and anti-inflammatory medications, alone or in combination, are adequate over-the-counter treatments for most types of acute pain.

“There are numerous studies that show that codeine is not the miracle pain relief drug that people think it is and there is compelling evidence of harm caused by overuse and abuse of over-the-counter codeine-containing medicines,” said Professor Murphy.

“This highlights that stockpiling over-the-counter codeine is simply a waste of time.”

More complex acute or chronic pain requires medical input via GP consultation, he added.

The Society of Hospital Pharmacists of Australia (SHPA) has come out in support of Professor Murphy’s statements.

SHPA Chief Executive Kristin Michaels said the organisation has long advocated for reducing the availability of codeine-containing medicines, which it deems “ineffective”.

“SHPA does not recommend sub-therapeutic doses of codeine for the treatment of mild to moderate pain, a view informed by the expertise of hospital pharmacists who provide care to patients with mismanaged pain in hospitals around Australia, and people experiencing the debilitating effects of codeine and opioid dependence,” said Ms Michaels.

“SHPA remains the only pharmacy organisation to join the Choosing Wisely Australia initiative curbing unnecessary tests, treatments and procedures, and our position on codeine has been one of our five Choosing Wisely recommendations since 2016.”

Ms Michaels said SHPA stands behind the ongoing Real Relief campaign, led by Painaustralia, to help ensure more Australians become empowered in the management of their pain.

“‘Real Relief brings together key pharmacy, medical and consumer groups to inform Australians about the realities of codeine dependence, pathways to seeking help and alternative approaches to self-managing pain,” said Painaustralia CEO Carol Bennett.

Non-profit organisation ScriptWise has also aligned itself with the government and other health organisations in support of the TGA’s decision.

“The cost of codeine misuse, dependence and addiction in our society is huge with an estimated 100 people dying due to codeine-related deaths each year,” said ScriptWise.

“People with chronic pain problems have also been seen in 35.8% of codeine-related deaths.

“These are the Australians who have been missing from the current debate and who would likely benefit from speaking to their GP to discuss appropriate pain management alternatives.

“This is not a matter of punishing people who are using codeine for pain management, but ensuring that the risks associated with its use don’t inadvertently end in tragedy.”

Meanwhile some pharmacists have been taking to mainstream media outlets to express their opinions on the upcoming codeine changes.

For example, Thurgoona pharmacist Simon Horsfall wrote to the Border Mail to warn that “if the proposed change goes ahead I believe it will force some in our community to suffer unnecessary pain because if they wish to use the products they will have to get a doctor’s appointment”.

Judy Plunkett, a branch committee member with the Pharmacy Guild’s NSW Branch, has appeared in the Port Macquarie News stating that the upschedule will mean “congestion at doctors’ surgeries and a crowded A&E” from February 1.

And University of Sydney’s Professor Peter Carroll penned a piece for the Daily Telegraph in which he criticised the upschedule and warned of lack of timely access to pain management, as well as the possibility that patients could be prescribed a higher strength codeine product by GPs.

With less than two weeks until the upschedule of codeine-containing OTC medicines, an AJP poll found pharmacists are experiencing an influx in complaints and stockpiling behaviour.

To help pharmacists and pharmacy assistants prepare in the transition to the upscheduling of codeine on 1 February 2018, the Pharmacy Guild and the PSA have collaborated to develop a range of materials and training resources.

See the PSA’s Codeine Resource Hub here.