Sunday, 29 November 2015

SPHPM's Dr Pilgrim weighs in on codeine debate

This article was published in Australian Doctor November 19 2015. 

Moves to up-schedule over-the-counter codeine products to prescription-only status have been put on hold until 2017 in response to strong lobbying from the Pharmacy Guild of Australia and industry groups. 

The Department of Health says a decision on whether to reschedule combinations, such as Nurofen Plus, has been deferred until June 2016 to allow the TGA to evaluate the large number of submissions received in opposition to the move. This means rescheduling of codeine could not occur before 2017.

The TGA said it received 127 submissions in response to its call for consultation on codeine rescheduling, of which 113 were against the proposal.

Most of the submissions in favour of rescheduling came from addiction medicine groups, which said they were dealing with increasing numbers of patients with nephrotoxicity and gastric perforation after taking massive quantities of OTC codeine–ibuprofen combinations.

They stressed that codeine was a poor analgesic at the doses used in OTC products and that effective alternatives were available.

However, the guild mounted a strong public campaign against rescheduling, warning that the move would increase MBS costs by more than 1 billion dollars over the next four years as a result of increased GP visits by codeine users seeking a prescription.

Rescheduling codeine would also result in patients being given stronger analgesics, such as Panadeine Forte or even oxycodone, by their GP, the guild claimed.

"The guild maintains there is a better way to address the incidence of abuse and dependence, including through real-time recording and monitoring of purchases, reduced pack sizes, and patient education," said Pharmacy Guild president George Tambassis, welcoming the TGA deferral.

"The guild will move quickly to implement a real-time recording system for codeine sales, as recommended in our submission to [TGA] Advisory Committee on Medicines. This system will help identify consumers potentially at risk and provide clinical referral pathways."

In a submission to the TGA, the AMA said up-scheduling alone was unlikely to address the problem of codeine misuse, and it recommended that alternatives to rescheduling be considered, including pharmacy requirement to record codeine dispensing in the same way as for pseudoephedrine.

However, the deferral was criticised by drug and alcohol researchers, who said it would result in ongoing and avoidable harm when patients could switch to alternatives, such as ibuprofen–paracetamol combinations.

"What a shame. Two more years of codeine harm and death when there's a far better alternative on the market!" said Dr Jennifer Pilgrim, head of the drug harm prevention unit at Monash University, Melbourne.

Dr Pilgrim said the decision was also bad news for pharmacists, who would continue to face "codeine tantrums" and have to manage difficult refusals to supply to codeine-seeking people.

Professor Peter Brooks, a rheumatologist and Executive Director Research Northern Health, Melbourne, condemned the deferral saying 200,000 Australians were abusing codeine and becoming addicted, often after starting to use it for simple problems such as back pain.

"I think that any groups that want to carry on the status quo and should take those figures on board and be held responsible because they are actually killing people," he told Australian Doctor.

Original article available here

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