The Therapeutic Goods Administration made the decision to up-schedule Codeine, after taking into consideration that US, most of Europe, Hong Kong and Japan had stopped the sale of codeine products without a script and evidence of the harm caused by their overuse and abuse.
In Australia, Codeine up-scheduling will create a major public health issue. These are some of the reasons:
- It will inconvenience 2 million Australians. Patients will be forced to go to the doctor to access a packet of pain relief medicine containing codeine, such as Panadeine or Nurofen Plus. They will be upset about that.
- It will potentially cause them unnecessary pain and anxiety because they will not be able to get satisfactory immediate treatment for migraine, other headache, period pain, toothache, and other minor
- Many people cannot take NSAIDS such as ibuprofen, so paracetamol is their only over-the-counter option. For a start, 500,000 Australians have heart problems- not to mention those with kidney problems- where NSAIDs are strictly contra-indicated
- Paracetamol will not give sufficient pain relief in hundreds of thousands of cases.
- Up-scheduling will increase the State health costs as more patients present to hospital emergency wards.
- Up-scheduling will increase the cost of Medicare due to more GP visits. A $6 dollar sale becomes at least a $36 Medicare cost.
- The inconvenience will increase costs to patients who go to private GP’s with higher out of pocket costs.
- Codeine up-scheduling will be have a disproportionate impact in regional and rural areas because of their lack of doctors. A pharmacist from Bateman’s Bay informed us that whether going public or private it takes 6 weeks to get a doctor’s appointment.
- The vast majority of people who use codeine safely will be seriously inconvenienced by the small minority of people who don’t. Problem users may be identified more effectively if real time recording system would be used. One such example is MedsASSIST but others could be built by the vendor community.
- Regarding the statement, ‘codeine is not effective in doses lower than 30mg’ – 2 million Australians, including many doctors and other health professionals, would disagree. Anecdotal evidence of doctors- including specialists- indicates the low dose works and in many cases is a superior option to higher doses.
- Many local GPs’ opinions on this are poles apart from that of the AMA.
- It is also debatable that is does not work, as lower doses wouldn’t be listed on the PBS.
AUTHOR: Adele Tahan Bpharm Syd Uni MPGA
Pharmacy Guild NSW Branch committee member
CESPHN Drug and Alcohol Advisory Committee
Owner, manager, and Pharmacist In Charge at Adore Pharmacy.
Specialist Advisor to the TGA Key regulatory Functions.