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14 Mar 2018

BY AMA VICE PRESIDENT DR TONY BARTONE

New scheduling laws surrounding the sale of codeine have come into effect and now all medications containing codeine are banned from sale without a prescription.

As we know, the decision was made by the Therapeutic Goods Administration, which describes codeine as a commonly used medicine of abuse.

The TGA has said it is clear that alternative regulatory controls were required for the public benefit.

In the face of great pressure from the pharmacy lobby groups, Federal Health Minister Greg Hunt said it would have been unthinkable for the Government to ignore the advice of the TGA.

The AMA, of course, supported the decision from the TGA as the independent regulator acting in the interests of patient safety in the face of strong evidence.  A robust public awareness campaign saw the President and me managing an extraordinary number of requests for commentary and interviews. This was another example of the trusted advocacy brand that is the AMA.

The Pharmacy Guild of Australia in particular launched a prolonged and very strong multi-State offensive against this change. As we know now, the Guild was unsuccessful in its lobbying campaign. We will always follow the evidence.

There were a number of over-the-counter preparations that contained codeine in various low dose amounts. Now we have a number of alternative over-the-counter options available for the management of short-term acute pain. We need to educate our patients that nothing has changed in that respect, if they have a toothache or a muscle sprain or some other form of localised pain. They are still able to procure an over-the-counter option that will manage their pain equally, and usually better, than OTC low dose codeine.

We all are aware of the studies showing that there are significant thousands of Australians who are using codeine inappropriately and putting themselves at risk, be it of organ damage or long-term tolerance dependency and addiction.

We have also heard a lot about the idea that people tried to stockpile codeine before the new rules came into effect and that many will keep trying to get around the regulations that have been brought in.

A crucial point in the changeover period has been to emphasise the relationships our regular patients have with their family GPs or other medical specialists. This relationship will underpin the education and wider health literacy around the transition and it is improved health literacy which is fundamental to a number of our public health aims.

Of course, the pharmacy lobby also attempted to hijack the issue by saying the new regulations would do nothing to stop doctor-shopping, and that the limited Pharmacy Guild MedAssist system was the answer. The AMA has long called for a genuine Real Time Prescription Monitoring system that tracks all prescribing and dispensing, is nationally consistent, and interoperable with prescribing doctor software programs. This continues to be a very important area of our advocacy.

These new regulations are about reducing the level of codeine in the community. They are not about switching the source of the supply of codeine in the community.

We know that outside of cancer pain, there is really no significant justification for long-term codeine use. A key message during our campaign was that non-pharmacological options, or other more effective opioid alternatives, can work better for managing a person’s pain. Of course, the focus is the importance or need to have an individualised clear management plan for pain for each of our patients. As doctors we can and will facilitate that.

In addition there has been enormous information, education, and professional development options to assist all health professionals in the switch-over period. Everybody in this chain of supply should know exactly what’s happening, what’s required, and what needs to be done.

So in the final wash-up, the independence of the TGA and the associated scientific evidence was upheld but perhaps more importantly, a serious discussion robustly continues on the amount and type of opioid medication in our community and the world wide emerging crisis that is evolving in this space. 


Published: 14 Mar 2018