Con­tro­versy on codeine risk

Benalla Ensign - - News - By Si­mon Rup­pert

The med­i­cal com­mu­nity has been split by the an­nounce­ment that pop­u­lar painkiller codeine will be made pre­scrip­tion-only from Fe­bru­ary 2018.

GP and ad­dic­tion spe­cial­ist Dr Hester Wil­son said the ev­i­dence shows that over-the-counter codeine prod­ucts are in­ef­fec­tive and carry sig­nif­i­cant risks.

‘‘There is a lot of mis­in­for­ma­tion out there re­gard­ing codeine,’’ Dr Wil­son said.

‘‘Codeine is ac­tu­ally a re­ally lousy painkiller, it has a lot of risks but no ben­e­fit.

‘‘Pa­tients are mis­led if they think they are get­ting ad­di­tional pain re­lief in over-the-counter prod­ucts con­tain­ing codeine.’’

Am­cal Plus Be­nalla phar­ma­cist Matt Crit­ten­den dis­agrees and said that this is only par­tially true.

‘‘In­ef­fec­tive at treat­ing what? There’s dif­fer­ent types of pain, chronic and acute are the main ones,’’ Mr Crit­ten­den said.

‘‘When treat­ing some­one who has a thump­ing headache that sim­ple anal­gesics haven’t helped, codeine can be ef­fec­tive.

‘‘When treat­ing other sorts of chronic pain, they are not ef­fec­tive.’’

The Ther­a­peu­tic Goods Ad­min­is­tra­tion (TGA) has opted to make the change which brings Aus­tralia in­line with other coun­tries such as the United King­dom and Canada.

How­ever, Mr Crit­ten­den said he thinks this is not nec­es­sary be­cause the drug, which is ad­dic­tive, is al­ready reg­u­lated.

‘‘It is reg­u­lated and it’s not on the shelf,’’ Mr Crit­ten­den said.

‘‘It’s a sched­ule three medicine which means a phar­ma­cist has to be in­volved in the sale of the prod­uct, it’s the law.

‘‘It’s be­hind the counter and with MedAs­sist , which is the soft­ware which does live reg­u­la­tion, you need to present ID.

‘‘So you can’t go to four phar­ma­cies down the street and get four pack­ets in a day.

‘‘The pur­chases are recorded, it is an at­tempt to re­duce abuse.’’

Dr Wil­son, how­ever, feels the new reg­u­la­tions are es­sen­tial and points to fig­ures which show that codeine re­lated deaths in Aus­tralia have dou­bled since 2000.

‘‘For long-term pain, peo­ple re­ally need to be speak­ing to their GP,’’ she said.

‘‘Ef­fec­tive chronic pain man­age­ment re­quires a holis­tic ap­proach in­clud­ing both phar­ma­co­log­i­cal and non-phar­ma­co­log­i­cal mea­sures.

How­ever Mr Crit­ten­den said the changed reg­u­la­tions will per­haps make it eas­ier for ad­dicts to get codeine.

‘‘Pa­tients doc­tor-shop and the doc­tors don’t know as they have no live sys­tem like MedAs­sist,’’ Mr Crit­ten­den said.

‘‘At this stage doc­tors don’t use MedAs­sist or any pro­gram like it. Phar­ma­cists do.

‘‘Another con­cern is that with it be­ing moved to the doc­tors it is not nec­es­sar­ily a so­lu­tion, it is just mov­ing the prob­lem to an area that is al­ready over­worked and un­der stress.’’

One area where Dr Wil­son and Mr Crit­ten­den agree is that pa­tients should at­tempt to deal with pain us­ing Parac­eta­mol and Ibupro­fen be­fore turn­ing to codeine, re­gard­less of if it is pre­scribed or not.

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