Codeine claims ‘emo­tive’

Pharmacy Daily - - NEWS -

THE cur­rent de­bate re­gard­ing the pro­posed reschedul­ing of over the counter (OTC) codeine-con­tain­ing prod­ucts to pre­scrip­tion only has driven some in­di­vid­u­als and or­gan­i­sa­tions to make claims “which are emo­tive and er­ro­neous” ac­cord­ing to the pres­i­dent of the NSW Branch of the Phar­ma­ceu­ti­cal So­ci­ety of Aus­tralia (PSA) Pro­fes­sor Peter Car­roll.

Car­roll is also Sydney Univer­sity of Notre Dame School of Medicine Pro­fes­sor and head of phar­ma­col­ogy and Univer­sity of Sydney Hon­orary Pro­fes­sor in the dis­ci­pline of Phar­ma­col­ogy.

In a schol­arly, well-ref­er­enced open let­ter, Car­roll writes he has “tried to ad­dress some of these claims from a sci­en­tific and clin­i­cal per­spec­tive.”

He presents seven ar­gu­ments which can be sum­marised as͗ 1. It is in­cor­rect to claim that the amount of codeine in OTC codeine-con­tain­ing anal­gesics is not ef­fi­ca­cious as it is not sup­ported by the ev­i­dence 2. To claim that Aus­tralia is out of step with other coun­tries re­gard­ing the sched­ul­ing of codeine is in­ac­cu­rate, and does not tell the full story 3. Any claim that codeine is a ma­jor cause of drug death in Aus­tralia is not sup­ported by the ev­i­dence, and is un­true 4. The pre­scrip­tion only move for codeine con­tain­ing prod­ucts has the po­ten­tial to in­crease its use 5. A switch to an ibupro­fen and parac­eta­mol com­bi­na­tion could lead to se­ri­ous ad­verse health out­comes for up to one mil­lion peo­ple in Aus­tralia 6. Claims sug­gest­ing that codeine can cause life-threat­en­ing tox­i­c­ity in up to 4-10% of the pop­u­la­tion is a gross over-ex­ag­ger­a­tion, and is not sup­ported by the ev­i­dence 7. There is no ev­i­dence to sup­port the claim that many con­sumers are us­ing OTC codeine-con­tain­ing prod­ucts to treat chronic pain. “If codeine is be­ing used to treat chronic pain, it is far more likely to be as a re­sult of the 3.7 mil­lion pre­scrip­tions writ­ten over 12 months for prod­ucts con­tain­ing 30mg codeine and 500mg parac­eta­mol,” he said. To view Pro­fes­sor Car­roll’s let­ter >/ < , Z .

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