As of today, the 1st February 2018, there is codeine control in Australia. We will join 26 other countries who have also introduced codeine control. If you want a painkiller that has codeine it will no longer be available over the counter (OTC) at the chemist. Pharmacists are little worried that some people may not have heard about the change. People will turn up and expect the pharmacist to hand them something stronger than paracetamol. To get a painkiller, stronger than paracetamol, a person will have to make a doctor’s appointment. There have been rumours of people stock-piling and there are good reasons for this for people who are sensible in managing their pain.
How did the codeine control come about?
An expert panel recommended to the Federal Government that codeine control for pain killers was the best way to protect the public.
What drugs have codeine
The painkillers that contain codeine and now only available by prescription include Panadeine, Nurofen Plus, Mersyndol, and pharmacy generic products. Some cold and flu medications also contain codeine. However, there is no mention to date, that we will have to go to our General Practitioner (GP) to get a prescription for cough mixture.
Extra trips to the doctor
Think of this scenario. I have a toothache but cannot get into the dentist until after the weekend. I have taken paracetamol for 24 hours and the pain persists. I will have to see my GP to get a prescription for something stronger, a painkiller that has codeine.
If you are one of those fortunate people whose GP bulk-bills then you won’t be too concerned about having to pay for a doctor’s visit to get stronger pain relief. If you are not entitled to bulk-billing your visit, then you will pay.
It’s Friday and I made an appointment to see a doctor. I can’t cope with this toothache all weekend! I can’t see my regular GP, fully booked, yet I am lucky enough to see another doctor. This should make me feel better, but my tooth is still aching. The visit, for less than a 20-minute consultation will cost me $75.00, but the good news is I will get a refund from Medicare of $37.05. Prescription in hand I take the shortest trip to the pharmacy. That little box of 20 tablets has cost me almost $60. Don’t think because you are an aged pensioner all is well in your world. Increasingly, medical practices are changing and charging pensioners up to $55 for a consultation.
Medicare costs will increase
The government argument for codeine control is about patient care. However, all codeine control will do is increase the cost of Medicare, for the government and consumer. It will also put more demand on GP’s and more waiting time for a doctor’s appointment. This will not make the public happy when someone with more serious symptoms, than a toothache, must wait a week or more to see a doctor. A few people needing codeine have congested the queue!
How harmful is codeine
Codeine is a low dose analgesic. It is at the lower end of the range of opioids. Codeine is a low efficacy opiate drug. On its own codeine is not a pain reliever. Once it is in the body, the liver metabolises codeine into morphine. Any pain-relieving effects is determined by how fast a person’s liver metabolises codeine. It cannot be predicted as to whether some people will have a bad response to codeine, hence now it is in the hands of the GP.
ABC’s Fran Kelly spoke last week to Professor Brendan Murphy, Chief Medical Officer. He said the main reason for codeine control is the concern about addiction, around 100 deaths a year from misusing the drug. Professor Murphy said that around 600,000 Australians are abusing low-dose codeine. However, Professor Peter Carroll, University of Sydney, holds the view that most people use low-dose codeine safely and appropriately for acute pain.
Read about Katie McQueen, as reported by the ABC, and how codeine control will affect her. Also, in the same article is a story about Peter Panas who has chronic back pain. With the help of Sydney’s Royal North Shore Hospital pain management program his quality of life has improved.
What are the statistics saying?
The Australian Bureau of Statistics tells us that in 2016 there were 1,808 drug induced deaths. This is the highest number of drug deaths in twenty years, and like those in the late 1990’s, when a steep increase in opioid use, specifically heroin, the deaths in Australia peaked at 1,740 in 1999. Although the 2016 statistic is the highest on record, the death rate per capita of 7.5 per 100,000 people is lower than that in 1999 (9.2 deaths per 100,000 people). Find more information here.
The highest number of drug induced deaths in 2016 is due to Benzodiazepines (663 – 36.7%). These include Alprazolam, Diazepam, Oxazepam, Clonazepam, Clozapine, Temazepam, and Oxazepam. Other opioids, including Oxycodone and Codeine account for 550 (30.4%) deaths and alcohol 222 deaths (12.3%). Of the top 20 causes of death in Australia there is no mention of codeine and the associated pain killers. Read more here.
The National President of the Pharmacy Guild, George Tambassis, said that the decision to up-schedule the medicines were short-sighted and ultimately would only add pressure to the already financially stressed health system, while also increasing the burden on already over-worked doctors. The codeine up-scheduling decision fails consumers according to the Pharmacy Guild of Australia.
As Mr Tambassis said “shifting it (codeine) to prescription only without a mandated real-time recording system or any screening program will simply bury the problem even deeper in the overwhelmed system and cost shift it to an already bursting MBS (Medicare Benefits Schedule)”. Well said George!