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Curbs on codeine analgesics
will not prevent misuse
BY DEON SCHOOMBIE
As anyone who has visited their pharmacist suffering pain, cough or cold
will know, analgesics containing codeine are one of the best options
available to relieve pain symptoms.
These are medicines comprising codeine
in combination with an analgesic, usually
paracetamol, aspirin or ibuprofen.
They provide short-term relief from
moderate to strong pain, as well as from
the symptoms of coughs and colds.
What many people may not know is
that these medicines may soon only be
available with a prescription from a GP.
A proposal to be considered
by the medicines regulator
in July involves rescheduling
codeine-combination analgesics from
the current S3 or ‘Pharmacist Only’, to S4,
or prescription medicine.
Such a move would have significant
impacts for many consumers; in particular
it would entail a GP visit for many common
and minor ailments.
It means that many people would be
forced to take time off work simply to
obtain a prescription. On weekends,
they may have to visit a hospital
In the current healthcare environment,
we simply do not need more GP visits,
extended waiting times or unnecessary
hospital emergency visits.
So why is this happening?
The body that oversees medicines
scheduling, the Advisory Committee
on Medicines Scheduling has listed the
matter for consideration due to what it
describes as ‘potential issues of morbidity,
toxicity and dependence’. In everyday
terms, this could be described as abuse,
misuse and addiction.
The Australian Self Medication
Industry (ASMI), which represents the
non-prescription medicines industry,
acknowledges that addiction is a serious
problem that warrants specialist attention.
However, ASMI cautions against knee-jerk
solutions, and draws attention to the
overwhelming benefits from access to this
class of medicines.
The vast majority of people use these
Australia already has in place several
measures to curb misuse, such as
limiting pack sizes and requiring them
to be available ‘behind the counter’ after
consultation with a pharmacist.
This means that consumers must interact
with a pharmacist every time that a
codeine combination analgesic is needed,
giving pharmacists the opportunity to
educate, counsel and monitor usage.
The pharmacy profession and industry
also support establishment of a real
time monitoring system coupled with
pharmacist training, guidelines and
protocols, to allow pharmacists to better
identify consumers if they suspect misuse
of these products, and refer them to a GP
or pain clinic for intervention.
If there is evidence of systematic abuse,
then it needs to be addressed by targeted
education and support, not through
a blunt measure that risks shifting the
problem to prescription medicines
Rescheduling these medicines to make
them harder to access may seem a
We need to bear in mind that such a
decision will have a significant adverse
impact on thousands of consumers, and
will lead to an unnecessary and costly
drain on GPs and hospitals at a time
when they are already over-stretched.
Dr Deon Schoombie is the Chief Executive office of
the Australian Self Medication Industry. Opinions
expressed in this article are not necessarily those of
the Pharmaceutical Society, its Board or staff.
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