Home' Australian Pharmacist : Australian Pharmacist January 2013 Contents Australian Pharmacist January 2013 I ©Pharmaceutical Society of Australia Ltd.
THE NATIONAL PRESIDENT SAYS
The need to better educate pharmacists in
pain management, addiction and mental
health care has been highlighted by the
debate on OTC codeine misuse following
media attention and public disquiet over
Pharmacists' responsibilities in helping to
reduce the misuse of these medicines was
summarised in a report published recently
in the International Journal of Pharmacy
Practice (IJPP), which found that misusers
'purchased OTC codeine with virtually no
pharmacist interaction, or the sale was
refused with limited discussion'.
This is a damning reflection on parts of the
pharmacy profession and one which we
must act on quickly and effectively.
Educating pharmacists about pain
management, addiction problems and even
mental health issues so that they are better
equipped to manage the health issues of
patients requesting OTC products containing
codeine will provide a very real and effective
avenue in helping to address this issue.
There is great responsibility on individual
pharmacists to help identify misusers and
provide appropriate support and advice,
and we as a profession must not shirk from
this responsibility. Unfortunately the IJPP
report points to a lack of robustness in our
approach to date.
The report, Opportunities and challenges:
over-the-counter codeine supply from
pharmacists and codeine consumer
perspectives by Suzanne Nielsen,
Jacqui Cameron and Sanja Pahoki, aimed to
gain a better understanding on perspectives
of over-the-counter codeine users and
issues relating to codeine dependence in the
community pharmacy setting in Australia.
Significantly, the report found: 'Key themes
identified included experience of
participants acquiring OTC codeine and
participants' interactions with pharmacists.
'The OTC codeine-dependent participants
found it generally easy to access
OTC codeine, describing "standard"
questioning, minimal intervention from
pharmacists and only occasional refusal
to supply. A better appearance and
presentation was generally linked to easy
The report concluded: 'The experiences
of participants suggest a number of
barriers exist to effective intervention for
OTC codeine dependence in the community
pharmacy setting. Identification of these
barriers will provide an opportunity to more
effectively target interventions to reduce
harm related to OTC codeine products.
Increased involvement of pharmacists in
OTC codeine sales was associated with
helpseeking by codeine users.'
The report's release came at a time of
increasing public concern in Australia
amid media reports about significant
adverse effects and even death over the
misuse of over-the-counter medicines
This is an issue PSA has been aware
of and the Society is working towards
finding ways to improving and increasing
pharmacists' roles in addressing the issue.
A number of options have been suggested
so far and I have no doubt that members will
help with further suggestions of their own.
I have written in the past about PSA's
pilot project on the health destination
pharmacy model in which non-dispensing
pharmacists would meet and counsel
patients in the pharmacy. This could also
be part of the solution to managing misuse
of pain medications.
Also, in addition to educating pharmacists,
we could look to better educating the
public about OTC codeine-based pain relief
Developing education campaigns to inform
the public of the dangers of the misuse of pain
killers could be a valuable and powerful tool
in helping to stop such abuse. There is a belief
that simply because a medication or drug is
legal and freely available, then it must be safe
-- we must change this view. Educating the
community through health campaigns could
be a good foundation on which to build the
quality use of medicines messages associated
with the use of pain relief medications.
Such a campaign could conceivably be
delivered in schools as part of a broader QUM
campaign incorporatedinto heath curriculums,
so as to educate young people before they are
exposed to the risk of such abuse.
Pharmacists could work closely with the
government, manufacturers, doctors and
other stakeholders to ensure a consistent
and widespread campaign was implemented
effectively and quickly. The great strength of
pharmacist involvement is that we talk to the
people purchasing these medicines and can
advise and counsel them.
The introduction of reporting mechanisms
is another tool in helping to address this
issue. An advantage of this approach is that
it gives pharmacists the opportunity to meet
users, discuss issues and identify patients
that require further advice and treatment.
There is a Federal Government proposal on
to introduce a national real-time reporting
system for controlled drugs which could
However, a danger exists with reporting
systems in that some pharmacists may
believe that having fulfilled the reporting
requirements, then their job is done. This is
not the case. We must follow up and address
the issues of the patient and try to achieve
better outcomes for that patient.
Regardless of any real-time reporting,
there is great responsibility on individual
pharmacists to help identify misusers and
provide appropriate support and advice.
The misuse of OTC codeine-based pain relief
medicines must be addressed through a
whole-of-profession approach to achieve
any real outcomes. I look forward to working
with our colleagues at the Guild and other
stakeholders to help make a very real impact
on reducing this problem and achieving
better outcomes for patients.
I would also welcome any suggestions,
views or comments you may have at:
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