Controversy on codeine risk

October 18, 2017

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 in-line 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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