Hope and fear as codeine D-Day approaches

GPs should brace for patient stampede, Guild warns
codeine in green pill

Patients in debilitating pain will be flooding GP waiting rooms across Australia next week as the ban on pharmacies selling OTC codeine finally comes into force.

This, at least, has been the vision touted by various pharmacy groups and their political supporters ever since the TGA announced its plan to upschedule the drug.

As of 1 February their grim premonitions will be tested against reality.

Dr Evan Ackermann, chair of the RACGP expert committee on quality care and a vocal supporter of the TGA’s decision to make codeine prescription only, says some of his patients have already asked about pain relief options.

The consults have reinforced his view that the move will allow GPs to properly address their health problems.

Read more on this topic and earn CPD points: How to Treat - OTC codeine

“There are all sorts of issues emerging from the clinical reviews,” he said.

“One is younger women self-treating their migraines, the point being that these women are or were on the oral contraceptive pill as well, which is contraindicated in migraine.”

No patients had presented to him with clear signs of a substance misuse disorder but several were in “the grey areas”, Dr Ackermann said.

“It’s where people have ongoing pain, mental health issues or socially poor circumstances. You know the codeine use is probably used as a crutch, but it doesn’t fit a substance use disorder,” he added.

The TGA first proposed a ban on OTC codeine, which is linked with roughly 100 deaths each year, in July 2015.

The Pharmacy Guild of Australia has been fighting against the move ever since.

A guild-sponsored report released in 2015 claimed the upscheduling would drive an extra 8.7 million GP consultations every year.

Background: Top stories of 2017 ... No.5: Codeine wars and guilded rage

Last November it warned doctors’ groups: “It is indisputable that there will be a very large increase in GP visits from 1 February ... how will already overstretched doctors manage this increase in demand?”

To circumvent the ban the guild has been lobbying state and territory governments for the past 12 months to keep codeine available OTC for acute pain by introducing special exemptions to the TGA rules.

The campaign has been rubbished by doctors, who point to the fact that the exemptions won’t help patients in acute pain because the doses of codeine available OTC are at sub-therapeutic levels.

But the guild has gained political traction, with NSW Minister for Health Brad Hazzard telling the media in October that the upscheduling did not strike the right balance between safety and convenience.

Mr Hazzard made these statements after two meetings with the guild’s hired gun — former federal minister-turned lobbyist Santo Santoro — according to emails obtained by Australian Doctor last month.

With a week until the ban comes into force, no state health minister has said they will adopt the guild’s exemption proposal.