Today’s the day when codeine-containing products can no longer be bought over the counter at pharmacies and legally require a prescription as schedule 4 drugs. Here’s what you need to know about the change:
What is being changed and why?
In 2016 the Therapeutic Goods Administration proposed rescheduling all codeine-containing analgesics to Schedule 4 (prescription only). It received submissions from pain specialists reporting rising levels of codeine dependence and from members of the public whose families had been destroyed by codeine addiction. Although some bodies, notably the Pharmacy Guild of Australia, argued against upscheduling, the TGA eventually decided that codeine-containing products would become Schedule 4 from February 1, 2018.
It cited the likely public health benefits of such a move, based on the evidence of harm due to dependence on easily accessible, over-the-counter products. In 2013 well over half of codeine-containing analgesics in Australia were sold over the counter. From 2014 to 2016, the proportion of people seeking help for opioid addiction rose from 2.7% to 4.6%, and around 150 people a year die from overdose due to opioid overdose per year.
This may not be the TGA’s last move concerning codeine. It is reportedly looking into banning GPs from prescribing strong opioids as a means of addressing misuse and overdose. Other restrictions on the horizon may concern pack sizes, along with a review of indications and label warnings.
Are GPs likely to see an influx of patients seeking codeine products?
This may happen, but it may also take a while for people struggling with codeine addiction issues to come out of the woodwork.
There is some anecdotal evidence of patients stockpiling codeine products in anticipation of restrictions. Self-denial and the stigma attached to addiction may also hinder people from coming forward, and it may be some time before the extent of the problem can be quantified.
What should doctors tell their patients about codeine products?
The TGA says it’s important for GPs to develop practice policies for prescribing analgesics and know when to refer to pain specialists or allied health professionals for alternative therapies.
If you have a patient presenting with pain who has previously self-medicated with over-the-counter codeine products, here are some approaches:
- Ask open-ended questions about your patient’s pain and don’t presume they’re just after painkillers;
- Manage expectations: let your patient know that sometimes pain management is a long-term process that requires more than drugs;
- Tell them that there’s evidence low-dose codeine is no more effective than OTC products without codeine, and that higher-dose codeine is indicated for acute rather than chronic pain;
- Ensure your practice has a drugs of dependence therapy agreement policy to inform people about the risks of codeine dependency;
- If you suspect a patient of substance abuse, use this opportunity to organise proper care and consider referral to local drug and alcohol services.
Read more tips and talking points on managing patients who were previously on OTC codeine medication here.