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Tensions reach boiling point over codeine changes


The row between the Pharmacy Guild and the medical community over the coming upscheduling of codeine products has well and truly boiled over this week, with the Guild accusing doctor groups of “hurling abuse and playing political games”.

Over-the-counter codeine products will become prescription-only as of February next year, in a move by the Therapeutic Goods Administration that has received the support of all main medical associations, including the AMA, RACGP, RACP and Pain Australia.

In its decision, the TGA cited the issue of opioid misuse and addiction as well as the poor additional pain relief offered by codeine compared with other common over-the-counter painkillers.

Over 6 million codeine-containing products, such as Panadeine and Nurofen Plus, are sold every year by pharmacists, who stand to lose up to $120 million in sales once these painkillers are upscheduled.

But the Guild has lobbied hard for a softening of the upscheduling decision. It wants pharmacists to continue to be able to continue supplying over-the-counter codeine products for the temporary treatment of acute pain, with a mandatory requirement for real-time monitoring to identify non-legitimate misuse.

Their argument is that upscheduling of codeine will merely overburden GP surgeries and ER departments, and that in rural and regional areas people will find it hard to see a doctor to get their medication.

The Guild’s intense lobbying efforts appear to be paying off. This month, health ministers from all state and territories, with the exception of South Australia, wrote to federal Health Minister Greg Hunt to express their concern about the new rules.

“Some people managing chronic conditions with codeine medications will deteriorate as they abandon medication due to the out-of-pocket expenses associated with accessing GPs for their prescription,” they wrote.

AMA President Michael Gannon hit back at the “irresponsible and unprincipled lobbying of state and territory governments”, while RACGP President Dr Bastian Seidel pointed to the $340,000 the Guild has donated to the major political parties in the past two years alone.

“They are trying to introduce policy by chequebook by donating large amounts to state and federal parties to gain open access to decision makers,” he said.

But on Wednesday the Guild said it rejected “the outrageous and baseless claim that it is putting the commercial interests of pharmacies ahead of patients in relations to the upscheduling of codeine”.

It said its arguments had been motivated solely by “the need to maintain convenient access for patients who use these products legitimately, and the safeguard of real-time monitoring for at-risk patients with addiction issues”.

It said that “rather than throwing mud”, doctor groups should be taking responsibility for the “very real patient issues that doctors will need to manage” once codeine is upscheduled.

It questioned how overstretched doctors will manage the increase in demand in areas where patients already have to wait long periods before seeing their GP.

At the same time the presidents of five high-profile medical and health consumer associations, including the RACGP and Pain Australia, have written an open letter to all state and territory health ministers, warning that any changes to the TGA’s plan to upschedule codeine will put health and lives at risk.

“The Guild’s proposed alternative model carries a serious risk of increased harms and potentially preventable deaths and cannot be supported by the medical community and consumer advocates,” the letter says.

It also notes the “serious and far-reaching implications” of any state or territory creating exemptions, as it would be “tantamount to walking away from nationally consistent regulation of medicines in this country”.

The European Union, Japan and Canada all require a prescription for codeine-containing products.