News

Codeine supply in Australia has almost halved


Matt Woodley


26/04/2019 1:57:12 PM

The massive decrease has been attributed to the 2018 decision to up-schedule codeine to a Schedule 4 prescription-only medicine.

Codeine pill
Sales of codeine-containing products halved in 2018 compared to the 2014–17 period.

A Therapeutic Goods Administration (TGA) analysis of pharmaceutical industry sales data found the total number of codeine-containing products supplied in Australia had halved in 2018 compared with the previous four years.
 
Approximately 17.1 million packs were dispensed last year, compared to the average of 34.7 million per year from 2014–17. Given up-scheduling was only adopted in February 2018, the figures also include one month of data for sales of over-the counter codeine-containing products.
 
Dr Evan Ackermann, GP and immediate past Chair of the RACGP Expert Committee – Quality Care, told newsGP the results show that regulation can be successful.
 
‘The 50% reduction is a good sign. It demonstrates the effectiveness of up-scheduling, getting a drug away from the retail influence of a community pharmacy and under the professional oversight of a GP,’ he said.
 
‘It also represents the general trend of GPs in reducing opioid use – even the use of fentanyl patches has declined.
 
‘General practice has really got the message about reducing medication, in particular opioids.’
 
According to the TGA, the sales data (provided by multinational health-IT company IQVIA) showed the difference in patients switching from low-strength to high-strength (30 mg) codeine medicines following up-scheduling was not statistically significant. Between February and December 2018, the supply of high-strength 30 mg Schedule 4 codeine was 7274 kg, as compared with the projected 6816 kg without up-scheduling.
 
Overall, more than 15.3 million packs of codeine-containing products were supplied in Australia in the first 11 months following up-scheduling, which amounted to a total of 8254 kg of codeine.
 
Past supply trends indicate more than 15,000 kg of codeine would have been sold if there had been no up-scheduling, meaning the actual amount supplied was approximately 46% less than it otherwise would likely have been.
 
The up-scheduling of codeine products followed evidence that showed medicines containing low-dose codeine combined with paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) were generally no more effective than other non-codeine medicines.
 
Codeine-containing combinations were also associated with a number of health risks, including addiction leading to misuse, liver damage, gastrointestinal perforations, blood potassium imbalances and respiratory depression. These risks were judged to be too high for the codeine combination products to be supplied without oversight from a doctor.



codeine codeine up-scheduling Therapeutic Goods Administration



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