Feature

RACGP codeine resources now available


Paul Hayes


31/01/2018 3:36:47 PM

The RACGP has created a range of clinical and professional resources – including an online information repository, prescribing guidelines and a 12-point opioid challenge – designed to help GPs throughout Australia address issues relating to the up-scheduling of over-the-counter codeine products.

News teaser
The RACGP believes the up-scheduling of codeine will help save lives throughout Australia.

The RACGP has long supported the up-scheduling of over-the-counter codeine to a Schedule 4 drug, believing such a move will ‘save the lives of many Australians’.
 
‘Clearly, the continued widespread availability of a drug product that causes so much drug dependence and harm, and provides no proven benefit, simply cannot be justified,’ RACGP President Dr Bastian Seidel said in December 2016. ‘As GPs at the frontline, we frequently see people getting into trouble with over-the-counter codeine.
 
‘First and foremost, GPs have the best interests of their patients at heart. Our position on this matter is significant because it is not distorted by any commercial interests.’
 
With the Therapeutic Goods Administration’s (TGA) decision to up-schedule codeine-based products coming into effect from today, newsGP has provided a number of articles to help give GPs relevant information to best deal with this significant change in healthcare policy:
 
New RACGP codeine resource now available
The RACGP has created a new online repository to assist GPs in addressing issues relating to the 1 February up-scheduling of codeine.
 
RACGP 12-point opioid challenge
Dr Evan Ackermann, lead author of the RACGP’s ‘Prescribing drugs of dependence in general practice’, has issued general practice with a 12-point challenge aimed at reducing opioid prescribing.
 
Codeine up-scheduling may offer chances for patient education and holistic care
The up-scheduling of over-the-counter codeine products may offer GPs a direct opportunity to provide patients with more holistic care to help address possible issues of addiction and misuse.
 
One of the many faces of codeine addiction
Jessica Khachan lives in Sydney with her husband and two teenaged kids in what she describes as ‘a normal suburban household’. She is also one of the increasing number of Australians with a history of codeine addiction.
 
Australian Chief Medical Officer confirms strong basis for codeine up-scheduling
Codeine is no better for pain relief than other over-the-counter medications, Australia’s Chief Medical Officer Professor Brendan Murphy said.
 
Examining the role of prescription opioids for chronic non-cancer pain
Many in the medical profession are debating the question of whether opioids should ever be used in the management of chronic non-cancer pain.
 
GPs criticise Pharmacy Guild on codeine rescheduling
Dr Evan Ackermann is critical of the Pharmacy Guild sending a letter to Federal Health Minister Greg Hunt seeking to maintain over-the-counter access to codeine-based medications.
 
Australians misusing painkillers
Figures have shown that 75% of recent painkiller/opioid misusers in Australia reported misusing an over-the-counter codeine product in 2016.
 
Non-medical use of pharmaceutical drugs on the rise
Close to one million Australians are misusing pharmaceutical drugs, a new Australian Institute of Health and Welfare report found.
 
Patients stock up on codeine prior to up-scheduling
Anecdotal evidence suggests some patients are building up their supplies of codeine ahead of its planned up-scheduling.
 
RACGP President wants states to consider patient safety in codeine up-scheduling
Dr Bastian Seidel calls on Australian health ministers to consider patients before making any decisions that will soften codeine regulations.
 
RACGP calls for system-wide reform for pain management in Australia
The RACGP wants to ensure a better balance between quality management and minimising harms ahead of the release of the latest part of its ‘Prescribing drugs of dependence in general practice’.



codeine-upscheduling TGA Therapeutic-Goods-Administration



Mai Maddisson   2/02/2018 2:46:55 PM

The most poignant word in this entire piece is the word ‘dependent’: In the context of this piece of course the comforter reached for is codeine. The alluded to need being pain relief: why has no one done an anonymous survey, maybe handed out by the pharmacists to codeine buyers (who may of course be buying it for another who has become a hermit) what the pain they are relieving is.

We, yes WE, are all dependent. At the end of a gruelling day we go home to our loved ones and friends and debrief the day leaving ourselves ready for another day. If the loved ones are overseas for an extended time then we press the Skype button.

During the last year while alluding to mostly another demographic a piece of mine was published in a different context. Among its words, extracted from a piece I wrote in2002, were
“Home is a place where one feels free to share one’s deepest pain without a sense of guilt. It is a place where one’s dearest wish is to extend that privilege to those around one..........
Home is a place where one does not have to be understood. Those around one just understand. They can relate to the notion that it is not always possible to coherently depict the events, which occur when one is caught in the turbulence of fast moving waters. They can relate to the notion that some of these memories may return with patient trust. They can accept that some memories will be forever dissociated. They can accept that at times one is incoherent because one wishes to spare another of ugliness in their lives. They can accept that one’s sadness and pain is to be trusted even if it cannot be accounted for in accurate detail. They accept that one is doing its best with the resources which it feels free to share.”

Australia is a vast pluri-cultural metropolis where there are endless people who can never find home: A home which was fractured at times decades ago. It would take months upon months to even begin to understand how they lost their ‘home’ which may still be visibly present.

Which one of us has the resources to set aside even two evenings a week for even one of our ‘codeine dependant’ patients, for the rest of time? Which of us is willing to do that for gratis: we all do it ourselves when we go home to debrief and our loved ones do not hand us an account. It is a luxury we all take for granted, yet we are quite ready to take the much less desirable, but only available luxury away from the patients we maintain we care about.

And even if all of us were willing to make such a sacrifice, given musical doctors’ chairs with only 7-10 minutes spent on each patient has become the order of the day, would there be a sufficient GP force to aspire to such a generosity.

The patients this piece alluded to will need someone/thing to depend on which our resources cannot provide: they are not mentally ill. Each of us, if left to go home to emptiness after a gruelling day, for even three months would probably increase that glass of whisky/wine or whatever the poison to larger amounts. Let us be honest, we are all addicted to human warmth and the opportunity to debrief our day to day tumbles.

And given the circumstances the patients find themselves would they even care if their lives were cut shorter? They will eke out in hope with whatever ‘poison’ they can access, and probably more toxic than codeine. As clinicians we have made ourselves feel better, let us not gloat that we have done the same for our patients.

Patients become sociologically isolated, at times, sequestrated by many means which are beyond our conception, and indeed we would all feel helpless when faced with their plight.

No one likes being a beggar. It becomes much easier to survive should one by chance find a little hope.

And no I am NOT philosophising: I well remember my last three years at medical school having arrived here as a ’refugee’ kid with fudged documents. Mother became very ill late in my third year, died during my fourth year. Until the end of medical school I went home day after day, month after month, year after year to a much younger sister whom I had become responsible for. All I can recall were the looks of those around stating don’t cramp our fun style of life: Words were not even needed to express that desolation. My eyes said it all.

Was it not for a very astute second assistant, who noticed that my work was patchy, either very good or very bad, I am sure that I would not be writing this piece. He found a way for me to catch up and offer me enough hope to complete the course.

It is easy to share now as I indicated in a piece written in a “Children in War” and called “Freedom comes when there is little left to lose”. I have become accepted in the world I was born into: That of war kids. The lack of opportunity to long ago make youthful meaningful bonds is no longer an encumbrance. At my age I don’t need more.
Ten, even five years ago I would have felt like a beggar making that disclosure.

Let us all get off our high horses and try walking for a while!


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