Codeine up-scheduling may offer chances for patient education and holistic care

Amanda Lyons

4/12/2017 4:13:35 PM

Next year’s planned 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.

Misunderstanding of codeine and its effects can be a major contributor to issues of misuse.
Misunderstanding of codeine and its effects can be a major contributor to issues of misuse.

‘The people coming for prescriptions are those that really need to be seen by GPs, because they’ve either got chronic pain or they’re addicted,’ Adjunct Professor Tim Greenaway, Chief Medical Adviser of the Therapeutic Goods Administration (TGA), told newsGP. ‘We’re encouraging people to go and talk to their GPs. If they’re thinking, “I need my Panadeine to get going”, then they’ve got a problem.’
While research undertaken by the Therapeutic Goods Administration (TGA) suggests that patient requests for codeine from GPs will likely increase when up-scheduling takes place from 1 February 2018, it may not necessarily be the ‘wave’ many have predicted.
‘Modelling shows that [patient requests for codeine from GPs] will increase, but the longer-term modelling shows it will abate,’ Adjunct Professor Greenaway said.
Bee Mohammed, CEO of ScriptWise, also sees the up-scheduling as a chance for a proactive approach in general practice.
‘If GPs are aware of their patients being on codeine, it’s the perfect opportunity to have that conversation, presenting the evidence that codeine is not effective over a long period of time and of the risk of dependency,’ she told newsGP.
Dr Emil Djakic, a GP who is currently working with a number of patients making the transition away from codeine, has found people can be amenable to addressing the issue of misuse – particularly when many may not even be aware they have a problem.
‘The fact that we’ve got huge cohorts of people using over-the-counter codeine in an unsupervised way is quietly leading them into health issues that they will be seeking more information on,’ he told newsGP. ‘As a result of this … the patients, when informed, have all sat back and said, “I didn’t realise that the codeine was potentially causing a problem for me”.’
According to Dr Djakic, widespread misunderstanding of codeine and its effects means increased opportunities for patient education are another significant advantage of next year’s up-scheduling.
‘Codeine has a wonderful reputation for being a great way to cause a headache, which is a paradox that patients are really quite gob-smacked about,’ he said.
‘A lovely outcome from taking people through an informed withdrawal process and educating and supporting them along the way is getting them to the end-point of being able to say, “I didn’t realise how much of a fog I was in as a result of the analgesics I was taking”.
‘Anybody who’s seeing the need to use an opioid analgesic on a daily basis for anything more than “I hit my thumb with a hammer” should really be talking about how they’re going to  manage their chronic illness, whether it’s a known, organic diagnosis or a pain syndrome that’s evolved.’
Resources for GPs
The latest part of Prescribing drugs of dependence in general practice has been written to help GPs when prescribing opioids or dealing with opioid use in general practice. It is broken into two components:

  • Part C1: Opioids – a clinical governance document
  • Part C2: The role of opioids in pain management – appropriate and accountable prescribing in the general practice context
The TGA’s Codeine information hub provides information about codeine use and misuse, and the planned up-scheduling from 1 February 2018. It also contains online guidance for health professionals with prescribing authority on talking to patients about codeine.

Codeine codeine-addiction opioid-misuse Therapeutic-Goods-Administration

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Neil Sheahan   11/12/2017 3:43:11 PM

Hi Amanda, good article.
I have a problem with the resource listed because it still advocates a role for opioids in chronic non-cancer pain (albeit with cautions) which is wrong in my opinion, not only doomed to fail, but will end up with the patient worse off.
I think it would be worth another news article specifically on this issue, reporting the responses of the people who produced the resource to this question of whether opioids should ever be used in chronic non-cancer pain?