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Pharmacists’ codeine fears overstated, GP says


Amanda Lyons


17/05/2018 12:28:47 PM

While pharmacists have raised concerns about a shortage of low-dose codeine, Dr Evan Ackermann, a GP with a special interest in drugs of dependence, says the evidence supports up-scheduling.

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Dr Evan Ackermann says there is no evidence of adverse consequences or patient harms occurring following February’s codeine up-scheduling.

With over-the-counter codeine-based products having been prescription-only since 1 February, pharmaceutical company GlaxoSmithKline has responded by discontinuing its codeine products, including Panadeine and Panafen Plus, from the Australian market.
 
Pharmacists have subsequently said this combination of events is creating a situation in which patients who use low-codeine products are being pushed onto stronger doses of the drug.
 
‘Anecdotal feedback the Pharmacy Guild has received from members is that there has been some increase in the rate of prescriptions of higher-dose combination analgesics containing codeine since the up-scheduling,’ Anthony Tassone, President of the Victorian branch of the Pharmacy Guild of Australia, told newsGP
 
‘Some pharmacy groups have reported an increase of up to 46% in the dispensed prescriptions of paracetamol 500 mg–codeine 30 mg combination analgesics.
 
‘Unfortunately, shortages of low-dose codeine combined analgesics have been beyond the control of the local community pharmacy, and pharmacists are trying their best on the front line to inform patients of their options and refer patients to their GP where needed and appropriate.’ 
 
The Pharmacy Guild said it is concerned that exposure to higher doses of codeine may lead to increased dependence and misuse among patients. But Dr Evan Ackermann, key author of the RACGP’s Prescribing drugs of dependence in general practice: Part C, told newsGP the evidence so far does not support such concerns.
 
‘The up-scheduling of codeine is progressing well without any evidence of adverse consequences or patient harms occurring,’ he said.
 
‘The RACGP continues to advocate for GPs and pharmacists to prioritise non-opioid options for people who have been on long-term low-dose codeine preparations; currently, the evidence supports that this is happening.
 
‘The major complaint of patients seems to be price rises at pharmacies.’
 
While Dr Ackermann is sympathetic to pharmacists’ concerns, he emphasises that the RACGP wants to see continued support for up-scheduling of codeine products.
 
‘We hope that pharmacists use the opportunity to counsel patients regarding the harms of un-monitored codeine use,’ he said.
 
Mr Tassone agrees that patient education and support for issues of codeine dependence is important, and believes all healthcare professionals should work together towards such a goal. He cited the upcoming Pain MedsCheck program trial, funded by the Federal Government, as an opportunity for further collaboration between pharmacists and GPs.
 
‘The Pain MedsCheck program will provide an opportunity for patients who have experienced chronic pain for at least three months to discuss their medication management with a pharmacist,’ he said. ‘And for the pharmacists to work with doctors and other health professionals to help best optimise use of medicines and pain management.’



Codeine-upscheduling opioid-prescribing pain-management Pharmacy-Guild





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