Patients stock up on codeine prior to up-scheduling

Paul Hayes

24/01/2018 3:18:01 PM

Anecdotal evidence suggests some patients are building up their supplies of codeine ahead of its planned up-scheduling from 1 February.

Many in healthcare believe making codeine prescription-only will offer GPs a chance to provide more holistic care to help address issues of addiction and misuse.
Many in healthcare believe making codeine prescription-only will offer GPs a chance to provide more holistic care to help address issues of addiction and misuse.

Dr Milana Votrubec, GP and Chair of the RACGP’s Pain Management Specific Interests network, has seen evidence of codeine stockpiling at her local pharmacy.
‘I looked at the shelves where the cough medicines usually reside floor-to-ceiling and asked [the pharmacist], “What are you going to do with your stockpile of over-the-counter codeine when it becomes up-scheduled?” and she said, “What stockpile? It’s all been bought. It’s all gone”,’ she told newsGP.
‘So, obviously, the patients have gotten wind of it and are taking it home.’
Anthony Tassone, President of the Victorian branch of the Pharmacy Guild of Australia, has heard similar stories in recent weeks
‘[While] the general trend year-on-year has seen a reduction in overall sales … there has been anecdotal feedback from some pharmacies of patients recently requesting over-the-counter codeine products before being absolutely needed ahead of being up-scheduled to prescription-only,’ he told newsGP.
What does this mean for GPs?
‘Most likely, people won’t run out on 1 February. They will be coming in a little bit later, but will be wanting some form of codeine if they’ve been taking it regularly and if they are well and truly addicted to it,’ Dr Votrubec said. ‘I think it’s going to be a golden opportunity for these people to be better managed.’
Adjunct Professor Tim Greenaway, Chief Medical Adviser of the Therapeutic Goods Administration (TGA), agrees that codeine up-scheduling may offer GPs an opening to provide more holistic care to help address issues of addiction and 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,’ he told newsGP in late 2017. ‘We’re encouraging people to go and talk to their GPs.’
Dr Votrubec believes one of the keys in addressing issues of codeine use – whether through stockpiling, prescription seeking, or anything else – is working to increase awareness within the broader patient population.
‘I think we probably need, rather than more incentives from the government for GPs, some program to upskill the patient population,’ she said. ‘This is an opportunity to re-educate the general population, not just those people who have been buying codeine.
‘That would save a lot of the GPs’ time than if they were to have to do it.’
While she welcomes the opportunity to provide codeine-seeking patients with more holistic management in general practice, Dr Votrubec understands that will not necessarily be a straightforward proposition for GPs.
‘The GPs have to not be shy to ask the patient to come back,’ she said. ‘I think the best advice would be that GPs should know this can take a bit of time and it can’t be resolved on that initial visit.
‘I can see it becoming problematic, but I think [it will be beneficial] if all GPs have the attitude that this is the time to help these patients and help them overcome the pain that they have been experiencing.’
Online resource
The RACGP has created a new online repository to assist GPs in addressing issues relating to the 1 February up-scheduling of codeine.
The ‘Upscheduling of codeine’ page is home to a broad range of clinical and educational resources, as well as a number of consumer-focused sources designed to help patients better understand and adjust to the change in policy.

codeine-stockpiling codeine-upscheduling

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Dr Arshad Merchant   25/01/2018 8:12:43 AM

It is shame that both patient and pharmacist are not taking responsibility of this seriou problem. It is time that we should stop GP as scape goats and take responsibility. I propose all pharmacies should be audited and all malpractice shall be dealt with iron hand