Codeine crackdown will do nothing but increase pain for all

Under the guise of possibly protecting the few from addiction, the rest of the country — while being told elsewhere to become more health literate and self-manage their chronic conditions — will be subsequently forced to make (and pay for) a 15-minute appointment with their already too-busy GP for a codeine script.

Understandably, this has raised the hackles of not just consumers and state health ministers.

This proposal is emblematic of everything the Productivity Commission just revealed is wrong with the health system: it’s not con­sumer-orientated, lacks patient-centred care, and the detrimental relationships between the federal government and the states result in poor patient results.

On the advice of the Therapeutic Goods Administration, Hunt is proposing from February 1 next year that all medicines containing codeine be available by prescription only.

Unsurprisingly, the Australian Medical Association backs the new regulation but says “vested ­interest groups” (presumably pharmacists) will oppose it “under the guise of being concerned for patients”.

According to the AMA, the loud and broad concern — particularly from the state health ministers and the Pharmacy Guild of Australia — for the 98 per cent of people who use codeine appropriately is ill-placed.

Codeine is a widely used and popular medicine for medium to severe pain, and there are already strategies to stop it being over-used or abused. The MedsASSIST monitoring system for over-the-counter medications enables phar­macies to track codeine-­related purchases and act accordingly if over-use is flagged.

The system has seen nine million transactions over 20 months for codeine-related products — or 450,000 a month on average. Pharmacists have barred an average 3500 sales a month because of identified risk factors. That’s 0.7 per cent of purchasers. And for this tiny proportion, the rest of the 450,000 pain sufferers — and the taxpayers — will be penalised by having to pay for GP visits.

According to the TGA, over 13 years (2000-13) codeine toxicity contributed to 1437 deaths. Extrapolating from the MedsASSIST data would suggest that over that time there might have been about 70 million transactions for ­codeine-related products. So the 1437 deaths represent 0.002 per cent of the usage.

But of those deaths, 24 per cent (343) were related to prescription codeine products while only 16 per cent (229) could be identified as being related to an over-the-counter product (60 per cent couldn’t be attributed to either), making the percentage of over-the-counter deaths 0.0003 per cent.

The Royal Australian College of General Practitioners, similarly in support of the new rules, highlights its concerns as about 150 Australians die of codeine-related overdoses a year, which is double the number a decade ago. Given that 800 Australians die per year from prescription drugs, it is hard to see how scripts offer safety.

The TGA cites the US opioid overdose epidemic for justification. However, of the 52,404 US ­lethal overdoses in 2015, 20,101 were related to prescription pain relievers — demonstrating that forcing problem users to obtain prescriptions does not solve abuse problems.

Nonetheless, there are significant adverse effects of these drugs that appear related to codeine in combination with other drugs such as paracetamol, rather than codeine itself. And the TGA claims too few people are aware of those issues.

So perhaps the real question is why are the millions of Australians using it not properly educated about the adverse effects. If they were, could we not treat them as responsible adults in managing their own symptoms?

Surely proper education would be better than forcing somebody with, say, severe menstrual pain, to see an overworked GP for 15 minutes every month.

Up-scheduling codeine shows that we are again in the habit of punishing the many for the few, of orientating the health system around the producers not the ­patients, of weakening the partnership between patients and ­clinicians, of lowering choice, of increasing costs, of impairing ­patients to increase their health literacy, of rewarding activity not outcomes, of not outsourcing an overburdened system to other qualified health professionals.

And of failing to uphold the very values the medical system preaches on paper: patient ­empowerment and self-management.

Jessica Borbasi is a research associate in the healthcare innovations program at the Centre for Independent Studies.