Big pharma under fire for spruiking strong painkillers to doctors
Drug companies have come under fire for allegedly using a crackdown on codeine sales as an opportunity to market stronger painkillers to doctors.
Since February, pharmacists have been banned from offering weaker codeine tablets such as Nurofen Plus over the counter, with the medication now available only via a doctor’s prescription.
One of the concerns about the change was that doctors could end up prescribing even stronger medication to pain sufferers.
Now doctors say that is exactly what some pharmaceutical companies are trying to get them to do, via advertising sent to GPs.
One of the ads causing concern, for painkiller Zaldiar, shows five silhouetted figures jumping into the air as the sun sets or rises behind a mountain range.
“Manage pain without codeine,” says the bold print underneath.
Cameron Loy, of the Royal Australian College of General Practitioners, said Zaldiar, which contains paracetamol and synthetic opioid tramadol, was about twice as strong as codeine painkiller Panadeine Forte.
“What that ad is saying is, ‘If codeine is not available, use tramadol,’” Dr Loy said.
He warned that tramadol had a number of side effects and also had a “large array of drug-to-drug interactions”, including with some antidepressants. (Zaldiar has been the subject of only one adverse event notification to Australia’s drug regulator in the past two years.)
The photo of the Zaldiar advertisement was provided to Fairfax Media by the Royal Australian College of General Practitioners after it was reportedly left at a doctor’s surgery.
Dr Loy, who has reported the ad to the Therapeutic Goods Administration, said the codeine change was important and broadly supported by experts.
However, he said it appeared drug companies were using the restrictions as an opportunity to market much stronger drugs.
“I guess, not surprisingly, you have the use of a good-quality health initiative being transformed into something else – the marketing of much stronger opioids,” he said.
The drug’s supplier, Aspen Pharmacare, refused to comment.
The Therapeutic Goods Administration said it was investigating a small number of complaints or queries regarding advertising of pain medication following the codeine overhaul.
Doctors’ groups have also raised concerns about an ad for painkiller Targin – a mixture of oxycodone and naloxone, and a schedule 8 controlled drug.
The advertisement provided to doctors presents a hypothetical scenario of a patient called Richard who suffers from “moderate to severe chronic osteoarthritis pain in his knee”.
In bold text it says: “Weak opioids are proving to be inadequate.”
It then cites two references, also in larger text, from the Faculty of Pain Medicine and Royal Australian College of General Practitioners. But both groups are unhappy they have been quoted and say the citations are not an accurate reflection of their current positions.
The pamphlet quotes the Faculty of Pain Medicine recommending that in moderate to severe chronic pain a trial should be conducted with a long-acting opioid. A second page of fine print is attached.
The faculty’s Meredith Craigie, a pain specialist, said the impression she got from the brochure was that if weak opioids were not working, doctors should try a stronger one.
“And that is not what we recommend,” she said.
Dr Craigie said her advice would be to first consider other treatments that looked at the root causes of the pain, including mental health, unemployment and financial stress.
She said for osteoarthritis, the ailment of the fictional Richard, exercise was “by far the most useful thing to be doing” – and that she would probably consider antidepressant drugs before she considered an opioid.
If Targin was to be used “way down the track”, Dr Craigie said, it would be for a short period of time, with the aim of allowing people to start exercise or to learn other management strategies.
She said it was disappointing that pharmaceutical companies were inaccurately presenting expert opinion about particular medications.
GPs had to be across so many different areas of medicine, she said, and therefore relied on good and accurate information from pharmaceutical representatives.
A spokesman from Targin supplier Mundipharma said the material predated the codeine rescheduling by more than a year.
“Mundipharma operates an ethical and responsible business in compliance with all regulations, the Medicines Australia Code of Conduct and indications approved for our medications by the Therapeutic Goods Administration,” a spokesman said.
“The material is always provided with other information emphasising the importance of the Quality Use of Medicines and supporting the judicious use of opioid pain relief for appropriate patients in the lowest effective dose for the shortest possible time.”
The decision to restrict lower-dose codeine products was partly based on information that people had died after becoming addicted to the medication and misusing it.