Codeine Re-scheduling

The interim decision of the Advisory Committee on Medicines Scheduling (ACMS) released last Thursday would see all codeine products, including many well-known cough and cold relief products, available on prescription only from June 2016.

While the Guild acknowledges that codeine dependence is a real and growing concern and that side effects from taking excessive amounts of codeine containing analgesics can be serious and potentially deadly, we believe the proposed re-scheduling is unlikely to address the issue of dependence and may instead create further problems including:

• For the large majority of people who use these products safely and effectively, re-scheduling will make pain relief medicines more expensive and more difficult to obtain
• There will be an increase in the workload of doctors, and possibly longer wait times to see them
• There will be increased Medicare and PBS costs (particularly if doctors elect to prescribe consumers high strength codeine products or other opioids listed on the PBS).

The alternative to re-scheduling should include:

• A real-time recording and reporting system to identify consumers potentially at risk, to prevent medication misadventure. A prototype of such a system has already been developed, with cross industry and consumer support
• A mandatory front-of-pack warning about the potential for addiction.

The Guild has already developed a prototype of a real time recording system as a clinical decision support tool which we will be demonstrating to Federal and State and Territory Ministers and officials over coming weeks as we argue that the up-scheduling decision should not proceed.

Project STOP in its current format is not suitable for recording the sales of OTC codeine products as Project STOP is a law enforcement tool with a database shared with the law enforcement agencies for the specific purposes of preventing diversion for manufacture of methamphetamine.

The Guild will submit our response to the interim decision before the 15 October submission closing date, with the final decision expected on 19 November.

We will argue for the final decision date to be deferred for at least 12 months. This would allow a real-time recording system to be deployed to gather evidence for pharmacy clinical management of codeine products provision and consumer outcomes/support pathways.

In the meantime, we will be increasing our advocacy activities at all levels, including directly to politicians. Since the interim decision, we have already met with Minister Ley’s office, demonstrating the prototype and making clear that the interim decision will disadvantage millions of Australians without addressing issues of misuse.

I have done more than 20 mainstream media interviews on the issue over the past few days, and other Guild National Councillors have also been interviewed and pressed the case for our alternative solution.

We are also liaising with consumer groups (Pain Australia, Consumers Health Forum (CHF), Australian Pain Management Association) who are opposed to the up-scheduling and supportive of the Guild position. We have formed a coalition with these groups and the PSA and ASMI to coordinate the provision of consistent messaging.

All Guild members can be assured that the Guild is doing everything possible to avert the up-scheduling, in a way that addresses codeine misuse issues and does not add further burden to an already stretched general practice system.