Patients falling through the cracks after codeine made prescription-only, experts say
People with acute and chronic pain say they are struggling to get the help they need since codeine-related medication was taken off pharmacy shelves.
In an attempt to stop abuse, addiction and problematic side-effects, codeine is now only available with a prescription.
Some opioid or codeine users had been preparing for the change, but many said weaning off and finding alternatives had been difficult.
Mary Lynne Cochrine, 61, has been living with chronic pain for decades — suffering from an arthritis-related illness.
“I went from one surgery to another and always thought I would get better after the next surgery,” she said.
“Now I realise it’s an arthritic condition that won’t go away, and I’ll be affected by this for the rest of my life.”
For a lot of that time, she was hooked on medication like morphine and opioids, including over-the-counter drugs.
But then she found a pain-management plan, and managed to wean herself off the medication.
“I now use a lot of allied health services — I go to a physio rehab place, I go see the psychologist, to look at how pain has affected me and how I feel about the pain,” she said.
These are some of the emerging alternative treatments for people like Ms Cochrine, but she said many other chronic pain sufferers were not so lucky.
“I would probably have gone out and stockpiled and I think a lot of people did that,” she said.
“It’s a good thing that it’s off the shelves, it’s just the in-between — what do we replace that with for people with chronic pain?”
Leah Dwyer spent seven years addicted to mersyndol to relieve her neck pain associated with her condition of cervical dystonia.
But she just recently managed to wean herself off the 14 tablets a day.
“People are going to the doctor and being told, ‘I want to get you off of codeine’, and people are sitting there going, ‘This is the only drug that has worked for me’,” she said.
“So there’s been no buffer time between February 1 and someone going to a doctor and [them] saying, ‘Let’s get you off this’.
“I’m not sure doctors are really explaining to patients that opioids are a bad choice for chronic pain.”
‘More support needed for sufferers’
Dr Charlotte Johnston, a chronic pain specialist behind the removal of codeine from the shelves, said she was worried there was not enough support out there for patients.
“If I go to look for resources online, these resources all describe what the problem is with codeine, but not so much how to manage the problems associated with it,” Dr Johnston said.
“An initial consultation with someone with chronic pain takes a whole hour … and this is generally out of the reach of most practitioners.”
To see a pain specialist a patient needs to obtain a GP referral, which usually has a waiting period of at least a month — and of course, it costs money.
“We need to train more pain medical specialists, at the moment we’re not keeping up with the demand — there needs to be a better rebate for people with chronic pain,” Dr Johnston said.
She said people needed to ask the question of what was behind the, “avalanche of chronic pain”.
“I think people feel that they want to have their pain managed more appropriately, but I don’t think we have the resources at the moment to do that,” she said.
She said many chronic pain sufferers were dealing with underlying health problems, and access to specialist care to deal with that was limited and expensive.
Fears patients ‘will turn to a black market’
The Pharmacy Guild of Australia said it was not surprised patients had complained about a problem with accessing pain medication.
Anthony Tassone, from the guild’s Victorian branch, said not only had there been delays in patients getting prescriptions, but the supply was simply not there.
“There has been a stock shortage in some instances, because some manufacturers have chosen to discontinue their products,” Mr Tassone said.
Mr Tassone said he feared patients might turn to a black market, unless more was done to improve pain management.
But the Royal Australian College of General Practitioners said its members had not seen a boost in demand for codeine.
“The run we anticipated, where patients make more and more appointments to get codeine prescriptions now, certainly hasn’t happened,” The college’s president, Dr Bastian Seidel, said.
Mr Seidel also urged patients to turn to their GPs for alternative pain management.
“GPs have upskilled significantly over the past years to meet the needs of our patients,” Mr Seidel said.
“We are always involving pain specialists and allied health professionals when it comes to patients who do suffer from chronic pain.”
The Federal Government said it could do more to address the needs of chronic pain sufferers.
Professor Brendan Murphey, the Government’s chief medical officer, called it a, “wake-up call”.
“I think all the removal of codeine has exposed is the fact that these people haven’t had proper management,” he said.
“All levels of government are proposing to develop a new pain strategy to improve access to these specialist services, because we all agree we need better access.”