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OTC codeine-containing analgesics should only be used to treat acute, short term pain such as migraine, toothache and period pain. They should not be to treat chronic pain.
The majority of pharmacies now have a real time monitoring system (MedsASSIST) for the sale of OTC codeine-containing analgesics, and data from this system has shown that of the people using the products, 98% use them as intended 1.
If codeine is being used to treat chronic pain, I believe it is far more likely to be as a result of the 3.7 million prescriptions written over 12 months (2015-2016) for products containing higher dose 30mg codeine and 500mg paracetamol (e.g. Panadeine Forte) 2.
The real time monitoring system (MedsASSIST) also allows pharmacists to identify the small number of people who may be misusing OTC codeine-containing analgesics, and to offer them counselling and referral to a doctor or other health care professional for further assessment and appropriate care.
We must remember that doctors’ surgeries do not have a real time monitoring system for prescription codeine-containing products, so there is no way of identifying and helping those people who may be ‘doctor shopping’ to obtain multiple prescriptions for the products.
It makes no sense to change from a system where the small percentage of people who may be misusing the products can be identified and helped, to one where they cannot.
NPS MedicineWise is also quoted as saying that the United Kingdom has successfully implemented the change to make low dose codeine-containing products prescription only. This is incorrect as the products are available OTC in the United Kingdom, as they are in other comparable countries such as New Zealand.
I believe our Health Minister, Mr Hazzard, should introduce mandatory real time monitoring (MedsASSIST) into all community pharmacies in NSW, and allow pharmacists to continue to supply low dose codeine-containing analgesics without a prescription for the treatment of acute, short term pain such as migraine, toothache and period pain.
This will allow pharmacists to identify and help those people who may be misusing the products, while at the same time allowing the vast majority of consumers who use the products appropriately and safely for the short term treatment of acute pain continued access to the products without a prescription.
Professor Peter Carroll
School of Medicine, University of Notre Dame, Discipline of Pharmacology, University of Sydney
