Pharmacy Daily | Codeine story ‘misleading’

WHILE the rescheduling of products containing codeine has been based mainly on the fact that codeine can cause dependence, and its misuse has led to addiction and even death, it is "misleading" to argue that withdrawing the products from OTC sale will reduce codeine use, according to University of Sydney Honorary Professor of Pharmacology Peter Carroll (pictured).

Also president of the NSW branch of the Pharmaceutical Society of Australia (PSA), Carroll says there are three common claims made about codeine-containing products that are untrue:

1. Low-dose codeine doesn't improve pain relief - two trials have shown products containing paracetamol and codeine, and ibuprofen and codeine, in concentrations equal to those in Panadeine Extra and Nurofen Plus respectively, are more effective than paracetamol or ibuprofen alone.

2. Making codeine products prescription-only will reduce codeine use - data drawn from the Repatriation Benefits Scheme shows that when doctors have the option of writing either 30mg, 15mg or 8mg of codeine, more than 90% of prescriptions are written for a 30mg codeine product.

This is likely therefore to increase the dose of codeine consumed if patients are forced into the GP surgery to access it, Carroll argues.

3. Taking paracetamol and ibuprofen in combination is a better way to treat pain - there are many people who should not take ibuprofen, Carroll explains and identifies groups of patients who should not take the product.

In a positive vein, Carroll goes on to argue for a universal (doctors and pharmacies) real time monitoring system such as that which both the PSA and the Pharmacy Guild of Australia had recommended and which would allow the pharmacist to identify and help those people who may be misusing codeine-containing products.

With no such system in the doctors' software, there is no way of identifying and helping those people who may be doctor shopping to obtain multiple prescriptions for the products.

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