Leading up to the codeine change
There are varied strategic positions of the key bodies associated with pain management advice in Australia in relation to the upcoming up scheduling of codeine to S4 (Prescription Only Medicine) on the 1st February 2018. This will cover all pain and cough and cold medicines containing codeine which were previously available as S2 or S3 medicines. This decision was made in December 2016, by the Therapeutic Goods Administration (TGA). This decision was taken to address what the TGA saw as abuse and addiction issues which were affecting some patients who may have been using these medicines inappropriately. This resource hub outline provides insight into the information currently available from the key bodies associated with pain management advice in Australia.
Pharmaceutical Society of Australia (PSA)
The PSA codeine resource hub provides pharmacists with a suite of resources to support the changes through the transition of codeine to a prescription only medicine. There are segments built around education and support resources. Support resources showcased are a jointly developed PSA and Pharmacy Guild pharmacist factsheet, consumer factsheet, pharmacy checklist and codeine template letter. Also featured is a Pain Referral Pathway.
The education segment features 3 pharmacist on line learning modules entitled Codeine rescheduling – Managing the transition to Prescription Only codeine, Codeine rescheduling: A patient focused clinical overview of pain and Transforming your business. A total of five training modules will be developed to cover protocols and procedures for pharmacists and pharmacy staff, while communication activities are proposed to support pharmacies transition from codeine to a broader ‘pain management’ approach, to enable them to inform and support their patients.
Referenced from PSA website accessed 27 November 2017.
The Pharmacy Guild of Australia
To help community pharmacists prepare for the transition to up-scheduling, the following materials are available for download. These have been developed in collaboration with the PSA:
- A fact sheet entitled ‘Changes to medicines containing codeine – what pharmacists need to know’ which can be used in discussions with your patients and their carers.
- A flyer to talk about pain management with patients
- A pharmacy checklist to prepare for the February 2018 upscheduling.
- A counter card to encourage consumers to talk to their pharmacists about pain management.
- Self-Care Fact Cards for pharmacists to use with patients.
- A flow chart to help pharmacists and pharmacy staff provide advice and referrals to patients.
- Template letters of referral communicating the changes to patients for pharmacists to send to their local health professionals.
Referenced from Pharmacy Guild website accessed 27 November 2017.
Queensland Health has formed a working group to coordinate the implementation of codeine rescheduling in Queensland. The group will guide communication efforts that will raise awareness of the changes among health professionals, and provide information and support to consumers. The first meeting of the working group was held on Thursday, 4 May 2017 and will occur monthly until implementation of codeine rescheduling. More information on codeine and the Therapeutic Goods Administration’s (TGA’s) decision is available at the Codeine Information Hub. Codeine harm and efficacy literature is also featured. Links to State and Territory Support Services are also included.
Highlights of resources on this information hub include for general practitioners, the suggestion is made to discuss changes with patients, as well as any alternative treatment options. Reference is made to a resource available to GPs entitled “Tips for talking about codeine-Guidance for health professionals with prescribing authority. Awareness is raised for pharmacists as codeine-containing medicines can continue to be sold over the counter until 31 January 2018. For pharmacists a “TGA’s pharmacist fact sheet” is available for more information.
Consumers are advised to speak to their doctor or healthcare provider who may be able to suggest alternative over the counter products, as well as discuss other treatment options. Some consumers may seek to stockpile medicines prior to the scheduling change. For consumer-focused information about codeine and the upcoming changes there are two factsheets featured on the codeine hub entitled “Codeine containing medicines-harms and changes to patient access and Codeine access for rural and remote Australians”.
Consumers with chronic pain are suggested to talk to their doctor or healthcare provider to determine better treatment options. Treatment options may include:
- non-drug therapies from an allied health professional such as a physiotherapist or psychologist
- self-management tools such as exercise or relaxation
- Medicare provided rebate for the preparation of a Chronic Disease Management Plan and Team Care Arrangement.
The NPS Medicine Wise are currently visiting GPs and other health professionals in relation to Knee and hip osteoarthritis. The main emphasis of this topic is that medicines have a limited role for osteoarthritis and that treatment now focuses on education, exercise and weight. Some key points discussed at the time of visits are:
- osteoarthritis is one of the most commonly managed conditions in the primary care setting
- typical osteoarthritis can be diagnosed with history and physical examination
- opioids have a limited role in the management of osteoarthritis due to their limited benefits and a significant risk of harm.
More information is available here. Resources for Health Professionals are profiled alongside a team approach to osteoarthritis care involving Exercise Physiologists, Physiotherapists and Dieticians. The fact that opioids have a limited role in osteoarthritis management is further emphasised, this could be set in the context of codeine rescheduling due in February 2018.
Codeine up scheduling resources (including consumer materials in different languages)
From 1 February 2018, medicines that contain low-dose codeine will no longer be available without prescription in pharmacies. Medicines affected include codeine-containing combination analgesics, available under brand names such as Panadeine, Nurofen Plus and Mersyndol, and pharmacy generic pain relief products, and codeine-containing cough, cold and flu products, available under brand ranges such as Codral, Demazin and pharmacy generic cough, cold and flu medicines.
Research shows that current over-the-counter low-dose (< 30 mg) codeine-containing products offer little additional pain relief when compared to similar medicines without codeine. There is evidence to suggest that paracetamol/ibuprofen combinations available as a single pill can be offered as an alternative to codeine-based analgesics for short-term management of pain in patients able to take NSAIDs and for whom paracetamol alone is not sufficient.
Pain Australia supports the implementation of up-scheduling legislation, which brings Australia into line with other regulatory agencies around the world. They have released a series of fact sheets that highlight a national approach to ensure people with chronic pain can access pain services.
Royal Australian College of General Practitioners
The Royal Australian College of General Practitioners (RACGP) has a guide available that aims to help General Practitioners prescribe opioids appropriately in the general practice context. This can be found on the RACGP website.
Other information sources
Information sources for GPs and other health professionals are available to make an enquiry on drugs of dependence use: