Codeine scheduling information
As of 1 February 2018, all medications containing codeine have been up-scheduled to S4 (Prescription Only Medicine). This includes all pain, cough and cold medicines containing codeine which were previously available as S2 or S3 medicines.
As a General Practitioner or pharmacist you may be seeking additional information regarding these changes. Please find a list of FAQs below:
Q: Why is codeine no longer available over the counter?
Other reasons for the decision include that:
- low dose codeine medicines have low benefits and high risks of dependency
- codeine shares the properties of other opioid analgesics and all other opioids are at least S4
- misuse can lead to death resulting from hepatic injury, gastrointestinal perforations, hypokalaemia and respiratory depression
- an appropriately qualified practitioner needs to assess the risk before making the decision that codeine will be used
- ultra-rapid metabolisers are at risk of morphine overdose, with potentially fatal consequences, following “usual” doses of codeine.
The change was supported by RACGP, Consumers Health Forum, Pain Australia and all major medical groups. It brings Australia into line with many other countries in the world, such as USA, Japan, India and much of Europe, where codeine is only available with a prescription.
Q: What medicines have been affected?
- codeine-containing combination analgesics (painkillers) (available under brand names such as Panadeine, Nurofen Plus, Mersyndol and pharmacy generic pain relief products)
- codeine-containing cough, cold and flu products (available under brand ranges such as Codral, Demazin and pharmacy generic cough, cold and flu medicines).
Q: What services are available to support primary health practitioners in treating patients with chronic pain or opioid withdrawal?
NPS Medicine Wise are also emphasising that medicines (including codeine) have a limited role for osteoarthritis. Information regarding pain management strategies for osteoarthritis can be found here.
Service providers and clients can contact the Alcohol and Drug Information Service 24 hours a day to access free anonymous telephone counselling, information and referral regarding drug dependency. Call 1800 177 833 to access their consultancy service for health and related professionals.
Queensland Health has commenced a 12 month pilot of the Alcohol and Drug Clinical Advisory Service (ADCAS). ADCAS, which launched on 15 January 2018, is a specialist telephone support service for medical practitioners in Queensland, providing clinical advice by on-call addiction medical specialists regarding the management of patients with codeine dependency and other alcohol and drug concerns. The free service is available 8am to 11pm, seven days a week, and can be accessed by telephoning 1800 290 928.
Guidance is available for GPs from RACGP on how to prescribe opioids appropriately in the general practice context with a specific focus on the up scheduling of codeine.
Q: How can primary health practitioners assess whether a patient has a dependency and is shopping for codeine or opioid prescription?
The Prescription Shopping Programme (PSP) will continue to help registered prescribers identify and reduce the number of patients who get more Pharmaceutical Benefits Scheme accessed codeine than they need. If you are not already registered for the PSIS, call them on 1800 631 181, or complete and sign the PSIS Registration form and fax it to 07 3004 5218.
The Queensland Drugs of Dependence Enquiry Service is also available for clinicians and medical practitioners. This confidential service provides information regarding regulatory requirements, whether a patient is known to have a history of drug dependence, and treatment involving drugs of dependence. To access this service call 13 78 46.
To register to be a private prescriber for drugs of dependence consider contacting the Queensland Opioid Treatment Program, which is also found by calling 13 78 46.
Q: What resources are available for pharmacists regarding the changes?
- A Pharmacist Fact Sheet jointly developed with The Pharmacy Guild of Australia
- Codeine Counter Card
- Pain Management Pathway Map
There are also pharmacist learning modules on the PSA website available for educational purposes.
Q: What support is available for patients affected by codeine up-scheduling?
There are also a number of fact sheets available on the Pain Australia website:
The Australian Pain Management Association (APMA) provides information and practical support for patients. This includes a PainLink helpline staffed by volunteers available 7am-7pm weekdays that is contactable on 1300 340 357.
The TGA website has a codeine information hub with an array of resources.
Patients may be registered on the Opioid Treatment Program provided through Queensland Health, which promotes harm minimisation in relation to opioid dependence. The program is offered through public clinics and registered prescribers. Patients may consider asking GPs to tell them more about the program.
Q: How has codeine up-scheduling influenced community pharmacy supplies of codeine?
Pharmacists are encouraged to provide updates on their stock levels to GPs. Patients will also need to be advised that the price of codeine containing products may have increased to compensate for a new dispensing fee and the increased cost of newly packed product equivalents from wholesalers.
Prescribing patterns may also change over time further influencing stock levels required for codeine products. “Pharmacist medicine only” branded codeine products can still be dispensed with a valid prescription until 31 October 2018. More information regarding codeine stock management for wholesalers, sponsors and retail pharmacies can be found on the TGA website.
The NPS Medicine Wise step by step guide on supporting patients with codeine dependence is also available, which may assist with guidance on future prescribing patterns. This guide suggests preparing for patient presentation before consultation in line with RACGP clinical guidelines.