Ban on over-the-counter painkillers takes power away from people like Monica

Pic of codeine products currently available over the counter. After February 2018, people will need a prescription for it. 28th November 2017. Picture by Simone De Peak
Pic of codeine products currently available over the counter. After February 2018, people will need a prescription for it. 28th November 2017. Picture by Simone De Peak
The Hon Brad Hazzard, Minister for Health.  speaking at the Junior Medical Officer Wellbeing and Support Forum, Cockle Bayy.  6th June 2017 Photo by Louise Kennerley SMH

The Hon Brad Hazzard, Minister for Health. speaking at the Junior Medical Officer Wellbeing and Support Forum, Cockle Bayy. 6th June 2017 Photo by Louise Kennerley SMH

Monica Cheah, who suffers from a chronic inflammatory condition, spent years trying different combinations of painkillers before she found the "sweet spot", which involved codeine-based tablets.

But from February 1, when codeine-containing medicines are up-scheduled, the 27-year-old will no longer be able to buy them over the counter. She will need a prescription.

Ms Cheah has endometriosis, a condition where tissue, similar to what normally lines the womb, grows outside the uterus, causing inflammation and debilitating pain.

"I use codeine during the worst four days of every month, typically a codeine-paracetamol product (Panadeine) together with ibuprofen or a codeine-ibuprofen product (Nurofen Plus) with paracetamol, along with alternative therapies," she said.

"There's nothing stopping me from going to my GP and getting a script, but it carries a degree of disempowerment and a removal of independence for people with chronic conditions, it prevents you from being able to take control and manage it."

The ban on over-the-counter codeine comes into effect in two weeks, but powerful pharmacy groups remain undeterred and focused in their efforts to see state health ministers rework certain elements and make exceptions.

The Therapeutic Goods Administration (TGA) banned over-the-counter codeine because evidence showed it was no better for pain than non-codeine painkillers, being "significantly" misused, and linked to about 100 deaths a year.

NSW Health Minister Brad Hazzard said his federal counterpart Greg Hunt had not agreed to a review of the decision as requested by state health ministers last year and he remained "concerned" about the restrictions.

He said he "prefers" the Pharmacy Guild's proposal that would allow pharmacists to offer codeine in urgent cases, subject to real-time monitoring of all over-the-counter codeine sales.

He has ruled out NSW independently introducing an emergency access scheme, saying it would not be "beneficial as all management of drugs has been on a national basis, which is logical and essential".

Professor Peter Carroll, NSW president of the Pharmaceutical Society of Australia, disputed the death statistics, saying a study in the Medical Journal of Australia showed between 2000 and 2013 there were 113 deaths - nine a year - specifically due to codeine toxicity.

He has been lobbying for the states to circumvent the ban and introduce real-time monitoring into all pharmacies and allow pharmacists to offer up to three days' supply of codeine products to customers suffering acute pain.

"We're hoping in the next couple of weeks something will happen," he said. "I've met 50 politicians from across the board in the last three months, and I can confidently say they agree with my position."

Lobbying with the big guns

The guild has also been heavily lobbying, with Mr Hazzard's ministerial diary showing they met with the minister four times - including twice with lobbyist Santo Santoro - between July and September last year.

When asked about the hiring of Mr Santoro, guild president George Tambassis explained the former Liberal minister had approached them about working on the codeine crackdown after helping them with the pharmacy review.

"There's misinformation that we're doing this to make more money, but we're actively decreasing the sales of these medicines," he said. "Sure we took Santo on, but he came to us."

The TGA said it stood by the data and the 100 deaths a year statistic was conservative because its data sources and calculations showed it could be as high as 198 deaths annually.

"Any call to allow codeine to be supplied over the counter flies in the face of evidence and international best practice and is inconsistent with the classification of a medicine as being suitable for over-the-counter use," a spokeswoman said.

"That is, if the risk of harm or dependence or diversion is sufficient to require a special monitoring system then it should be classified as prescription-only in any case."

Codeine is harmful

The Australian Medical Association said for lobby groups to slur the medical profession and blur the truth about the addictive, opiate drug was "inappropriate, unfair and incorrect".

Its president Michael Gannon said all MPs must resist the pharmacy industry's calls, although pointed out "it wouldn't be the first time the government makes decisions that aren't in the interest of the health of Australians or the first time we'd been disappointed by an 11th hour call by a lobby group".

He said the up-scheduling was long overdue, especially as opioid epidemics ravaged countries around the world.

Despite the debate, Amcal senior pharmacist James Nevile was hard at work looking for solutions for his patients.

"I think things are unlikely to change, so I've been focused on finding them other options to manage their pain," he said.

This story Ban on over-the-counter painkillers takes power away from people like Monica first appeared on The Sydney Morning Herald.