Medicare is set to suffer a massive cost blow-out as a little-known committee of public health bureaucrats tries to prevent consumers accessing codeine over-the-counter.
Yesterday, the Advisory Committee on Medicines Scheduling, which is part of the Therapeutic Goods Administration, issued an interim decision that would have all codeine products, even those with codeine as low as 8mg, banned from over-the-counter sale from July 1 next year, meaning they could only be acquired with prescription.
The result will be that for anything beyond mild pain that can be treated with paracetamol, a visit to the doctor will be required for a prescription, adding potentially hundreds of millions of dollars a year in Medicare costs (one estimate today is $170 million extra a year) and costing more in lost productivity as Australians wait to obtain products they can currently obtain with a trip to the chemist. The Australian Medical Association and the Royal Australian College of General Practitioners, unsurprisingly, welcome the interim decision, because it means more revenue for GPs as patients have to book more appointments.
But if you’re thinking of objecting to the decision, you’re wasting your time — the committee that made the decision says it doesn’t need to pay any attention to submissions from “stakeholders” who haven’t previously made submissions on the issue, meaning complaints from ordinary Australians can be binned by bureaucrats.
The Advisory Committee on Medicines Scheduling is made up of government-nominated health bureaucrats and academics and invited appointees, with just one consumer representative, and is not directly accountable to either the minister for health or Parliament. Its rationale for the ban appears self-contradictory. On the one hand, it concludes the “benefit is low” for codeine, which has a “relative lack of efficacy”. On the other, it complains that the product is being abused and can get people addicted. But the real rationale appears to be that the committee simply doesn’t like people making judgements about how to treat their pain without state regulation. “OTC [over-the-counter] intended for management of acute self-limiting pain, however, there is inappropriate use for chronic pain,” the committee concludes in its brisk bureaucratese.
For the vast number of Australians who use codeine responsibly to manage a variety of forms of pain, it’s a peculiar logic to be told that codeine doesn’t work, but also works so well that people get addicted to it, and they can’t be trusted to manage their pain anyway — even though it is possible to deal with those who want to abuse the drug. The Pharmacy Guild, which opposes the ban, says a real-time recording and reporting system has already been developed that could be rolled out quickly to help track people making serial acquisitions of codeine products.
Perversely, industry figures say, it may also lead to Australians consuming more codeine as doctors are more likely to prescribe products with higher dosages of codeine than what’s currently available over-the-counter — some pain relief products with low levels (like 8mg of codeine) are likely to vanish with the shift to prescription-only products of higher dosage, up to 30mg for a product like Panadeine Forte. Yet AMA vice-president Stephen Parnis told Fairfax the ban was justified because it would prevent “the loss of a young life from the misuse of an addictive medication like codeine”.
Most nanny-state interventions urged by the public health lobby come with a hidden cost to business. The codeine ban, however, will come at a cost of hundreds of millions of dollars to taxpayers — money that could be spent delivering real health outcomes elsewhere — and Australians enduring more pain to enable the warm inner glow of middle-class paternalists.
prevent “the loss of a young life from the misuse of an addictive medication like codeine”
So these young people, in the absence of codeine derivatives will give up their search for drugs and watch TV.
Last year i had the misfortune of cracking a rib while picking up my luggage on my way to holiday in Darwin. I went to a pharmacistnear my hotel, asked for their advice (between shallow breaths) and within a few hours the codeine-based pain reliever did its thing. These new rules would mean many many hours waiting in a public hospital: for what purpose?And what exactly is the purpose of the years of training for pharmacists if not exactly for situations such as these?
“the loss of a young life from the misuse of an addictive medication like codeine” —
it is actually nearly impossible to OD on codeine as the liver can’t convert it into morphine fast enough. This is why codeine has been considered a safe opiate to supply over the counter in Australia and the UK. Like all opiates codeine is quite harmless to the body up to the point of OD. Paracetamol on the other hand causes liver damage in large doses.
This strikes me as all part of the opiate fear which is at the heart of the war on drugs. Never mind that all opiates were over the counter medicine for all of human history up until prohibition era Americans began to take the moral highground for all the rest of humanity.
The risk with these medicines is that they might cause pleasure — that is the moral wrong which is being legislated against here.
“Perversely, industry figures say, it may also lead to Australians consuming more codeine as doctors are more likely to prescribe products with higher dosages of codeine than what’s currently available over-the-counter”
this is exactly what will happen.
That’s not true. There’s no practical difference between the onset of effects of different opiates – you don’t take it for pain which is fleeting. There’s a lot of evidence for the abuse of codeine even in OTC form. Codeine is actually a poor analgesic and the amount of the drug in OTC meds is actually sub therapeutic, i.e. it’s actually not enough to provide any analgesia at the recommended dose (See NPS.org.au), so I am not sure why all the pleading that you can’t live without it. Using any opiate for analgesia is fraught with difficulties even for those with good analgesic effect, eg. oxycodone because there’s always the risk of addiction and significant side effects.
Much more likely to die from the paracetamol part. This is a piece of utter bullshit. I cannot use NSAIDs like ibuprofen and aspirin due to a long standing heart problem (30+years). Panadol is utterly useless, it just doesn’t do anything. It didn’t help my mum either. Hence panadeine is all that is left and I know at least half a dozen including my wife and daughter who are allergic to the NSAIDs. What the hell are we meant to do at midnight with a headache?
Thanks for a good article, Bernard. It has needed to be written for some time
This decision has been coming for a couple of years. There have been several articles by “researchers” and other non-practicing medical types urging restrictions on the use of codeine-based meds. Their arguments are all the spurious nonsense quoted by this committee. They also appear to be merely individual opinion rather than evidence-based reports. I’ve commented and written to authors to point out the problems with their arguments (and the lack of foresight they’ve displayed), but of course one gets ignored.
There are a lot of older people out there, including me, with mashed knees and other joints which are treated very effectively by judicious occasional use of codeine. I don’t have the figures, but I suspect that many, many of us will be using our pensioner concessions if this interim decision is taken up, thus costing the tax payer even more.
This is a really, really dumb decision: just the sort you expect from bureaucrats who have been securely in one place for way too long and have lost their way.