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Upscheduling of codeine

Upscheduling of codeine

From 1 February 2018, medicines containing codeine will no longer be available to consumers over the counter at pharmacies.

The Therapeutic Goods Administration (TGA) upscheduled codeine to a Schedule 4 prescription only drug because of evidence about its safety and effectiveness. Evidence shows that over the counter medicines containing codeine provide little additional benefit in pain relief in comparison to other similar medicines without codeine. Furthermore, codeine can be addictive and with regular use, patients can become dependent on it, leading to misuse and in extreme cases, death. In Australia, there are over 150 codeine related deaths per year. 

The RACGP supported the TGA’s decision, as did the Consumers Health Forum, Pain Australia and all the major medical groups.

The change will bring Australia into line with many other countries in the world, where codeine is only available with a prescription. This includes the USA, Japan, India and much of Europe. 

Pain management is a core general practitioner skill. But the complex (and sometimes controversial) nature of pain, particularly the management of chronic pain, can push the limits of this skill. Drug therapies will only ever have a partial role in managing complex biopsychosocial issues that characterise pain management. In the modern health environment, we must explore and use non-drug therapies, and redefine the place for existing medications. 

Requiring patients to have a prescription for medicines containing codeine will provide the opportunity for GPs to:

  • talk to their patients about managing their pain more effectively and safely;
  • provide help and support for patients with addiction issues; and,
  • develop an appropriate management plan that can be reviewed on a regular basis. 

We have compiled a list of available resources to help support you, your practice, and your patients with this change. 

Clinical

Over-the-counter codeine: changes to supply – Information and resources for health professionals : NPS Medicinewise

Current list of up-scheduled codeine containing products : Therapeutic Goods Administration

Prescribing drugs of dependence in general practice – Part C1: Opioids : RACGP

Prescribing drugs of dependence in general practice – C2: The role of opioids in pain management : RACGP

Codeine information hub : Therapeutic Goods Administration

Tips for talking about codeine: guidance for health professionals with prescribing authority : Therapeutic Goods Administration

Codeine prescriber toolkit : Scriptwise

Managing patients with regular OTC codeine use : Drug and Alcohol Services South Australia

Codeine Becomes Prescription Medication : Western Australia Primary Care Quality Use of Medicines Working Group

State Resources

Codeine rescheduling : Department of Health and Human Services Tasmania

Medicines containing codeine : Queensland Health

Information for your patients

Medicines with codeine – what you need to know : NPS Medicinewise

Over-the-counter codeine: changes to supply : NPS Medicinewise

Patient resources available in English, easy English (with pictures), Arabic, Simplified Chinese, Traditional Chinese, French, Greek, Hindi, Italian, Korean and Spanish.

Codeine information hub: Codeine use can be harmful : Therapeutic Goods Administration

Codeine information hub: How and where to get advice : Therapeutic Goods Administration

Codeine information hub: chronic pain management resource : Therapeutic Goods Administration

Community toolkit (for patients) : Scriptwise

Information for consumers having difficulty ceasing their over the counter codeine medications : Drug and Alcohol Services South Australia

GP education

RACGP webinar recording - The implications of codeine rescheduling (6 December 2017) : RACGP Victoria

98529 – Management of moderate acute pain and the role of combination analgesia : gplearning

Codeine information hub – Education resources for health professionals : Therapeutic Goods Administration

Better Pain Management Program : ANZCA, Faculty of Pain Management

State-based education

Medication Assisted Treatment for Opioid Dependence (MATOD): Module 1 – Safer opioid prescribing : RACGP Victoria 

119722 – Opioid treatment in general practice: Assessing for dependency and understanding treatment options : NSW & ACT RACGP Faculty, 31 January 2018

118298 – Codeine prescribing workshop : Capital Health Network Limited, 1 February 2018

119822 – Codeine rescheduling – Practical tips for GP, pharmacy and practice readiness : South East Melbourne Primary Health Network, 6 February 2018

Western & South Western Sydney AOD18: Recognising and responding to changing substance use : RACGP NSW&ACT and Western and South Western Sydney PHNs, 10 February 2018

Medication Assisted Treatment for Opioid Dependence (MATOD): Module 2 : RACGP Victoria, 18 February 2018

Codeine changes : Victorian PHN Alliance

Codeine upscheduling workshops – Melbourne : Therapeutic Goods Administration

Codeine upscheduling workshops – Perth : Therapeutic Goods Administration

Codeine upscheduling workshops – Brisbane : Therapeutic Goods Administration

Codeine upscheduling workshops – Wagga Wagga : Therapeutic Goods Administration 

RACGP Advocacy

News articles and media releases

Examining the role of prescription opioids for chronic non-cancer pain - 15 January 2018

Australian GPs call for state health ministers to put patient safety first in their approach to codeine regulations – 3 November 2017

Put patient health first in regulating codeine use, Health Ministers urged – 2 November 2017

All political decisions regarding codeine must be informed by high quality evidence – 27 October 2017

Australian GPs call for reform in pain management to protect patients and reduce risky opioid use – 27 October 2017

Changes to codeine rescheduling carries health risks – 18 October 2017

Codeine rescheduling changes are about patient safety not commercial interests – 6 October 2017

GPs urge pharmacists to back moves to restrict codeine and help save 150 lives a year – 12 August 2017

Rescheduling of over the counter codeine products will save lives – 20 December 2016

Letters to pain specialists

RACGP promotes standardised opioid management plans on hospital discharge – 24 October 2017

Where to find advice and support

All state and territory health authorities have 24–hour telephone access to assist drug and alcohol queries.

State/terrritory

Legislative framework

24-hour clinical advisory services

Australian Capital Territory Pharmaceutical Services Section,
ACT Health – 02 6205 0998
Drug and Alcohol Clinical Advisory Service – 03 9418 1082
New South Wales Pharmaceutical Services Unit,
NSW Health – 02 9391 9944
Drug and Alcohol Specialist Advisory Service – 02 9361 8006 (Sydney)
1800 023 687 (rural)
Northern Territory Poisons Control Unit,
Department of Health – 08 8922 7341
Drug and Alcohol Clinical Advisory Service – 1800 111 092
Queensland Medicines, Regulation and Quality,
Queensland Health – 07 3328 9890
Alcohol and Drug Information Service – 1800 177 833 (to be put through to Alcohol, Tobacco and Other Drugs for clinical advice)
South Australia Drugs of Dependence Unit,
SA Health – 1300 652 584
Drug and Alcohol Clinical Advisory Service – 08 7087 1742
Tasmania Pharmaceutical Services Branch,
Department of Health and Human Services – 03 6166 0400
Drug and Alcohol Clinical Advisory Service – 1800 630 093
Victoria Drugs and Poisons Regulation,
Department of Human Services – 1300364 545
Drug and Alcohol Clinical Advisory Service – 1800 812 804
Western Australia Pharmaceutical Services Branch,
Department of Health – 08 9222 6883
Clinical Advisory Service – 08 9442 5042
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