” From 1 February 2018, codeine will no longer be available over the counter. This means you will need to get a prescription from your ACCHO doctor to buy codeine. For people with ongoing chronic pain, there are other treatments in addition to or instead of medication that can be very helpful

There are many different ways that people can manage their pain without using codeine. Research shows low-dose codeine is not superior to over-the-counter alternatives such as a combination of paracetamol and ibuprofen for pain relief.”

From Real Relief

Opening graphic courtesy of Redfern AMA ACCHO

From 1 February 2018 medicines containing codeine will only be available by prescription. These medications are used to treat pain. Codeine is also sometimes used in cold and flu medicines.

If you live in a rural or remote area and you think that this change will affect you, it’s a good idea to know your options and plan ahead.

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If you normally take medicines with codeine for ongoing (chronic) pain you should talk to a health practitioner about your pain management options. Codeine is only recommended for a maximum of three days and is not considered an effective treatment for chronic pain.

The best place to get advice and assistance will depend on the health services available in your area and your personal preference.

Visit your health practitioner

If you have access to a local GP, they can provide information and help with managing your pain and write you a prescription if you need one. If they feel you need extra help to manage chronic pain they might refer you to see a specialist – either in person or through a service called Telehealth that is used to deliver health services across Australia without the need for travel.

Go to a community health centre or remote health service

If you don’t have a local GP, you can get advice and help at a community health centre or a remote health service in your area. Remote area nurses and registered nurses can also provide advice and, in some areas, they can write prescriptions.

Visit your local Aboriginal and Torres Strait Islander Health Service

Aboriginal and Torres Strait Islander Health and Medical services can provide holistic and culturally appropriate advice and care on all health and medical issues including pain management.

Get free advice over the phone

For free health advice 24 hours, 7 days a week, you can call Healthdirect Australia on 1800 022 222. Healthdirect can provide you with advice on all health topics, including pain management. They can also help you locate your nearest health services and chemists.

Download our NRHAM resources

Click here to download the NRHA Codeine Fact Sheet 

Click here to download the NRHA Posters

If pain is ongoing the best way to manage it is with a combination of strategies that suit your condition and personal situation. Medication alone is not effective.

Multidisciplinary pain management will address all of the factors associated with pain – including emotions, mental health, social relationships and work – to help you get the best results.

One of the best ways to manage pain is to take control of it. With access to the right education and strategies, most people with chronic pain can successfully regain quality of life without the need for opioids, surgery or other invasive treatments.

You can learn more about multidisciplinary pain management through your ACCHO GP who can refer you to your nearest pain service.

Rural Doctors RDAA are working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change

AMA Interview

“ Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.”

AMA President, Michael Gannon see interview in full Part 2

President of the Rural Doctors Association Australia (RDAA), Dr Adam Coltzau, said that while the up-scheduling of codeine has been well publicised, some patients will remain surprised when they can no longer buy their preferred pain medication over the counter.

“I have no doubt that starting today there will be disgruntled people who were either unaware of the coming change or who did not make plans to change their medication,” Dr Coltzau said.

“Everyone should be aware that they may consult with their pharmacist where available or where there is no pharmacist their health clinic team regarding alternative over-the-counter medications. It is imperative that consumers who have previously used over-the-counter codeine to manage pain see their health care provider regarding alternative medications or therapies that are available to them.

“And of course for those patients whose doctor or nurse practitioner recommends codeine-based products these remain available to them by prescription.

“The up-scheduling of codeine has provided a positive opportunity for both patients and prescribing practitioners to increase their knowledge of the safer and more effective pain relief medications and treatments, review their condition and re-assess their approach to management of these conditions,” Dr Coltzau said.

President of the Australian College of Rural and Remote Medicine (ACRRM), Associate Professor Ruth Stewart, said that patients should start a conversation with their GP about their pain problems to find a treatment that works for them.

“There’s no clinical evidence to suggest that over-the-counter codeine products are more effective analgesics than similar medicines without codeine,” A/Prof Stewart said.

“Talking to your GP about your pain is the best way to address it, as they’re equipped to suggest a pain management strategy based on your symptoms.

“Medication alone is often not the most effective way of treating many conditions, and a multidisciplinary pain management plan will help get the best results.

“In rural and remote areas, where people may have to travel to access their health care provider to review the management of their condition, it is important for consumers to schedule a visit with their

GP or other health care provider. Where pharmaceutical services are available, consumers can take advantage of the Government’s new Pain MedCheck program that will be rolled out across community pharmacies for a one-on-one consultation with your pharmacist.

“Online resources such as http://www.realrelief.org.au can provide consumers with the facts and information on the proven alternative pain medications that are available and there may also be specialist and allied health services available via telehealth for people living in rural and remote communities,” A/Prof Stewart said.

RDAA is working with ACRRM, CRANAplus and the National Rural Health Alliance (NRHA) to ensure that all rural doctors, rural and remote nurses and Aboriginal and Torres Strait Islander Health Workers can access relevant training and information so they can advise and/or prescribe the best and most appropriate form of treatment available to consumers following the change.

Visit www.rdaa.com.au for more information.

 Part 2

LAURA JAYES:   AMA President, Michael Gannon, joins us now live from Perth. Dr Gannon, thanks so much for your time. Is the AMA on board with this decision?

MICHAEL GANNON:   The AMA supports the decision made by Minister Greg Hunt, who in turn was taking the advice from the TGA, the Therapeutic Goods Administration. They’re the bureaucrats who have looked at the science and made a decision that brings Australia into line with 25 other countries.

LAURA JAYES:   There’s been a bit of reaction to this, you would’ve noticed, Dr Gannon, but most people do use these codeine products in a very responsible way. Are you concerned about what this might do in regional areas, where people don’t have access to this, they have to find a GP? That might delay them in seeking this medication.

MICHAEL GANNON:   Look, the Pharmacy Guild stands alone in their opposition to this change, and we’ve seen a lot of mythology out there. The important message – for people who have always required a prescription for higher doses of codeine, nothing’s changed.

Now, we’ll have more to say about that. This is a drug that is causing more harm than good in our community, and ideally over time we’ll see fewer and fewer prescriptions for opioids.

But for the lower doses of codeine that this change affects, it’s very important to deliver the message to people that there’s very clear scientific evidence that the low dose codeine-containing preparations are no more effective than the paracetamol or the anti-inflammatory alone.

That’s the message that should be delivered to a patient presenting to a community pharmacy today or in coming weeks: here’s some paracetamol, here’s some ibuprofen – it’s every bit as effective, and it’s a lot safer.

LAURA JAYES:   Well, you said myth-busting; what kind of myths did you want to bust? I’ll give you the platform to do it right here and now.

MICHAEL GANNON:   Well, first of all, the myth that something’s changing for people who have already required a prescription for opioids. We are more and more concerned about the use of opioids in our community. It’s not unique to Australia. So many of the people who die from heroin overdoses in the United States and Australia started off on prescription opioids. So, if anything good has come of the Guild’s advocacy on low dose codeine, it’s been shining a light on the opioid epidemic we have.

But the most important myth to bust is that – for those people who reach occasionally for one of these preparations for a headache, for backache, for period pain – an anti-inflammatory alone, paracetamol alone, is every bit as effective, and in fact it’s better, because for a lot of people codeine causes headaches, it doesn’t make them better.

LAURA JAYES:   You sound like the AMA is preparing to actually look more deeply into opioids other than codeine. It seems like codeine is the first frontier. Why is codeine any worse than some of the others?

MICHAEL GANNON:   Well, the reason that codeine is worse is that it’s unique amongst the opioids in that’s it’s being treated in such a permissive manner. You still need a prescription for fentanyl; you still need a prescription for oxycodone; you still need a prescription for morphine.

But if anything good has come out of this conversation in recent months, it’s been that we, as doctors – whether that’s surgeons dispensing opioids after surgery, whether it’s emergency departments dispensing them in people who have presented with trauma or some other form of pain – we need to do something, because oxycodone, fentanyl, higher doses of codeine, are also causing damage in our community.

We need to look carefully at better opioids. Codeine is very much yesterday’s drug, it would not be licensed if it was invented next week. But we need to look carefully at our prescription of other opioids and really look carefully at non-pharmacological approaches to chronic pain.

LAURA JAYES:   What ones are you concerned about? Are you concerned about pseudoephedrine? Because I believe if I’ve got a bit of the flu, I go to the chemist, I get some cold and flu tablets that contain pseudoephedrine. You can certainly get through a day of work with those drugs, but are they an addictive substance? If codeine is the first one you’re concerned about, what are the next?

MICHAEL GANNON:   Pseudoephedrine is not an opioid, so it’s not used for pain relief, and the main reason to be careful with its use is it’s used to cook up methamphetamine in criminal backyard laboratories.

But you raised an important issue there, the need to monitor. We support real-time prescription monitoring. We’ve been very supportive of what’s existed in Tasmania until now. State Minister Jill Hennessy in Victoria, Federal Minister Greg Hunt, have made noises about real-time prescription monitoring. We agree with the Pharmacy Guild that that’s the way forward, especially for other licit opioids that have become drugs of abuse, like fentanyl, like oxycodone.

LAURA JAYES:   Okay, so those are the main concerns that are being abused if the opportunity is given?

MICHAEL GANNON:   Well, we are concerned about these drugs as drugs of abuse. I mean, the evidence comes from coronial reports in Victoria and other States.

LAURA JAYES:   How do people get them, though? Do they doctor shop?

MICHAEL GANNON:   Well, there is no question that some people doctor shop, but that’s a pretty ambitious effort to doctor shop for 8mg codeine tablets. But there’s no question that some people, they cook up all sorts of stories, they’re very sophisticated in how they go around collecting prescriptions for codeine 30mg tablets.

We know that fentanyl patches, that people use them, and they get the drug out of the patch for intravenous or subcutaneous administration. Australia has long been a high user of opioids, we’re a big exporter of opioids, and the story of the harm they do in the community is not a new one. But this decision, it’s at least two or three years overdue, and it brings us into line with much of the rest of the developed world.

 LAURA JAYES:   Dr Michael Gannon, thanks so much for your time today. This is a fascinating area that I agree with you we need to look a lot more closely at. We’ll get you back another time and deep-dive into that issue. Thanks so much for your time.

 MICHAEL GANNON:   Thank you, Laura.