Codeine use halved following OTC ban

The ban on OTC sales of codeine by pharmacies has halved consumption without increasing use of higher strength prescription formulations of the opioid.

Last year’s legislative changes making codeine prescription-only has led to an almost 7000 kg drop in the amount of the medication being supplied to patients.

Figures released by the Therapeutic Goods Administration based on sales data  showed in the first 11 months after the decision came into force on 1 February 2018, codeine supply plummeted by around 50% to 8254 kg, equal to 15.3 million fewer packs.

In the preceding years 2014 to 2017 an average of 34.7 million packs per annum were being sold over-the-counter.

The TGA up-scheduled codeine to prescription-only in the wake of evidence showing low-dose codeine combinations were generally no more effective than non-codeine medicines and had a number of health risks, not least addiction. Clinicians expressed particular concern that prolonged misuse of combination codeine-NSAID products was leading to gastric haemorrhage, renal impairment and life-threatening biochemical imbalances.

Many of the individual submissions made to the TGA lobbied against the restriction, with patients claiming that simple analgesics were inadequate for their arthritic pain and the cost of a doctor consultation to obtain codeine on prescription would be an additional burden.

The TGA said its data analysis did not support the assertion that many patients were switched by doctors to high-strength codeine prescription products after up-scheduling.

“Between February and December 2018, the supply of high-strength 30 mg Schedule 4 [prescription-only] codeine was 7274 kg, as compared with the projected 6816 kg without up-scheduling. The difference was not statistically significant.”

Rheumatologist Professor David Hunter, Professor of Medicine at University of Sydney and Royal North Shore Hospital told the limbic the upscheduling had addressed both the issue of codeine misuse and that for non-cancer related musculoskeletal pain “opioids don’t provide a clinically meaningful benefit and carry a real risk of harm”.

He said for both back pain and for osteoarthritis he would encourage people to stay active, promote muscle strength and exercise around the joints, lose weight if appropriate and use adjunctive therapies such as heat or cold and topical and oral anti-inflammatories.

While treatment should always be driven by the indications he recommended osteoarthritis patients go to the Arthritis Australia joint venture website to look at other alternatives.

The TGA said it was currently undertaking further analyses of the data and will include comparisons with other data sets in future.

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