Codeine restrictions: Drug 'ineffective and unpredictable', Dr Chris Hayes says
CODEINE is doing more harm than good, and research is showing it to be an “increasingly underwhelming” drug, a Hunter pain specialist says.
Dr Chris Hayes, the director of the Hunter Integrated Pain Service based at John Hunter Hospital, said codeine was proving to be more problematic than helpful, as it was an ineffective drug that was unpredictable in its effects.
“It is a matter of weighing the balance between any potential benefits and the potential harms, and if you look at the benefits side of the equation – codeine is not a very effective drug,” he said.
“The way the body breaks it down is variable from one individual to another, so you don’t get a consistent effect.
“It is not that powerful, and for much of short-term acute pain, paracetamol and anti-inflammatories either alone or in combination work pretty much as well, or better, than codeine combination therapies.”
As of February 1, patients can no longer buy codeine-containing products over the counter, following the Therapeutic Goods Administration’s (TGA) decision to make it a prescription-only medication.
These include Panadeine, Nurofen Plus, Mersyndol and pharmacy generic painkillers, as well as codeine-containing cough, cold and flu products like Demazin and Codral.
Dr Hayes said the 2015 Roxburgh study showed the opioid death rate had increased more than two-fold from 2000 to 2013.
“At that stage there were about 200 deaths a year,” he said.
“The 2016 National Drug Strategy Household Survey report showed about 5 per cent of the population misuse pharmaceutical drugs, with three quarters of painkiller misuse related to over-the-counter codeine.
“We have a fair sense that there is a lot of harm associated with it, so to my mind, it’s a good decision and I agree with the TGA.”
Dr Hayes said if codeine was a new drug, and the TGA was considering whether it met current registration requirements on the pharmaceutical benefits scheme, it “wouldn’t make the cut.”
About 10 per cent of people did not metabolise it into morphine, its active form, at all, rendering it redundant.
Other individuals broke down the codeine quickly, getting a higher dose of morphine into the blood stream.
They were at “particular risk” of death.
Dr Hayes supported calls for a national, functional real time monitoring system to alert GPs and pharmacists when someone has already been prescribed codeine, and other opioids, although he said a GPs office was often better suited to having those sensitive, private conversations.
“I don’t think it’s an easy conversation to talk about the details of someone’s background medical history, or if they are struggling with a dependence, with a pharmacist at the counter with other people in hearing distance,” he said.
“If you look at all the opioid pack sales in Australia, a third of it is medically-prescribed codeine, a third is over-the-counter codeine, and a third is all the rest, such as Fentanyl etc.
“There is a lot of codeine use going on out there, and it is not a very effective drug. So my gut feeling is that there is a lot of problematic use.
“We are all part of a society, and part of a healthcare system, and I think we’re asking people to recognise the harm from codeine - even if it is not their personal harm.
“We are asking them to take a more society-wide view and recognise there are several hundred people a year dying from codeine-related deaths, and there are a lot of problems with dependence. So we are asking those people who may be using it legitimately and feel they are getting some benefit, to go through a slightly more complex pathway for the sake of limiting harm to our society.”
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