Codeine changes won't stop addicts

[rahli]

The Federal Government is set to introduce changes to the way painkillers containing codeine are sold over the counter.

But health professionals say the amendments, due to come into force within a month, will do little to fix the problems which sparked concern in the first place.

It's not a pretty picture: addicts taking up to 80 Nurofen Plus tablets a day, crushing the opiates and injecting them; people with anxiety and depression, dependent on codeine's euphoric affects; and chronic pain sufferers needing more and more of the drug to get relief.

Then come the consequences: stomach ulcerations and perforations, renal complications, gastric bleeding and in rare cases, death.

Experts say these substance abuse issues are on the rise. In October last year they prompted the national drugs and poisons committee to reschedule all combination analgesics containing codeine.

Effectively, the May 1 changes will see products like Nurofen Plus, Panadeine and Panadeine Extra in smaller pack sizes and with smaller doses of codeine. A pharmacist must also be involved at every sale to record the customer's details.

Addiction and pain medicine physician Dr Christian Rowan says while limiting access to codeine medication is an initial step, it will be redundant if left to work in isolation.

He says over the past few years there has been a rise in the number of people abusing the substance.

"There seems to be growing evidence that numbers of people in the community are obtaining considerable quantities of those tablets and taking them on a daily basis... and significantly so that we are concerned from a collegial perspective," he said.

"I've certainly treated people who have been taking 60 to 80 of those tablets per day. Sometimes they've been accessing them from different pharmacies, but sometimes they've been accessing them from the one pharmacy.

"That's led to adverse physical consequences, not only because of the addictive nature of codeine but from the anti-inflammatory side of things."

Codeine is typically used in combination with the anti-inflammatory agent ibuprofen.

Dr Rowan says some people are taking enough tablets to get an equivalent dose of morphine.

"Sometimes they're consuming the medication orally and other times they're crushing it and injecting it," he said.

Massive loopholes

But it seems next month's changes will do little to stop people from misusing codeine analgesics.

The Pharmacy Guild of Australia says the new legislation will be more a nuisance than anything.

"The industry is frustrated because we are talking about a very, very small number of people - something like one in 10,000 people - who are abusing codeine, but the committee felt that was enough to warrant the decision," the guild's national director, Kos Sclavos, said.

"At the end of the day if somebody is abusing these products they're going to go from pharmacy to pharmacy and just make more visits.

"This is not going to address the problem it is just going to inconvenience 3 million people a year who take codeine products at some stage or another."

Mr Sclavos says real-time recording, which is currently in place for pseudoephedrine purchases, would prevent people from chemist hopping to obtain large amounts of codeine. But this system will not be part of the May 1 changes.

"The real-time database makes sure that if somebody went to the pharmacy down the road 20 minutes ago and then came to mine, it says this item has been purchased 20 minutes ago and not to supply this medication," he said.

"People coming off addictive cycles who used to go to eight pharmacies, now they'll just have to go to 20 because of the smaller pack size."

But he says the guild is primarily concerned about the impact the changes will have on the majority of Australians who use codeine appropriately.

"Patients who are legitimately and correctly using it, especially when it comes to families or elderly couples, they're going to have to send different members of the family in because a five-day supply for a husband and wife now becomes a two-and-a-half day supply," he said.

"It's a shame that a very small number of patients are going to create such an inconvenience for the majority of patients who use these products appropriately."

Under the current state and territory laws, customers can buy packs of 96 tablets. But as of May 1, they will only be able to buy 30 tablets in a six per day pack and 40 tablets in an eight per day pack.

This means the duration of treatment will not exceed five days, with a limited maximum dose of 12 milligrams of codeine.

Driving factors

Dr Rowan agrees the schedule changes will not stop people pharmacy hopping to get their fix, and says an effective monitoring system must be implemented for a difference to be made.

"The pharmacy guild is right in that just restricting access at an individual pharmacy won't solve the problem, but having said that if we've got the problem out there that has to be part of the solution," he said.

He says once an effective monitoring system is in place, the reasons behind substance addiction and abuse also need to be addressed.

"All of these things need to be put in place, you need to limit the access, you need to have the monitoring, and then look at what the drivers are out there that need to be addressed," he said.

"For some people it is a cheaper way of accessing a drug to actually abuse, for other people it's inadequate pain control, which then leads to an escalating situation where they just consume more and more and it gets out of hand.

"Then there's the euphoric effect that comes with these medications... some people are using that to treat anxiety or depressive symptoms or post-traumatic stress disorders."

Dr Rowan says prevention funding must be increased if codeine addiction, as well as addiction at a broader level, is to be tackled.

"We only spend a fraction of money on treatment and rehabilitation when it comes to people with substance disorders and that's one of the big gaps in the health system," he said.

"There are billions of dollars spent on treating the consequences... and all of that costs a significant amount of money in the system, but there is not a huge investment in the front end to try to prevent all of that occurring."

The National Drugs and Poisons Schedule Committee says it felt restricting the duration of treatment to no more than five days would balance the access needs of legitimate users with the need to address the risks of harm from these products through misuse or abuse.

The Government has been contacted for further comment

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[FancyPants]

Crushing and injecting? Little bit misleading isn't it? If the aim is crushing for a CWE and then injecting the codeine+water rectally or orally well then that's removing the majority of risk from the ibuprofen or paracetamol. So that would be harm minimisation techniques.

Pisses me off that they spend so much money, time and effort in focusing on CODEINE (ooooh sounds dangerous!) and not the other overabused crap in it.

"For some people it is a cheaper way of accessing a drug to actually abuse, for other people it's inadequate pain control, which then leads to an escalating situation where they just consume more and more and it gets out of hand.

Up to $25 I've spent on a single box of 72 nurofen plus to get me through a day and a half or so at worst. I don't think that's particularly cheap on a habit. Who picks a drug to abuse?

To be honest when I was still using (though addicted) for genuine pain relief I would've definitely tried to buy heroin had I known anyone with it. All the while in the back of my mind not to actively go out and try to locate some, knowing inevitably it'd be a worse situation in the end. BUT, had the possibility been there, codeine wouldn't be first choice for the pain relief. What about those who may now find heroin (or blackmarket oxycodone or morphine) easier to find than codeine+shit will be?

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Edited April 5, 2010 by lsdreamz

[oface]

So now people will have to ingest more paracetamol and/or ibuprofen in order to get the same dose of codeine? Good one!

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Edited April 5, 2010 by lsdreamz

[Chiral]

So now people will have to ingest more paracetamol and/or ibuprofen in order to get the same dose of codeine? Good one!

 

or quit using...

Perhaps saving themselves from gastric, stomach and liver complications. People in genuine pain should be on proper pain management with their specialist or GP. A huge chunk of the populus that is hooked on OTC painkillers are not really in terminal or lifelong pain, they are mainly either abusing it for a high or lazily using it to prevent what they think are headaches, minor backpains from improper lifting and poor fitness, which probably could well be controlled with a better diet, stopping smoking, more fluid intake and a less salty and caffeine free diet.

These painkillers were marketed for people with short term pain from sporting injuries, or minor to bad headaches, hence the addition of an analgesic or anti - inflammatory to help with swelling, honestly have no idea why they market the tablet with paracetamol and codeine, to me that's unnecessary, same with cold and flu meds, they have paracetamol, codeine and psudeoephedrine.

Anyways it's obvious people can't be trusted to use these meds safely and properly and take precautions to avoid overuse...I am a classic example, so I think the move is an acceptable one even though junkies will still get what they want no matter what, at least people like me who were addicted and really wanted out will now make the move to live better and stop poisoning ourselves.

[blog]

or quit using...

These painkillers were marketed for people with short term pain from sporting injuries, or minor to bad headaches, hence the addition of an analgesic or anti - inflammatory to help with swelling, honestly have no idea why they market the tablet with paracetamol and codeine, to me that's unnecessary, same with cold and flu meds, they have paracetamol, codeine and psudeoephedrine.

 

Codeine alone is prescription. Pseduoephedrine alone is Prescription. Drugs such as inburprofen may indeed be anti inflammatory but that's not their main mode of action for prevention of pain. For dogs as an example, anti flammatory's are most used drugs for general pain relief

Anyways it's obvious people can't be trusted to use these meds safely and properly and take precautions to avoid overuse...I am a classic example, so I think the move is an acceptable one even though junkies will still get what they want no matter what, at least people like me who were addicted and really wanted out will now make the move to live better and stop poisoning ourselves.

 

I don't think it's reasonable to remove these pain killers because a small percentage of juankies misuse and harm themselves. What about the vast majority that use these medications are aent' junkies, or those that use the medication recreationally but dont' do harm to themselves. REmoval of such medication should be related to the cost to the tax payer and the community due to harm caused by mis-use.

An example was the 10mg gelcap temazepam. Junkies would heat the gel cap and inject, destroying veins, causing tissue death, loss of limbs, and death. Although the vast majory of people prescribed these drugs weren't junkies injecting them the sheer cost to the tax payer in monetry terms and to the junky in health terms meant it was reasonable to ban the gelcap.

It'll be interesting the tensions that may occur now when people are forced to go to dr's for no other reason than pain relief. Dr's are all trained to never give pain killers to new, non elderly patients asking/requiring pain relief. My Dr that i'll be visiting more regualrly now it seems even has a sign saying no opiate based pain killers will be prescribed to under 65yo's. No doubt a bluff, but I can see this is going to casue problems

Edited April 2, 2010 by blog

[ballzac]

These painkillers were marketed for people with short term pain from sporting injuries, or minor to bad headaches, hence the addition of an analgesic or anti - inflammatory to help with swelling, honestly have no idea why they market the tablet with paracetamol and codeine, to me that's unnecessary, same with cold and flu meds, they have paracetamol, codeine and psudeoephedrine.

Anyways it's obvious people can't be trusted to use these meds safely and properly and take precautions to avoid overuse...I am a classic example, so I think the move is an acceptable one even though junkies will still get what they want no matter what, at least people like me who were addicted and really wanted out will now make the move to live better and stop poisoning ourselves.

 

Well paracetamol actually reduces fever, so it makes sense to be in flu medication. I find it worrying that you think because you fucked up that access to this drug should be restricted for others .

[Chiral]

Let's just get this straight...these meds are not being taken away, they are just now behind the counter so idiots who abuse them can't go in and fill up a plastic basket with box's of 75 tablets. It's also a safe guard agaisnt teens and kids going in and buying them and misusing them.

Genuine users won't mind the extra minor inconvenience as they have faith the pharmacy guild and health authority have them and their childrens best interest at heart...in fact most people know that the reason this has happened is because of junkies abusing them, same with the psuedo affair, but they don't flinch really as the majority are anti drugs and VERY anti drug user.

The only people who will kick up a stink about this are people misusing them intentionally and addicts. Do you think the general public are even remotely concerned about this fringe element..not really they prolly hope they do kill themselves so their neighborhood is safer...hard line of thought but easy to believe.

Yes Zac i know paracetamol reduces fever that's why it's sold as a standalone tablet, my point was why is it mixed in a pain med...an opiate..in cold n flu yes I can see that but straight up pain relief you only need the opiate not the paracetamol.

I find it worrying that you think because you fucked up that access to this drug should be restricted for others

now now let's not go putting words into my mouth...I can't ever remember saying anything of the sort..I'm simply saying that the move to place them behind the counter can't be bad if it helps people like me, who came out of a horrible surgical procedure in pain for 6weeks and ended up hooked on them.

Should they not put them behind the counter...?

Perhaps they should just put out 150mg oxy's as well, hell just put half kilo bags of BEX on the counter and we can all go in and scoop up a fix in a plastic spoon washed down with some methadone.

[ballzac]

Some good suggestions there

[Chiral]

Even though it is an inconvienence to goto 4-5 different pharamcies a week.. it is nothing to going cold turkey.

 

WTF...?

edit...nevermind...I missread this...thought you were saying doing cold turkey is easy.

Edited April 2, 2010 by Chiral

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Edited April 5, 2010 by lsdreamz

[Chiral]

Some good suggestions there

 

lol...yeah can you imagine...your local discount chemist with a library coffee and kilo bags of bex and jugs of methadone, some smoking black tar opium through shisha...geezes.

Opiates scare the fuck outta me, never ever underestimate the power and claws of this drug, and even though it definitely has it's use's I find it to be the most incredibly addictive of any drug period.

Remember morphine is what got Alexander Shulgin interested in drugs and pharmacology.

[blog]

Let's just get this straight...these meds are not being taken away, they are just now behind the counter so idiots who abuse them can't go in and fill up a plastic basket with box's of 75 tablets. It's also a safe guard agaisnt teens and kids going in and buying them and misusing them.

 

Are you actually on drugs right now?

They are being taken away. conbination codeine analgesics in 48 packs and above will be prescription only from 1st of may.

ALL CODEINE COMBINATION tablets have always been behind the counter, as they are 'pharamcy only'. I"d have to google it, but in pharmacy talk

they have an area called 'professonal services area'. This means 'behind the counter' . I've never seen 'pharmacy only medication' not behind the counter. I think they are making it mandatory that codeine tablets are behind the counter but I don't believe they've ever not been behind the counter.

[Chiral]

Are you actually on drugs right now?

They are being taken away. conbination codeine analgesics in 48 packs and above will be prescription only from 1st of may.

ALL CODEINE COMBINATION tablets have always been behind the counter, as they are 'pharamcy only'. I"d have to google it, but in pharmacy talk

they have an area called 'professonal services area'. This means 'behind the counter' . I've never seen 'pharmacy only medication' not behind the counter. I think they are making it mandatory that codeine tablets are behind the counter but I don't believe they've ever not been behind the counter.

 

What the fuck are you talking about man...codeine has been freely available on any shelf of every chemist in Australia for ever...now it will be behind the counter and you have to ask for it and have a discussion with the pharmacist and perhaps show some form of ID...it's not prescription only at all.

perhaps it is you who is on drugs my friend.

[Quill]

i remember purchasing some. All i had to do was pick it up off a shelf and take to counter

They have not always been prescription only and behind the counter

[blog]

Ok 2 people have stated they've bought it from the shelf. must vary state to state.

Edited April 2, 2010 by blog

[Quill]

Me? Yes

Do you live in reality?

[ballzac]

Plenty of pharmacy only stuff is just on the shelf. Depends on the pharmacy.

[Chiral]

Do you live in Australia?

 

Yes I do, why...do you want me to go get you a box of panafen 75 off the shelf at my local discount chemist for you...I'm sure I can do that for you seeing as how I've been doing it for the last 2 years...admittedly there are some pharmacies that have them directly behind the counter but there are many stores where they are freely on the shelves not behind and no asking anything about why I need 4 boxes of em.

[blog]

Me? Yes

 

No not you. the junkie that needs pandeine removed from the shelves to stop him eating it but fuck everyone else.

Edited April 2, 2010 by blog

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Edited April 5, 2010 by lsdreamz

[Chiral]

No not you. the junkie that needs pandeine removed from the shelves to stop him eating it but fuck everyone else.

 

oh how appropriate to name call when you are wrong and condescending...nevermind maybe mummy will give you a hug before bed with your warm coca and spongebob blanket.

[blog]

But yeah i think there is a misunderstanding somewhere lol Some chemists in nsw sell it behind the counter and you need to ask for it... while discount places have it stacked up like bricks allowing you to buy as many as you want.

The overpriced panadeine extra or whatever its called.. forte.. that is behind the counter for sure. I really don't see why people by nurofen though? Its 72 tablets.. 12.8 mg but something like $17! AND it has ibuprofen. Chemists Own are $9 have 100 tablets and are 9mg i think.

 

Yeah it seems Schedule3 is behind the counter in all states but schedule2 (pharmacy only medication) is only behind the counter in certain states. Thanks for clearing that up. I stand corrected.

EDIT let me correct that again.... S2 medication applears to be "pharmacy medication" on labels. while S3 appears to be "Pharmacy only medication" on labels. But as far as S2 panadeines (24pack) and s3 panadeines (48pack and above) I've never seen them not behind the counter. but accept they are on the shelves in some states.

Edited April 2, 2010 by blog

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Edited April 5, 2010 by lsdreamz