Interview regarding how Codeine can no longer be bought over the counter starting from February next year

Media Release

Date: 2 November 2017

Interview with Greg Turnbull, Communication Director, Pharmacy Guild of Australia

TIM SHAW:If my doctor says he needs to prescribe me certain medications for a condition, I take the advice of my professional GP here in Canberra, and I just want to say good morning to all of our GPs out there doing frontline work, many for not much return. Well done to the bulk-billed GP facilities that are doing the best they can on the frontline servicing those Canberrans that can't afford to go for a $75 doctor's consultation. But can I reserve the bigger shout-out to the pharmacists of Canberra, giving frontline information to patients, people that have come in. They may have a script to fill. I've just got to say, I go to a wonderful pharmacy here in Mitchell and the team there are just great. But guess what, things are changing.

From the 1 February 2018, Federal Health Minister Greg Hunt has said that codeine can't be bought over the counter. Now, I don't suffer from serious pain of any type, but I understand about 100 people a year have died from overdosing on codeine. And this is very serious, any death from an overdose is very serious, but that represents 0.0002 per cent of those people buying that type of medication over the counter. What about the law-abiding, decent, smart people who follow the instructions, the 99.9998 per cent that don't overdose on codeine? Now, this is going to cause bigger delays in GP's waiting rooms, people who are living with some form of serious pain may not be able to get into their bulk-billed GP.

Now, what's this mean? More people flooding to pharmacies for advice? Well, listen, it's important that we understand from the front end at pharmacy what's going on, and I'm pleased to say Greg Turnbull, communication director for the Pharmacy Guild of Australia has come into the studio to speak with us now. Greg, welcome to 2CC Breakfast.

GREG TURNBULL:Pleasure to be here, thanks.

TIM SHAW:What do these changes mean, what happens from the 1 February 2018?

GREG TURNBULL:Well, to be clear, this is a decision that's been a long time in the coming. It was actually announced in December 2016, so there's been quite a lead-up to it. It's a decision, I might say, of a committee of the Therapeutic Goods Administration. It's not an act of ministerial discretion, it's something that's handed down from clinical experts, and we have to respect that. They've come to this decision. It will mean some inconvenience and perhaps some cost for some patients, but as you suggested, the important thing is that patients speak to their doctor or pharmacist about what alternative pain relief medication they might need. They might need a script for some of these medicines which they can currently buy over the counter, but it's also possible that an alternative medicine might be available over the counter and they should talk to their pharmacist.

TIM SHAW:Now, Greg Hunt said on the 27 October that there are now more resources to help fight opioid addictions. What he's flagged is that medicines containing codeine will no longer be available over the counter and will instead require a prescription through a doctor. Now, I'm not a doctor. We respect the decisions made by the Therapeutic Goods Administration, and chief medical officers, chief health officers. States have come on board, all states and territories have said yes.

GREG TURNBULL:Well, they have, but there's been some discussion as we've approached the date, 1 February next year, there has been some discussion about it. But let me make clear the concern of the Pharmacy Guild. We want patients to be aware of this change, to talk about it with their pharmacists and doctors so that they can get relief from pain, particularly acute pain. The fact of the matter is, Tim, that the misuse of these medicines, the inappropriate use, has been where they've been used for chronic, ongoing, long-term pain. These medicines should only have been used for acute pain. So that's why the up-scheduling or the prescription-only move has been made.

But here's the real concern: whoever said that making a medicine prescription only prevents its abuse? No coroner in Australia ever, because year after year and state after state, there are deaths from prescription medicines and prescription opioids. This is from a problem in part called doctor shopping. Doctors have no real-time, IT connection so that one doctor doesn't know when another doctor has written a script, and people will game that system and will get more scripts than they should, and they'll do themselves harm. So what we're saying is that they're going to be prescription only, we need real-time recording connecting doctors and pharmacies so that health professionals are informed when somebody's putting themselves in jeopardy.

So that's our priority now, as well as informing patients that from 1 February- look, you used to buy- are you okay if I mention the brands? Nurofen Plus, Panadeine- by the way, is going off the market. It won't be available even on prescription. So there are alternative products and also, if somebody says: I need those medicines because I've been taking them- I take 10 of those a day. Well, then that's a red flag and that's exactly where they should not be able to access those medicines, because they're doing themselves harm and they need to talk to their doctor or to go to an addiction service so that they can be taken off these, so they don't - in the end - kill themselves. Because it's not the codeine that kills people, it's the other components in those medicines that they're overusing.

TIM SHAW:This is the point and you're going to be facing your members at the frontline - and I've said my Mitchell pharmacist magnificent, great communicator, the team there are fantastic - but I don't abuse drugs. I don't take drugs at a higher level than what I've been prescribed. To your point though if I go to my GP in Franklin then pop to Mitchell to get that script filled, shouldn't there be like a referral attached to that prescription that says; this is Tim, you're the pharmacist Greg, here's my referral for you to fill this scrip once. Wouldn't that stop this doctor shopping and the use inappropriately of access to some of these drugs? Is that part of the system?

GREG TURNBULL:Well, at the moment there's no visibility either for the doctor or the pharmacist to know that you didn't go to a different doctor the day before and a different pharmacy the day before and get the same medicine. That's a simple fact of the matter. Now the Federal Government, Minister Hunt to his credit is putting some money into trying to develop what's called a real-time recording system but that's mainly for the higher end so called Schedule 8 dangerous [indistinct] oxycontins, they're called hillbilly heroin. But it's these drugs that are currently over the counter. We've got a recording system for the over the counter drugs but ironically there's nothing when they move to Schedule 4 or prescription only. So it's a crying need out there because otherwise we'll have coroners around the country still reporting deaths from opioid abuse, from doctor shopping, from too many prescription medicines out there and we won't have achieved anything by moving these medicines to prescription only.

TIM SHAW:What could Minister Hunt do to appease the pressure that's certainly being lumped on his shoulders, what should the Government consider doing in response to the call from the Pharmacy Guild of Australia, expedite this live reporting, is that what you're calling on the Federal Government to expedite?

GREG TURNBULL:Well certainly as I said the Pharmacy Guild developed at its own expense a real-time recording system called MedsASSIST. You might find when you go to your pharmacy, Tim, that if you're buying a codeine containing medicine, an analgesic pain relief medicine, you will be asked to identify yourself and there will be a system to tell whether you've bought it. That all finishes 1 February because it moves to prescription only and it's a system that's not designed for prescription only.

So I guess what the Minister and the Pharmacy Guild and the Pharmaceutical Society and all the doctor groups want is for people to be aware of this change, talk to their doctor, talk to their pharmacist and think about alternative pain relief protocols that may involve these medicines in a script but may not, there might be an alternative.

TIM SHAW:Just finally, I think Minister Hunt is a fine minister, I think he worked very hard in this portfolio. Are you delighted that it seems more and more drugs have been entered upon the PBS in this term of this government? It seems that those families that are suffering enormously expensive drugs that aren't on the PBS and it's costing lives, do you think Minister Hunt's been on the right track in that regard?

GREG TURNBULL:Look I certainly do and creating room for these are very expensive usually, new drugs to come on. There's a hepatitis C drug, Tim, a month's worth cost $22,000. In Australia if you're a pensioner or concession card holder you get that for $6.30. There's no better system in the world.

But let me just say this. The industry, pharmacists, the pharmaceutical companies, the generic medicine makers, they've all contributed to this because through a process called price disclosure - I won't bore you with the details - medicines on the PBS have become more affordable for the Government to pay for and that's created extra space in the budget to put these very expensive drugs on the PBS.

TIM SHAW:Just finally, flu in Canberra, horrendous flu situation we've had. Do we need to have the number one super flu vax for 2018 available to Canberrans to avoid the horror of what we've experienced this past flu season?
GREG TURNBULL:It was a shocking season and pharmacists all over the country were reporting high rates. And of course vaccinating people against the flu was bigger this year but the flu that arrived in our community was bigger than that. And certainly I know, I've read the last couple of days controversy about the strength of flu vaccines, I'm confident that our health department and our doctor groups and the immunology specialists will have the best flu vaccine available for Australians.

TIM SHAW:Stay in touch with us as we get close to 1 February and I want to thank you so much for your time this morning.

GREG TURNBULL:My pleasure.

TIM SHAW:Greg Turnbull, communication director, Pharmacy Guild of Australia. The issue of codeine not being able to be bought as you have been previously buying it over the counter from 1 February.

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