How did we go?
The decision to remove low-dose codeine from open sale was not initiated by pharmacists and certainly there was poor planning for its implementation. But what is obvious is that the problem evolved not from low-dose codeine sales, but from high-dose medical prescribing. And the debate was framed using false metrics for the death rate. So a clumsy mess that is forced on pharmacists as they now have to scramble to provide solutions for patients. Codeine addiction is just the tip of an iceberg – it involves all opioids. And the problem occurs because of poor doctor prescribing and over-prescribing, engineered by global pharma marketing pressure. The entire illness model of medicine is now permanently fractured and is beyond repair.
Gerald Quigley - An advocate for Integrative Medicine
The codeine debacle has come and gone, and I’m not sure if our profession has come out of this squeaky clean.
Judging by the number of media queries around the place, it’s timely to look back and see if this issue could have been handled better.
And those enquiries and still coming.
In retrospect, might a codeine-monitoring service have worked?
Why couldn’t the profession agree on a compulsory system similar to the pseudoephedrine model?
Greed?
What’s in it for me?
Where was the leadership at that time?
What’s happened, has happened.
The decision has been made, and it wasn’t made by pharmacists.
Disputes abound within our own profession, as to how this decision could have been handled better.
It seems now that we are portrayed as the bad boys…..forcing Australians to see their GP for regular doses of codeine.
I now hear of prescriptions being presented for hundreds of Panadeine tablets with multiple repeats.
One pharmacist rang the Professional Services Team within his group seeking advice.
He was told to “use your professional discretion!”
Should he have had the strength to speak to the prescriber, potentially damaging the inter-professional relationships he had established?
Should he have reported this pathetic prescribing to a higher authority, probably for that prescriber to get a slap on the wrist with a wet lettuce leaf, six months down the track?
Did you see that drongo in South Australia who announced on his radio show that he was going “shopping for drugs” last weekend to build up his codeine stocks?
Surely we could have foreseen instances like this, and given a consistent response guideline.
The Guild have been up and about?
I don’t seem to hear much on the codeine issue in the big wide world from PSA though.
I conclude therefore, that the retail considerations are more important than the patient obligations with which we are entrusted.If we are the “guardians of medicine”, then why didn’t a public educational campaign begin earlier.
As usual, we seemed to be waiting for it to be done for us.
So, where does that leave the patient at present?
Brilliant marketing of the paracetamol/ibuprofen combinations are reaching saturation.
Is this the ready-made solution?
Do you have the courage to actually educate your patients about their pain?
By definition, doctor means educate, but that group “don’t have the time”, and seem to be excused because if one GP won’t conform to a patient demand, there’s always the next one down the road.
Helping a patient understand the role of pain is actually rewarding, both professionally and financially.
Pain dominates the Australian medical landscape, and our patients need help, guidance, reassurance and a little of our time.
The illness system has let them down, and sadly, we are part of that system.
You can make the change is you wish.
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