The MedsASSIST system, designed to monitor pharmacy sales of codeine products, has reached the stage of progressing to stage two of a pilot, involving approximately 150 pharmacies in the Newcastle and North Queensland regions.
The system is being introduced because government was intending to reschedule codeine to schedule 4 (prescription only) status.
Addiction to prescription medicines has been reported at epidemic levels, with oxycodone (prescription only) being the most reported drug creating addictions.
What is not really known is whether over-the-counter sales of codeine are being used to support a narcotic addiction originally created through doctor-prescribed opioids or whether pharmacy sales of codeine products are not being monitored satisfactorily by pharmacists – or is there some other reason?
The Pharmacy Guild of Australia has successfully negotiated a stay of the rescheduling decision, which was made without a full understanding of what was causing an apparent overuse problem by the community.
There is also another possibility, and that is that codeine is being bulk purchased to convert into more highly addictive forms, such as morphine, and sold illegally outside of pharmacy.
The stage two pilot will be launched in early February 2016 and will be officially launched at the APP conference being held at the Gold Coast.
The Pharmacy Guild also has a high profile partner in the project in the form of the Australian Self Medication Industry (ASMI) association.
The system is styled as a clinical decision-making program, while Project Stop is primarily a law enforcement tool to prevent diversion of pseudoephedrine.
While it is good that the Pharmacy Guild have become proactive and doing its job in preventing government “knee-jerking” decisions from flowing through to community pharmacy, it is nonetheless a public health issue that government should be providing correct infrastructure and reporting for – and paying for.
Therefore, it is important that government must legislate that a mandated fee be charged to offset the time element required for a pharmacist to report patients to the MedsASSIST system.
That may not necessarily be on the current agenda, but a responsible government needs to acknowledge the real costs of a responsible pharmacy profession providing better solutions.
A mandated fee, of course, will not prevent the retail discount pharmacies from discounting the product, but they will have to live with the adverse public relations of trying to increase sales through discounted products, where the endeavour is to sell responsibly.
It’s a little like the advertisements for alcohol that always finish up with the words “and please drink responsibly”, but sounding a bit hollow and insincere.
The US has had similar problems to Australia in that pseudoephedrine products and codeine products have been abused to epidemic proportions.
However, they are developing systems much like the PGA have developed here in Australia, but with one very clear difference.
Police in the US have to prepare a file for pharmacy access for known drug offenders, and they have backing legislation that prohibits any sale by a pharmacy to a known offender listed on the police database.
That would be a very useful database for both Project STOP and MedsASSIST.
Once a patient has been screened for eligibility of purchase, then most of the anxiety concerning such a sale is dissipated.
It then gets down to reporting an offender or more productively, helping a patient to make a good choice for their pain condition.
Schedule 4 rescheduling is not likely to provide public benefit.
Most addictions have been created by the prescription of a doctor using much stronger opioids than codeine.
And when you add the additional cost to Medicare for a doctor visit, both the public cost and extra patient costs becomes an unnecessary burden to both sides.
That process also reduces patient access for more needy primary health care time, so the entire health system becomes more burdensome than it already is.
It is also obvious that there is a need for government to stop impacting negatively on community pharmacy.
Pharmacy can no longer sustain the overheads of unnecessary compliance through the decisions of ill-informed bureaucrats who are primarily interested in building their own little empires.
We do not require more unnecessary regulation and legislation.
MedsASSIST need not be a permanent imposition on codeine sales, for if it is proven that pharmacy has indeed created the right sort of controls on a product that has been abused, and that the problem is addressed because of known causes, then the need to document disappears.
And, of course, codeine will not be the only product from the shelves of pharmacy that will be abused in the future.
At least there is a system to handle future need, and it is a system in place that basically measures the effectiveness of pharmacy, which can further prevent future government “knee-jerking”.