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What happened after 1 Feb 2018?

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Inspectors have been routinely asking pharmacists about abuse or threats arising from the rescheduling… here’s what they found

With the codeine upschedule occurring on 1 February this year, the police warned of the possibility of aggressive confrontations in pharmacies by members of the public seeking to obtain codeine-containing products.

After routinely asking pharmacists about their experiences, the Victorian Pharmacy Authority (VPA) says “pleasingly” pharmacists have reported an absence of incidents even in areas where abuse of codeine was a problem.

“The main complaint was the price increase of certain products,” states the VPA.

It also says no increase in the prescribing of S8 analgesics has been evident across the state so far – although some pharmacists have reported a small increase in the number of prescriptions for paracetamol 500mg with codeine phosphate 30mg.

Pharmacy Guild National President George Tambassis confirmed to the AJP that while pharmacists had receive “some” customer backlash, this was not a huge problem across the board.

“I still work Saturdays in my pharmacy and [there has been] some [backlash], but most of the Australian public, if a pharmacist explains it to them that this is the independent umpire’s decision, please don’t shoot the messenger, most Australians says ‘oh fair enough, we think it’s a horrible decision’.

“And we say to them, ‘yes so do we. Now these are your options. Are you willing to listen?’

“Most patients are very cool, calm and collected over that. We’ve had some issues but we’re dealing with it. We deal with those issues every day, not just on codeine.”

The Guild still holds out some hope that pharmacists will regain accessibility to OTC low-dose codeine for patients that use them properly.

“We still feel pretty strongly about that,” says Mr Tambassis.

“We’ll manage without them at the moment, but that doesn’t stop us advocating for those medicines to one day still become S3 or S3 recordable, let’s call them, in a system where the people that were using those medicines appropriately still have access to those medicines using appropriate protocols and systems and in very, very small doses and pack sizes.

“As pharmacists we deal with regulations every day. We accept the independent umpire’s decision, we don’t have to necessarily agree with it … and we told the TGA that.”

NSW Guild President David Heffernan says Australia should look to New Zealand, which he says is leading the world in its policy on codeine.

“They have removed codeine from the drugs that cause death. And that was my biggest frustration with the whole thing, they say ‘codeine-related death’, they don’t say deaths from codeine – because you have to have a lot of codeine to die from it, and we’re pharmacists, we know that,” he tells AJP.

“Some of the politics behind it I think were unfortunate, it’s happened and we have to deal with it, but I think still there is some cleaning up to do around it. If anything it is very good to see a commitment from the states and territories for real time monitoring, that’s exciting.

“It’s been something that we’ve been crying out for for a long, long time. To have that vision and the ability to actually help our patients who might be at risk of addiction.”

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