Australia looks likely to upschedule (reverse switch) all codeine-containing medicines to prescription only with an interim decision just released, and due to be confirmed or rejected in November.
Australia and NZ have grappled with codeine for some time, upscheduling codeine-containing combination analgesics to pharmacist-only and limiting pack sizes in 2009. The committee, and Delegate (who makes the decision) look serious, citing a litany of reasons for the upscheduling which basically boil down to: abuse and misuse that cause harm, low efficacy, inappropriate use for chronic pain, and genetic variation that causes some people to get fast and extensive metabolism of codeine to morphine. It was also noted that ibuprofen-paracetamol was available as an alternative, although I’m sure a simple single analgesic will work for most.
Fortunately it also appears that naloxone for opioid overdose could be switched in Australia to pharmacist-only. Over 800 oxycodone-related deaths occurred in 11 years in Australians, 40% of whom were legitimately prescribed the product. In the US, nearly 7000 people per day present to emergency departments for inappropriate use of opioids, and 44 people die per day from prescription opioids. Prescribed opioids are a significant problem, and the reclassification of naloxone could save more lives than the upscheduling of codeine – especially if people currently using these OTC products get something stronger from the doctor if the codeine upscheduling goes through.
Natalie Gauld DipPharm MPharm PhD FPS RegPharmNZ, Auckland, New Zealand.