Where do doctor’s prescriptions end and pharmacists dispensing begin?

An article in news.com.au on Tuesday ( the 24th) has brought up an interesting question in my mind, where does the line exist between pharmacy dispensing of medications and requiring a doctor’s prescription?

The article describes the debate over restricting medications containing codeine to prescription-only, requiring patients wanting these medications to see their doctor’s first before obtaining the drug. The Thearputic Goods Administration was indicating a change in codeine-related products from pharmacy-dispensed to prescription in 2016, although debate over the issue is heading up as the deadline for the change is February next year.

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Pharmacy representatives state this would affect the quality of analgesic care for patients by requiring them to see their doctor first. Physician groups are stating that low-dose codeine found in these medications show on therapeutic benefit, and the restriction would prevent misuse. Politicians are stuck in the middle in wanting to satisfy both sides.

So what is the issue with codeine? It is addictive and potentially harmful in high doses. Codeine is an opiate, an analgesic similar to Morphine. Therefore, its properties of pain relief can lead to addiction if misused. The Sydney Morning Herald stated that 12% of Australians surveyed exceeded the recommended daily dose of analgesic medications containing codeine. While the codeine dose is quite small the issue with this worrying fact is the potential for overdosing on paracetamol and ibuprofen; both have potentially toxic effects if too much is in the human body. An article by NPS Medwise has shown that when codeine has been consumed to lethal levels, although being accidental in nature, the number of deaths are double that of deaths related to stronger prescription medication such as morphine.

So why take it away from pharmacists hands? Simply control and monitoring. Even in my role within a public hospital I see frequently patients who travel from one hospital to another asking for pain relief, sometimes discharging and presenting to multiple hospitals in the course of a day. I am sure that most pharmacists are very conscientious and ethically-responsible people. However, a patient could approach one pharmacy let’s say in the morning and buy a codeine-related product, and then travel to a completely different area in the afternoon approach another for more product. This individual may not even intend to do this, instead they may work in the city and travel from home in a completely different area by public transport. The second pharmacist would not have knowledge of the previous purchase and therefore would not question the transaction.

A doctor’s prescription requires individuals to physically see a doctor. A record of the prescriptions would exist and could be tracked. Additionally, higher consumption could trigger the doctor to investigate the reasons for the increased usage and try to eliminate the cause of pain in the first place.

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 While I have no issue with pharmacists as I think they are very competent and ethical practitioners I do support the moving the responsibility of codeine release from pharmacists to doctors.  Codeine is an opiate, and most opiates (along with other analgesics of similar strength) are classified as schedule eight restricted due to their addictive properties. The low doses of codeine and the toxic properties of the main ingredients (paracetamol and ibuprofen) mean that overdosing on these over-the-counter medications can lead to serious health consequences. Finally, as I stated above requiring a prescription can then lead a doctor to investigate, and hopefully treat, the source of pain rather than continuing to mask it through analgesics.

What do you think of codeine-related products requiring a prescription? Does it even matter to you?

Until next time,

Ray

News.com.au- MPs push to water down ban on codeine sales without prescription

New Scientist- Australia bans non-prescription codeine to fight opioid crisis

Therapeutic Goods Administration- Update on the proposal for the rescheduling of codeine products

Sydney Morning Herald- More than 2 million Australians exceeding recommended medicine dosage, worrying doctors

NPS Medwise- Codeine-related deaths: a cause for concern

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Can too much weed kill you?

 

The idea for this post came from a Facebook friend who indicated they were concerned about the US’s recent push to legalize marijuana, particularly in light of the chances of death from an overdose. Myself and another ED colleague had never heard of a death resulting from THC. So off to research I went.

Scouring the search engines I could find no credible evidence to say overdosing on marijuana has, in fact, been attributed to a death. Having too much marijuana can cause a number of unwanted conditions within the body which can make you VERY uncomfortable:

  • Temporary feelings of paranoia, fear and anxiety
  • Shortness of breath
  • Pupil dilation
  • Vomiting and/or nausea
  • Fast heart rate
  • Shaking that is hard to control, feeling cold
  • Disorientation or hallucinations
  • Hangover

But these symptoms are also common with other illicit and legal drugs, such as alcohol. Studies have shown that a person would have to receive a massive amount of THC, the active high-producing ingredient in marijuana, to die from it- this would equate to pounds being used at a time. Very unlikely.

So marijuana is harmless?

Not so fast! The question is whether you can die from a single overdose of marijuana. But just like other chemicals that humans used for pleasure marijuana can have serious effects which could indirectly lead to death. It is these items I think many are talking about when they discuss the dangers of marijuana consumption.

A report from Colorado USA where marijuana is legal has found that traffic fatalities with drivers showing marijuana in their system at the time of the accident rose by 154%! Hospital presentations were also mentioned as increasing due to marijuana consumption, however the evidence was not clear that marijuana definitely had an impact. School suspensions from marijuana use were also mentioned.

Marijuana also has shown long-term health affects in terms of memory and brain function. There can also be secondary effects from smoking the drug and there are associated birth defects when women who are pregnant use marijuana.

The bottom line…

The actual THC in marijuana can kill you if consumed in large enough quantities. However, obtaining and using those quantities will either land you in jail for a very long time or be practically impossible. There are no known attributed cases to anyone dying from consumption of marijuana.

However, there are dangers in misuse of marijuana. As with all other chemicals consumed by individuals to obtain a euphoric state marijuana can alter a person’s functioning and cause health concerns. Therefore, any use of this or any other substance must be done so with full knowledge of the effects. And there it goes without saying a careful review of current laws on consumption in your area.

Should it be legal?

The eternal debate in modern society. Like other legal substances marijuana has very negative side-effects both short and long term, however that has not stopped tobacco and alcohol from remaining legal. Some would argue that it is a ‘gateway’ drug and could lead to greater abuse. However we do not know the numbers of individuals who use marijuana and never progress to harder drugs, so how can we really know? Like alcohol marijuana can impair a person’s driving and other complex and fine motor skills. So policies and laws would need to be put in place outlining legal limits on consumption and operation.

There is growing credible evidence that marijuana is beneficial to relieving pain and other neurological symptoms. Therefore, I think it’s use as a medical alternative to stronger and harsher medications is welcomed. Especially if those with severe and chronic pain can be helped. These individuals are often struggling, and if allowing this avenue can bring relief then I am all for it.

As for the rest of us, I still don’t know. I will state for the record I have never used marijuana. I can see both sides of the debate, and I guess as I have gotten older my views have become more complex. While once very much against the idea now I am leaning toward society’s choice. There are some distinct advantages to legalizing marijuana.

  • Once legal safe limits on consumption can be placed.
  • Regulations on growing, processing, and distribution can be instated and ensure a safe product.
  • There will be a decreased demand from law enforcement agents in going after marijuana users and dealers.
  • Marijuana use can be taxed leading to revenue.
  • Legalization may also spark increased interest in investigating other medicinal properties.

So I guess I am on the legalizing side of the debate. I also can see the arguments with those who wish to uphold the laws against marijuana use. However, I do feel that they will be fighting a loosing battle in years to come.

References

Herb.com: Marijuana Deaths: How Many Are There?

Huff post: Here’s How Many People Fatally Overdosed On Marijuana Last Year

New Health Guide: Can You Overdose On Marijuana?

Family Council: Number of Deaths Caused by Marijuana Much More than 0

National Institute on Drug Abuse: What is marijuana?

 

 

 

Medical Marijuana, treatment or just an excuse to light up?

A trend amongst the medical community over the last few years is the use of medical marijuana. According to National Institute on Drug Abuse medical marijuana ” refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions.” Australia has joined 25 other countries in investigating and adopting the use of medical marijuana for treatment in certain patients.

While there is no doubt that recreational use of marijuana is illegal and harmful there have been some benefits shown around pain control and neurological disorders such as Parkinson disease. There are other well known and respected medications which have similar roots in illicit narcotics, opiates such as Morphine is a prime example.

In recent months the TGA has reported to have introduced a scheme to allow for importation of marijuana to allow patients to undertake treatment. The Age has also reported that Australia is following America’s lead in introducing university programs to teach cultivation, legislation and production of marijuana crops.

Is allowing medical marijuana leading our society down a slippery-slope and making it easier for individuals who want a high to obtain their product, thereby the government indirectly condoning it’s use? I think not. Symptom control is a difficult process in those with chronic or severe pain. If we can minimize the use of opiates and help better control pain and other symptoms through the use of marijuana than do we not as a society owe it to ourselves to take this opportunity?

I applaud the Australian government and the healthcare and academic community for continuing its progression to add this treatment to the arsenal available. While I do not believe that there are those who are naive to the fact that there will be nasty side-effects the benefits can outweigh the costs. At least allowing for the trials will give the medical community the information it needs to decide on its future use.

References used:

Drug Facts: Marijuana as Medicine

The Age: Australia’s first medicinal cannabis course to teach students ‘whole continuum’ of plant

News.com.au: Medical marijuana legal in Australia: What it means for you

Medical Daily: Medical Cannabis 2016: New Benefits Of Medicinal Marijuana