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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Australian drug names to get an overall in keeping with international standards

According to an article published on the GIZMODO website by Rae Johnston the Therapeutic Goods Administration (TGA) is planning to change the name of approximately 200 medications in Australia over a seven year period to better align with the international community. According to the article the TGA determines the approved names for medications, however in some cases the names may deviate from the internationally known name as identified by the World Health Organization. During the transition period the TGA will insist that labels show both the old and new medication names.

There is a website setup by the TGA acknowledging the name changes and listing some of the medications names which will be changed. Most will stay relatively the same with only minor variations due to the differences of spelling. Interestingly enough the TGA website was published in November, 2016 and the article in GIZMODO published yesterday. I wonder if there is a delay in the name-change process?

References

GIZMODO: 200 Australian Medications Are Getting A Name Change

Theraputic Goods Administration: Updating medicine ingredient names – list of affected ingredients

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