THE CASE
Pressure has been put on the Australian National Drugs and Poisons Scheduling Committee to consider rescheduling all codeine containing compound analgesics to Prescription Only Medicines (also called Schedule 4). There is even a body of thought that these products be reclassified as Controlled Substances (Schedule 8), because of their addictive potential. They would then have the same status as morphine, dexamphetamine and methadone.
The reason given for this proposed change is that, as compound analgesics containing codeine are available over the counter (Schedule 2 or Schedule 3 depending on Australian State law), there is very little control over them and therefore there is a potential for opiate addiction. For example an addicted person can easily buy a packet of Nurofen Plus, each tablet of which contains 200 mg of ibuprofen along with 12.5 mg of codeine phosphate, but in order to placate their opiate addiction this person would need to take an effective overdose of the ibuprofen component. Unfortunately ibuprofen, along with all the other non-steroidal anti-inflammatory medicines (NSAIDs), causes gastric irritation with the potential for life threatening complications such as duodenal perforation.
Naturally, users (as opposed to abusers) of these analgesics will not be pleased with this proposed change, they will need to see a doctor to obtain a prescription for the relief of a minor, short term, self-limiting complaint. These products are especially useful for treating the severe pain associated with toothache, backache, period pain and severe headaches.
Doctors are unlikely to be pleased, they are already overworked, they do not need this extra patient load.
Pharmacists are already displeased, they are set to lose a major tool in their therapeutic armory, most of their patients who buy strong over-the-counter analgesics really do not need medical intervention.
Medicare (ultimately us taxpayers) will be a loser too. Many of the patients who will seek prescriptions for simple pain relief will be eligible for bulk billing. In addition the doctors are likely to write prescriptions for Pharmaceutical Benefits Scheme (PBS) listed items rather than the non-subsidised over-the-counter analgesics.
Pharmaceutical companies are annoyed, they will lose revenue. Currently over-the-counter medicines are priced according to the free market. But PBS listed items are priced according to a much lower Government imposed formula.
MY VERDICT
Its lose-lose-lose-lose-lose. Why bother to make this change to attempt to help an unknown but very small number of opiate addicted persons? The public benefit really does seem to be on the status quo side of the equation.
If Nurofen Plus is the particular culprit, as indicated in a blog site, then lets make it prescription only, don't generalise this to all over-the-counter mixed analgesics.
NOTES
Other products potentially affected include: Aspalgin, Codalgin, Dolased, Fiorinal, Mersyndol, and Panadeine.
Pressure has been put on the Australian National Drugs and Poisons Scheduling Committee to consider rescheduling all codeine containing compound analgesics to Prescription Only Medicines (also called Schedule 4). There is even a body of thought that these products be reclassified as Controlled Substances (Schedule 8), because of their addictive potential. They would then have the same status as morphine, dexamphetamine and methadone.
The reason given for this proposed change is that, as compound analgesics containing codeine are available over the counter (Schedule 2 or Schedule 3 depending on Australian State law), there is very little control over them and therefore there is a potential for opiate addiction. For example an addicted person can easily buy a packet of Nurofen Plus, each tablet of which contains 200 mg of ibuprofen along with 12.5 mg of codeine phosphate, but in order to placate their opiate addiction this person would need to take an effective overdose of the ibuprofen component. Unfortunately ibuprofen, along with all the other non-steroidal anti-inflammatory medicines (NSAIDs), causes gastric irritation with the potential for life threatening complications such as duodenal perforation.
Naturally, users (as opposed to abusers) of these analgesics will not be pleased with this proposed change, they will need to see a doctor to obtain a prescription for the relief of a minor, short term, self-limiting complaint. These products are especially useful for treating the severe pain associated with toothache, backache, period pain and severe headaches.
Doctors are unlikely to be pleased, they are already overworked, they do not need this extra patient load.
Pharmacists are already displeased, they are set to lose a major tool in their therapeutic armory, most of their patients who buy strong over-the-counter analgesics really do not need medical intervention.
Medicare (ultimately us taxpayers) will be a loser too. Many of the patients who will seek prescriptions for simple pain relief will be eligible for bulk billing. In addition the doctors are likely to write prescriptions for Pharmaceutical Benefits Scheme (PBS) listed items rather than the non-subsidised over-the-counter analgesics.
Pharmaceutical companies are annoyed, they will lose revenue. Currently over-the-counter medicines are priced according to the free market. But PBS listed items are priced according to a much lower Government imposed formula.
MY VERDICT
Its lose-lose-lose-lose-lose. Why bother to make this change to attempt to help an unknown but very small number of opiate addicted persons? The public benefit really does seem to be on the status quo side of the equation.
If Nurofen Plus is the particular culprit, as indicated in a blog site, then lets make it prescription only, don't generalise this to all over-the-counter mixed analgesics.
NOTES
Other products potentially affected include: Aspalgin, Codalgin, Dolased, Fiorinal, Mersyndol, and Panadeine.
8 comments:
Several of my colleagues pop Nurofen Plus pills as if they were lollies. It alarms me; people need much more or better education about the uses of Nurofen plus versus, say, aspirin (as in the case of one workmate who takes N+ the minute he feels a headache coming on, for chrissake, and then wonders why nothing works for him when he's in genuine pain).
But restrictions are not going to work on the people they're intended for. A person in severe pain would rather do anything than sit in a doctor's waiting room under fluorescent lighting just to hit them up for a codeine prescription. But a run-of-the-mill over-the-counter codeine junkie might see this as a perfectly fit use of her time. Meanwhile, we need to move away from the "Hi Doc, I need a script for Drug X" mode of healthcare, not towards it.
And the minute they heard the news, my colleagues raced out to buy bumper packs of Nurofen Plus for the possibly upcoming rainy day. Sigh.
Hail,
I'm a long way from an expert, but I don't know that your confidence in your conclusions is entirely justified. It's very difficult to add up each side of the ledger in cases like this.
For example, I saw two young people in three years brought into ED with perforated duodenal ulcers associated with nurofen plus use - and that was one small ED in a small city. One patient was okay but one required a very long period in ICU and emerged with considerable impairment. I am not saying this to tug at anyone's heartstrings, but it is difficult to determine how many people with untreated toothaches you would have to add to the other side of the ledger to balance out that particular patient. She was in the ICU for almost fifty days and continues to require a high level of care.
One approach to look at would be to calculate how much nurofen plus "costs" us versus how much it "benefits" us - and that'd be a mammoth task. You'd have to try to try factor in days off work with period pain on one side of the equation versus deaths from endoscopies gone wrong on the other, and so on.
My own opinion is that combination medications are sometimes (not always) a bad idea. You gain in compliance and decreased rates of medication errors, and there are also drugs with added benefits like like suboxone, but you lose in the ability to appropriately target a particular medication to a particular condition. It's interesting that you can get nurofen plus codeine more esily than you can get pure codeine.
I don't know that making something schedule 8 is the answer - flunitrazepam is a lot harder to get, but that is not only due to it being S8 - but I think there are better ways to manage nurofen plus prescribing than what we've been doing.
Just my thoughts. This is a complex area.
Everyone seems to have an abuse horror story re over-the-counter painkillers.
However, DOH stats do not bear out the current level of panic over the problem.
It's hard enough for pensioners, unemployed and the working poor to afford medication(a doctor's visit and prescription cost or payment to GP for script request over the phone and prescription cost) as it is.
I'm becoming rather tired of all the manufactured moral panic which is around at the moment.
It is all starting to sound like a chorus of political dog whistles.
I have been taking mersydol for a long time i have a slight addiction to them but without them i would kill myself. I suffer from hedaches, migraines, bulging discs in spine , nerve damage in spine and missing a ball joint on my jaw.Its hard to explain why im in so much pain i have a verry high pain tolerance my spine isnt as bad as it sounds it doesnt affect me that much but add all the problems together then i have a problem.If i could not get mersydol to treat these problems i would have definetly killed myself i just cant handle the pain its bad enough even when i take mersyndol i still dont want to talk to my friends go out for dinner spend time with friends the pain is just so bad i cant talk think concentrate ect.3 months ago my doctor put me on mersydol forte because i was taking so many mersydol i felt better for a little while thought i would get more of my life back by taking stronger pain killers but it dont work like that but atleast i can smile and have a laugh now.If ihad to buy mersydol on perscrption all this time im not sure if i would have made it this far i would have definetly thought about suicide or smoked marajuana. marajuana is fine for the pain but i still ended up with really bad migraines so their was no point in smoking it .
Hi Revstar,
I'm sorry to read that you are in so much pain, and I am sorry that you may be addicted to codeine.
But by taking Mersyndol and Mersyndol Forte at least you are avoiding the digestive system damage caused by the Nurofen in Nurofen-Plus.
michelle from surrey - well i am totally lost, i have a very addictive personality that i hate but hey reading your messages kinda helps - but deep down, in there - not really!! i wish and prey my life will be diferent!!! its not tht easy - the people u thought u wer close to all of a sudden disappeared, your family r there but when they choose too be!! in this life we r olone - sad!!!
just hang in there and please get help for your addictions as i am - its shit!! but i know i want better, a better life!
take care you all .....mwah. xxx
x
hey guys i have a question i took 2 packets of the mesydol night strenght nd got taken to hospital in ambulence nd they said that i could go either way die or live well they discharged me that night but its been three days now nd i stil feel tired with no energy nd got diareah nd sore stomach do u rekon im dying??
Dear anonymous
I don't think you have done yourself a favour.
You have taken 20 grams of paracetamol and toxicity starts at 10 grams or 200mg/kg of bodyweight.
You must get further medical advice immediately.
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