Thu. Jul 7th, 2022

‘A tsunami of pain’: Changes to codeine availability shed light on hidden epidemic of addiction

When you think about drug addicts, an “upper-middle class” massage therapist doesn’t fit the stereotypical profile.

But just a few months ago, Leah Dwyer was taking at least dozen tablets each day of Mersyndol, addictive codeine pain pills that she was easily able to get from her local pharmacists.

Push to make codeine painkillers prescription-only

The 53-year-old Sydney woman had been left with an extremely painful neck condition after she tripped running backwards at a mothers’ race at a school sports carnival.

Worried about taking prescription drugs, she looked for something weaker and found codeine pills, widely and simply available over the counter.

Ms Dwyer says in the years she misused the drugs, frequenting five different pharmacies in her neighbourhood, she never realised she was addicted.

“I just thought it was inconvenient,” she said.

Leah Dwyer keeps active despite living with chronic pain.Leah Dwyer keeps active despite living with chronic pain. Photo: Supplied

Come February 1, they could face literal withdrawals, as they find they can no longer access them – at least without a trip to the doctor.

Customers will need a prescription to buy codeine-containing painkillers or cold and flu medications, drugs which for years have been sold in their millions to Australians, and become household names in the process.

It’s a significant change that will force a major shift in the way Australians treat their pain.

Melbourne pharmacist Jarrod McMaugh says brand names like Panadeine have become as commonplace in pharmacies as Vegemite is in supermarkets.

“And in the last 10 years Nurofen (which does not contain codeine) and Nurofen Plus have had a big impact as well,” Mr McMaugh said.

“It means people coming in expect that’s what they’ll need for their pain.

“Most people request the codeine-type products, because it’s what they familiar with.”

Melbourne pharmacist Jarrod McMaugh.Melbourne pharmacist Jarrod McMaugh. Photo: Jason South

Despite its popularity, codeine is not recommended for use more than three days in a row, and experts now say there is little evidence that codeine tablets are better than the alternatives, paracetamol and ibuprofen.

The addictiveness of codeine means that some people have taken up to 100 tablets a day, which they have collected over the counter from multiple pharmacies.

Abuse of the drug can cause liver damage, stomach perforations, internal bleeding, kidney failure, heart attacks and hypoventilation (often side effects of the high doses of other drugs mixed with codeine).

There have also been a number of deaths directly linked to codeine misuse.

Australia’s drug regulator, the Therapeutic Goods Administration, said its decision to ban over-the-counter sales of codeine “took into consideration compelling evidence of the harm caused by overuse and abuse”.

A family who wrote to TGA said their son would drink the entire contents of a 200 millilitre bottle of cough syrup in one sitting several times a week, or alternatively, buy 48-tablet packs of Panadeine Forte or similar pills.

“Please count us as a family devastated by the over-the-counter supply of codeine products to teenagers,” they wrote.

Products impacted by the change will include popular painkillers Panadeine, Nurofen Plus, Mersyndol, and cough and flu products sold under brands including Demazin and Codral.

While some suppliers will continue producing their drugs with the expectation they will be prescribed by doctors in the future, others have reformulated their products without codeine, or abandoned their lines completely.

Panafen Plus, Panadeine, Panadeine Rapid Soluble and Panadeine Extra will be pulled from the Australian market, while there have already been reports of pharmacies running out of supplies of over-the-counter codeine.

Pharmaceutical Society of Australia president Dr Shane Jackson, said over-the-counter codeine stock had been very limited at most pharmacies since November.

 “I think we’d be lucky to have 20 boxes of stock left in our pharmacy,” he said.

It is a huge change when you consider Australians are estimated to buy more than 20 million packs of low-dose codeine every year.

While most customers who buy the drug only do so occasionally, the 20 per cent of people taking it for chronic conditions bought an estimated three quarters of the packets, according to the TGA – which means the vast majority of the products are probably being used incorrectly.

The public is being urged to talk to their pharmacist or doctor about alternative treatment or drugs (likely paracetamol, ibuprofen or a mixture of the two) in the lead up to the change in February.

Some people may be able to ditch medication entirely with physiotherapy, exercise and psychological treatment, according to pain specialists like Associate Professor Malcolm Hogg.

Professor Hogg, a Painaustralia​ board member and head of pain services at the Royal Melbourne Hospital, said there were also safer and more effective medications for those with “opioid responsive pain”, including buprenorphine or tapentadol, which are “less dependence forming”.

GP and doctor groups have said that they will not prescribe stronger drugs when they begin to treat former over-the-counter codeine users, despite alleged efforts by drug lobbyists to fill the void with other addictive products.

Royal Australian College of General Practitioners president Dr Bastian Seidel​ confirmed that “certain drug companies” had been promoting even stronger prescription opioids, such as oxycodone and endone, as substitutes for codeine.

“It is the last thing we need,” he said.

Dr Bastian Seidel has warned of lobbying from drug companies eyeing new business opportunities. Dr Bastian Seidel has warned of lobbying from drug companies eyeing new business opportunities. Photo: Supplied

Dr Seidel said GPs were well aware of the dangers posed by opioids, which in the United States were fuelling the deadliest drug crisis in the nation’s history.

“We can’t follow the nightmare scenario that America is going through now,” he said.

“Opioids are never the first choice treatment for any medical condition. There is a very limited role of opioids for pain management.”

While the codeine overhaul has the broad support of the medical profession, it has not been without controversy, facing resistance from some pharmacy groups, including the Extended Hours Pharmacies Association who say it could lead to people flooding emergency departments late at night.

It has also garnered plenty of outrage from the Australians who use low-dose codeine for short periods, including for period pain, and are upset about cost and inconvenience of a doctor’s visit.

In Sydney, 60-year-old Karen Baines said she often took Nurofen Plus or Mersyndol to treat her knee and ankle pain, and had already tried Panadol and Panamax with no satisfactory effect.

Karen Baines is very worried about the codeine change. Karen Baines is very worried about the codeine change. Photo: Fiona Morris.

The disability pensioner said she was worried that she would be left without medication on the weekends, when her local doctors did not bulk bill, as she could not afford to pay the gap.

“I’m going to have to be in pain until the Monday when I can go to the doctor and not get charged a fee,” she said.

Ms Baines said she expected February 1 to result in absolute havoc at GP clinics.

“I’m telling you now, you won’t be able to get in to see a doctor,” she said.

Over the past four months Leah Dwyer has been able to wean herself off codeine, after she heard her pills would no longer be available over the counter.  She went to visit one of her pharmacists and told her: “I have a problem, please help me”.

It was only as she tapered herself off the drug, transitioning to Panadol and ibuprofen, that she realised how addicted she had become.

“The little voice in my head that said ‘Just go get some codeine’ was there for the entire time,” she said.

Ms Dwyer said she hoped pharmacists and doctors had been trained to deal with “this tsunami of pain” that would flood in from February 1.

“Because I know they’re out there and they are normal people.”



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