Dr Hartley Atkinson Codeine Dangers Interview

Are consumers getting appropriate advice about their use of codeine from doctors?

New survey shows that majority of people seeking codeine from their doctor are not being offered or advised about alternatives.

The survey, commissioned by AFT Pharmaceuticals, also showed that almost all of those who have been to doctor for a codeine prescription are still receiving codeine in some form – 65% the same codeine product as they were taking before; 33% a different or stronger codeine-based drug.

Fewer people have switched to alternatives than anticipated. A significant proportion have gone to their doctor in search of continued codeine (28%) plus others have stockpiled over-the-counter codeine products before the scheduling change (18%) and will be facing decisions around seeking alternative over-the-counter pain relief or visiting their doctor for codeine on prescription over the coming months.

The survey was of over 200 people who, pre-February, had been codeine buyers and raises questions regarding whether post-rescheduling Australia is moving in the right direction when it comes to the appropriate use of opioids for pain. It also indicates that prescribers could benefit from more support in this area.

"Long-term pain sufferers were less likely to have switched to a non-codeine drug," claims pharmacologist and CEO of AFT Pharmaceuticals Dr Hartley Atkinson. "It's troubling because in such people there's little evidence for effectiveness and a higher risk of dependence and side effects. Consumers need to be aware of the significant risks and dangers.

"It begs the question, given the reasons for rescheduling OTC analgesics, are consumers getting appropriate advice about their use of pain relief?"

Results of the survey showed:
The primary factors for consumers in choosing pain relief are strength and speed (overall efficacy).
18% of those surveyed have stockpiled codeine and will face a decision as to what to do about alternatives in coming months.
28% of patients are going to doctors for codeine despite the reason for rescheduling being limited efficacy of codeine and potential for harm. Two thirds of these patients are getting the same codeine pain relief they were taking previously and one third are getting a different or stronger form of codeine for pain relief from their doctor.
80% said that their doctor did not suggest an alternative pain killer that does not contain codeine.
Whilst 67% of those surveyed only required pain relief for short term pain like headache and period pain, doctors continue to provide codeine despite primary reasons for rescheduling including the limited efficacy of codeine and the potential for harm and dependence from its use.

"People are looking for trusted advice about codeine alternatives for their pain relief, whether they are doing their own research online, going to their pharmacy or even their supermarket. If going to see their GP it's important for consumers to ask about non-opioid alternatives, the efficacy of codeine and the risks in using it.

"However, not everyone wants or needs to pay for a doctor's visit. It's important to remember that pharmacies offer effective non-opioid alternatives for short-term, acute pain that most consumers are seeking relief from. In the survey results, pharmacists and pharmacy staff were shown to be the most influential combined source of professional advice for people who had switched to non-codeine alternatives and the largest proportion of respondents (34%) have sought an alternative from a pharmacy. They have a very important role to play in educating consumers and are a good and accessible source of professional advice for consumers."

"Ultimately, it's important that we head down the right path post codeine rescheduling. Consumers need to be empowered to ensure they are seeking advice and asking the right questions to find the best pain relief alternatives for their needs," finished Dr Atkinson.

Interview with Dr Hartley Atkinson

Question: Are you surprised about the results from the AFT Pharmaceuticals commissioned study?

Dr Hartley Atkinson: The results of the survey commissioned by AFT Pharmaceuticals included:
• The primary factors for consumers in choosing pain relief are strength and speed (overall efficacy).
• 18% of those surveyed have stockpiled codeine and will face a decision as to what to do about alternatives in coming months.
• 28% of patients are going to doctors for codeine despite the reason for rescheduling being limited efficacy of codeine and potential for harm. Two thirds of these patients are getting the same codeine pain relief they were taking previously and one third are getting a different or stronger form of codeine for pain relief from their doctor.
• 80% said that their doctor did not suggest an alternative pain killer that does not contain codeine.
• Whilst 67% of those surveyed only required pain relief for short term pain like headache and period pain, doctors continue to provide codeine despite primary reasons for rescheduling including the limited efficacy of codeine and the potential for harm and dependence from its use.

It wasn't surprising that the primary factors for consumers in choosing pain relief are strength and speed, as this basically means that people are looking for products that provide fast, effective pain relief. However, given the dangers of codeine and the reasons behind recent changes requiring a prescription for codeine, it was surprising that many people said doctors did not suggest an alternative pain killer that does not contain codeine.


Question: What are the dangers associated with codeine?

Dr Hartley Atkinson: Most Australians are unaware that low dose codeine (<30 mg) containing medicines used for pain relief offer very little additional benefit when compared with medicines without codeine. However the use of these medicines is associated with increased health risks, such as developing tolerance or dependence on codeine. This happens because over time codeine becomes less effective and so the body needs higher and higher doses to feel the same relief. People can develop severe withdrawal symptoms when they stop taking the medicine, such as insomnia, nausea, vomiting, head and muscle aches, and diarrhoea. People can mistake withdrawal for the symptoms that low-dose codeine products are often used to treat, leading to people incorrectly continuing to take the medicine longer or in higher doses.


Question: Are consumers getting appropriate advice about their use of codeine from doctors?

Dr Hartley Atkinson: A new survey commissioned by AFT Pharmaceuticals shows that 80% of people who have gone to the doctor for a prescription for codeine have not been recommended an alternative. This is despite the serious issues of limited efficacy and potential for harm that were a key pillar behind the government's decision to reschedule over-the-counter codeine products earlier this year.

The survey, also showed that almost all of those who have been to doctor for a codeine prescription are still receiving codeine in some form – 65% the same codeine product as they were taking before; 33% a different or stronger codeine-based drug.

Given the risks, it is important that consumers are empowered to ensure they are seeking advice and asking the right questions to find the best pain relief alternatives for their needs.

Question: Why do you believe it's important to have codeine alternatives offered?

Dr Hartley Atkinson: Pain management is a complex issue that can affect every aspect of a person's life including their mental and social wellbeing. Given the significant risks of codeine it is important for people to be aware that alternatives are available.


Question: What codeine alternatives are there?

Dr Hartley Atkinson: For acute, short-term pain, there are more viable alternatives for pain relief such as paracetamol or ibuprofen and ibuprofen/paracetamol combinations – without the risks of misuse and abuse that can arise from a dependence on codeine-based products.

For long-term pain, it is important for people to discuss a pain management plan, and in some cases a mental health plan, with their GP. Effective chronic pain management requires a holistic approach that embraces a combination of medical, physical and psychological therapies. It involves a team of health professionals who will comprehensively assess a person's condition and work with them to achieve their goals using a range of treatments and strategies.


Question: How are these alternatives as effective as codeine?

Dr Hartley Atkinson: The low dose codeine-containing medications which are now available only by prescription are not intended to treat long-term health conditions. Evidence suggests that there are many safer and more effective alternatives, both pharmaceutical and non-pharmaceutical, available to help manage persisting pain. Recent research has also shown that low doses of codeine do not provide any more pain relief than products that do not contain codeine. Evidence in acute pain suggests paracetamol/ibuprofen combinations may frequently offer better pain relief than either component alone.


Interview by Brooke Hunter
Photo by rawpixel on Unsplash