Codeine Rescheduling – implications in general practice

Codeine Rescheduling – implications in general practice

02 January, 2018
  • There is little evidence that low-dose codeine medicines are more effective than alternative medicines without codeine.
  • Codeine containing analgesics are not appropriate for long-term use, but public consultation reveals many consumers use them long-term, including for sleep, anxiety and stress.
  • There is substantial evidence of harm from the misuse and abuse of low dose codeine-containing medicines.

Prepare your practice response for:

  • Patients who may not fully disclose extent of overuse
    • Be alert to the risk of prescribing paracetamol 500mg/codeine 30mg (e.g. Panadeine Forte®) to people previously taking over-the-counter ibuprofen/codeine analgesics. Self-titrating to established codeine doses can lead to serious paracetamol hepatotoxicity (i.e. paracetamol dose exceeding 2g/Kg or 10g daily).
  • Telephone requests for codeine containing analgesics
    • An appointment is advised to assess reasons for use, perceived benefits, pain, current management and level of codeine use.
  •  Patients presenting with symptoms of opioid withdrawal
    •  There is a well-defined pattern of withdrawal symptoms (see Appendix 2 of National Guideline for Medication Assisted Treatment for Opioid Dependence.)
    •  Some patients may only need assistance with withdrawal and no further treatment if they are well supported, highly functional and determined to prevent relapse.
    • Some patients may only need assistance with withdrawal and no further treatment if they are well supported, highly functional and determined to prevent relapse.
    • For most, the risk of relapse is very high, so after withdrawal they may need ongoing treatment. Withdrawal is usually regarded as only the first step in the process of addressing opioid use and dependence.
    • EMPHN has funded the Medication Support and Recovery Service (MSRS) to support consumers with codeine-dependence in a community health setting. The free service is taking referrals 1800 931 101 www.msrs.org.au.
    • Pharmacotherapy Networks provide support for provision of Opioid Replacement Therapies in general practice.

More information and resources at www.emphn.org.au/codeine.