Dependence on over-the-counter (OTC) codeine-containing analgesics is a significant concern and can cause serious, sometimes life-threatening adverse effects due to the combination with paracetamol or NSAIDs, in addition to potential codeine toxicity.

In December 2016, the Therapeutic Goods Administration (TGA) announced the decision to transfer all codeine-containing products (analgesic and respiratory) to Schedule 4 from 1 February 2018. 

Current list of up-scheduled codeine containing products

Codeine will be included in the Schedule 4 medications to be monitored in the Victorian real-time prescription monitoring system (SafeScript) commencing in April 2019.  

People who previously used codeine-containing analgesics for relief of acute, short term conditions will be able to access suitable non-codeine products with advice from their pharmacist.

However, there may be many people presenting to their pharmacy requesting analgesics who will require referral to their GP for assessment of pain, condition management, and their level of codeine use.

It is important that the possibility of dependence is explored with the patient so that a suitable treatment plan can be developed. 

A clear practice policy on prescribing opioids can provide a consistent approach to managing patient requests and accountable prescribing of opioids. 

Consider assessing patient for opioid use disorder

What options are available?

Drug and Alcohol Clinical Advisory Service (DACAS)

Free 24/7 telephone consultancy service for clinicians, 1800 812 804

Medication Support and Recovery Service

Referral and other information: www.msrs.org.au or phone 1800 931 101.

The Medication Support and Recovery Service (MSRS) is a new service funded by EMPHN to assist people who have problematic use of prescription or OTC medications. These people often do not identify as ‘drug dependent’ and tend not to access traditional alcohol and drug services.

The MSRS is provided from Community Health Centres and is well positioned to support GPs to manage patients who have developed misuse and dependency problems with codeine.

The Community Health setting facilitates access to a range of co-located services including:

  • Individual and family counselling
  • Nursing and withdrawal support
  • Peer support and group programs

Referral and support to access:

  • Specialist addiction medicine and pharmacotherapy services
  • Residential withdrawal and rehabilitation
  • Other health services (physiotherapy, chronic pain services and sleep clinics)

The MSRS is an initiative of Connect4Health – a collaboration of community health services in inner east Melbourne, in partnership with Inspiro Health Service and healthAbility, to provide service coverage across the EMPHN catchment. 

Other options for GPs:

Consider prescribing pharmacotherapy for opioid dependence

  • All GPs can prescribe buprenorphine/naloxone (Suboxone®) for up to 5 patients without completing prescriber training
  • An S8 treatment permit and supervised dosing at a pharmacy providing pharmacotherapy service is required. Click here for prescribing guidelines
  • Support is available for new prescribers – contact your  Pharmacotherapy Area Network (see below)
  • There is opportunity for shared care with an Addiction Medicine Specialist
  • Request a QUM topic visit on De-Mystifying Opioid Replacement Therapy

Assist Patients to access Pain Management Services

  • HealthPathways Melbourne – Clinical Referral Pathways for Pain Management
  • A range of evidence-based online pain management courses are available

NSW Agency for Clinical Innovation – Pain Management Network

  • Information to enable consumers to develop skills and knowledge in the self-management of pain in partnership with healthcare providers 

eCentre Clinic Pain Course, Macquarie University. 

  • Free, online and internet-delivered pain management program to teach practical skills for managing the impact of pain on day-to-day activities and emotional wellbeing 

This Way Up - Online Multidisciplinary Pain Management Program

  • Requires clinician and patient registration. Patient cost for 4 months access to the eight module program is $59.00
  • Prescribed by health professionals as an adjunct to care or for those who are unable to attend a face-to-face pain management program.
  • Created by Clinical Research Unit for Anxiety and Depression and the Department of Pain Medicine, St Vincent’s Hospital, Sydney. More information here.

Education and events

1. RACGP Recorded Webinar The Implications of Codeine Rescheduling

Provides strategies on how to approach potentially tricky situations with patients who may have developed an addiction to codeine. Presenters: Dr Paul Grinzi, GP, Dr Michael Kozminsky, GP, Dr Ahmed Nagla, GP. 

2. Medication Assisted Treatment for Opioid Dependence (MATOD) – Module 1

Safer Opioid Prescribing

Two-hour on-line learning module to provide information and strategies for safer prescribing of opioids in chronic pain settings. Pre-requisite for MATOD- module 2. Available at any time

3. Medication Assisted Treatment for Opioid Dependence (MATOD) – Module 2

Full day work-shop to provide prescribers (GPs and Nurse Practitioners) with the skills and confidence to assess, manage and initiate patients on Opioid Replacement Therapy.

(Complete Module 1 online first). Successful completion authorises prescribing of methadone or of buprenorphine/ naloxone for more than five patients. 

4. TGA Workshops

Sessions delivered by leading specialists in acute and chronic pain management and addiction available as recorded video and transcripts.

Resources

            

Resources and links for prescribers

Resources and links for pharmacists

Resources and links for Allied Health and AOD providers

Other supports and resources

Contacts

Eastern Melbourne PHN: For more information on codeine scheduling changes contact Christine Bellamy christine.bellamy@emphn.org.au

Pharmacotherapy Networks: For assistance with establishing opioid replacement therapy services in general practices and community pharmacies.

South and Eastern Melbourne Pharmacotherapy Network

Jana Dostal

a4pn@semphn.org.au

North and West Melbourne Pharmacotherapy Network

Andrea Calleja

pharmacotherapy@cohealth.org.au

Hume Pharmacotherapy Network

Tim Griffiths

TGriffiths@primarycareconnect.com.au