Letters to the Editor: codeine changes

In 15th January issue of The Northern Daily Leader Dr Ian Kamerman is quoted as saying there was ‘no evidence’ the doses used in over the counter (OTC) codeine products “made any difference at all” and it was ‘sub-therapeutic’.

I believe these statements are wrong as an Australian study has shown that 1000mg paracetamol combined with 30mg codeine phosphate (equivalent to two Panadeine Extra tablets) produced significantly greater analgesia than 1000mg paracetamol alone (equivalent to two Panamax or two Panadol tablets 1.

In addition, another study reported that 20mg codeine base combined with 400mg ibuprofen (equivalent to 2 Nurofen Plus tablets) produced significantly greater analgesia than 400mg ibuprofen alone (equivalent to two Nurofen tablets) 2.

At present both Panadeine Extra and Nurofen Plus are available OTC, and both have been shown to exert a greater analgesic effect than either paracetamol or ibuprofen alone.

Dr Kamerman is also reported as saying that real time monitoring for OTC codeine-containing products has been shown not to work because not all pharmacies do it.

At present over 70 per cent of pharmacies are using real time monitoring which allows the pharmacist to identify those people who may be misusing the products, and to offer them counselling and referral to a doctor or other health care professional for further assessment and appropriate care.

We must remember that doctors’ surgeries do not have a real time monitoring system for prescription codeine-containing products so there no way of identifying and helping those people who may be ‘doctor shopping’ to obtain multiple prescriptions for the products.

It makes no sense to change from a system where the small percentage of people who may be misusing the products can be identified and helped, to one where they cannot.

I believe the Government should introduce mandatory real time monitoring into all community pharmacies in NSW, and allow pharmacists to continue to supply low dose codeine-containing analgesics without a prescription for the treatment of acute, short term pain such as migraine, toothache and period pain.

This will allow pharmacists to identify and help those people who may be misusing the products, while at the same time allowing the vast majority of consumers who use the products appropriately and safely for the short term treatment of acute pain continued access to the products without a prescription.

Professor Peter Carroll 

School of Medicine,

University of Notre Dame

Discipline of Pharmacology

University of Sydney

  1. Macleod AG et al  (2002) Australian Dental Journal 47(2),147-151
  2. McQuay H.J et al (1989) Pain 37, 7-13


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