Pharmacists' views on the upscheduling of codeine-containing analgesics to 'prescription only' medicines in Australia

Abstract

Background Codeine is the most commonly used opioid worldwide, and is available over-the-counter (OTC) in many countries. There is continual debate regarding the risk:benefit profile for OTC codeine. In Australia, codeine containing analgesics became 'prescription only medicine' from February 2018. However, there is currently limited knowledge on the views of community pharmacists on this upscheduling and the perceived impacts on clinical practice. Objective To investigate the views of community pharmacists on the recent codeine upscheduling in Australia. Setting Community pharmacists in Australia, predominately recruited from Victoria. Method A descriptive cross-sectional study was conducted using a pre-tested customised anonymous self-administered online questionnaire between March and May 2018. To capture a broad range of demographics, pharmacists were recruited via local industry contacts and the Pharmaceutical Society newsletter, with further recruitment through snowball sampling. Main outcome measure Pharmacists' opinions to targeted questions regarding the perceived advantages and disadvantages of the recent 2018 codeine rescheduling from both their perspectives and their perceived impact on patients. Results A total of 113 pharmacists completed the survey. Approximately 43% of pharmacists agreed/strongly agreed that they believed upscheduling will positively impact their ability to manage pain; while 30% were neutral. Approximately 54% of pharmacists agreed/strongly agreed that they believed upscheduling will positively benefit their patients; while 25% were neutral. Perceived advantages for codeine upscheduling included: increased pharmacist/patient engagement, and less codeine use leading to better overall risk:benefit outcome; while disadvantages included: fewer analgesic options, and increased burden for patients, General Practitioners, and the health system. Conclusion This study showed that the current views on the recent codeine upscheduling are quite mixed, with both advantages and disadvantages perceived. Improving education and up-skilling in this space is essential.

Keywords: Australia; Codeine; OTC; POM; Pharmacists’ views; Prescription-only; Upscheduling.