Jan 22, 2018

Codeine Ban: What Does This Mean for Aged Care?

There is a major change coming soon to over-the-counter medications in Australia – soon people will not be able to get any products containing codeine unless they have a prescription.

Over-the-counter drugs that contain codeine include Nurofen Plus, Panadeine or Panadeine Extra, Mersyndol and their generic equivalents.

Codeine is an opiate used to treat pain, as a cough medicine, and for diarrhea. It is typically used to treat mild to moderate degrees of pain.

These changes are slated to take place February 1st – which is a little more than a week away.

One of the challenges of codeine is that it can potentially lead to dependence, and can be addictive.

Australia’s drug regulator the Therapeutic Goods Administration(TGA) made the decision late last year.

According to them, “Research has found that over the counter, low-dose medicines with less than 30mg of codeine, when used for pain relief, has very little additional benefit compared to similar medicine without codeine.”

“Given the high levels of risk and the relatively low levels of therapeutic benefits, the Therapeutic Goods Administration has made the decision that codeine products need the oversight of a doctor.”

Codeine and Aged Care

Pain is often underdiagnosed and undertreated in aged care, so it’s understandable that people with a loved in aged care may be concerned about changes to the availability of pain medication.

It should be noted that anyone already on a prescription will not be impacted by the changes.

In aged care, the recommended course of pain manangement goes;

  1. first try to manage pain with non-opioid analgesics such as paracetamol and/or non-steroidal anti-inflammatory drugs (NSAIDs), plus or minus adjuvant analgesics.
  2. If the pain is persisting or increasing, weak opioids are introduced to manage pain. These can be combined with non-opioid analgesics, plus or minus adjuvant analgesics.
  3. Then, if pain is still inadequately controlled, strong opioids such as oxycodone or buprenorphine are used, potentially in combination with non-opioid analgesics

It has been suggested, but the TGA,  that prescribers – doctors, nurse practitioners – and pharmacists will be the first allied health professionals to notice the changes in the codeine restrictions.

People with genuine pain concerns should first speak to their doctor about alternative options that are available to them.

Alternative options may include other over-the-counter medicines, prescription medicines or non-drug therapies from allied health professionals.

It should be noted that many people will be able to manage their acute pain with other non-codeine medicines.

However, for residents with chronic pain, they may be referred to a pain specialist or to a pain management clinic.

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  1. After working in aged care for the better part of my 35 year nursing career, I am getting to the opinion that aged care is to hard for the system to be interested in. Not a lot of residents are usually prescribed codeine based medications in aged care and it isn’t the sort of thing most in aged care would pop down to the local chemist to pick up.

    However It is fine to say that those with chronic pain should be refereed to a pain management specialist. the wait in the public sector for a pain specialist clinic I have been told whilst researching for a family members is over 18 months.
    You may be able to access a private pain specialist in 3 months but then don’t have access to the multi disciplinary team approach.You have multiple out of pocket gaps at private hospitals where they work, which those on limited income usually cant cover anyway.

    I agree that codeine has an addictive risk however the depression levels in those with chronic pain and the impact this has on their quality life and enjoyment has not been considered. it is reported that 52% plus of people in aged care suffer depression already, worsen their pain and it will increase.
    To add injury to this fact because of the fact that resident in aged care facilities are government funded they are not eligible to services under the better access mental health policy. So they have depression,we say they cant have codeine based medications, so their depression gets worse due to worsening pain and poor quality of life but we cant support them with psychotherapy, because the government is all ready supporting them and their mental health doesn’t seem to matter.

    Implementation of plans like these need to be thought through and the flow on affect and impact taken into better consideration. If you are going to stop something and expect another area of the health service to pick it up then extra funding needs to be forth coming before the event not after it.

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