My name is Adrian Reynolds.
I am the Clinical Director of Tasmania's Alcohol and Drug Services and I'm the President of
the Royal Australasian College of Physicians chapter of addiction medicine.
As of the 1st of February 2018 all compound analgesics containing codeine will no longer
be available over the counter and they now require a doctor's prescription.
I'm here today to talk to GPs about how to manage patients who present or are referred
to them as a result of recent up-scheduling of codeine containing medicines.
As a doctor specialising in addiction medicine I see and am very aware of the wide ranging
harms associated with these medicines and they include an alarming increase in the number
of over dose related deaths and a range of other medical harms.
I therefore strongly support the recent up-scheduling of these medicines.
This is a rich opportunity for GPs to provide high quality care to their patients who are
finding themselves in difficulty as a result of using these medicines.
In diagnosing opioid dependence the key indicators are a loss of control, patients describing
a craving and compulsion to use, continuing to use despite a range of harms including
medical harms and also obtaining and using these medicines becomes more important than
other life priorities.
If this is the case the GP should remain non-judgemental but have a clear and honest discussion with
the patient about what is going on in their lives, the problems that these medicines may
have contributed to and work through how the GP can assist the patient to arrive at a better
treatment plan that is safer and that is going to be more effective for them.
In assessing the patients who present with problems related to these medicines the first
thing is for the GP to assess whether there is evidence of sedation or intoxication or
opioid withdrawal signs and symptoms.
That gives the GP a very good head start in determining whether they can treat the patient
safely and with confidence or whether they may need to consider a referral to an addiction
medicines specialist.
There are a range of tools that are also available to GPs and these tools will be made available
on the website.
They include a codeine screening tool, there is a clinical opioid withdrawal scale that
doctors can access and that gives them objective signs to examine for in the patient and there's
a scoring regiment that goes with the COWS and that gives them some indication of the
presence and the level of dependence and there are a range of other drug and alcohol
related assessment tools.
For example, the audit tool that patients can actually self administer in the waiting room
to assess whether there are other drug and alcohol problems, in this case an alcohol
dependence and then there are further tools such as the ASSIST, which is a WHO tool, to
assist the presence of other drug problems in the patients.
That assessment allows the GP to have more global assessment of whether this patient
has and the extent of their drug problem and also informs them whether they can they can
treat the patients themselves or once again whether they need the advice or direct support
of more specialised drug and alcohol services.
If a GP is waiting for their patient to be seen by an addiction medicine specialist the
first key consideration is patient safety.
Patient safety really depends on what medicines the patient's actually been taking, how much,
for how long and related harms that may have already arisen.
Also, of course other medical and mental health issues need to be assessed and considered.
It's really important that the doctor not jump to prescribing other psychotropic medicine
that alter the way people or their patients think, feel or behave.
What we don't want doctors to do is jump to prescribing other medicines that are low value
and high risk.
The reason these medicines were up-scheduled was to address that very problem.
Once your patient starts seeing an addiction medicines specialist it will be important
for you to remain involved in their care.
Not only the treatment of their other medical conditions but the treatment and management
of their opioid problem that has been identified.
It will be really important for you to continue working in parallel with the addiction medicines
specialist and to be providing coordinated care with the patient's best outcomes.
With the states and territories there are specialist drug and alcohol services and doctors
who specialise in addiction medicine and GPs should be forthcoming in contacting those
specialists services and health professionals for advice and indeed what GPs will find is
those specialists services are very keen to up-skill GPs to provide training and support
to them.
There aren't enough addiction medicine specialists in the country to see every patient who presents
with an alcohol or other drug problem so it really is vital that GPs do up-skill and develop
their confidence to assess and manage patients presenting with codeine problems and other
drug and alcohol problems.
This is really a rich opportunity for doctors to help patients whose lives may being dominated
by their addiction.
It's an opportunity for doctors to free patients from the chains of addiction and help them
to get on with their lives.
It's a chance for doctors to help patients achieve better health outcomes today and into
the future.
To learn more about the codeine rescheduling decision visit nps.org.au/otc-codeine