Access to Nurofen Plus, Panadeine and other common painkillers sold to millions of Australians each year could soon be curtailed by health authorities amid reports of harmful side effects, addiction and fatal overuse.
Australia's drug regulator is considering a proposal to make about 150 codeine products prescription-only medicines, meaning they could no longer be freely purchased over the counter at pharmacies and would require a visit to a doctor.
Medicines affected by the change could include Codral Original Cold and Flu Tablets, Aspalgin Soluble tablets and Mersyndol Tablets, which are marketed for short-term pain such as headaches, toothaches and period pain.
Although many people use the drugs safely in recommended amounts, doctors say an increasing number are suffering severe gastrointestinal damage and internal bleeding from taking excessive doses of ibuprofen, which is often mixed with codeine, a weak but potentially-addictive opioid.
In 2013, Monash University researchers reported nine deaths over a decade linked to toxicity from codeine-ibuprofen medicines such as Nurofen Plus.
Codeine addicts swallowing up to 100 tablets a day have been known to visit multiple pharmacies to get around rules introduced in 2010 that restrict purchases of more than five days' supply of the drug at one time.
Recent government agency data shows the number of Australians being treated for codeine addiction more than tripled over the decade to 2012-13, from 318 to more than 1000 a year. But Matthew Frei, addiction medicine specialist and clinical director of Turning Point Alcohol & Drug Centre, said this figure probably vastly underestimated the number of problem users as many patients who abused drugs were not detected.
In response to these concerns, a July meeting of the Therapeutic Goods Administration's Advisory Committee on Medicines Scheduling will discuss whether codeine drugs should be made "schedule 4" drugs that require a doctor's prescription. They are currently "schedule 3" medicines.
While Australian Medical Association Victorian branch president Tony Bartone said he personally supported the idea of making codeine a prescription only drug, the Pharmaceutical Society of Australia and the Pharmacy Guild of Australia opposes the proposal. It says governments should instead be investing in real-time prescription monitoring systems to better detect people abusing the drugs.
Pharmacy Guild Victorian president Anthony Tassone said pharmacists were qualified to determine who could purchase codeine products over the counter and who should be referred to a doctor for further discussion.
"For pharmacists to supply schedule 3 medication including codeine they need to establish a genuine therapeutic need," he said.
Australian Self Medication Industry executive director Deon Schoombie said forcing people to go to their doctor for codeine tablets ran the risk of them walking away from their GPs with even stronger drugs.
"It just shifts the problem [to doctors]. Does it solve the problem? I doubt it," he said.
But pain medicine specialist Dr Michael Vagg said codeine purchased over the counter was in such low doses that some people may find themselves taking more and more to produce meaningful pain relief.
Furthermore, he said up to 30 per cent of people do not have the right enzymes in their liver to process codeine, meaning they will not experience pain relief when taking it but will experience other side effects.
"You could certainly make a case that it's not valuable enough and that it's too harmful," said Dr Vagg, a senior lecturer at Deakin University Medical School.
"If you have severe acute pain and the simple analgesics are not cutting it, you are better off going to your doctor to get a diagnosis and prescription. With persistent pain, that advice is even more important. Trying to manage long-term persistent pain with lots of doses of short-acting analgesics is not the best approach."