NZ pharmacists concerned about codeine-based analgesics

An independent survey of New Zealand pharmacists has revealed that many pharmacists have significant concerns about over-the-counter (OTC) codeine-based analgesics.

Company founder and Managing Director, Dr Hartley Atkinson, says that AFT Pharmaceuticals wanted to know the extent to which New Zealand pharmacists are concerned about the risks associated with codeine-based analgesics, and their openness to alternative non-codeine products.

“The views of pharmacists here are really important,” said Dr Atkinson. “They know this category of product intimately, and they are the experts that people rely on for advice around OTC pain relief options. If they have concerns around codeine-based products, then our industry needs to know about it”.

AFT Pharmaceuticals contracted Dart Public Affairs in Wellington to undertake the survey. No mention was made in the survey of AFT Pharmaceuticals or its codeine-free analgesic Maxigesic®. The survey had 493 responses. The results of the survey showed that:

• 70% of respondents said they were either somewhat concerned, or very concerned, about the potential for adverse consequences resulting from the ordinary use of codeine-based analgesics.

• 98% said they were either somewhat concerned, or very concerned, about the potential for adverse consequences resulting from the misuse of codeine-based analgesics.

• 74% either somewhat agreed, or strongly agreed, when asked whether they thought codeine combinations are used too often by consumers and patients in New Zealand.

“These results indicate that a number of pharmacists have real concerns about the use of codeine- based analgesics,” said Dr Atkinson. “Nearly all respondents have concerns with the potential for abuse of these products. Plus over two-thirds are concerned about dependence risks resulting from ordinary usage – in other words, people using the product as directed.”

The results mirror concerns being expressed in media reports both here and overseas as to the increasing prevalence of codeine dependence resulting from OTC codeine-based analgesics. Questions are also being asked of the value codeine adds to analgesics. Jennifer Pilgrim and Olaf Drummer of Monash University recently concluded that there is little evidence that combining low- dose codeine with simple analgesics provides more than a trivial benefit for pain relief.[1] Ross Tsutuki, editor of the Canadian Pharmacists Journal and a professor of medicine at the University of Alberta, has suggested that the addition of codeine to analgesics brings very little in the way of medicinal benefits, but brings with it quite significant risks.[2]

Dr. Atkinson says the results of this survey give AFT Pharmaceuticals a lot of comfort. “It was clear to us quite a few years ago that codeine would become a serious issue. So we built Maxigesic® from the ground up to create an effective OTC painkiller that doesn’t use codeine. We’re now in the fortunate position of having a trusted and effective non-codeine analgesic at the same time as the safety and efficacy of codeine is increasingly under the spotlight”.

According to Dr Atkinson, one of the most interesting results from the survey was the willingness of pharmacists to be open to newer OTC analgesics that do not rely on codeine-based ingredients.

When pharmacists were asked in the survey whether paracetamol-ibuprofen combination products could be a suitable alternative to codeine-based combinations, 72% of respondents either agreed or strongly agreed.

“This shows that pharmacists are quite open to products that take a different approach from how things have been done in the past. Frankly that’s very encouraging for us as a company given that our emphasis has always been on innovation and thinking outside the box.”

1 Jennifer Pilgrim and Olaf Drummer “In reply: Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia” Medical Journal of Australia 2014; 200(3): 150151.

2 Jennifer Yang and Diana Zlomislic “Canada’s invisible codeine problem” Toronto Star (17 January 2015).