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Experts call for action on OTC codeine ahead of first NICE chronic pain guideline

Experts advising NICE on its first-ever guideline on chronic pain have raised concerns about over-the-counter codeine.

NICE is due to publish draft guidance on the assessment and management of chronic pain in the coming weeks, with the final guideline planned for August of this year.

Some experts on the committee have called for a ban on OTC codeine sales, but others raised concern about the workload implications this could have for GPs.

Speaking with Pulse, Dr Jens Foell, a GP and honorary senior clinical lecturer at Imperial College London, who is on the guidelines committee said: ‘I don’t like OTC codeine because it builds a culture of pill popping and I’m aware of people who are really dependent and addicted to codeine. 

‘But I don’t know how many people use it and I also don’t know what it would mean to take it away in terms of increased demand on GP practices so there may be a price to pay.

‘Personally I think a public health campaign would be better.’ 

He also cautioned against the use of stringent targets for practices to reduce prescribing as it could harm patients not ready to stop taking them.

‘It would need to be about doing reviews and doing them properly and not just as a tick box exercise,’ he said.

The NICE guidance is part of a raft of recent reports looking at the prescription drug addiction and the dangers of opioids.

A Public Health England review published in October last year pointed to significant issues with some medicines including opioid painkillers.

The Medicines and Healthcare products regulatory Agency has also set up an Expert Working Group to review the benefits and risks of opioid medicines with the aim of cutting overprescribing and drug misuse.

Dr Foell added that GPs were frustrated as some invest a lot of time in patients who were dependent on painkillers but there was not much evidence on what to offer instead.

‘There is often lots of comorbidity and there is a lot to do with welfare support and that’s a large unmet need.

‘Everyone is aware of how huge the scale of this problem is, when medication is more of a problem than a solution. But there is not much evidence to base your practice on.’

Instead the current model of pain services should be overhauled with a central role for GPs as the experts providing holistic care as they do in other chronic disease management, argued Dr Foell.

‘We need to change how we provide pain management and look at other models we have for chronic disease management with regular recalls and an ongoing health relationship.

‘At the moment, people are going round in circles because it is a chronic condition with ups and downs.’

He added that the GP is the expert because chronic pain is so linked with other co-morbidities, mental health and social problems that don’t get addressed in secondary care.

‘It needs to be funded or it won’t happen. This needs to be a normal part of GP work and there needs to be something in the contract that this is part of normal treatment.’

 

Readers' comments (5)

  • er, OTCs, isn't this a pharmacy issue? They've done this already in Australia..... and yes, it did result in more consultations from people who use codeine even if only infrequently....... so I predict it will increase GP demand in the UK.....
    https://ama.com.au/media/drop-codeine-sales-vindicates-over-counter-ban

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  • why don't you have a OTC prescription, paid for by the patient, for such drugs, get from a GP to check re other script interactions, 12m script for monitoring by a pharmacist for over use, can only get from that pharmacist. ban GPs from prescribing gabapentin, pregbalin and sleeping tablets - consultant scripts only under shared care agreement for which we get paid a fee to provide. morphine only for palliative care and acute once only , long term only from a pain specialist. GPs get paid a fee for every patient they wean off z meds, morphine and other controlled drugs. Not difficult to sort out.

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  • Australia has all the sensible laws. They passed a good samaritan law to stop people being prosecuted for helping.eg. RTCs.

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  • Dr Jens Foell starts by saying "I don't like OTC codeine because......." Does this mean that a freedom for millions of people to buy OTC codeine has to be taken away? Not everyone doing so is abusing codeine. Maybe if Dr Foell "doesn't like OTC codeine" he simply shouldn't buy it. He doesn't have to become a self-appointed nanny telling everyone else what to do. This country has too many nannies telling us all what to do. Believe it or not most people are perfectly able to make their own decisions without control by the Dr Foell's of this world.

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  • While appreciating the potential of addiction to OTC codeine, anyone who's serious about it gets it from the GP. An OTC ban could even increase the number of people on 30mg tablets.
    What do we have to offer in chronic pain? No availability of psychological services, opioids are out as are gabapentinoids. Paracetamol and NSAIDS don't work. Pain clinics have little to offer most other than a long wait.Seems like capsaicin cream and a lidocaine sticking plaster are all we have to offer. Maybe a public info film telling joe public that GPs have nothing to offer would be most helpful.

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