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NICE is due to publish draft guidance on the assessment and management of chronic pain in the coming weeks, with the final guideline planned for August of this year.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