All codeine-containing medications could be prescription-only from next year
Common painkillers such as Nurofen Plus and Panadeine could soon require a doctor's prescription after a shock decision by Australia's drug regulator.
From June next year, about 150 codeine products may no longer be available "over-the-counter" at pharmacies.
Medicines affected include Codral Original Cold and Flu Tablets, Aspalgin Soluble tablets, Mersyndol tablets and a number of cough and cold medications which can be bought at chemists with no current restrictions.
The interim decision by the Therapeutic Goods Administration follows escalating concerns over deaths and internal injuries caused by the abuse of popular drugs that mix codeine, a weak but potentially addictive opioid, with ibuprofen or paracetamol.
The TGA found a 2010 decision to charge pharmacists with dispensing the drugs had not done enough to stem the problem.
"Codeine is increasingly a drug of abuse in Australia," the TGA ruling stated.
With no way to track those visiting multiple stores, pharmacists have been struggling to identify addicts taking up to 100 painkiller tablets a day. People using drugs such as Nurofen Plus should take no more six tablets every 24 hours and only use it for a few days.
The interim ruling has been backed by the Australian Medical Association, addiction specialists and the Australian College of General Practitioners, which said the change would "save lives".
But industry groups including the Pharmacy Guild of Australia will fight the decision, saying it would be "unlikely" to curb addiction, create more work for doctors and disadvantage the majority of people who use the products safely.
Pharmacy Guild National President George Tambassis said a "real-time" system that tracked codeine individuals were buying would do more to prevent painkiller abuse – an initiative backed by the AMA.
Meanwhile Australian Self Medication Industry chief executive Deon Schoombie estimated the change would cost Medicare $170 million a year because of unnecessary doctor's appointments.
But national AMA vice president Stephen Parnis backed the TGA's judgment. "This about the patient's interests, not the people treating them," he said.
He said the change could mean people would be more likely to seek medical advice for codeine addiction, particularly "accidental addicts".
"If that means more expenditure so be it but the loss of a young life from the misuse of an addictive medication like codeine is astronomical to the community in social as well as economic terms," he said.
Industry groups will be able to make submissions on the TGA's interim ruling, before a final decision is made in late November.
The move has the support of a number of community pharmacists who have faced abuse when questioning people's demand for codeine tablets.
Irvine Newton, chairman of the Pharmaceutical Society's harm minimisation group, said having codeine products available in pharmacies had "been a disaster by any stretch of the imagination".
Often those who become hooked on the tablets had no history of drug abuse but accidentally became dependent after taking more than they should, he said.
Mr Newton has seen growing numbers of people so addicted to over-the-counter medicine they had been placed on drug treatment programs.
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.
Mr Newton said there were some alternatives to the low-dose codeine tablets, such as ibuprofen and paracetamol combinations, that were more effective for treating pain.
Codeine is not available over the counter in the US, most of Europe, Hong Kong, India and Japan, but about 1.3 million packets are sold at pharmacies around Australia every month.
