What do pharmacists see when you purchase codeine OTC

[Poss]

Thanks Willow your so right for the first time ever I am sticking to my tapering plan with knowledge I'm finally towards the end I have even come clean with my personal trainer who has agreed to work with me through this he has said as long as I get to the session he will work with me so even if all I can do that day is walk slowly on the treadmill then so be it! I can't tell you how the support I have from here and the people in my life is spurring me on to succeed. At work I have told them I am coming off some medication (did not go into detail left the impression it was anti depressants) and they have offered to put my counselling through our EBA and have agreed to support me through this change - I know how lucky I am to have such supportive people in my life and I don't take this for granted I guess what I'm trying to say to others is you don't know what will come when you decide to quit I never in a million years would have expected or even thought what has happened for me would have happened I thought it was more likely people would turn their backs, I'd loose my job and my family but if anything it has been the opposite so if anyone is struggling with this issue like I am I know how scary it is honestly when the whole MedsAssist change occurred without warning I had no idea what to do and thought my life as I know was over and now I honestly feel like my life is just beginning again take this time we have to make a change and do something while there still time I don't know when Medassist will become law but I know it will be sometime soon there is a government meeting about the issue in June so I wouldn't be surprised if it closely follows
Please don't get me wrong I know I'm in for hard time and this won't be easy that I'll have to deal with PAWS but for the first time I know I'll be better off in the long run I cursed MedsAssist when I first heard about it but now I feel like it could have given me the kick up the backside I so needed x

 

[swilow]

^I think this system will be of some benefit to you and other addicted peoples. I really hope people don't resort to using stronger legal opiates like poppyseeds or illegal ones like heroin, or maintenance methadone. That will be disastrous. For me, this system removes some pull to random opiate use. I think ill keep going with use once or twice a month.

From my own experience and my brothers, this program seems very widespread now. Various forms of ID can be used.

A pharmacist I go to sold and recorded purchases three days apart. I found that odd...

But, according to my brother, this was an anomaly. He has had a few purchases rejected.

 

[Poss]

Confirmed from June 1st all pharmacies will be asking and recording so those in my situation I would begin to make plans

I can tell you that I have received my elimidrol which you continue to taper then job off after one week - I can tell you my intake is greatly reduced (down to about 100mg) it is holding me so I can get to work and be productive which is all I care about at the moment I have booked a week off next week and have prepared everything so I guess time will tell but once I'm over this hurdle I have decided to request they place a note next to me on the system not to sell I never want to go through this ever again!

 

[pharmarat]

Not yet a registered pharmacist, but nearly there. I've been working in various pharmacies for a few years now, so thought I'd share my thoughts and experiences. Project STOP has been used to record sales of codeine for at least the past few years. It's not strictly legal, but a lot of pharmacies do it anyway. It allows us to see what you purchased and on what dates, as well as any instances where you were denied a codeine product or it was sold to you as a 'safety sale' i.e. The pharmacist was concerned for his/her safety if they refused to sell it to you - while (thankfully) relatively uncommon, it is something we see, and is a gigantic red flag. Now that we have MedsASSIST, most pharmacies will be switching over to that. However, it is only a trial at the moment. My understanding is that the Guild has trialled this database as a way to see if tracking codeine purchases can curb overuse or 'inappropriate' use as an alternative to re-scheduling as S4. Getting grilled by the pharmacist or an assistant seems to be a pretty common theme, but the reason I ask people questions about their pain is so that I can offer a safer, more efficacious alternative. I treat every request as legitimate, even if I knew what you were going to ask for from the second you walked in the door (we're pretty good at predicting that). Being an S3 med, the pharmacist legally has to make a decision as to whether it is therapeutically approriate, and the only way to do that is to ask questions in exactly the same way a doctor would. The doses of codeine you get in those combination OTC products is basically useless from a therapeutic perspective - No better than paractemol/ibuprofen alone, but with more side effects. It's usually at that point that I can determine how someone is using their codeine...the info from Project STOP or MedsASSIST usually just backs this up. Btw, we're looking for a pattern in usage rather than a set number of days since your last purchase. If I pull up your history and it shows 50 purchases over the last 24 months, I know what you're up to, regardless of whether or not the last purchase was yesterday or two weeks ago. It's very rare for me to refuse a sale though, and most pharmacists are the same. We know you're not using codeine therapeutically. We know about cold water extraction. We know not to sell the gel cap variety. We also know that if we don't sell it to you, you'll go down the road and buy it elsewhere, probably in a larger pack size (we only sell small packs for this reason) and without question. So, we'll sell you a small pack, reinforce the '3 day maximum' thing, and let you go about your day. I also try not to put people off from coming back, as I don't want to discourage anyone from coming in and asking for help if they need it. We've had a few people go from regular purchases of codeine or fitpacks to suboxone/methadone, and occasionally a request for codeine will turn into a request for help. Our biggest concern is always for your safety - the thought that we could be selling you something that could seriously harm your health can be really distressing, and is not the job we signed up for. I've known of people who have done serious damage as a result of ibuprofen/paracetamol overdose, so if I think it's appropriate, I'll point out that the maximum daily dose relates to the non-codeine component in the hope that I might at least minimise the harm. Please also consider that this is something that we deal with multiple times a day, so sometimes we get just as frustrated with the situation as the people purchasing it. I'm completely open to any suggestions as to how we can improve the way we go about this process (except for not asking questions and just handing it over - I'm not going to do that). That all being said, if you come in with an elaborate and completely ridiculous story as to why you need PainStop Night...I'll most likely respond with an elaborate and ridiculous story of my own.

 

[Verybuffed]

I play hockey and get banged into the boards weekly so always have new injuries. My pharmacist has always sold me codeine regularly without any hassles. Codeine definitely treats me therapeutically in the OTC doses.

 

[Poss]

Hey Pharmarat thank you for your response, although from my posts it may not seem this way I actually agree with the whole medsassist thing - I hate the situation I have managed to get myself in, wish I'd never started and believe that this system will hopefully help people avoid the situation I'm in now. I also view this as giving me a massive kick up the backside to actually do something about it - if this change had not come along I would have gone on my merry way until something really bad happened. I also figured that pharmacists knew what was going on and only wish I had taken the help offered rather than being to embarrassed to actually admit my problem. I do have one question for you - now that I have almost managed to kick this I don't want to ever be in this position again is it an option to have it noted not to sell to me? I realise this may seem dramatic and silly but I've come so far and don't want to have a bad day and fall backwards if that makes sense?

 

[pharmarat]

Codeine definitely treats me therapeutically in the OTC doses.

How do you know for sure that the pain relief you're getting isn't a combination of the other ingredient and the placebo effect? Current evidence shows us that the numbers needed to treat (i.e. the number of people you need to treat in order to achieve pain relief in one person) is higher for codeine products than for other analgesic combinations, and that the minimum effective dose is 25-30mg (2x Panadeine Extra will get you to this minimum provided that you're not one of the 10% of people who are unable to convert it to morphine). Nowhere in the therapeutic guidelines does it suggest the use of Panadeine or Nurofen Plus for pain, because there are more efficacious treatments available with fewer side effects. Most pharmacists know this, but will choose the path of least resistance and just hand over the codeine, because we know we're fighting a losing battle. If someone can prove otherwise (anecdotes don't count), I'll change my view...but until then I'll always recommend the treatment with the best evidence.

 

[pharmarat]

I do have one question for you - now that I have almost managed to kick this I don't want to ever be in this position again is it an option to have it noted not to sell to me? I realise this may seem dramatic and silly but I've come so far and don't want to have a bad day and fall backwards if that makes sense?

Hey If I were you, I'd find myself a good pharmacist who is open-minded, and talk to them. Then just stick with that pharmacy. It is really easy to put a note in the dispensing software to say not to sell codeine to a particular patient (it'll only be visible at that pharmacy), but normally the S3 sale process doesn't involve the dispensing software, so it might not be noticed. MedsASSIST allows you to enter notes as well, but I'm not actually certain that these come up when someone else enters the license number. It's a pretty good idea though (as an opt-in system obviously) so I might actually make that suggestion. I'm really interested in finding ways for pharmacies to become more involved in harm minimisation, possibly as access points to other resources such as drug & alcohol counselling, regular counselling, drug information etc.

Edit to add: The ethics of the MedsASSIST program is tricky, because I really do understand that people want and need privacy. I also know that anyone in the midst of an addiction is likely to despise the program...I guess I wonder if people do appreciate that kind of monitoring once they're on the other side, like you do? The other thing I would hate is for OTC codeine to become unavailabe, and for everyone to just switch to using something else - what's the point of that? What I'd love to see is more resources available to people who are having a shitty time, BEFORE they get addicted to anything i.e. trying to minimise use that stems from other problems (mental health or otherwise). I feel like that might work a lot better than trying to catch people once they are using.

 

[spacejunk]

The ethics of the MedsASSIST program is tricky, because I really do understand that people want and need privacy. I also know that anyone in the midst of an addiction is likely to despise the program...I guess I wonder if people do appreciate that kind of monitoring once they're on the other side, like you do? The other thing I would hate is for OTC codeine to become unavailabe, and for everyone to just switch to using something else - what's the point of that? What I'd love to see is more resources available to people who are having a shitty time, BEFORE they get addicted to anything i.e. trying to minimise use that stems from other problems (mental health or otherwise). I feel like that might work a lot better than trying to catch people once they are using.

Great posts, pharmarat. I really appreciate your perspective from the "other side" of most of the experience of most of the posters here.
Thanks for taking the time to explain - and to muse with us about the logistics - and merits - of this system.
Very interesting and highly useful for our community. Thanks

 

[Harry boals]

Hey all first post.

Ive ended up here after being able to buy OTC codiene products freely for the last couple of years until last week when I was refused for the first time. From there after some googling I've found out about medsassist.
On one hand I'm glad it's come about as Its given me a reason to quit. I wouldn't say I have a huge habit ( 8 panadiene xtra, 8 nurofen plus mixed /day ) but it'll be pretty shit come off none the less.
On the other hand abit of fucking notice wouldn't of gone astray rather than being cut off promptly so I could at least prepare and do it on my own terms.

Anyway as a heads up to anyone else in my situation -
On the MedsAssist webpage it states that only the ID number on the photo identification is recorded. No name, address, photo or anything.
Well Monday I used my drivers licence to buy a box from a pharmacy I'd never been to before. Today I tried to use my Medicare card with a work ID with only my name and photo on it, thinking that Monday they would have used my drivers licence number and today they would use my Medicare number.
I was refused as they knew that I had bought yesterday and from what pharmacy.

As I said I'm glad for the kick up the arse to quit but I hate being lied too.

 

[pharmarat]

On the MedsAssist webpage it states that only the ID number on the photo identification is recorded. No name, address, photo or anything.
Well Monday I used my drivers licence to buy a box from a pharmacy I'd never been to before. Today I tried to use my Medicare card with a work ID with only my name and photo on it, thinking that Monday they would have used my drivers licence number and today they would use my Medicare number.
I was refused as they knew that I had bought yesterday and from what pharmacy.

I'm going to check this out next time I'm working. I use MedsASSIST but this sounds really odd. Only thing I can think of is that both pharmacies were actually using the Project STOP database instead...but that doesn't tell you which pharmacy it was bought at. If you were in the same area though, it's entirely possible that one of the staff was at both pharmacies (pharmacy staff often move around a lot). I can think of a few instances where that has happened.

 

[spacejunk]

If you were in the same area though, it's entirely possible that one of the staff was at both pharmacies (pharmacy staff often move around a lot). I can think of a few instances where that has happened.

Other concerns aside, the privacy issues this raises are a tad troubling...

 

[Harry boals]

I'm going to check this out next time I'm working. I use MedsASSIST but this sounds really odd. Only thing I can think of is that both pharmacies were actually using the Project STOP database instead...but that doesn't tell you which pharmacy it was bought at. If you were in the same area though, it's entirely possible that one of the staff was at both pharmacies (pharmacy staff often move around a lot). I can think of a few instances where that has happened.

Im 100% certain it was different staff with both pharmacies. They were 2 small pharmacies with only the pharmisist and maybe 2 counter girls. The second pharmacy could tell me what brand pharmacy and what suburb It was in from the previous day.

 

[swilow]

^That is Project Stop at work. Given that it is unethically obtained information, it really irritates me that pharmacists make judgements based on this.

Great posts pharmarat. Thanks. I have a question, is a student card (photo ID) acceptable? I'm told it is and isn't.

 

[Poss]

Hi Pharmrat thank you for the suggestion I do have a pharmacist who I believe would assist me with this and will definitely talk to them - I've finally got to the point that I'm just about to jump off and have them arranged drug addiction counselling for myself since I don't want to end up back here ever again!

I can understand how people who weren't aware of medsassist feel I was quite lucky and was actually originally told the law had changed from 1 May then somewhere else told me 1 June anyway there are still a handful of independent pharmacies close to my home and work not recording so I have been able to taper right down and book time off work to deal with the withdraw with the support of my family - I truely appreciate how lucky I am! As if I'd had to go straight CT that would have been hideous

I actually believe this program is a good thing as I would hate for anyone else to go through what I am right now but I also agree that there should be more help available or at least available that is easily accesiable I think changing everything without advising people especially when your changing it because of concern of people abusing the meds could potentially lead to a lot of very unwell people who may seek relief from a stronger drug I think the whole thing could have been handled a lot better by making where to go for help easy to find - in my own case I am in a position that I can afford to pay for my counselling so it wasn't that difficult to arrange but people who are not in a position to do so would find it really hard to figure out what to do to stop and may just switch to another drug because it's easier which isn't a good outcome!

 

[pharmarat]

I have a question, is a student card (photo ID) acceptable? I'm told it is and isn't.

There's actually a discussion on a particular pharmacy fb group about this right now, specifically about what to do if someone doesn't have ID. It's pretty much up to the pharmacist (or store) to decide on a policy regarding what is an acceptable form of ID, although I'd say the consensus is for something state-issued. I suspect the rules regarding this will tighten up pretty soon though. We always get people saying they don't have ID, or giving us outdated ones...I personally really don't enjoy policing this sort of thing, and I think having strict rules helps a lot of pharmacists feel a bit better about the situation. No ID = No sale just makes things easy for us.

 

[pharmarat]

I actually believe this program is a good thing as I would hate for anyone else to go through what I am right now but I also agree that there should be more help available or at least available that is easily accesiable I think changing everything without advising people especially when your changing it because of concern of people abusing the meds could potentially lead to a lot of very unwell people who may seek relief from a stronger drug I think the whole thing could have been handled a lot better by making where to go for help easy to find

I'd love to see more resources available to people, and pharmacies seem like such a perfect place to access that...provided we don't scare people off with this whole 'us vs them' mentality. I absolutely agree that counselling should be much more easily accessible (for everyone, not just drug users!). No reason why pharmacists can't get a qualification in drug & alcohol counselling! It's certainly something I'm keen to do.

Regarding MedsASSIST, I'm definitely going to be making much more of a conscious effort to explain why we record codeine sales - I agree that this is really important and is something we should be doing more of.

Also, I just want to say that what you're doing now is amazing. Good luck and don't give up!

 

[The_Masochrist]

ive been an addict probably 11 years now, ive tapered off successfully when i need to travel and when im overseas its out of sight and mind and im fine. when i come back the pharmacies are everywhere and its all too easy. im glad the med assist program is coming in. I was wondering if anyone is certain is on a deadline when this comes into effect for all pharmacies? Big chains require ID but smaller ones i can still get my codeine. I'm currently on 150mg a day, and tapering one pill a day until my holiday, i have enough on stock and can rotate 3 seperate IDs to comfortably taper off. I use my liscence, my new passport and my expired passport. I could also obtain an over 18 card but that will probably prolong my problem. I will probably remove the unique id from the expired passport so that i only have 2 to rotate through.

PAWS is going to be a big thing with me, can anyone recommend good counseling resources? I saw a drug counselor a few times years ago, it just didnt help, they said stuff like just take a walk when you get cravings, yeah right, walk straight to the pharmacy. I remember i first got hooked on the stuff becuase of migraines, the euphoria felt great and it felt like all my mental health problems were cured, when people were saying that nicotine is more addictive than heroin, i thought this would be a peice of cake to quit, well at my worst i was on 200 tablets a day CWE, that was two weeks of hell. i was a naive 21 year old back then. well i quit smoking just fine but opiates are a tough nut for me, and ive vowed to never try anything stronger.

anyways, given my situation, i believe i can taper off, i have decent stocks and have a holiday targetted where i was going to taper off anyway. can someone give advice for my situation? a good counselor, subs even? im in NSW if that makes a difference.

 

[Poss]

Thank you so much Pharmarat - I have been planning this for 2 months now and even though next week is going to suck in a strange way I'm excitied I feel like I'm finally getting a fresh start and closing the door on a really hard part of my life - this is my final hurdle and I am determined to beat it! I took your suggestion and spoke with my pharmacist and he has agreed to work with my providing I give my word to only go to that pharmacy, so I have arranged my scripts to go there direct and left him holding my repeats - so I have no reason to go anywhere else! I have started counselling so getting support there as well.

If its ok with everyone I would like to post next week as I go through this - I just wasn't sure if this is the right thread?

The Masochrist I'm in Melbourne so dont have a recommendation for Sydney, however I can tell you that close to my home I have a private mental health facility who had a department that was able to help me - I'm not sure if there is anything similar in Sydney. I have been doing a lot of research on PAWS as it is a huge concern of mine as I already struggle with anxiety and depression, I have come up with a game plan that I'm going to use and am happy to share it with you - I have no idea if it will actually work but I have basically taken all I have learnt and incorprated it into a 2 month plan - including counselling, regular exercise, making regular plans (I'm a reader so have joined a book club), accupuncture and a few other things in other words just keeping myself busy!

 

[swilow]

Poss, definitely keep us posted, I wanna help you as you through this. You are not alone, neither the first nor the last to experience this. I'm excited for you, you are about to reclaim your life. Trust me, withdrawal from codeine is managable. Feel free to PM me at anytime.

You could also check our recovery forums for advice...