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Australian Journal of Pharmacy : May 2008
over the counter feATure | PAin ‘extreme’ move to restrict nurofen plus to s8 ‘These medicines play an important New restrictions on the availability of codeine-based pain relievers is not warranted, and moves to make it more difficult for consumers to purchase OTC medicines containing codeine were extreme and premature, according to a statement by the Australian Self-Medication Industry (ASMI), the industry body representing non-prescription consumer healthcare products. The comments came in the wake of the National Drugs and Poisons Schedule Committee’s (NDPSC) foreshadowed consideration, to be taken at its June meeting, whether to reschedule pain relievers containing ibuprofen and codeine to Schedule 8, a category reserved for drugs at high risk of being abused. ASMI’s scientific director pain confusion abounds But Ms Kahn saidthe analgesic category was confusing to customers. ‘There is no clarity between the different active ingredients (eg paracetamol versus ibuprofen), and there is no clarity between the advantages and disadvantages of each. ‘While we understand that, in theory, staff are supposed to explain it, in practice they don’t so it is very important to put more customers “in control”.’ Ms Kahn said the point of self- navigation was really not so much an easier self-service but more a question of prompting the customer to query or get an explanation. ‘There is an enormous opportunity Deon Schoombie said that OTC analgesics combined with codeine have a long history of safe use when used according to label instructions. ‘If Nurofen Plus is made a Schedule 8 drug, patients will need a complex prescription that must be copied, registered and locked in a safe by the pharmacist,’ he said. to not only differentiate the ingredient types and their uses, but also the levels of pain different preparations can alleviate,’ Ms Kahn said. The conundrum was that one particular pain product (for example, paracetamol) could relieve a number of different types of pain, so where do you put them? Could scattering the products in different areas around the pharmacy confuse customers? ‘It could look like a dog’s breakfast but it doesn’t have to—you need to have some careful planning to understand where you put the products and where you use information and ways in which you can cross-refer,’ Ms Kahn said. role in relieving mild-to-moderate pain and any move to restrict their availability would be an enormous inconvenience to thousands of responsible users. In particular, older people who suffer chronic pain, perhaps from arthritis, would be enormously inconvenienced,’ Mr Schoombie said. According to ASMI, the NDPSC is considering two elements associated with these codeine-based products, there appear to have been a very small number of anecdotal reports of increased misuse, ASMI said. The Pharmacy Guild of Australia has previously condemned the move, saying it would cost the nation millions of dollars and inconvenience thousands of legitimate patients. The chairman of the Australian Medical Association’s federal therapeutic committee, John Gullotta, also said patients wiLL need a compLex prescription that must be copied, registered and Locked in a safe by a pharmacist. medicines: how readily codeine can be extracted from products for the manufacture of illicit drugs, and the more general issue of abuse of these products. In relation to the issue of separation, there is no substantive evidence of codeine being diverted, so any further inquiry into this aspect would, therefore, seem to be of academic interest. In regard to alleged abuse of brand power GlaxoSmithKline category development manager analgesics, Ian Alexander said it was vital to maintain pain brand blocks. ‘Our shopper studies have shown people still associate with icon brands in the pharmacy and consumers are still tending to shop by brands first,’ Mr Alexander said. ‘Therefore, it is still important for pharmacies to have highly visible brand blocks as a beacon to help customers navigate through the various categories. ‘And two; have a general / all- purpose Pain Relief category to cater for the majority of customers. ’ he said. Mr Alexander said the concept of making the drug prescription-only would be an extreme move. ASMI said that healthcare professionals should always maintain a high level of vigilance— adverse reactions need to be reported to the Adverse Drug Reactions Advisory Committee— and pharmacists need to maintain a high degree of awareness about people buying large quantities. linking pain products with various health problems was one approach GSK had been looking at. ‘But if you are considering spreading the products around, you still need to maintain the brand block otherwise, you could lose the power of a brands’ identity at first sight,’ he said. Lost in space Crucial to all this, of course, was the issue of space. ‘As a pharmacist, it’s important to get the optimal mix of shelf space, relevant to the category in order to maximise returns,’ he said. Mr Alexander added the brand blocks themselves created a story of The AusTrAliAn journAl of PhArmAcy vol.89 mAy 2008 57