CONSISTENCY is sometimes difficult to find when it comes to lawmaking.
On the one hand, Australia along with the United States, is in the midst of a radical reappraisal of the marijuana plant, cannabis sativa. America, which once led the “war on drugs” has all but reversed its stance on marijuana, which is available over the counter in many states, both for recreational and medicinal purposes.
Things haven’t gone that far here yet, but the medicinal cannabis lobby is gaining political support, with all sorts of claims being made about its efficacy.
At the same time, however, authorities are tightening controls on the opiate codeine, which has long been used in cough syrups and pain pills. Pure codeine phosphate is a prescription-only S8 medicine but the Therapeutic Goods Administration decision on other codeine-containing medicines means a doctors’ prescription will be needed for anything containing codeine – no matter how little – from February 1.
In justifying its decision, the TGA says codeine is “a commonly used medicine of abuse”. It says long-time use carries potentially fatal health risks, and not only from overdose. It also says that “for most individuals, there is little evidence that low-dose codeine medicines are more effective than alternative medicines without codeine”.
If the third point, about codeine’s lack of efficacy at low doses, is correct, then perhaps the TGA should be asking why these products are on the market at all, especially if they are to require a visit to a doctor, or a nurse practitioner in remote areas without a GP. Despite this consideration, a lot of people believe these products work for them, otherwise they wouldn’t be selling in the numbers they do.
Yes, it is recognised that some sales will be to people who have become addicted to the codeine in these products, but history shows that restrictions on one drug almost inevitably result in the rise of use of another. And that will likely be the case here.
Making codeine prescription only will have its flow-on effects, and to the extent that this decision leads addicted users to seek treatment, then it should turn out to be a good thing.
On the other hand, no-one is suggesting that problem users are anything more than a small percentage of the overall market. In this regard, the decision makes things harder for the many, to control the few.