Medicare is set to suffer a massive cost blow-out as a little-known committee of public health bureaucrats tries to prevent consumers accessing codeine over-the-counter.
Yesterday, the Advisory Committee on Medicines Scheduling, which is part of the Therapeutic Goods Administration, issued an interim decision that would have all codeine products, even those with codeine as low as 8mg, banned from over-the-counter sale from July 1 next year, meaning they could only be acquired with prescription.
The result will be that for anything beyond mild pain that can be treated with paracetamol, a visit to the doctor will be required for a prescription, adding potentially hundreds of millions of dollars a year in Medicare costs (one estimate today is $170 million extra a year) and costing more in lost productivity as Australians wait to obtain products they can currently obtain with a trip to the chemist. The Australian Medical Association and the Royal Australian College of General Practitioners, unsurprisingly, welcome the interim decision, because it means more revenue for GPs as patients have to book more appointments.
But if you’re thinking of objecting to the decision, you’re wasting your time — the committee that made the decision says it doesn’t need to pay any attention to submissions from “stakeholders” who haven’t previously made submissions on the issue, meaning complaints from ordinary Australians can be binned by bureaucrats.
The Advisory Committee on Medicines Scheduling is made up of government-nominated health bureaucrats and academics and invited appointees, with just one consumer representative, and is not directly accountable to either the minister for health or Parliament. Its rationale for the ban appears self-contradictory. On the one hand, it concludes the “benefit is low” for codeine, which has a “relative lack of efficacy”. On the other, it complains that the product is being abused and can get people addicted. But the real rationale appears to be that the committee simply doesn’t like people making judgements about how to treat their pain without state regulation. “OTC [over-the-counter] intended for management of acute self-limiting pain, however, there is inappropriate use for chronic pain,” the committee concludes in its brisk bureaucratese.
For the vast number of Australians who use codeine responsibly to manage a variety of forms of pain, it’s a peculiar logic to be told that codeine doesn’t work, but also works so well that people get addicted to it, and they can’t be trusted to manage their pain anyway — even though it is possible to deal with those who want to abuse the drug. The Pharmacy Guild, which opposes the ban, says a real-time recording and reporting system has already been developed that could be rolled out quickly to help track people making serial acquisitions of codeine products.
Perversely, industry figures say, it may also lead to Australians consuming more codeine as doctors are more likely to prescribe products with higher dosages of codeine than what’s currently available over-the-counter — some pain relief products with low levels (like 8mg of codeine) are likely to vanish with the shift to prescription-only products of higher dosage, up to 30mg for a product like Panadeine Forte. Yet AMA vice-president Stephen Parnis told Fairfax the ban was justified because it would prevent “the loss of a young life from the misuse of an addictive medication like codeine”.
Most nanny-state interventions urged by the public health lobby come with a hidden cost to business. The codeine ban, however, will come at a cost of hundreds of millions of dollars to taxpayers — money that could be spent delivering real health outcomes elsewhere — and Australians enduring more pain to enable the warm inner glow of middle-class paternalists.