Tough checks for codeine buyers

People who want to buy codeine-based painkillers will face probing questions from their pharmacist under proposals aimed at deterring drug addicts.

New Zealanders spend more than $13 million a year on the popular medicines, including Nurofen Plus and Panadeine, which are commonly used to treat the likes of headaches, back pain and toothache.

Within weeks, the Health Ministry will make a final ruling on the recommendations of the medicines classification committee that would switch the drugs from over-the-counter pharmacy sales, to "restricted medicine" status.

Only qualified pharmacists - not pharmacy sales staff as at present - would be permitted to sell them and they would be stored behind the counter out of public view.

Buyers' names and addresses would be recorded and they would be quizzed on why they wanted the medicine, asked if an alternative might be preferable, and advised of the possible side-effects and risk of addiction.

Pack sizes would be cut from upto eight days' supply now, to a maximum of five days', and they would be labelled with an addiction warning. Larger supplies would be available only on a doctor's prescription.

The committee chairman, Dr Stewart Jessamine, who also heads medicines regulator Medsafe, said the recommendations were in line with changes in Australia and Britain, and reflected increasing rates of codeine addiction.

Auckland's Community Alcohol and Drug Services (CADS) sees one or two new clients a week - thought to be the visible tip of a much wider problem - who are taking excessive doses of over-the-counter codeine medications.

Some are taking up to 100 tablets a day and have stomach ulcers or kidney damage from the ibuprofen in Nurofen Plus or liver damage from the paracetamol in Panadeine.

CADS sees roughly the same number of new clients who are addicted to straight codeine, which is prescription-only.

The makers of the over-the-counter drugs opposed the committee's moves, saying responsible users would be needlessly penalised because of the actions of a small number of addicts.

Pharmacists interviewed by the Weekend Herald already storethe drugs behind the counter, but support the committee's proposalsto tighten the restrictions.

"Bloody good idea," said west Auckland pharmacist Warren Flaunty.

A member of the Waitemata District Health Board, he has campaigned for tighter controls on codeine and pseudoephedrine, an ingredient in cough and cold medicines and the illegal drug P - both to protect pharmacists and to fight drug addiction. Mr Flaunty said codeine had long been behind the counter at his Westgate Pharmacy because a lot of it had been stolen from open shelves.

South Waikato pharmacist Richard Heslop said it was easy to identify bulk-codeine shoppers, especially if they visited twice. If he became suspicious, he probed their motives and restricted them to a small pack, and turned them away if they returned.

"It's the way they ask - if they want a specific product and won't have anything else. But people do get frustrated, the genuine purchasers, when you ask them questions."

A specialist medical officer at CADS, Professor Brian McAvoy, said many of its clients who had been abusing over-the-counter codeine were otherwise functioning effectively, had jobs and did not take illegal substances.

"They're just taking these tablets on a gradually escalating basis, thinking that they are treating their backache or migraine. Some are quite surprised when we say there is an issue around addiction here."

The main treatment approach is to switch them to straight codeine and gradually reduce the dose until they are taking none.

TIGHTENING UP
* October 7, 2009: Health Ministry warns that most cough and cold medicines should not be given to children aged less than 6.
* October 8, 2009: Prime Minister announces pseudoephedrine cold medicines will become prescription-only - virtually a ban.
* 2010: Ministry expected to further restrict public access to painkillers containing codeine.

PHARMACIST'S CODEINE CAMPAIGN

When making of homebake heroin was at its height, Auckland pharmacist Warren Flaunty took unusual steps to curtail the illegal trade in codeine.

The opium-linked painkiller can be converted into a form of heroin. Before the rise of illegal methamphetamine laboratories, drug cooks concentrated on homebake. For this they needed a supply of codeine or painkillers containing it, obtained by pharmacy burglaries or by buying large quantities.

Mr Flaunty said that in the 1990s and early 2000s, when homebake was a big problem, he voluntarily recorded details of all purchasers of codeine-based medicines and sometimes went even further if he suspected a customer was a bulk-buyer.

"I would follow purchasers all the way to the airport. They would just come shopping for a day in Auckland then catch a plane home.

"I would follow them to four or five different pharmacies on their way to the airport."

He passed information about them to the police, said Mr Flaunty, a campaigner for tighter controls on codeine and pseudoephedrine, the cold-medicine ingredient used to make methamphetamine or P.

"Addicts would come in and get uptight and say, 'I'll smash all your windows'."

Codeine demand dropped dramatically as the illegal drug fashion switched from homebake to P.

"We've seen an upsurge in demand for codeine-based products since pharmacies have become tighter on pseudoephedrine."