Real time recording of codeine in Australia

To everyone else, the thread has gone really quiet. Please keep in contact, SERIOUSLY, everyone deserves to be supported, NO ONE is alone as long as we stick together and support each other.

Every one of us deserves to have the support, assistance, caring and motivation that we can all provide each other.

Please, don't run out of steam my friends, it happens on so many other forms where people lose the motivation to continue and post.

We have a unique situation in Australia at the moment and this is the absolute best place to share stories with other normal people experiencing the same thing.

Wilro

Hi all, still about. It's late, so not a long post. I'm not doing so great. My downfall has been finding 2 chemists that don't record codeine sales.

I will keep trying, but am struggling.

Also, great job Wilro on the radio. You spoke with honesty, poise, and clarity. How lucky are we to have such a voice for our little community here.

Will write a more detailed post at a more sensible hour.

Would love to hear how everyone is.

Hi ellenbe and Becky07,

Sounds like you're both still really having a difficult time with things. I'm now over 3 weeks codeine free and loving it. As you both know from my previous posts I chose an opioid maintenance program to deal with my codeine addition.

I've purposely chosen not to recommend my solution to everyone by constantly saying I've found THE solution for all codeine addiction (because I haven't) but if either of you would like me to go into much more detail about what I've learned and now experienced I would be so happy to do so for both of you. We could do it via personal messages if that would be more comfortable for you.

I'm fully aware that I will still need to address my Addiction issues later (in my mind, in the next year or two) but until then (which will be with 100% support from an addiction specialist) my body will have had a chance to heal and equally importantly I will have worked a lot on the psychological addiction.

By that I mean the constant trips to the chemist, the games we play in our minds in relation to justifying codeine use and the daily actions we take to satisfy the addiction. Please think about that last paragraph.

Take smoking cigarettes for example, when people are trying to quit, the advice given is to try and separate the psychological addiction from the physical. This means things like, if you always wake up in the morning and the first thing you do is make a coffee and then sit and enjoy them together, break up the habitual association, i.e, do not have a cigarette when drinking coffee.

It's the same with us. We have a psychological (habitual) addiction to the process of going to the chemist to buy codeine as much as we have the physical addiction to the drug.

This is why my specialist still asks me to go into the chemist daily to get my Suboxone, because I'm used to going everyday. His intention is to help me fully break the physical addiction first so we can then work on the psychological/mental addiction when I am in a stronger position to do so.

Lets me know if you both would like me to be more specific around the opioid replacement options. Unlike taking 90 N+ per day and actually feeling some sort of buzz and euphoria, suboxone doesn't give me any pleasurable (except the mild anti depressant) effects. What it does do though, and very very well is prevent me thinking about codeine at all. Its truly a wonder drug for me.

The other think I'd be more than happy to talk to both of you about are my struggles with depression and anxiety. I have tried every single anti depressant medication available. Unfortunately none of them work well on me so I'm looking into other options now. My anxiety was so bad for a couple of years that I couldn't drive at all, I would end up having a full blown panic attack the minute I got into a car and couldn't even walk to the shop without feeling like I was going to faint.

I'm much better now and very happy to discuss my issues and eventual recovery.

Always here for all of you

Wilro

Hi, I too have an addition to Nurofen plus. I am halfway through a 20 week taper plan that was provided to me via an online drug counsellor. I went that way because I'm embarrassed about it and didn't want to see anyone in person, nut also because I've tried to go cold turkey a few times but just can't function the withdrawals are so bad. 

Since bringing this program in with the chemists I'm having so much trouble finishing the program that actually sucked up some courage and went to a dr. Well that was a mistake. I explained it. She didn't take me seriously telling me it's impossible. And told me the only thing I could do is be referred to a drug place which could take weeks to get into. Which is fine but what do I do in the meantime? So I was back hunting chemists that haven't started taking ID. I don't want to do this anymore. I just want to finish this program and get on with my life. I'm so sick of it. But now I don't know what to do. I'm dubious about going to another dr, baring my soul and being treated the same way.

Hello everyone

Thank you all for sharing your stories, particularly WilRo, ellenbe and Becky07.  I stumbled across this forum last week in an unsuccessful hunt for an online supply of Nurofen Plus.

I too, am a codeine addict and have been using it off and on - more on than off - for the past eight years.  I am "down"  to twenty Nurofen Plus a day: taken all at once, usually first thing in the morning on an empty stomach, with some hyoscine (Buscopan) and omeprazole (Nexium). 

A little bit about me.  I am a registered nurse in my mid-forties.  I live on a farm, which is an hour's drive from the small regional city (where I work) in rural Australia.  I am married; we have no children.

I would like to keep this thread going: I am sure that there are many more people out there caught in the clutches of codeine who would benefit from reading stories such as yours.

I will type up my story and post it later today.  Ellenbe and Becky07: I hope you are both OK.  WilRo: I have just finished listening to your RN interview.  You spoke so well and I admire what you have achieved.  Monsoon28: hang in there and stay in touch - we can all help each other.  

Hi ellenbe, 

And hello to all other followers of the forum. Sorry for delay have been busy and wanted to give this topic the time it deserves. 

Firstly ellenbe you asked about honesty being the best policy with pharmacists, and that if you admitted addiction we would just refer straight to a Dr. In my opinion I would see this scenario as refreshing and open a wide array of avenues and options for pharmacist and patient alike. For example if i had a patient requesting nurofen plus for "dental pain" and on looking at history on medsassist it shows a history of repeated use every few days for migraines, back pain, period pain etc I would be more inclined to flat out refuse a sale and offer education and options. Compared to a scenario whereby a patient tells me they are addicted to codeine and attempting to taper the dose. Here I could view the history and track how they are going. Offer services such as a staged supply whereby I could disepnse a daily dose to the patient and ensure things where heading in the right direction. Also i could recommend things such as alternating the nurofen/panadol components to prevent overdose on these components. 

Just from a pharmacists point of view we are never just going to roll over and support a dangerous addiction. Sure it is a legal addiction for the patient but it is illegal and immoral for a health practioner to turn a blind eye and continue unregulated supply of the medication. If we cannot see therapeutic need and the potential for harm, we will act appropriatley to try and support the patient to make adequate changes to therapy. In this day and age this should be seen as refreshing as we make more revenue if the "not our problem" approach is taken. 

You also spoke of poor GP experiences. Like any occupation people are good and bad at their jobs. Drs are human and are not exceptions to the rule. This is where a pharmacist can also help, we deal day in day out with Drs handywork. We know the good the bad and the ugly of the medical profession. We will know of nearby Drs with active interests in this field and can refer appropriatley. But we need patients wanting to help themselves. 

Now to WilRo. Once again sorry for the delay but wanted to respect your long reply with some appropriate insight. 

You asked about my understanding of MedsAssist. And yes at this stage it is merely a guideline to use it as a tool in determining therapeutic need for codeine containing medicines. It is not law and a pharmacist is free to use their professional judgment in each and every event. May be easier said than done and bear in mind we deal with 30+ of these requests a day and also have the rest of our working day happening in and around these requests. For every request I will take into account what I am being told by the patient, what the history looks like and if I feel it is medically necessary / warranted without the likely hood of harm. This is a difficult task and will never reach a point where everyone is happy. 

You mentioned that 95% of people using these medications are doing so correctly whereby other options i.e ibuprofen/paracetamol will not suffice. I do agree the majority are using these medications without major problems but still believe the community in whole do not respect these medicines as would a health professional. For example 2 of the OTC (over the counter) high dose codeine tablets equates to 30mg of codeine or approximately 5mg of Morphine when metabolized by the liver. Now ask yourself is 5mg morhine a worthy medicine for a tension headache, simple period pain, a stiff neck, a tight back, to help get some sleep.... the list goes on. The answer is a resounding NO. Most of these current requests link back to my "mom told me they are good", "my neighbour recommended them" etc. The average Aussie is too preoccupied with the quick fix then the right fix. So at the very least hopefully medsassist will help people learn respect for these medicines and decrease the current addiction issues we are currently faced with. 

The 3 day use warning has been for around the last 12-18 months. This was a last ditch effort after previously reducing pack sizes to a maximum of 5 days use. If you remember pack sizes of nurofen plus used to be 72. None of these changes had much effect on peoples use of the medication. Hence the TGAs stance to turn them into Schedule 4 (prescription only) medicines in line with the rest of the Western World. I myself am in two minds regarding this decision. I believe it could curb alot of addiction issues and prevent new addictions. But at the same time poor Dr decisions may lead to same addicts having access to more potent medications and hence further harm. I feel in a perfect world the pack sizes should be cut to a maximum quantity of 3 days i.e nurofen plus = 18 and panadeine extra = 24. And Medsasssist become a legal requirement and be audited by the TGA to ensure all pharmacists are diligent in supply of the medicines. 

You menitoned how hard it is to present to a Dr and get painkillers. This is all about trust and rapport. No good medical professional will give in to acute demands for chronic problems if harm is possible or suspected. All chronic issues to to be addressed by the same , continual Dr. Just a matter of finding a practioner you trust and feel puts your health first and foremost. But once again you need to want to help yourself. Dont just Dr shop to get the answers you want, rather have faith in a good Dr to provide the options to get the result you want. 

I feel myself and alot of other young medical professionals are dealing with the fall out of outdated medical policies used by our predcessors. For example we are currently trained that codeine has NO role in headaches, and more likely to cause harm (i.e rebound headache/ medication overuse headaches) then offer benefits. This flies in the face of old school Dr recommendations. But these days if you see a neurologist first thing they will do for chronic headaches is to wean any codeine containing medications. Same goes for chronic pain, codeine can cause hyperalgesia (heightened sense of pain) therefore not a great option for a ongoing pain problem. Hence most pain specialists use other options such as tramadol, buprenorhine (Norspan/temgesic) , lyrica, tapentadol (palexia) etc. Codeine is only worthwhile for short/acute self limiting pain. Eg sports injuries/dental pain (whilst seeing a dentist)/burns etc. Things that have an end date in sight and not continual in nature . 

You mentioned the Pharmacy Guild and their role in this. Good reference!!! They are a owners lobby and nothing more. Their main aim is to make the industry profitable for its owners firstly and keep their members in good community standing second. Therefore they would see rescheduling of codeine as a money drain for community pharmacy and therefore came up with medsassist in order to fight the rescheduling. Although medassist is a great platform and I see alot of positives in its use , this is the reason why it has such issues in its role out. The guild are not super interested in the fall out and hence the lack of referal pathways and well thought out strategy following its implementation. I have always been team PSA (pharmacutical society of Australia). This body represents professionalism within the industry and supports the gold standards of medication use. So if you have queries or recommendations and want to be heard and listened to, this is the body I would recommend speaking to. 

I hope you dont see any of this as being judgemental or bigoted. I am mainly trying to get you guys to see throught the eyes of a pharmacist. I try to treat medical scenarios as if I were treating my own mum. Alot of these issues should never have been allowed to spiral this far. If every Pharmacist cared and every patient listened , we would not have this forum. 

Take care guys. 

Hi all. Really hope this thread is still active. I live in south Australia, and most chemists around here are not asking for identification. I wish they were .... I've been taking up to 15 tablets a day for around 7 years except for when I was pregnant and the year after I had my baby. It has made me put on so much weight. When I stop taking it I just feel miserable. But my god I want to quit.

So just a quick update

2 days completely codeine free

And a few days before that on a greatly reduced dose.

It's a mental game right now as I desperately want to go and get some. I'm also sick at the moment which in some ways distracts me wanting to take it, while at the same time makes me want it more.

I had awful headaches since not having any, but being sick I've tried to put it down to that even though I know it's withdrawals.

I'm really trying to fight the urge to go and buy more.