Australia's move to limit codeine products to prescription only has sparked concerns about added medical costs, and been criticised for failing to deal with barriers to addiction and pain treatment.
Drugs like Panadeine and Nurofen Plus will require a doctor's prescription from February 2018 due to rising concerns about addiction, fatal overdoses and other harm.
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While the move was backed by doctors, pain and addiction medicine advocates say the flow-on needs of addicts and those who use the drugs for intermittent pain has been overlooked.
Like an estimated 10 per cent of women, Vanessa Watson lived with endometriosis that for more than a decade went undiagnosed, resulting in painful periods each month, until she had a hysterectomy at age 30.
Ms Watson, who runs a pain support group in Perth, said she used a combination of an anti-inflammatories and pharmacy-bought Panadeine but never no more than four days each month.
"[This] is just going to impact people's lives hugely and it's just going to create an underground market," she said. "This is going to create a frenzy of people stockpiling."
The Therapeutic Goods Administration's decision to re-schedule the drugs was announced on Tuesday and brings Australian in line with countries like the US, Japan and parts of Europe.
It comes after reports of codeine addicts swallowing up to 100 tablets a day, and people "pharmacist shopping" to get around rules that restrict purchases of more than five days' supply of the drug at one time. Government data also shows Australians being treated for codeine addiction more than tripled in the decade to 2012-13.
![Painkillers such as Nurofen Plus will soon require a prescription.](/web/20170407180628im_/http://www.theage.com.au/content/dam/images/g/j/z/j/a/n/image.related.articleLeadwide.620x349.gtewlg.png/1482271597028.jpg)
The move reinforces the need for access to affordable addiction and chronic pain management treatments, said Lesley Brydon, the chief executive of advocacy group Painaustralia, and Consumer Health Forum of Australia chief executive Leanne Wells.
"They're simply depriving people access to medication without solving the problem for those people who do have a problem with addiction," Ms Brydon said. "There is no plan for these people to be referred to adequate pain management, no plan to refer people to addiction programs."
![Vanessa Watson says women with severe period pain will face added costs under the changes.](/web/20170407180628im_/http://www.theage.com.au/content/dam/images/g/t/e/w/o/3/image.related.articleLeadwide.620x349.gtewlg.png/1482271597028.jpg)
Ms Brydon said it would also drive up medical costs for people with intermittent pain, like severe period pain, who use the drugs as advised. "Most of us cannot get ready access to a GP who bulk bills, most of us pay up to $80 or $90 to see a GP," she said.
Dr Elizabeth Farrell, a gynaecologist and medical director at Jean Hailes, said while some people may use the drugs for period pain, it was not a recommended first-line treatment. "We would recommend to use the anti-inflammatories," she said.
People who experience period pain, as well as those with intermittent migraines, tension headaches and musculoskeletal pain, were most likely to be affected by the change, said pain medicine specialist Michael Vagg.
He said there was no evidence codeine was an effective painkiller at the doses sold over the counter and when misused in combination with products containing paracetamol and ibuprofen could lead to severe liver, kidney and stomach damage.
To prepare for the change, people could either get codeine scripts from their doctor who might give them repeats; find a better alternative such as ibuprofen and paracetamol; or get prescribed a less addictive drug, he said.
"This change might actually lead to people getting more effective treatment," Dr Vagg said.
Fertility doctor Anusch Yazdani, who sits on the advisory board of Endometriosis Australia, said: "While we all completely support this move there needs to be mechanisms in place for the increased costs that our patients will have from going to see GPs, going to see specialists; there are not appropriate avenues for funding for people to be able to access pain services."
Victorian Alcohol & Drug Association chief executive Sam Biondo said the health needs of those affected, downstream impact on support services, and risk those abusing the drugs would jump to another substance, did not appear to have been considered.
"There's not been much consideration about pain management and the supports that are needed there, nor in the treatment space," he said. "I'm not even sure how far they've thought about community education and informing people what they should do if they've got a problem."
The Royal Australian College of General Practitioners welcomed the new restrictions.
A TGA spokeswoman said it had received advice that alternative pain management treatments could be arranged, including other over-the-counter products. "In addition it is expected that real-time monitoring of prescription and over-the-counter medications will be progressed to minimise doctor or pharmacist shopping," she said.
Fairfax Media has partnered with the Global Drug Survey for its fifth year to help understand how and why people take drugs in Australia.