Australian Doctor Australian Doctor 4th August 2017

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Editorial, page 28
GPs sued
after teen
overdose
cont’d page 6
Pharmacy Guild ‘undermining’ TGA on codeine
ANALYSIS
PAUL SMITH AND ANTONY SCHOLEFIELD
THE TGA may be the last word on
patient safety but its decrees don’t
much matter if you are the Pharmacy
Guild of Australia.
Eight months ago the regulator up-
scheduled codeine, banning the drug
from being dispensed over the counter,
in order to curtail its rampant misuse.
This was done to reduce real harms
and the misery of addiction.
But it has emerged that the guild
has written to its 4000-plus members
telling them not to worry about the
impact of the ban (and the potential
loss of $145 million in codeine sales)
when it comes into force next year.
The reason? It is going to ignore
the TGA scheduling drug system, and
lobby state and territory governments
to change poison and drug regulations
‘The vast majority
[of fatalities] are a
result of high strength
medicines that are
prescribed by doctors.’
— David Quilty
Pharmacy Guild of Australia
executive director
so that patients can buy “prescription-
only” codeine without a prescription.
This can be done by creating, in the
guild’s words, a “schedule 3.5”.
As long as pharmacists have special
training and are using the guild’s real-
time codeine monitoring system Meds-
Assist, patients with acute pain will be
able to access OTC codeine without
The trip that saved my son
GEIR O’ROURKE
TEENAGERS with autism are not
supposed to miss half a year of
school to go on madcap adventures
through Africa. Nor are their GP dads.
Dr James Best was familiar with
the conventional wisdom that his
son Sam, diagnosed with autism at
the age of three, should be offered
routine and structure in his life.
But reading through the research
literature, Dr Best came to believe
that exposure to stimulation and
novelty could offer his 14-year-
old son significant developmental
benefits because of adolescent
neuroplasticity.
So two years ago, Dr Best and
Sam dropped everything to boldly go
where they — and the evidence —
had never been before.
“While the trip was not evidence-
based, it was evidence informed
and I really wanted to try to help the
understanding of autism by measuring
Sam’s progress,” Dr Best says.
Last week, the pair’s African
Print Post Approved PP100007880
See page 30 for details
What is schedule 3.5?
RACHEL WORSLEY
FOUR GPs are being sued
for prescribing the tricyclic
antidepressant amitriptyline
hydrochloride, which allegedly
led to the death of a 14-year-
old girl.
The family of Angel Cowie
are claiming damages for
personal injuries arising from
shock and distress, according
to the statement of claim
lodged with the District Court of
Queensland.
The four doctors who worked
at the same practice, have yet
to file their response.
The statement claimed that
Ms Cowie saw the doctors over
a two-year period.
The first GP allegedly
prescribed 10 10mg tablets
of amitriptyline hydrochloride
(Endep) once daily in February
2012 when the patient was 12.
4 AUGUST 2017
adventure was screened on the
ABC’s Australian Story, which
documented their journey, with
its disorder, lack of routine and
constant stimulation.
“I saw a very distressed boy for
the first month or two, but he slowly
turned the corner in the middle part
of the trip and was really blossoming
by the end,” says Dr Best, who
practices in Sydney.
“He really grew not just in his
communication skills, but also in his
confidence.”
Dr Best hopes their story will
serve as inspiration to other parents
of autistic children to find ways of
providing them life experience.
“It doesn’t have to be Africa,
which I realise isn’t for everyone,”
he says.
“It could be that you take your kid
more often to the footy or just catch
the ferry and go to the zoo together.”
See News Review, page 11,
for full story
trouble. Schedule 3.5 is meaningless,
with no formal status with the TGA.
But the guild, which is one of the most
effective lobby machines in Canberra,
is already wining and dining state min-
isters and is confident of success.
It has also urged pharmacists to
tell patients the guild was working on
ways to get around the TGA’s OTC
codeine ban.
Last week, the guild’s executive
director, David Quilty, wrote an
open letter in the Australian Journal
of Pharmacy, defending the organisa-
tion’s actions.
The guild was “not seeking to
reverse the up-scheduling decision”,
he claimed.
“However, we believe that it is a
blunt instrument that, on its own, will
not address issues of addiction and
could actually exacerbate them, par-
ticularly given the lack of any manda-
tory national real-time recording and
monitoring system for doctors and the
likelihood that some patients will be
prescribed high strength codeine-con-
taining products (with repeats).”
He also claimed it was “not accu-
rate to infer, as some have, that all
fatalities from codeine are as a result
of over-the-counter codeine”.
“On the contrary, the vast majority
are a result of high strength medicines
that are prescribed by doctors and/or
as a result of combination of medi-
cines consumed by patients.”
The RACGP has accused the guild
of “actively undermining both the
credibility and actions” of the TGA.
Privately the TGA should be
alarmed. But publicly it is playing with
a straight bat.
A TGA spokesperson said: “While
states and territories have consist-
ently indicated a desire for a uniform
approach to medicines scheduling
cont’d page 6