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Presentation: Additional communication and education activities to support the transition of codeine from over-the-counter to prescription only

Codeine up-scheduling workshop, Melbourne, 28 November 2017

16 January 2018

For further information about changes to medicines containing codeine, see the Codeine information hub.


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  • Presented by: Avi Rebera, Assistant Secretary, Regulatory Education and Planning, Health Product Regulation Group, Department of Health
  • Presented at: TGA workshop: Codeine up-scheduling, 28 November 2017
  • Presentation summary: This presentation provides an overview of the communication and education activities being supported by the government as part of the transition for the up-scheduling of codeine.


Additional communication and education activities to support the transition of codeine from over-the-counter to prescription only

Avi Rebera
Assistant Secretary
Regulatory Education and Planning, Health Product Regulation Group
Department of Health

TGA workshop: Codeine up-scheduling, 28 November 2017

As John said, my name's Avi Rebera, and for my sins, I have responsibility for scheduling in the poison standard. And no, John didn't tell me when I took the role that I'd have Codeine. So, I've slowly lost some hair as well through this process. I did have hair before this.

So, what I want to talk to you very briefly about today as John mentioned in his previous slides. There is a nationally coordinated communication strategy and education strategy that is run by the department, and like every good government agency, we have an acronym. So ? as John has mentioned, but on top of that, the government is also committing over a million dollars to provide additional communication and education activities through peak bodies. And over the next few months and even beyond 1 February, all of you will start to receive communication and opportunity for education programs through your relevant peak bodies and through your membership. So, what I'll do today is just very high-level run through what that is. I'm not going to go through all the details on these slides but they will be available, as John said outside, and they will also be available on the codeine information hub on the TGA website for you to go in and have a better read of all the information. And John's presentation will be on there as well.

So, broadly speaking as I said, the government is committing over a million dollars to provide support through certain peak bodies to provide education and communication materials. Some of you were asking when you came in whether you get CPD for tonight, points for tonight. You don't, but through some of these programs, it will be available as well.  So, I'll run through them very quickly.

So, the first group is for GPs, and the support work that will be provided to GPs through the AMA and also RACGP and the College of Physicians. A lot of this work will actually be done by NPS Medicinewise for them, so you might see it coming out from NPS Medicinewise, but it is working very closely, and the messaging will be actually derived from these organizations and these peak groups. And the key thing around this is actually to provide information, education and also certain tools and materials for GPs, both the GPs to understand the implications of the changes, and the types of conversations to have, but there will be some material to hand out to patients as well. So, when those conversations are being had, especially around chronic pain and addiction, that GPs are actually able to have some tools and some material to be able to know what clinical pathways are, what pathways the patients will be taking, and the conversations that need to need to happen.

 So, as John said, some of the consumer fact sheets, we're actually looking at how we do them in other languages as well. And so you'll see some of that coming out.

We'll also have a specific focus for rural health professionals, and this is quite an important aspect of the work that's happening, because while a lot of this will overlap with the material, and the material coming out for GPs can be used by rural health practitioners, we understand that some of the requirements and some of the challenges being faced in rural and remote communities is going to be different. So, what we'll see coming out from this is specific targeted information and support for rural health practitioners, and that's beyond GPs. That's also your nurse practitioners because there could be others that prescribe, not just GPs, so there will be targeted support that comes out, and this work will be done through ACCRAM, but also there's other groups they'll be working with as well. So, while we've got one key name in collaboration, they are all working together. We just have a lead agency or a lead peak body that will be running with this work as well.

So, there'll also be support provided and the guild will be working very closely with the PSA to provide targeted messaging and support for pharmacy owners, pharmacists and also pharmacy staff. And again, this is about enabling the pharmacists to be able to have conversations when people present. They won't be able to access their codeine over-the-counter product anymore. What are the conversations that support pharmacists need to have with those patients as they come in? And that will range from, how do I support the patient through chronic pain and potentially addiction? And what are the pathways that they need to take? Who do they need to be referred through? To conversations of identifying, well it's an acute pain issue, so how does that get managed at the pharmacy? And there'll be significant support provided to pharmacists through the guild and through PSA and the work that they're doing, and it'll be multi-channel.

Again, we've identified that while there'll be broader communications for the pharmacy sector, there is a special requirement for pharmacists working in hospitals, and so there'll be some work done through SHIPPA in in order to target that, and part of that will be what happens at the point of discharge when that pharmacist might be talking to that patient when they're leaving hospital, and conversations around acute pain versus chronic pain, and the support that they might need. And there could be additional materials that will be provided to that patient at that point in time. So, there'll be some targeted support there as well.

We're also going to be …the government's also going to be supporting consumer groups, and there are two main consumer groups that we'll be looking at work in this area. And the first one is is Pain Australia. So, Pain Australia will be setting up a communication and education program for their members and they've already done some work. I believe they had a workshop here in Melbourne last week to start that process in terms of that strategic workshop, and so they're going to be developing material, and this is now to actually communicate out to the broader community, and to consumers, and to patients around what support and what's available for them, not just in terms of how to manage chronic pain with medication, but other alternatives as well. And a lot of that will also be information that will be provided to GPs and other healthcare professionals to look at how, aside from medication, patients with chronic pain can be supported. And the important thing too is of also identifying people who are addicted.

So, that's work that Pain Australia will be doing. CHF will also be supporting Pain Australia in this, but on top of that, CHF will also be doing their own work in relation to getting information out to the community with regards to chronic pain, more specifically, but also the CHF will be looking at their own networks like the PHN networks to provide them with tools and material so that when they're having conversations with their staff, and also with patients, that the ability to have that consumer focus and understand what the patient and the consumer is thinking, and what they're going through will also be a key part of the communication in the education that's happening.

So, very quickly, and I've run through that very quickly that's what's happening. More broadly, from a communication perspective, a lot of you will start to receive material from these groups, so just so you're aware of it. The slides are available and if you need more information, happy to talk to you afterwards.

Thanks Avi. Well, we're going to have a… give you all your slides back. we're going to have a broader Q&A and discussion at the end, but at this stage, happy to take any questions clarifications or comments if you've got something in your mind at this stage.


Is the KPMG report available online?

Yes, it was published the day the decision was announced. So it's written in a dense style, sadly of health economists speak, but at the codeine hub on the TGA website, you'll not only find the KPMG report and the regulatory impact statement, and the regulatory impact statement is a bit easier to read than the KPMG report, but they both have data online, so yes it's public, it's part of a transparency thing in making any decision that has impacts on the population. This was the first time it was ever done for a scheduling decision, but for most other regulatory decisions, it's normal to do a regulatory impact statement. I don't mean to be crass about it, and politicians will call these winners and losers and to see whether overall there's a benefit or a negative impact on society.

Now it's a kind of a funny thing to do if you're doing something for public health safety reasons, and for that reason, this wasn't mandated on us, but we felt there's a lot of corridor whispering about the cost of a crushing of a health system. We saw headlines like that, so let's get a bunch of respected health economists to go and run the numbers, and I'm glad that we did it. But we didn't tell them what the answer had to be, I mean they they're professional independence is stronger than that but it's all up there on the website at that codeine hub. You'll see on the slides but if you just type in, Google TGA and codeine hub. All this will take you straight to the site.

Any other questions or comments at this stage?

Yes, Wes.

It would be good to know who the audience is. How many are doctors…

If people don't mind, let's start. Who is a medical doctor in the audience? About 18 or so. Who is a pharmacist? Okay, the pharmacists outnumber the doctors, about 30. What other categories would we have folks? Who work in the health sector but not as a doctor or a pharmacist? Quite a few of us, I won't use the word hangers-on because we dominate. In fact, we hangers-on are pretty important so I guess the other people would be those who are working in support roles, those who have a policy role, those who may have other service delivery roles. And who would see themselves as a consumer rep? N equals one, the lone consumer.. we did invite consumer groups more broadly, but I am aware that both Pain Australia and consumer health forums work is very focused on the consumer group, and thank you for coming. Now, we all hate having names applied.  Dentists, that's right. Yes, one, two, three. I knew there were three dentists and there are. Who have we forgotten?

Anyone from the media? That's good. This has been a very .. you wouldn't think with codeine, we're up to about 300 media articles in the last 18 months on codeine and it's absolutely amazing.

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