Pharmacists’ views on the upscheduling of codeine-containing analgesics to ‘prescription only’ medicines in Australia

  • John Mishriky
  • Ieva Stupans
  • Vincent ChanEmail author
Research Article


Background Codeine is the most commonly used opioid worldwide, and is available over-the-counter (OTC) in many countries. There is continual debate regarding the risk:benefit profile for OTC codeine. In Australia, codeine containing analgesics became ‘prescription only medicine’ from February 2018. However, there is currently limited knowledge on the views of community pharmacists on this upscheduling and the perceived impacts on clinical practice. Objective To investigate the views of community pharmacists on the recent codeine upscheduling in Australia. Setting Community pharmacists in Australia, predominately recruited from Victoria. Method A descriptive cross-sectional study was conducted using a pre-tested customised anonymous self-administered online questionnaire between March and May 2018. To capture a broad range of demographics, pharmacists were recruited via local industry contacts and the Pharmaceutical Society newsletter, with further recruitment through snowball sampling. Main outcome measure Pharmacists’ opinions to targeted questions regarding the perceived advantages and disadvantages of the recent 2018 codeine rescheduling from both their perspectives and their perceived impact on patients. Results A total of 113 pharmacists completed the survey. Approximately 43% of pharmacists agreed/strongly agreed that they believed upscheduling will positively impact their ability to manage pain; while 30% were neutral. Approximately 54% of pharmacists agreed/strongly agreed that they believed upscheduling will positively benefit their patients; while 25% were neutral. Perceived advantages for codeine upscheduling included: increased pharmacist/patient engagement, and less codeine use leading to better overall risk:benefit outcome; while disadvantages included: fewer analgesic options, and increased burden for patients, General Practitioners, and the health system. Conclusion This study showed that the current views on the recent codeine upscheduling are quite mixed, with both advantages and disadvantages perceived. Improving education and up-skilling in this space is essential.


Australia Codeine OTC Pharmacists’ views POM Prescription-only Upscheduling 



The authors would like to thank the pharmacists who participated in the survey for their valuable insights and comments. We would also like to acknowledge Reckitt Benckiser Australia for supporting this study, and CHE Proximity for assisting with the communications and facilitation of this study.


This study was supported in part in a research agreement with Reckitt Benckiser Australia. The funding had no impact on the study and survey development, results, or the analyses of the results of this independent study. Reckitt Benckiser has a health portfolio in codeine-based analgesics, however there were no references to the company or specific brand products in the questionnaire.

Conflicts of interest

This study was supported in part by a research agreement with Reckitt Benckiser Australia. The authors’ work and results of this study were otherwise independent of the funders. The authors have no other affiliations with the funders.


  1. 1.
    Cairns R, Brown JA, Buckley NA. The impact of codeine re-scheduling on misuse: a retrospective review of calls to Australia’s largest poisons centre. Addict. 2016;111(10):1848–53.CrossRefGoogle Scholar
  2. 2.
    Hamer AM, Spark MJ, Wood PJ, Roberts E. The upscheduling of combination analgesics containing codeine: the impact on the practice of pharmacists. Res Soc Adm Pharm. 2014;10(4):669–78.CrossRefGoogle Scholar
  3. 3.
    Carroll PR, Moles R, Hillman J. Do pharmacists have a role in recommending codeine for pain management? Australian perspectives. Can J Hosp Pharm. 2016;69(6):501–4.Google Scholar
  4. 4.
    McCoy J, Bruno R, Nielsen S. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication. Drug Alcohol Rev. 2018;37(2):257–61.CrossRefGoogle Scholar
  5. 5.
    Schug SA, Dobbin MD, Pilgrim JL. Caution with the forthcoming rescheduling of over-the-counter codeine-containing analgesics. Med J Aust. 2018;208(1):51–2.CrossRefGoogle Scholar
  6. 6.
    Van Hout M-C, Norman I. Misuse of non-prescription codeine containing products: recommendations for detection and reduction of risk in community pharmacies. Int J Drug Policy. 2016;27:17–22.CrossRefGoogle Scholar
  7. 7.
    Tan AC, Emmerton L. Non-prescription medicines: current issues in Australian community pharmacy. Int J Pharm Pract. 2009;17:207–13.CrossRefGoogle Scholar
  8. 8.
    Emmerton L. The ‘third class’ of medications: sales and purchasing behaviour are associated with pharmacist only and pharmacy medicine classifications in Australia. J Am Pharm Assoc. 2009;49:31–7.CrossRefGoogle Scholar
  9. 9.
    Bresee LC. An introduction to developing surveys for pharmacy practice research. Can J Hosp Pharm. 2014;67(4):286–91.Google Scholar
  10. 10.
    Hassali MA, Saleem F, Farooqui M, Aljadhey H. Strengthening pharmacy practice research: the need for combining both qualitative and quantitative methodology. J Pharm Care Health Syst. 2014;1:112.Google Scholar
  11. 11.
    Pharmacy Board of Australia: Statistics [Internet]. AHPRA; 2018. Cited 21 Apr 2018.
  12. 12.
    Foley M, Carney T, Rich E, Parry C, Van Hout M-C, Deluca P. Medical professionals’ perspectives on prescribed and over-the-counter medicines containing codeine: a cross-sectional study. BMJ Open. 2016;6(7):e011725.CrossRefGoogle Scholar
  13. 13.
    Byrne GA, Wood PJ, Spark MJ. Non-prescription supply of combination analgesics containing codeine in community pharmacy: a simulated patient study. Res Social Adm Pharm. 2018;14(1):96–105.CrossRefGoogle Scholar
  14. 14.
    Shaheed CA, Maher CG, McLachlan A. Investigating the efficacy and safety of over-the-counter codeine containing combination analgesics for pain and codeine based antitussives. Canberra: Therapeutic Goods Administration; 2016.Google Scholar
  15. 15.
    Acute pain: a general approach, In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2018. Cited 25 Mar 2018.Google Scholar
  16. 16.
    Chan V, Tran H. Purchasing Over-the-counter medicines from Australian pharmacy: what do the pharmacy customers value and expect? Pharm Pract (Granada). 2016;14(3):782–9.CrossRefGoogle Scholar
  17. 17.
    Kress H-G, Aldington D, Alon E, Coaccioli S, Collett B, Coluzzi F, et al. A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr Med Res Opin. 2015;31(9):1743–54.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of Health and Biomedical SciencesRMIT UniversityBundooraAustralia
  2. 2.Discipline of Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraAustralia

Personalised recommendations