Economics / Policy

Codeine changes will only make pain more painful

Imposing mandatory prescriptions for drugs containing codeine will line the pockets of medical professionals at the cost of taxpayers, writes Darcy Allen and Jason Potts.

Recently the National Drug and Alcohol Research Centre at the University of NSW released research showing codeine-related deaths increased from 3.5 to 8.7 per million of the population from 2000 to 2009.

That sounds very bad, but almost all of these approximately 150 deaths per year involved ‘multiple drug toxicity’. That is, codeine was one of several drugs involved. So it’s not actually even obvious that codeine is the problem here.

Nevertheless, the Therapeutic Goods Administration (TGA) maintains codeine is an addictive ‘drug of abuse’ in desperate need of regulatory attention. Their recent interim decision means all over-the-counter medicines containing codeine be changed to prescription-only as early as mid-2016.

One of the quickest ways to effectively assess calls for new regulations is to follow the money. So, who wins and who loses from making codeine prescription-only?

Doctors win. Forcing more patients to queue at the door for basic prescriptions means more money in the pockets of GPs. A Macquarie University study finds up-scheduling analgesics will directly cost consumers an additional $70 million, and cost the PBS an additional $170 million. That money flows to doctors.

Consumers and pharmacies lose. If such a proposal goes ahead this means hundreds of popular painkillers — including Panadeine Forte, Nurofen Plus and Codral Cold and Flu — will become more expensive and inconvenient for everyday Australians. Pain will become a lot more painful.

Rather than your late-night flu-ridden pharmacy run, you will wait 3 days for a GP appointment, an obligatory 2 hours in the waiting room, and then still go to the pharmacy afterwards. And this will happen to millions of people, unless they simply decide to go without and live with the pain.

It is not surprising, then, that the Australian Medical Association (AMA) and the Australian and New Zealand College of Anaesthetists welcome these changes. The Pharmacy Guild and the Consumers Health Forum, on the other hand, are much more sceptical, noting the blunt nature of the instrument.

Just last year the AMA was vehemently against the $7 GP co-payment. The problem was precisely because of rising medical costs of such a change. This week, however, they’ve changed their tone. The added costs to the individual and the health system are now outweighed by the claim that this might save a few lives.

The wild inconsistency of the AMA reveals their underlying rent seeking intentions.

The economics of rent seeking says political influence can be used to craft regulations that benefit them. This often means making their profession more exclusive by creating barriers to entry. The result is higher prices and wages for insiders.

Effective rent seeking is all about marketing. It’s about creating some public feelings that are so indisputable your adversaries (everyone else) looks like terrible people for opposing you. And no political tool is better than saving future lives. No inconvenience is too big against that.

This bad economics is compounded when it meets the Nanny State. Regulators are suggesting Australian consumers lack the personal responsibility to make their own decisions. The poor choices of a few are now seemingly grounds for the illiberal control of the many – literally requiring them to experience pain.

AMA vice president Dr Stephen Parnis has argued that some other developed nations have prescription-only rules. The argument is that eventually we’ll get used to it. That just proves that rent seeking doctors and push-over regulators exist outside Australia too. No bad idea becomes good just because someone else does it.

Further regulation of codeine will only line the medical profession’s pockets at the cost of the individual taxpayer. At a time when our medical system is desperately strained, we should be especially cautious of insider calls to exacerbate our public health cost problems.

This post originally appeared on the Institute of Public Affairs



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