Wednesday, January 20, 2010

From pain killer to killer pain

The Medicines Classification Committee wants to limit sales of products containing the opioid codeine, such as Panadeine and Nurofen Plus, to direct sale by a pharmacist with pack sizes be to a maximum five days' supply, in response to concerns about addiction and misuse.

The potential impacts of driving up the costs of these items currently sold, at great convenience and low cost relative to regulated alternatives, to many thousands of people? Difficult to know where to start isn’t it? Let’s try it this way:

§ Are the concerns justified? They could be. So were the concerns about alcohol abuse and addiction at the time prohibition was introduced. So are concerns about the most lethal weapon ever invented by man – the motor vehicle. In neither case is resorting to a “five pack only” approach or raising costs to consumers an effective response.

§ Most importantly, even if the restrictions were effective – they raise costs for everyone and possibly, only possibly benefit a few. So to the community as a whole it’s a net loss. Those who suffer most from the loss are the poor, the elderly and those who can least afford the increased cost which necessarily accompanies restrictions.

§ Third we know that consumers will search for – and find – substitutes. These could take any number of forms. For the products themselves the possibilities include other less suitable drugs, more alcohol, putting up with pain, longer off work or more sick days and on and on. Substitutes for complying with the regulations would be legion as well – send in the kids, the Aunt, sweet talk the chemist.

§ Are these costs trivial? Many are tough to measure and involve all sorts of subjective judgments. In crude financial terms though, total turnover for all goods in supermarkets and groceries was worth about $9.95bn over the year to June 2009. It is easy to see that even the loss of one item such as this is likely to have significant impacts on consumers.

We know that to figure what the origins of any regulation are we need look no further than to who benefits.

Since first manufactured, aspirin based products which have the potential to, and have, killed consumers who take them when they are suffering from stomach ulcers have been sold in shops and supermarkets while paracetamol derived products which do not and are more benign, were restricted, pharmacy only products. The fight to make paracetamol more widely available was a bitter one. The result, unsurprisingly involved lower prices and grumpy chemists.

Now we are about to have a re run.

How could this happen? Here is a small clue drawn from the Department of Justice website:

“Under section 9 of the Medicines Act 1981 the membership of the Medicines Classification Committee shall consist of:

* two persons, to be nominated by the New Zealand Medical Association;

* two persons, to be nominated by the Pharmaceutical Society of New Zealand; and

* two persons, being officers of the Department of Health, one of whom shall be appointed as chairman.”

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