From this month Australians will no longer be able to purchase medication containing low doses of codeine over the counter from pharmacies.

Instead, you will need a prescription from you GP in order to buy drugs like Pandeine and Nurofen Plus. The over the counter codeine ban was proposed by the Therapeutic Goods Administration (TGA) after taking into account “compelling evidence of the harm caused by overuse and abuse of OTC codeine containing medicines”, as well as the fact countries including the US and Japan had made similar decisions.

The federal government has justified the ban on the grounds that it will prevent “up to 100” avoidable deaths every year from misuse of the drug, and cited “unanimous” support from medical groups.

But the situation is much more complex than the government wants to make out. While the Australian Medical Association (AMA) support the ban, the Pharmacy Guild has been calling for a rethink, and the NSW state health minister has been urging his federal counterpart to review the decision.

Those in favour of the codeine ban have been pushing two main arguments: they say the codeine ban will save lives, therefore the potential inconvenience to many patients is worth it, and they’ve cited economic modelling that shows the ban will result in a net economic benefit for Australia.

These are blindingly simplistic positions, especially for a topic as complex as drug use. While there might some justification for a more restrictive codeine regime the current debate, and certainly the position from the federal government and the AMA has failed to take the concerns of chronic pain suffers seriously enough. It’s also clear the evidence from failed drug prohibition policies hasn’t been heeded.

And it’s also worrying that so many of the “facts” thrown around in the debate just don’t stack up.

What Problem Is The Codeine Ban Trying To Solve?

By rescheduling codeine and making it prescription only the government is hoping to reduce the number of Australians that misuse codeine.

According to the government more than half a million Australians misuse codeine every year, with nearly 100 dying annually as a result. It’s worth noting that drug misuse has a different definition to drug abuse. The former refers to instances where individuals take the drug contrary to the prescribed instructions, like taking three pills at a time instead of the recommended two, for example. Drug abuse is the intentional use of a drug for non-medical purposes, like getting high.

The Numbers Are More Complicated Than It First Looks

This technical discussion might sound boring, but you’d be surprised at how often politicians and some media outlets are getting their figures mixed up. For example, the federal health minister, Greg Hunt, said this week that “more than 500,000” Australians were addicted to codeine. That’s not true. Hunt has, deliberately or accidentally, confused the figures of codeine misuse with addiction.

Some studies have shown that the number of people with some kind of codeine addiction is around 150,000.

The commonly cited figure of 100 deaths per year due to codeine misuse is also an oversimplification of the issue. The study underpinning this number did find that codeine related deaths had increased from 3.5 per million in 2000 to 8.7 per million in 2009, but there’s a lot more going on than the headline figure.

The study also found that in 84 percent of cases the deaths were attributed to “multiple drug toxicity”. It found that only 16 deaths per year were actually attributable to over the counter codeine products like Panadeine Forte. It further found that in 54 percent of cases the individual had a history of mental health issues, and 36 percent had a history of substance abuse problems. Thirty-five percent of codeine related deaths were due to intentional misuse.

Finally, the study suggested that a ban on over the counter codeine medication could potentially save five lives annually. That figure was used as a key assumption by the TGA in its report underpinning the codeine ban. The TGA reported valued each preventable death at $4.2 million and used that to develop a cost-benefit model of a potential ban.

Interestingly the government’s chief medical officer, Professor Brendan Murphy, recently said: “I don’t think it can be accurately quantitated but every life saved is worth it,” suggesting he’s seemingly unaware of the government’s own logic motivating the ban.

So What Do These Numbers Actually Mean?

Health and drug policy is complicated because we’re talking about people’s quality of life — something that’s hard to quantify and put in a spreadsheet (even if the TGA has tried to do exactly that). It’s temping to think that if this codeine ban results in just one fewer death, that makes it the right thing to do.

But how do you weigh up the impact on chronic pain sufferers, who are the people that are going to most directly impacted by the ban, against that? And what’s the threshold at which a policy aimed at preventing deaths gets to override every other concern?

The government has tried to sell the policy by throwing around alarming figures suggesting half a million Australians are addicted to codeine, and that a ban could save 100 lives a year. However, we now know that we’re talking about approximately 150,000 addicts and 16 deaths related to over the counter codeine medication, five of which may be preventable.

For comparison the Australian Bureau of Statistics estimates that 170 Australians die from paracetamol misuse every year. That’s 10 times the number of deaths related to over the counter codeine, but there’s no push to ban paracetamol sales, presumably because the government acknowledges the benefits outweigh the risks — as tragic as they might be.

This isn’t about ignoring the harm drug misuse can cause, but acknowledging that policy measures like this need to be measured across more than one criteria. The key problem behind this kind of approach is the assumption that codeine misuse is something individuals are deliberately seeking out, as opposed to a symptom of broader issues.

Banning Codeine Won’t Stop Drug Use And Misuse

Only a small proportion of codeine related deaths are due to the accidental misuse of over the counter drugs. The fact that one-in-three deaths were intentional suggests that the problem goes much deeper than the specific drug.

People misuse and abuse drugs for a number of reasons. Over the same period that deaths relating to codeine and oxycodone started to go up, deaths relating to heroin misuse, another opioid, went down. If someone wants to deliberately misuse or abuse a drug, for whatever reason, they’re going to find a way to do it. That doesn’t mean we should throw our hands up and accept drug related deaths as a permanent reality, but we should be spending far more time talking about the underlying causes behind drug use and abuse than we spend talking about banning drugs.

A federal government report found that there was a strong correlation between opioid use and depression and anxiety.

“An indirect short-term reduction in symptoms of anxiety may be a strong motivator for opioid use in those with anxiety disorders,” it said.

Let’s not beat around the bush: plenty of people experiencing mental health issues turn to legal and illicit drugs, including opioids, to help manage their conditions. Pretending like that’s going to stop because codeine won’t be sold over the counter anymore isn’t just absurd, it’s a massive distraction from policies that actually could help — like more investment in mental health services to make them more affordable and accessible, and better drug support and education services.

We already know that punitive policies that prohibit drug use don’t work In fact, they can, and regularly do, have the opposite effect. Some drug users believe the current rise in opioid use is directly related to the “war on ice”, which has made methamphetamine harder to source.

Even though the government is couching its arguments using health policy language, the logic is still the same as any other punitive drug policy: “This drug is killing people, so we’re going to make it harder for people to access,” ignoring that that’s exactly the approach that led to the ‘opioid crisis’ in the first place.

What Does This Mean For Chronic Pain Sufferers?

The AMA claims that low-dosage codeine, such as that found in Panadeine Forte and Nurofen Plus, is ineffective for treating chronic pain, and they’ve pleaded with patients to stop “self-medicating” with it.

But that advice doesn’t gel with the experience of many women suffering from endometriosis, plenty of whom rely on accessible, over the counter codeine to manage pain symptoms. Contrary to the AMA’s line, studies do show that codeine is an effective pain management treatment. Given the failure of many doctors to correctly diagnose endometriosis in the first place, it’s not surprising to see such significant scepticism in the community regarding their advice around self-medicating.

Many people dealing with chronic pain self-medicate because doctors don’t take their condition seriously, or misdiagnose. Some women are forced to wait 10 years between first seeing a doctor with symptoms of endometriosis and ultimately being diagnosed. What happens to them under the new codeine regime, where a prescription is required to help them manage their pain?

The over the counter ban is either going to make suffering worse for people dealing with chronic pain, force them to spend more time finding a doctor who takes their condition seriously, or lead them towards other drugs that might now be more accessible than prescription opiates, including illicit drugs. The government doesn’t appear to have given this any kind of thought of all, despite the very high likelihood of all of these scenarios occurring.

Telling People To “Just See A GP” Ignores The Reality Of Our Medical System

In an ideal world everyone would have access to free, accessible, and high quality medical care. In that world a prescription based model for drugs like codeine would be less objectionable. But we don’t live in that world.

Australians regularly talk up our “free” and “universal” health care system, but in reality it’s anything but. Nearly one-in-five visits to a GP aren’t bulk-billed, meaning people are paying out of pocket to see a doctor. For specialist services it’s worse. Seventy percent of specialist appointments aren’t bulk-billed and the average cost of an appointment is more than $70.

Forcing people to schedule medical appointments to access low-level pain management medication has an uneven impact across the community. For many wealthier Australians, it might not change much. But for people on low-incomes, or those who find it difficult to take time off work to see a doctor, it’s an extra impost.

Theres Just Not Enough Evidence To Support The Ban

Like I said at the start, there may good reasons to make low-dose codeine harder to access. But we haven’t been given them. Instead the government has pushed inflated figures that don’t stand up to scrutiny, and attempted to link the codeine ban to the opioid crisis in the US.

The government has pointed to the fact the codeine is prescription only in the US, and used that to argue for a similar regime in Australia. However, the US still has a huge, and growing, opioid problem despite its codeine regulations. Deaths from opioid use continue to rise as fentanyl has overtaken prescription opioids in terms of harm.

Some doctor’s in Australia have suggested that than just focusing on restricting certain kinds of drugs, the government should also focus on making other treatments, like medical cannabis, more easily accessible.

“When you look at jurisdictions in the US that have implemented a medicinal cannabis system, opiate deaths have been reduced by as much as 30 percent,” Dr David Caldicott, a senior clinical lecturer in medicine at the Australian National University, told The Guardian. “If we don’t put alternatives in place here in Australia and ensure people who are in pain and who are reliant on codeine have alternatives, then we are simply pulling the rug out from under them.”

It’s hard to disagree, but unfortunately it doesn’t seem like the government cares.