School of Pharmacy, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Int J Health Policy Manag. 2023;12:6872. doi: 10.34172/ijhpm.2022.6872. Epub 2022 Dec 19.
There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator's decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy.
This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semi-structured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare.
Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process.
Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes.
世界各地对阿片类药物相关危害的担忧日益加剧。2018 年，在澳大利亚，可待因类产品从药店的非处方购买升级为需要处方。药品监管机构将此类药物升级的决定颇具争议，引发了广泛讨论，因为这可能会对消费者和医疗保健专业人员产生重大影响。本研究旨在分析可待因类药物升级政策的影响因素。
本回顾性政策分析采用倡导联盟框架（ACF）来理解具有共同信念的政策参与者如何形成对抗联盟以制定政策。数据来自文件（监管机构政策文件、公开意见书、新闻报道、组织媒体发布和立场声明）和对 15 名关键政策参与者的半结构化访谈。生成与政策过程和参与者信念相关的代码；广泛的主题包括卫生专业人员的作用、对阿片类药物的看法、对消费者的影响以及政府在医疗保健中的作用。
确定了该政策子系统中的两个联盟：（1）支持[赞成升级]，和（2）反对。支持联盟的关键明显信念是可待因的危害大于益处，并且政府监管是保护消费者的最佳途径。反对联盟认为，药剂师提供的可待因的益处大于任何危害，并且消费者应该在不需要任何超出必要的干预的情况下管理自己的健康。该政策决定反映了支持联盟的影响，该分析强调了他们对问题的公共卫生框架的重要性、他们的专家和支持证据的可接受性以及升级过程的合法性。
了解这些联盟、它们的信念，以及它们如何通过现有的政策过程和机构转化，为那些有兴趣影响未来卫生政策的人提供了深入的了解。具体的经验教训包括战略框架和宣传的重要性，以及与正式政策过程的参与。
