Kelly Wade is a multi-genre writer, gardener and scientist based near Canberra, Australia. When not freelancing, she can usually be found writing and illustrating personalised children’s books or in the garden.

In 2017, the Australian market for non-prescription medicines, including over-the-counter (OTC) and complementary remedies, was worth $4 billion.

 But the reclassification of codeine – making it a prescription-only medication – along with a surge in media interest around addictive prescription drugs, presents a huge opportunity for providers of alternative therapies and complementary medicine, particularly as health has become a source of considerable disagreement nationwide. 

 More Australians misuse legal drugs than use most illegal ones, yet preventative measures such as vaccinations “scare the living daylights out of parents.” 

 So, what guides Aussies when making decisions about medication and healthcare?

 provides vaccinations for more than 15 diseases. Although these immunisations are free and prevent serious, often deadly, conditions, half of Australia’s elderly population is under-immunised and 7% of five-year-olds are not fully covered.

 Anti-vaccination attitudes promoted by organisations like the Australian Vaccination-skeptics Network are partly responsible for the rates among children not hitting 100%, but Angela Morris, a healthcare worker with nearly 20 years of experience, states that “the reason a lot of [elderly Australians] haven’t been immunised is because of lack of education in the past.”

In an attempt to boost immunisation levels, the government introduced a ‘no jab, no pay’ policy, withholding certain tax benefits unless recipients’ children are fully vaccinated, with some states and territories also denying childcare.

 This has caused such outrage in the anti-vaccination community that some groups have established their own social services in order to circumvent the legislation.

According to a 2004 study that looked at the reasons why parents didn’t fully vaccinate their children, 70% claimed that they were concerned about the side effects. 

 A separate research paper published in 2010 revealed that vaccine-declining parents often don’t understand the risks associated with contracting diseases, believing them to be mild or uncommon. 

 In short, it seems that many mums and dads lack scientifically-proven information to make the right choices for their kids

Anti-vax attitudes often boil down to the spread of misinformation

The flu is responsible for roughly 18,000 hospitalisations and 3,000 deaths in Australia each year. Yet despite the dangers, a survey conducted by the Pharmacy Guild revealed that only 45% of people planned to get a flu shot in 2018. Among those who chose not to get a jab in 2017, 68% believed themselves to be at a low risk and 17% thought they could protect themselves simply by living a healthy lifestyle. Additionally, 43% of survey respondents didn’t understand why annual vaccination is required for ongoing protection, rising to 67% among Boomers. “Most Australians don’t realise how infectious the flu is, with 77% of respondents unaware the flu virus can remain active when airborne for 45 minutes or more,” says George Tambassis, national president of the Pharmacy Guild. 

A small-scale poll conducted by Canvas8 in May 2018 investigated attitudes towards flu vaccination among 182 Australian mothers and pregnant women, finding that 21% believed their children were healthy and so didn’t need to get immunised. One mother commented: “I had the flu shot twice in my life and became sick immediately afterwards. Never had the flu shot since and haven’t had flu-like symptoms since then, so I’m definitely not giving it to my baby. I’m opting to boost my immune system through alternatives.” 

Most Australians don’t realise how infectious the flu is, with 77% of respondents unaware the flu virus can remain active when airborne for 45 minutes or more

This sentiment was echoed by 11% of respondents, who said they weren’t getting their kids or themselves immunised as a result of previous reactions to the vaccine, while another 5% weren’t getting the shot because they’d heard it can give recipients the flu. Many of the women polled agreed that they would take steps to boost their family’s immune system instead of getting the injection. 

Around 3% of respondents claimed that they weren’t getting their children immunised because their family GP advised them that it’s more dangerous for a child to be vaccinated than not.

 There will always be a proportion of the population that either isn’t immunised because of medical contraindications or for whom immunisation is ineffective. A study published in the journal 

 however,found that students in Australia (and their parents) have a poor understanding of vaccines in general. The research focused on the cervical cancer vaccine and found that those investigated didn’t understand what the vaccine protected against or how it worked, despite heavy media attention when it was introduced. 

Many Aussies remain unsure of how exactly how vaccines work

While many Australians aren’t taking advantage of standard immunisations that could save lives, they’re not shy about self-medicating with OTC drugs. Indeed, the overuse and misuse of OTC codeine preparations saw them up-scheduled to prescription-only medications in February 2018. This decision proved unpopular with the public, with a study carried out in November 2017 finding that 36% of consumers opposed the reclassification, even after learning that codeine was an addictive opioid that’s only available on prescription in several other developed nations. While 52% supported the change after learning the facts, this suggests that many others are willing to overlook the potential for abuse. 

Low-dose codeine-containing medicines have not been shown to be more effective at relieving pain than other OTC pain relievers. 

 And there are many alternatives to pharmaceutical pain relief, including acupressure, acupuncture, heat, massage, dietary supplements, and herbal remedies. Not all Australians believe that these substitutes are suitable, however. Commenting on an MJA InSight article on codeine rescheduling, Chris Arthur writes: ”We keep being told that evidence indicates that paracetamol is as good as a combination of codeine 30mg plus paracetamol 1000mg. I have migraine-like headaches intermittently and paracetamol is next to useless but paracetamol plus codeine works every time within 30 minutes. I don’t look forward to sitting in a waiting room at my overworked GP’s surgery to get a prescription for a couple of panadeine.” 

Over the past decade, there has been a substantial rise in the number of deaths involving a prescription drug, with drug-induced deaths more likely to be due to prescription drugs than illegal drugs

OTC codeine is not the only medication that Australians are misusing; a 2016 survey found that one in eight people nationwide had inappropriately used legal drugs in their lifetime. In fact, more Australians (4.8% of people) misused legal drugs in 2015/16 than any illegal drug except cannabis (10.4%). 

 “Over the past decade, there has been a substantial rise in the number of deaths involving a prescription drug, with drug-induced deaths more likely to be due to prescription drugs than illegal drugs,” says Matthew James, a spokesman for the Australian Institute of Health and Welfare. 

 Rural residents, those living in areas of lower socio-economic status, and indigenous Australians are more likely to misuse pharmaceuticals, and there is some evidence to suggest that women make up the majority of patients who require ambulance attendance for pharmaceutical drug-related incidents. 

In 2016, drugs were the cause of 1,808 deaths in Australia, with opiates like codeine and sedatives like benzodiazepines involved in the majority of them (550 and 663 respectively). 

 Yet just as there are a wide variety of alternatives to codeine, so too are there alternatives to pharmaceutical sedatives. Benzodiazepines are most commonly prescribed for insomnia and anxiety despite the fact that they’re not recommended as a first-line treatment for either condition or as a treatment for long-term problems. 

 “Dependence on these medications is increasing and side effects are common, so we increasingly need to look to alternative therapies,” writes Ben O’Mara, an adjunct research fellow at the Swinburne University of Technology. For instance, exercise, a well-balanced diet and cognitive behaviour therapy may all be used as treatment options for stress, anxiety and sleeping difficulties as these have been shown to be more effective than benzodiazepines with fewer or no negative side effects. 

Painkiller addiction is plaguing countries around the world

Some parts of the complementary medicines and alternative therapies industries have experienced significant growth as a result of Australians becoming more health-conscious. For instance, online sales of vitamin and supplement grew by 5.3% annually between 2013 and 2018, reaching a valuation of $149 million, and the Australian complementary medicines industry was valued at $4.7 billion in 2017, up from $2.3 billion in 2014. 

Amid this growth, there is an opportunity for medical and alternative therapy providers to educate people, which could lead to improved national health as well as increased industry revenues. Writing for NPS MedicineWise, Dr. Richard Kidd and Dr. Adrian Reynolds note that the up-scheduling of OTC codeine products “gives health professionals and patients opportunities to discuss alternative pain management options and explore more effective and safer approaches to pain,” and “will bring to light patients with dependency issues requiring additional care and specialised management.” 

Some pharmaceutical companies have already attempted to capitalise on the reclassification of codeine by advertising stronger pain drugs to GPs. 

 So, now is the optimal time for industry players to embark on new education-based marketing campaigns, particularly for those seeking to fill the void previously occupied by OTC codeine preparations as well as those who are savvy enough to leverage consumer sentiments about these drugs and apply them to other market segments. With research from 2013 finding that Aussies prefer to buy vitamins and supplements from pharmacies, these locations can be key to ensuring people have access to professional advice and a good range of safe products.

Angela Morris has worked in the Australian healthcare industry for nearly 20 years. Her current role is as a healthcare worker in a variety of nursing homes where she cares for elderly and disabled Australians.

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From parents who refuse to vaccinate their kids for fear of any side effects to the endemic abuse of pharmaceuticals, many Australians make bad medical decisions in spite of established advice. How can healthcare providers and brands help them make more informed choices about their wellbeing?

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