GP cutting cocodamol dose no taper

[RedLipClass]

Hello!

I'm looking for a bit of advice and wondered if anyone had been through similar. Post might be a bit long, don't want to miss out any info that might be important.

I was prescribed 30/500 strength cocodamol last October for an issue that's causing me a lot of pain. I'd been back and forward to the GP for a few months and tried a few different suggestions from them with no improvement. The GP then referred me to hospital for investigation. Over the months the pain had increased in severity and frequency to the point I was in pain pretty much every day and was starting to struggle with work (physical job). I asked for some pain relief to help until things were figured out by the hospital as paracetamol and ibuprofen weren't helping. I tried a couple of different things before they gave me the cocodamol and those really helped, it was such a relief after months of feeling at best uncomfortable and at worst in severe pain. The amount I am taking has varied week to week due to my pain levels fluctuating but hasn't increased ie, I've never had to request extra. I've had a repeat prescription that I've requested at the same time every month.

Flash forward, due to covid backing up waiting lists, I'm still waiting for my hospital appointment and haven't even been given a date. Today the GP surgery contacted asking for a med review. It was a GP I had never spoken to and he rhymed off all the reasons they don't like to prescribe opiates. Most of these I knew from my own research but I had weighed up the risks and decided I'd rather be pain free. He then said he wanted to try and cut down on the cocodamol and find another solution which I was happy with - if they can give me a solution with less risks then fab! He then said he was going to prescribe naproxen with 8/500 cocodamol.

My concern is that 8mg codeine per dose is a big drop from 30mg and I've been taking those tablets most days for a year. Everything I've read about reducing codeine advises a gentle taper as withdrawal symptoms are common and can be nasty. I mentioned this to him and he said I shouldn't have any problems but I don't see why that would be true when I've been taking them this long. I only have a few tablets of my old prescription left so once those are done it'll be straight to the lower strength ones.

I didn't want to argue it in case he thought I was addicted, the tablets have been very effective for me and I don't want anything in my notes that would prevent me from getting them if I ever need them in the future. I'm happy to work with them to find another solution as I had only wanted to be taking them as a short term fix but it doesn't seem right to cut my dose so suddenly. Although I am not addicted as in I don't crave the tablets, I'm sure I will be physically dependent just because of the regular use.

Does anyone have any experience of this or similar? If I do experience physical withdrawal symptoms and tell the GP this will it prevent me from being prescribed opiates in the future? Also can they refuse to taper down my dose if I request that? I've already had time off work with the original issue so don't want to be forced to take time off from work for codeine withdrawal that could be avoided!

Thanks in advance!

They make a 15/500. See if he'll prescribe those as an intermediate dose.

I have chronic autoimmune issues and regularly take both Cocodamol 30/500 and Tramadol (although not together obviously)! Being honest if the amount you take fluctuates according to how much pain you’re in (understandably - I do the same thing) you should be able to reduce to the 8/500s with no issue. But this doesn’t mean you won’t be in pain! I would ask for a second opinion. Naproxen isn’t particularly safe long term either! It is essentially a stronger version of ibuprofen and you’ll need a stomach protector like Nexium prescription strength 40mg or omeprazole if you stay on it for any length of time. There seems to be a huge drive to reduce opiates on prescription but for some of us with chronic pain they really are the only thing that works!

I've been on 30/500 for years. I get 120 a month from the GP, on good days I take 3 and on bad days I take 8.
I don't think you should just reduce to 8/500, has the GP explained the possible withdrawal symptoms?
I dread my medication review, luckily with COVID I haven't had one for about 2 yrs.

If you start shaking then its too much of a drop

The doctors did this to a friend of mine but he cut her off totally because she wasn't cutting down he literally offered no other pain relief for her incredibly painful condition she tried they showed up on my doorstep grey and shaking I gave her my prescription while she waited for specialist to intervene and get her pain relief back

She had been on them more than five years and was addicted

I have taken these on and off for a few years. I’ve had a couple of periods where my pain has lessened so I’ve just stopped taking them. I do only take one twice a day and then two at night. If I take two together during the day I can’t actually function. I was quite surprised to watch a programme a while ago which said they were addictive and coming off them could cause bad side effects as these were not something I’d experienced. I think posters have given some good advice, sorry I’m unable to!

Thanks for the replies and advice! Sorry for the late response, I went to the cinema this evening!

@Bagelsandbrie I'm worrying I'll still be in pain and they won't give me the cocodamol back but at the same time don't want to seem too reluctant to give up the cocodamol in favour of something they say will help in case they get the wrong idea! I actually asked that about the naproxen and stomach issues and he says it should be fine if I eat first but if I have any stomach pain to get in touch and they will give me something  surely it would be better as a preventative measure?! Yes, definitely seems that they're trying to crack down on opiates but I'm a bit miffed since they're the ones who prescribed it in the first place and have continued to prescribe it monthly ever since with no checks. He was speaking to me a bit like I was a naughty child who had been sneaking something I shouldn't be!!

@Idyllic Yeah, I'm the same as you. Some days I can manage on just 2 and other days I need the full 8 in 24 hours but I have been taking them pretty much every day so it seems a big drop to go from 30mg to 8mg. Wondering if I should chance calling tomorrow and asking if they will compromise with the 15mg? I'm especially worried as it's coming up to the weekend so if I'm in a lot of pain and the new stuff doesn't help or if I withdraw badly I won't even be able to contact the surgery.

@Theunamedcat That is absolutely awful. It seems so inhumane to me that they prescribe these tablets without a second thought when they know full well how easily someone can become dependent and then just cut them off with no warning or support. It shouldn't be allowed and they shouldn't be making patients feel like it's their fault if they struggle to get off them or if they genuinely need them long term for pain. They seem to conveniently forget that they prescribed them in the first place.

I think I'm going to call the doctor and say I've been having a think and doing some reading and I'm not happy dropping from 30/500 to 8/500 in one go and would feel more comfortable with an intermediate step of taking the 15/500 ones with a view to lower it again to the 8/500 if all is well. I really don't want to be left in pain over the weekend if what they've given me isn't sufficient or to be struggling with withdrawal symptoms if I get them when I can't contact the surgery until Monday.

Does that sound reasonable? I just think they've been happily prescribing these for a year, so they surely need to work with me a bit if they don't want me to take them anymore.

Having run out of my 30/500 (was only taking it once a day) by mistake I then didn't sleep for three nights 🙄.

I would definitely endorse going down to 15 first (and if you have any withdrawal at all, adding the 8 and going back to 24 for a bit).

It's far, far better to have a very gradual but effective tapering off of codeine. All the best!

That sounds totally reasonable OP

Sounds reasonable. Good luck

Remember too OP if the GP offers you Naproxen you need something like lansoprazole or omeprazole as well to protect your stomach lining. Naproxen gave me awful side effects so I stopped it after 2 days.

Good idea to ask to taper it to 15/500 for your Co codamol.

Thanks all, I'll let you know how I get on!

@Idyllic I mentioned about stomach issues in regards to naproxen and he said I shouldn't need anything to protect my stomach if I take it with food but if I have stomach pain to call back and he will prescribe something. Which totally goes against everything I've read about NSAID's so I'm wondering if this is all a cost cutting exercise?? Because otherwise why wouldn't you rather prevent a problem than try and deal with it after the fact?

Suggest

1 week on 1x 15/500, 1× 30/500
1 week on 2 x 15/500
1 week on 1 × 15/500, 1 x 8/500
1 week on 2 x 8/500
And see how you go.
I hate the stuff and find naproxen (+daily omeprazole) am and pm works best with perhaps a midday dose of 2 x 15/500 (or 1 x 30/500 and one paracetamol). The beastly stuff numbs my brain x

@RedLipClass

Thanks all, I'll let you know how I get on!

@Idyllic I mentioned about stomach issues in regards to naproxen and he said I shouldn't need anything to protect my stomach if I take it with food but if I have stomach pain to call back and he will prescribe something. Which totally goes against everything I've read about NSAID's so I'm wondering if this is all a cost cutting exercise?? Because otherwise why wouldn't you rather prevent a problem than try and deal with it after the fact?

If he really won't prescribe a buffer for the naproxen, you can buy Esomeprazole over the counter.

Pressure is bring put on Drs to stop opiate based meds for long term use (more than three days) due to some rather dubious research - I say dubious as one of the "researchers" was my rhumatologist years ago and told me I was a "druggie" and he was stopping everything and referring me to drug addiction service, weight watchers, gym and stopping all my meds, putting me on antidepressants, propranolol (which is really bad for autonomic issues another problem of mine) and referring to mindfullness because I'm not in any pain at all, just "think" I am due to being an addict.

Firstly, he'd literally qualified days before. Secondly, he informed me that Ehlers danlos syndrome* was made up "by some bloke wanting to make a name for himself" and is just a fancy name for being lazy. Thirdly, my GP rolled their eyes and said we'd stick with the advice from "some bloke" and cancelled the referrals. Finally, I read his "research" and honestly I'd have failed him, and I'm not even a Dr it was deadfully written, his English and grammar appalling and his idea of "research" extremely short of what I'd allow my students for an undergrad dissertation - whoever allowed him to qualify should have been dismissed on the spot.

Literally went to see him for other options due to the increasing severity of subluxations. Not a lecture about being a druggie. The nurse with him was appalled. I was his first ever patient and she gave me the details to complain and apologised for his behaviour.

That's all on my file now so if I go into hospital I'm refused any medication.

PS The "bloke wanting to make a name for himself" was Professor Grahame a world recognised specialist in my condition, and he certainly did and helped so many people.

• for those who don't know is a very painful genetic illness that can impact multiple systems in the body. I have subluxations every day and have even had dislocations just from putting on clothes.

*he certainly did make a name for himself and helped so many people