GP messing with medication

[SimplySteveRedux]

Moved in October last year and had to transfer GPs. I take around 15 different medications each month and have seen numerous professionals over the years, and has taken close to a decade to find a medication regime that works for me.

However, my medication was summarily reviewed in November, and no changes made. Since them I have had a strong opiate removed from my repeat and I have to request it individually; same with diazepam,; same zopiclone; same anti-sickness drug. I've now been asked to attend another medicaments review.

AIBU to question what they are doing? How do I prepare to deal with - I will be in a terrible state if the above three medications are deemed unsuitable, and worried they may individually target others. I have several medical conditions, some of which are rather broad in regard to symptoms. Not sure what to do here!

Thanks for reading :)

I'm on Diazepam, it's a controlled substance and they cannot put it on repeat as such any more, same with Zopiclone and others. I have to pick 2 of my meds up separately to the other 3 for that reason.

I have to request oramorph and zopiclone separately, not a problem I just email at the same time as the rest on repeat

I too have had opiates cut down on my prescription. I was taking codeine, which they have now stopped. They are also wanting me to cut down on my morphine tablets (for chronic pain) but are not offering anything else in replacement.

Your gp is not "messing" with your drugs, they are doing their job.
Those controlled drugs are not suitable for repeat prescribing and patients shouldn't be on them long term.
I'd expect your gp wants to talk to you about this as they should.

I would say that kind of procedure for those particular drugs is very normal. It’s not standard to prescribe more than 8 diazepam in one go or on repeat for example, most of the other drugs you’ve listed are the same. I understand your frustration as someone myself who takes a lot of medications and has experience with those drugs. All you can to is write to your GP and try to find a way forwards.

All the ones that have been removed, or the you're now made to order separately are addictive. Theres a lot of pressure to try and reduce the amount of opiates patients are on, hence the measures that have been put in place. I wouldnt take it personally.

With regards to the review, say you've drawn each prescription each time because other pain relief doesn't cut it. You can say things like your quality of life is reduced without the pain relief. Say its taken 15 years to get the dose right etc etc. They may still try and reduce your opiate intake though...

Unfortunately your GP can be hauled over the coals for prescribing these types of drugs inappropriately - Diazepam and Zopiclone are only licensed for short term use, not as repeats. GPs will also be called to meetings by health boards if they are seen to be prescribing for example higher amounts of opiates than neighbouring practices.

My friend is a GP and recently quit her practice for these reasons - countless meetings with board/prescribing advisors and countless complaints from patients when she tried to reduce the prescribing. She was sick, sore and tired of it and I’d never seen her so stressed.

Unfortunately while you may we’ll need these meds, others are misusing them therefore everyone suffers.

Unless you have a terminal condition, they should of course be trying to reduce your dependence on opiates and benzodiazepines.

I think the doctors are cracking down on opiate use to be honest. I work in pharmacy and we have a few patients on zomorph who have been on it forever and are clearly addicted starting reducing doses. The zopiclone and diazepam will need to be ordered seperately due to new guidelines. No one's ever happy about reducing morphine, but it's easier to weekly scripts for them and keep an eye on intake than just keep doing monthly scripts. They won't just completely pull you off of morphine or benzos, though.

Why, Cherry, have some new wonder drugs come onto the market that work just as well or better?

Or are you saying patients should be left with crippling untreated pain, and unable to sleep?

Your gp is not "messing" with your drugs, they are doing their job.

No they are not. Changing someone’s prescription particularly dosage without informing them is not doing their job, it’s dangerous.

I was recently called to a chronic pain review with an independent doctor for a 40 min appointment. He agreed that my meds should remain unchanged. I was dreading it but he was great.

Just requested my usual pain relief and the dosage on the repeat has been reduced by around 2/3. No discussion or notification whatsoever. I’m really angry about it. When I inevitably need more than what’s written on the label, it will be me who’s in the wrong. I spent 40 mins explaining my long and complex history and the fact that I have already reduced my dose myself by 80% a few years ago and I haven’t increased it since but I cannot function or care for my children if it’s reduced any further. He agreed there was no need to change anything, but either he or someone else has done.

Seeing a GP in a few weeks so I’ll be challenging it then. They cannot tell you that your meds should remain the same and then sneakily change the instructions without even notifying you.

"Or are you saying patients should be left with crippling untreated pain, and unable to sleep?"

The trouble is there is a big risk of that happening anyway as they have found these drugs to lose effectiveness over time but the risks and side effects remain. Who would want to be stuck forever on medications that don't actually help them and actually cause them harm? The doctors haven't just turned mean, they want to help their patients get the best from life and sometimes (not always, but each case needs looking at) that is difficult decisions for the longer term good.

If you haven't seen it already this episode of Horizon is a good starting point to understand.

I work in pharmacy and we have a few patients on zomorph who have been on it forever and are clearly addicted starting reducing doses.

How would you know they’re addicted? Longterm use does not necessarily mean addiction. I’d hope if you work in a pharmacy you know the difference between dependence and addiction?

No one's ever happy about reducing morphine
This is just nonsense. I reduced my dose by 80% when I was pregnant because my pain improved dramatically. I was delighted. If people are unhappy about their painkillers being reduced it’s probably because, you know, they’re in pain.

I think people who haven’t been in long term pain can be very judgy about people using these medications. It’s very easy for people to say they’re addictive (which they can be) and that everyone should be coming off them but when someone’s quality of life depends on them that’s not always a straightforward thing to do. In extreme cases who cares if someone is addicted to them if that’s the difference between them being bedbound and actually having a life?

Or are you saying patients should be left with crippling untreated pain, and unable to sleep?

No, I’m saying a referral to a pain clinic, psychological management of pain, review of addiction or more recent alternatives might be better. Pain is a symptom not an illness. Proper assessment is a good thing. Long term use of painkillers needs review as analgesics become less effective overtime and the dependency increases.

Motacilla I understand, as I have been there. I took sleeping tablets for years, and benzos for a while too.

The problem with summarily taking people off then is a) there are often no good alternatives, so you are leaving people in intolerable pain and/or exacerbating mental health issues, and b) these actually work really well for some people. The studies show there can be diminishing returns at a population level.. They don’t predict how well any individual will respond to them. For example, I took 2 Zolpidem a night for about 7 years, and never had to increase the dose. When I wanted to quit I just tapered off slowly over a matter of weeks and it was absolutely fine. I’ve been off them for years now with no problem. With Xanax, I was cautious to use it sparingly and never develop tolerance, so that was fine too. Both drugs were lifesavers, I would have committed suicide without them.

Why should 95% of patients in intolerable pain be left to suffer because 5% abuse them? How is that in patients’ best interests? And what is being done to address the needs of the 5%, so they no longer feel the need to self-medicate?

If patients are to be taken off these drugs (and I do understand the concerns), there needs to be effective alternatives in place. What are they?

Over 10 years on opiates, in severe pain with them some days still. I'm largely bedbound, taking me off opiates would see me never leave the house. I barely function as is.

Completely fine with requesting opiates, benzodiazepines and zopiclone individually if that's the outcome.

Without intending to be inflammatory, unless you've experienced chronic pain (and lots of people assume chronic pain is low-level and can be treated with paracetamol) you've no idea of the physical and psychological restrictions it placed on quality of life.

I'm not taking these drugs for fun, it's so I can at least have some semblance of a life.

Cherry I agree that the interventions you mention should be offered, as they are helpful for some. If it turns out that these interventions help, then there should be a conversation about cutting down or stopping meds.

Simply pulling the rug out from under people with desperate lives, just because you want to reduce your prescribing, without having first ensured there is an effective alternative, is incredibly poor patient care. It is cruel and actually pretty stupid, as it risks causing other - potentially bigger- problems.

I hope psychological interventions are not going to be pushed as a panacea. They can be helpful, but are far from universally effective. Also, there just isn’t the level of staffing or expertise in either pain clinics or IAPT services to pick up the slack here.

unless you've experienced chronic pain (and lots of people assume chronic pain is low-level and can be treated with paracetamol) you've no idea of the physical and psychological restrictions it placed on quality of life.

Completely this.

SinkGirl I would be making a fuss about this now, rather than soldiering on and waiting for a review. You might find they use a period of you managing without adequate relief as an excuse to cut you down permanently, ‘because you’re coping on a lower dose’.

I would be asking why they have cut them down without having ensuring there is an effective alternative in place. How is that beneficial for you? If they go on about the dangers of long-term use, ask them what they think the ongoing effects of being in crippling pain will be for you. Iirc, you have two young twins with health issues? What would happen in your family if your ability to care for them reduced? What effect would it have on your MH to be constantly suffering on top of your day to day stresses. Why are they summarily reducing doses without consultation or explanation. How do they explain this as good patient care?

Go and meet the GP and form a relationship so they know you as a person rather than a name who keeps requesting large amounts of heavy duty medication.

I’m on a serious combination of meds and they are, rightly, reviewed frequently but left as they are because they do help and I’m known at the surgery.

There has been so much in the media about over prescribing of opiates that it has been lost that some people do benefit from long term use, do not have an escalating need for more and more and are safe, sensible people who are unlucky enough to need their meds to have any quality of life.

I would be making a fuss about this now, rather than soldiering on and waiting for a review. You might find they use a period of you managing without adequate relief as an excuse to cut you down permanently, ‘because you’re coping on a lower dose’.

Don’t worry - I am seeing the GP before my next prescription is due, they’ve given me the same quanity of liquid as they always do, just changed the text on the label (which was “1ml as needed”, knowing that I vary my dose according to my pain and actually take more than 1ml 6x a day on bad days and less on good days, and now says “0.5ml up to 4x a day”).

I’ll be taking it the same as I always have so there’ll be no “coping”. I completely understand they have to be cautious which is why I’ve jumped through all their hoops, but this has just angered me. Saying one thing to your patient and doing something else is ridiculous. The fact I have two disabled children I need to care for is one of the things I discussed extensively with them. I can’t just lie in bed in agony without proper pain relief. My dose is already so reduced compared to what it was, and they can argue all they like about how it stops working over time but it still works for me (before these meds I was admitted to hospital six times in four months in agonising pain and I haven’t needed a hospital admission in years because of the pain relief).

I know a few friends on long term meds for chronic pain which is debilitating. The problem for them is that the meds are also debilitating but in a different way. Surely more research needs to go into finding ways to treat the conditions that cause the pain in the first place. Pain relief isn’t treating the condition it’s dealing with the symptoms.
I’m really lucky that I don’t have a condition requiring strong pain relief, I just have arthritis in my hands and take naproxen daily, plus paracetamol as required.
There’s a great deal of recent research on the impact of long term opiate use on pain, and GPs are tied when it comes to prescribing.
OP, you haven’t said why you need such powerful drugs, but have you considered medical cannabis?

I agree that the studies showing some diminishing returns have been interpreted as ‘will not work longer than short-term for anyone’, which shows a fair amount of ignorance about genetics and personality variables.

I wish you luck SinkGirl. No way should you be left in pain. If the meds work for you, they work for you, nobody should be arguing against that.

No, I’m saying a referral to a pain clinic, psychological management of pain, review of addiction or more recent alternatives might be better. Pain is a symptom not an illness. Proper assessment is a good thing. Long term use of painkillers needs review as analgesics become less effective overtime and the dependency increases.

Cherry this is a very naive statement.

Firstly most people on longterm opiates already have done all these things and more. I’ve been to so many pain clinics, pelvic pain specialists, pain management courses, physiotherapists, I’ve had six surgeries, I’ve tried every drug for the medical management of my condition, I’ve tried every alternative to opiates and every opiate available. I even had accupuncture and homeopathy on the NHS.

If there were something else to try, I would have tried it.

It also ignores the fact that in most areas pain clinics are inaccessible due to high demand or shut down. The doctor I saw for a pain meds review recently told me to pay for a chiropractor and accunpuncture, which I can’t afford to do since I can only work 5 hours a week between my health and my twins disabilities.

The pain medication I’m on is the difference between me being able to function and not. I’m not going to apologise for it.

The idea that the majority of people on opiates just haven’t tried other things is very far from true in my experience since doctors will try anything to avoid prescribing them.