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 :)

‘Psychological management of pain’ ffs
All this sort of unmitigated twaddle is exactly the reason people are being driven to buying from the internet (with obv associated risks)

Ah, yes. CBT, the panacea for all ills.

It can be helpful, but is far from the cure-all the NHS/government sell it as because it’s cheap.

Cherry the issues you mention with opioids are risks, for sure. They don’t affect everyone, though. And for some, opioids are the only thing that touches the sides and I’m afraid CBT for pain can be like sticking an Elastoplast over the bleeding stump of what’s left of a leg after a shark attack.

Chronic pain ruins people’s lives. Most people on opioids for pain are doing so reluctantly. Nobody likes being constantly constipated, with all the knock-on problems that can bring. Most people don’t like feeling spaced out (a side effect also common with the alternatives like pregabalin). People are aware of the issues. The problem is that the ‘alternatives’, such as they are, are often useless.

It’s not about judging you but the GP probably takes a more holistic view of pain that is a symptom not a disease.

If conventional medicine were to suddenly focus on finding and resolving the root cause of medical issues, rather than focusing on ‘treating’ symptoms, I and millions of others would be very happy.

The meds management department of my new surgery decided to mess about with my painkillers too.

I was on Shortec (oxycodone), co-codamol and amitriptyline for my array of conditions, including two which leave me bedbound when they flare. I'd been on them for 5 years after 4 years of messing about with different medications.

The person in meds management decided to stop the Shortec all together, halve my dose of amitriptyline and ask me to cut down on my co-codamol as much as possible.
I was left in agony. When I complained to him he was making noises about dependency and addiction, without taking into account the fact I was in tears because I couldn't move.

I asked for a referral to the pain clinic and the specialist I spoke to reinstated all my medicines, he couldn't believe that with my condition they'd been stopped.

Every time I put in for my repeat now I get a stroppy phone call from the bloke in meds management asking me to consider cutting down, that he'd prefer if I did, that we can work out other medicines to take.
I have no trust in him after he left me bed bound last time.
Drives me mental.

Opiates don’t treat the cause of chronic pain though, they don’t make it better, and there is a growing body of evidence that for most chronic pain opiates aren’t even as effective as other ‘milder’ forms of pain relief. Let the GP review your meds and see what they come up with - biological drugs, for example, are often much better for inflamatory arthritis.

I agree they don’t treat the cause of the pain, Grumpy, but for some people they are the only thing that works to any extent. They are a very imperfect solution, but for some they are the only one. I am all for exploring other options, what I am against is pulling the rug out from people if they have no other option/have tried the alternatives and found they don’t work.

They have just changed the way you order them, not removed them totally. They haven’t stopped you ordering them. Drugs such as zopiclone and diazepam are highly addictive.

No-one should be on long term diazepam, zopiclone and strong opiates. It doesn't sound like they are doing you any good. If you registered with us the first appointment would be to discuss a slow steady reduction.

The problem with all this debate about opiates being bad for people is that pain is bad for people too. If you never get any sleep or you can never do the things you want to because of pain, your quality of life is shot to pieces.

It's all very well saying that you don't need painkillers after three months but while the medics might know that, your body doesn't! Thinking of lovely flowers doesn't really cut it (suggestion to my mum at the pain relief clinic) and people still need pain relief. It isn't in the mind, either. My mum has a cocktail of various things and she forgot to take them one night. She wondered why she had a bad night and then when she woke up she found she hadn't taken them.

The people who are propagating these views have quite obviously never been in chronic pain themselves and/or have never had someone close to them who is.

Whilst you fear being worse without opioids, in the longer term it might be beneficial to consider alternatives such as CBT

Yeah right.

Whilst you fear being worse without opioids, in the longer term it might be beneficial to consider alternatives such as CBT.

Haha. I've had CBT in the past, bloody useless. If anything it exacerbated my PTSD, CPTSD, GAD and caused more issues than it solved. With regards to pain management I'll stick with the opioids and other medication, thanks.

In some cases you can't fix the cause of the pain, so pain relief is the only option.

I am sure that in such circumstances people discuss their meds very carefully and try out different things to work out which have the least bad side effects. People new to a surgery should not assume that they are right and the person who has been treating the person for the las decade or so is wrong. Yes you can suggest something new, but check the notes first. And don't just change things without having the courtesy to discuss with the patient.

No-one should be on long term diazepam, zopiclone and strong opiates. It doesn't sound like they are doing you any good. If you registered with us the first appointment would be to discuss a slow steady reduction.

Completely ignoring my medical conditions. I've tried tapering off them around summer last year and things were far, far, worse. I'm unsure how you've derived they aren't doing me any good from my posts, and I've not given details of my conditions.

My friends doctor cut her codeine off cold she began to go into withdrawal I subbed her some of mine so she could wait for the appointment to discuss her cutting down slowly

Whilst she should have been taken off them the amount she was on and the length of time meant a managed withdrawal plus an alternative should have been in place first

I meant to add leaving people with chronic health conditions in pain shaking and vomiting really isnt useful

The lack of understanding of medicine is very depressing. How anyone can compare inhalers and reflux medication to opiates and benzodiazepines I don’t know.

OP the drugs you’re taking are heavy duty, have a high street value and are potential lethal. I’ve been a GP for 25 years and I’ve seen people stockpile such drugs then take them all in one go. GPs are then hauled over the coals for prescribing so indiscriminately. Yes of course, a face-to-face review doesn’t guarantee that a patient isn’t stockingpiling or selling the drugs, but at least the GP can prove they reviewed the patient regularly when the GMC come knocking.

I’ve also seen several patients who have developed a tolerance to these drugs, such that they need higher doses to achieve the same results. The doses they need go beyond the legally prescribable dose, so they end up supplementing their prescription drugs with street heroin. Most of my heroin-addicted patients started out this way.

Of course you may have been stable on the same dose for decades, but your doctor is new and they therefore need to establish a rapport with you and engage in regular reviews.

All chronic diseases requiring regular medication necessitate reviews of the patient, the frequency of which varies depending on the condition.

There’s no need for angst. Just go in, explain the situation, and allow the GP to tick the box so that he/she is covered medicolegally and can be sure that all necessary safety precautions have been taken.

If you registered with us the first appointment would be to discuss a slow steady reduction.

What EFFECTIVE alternatives would you be offering, waterboy?

@Tolleshunt I'd be interested to know the answer to that also.

If the answer is CBT, pacing or reframing the patients mindset - it's bollocks.

I get very annoyed when 'professionals' suggest pacing, how am I supposed to pace with a 4 year old, a house to run and a degree.
How are those with full time jobs, kids, homes, families, commitments and no support supposed to do it?
Why should we lower our quality of life to 'pace' when there are medications available that do work and allow us to do what we want/need to.

There’s no need for angst. Just go in, explain the situation, and allow the GP to tick the box so that he/she is covered medicolegally and can be sure that all necessary safety precautions have been taken.

That you make this statement with such confidence, strongly suggests that you're a good doctor who cares, listens and actually hears what your patients are telling you. Not every person is fortunate enough to have a doctor like you, for some people with long term and complex conditions they have very real reasons to fear these types of reviews (especially when it has taken years to reach 'relative' comfort and functionality.

Isn’t part of the point OP is making that she had her review only THREE MONTHS ago?

How anyone can compare inhalers and reflux medication to opiates and benzodiazepines I don’t know.

Ah. You’ve misread my post, or perhaps I wasn’t clear, in which case apologies.

I wasn’t in any way suggesting that benzos or opiates are similar medications to asthma inhalers or PPIs. The point I was trying to make (badly, it would seem), is that I found your idea that drs were being treated as ‘shops’ because patients wanted to continue taking pain medications that were helping them quite intriguing. And I can’t understand why you would feel a patient would be treating you like a shop by asking for effective pain relief, any more than they would be treating you like a shop by requesting other meds. Unless you feel like that about all patients who make repeat prescription requests?

Not sure why you would feel like that? At the end of the day, both patients want to continue treatment that they find helpful (or at least is the best of a bad bunch, as is often the case).

Opiates, benzos etc are controlled more tightly for good reason. I get that. What I don’t get is why people with chronic pain and chronic mental health issues are having their lifeline whipped away from them without effective alternatives being put in place first.

In fairness, your last post sounds like you personally wouldn’t be doing that, and have an understanding that in the messy human world there is often a need for compromise and compassion. Other GPS are not acting so reasonably, though, as Pickle points out.

Trauma focused CBT has a strong evidence base for treating PTSD.

It's hard though, and it expects a lot from the client which not everyone is ready to give to it.

Easier to take benzos or whatever daily than look at learning coping skills to manage symptoms and processing the underlying trauma. People tend to not want to go there which is understandable.

I'm not meaning to be facetious either, it genuinely is an issue I empathise with.

My father was close to suicide with pain he could not bear. (I didn’t realise this until I visited him). He was waiting for a consultant’s appointment that had got lost in the system.

When I phoned the hospital, they were so horrified at the level of pain they sent someone round with controlled medication that was like a miracle in that it brought him back from close to suicide to being able to live and have some quality of life.

And he stayed on that medication until the day he died - thank goodness.

And if someone had made comments to my face like some of the posters here or behaved like some of the doctors described here, I would find it difficult to restrain myself. The pain medication literally save his life

It's hard though, and it expects a lot from the client which not everyone is ready to give to it.

Easier to take benzos or whatever daily than look at learning coping skills to manage symptoms and processing the underlying trauma. People tend to not want to go there which is understandable.

I'm not meaning to be facetious either, it genuinely is an issue I empathise with.

Bingo!! Typical ‘blame-the-client-if-it-doesn’t-work’ mentality often to be found in CBT advocates.

After all, it couldn’t possibly be the case that the treatment modality is the wrong one for the client, could it? Let’s just bend the client to fit the modality, rather than the other way round! That will work splendidly! And if it doesn’t, it’s all the client’s fault.

CBT can be effective for some issues. Last time I looked, IAPT were reporting c50% efficacy rate for depression and anxiety. I’m not sure if the latest success rates they’ve published for pain, but i’d Be willing to bet the farm they won’t be much better, if at all. Even the 50% efficacy rate is largely for the short term, with little long-term follow up. So nothing stellar. What should the other 50% do?

In any case, for trauma it’s not ideal to rely solely on CBT. EMDR is likely to be more effective. And other forms of longer-term (but more expensive) therapy are often required to truly transform somebody’s experience of life and fully resolve issues, as opposed to simply patching people up so they are more ‘functional’ (ie still miserable, but at least they are back to work and off the government’s benefits bill).

You may not have meant to, Jiggles, but your post very much implies those who do not magically get cured with a few sessions of CBT are weak, cowardly and have themselves to blame. This is not true, in my experience. Often those struggling with pain or MH issues endure much, much more than others.

Therapy is not a guaranteed cure for anything, even when the client fully engages.

@Jiggles101 - most of the people I've met who have PTSD would love to get the root of the trauma, process it and reach a point where they don't need medication to manage their condition. Unfortunately, it tends to take more than the 6/12/18 (very occasionally!) sessions the NHS offers and then getting further treatment can be a huge fight, you're not assured of the same therapist, you're back on waiting lists...the list goes on. Good luck if trauma focussed CBT doesn't work and you need EMDR!
Both trauma focussed CBT and EMDR have strong evidence supporting them as treatments, but unless you have several thousand pounds to throw at private treatment you're not likely to get the full benefit.