To think that doctors in the UK/EU are stigny with benzos/opioids?

[janef001]

I understand how addictive these drugs can be but I think the pendulum is swung too far on the other side. I know a woman who had to have a painful root canal and wisdom tooth extraction. She wasn't given any strong post-operative painkillers but instead told to take panadol . OTC Codeine and tramadol never worked for her as she was deficient in the liver enzyme that metabolises them. She ended up having to get a friend from America bring her Vicodin.

I've heard the same things with benzos. Many GP's and psychiatrists just refuse to hand them out and instead put patients on SSRI after SSRI even when they say that they don't work.

Totally agree op. I've mentioned my top tip on here many times but it bears repeating: if you want benzos, try to see the oldest doctor in your practice.

For years I had a fabulous old school doc, we wore a shirt and tie and had seen it all. He knew I wasn't an addiction risk and have me generous scripts.

He's retired now and my current lovely doctor thinks insomnia can be cured with a walk outdoors and writing a journal.

I'm too scared to try to get 'street drugs' but I have ordered zopiclone from India. I'd so much rather have properly licensed UK stuff but that's not an option.

There is definitely a better balance that could be struck here, but I agree that the approach in the US is horrific. For a while I was on Mirtazipine (UK), but I had to come off it as it was causing involuntary muscle movements. While doing some Dr Googling I read an account from a man in the US who had the same issue, and was prescribed something which solved the problem, which he now takes every day. Great, I thought. Then I looked it up - it's a powerful muscle relaxant and benzodiazepine, which is for short term use only. He's been taking it for years.

I've had two wisdom teeth removed under local anaesthetic. My pain threshold is very low and I had nothing stronger than paracetamol. It was fine and any pain was gone within 24 hours really.

Opioids would not alleviate nerve pain, might make you forget about it for a while but would not alleviate it or treat the cause.

Errr, it can all go very badly wrong if they’re prescribed to the wrong person who happens to develop a dependence on them.

My younger brother was prescribed Codeine for a torn ACL that needed surgery, unfortunately it turned out that he very much liked the codeine (and opiates in general), and turned down the surgery because he knew his supply of Codeine would stop once he was considered healed. He eventually died from smoking a fentanyl anologue drug that he bought on the dark web. He went to sleep that night, and never woke up, three days before his 26th Birthday.

He was very bright and capable, a gifted scientist and well liked by everyone who met him. Privately educated, a champion archer, loved to cook and enjoyed every aspect of life. Unfortunately these things all meant he was very competent at gaming the system and charming the right person at the right time for a prescription. He lost control of it and we are all so much worse off for it. I wish, more than anything, that some HCP would have stood up to him and told him that he couldn’t have any more after he declined the surgery.

I know that but unfortunately you cannot buy much else, wasnt prescribed anything that actually helps with acute nerve pain and I cannot take NSAIDs.

I’m another one where who’s had two csections. One was an emergency. Only pain relief after was paracetamol and ibuprofen. After reading some of the posts above I’m now thankful for that!

That’s how it was until about 20 years ago. In brief the history goes: in the early to mid 20th century doctors used to prescribe heroin or other opiates for pain. They eventually realised this was creating addicts. Not because of a moral weakness in those prescribed for, but because for a large proportion of their patients a few days’ supply, taken exactly as prescribed, would get them irrevocably hooked. So it became medical orthodoxy that opiates were too dangerous and they were basically never prescribed.

When the hospice movement began in about the 70s (slightly hazy on dates, sorry) Cicely Saunders and others pointed out that it was idiotic to worry about addiction in people who had perhaps two weeks to live, which was the patients they were dealing with. So opiates started being prescribed for end of life care.

In the 90s to early 2000s in the USA drug companies saw a marketing opportunity and started talking about an ‘epidemic’ of untreated pain. Doctors and nurses were trained to see pain as the ‘fifth vital sign’ and any level of pain in a patient seen as unacceptable. This ended in the place we are now, with the deaths from opiate addiction well into the millions. Many or most of those started taking opiates exactly as prescribed for real pain.

I agree that Dopesick and other documentaries on the US opiate crisis are essential viewing.

Speaking as someone who lives with chronic pain, one problem I think is that there’s a belief that doctors should be able to solve it, when in fact there just isn’t a pill to make it go away. There’s good evidence that opiates do not actually provide significant pain relief, certainly not for more than the very short term, but that they are very highly addictive for almost everyone. I also agree that we need more and better pain management clinics, access to physios etc. Doctors aren’t refusing to prescribe opiates because they’re sadists who enjoy watching people suffer. They have very good reasons not to.

Have you guys watched Dopesick? Enough said ...

Leaving people in severe acute and chronic pain when there's access to numerous decent painkillers is crass and cruel. Yes, giving someone access for chronic pain will lead to dependence but if it's going to be a longstanding issue then who cares?

I'm fortunate enough to have landed on my feet and am repeat prescribed Tramadol and Oxycodone. Am I dependent? Absolutely. Addicted? Possibly but I'll be on these drugs for life and they give me a semblance of quality of life.

My daughter had to have opiates as part of a cocktail of drugs to sedate her in intensive care.

She was on it 8 days. The night she was coming off it was the worst night of my life, worse than when she was seriously I'll & ventilated

When you have watched a tiny baby go through opiate withdrawal after just 8 days, you take this stuff seriously. You cannot imagine the distress, she just didnt sleep, at all, for nearly 24 hours. I will never touch opiates.

Who knew so many Mumsnetters were experts in pharmacology!

A member of my family has battled lifelong Benzodiazepine addiction caused by years of irresponsible prescribing when she was a young woman, having a normal and natural reaction to a sudden bereavement that was labelled as "a nervous breakdown". She was never able to work due to the effects of benzos, and it impacted her parenting to the extent that her adult children are very distant from her as she was never emotionally available to them. She was like a zombie throughout their childhoods, never played with them or bonded with them, she would just sit and stare into space and they didn't know why. She is now in her 60's but looks at least 20 years older and is riddled with numerous physical health problems.

I am glad that nowadays GP's and specialists are more cautious when it comes to prescribing medicines that have huge potential to be psychologically and physiologically addictive, and can cause irreparable damage to people's physical and mental health. I feel sorry for GP's because many of the people who rant at them for declining to prescribe Valium so they can get on a plane aren't willing to try any of the safe, effective alternatives available.

After a while your body develops a tolerance (that's what addiction is)

Tolerance is becoming physiologically used to a drug and needing higher dosage for the same outcome.

I've had two wisdom teeth removed under local anaesthetic. My pain threshold is very low and I had nothing stronger than paracetamol. It was fine and any pain was gone within 24 hours really.

This. I've also had a c-section and was fine on paracetamol and ibuprofen.

The dentist could have prescribed diazepam for her tooth extraction. Plenty of dentists prescribe it for anxiety.

Me too! I thought it was a bit mean at the time but perhaps we had a lucky escape!

I understand how addictive these drugs can be

If you did, you wouldn't been posting. A close friend of mine has been stuck on benzos for 35 years. They have changed her brain chemistry and she cannot quit them as it triggers potentially fatal seizures.

For whom are benzos and opiates prescribed then? Is it end of life care only.

I've worked with many people with severe mental health issues who have been prescribed Benzodiazepines. All acutely unwell and monitored very closely. For most people who suffer from anxiety something like Propranolol, which is safe, effective and importantly not addictive is sufficient.

There’s a reason why the opioid crisis is pretty much a US only crisis and it’s how strictly they’re regulated elsewhere

Look at what happened in the US.

I agree, I have had the misfortune of working with some doctors and nurses who I have heard accuse patients of actively seeking morphine, deny that they could possibly have that much pain, that they or their relative had the same op and managed well with otc, a bit of pain never did anyone any harm and to take the paracetomol and if that doesnt work then the nurse will call me to write up somerhing stronger, obviously without telling the patient this could actually take hours if it happens at all.

My Dad was addicted to benzos and it was horrific for him. He weened himself off down to a 12th of a tablet before going without. There are alternatives to chronic pain relief like accupuncture, meditation, virtual reality... which should be considered before benzos.

Leaving people in severe acute and chronic pain when there's access to numerous decent painkillers is crass and cruel. Yes, giving someone access for chronic pain will lead to dependence but if it's going to be a longstanding issue then who cares?

You are completely missing the point. It is neither crass nor cruel to work with people to reduce their pain through other means when the alternative is more harm than good. Numerous studies have evidenced that even short-term use can and does lead to significant levels of addiction, especially in young people and younger adults. Thankfully “someone” does care – and that is the medical community who recognise the harm that irresponsible prescribing does. Anyone who understands how these kinds of drugs function will know for a fact that “painkillers” do not “kill pain”. They have absolutely no impact on the cause of the pain. They function by changing the way that the brain reads the signals it is being sent. That is why so many of these drugs are “so nice” – even one has an impact, two a bit more, and it is very easy to slip into chasing that experience, whether with prescribed drugs or street drugs.

It's astonishing to me that a country that recognises the damage done by so many “street drugs” is so blasé about prescribed ones – when they are very often exactly the same thing, have the same impact, and carry the same risks. If your teenager comes home and happily tells you that they had a great time smoking heroin, snorting some cocaine or injecting ketamine, but don’t get your knickers in a twist because “it’s only once”, would you be so laid back about it?
Drugs have to be respected, and whilst drugs have a part to play in medicine, they are often far too often seen as the answer. They are no more the answer in a doctors surgery than they are on a street corner, and where there are other alternatives, even if those alternatives are not quite as effective, they should be the first avenues used. And I say that as someone who has daily chronic pain to contend with whose “lovely old-fashioned doctor” was happy to prescribe never-ending supplies of pain killers. I got rid of the prescription AND the doctor. I am not saying such drugs should never be used – but they should be the last resort, and nobody should expect an entirely pain free life. If it’s a few days of pain after some surgery or a tooth extraction, count yourself lucky.

This is a good summary of why benzos are no longer prescribed for flying, influenced in part by the aviation authorities

Speaking as someone who became addicted to opioid-based painkillers nope, they shouldn't be easier to obtain.

If anything, co-codomol and similar drugs should be far harder to get then it currently is.