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.

The healthcare system in the US is terrible, and their benefits system contributes to their opioid problem. We shouldn't compare the two systems and we shouldn't import their system here.

I'm sick of dealing with the 'its addictive' attitude that makes getting prescription painkillers so difficult. Addiction and pain management are different issues. I'm terrified of losing my prescription, because nothing else is either suitable for my condition, or works.

Because for many people, with addiction comes tolerance, and a need to increase the dose for ever. Which is dangerous.

Yes that's what I said

OP's friend must have had a long duration of post-dental-work pain.

Quite possible - I was in severe pain, after difficult extractions of my wisdom teeth, for 6 weeks. I lost 2 stone, and eventually stopped eating and drinking altogether. I neither knew nor cared, if it killed me - because I was so ill and out of it. I couldn’t talk due to the trismus, so couldn’t ring my doctors for advice, even if it had occurred to me, which it didn’t. It’s only because my husband came home from work and saw the state I was in and called the doctor out. Even when the GP asked me if I could drink, and I said no, it didn’t occur to me that I was going to die, although I didn’t care anyway, because I was in so much pain! (Yes, I had been to my dentist and the dental department at the hospital, and been given oral antibiotics, which didn’t work!) What stopped it, were the IV antibiotics in hospital!

@SillyDoriswithaDangler the cocodamol that you can buy (only from a chemist) is the lowest possible dose it's 8mg of codeine and 500mg of paracetamol per tablet and you can only buy 1 pack.
The government did ban its sale and/or prescription of that particular dose of cocodamol for about a decade to try and prevent addiction but it actually made it worse because higher doses were prescribed instead and because the vast majority of people who used it very rarely couldn't get it they ended up at the Dr's again getting a higher dose with a greater chance of addiction so they did a quite reversal of that particular ban

I completely agree. If opioids are used for intense, short-lived pain you aren’t using them to get high, simply to get relief - and they can be easily tapered off.

I had a knee ligament reconstruction a few years ago at a private hospital, and for serious post-surgical pain I was prescribed nefopam (not an opioid, absolutely shit) or told to take paracetamol. It was shocking.I was in agony and my mum had to haul me to urgent care a couple of days later.

I hadn’t slept, was crying and screaming in pain and barely able to walk on my crutches. The doctor was horrified and immediately prescribed oromorph. I really needed it for the first couple of weeks, but it made such a difference. I only took as much as I needed and easily stopped. I then used tramadol as and when, didn’t need it at night after a few weeks and just gradually tapered down.

Using opioids for a short period allowed me to recover properly and to tolerate the pain of the 5-times-a-day physio exercises I had to do to get my leg functioning again. I couldn’t have done it without them.

People do not get addicted if they are using them as directed and make sure to taper down. They shouldn’t be overprescribed but in cases of severe pain they are sorely needed.

I can't get a one off benzo script to get the Covid jab (am severely needle phobic). Is daft, because if I end up in A&E/136 in a mental health crisis, I am pretty much forced to take benzos.

Having nursed someone through chronic benzo withdrawal I would say it is a last resort, not first line- It was the worst time of my life, I wouldn’t wish it on anyone if there was an alternative.

It’s well known that tolerance and physiological response to opioids varies substantially between individuals.

I can’t tolerate opioids, for example (they make me vomit uncontrollably and have violent nightmares), but some people can develop addiction issues during only a very limited use period. Just because you found it easy to taper then off, does not mean others can.

I'm British but in Canada, where we have free healthcare and an excellent benefit system. We have an opioid crisis on a par with the US.

I've personally seen how easy it is for people to go from short-term prescription to longterm addiction (and it's rarely people you think it would be). The UK could just as easily develop the same crisis, and all recommendations from the medical field worldwide is that opioids should be more controlled, not less.

The problem is this. If you are going to properly manage pain and painkillers you need a LOT of staffing. People need proper check-ins, management, counselling, alternatives and monitoring. We don't have that and so the alternatives are stingy painkillers or mass addictions.

Choose. And if you choose the latter, get trained and carry naloxone.

People do not get addicted if they are using them as directed and make sure to taper down.

Bless you. When you talk to addicts about what they felt when they first tried their drug of choice, the answers are things like 'coming home', 'a warm bath', 'safe and blissful'. One pill.

And I think I can safely say if they handed out valium like they did in the States, I would be addicted. I had it for flying. I bloody LOVED it. Like really really loved it. Wanted more. My doctor would ask how many flights, want to see tickets and only give me one for each flight. Thank fuck. Stingy bastard.

This thread has been an interesting read with some posters who really know what they are talking about.

So…slightly off topic, can anyone explain why paracetamol usually, but not always, makes me vomit but ibuprofen, supposedly much harsher on the stomach, doesn’t?

Thank you!

Back to opioids - my mother moved from the UK to California and was on high doses of opioids/opiates for cancer related pain relief. She was terrified of becoming addicted but, as she was terminal, the doctor brushed off her concerns to focus on her quality of life.

I could have made a fortune selling the drugs that were left in her house after she died. But I took them to the fire station instead (as advised by the pharmacist).

I think it's a really hard balancing act.alot of people struggling with addiction.so too mental health.talkinvbtherapy should be available.mote support.social care etc.so medication like this aren't either needed or on their own with agreeing the problem.
They have had to come right down on them.aome people really can't not get addicted.
There have been a few too many deaths too.based on malnourished which often comes with mentally ill and things like eating disorders they can be fatal very very quickly.

Haha and this is why doctors don't give them out.ignorant comments like that.annoying how far we have to go on learning about mental illness,addiction etc.
Haha yes that's exactly how not to get addicted.soooo simple.how Do people get it wrong.

Doctors are respected all around the globe. Our health is ultimately all we have. Opioid addictions are incredibly easy to fall into and incredibly difficult to fall out of.

It's interesting to see so many comments comparing drug addiction to alcohol addiction.

A lot of my relatives are in the medical profession and they've pretty much all said that if alcohol was invented today, then it would never be approved for general sale the way it is at the moment.

It's one of hell of a dangerous drug but it's so normalised that banning it now would be impossible.

@coffeecupsandfairylights

To be fair lots of drugs on the market - including aspirin - likely wouldn’t get past the FDA today.

I agree.

I just think the comparisons are interesting. People are posting saying these drugs are so dangerous and so addictive - yet I wonder how many of them drink alcohol most days?

I'm not saying benzos etc. should be more freely available by any means, I just think it's an interesting conversation to have.

I agree with others about alcohol. And I think it weakens the “won’t prescribe Valium for fear of flying as it might make you drowsy” argument. If so, ban all alcohol on flights.

I suppose it's because alcohol isn't a prescription drug, so if anything bad happens because someone drinks on board - it can't be traced back to a GP.

Whereas if someone takes prescription drugs on a flight and something goes wrong, the GP could end up taking the blame?

The main reason alcohol is sold on flights is that you're a captive audience and they make a lot of money out of it, I suspect 🤷🏻‍♀️

The whole ‘diazepam for a flight’ request really annoys me as a GP on so many levels.

1. Getting a flight is a lifestyle decision. If you’re anxious, perhaps deal with this anxiety before booking. There are lots of private anxiety surrounding flying courses you can book
2. it is my name on that prescription. If you take too many, become unwell and cause the flight to have to divert, the airline could come after me

Ive been on a flight when a passenger took several valium and a couple of vodka chasers. He stopped breathing. It was scary (he was ok in the end) but the pilot was informed and plans were made to divert.

It’s not really an NHS problem imo. In current climes, we really need to be focussing our time and resources on where it is needed, and I don’t think prescribing Valium for flights is one of these things.
I very occasionally give a very short course of diazepam for acute severe back pain or for patients who have had a significant trauma (bereavement etc) with the caveat that they’re addictive, short term use only, won’t be able to give more. Occasionally, you do get repeat requests for more within days of initial prescription, it really is a very addictive drug and coming off them after long term use is an absolute nightmare.

I had to beg for oromorph after my c section. Aspirin just wasn't cutting it. Funny that, since it's abdominal surgery cutting through seven layers of tissue!

@3weeksuntilwine I disagree. I have tried various expensive courses and they haven't worked. My GP gave me some diazepam for flying, I took it as directed and was able to keep my job as a result. Surely any medicine can be used to overdose or use incorrectly? Do you never prescribe anything?

Also it sounds like you are one of those doctors who really don't understand or want to understand anxiety tbh! Don't you think that if it were so easy to just "deal with it" most sufferers wouldn't do that anyway?