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.

@3weeksuntilwine sorry if this is a bit cheeky but as a dr what would you suggest that someone who has a severe phobia about a particular medical procedure (as in panic attacks just at the mention of said procedure) that they really need do ie is there something that they can take to get them into the hospital that wouldn't interact with the general anaesthetic? Am asking for a relative who cant/won't discuss with a dr and won't ingage with a treatment plan and I'm wondering if I'm maybe being harsh by saying talk to your dr

Does no one else remember the benzo scandal in the late 80s? My first job in a law firm back then and there were literally filing cabinets full of people making claims because they'd become addicted to benzodiazepam. This could partly explain the reluctance to prescribe.

I completely agree with this, I was finally seen in the chronic pain service clinic this week and the support that was suddenly offered was brilliant. I've been on various forms and amounts of (prescribed) opioid pain relief for 25 years now. I broached the question with my gp about coming off Tramadol / pregabalin / nortriptyline / duloxetine just before the pandemic but was told it was 'working' so why alter what the consultant had prescribed me 10 yrs ago. I read and watched numerous documentaries and DopeSick and came to the conclusion that everything I was currently prescribed I was tolerant to which was my pain levels were increasing again. Sadly, my gp's were not particularly helpful when I requested help in lowering my dose (liquid forms of medicines were too expensive and when I requested alternate pain relief options - muscle relaxants/ Nefopam - I got told no) so I self referred to physio who saw me 6 months later and said they couldn't help either BUT would refer me to the chronic pain team.
I saw the lead nurse this week (15 months after my original referral to physio) and she was fantastic, agreed that everything I was on (aside from duloxetine) wasn't going to be helping much now and we have created a plan to go forward reducing my dependence on the opioids and gabapentinoids too. It will take months, I'm sure I will have a battle to get the liquid Tramadol prescribed due to its cost but I finally feel I have a plan in place.
The nurse said to me that NICE have now ruled out opioids and gabapentinoids being prescribed now for chronic pain as they don't work and the addiction plus side effect problems they cause are huge.
I'm so relieved that I'm now in the system to start coming off them but it's explained to me that it won't be a quick or pleasant process and they'll up my duloxetine to try and manage my anxiety which will most likely raise.
If I'd known this when I was 20 then I would never have started taking them but at that stage all I wanted to do was get back to my life so didn't think twice and if taking tablets enabled me to do that then what was the problem..

It's weird because I'm addicted to nicotine (have been for years) and am quite well, that personality that tends to get fixated/addicted

Yet I had diazepam for 3 months and came off it cold turkey, no issues. Currently on zopiclone, have some in the drawer and again, don't feel any urge/need and come off it with no issues
Take dihydrocodeine daily but can stop if needed. It's weird! The codeine doesn't really affect me though, I was on 60mg x 4 daily and still working and my friend can't even take one without falling asleep

The ‘people don’t get addicted if they take them as directed’ is the (truly awful) argument that Purdue Pharma used repeatedly to pretend that their drug (OxyContin) wasn’t the problem, addicts were. But the (very clear) evidence was that people taking them exactly as directed did become addicted. That’s what happens with opioids.

This is for the operating surgeon and anaesthetist to manage and plan for, not the patients own GP.

The issue with drugs like diazepam is that even taking it as directed can result in severe addiction.

It's not as easy as telling people to just follow the instructions.

@Fitterbyfifty it’s ok to disagree with me.

The issue is even when take as prescribed, benzos are addictive and can be dangerous.

I never said ‘deal with it’. I said ‘deal with their anxiety by other approaches.. ie anxiety management’.

Not sure how me advising management plans based on NICE guidance for patients with anxiety is me being unsympathetic.

I don’t need to justify myself but in my practice of 4 GPs, many patients choose to consult with me if they have anxiety/depression.
I give my patients informed, guidance driven advice and support. Benzos just don’t feature in 2022.

Is there a reason why someone wouldn't find them addictive? I'm a redhead but my tolerance to painkillers/codeine/diazepam is ridiculous. Same with antihistamines, I can take 4 a day (prescribed) and not even sleepy

I've been on morphine on and off for over five years. Never had withdrawals never had any cravings for it. I take it when I absolutely have to at the point I can't cope without it due to the pain I'm in.
I usually take half the prescribed dose and always try to manage my pain in other ways. Exercise, hot packs, paracetamol, naproxen and then finally morphine.

I cannot take codeine anymore gives me a terrible terrible headache about 50 minutes after taking it and lasts several days. Tramadol gives me restless leg.

@ticktock19 all the very best with it. It's a hard road but it sounds like you have a good plan and a solid team.

It’s a fine balancing act. Having seen my husband in excruciating back pain, I can empathise with the need for strong pain relief in such circumstances. However the Louis Theroux documentary about addiction in a West Virginia town, rooted in excessive pain killer prescription was a real eye-opener and very tragic.

@MrsTerryPratchett thank you

I suppose it's also an example of confirmation bias. If you think about it, Netflix and other companies are not going to create documentaries on the tens of thousands of people who take benzos/opioids and don't get addicted/go on to lead normal lives; it doesn't make for interesting television. They'll show you the life changing stories.

The fact that opioid use is also in impoverished areas suggests that it's a coping mechanism rather than opioids being inherently addictive. I know if I was unfortunate to live in some areas of America, I'd be more likely to turn to drug use.

My story is exactly the reason why GPs only prescribe benzos very sparingly.

I have a long history of mental health issues and when my dad was dying 8 years ago I started waking up with panic attacks in the night. My psychiatrist gave me a prescription for a benzo called oxazepam. I felt loads better on it, my daytime anxiety was also gone and he said I could take it long term, I obviously knew benzos were addictive but he told me the only people who run into problems are the people who abuse them and they were completely safe.

I am now a mess, I have had a pretty severe change of personality. Before I was someone who cared a lot about things and had some spark but now I'm mentally dull and lazy (which the psychiatrists say is depression rather than long term sedation and offer me more pills). They also have negative physical effects, my coordination and balance is so poor I have thought about walking aids and I have slipped and fallen a couple of times. The muscle weakness and lack of confidence walking has made me severely unfit and slug like. It weakens all muscles including the bladder and bowels, my bladder muscles being so weak I am incontenent overight (I had loads of physical tests when it started and everything physically fine) and bowel muscles struggle.

I had been asking for help to come off them for 3 years and my old psychiatrist always said no but after he retired the new one agreed. I had to convert from oxazepam to diazepam but they set the taper far too fast and I got horrible withdrawal symptoms. I am now withdrawing a lot more slowly but the real problems are meant to start when you get to a really low dose. I'm currently on roughly half on the orogonal dose right now.

You might think my story is unique but it is not. There are lots of prescribed benzo addicts out there and the withdrawal is extremely hard and dangerous if not handled properly. I know one woman who was taken of benzos cold turkey after 30 years and was housebound for years. Others develop akasthesia, a motor disorder and others commit suicide as it is all just too much to handle.

I get diazepam on repeat prescription from my GP on my psychiatrist’s advice. I’m not addicted - my repeat is for 10 x 2mg a month and I have a couple of unopened boxes. I don’t need a prescription every month.

I’m on a baby dose but I have PTSD and absolutely crippling anxiety. I also have a son with ADHD and autism who is extremely demanding and doesn’t sleep. Im
on venlafaxine but I often need diazepam to help with anxiety and agitation because of trying to cope with DS’ constant challenging behaviour.

It works for me and it shouldn’t be totally off-limits.

I was given 30/500 co-codamol after an operation back in 2016. Didn't seem to be any issue with me having it then - they didn't even tell me, just gave me two tablets, it was only when I felt myself sliding off the chair that I realised it wasn't just paracetamol. Gave me a box of it to take home as well.

You can buy Ibuprofen with 12.5mg of codeine from a pharmacist with just a few questions, so not giving it to people post op for very short term use seems unreasonable. I will admit though that I was off the 30/500 as quick as possible - no chance of me getting addicted because it gave me the most horrendous and realistic nightmares.

I don't think comparing us to the US is right - drug companies don't bombard us with tv and mag ads telling us that x or y is what we need so that the insurance covered patientscan demand whatever it is.
If it's addictive that can be explained and the patient warned that that is the case therefore there is a limit to the number of pills they can have.

Benzos just don’t feature in 2022
So that's that. No bother listening to the patient and the reason for them asking for it. No need to consider their history (and ascertain there is no history of mental health issues or addiction). No consideration how the anxiety, that can be only to a very specific trigger rather than dealing with anxiety as a whole.

I used to love flying in planes, really look forward to it until a very traumatic experience. After that, I refused to get on a plane for over 10 years but really missed going on nice holidays.

My GP at the time agreed to prescribe valium and it changed my life to be able to fly again nervous, but without utter fear and panic. Gradually, the experience got more bearable and I reduced the dose to the last flight where I was able to fly without it but knowing I had some with me just in case.

That was before covid and I am due to fly again in August. I'm back to scare one. If my GP refuse to prescribe a few pill, knowing I've done without it for 3 years so clearly not addicted, and tells me 'benzos don't feature in 2022', I will be massively pissed off. Its an easy response to avoid any risks however very mild not giving a care for the repercussions of that decision. Not in the spirit of the medical profession.

Benzos are frequently prescribed within inpatient mental health facilities but we have strict monitoring. There are less addictive drugs out there for anxiety SRRIs , Beta blockers , Promethazine for insomnia.

You can't really compare the UK and the USA. In the USA there is a long rooted culture of always prescribing something, even if you go to the Dr for a cold in America and come away with at least three different prescriptions including antibiotics every single time! That simply would not happen in this country.

I think some GPs see benzos as sweets not to dish out to dc before a meal - naughty greedy children. When actually we're not dc and from personal experience 2 weeks of diazapam sorted me right out compared to 6 months of being house bound and on a cocktail of drugs that have long term health impacts.

They are a perfectly valid short term drug.

Oxycontin has devastated large swathes of the US. It's killed more people and done far more damage than crack and heroin combined. It's a good thing that British doctors are "stingy" and reluctant to prescribe it.

I got tramadol after surgery once. A box full of them I only used 1 it made my face feel fuzzy. Kept that box for around 6 years before throwing them out I was only 18/19 when they prescribed them.

I was on tramadol for a month/6weeks after crash c-section/complications and intense pain. Weaning off I totally understand why doctors are very reluctant to prescribe it. Look at addiction rates in the US and some of the wonderful people who’ve had issues - look at Matthew Perry.

there needs to be careful control of these drugs without holding them back from people who really need them.