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.

If I were a prescriber (I’m not), I would want to ask why I should do something risky for me and the patient (prescribe diazepam) for their totally non-essential foreign holiday.

If I had a morbid fear of flying, I just wouldn’t fly. It really isn’t a human right/essential need to flit overseas to relax in another time zone.

If flying was part of my job, surely I would have known that going in and not applied? E.g. I am afraid of spiders, therefore didn’t apply to work in the arachnid section of the local zoo - rather than go ahead with it and ask for benzodiazepines to get me through!

If, after starting a job that entails flying, I developed a phobia, then I would re-consider my job.

It would really not be fair of me to get all huffy and puffy at my GP for following up to date, evidence based current practice and demand they abandon their way of working because I’m stamping my feet. To me, that’s the childish behaviour.

Just look at the opioid crisis in the US ? !

My DS got hooked on opioids. He had a bad accident and was prescribed opioids and that helped him over the pain and he got better, stopped the drugs. He then had a further accident and the second time he was prescribed them he was hooked instantly. His body remembered the first time and became almost instantly addicted when he was prescribed them again. Its been a long hard slog to get over his addiction. In my opinion they should be used with extreme caution.

Because they are incredibly addictive and that addiction can destroy lives and lives adjacent. Even a week on some of these drugs is enough hence the strict controls.

What I find interesting is that opioids are considered dangerous and addictive by doctors and a fair amount of the public yet codeine is available OTC in many European countries? That's pretty strange.

Codeine gets converted to morphine albeit in very small amounts so I wonder would someone using high enough doses end up moving to stronger opioids.

@janef001 Good point. I don’t think codeine should be available without prescription.

Mostly combined with paracetamol and in doses that are miles off recreational.

Codeine tincture, which you used to be able to get anywhere is now not readily provided.

Washing up 500/8 cocodamol to make ~250mg codeine (an ideal recreational common abuse dose) is a fucking mission. It's also shit and makes you itch like a motherfucker unless you dose up on antihistamines.

It's also really hard to remove all the paracetamol so even if you do wash up 3 packs of it you're still gonna have a dangerously high dose of paracetamol left in your finished product

But then the people who are sensible and need stronger pain relief can't get it
Trying to get a GP appointment because all that's left then is ibuprofen and paracetamol

Like someone said earlier about sliding off a chair after cocodamol whereas I can take 240mg dihydrocodeine a day and be absolutely fine to work
We all have different tolerances and people would just be selling on codeine then, it wouldn't stop people abusing it

I can't tolerate 20mg of codeine and have yet to find long-term pain management.

Is there a safe way of buying valium on line for occasional use?

@Bookridden there really, really isn't. There are dozens of websites claiming to sell genuine valium (and various other things) but the reality is that you don't know what you're getting. It could look completely legit but turn out to be deadly.

www.theguardian.com/society/2019/feb/03/fake-valium-increase-drugs-deaths

If I were a prescriber (I’m not), I would want to ask why I should do something risky for me and the patient (prescribe diazepam) for their totally non-essential foreign holiday

Instead of needing a benzo for a flight, how about something like a medical procedure?

What if they were flying to see family, perhaps a family member's funeral? Would you just say tough luck, won't help you? People don't just fly to go on holiday.

I can’t tolerate opioids, for example (they make me vomit uncontrollably and have violent nightmares)

me too. I was prescribed co-codamol 30/50 after a severe back injury.

took me a while to realise it was the cc making me throw up and feel so bloody out of it. People thought I’d been drinking.

post section too I think they gave me some sort of opiate during surgery as I the same upchuck response for 24 hours after. That was not fun.

i had a benzo once and bloody hell I’d take that stuff every day if I got chance. Made me calm, i slept so well and the whole world was right.

i do find it interesting on here that there are many phrases popping up that are red flags for addition- it’s the only thing that works for me, the o/p where the milder form of the same drug doesn’t work due to “lacking an enzyme” yet the stronger one does…

being deficient in such an enzyme would mean you don’t break it down, so small amounts have a much bigger effect as it would stay in your system longer.

@Reallyreallyborednow I know some people can't convert codeine and I'm sure there's something about dihydrocodeine can but codeine can't. Maybe.. it's a vague memory!

I have absolutely no issues with addiction but I'm a typical redhead that it takes a LOT to knock me out and I need extra local anaesthetic too

Found it

Genetic differences in the expression of the CYP2D6 enzyme results in differences in the extent to which codeine is metabolised. Patients deficient in or lacking this enzyme cannot convert codeine to morphine and therefore may not obtain adequate analgesic pain relief. Conversely, patients who metabolise codeine very rapidly (ultra-rapid metabolisers) are at increased risk of developing adverse effects of opioid toxicity, even at low doses

Co codamol gave me terrible pain all over my torso. stomach chest and back. Bananas do the same.

@JamesBlond I have a phobia of snakes so tend to stay away from them. Kind of hard to do that though when the neighbours pet one got into my kitchen..

Valium is horribly, horribly addictive. My father was prescribed it "for two weeks" in 1980. He ended up on 30 mg a day. It took him years to come down to 5mg a day. He was a "functional" - high functioning - addict. He held down a big job. But it had a terrible effect on his life, my mother's life and my life. I can't describe what it is like to live with someone who isn't fully present, but isn't drunk or high. The constant, constant background music of "what is wrong here".

My father wasn't the only one. There was a massive scandal because millions were prescribed it in the 70s and 80s. This is why doctors are so careful with it now. You might be fine after a few weeks and trot back to normal life. Good for you! Unfortunately millions weren't and it is very difficult to predict in advance.

My experience living in an EU country is the opposite. Drugs are much stronger and possibly at risk of overdose or addiction

@mmmmmmghturep Ah well in your case, it’s obvious; you need to take diazepam every day in case of sudden domestic contact with escaped reptiles.

😜

I agree. There are instances when these drugs are needed. Valium, used very occasionally and judiciously, is a wonder drug for my anxiety. Fwiw, I took it every day for a year when my late DP was terminally ill. I weaned myself off gradually, no problems. Not saying that is everyone's experience, just saying there are circumstances when its usage is appropriate.

But how is the doctor or anyone to know whether you are the person who will not have a problem, taper down off it and walk away from it or you're the person who will end up with a problem that can end up destroying your life? The effects of addiction can be horrifying. If you read a lot of the US stories, a lot of addiction over there starts with being prescribed opiates for a surgery or injury. A few days can be enough and everyone reacts differently - you don't know until it's too late. That is why doctors are so cautious - the pain of a lifelong addiction outweighs the pain of a lot of other things. Obviously it's different if someone is in a hospice, etc.

I take dihydrocodeine for chronic pain, I have to take two in the morning to unravel myself, to be able to get up and function properly. I will have two at dinnertime most nights but that’s it no more than four a day max. I can’t take naproxen as it hurts my stomach. They have been life-savers for me.

@JumpingPiglets Wow, I've heard those sentiments echoed about benzos in general.

When you say the effect on his life, what is the physical symptoms/withdrawal (seizures, sleeplessness) or the psychological ones (slowed mental state, amnesia)?

There was a massive scandal because millions were prescribed it in the 70s and 80s.

They should never have been prescribed for more than 2 weeks; but was that known at the start? I knew women on valium for years - because they were in bad marriages. Would it have been any better, if those people became alcoholics instead? People have used drugs to numb the pain in their lives for centuries; and I suspect people are self medicating with food now - is getting Type 2 diabetes, cardio-vascular disease, cancer, etc instead any better?

Anyway OP, I find it strange that most doctors are obsessed with addiction; when no consultant neurologist has ever raised it with us, in discussions about benzodiazepines for epilepsy! They are life saving drugs; used by families, paramedics and A & Es as first and second line emergency drugs. If your child were in front of you, having virtually non-stop seizures and possibly about to:

1. stop breathing
2. their heart might stop
3. suffer brain damage and death within a couple of hours

would you be worried about addiction? You are told to give them benzodiazepines hopefully to stop this! If they don’t work, you have to call 999, who might give rectal diazepam on the spot; or the ambulance will take them to A & E for lorazepam as the second line emergency drug! You will be told not to take them to A & E yourself, as if your child stops breathing in the car, there won’t be anything you can do about it!

Clobazam, a benzodiazepine is also prescribed as a regular medication, to improve the quality of life for patients with epilepsy, because they are regarded as having a good safety profile, and are one of the most effective drugs in preventing drop attacks (the most dangerous type of seizure for the injuries they cause); and in preventing all seizure types in the most severe syndromes. People like this will be on three to four drugs, and the side effects of some of the other drugs are more serious. Tolerance is not a significant problem; they work effectively for years for many people. DD has been given clobazam both as a regular medication for years, and as an emergency medication. I’ve weaned her off it, at least three times while they try different combinations of three or four drugs; and with a good weaning schedule, it’s quicker and easier, than weaning off many of the other anti-epileptic drugs - which all take months and cause rebound effects!

It’s in the Nice guideline for Epidiolex (the cannabis drug), that patients must take it with clobazam.

Clobazam is a wonder drug for DD; the most effective and no consultant neurologist has ever appeared to be bothered by the idea of addiction at all. They have been visibly worried about her dying.

Clobazam is a wonder drug for DD; the most effective and no consultant neurologist has ever appeared to be bothered by the idea of addiction at all. They have been visibly worried about her dying

well yes. The bigger risk is seizures, and benzos are the standard of care.

addiction is not a concern when withholding them means brain damage or death from a seizure. You will not find a dr who won’t prescribe benzo’s in your case.

it’s all back to the old risk:benefit. Pain is awful but won’t kill you while you try other pain control methods to find one that suits. Addiction is the bigger problem, so guidlines are other medications.

@janef001 it was all of it. Stories about my father "passing out" at eg parties were numerous. He appeared functional to many people, but it massively slowed his cognitive functioning, and he'd spend a long time at home just not engaging and sitting in silence, as if we were in a foreign film and he didn't have the subtitles.

When he tried to quit it took him years, the better part of half a decade, to get from 30mg to 5mg.

Unfortunately, over the long term, valium made his anxiety worse not better. He smoked heavily to reduce the physical sensation of anxiety ("in his bones") which valium gave. He eventually gave up smoking completely. Unfortunately, though, he died of lung cancer many, many years later. His body was very weakened and one doctor said to me that the years of prescription drugs had done it no favours.

My father became addicted to valium before I was born. You wouldn't have been able to predict in advance that he would become so horribly addicted: future addicts don't walk around with red flags on their foreheads. And if you had met him during his addiction likely you'd never have guessed. Because the true pain of addiction is mostly behind closed doors.

I'm flabbergasted that medical professionals let it go on as long as it did and very, very angry. If they have learnt as a profession not to do prescribe this stuff on request that is only a good thing. Because there really is no way of predicting the outcome in advance and sadly, once sometime becomes addicted/dependent to anything they are often the last person to have any real insight into it.