Do you agree there should be more checks before drugs are prescribed.?

[RedHillLady]

There has been a lot in the media recently about how the current system is too weak and needs to be more robust.
I think we are going to see increased regulation soon and I see that as a good thing.

Oh gosh. I can how easy that could happen. I hope your friend will be ok.

As someone who is a recovered bulimic I can tell you that laxatives don't cause weight loss - it's artificial loss that you shit out of yourself when you are so utterly disgusted with the binge you just did.

I remember once that I was so terrified of binging, I poured paint on all the food in the house and threw it away (the paint was to stop me getting it out of the bin and eating it). Such was my urge to binge that 10 minutes later I was literally taking paint covered biscuits out of the bin, scraping off the paint and stuffing the food in mouth. After my binge I felt so disgusted with myself I took laxatives and collapsed on the bathroom floor with shit coming out of myself. Laxatives are not pleasant for ED patients and they aren't something which actually helps us loose weight at all. They r just a method of making your stomach feel empty so you feel less disgusted with yourself. You cant really abuse them too much because the side effects are not pleasant. Must don't help weight loss and ED patients know that so they only bother with them in emergencies.

These glp 1s are a totally different ball game. They will PREVENT the binge in the first place, (which for some bulimics may actually be a good thing - we need research). But for anorexic people they will be the golden ticket they crave to keep the hunger at bay and enable them to get to extremely low and dangerous weights.

When I was at the height of my ed I could go a whole week eating NOTHING and drinking only water. But I was sooooo hungry and when the urge to eat was too strong I'd binge for up to days. If, in the midst of my fasting week I'd have been able to take a GLP1 that might stop me getting hungry, who knows how long I may have continued to starve and that could've resulted in anorexia and even death.

Yes, people talk of personal responsibility but when you have an eating disorder you can't just stop yourself starving and seeking out glp1s. Just like an obese person can't stop themselves giving in to hunger and binging.

I do firmly believe these drugs should only be available via face to face appointment with a GP. I don't know, but I'm pretty sure meds like antipsychotics and diazapam are only available via face to face consultation with a GP, so I don't see why GLP1s are any different.

Laxatives prevent you gaining weight from the food you’ve eaten. Like being sick. Purging it from your body stops gain. That’s why rhey are abused by many of those with eating disorders. I get for you it was more about feeling empty, but biologically they stop the food meaning weight gain, and many abusing them know this.

i have a friend who has an ed,she is bulimic and she abuses laxatives nearly every day to keep her weight down.

As I understand it @HottWaterBottle at the moment, WLI are not available on prescription via the private prescribers for those who declare their EDs. I'm sure I will be corrected if I am wrong.

For some people the GLP inhibitors could help prevent binging, but if you follow the threads on here you will see that appetite suppression, food noise suppression etc varies massively from person to person. You are right lots more research needs to be done.

I'm sorry for your friend. Please watch her closely because if she's prepared to use laxatives daily then she will definitely be prepared to give GLP1s a try x

Actually, that's a good point. "Personal responsibility" is trotted out whenever people express concern for ED sufferers around the availability of these medications.

Why is that ED sufferers must use personal responsibility so that people with obesity can avoid using personal responsibility around the amount of food they eat?

And why is it that we don't use personal responsibility around other medications such as opiods?

Could be that it is not that simple which is why we have sufficient checks and balances for all other prescription medications?

@Frequency maybe it simply comes down to the money. There are so many more obese people than those with EDs. Obesity and its effects costs millions, probably billions each year to healthcare systems and governments. Perhaps it is quite simply worth the risk of some abuse at the edges to get the overall population to be less obese and less of a drain on the system.

I'm not saying that is the reason, but I'm sure it is a factor.

That's true.

I am a recovered bulimic however, and I managed not to disclose my ed history when getting mounjaro. I also managed to lie about my weight.

I am taking it because I am recovered but I still hate my body and continue to suffer food noise and endless hunger and mounjaro is really helping me. I also know that I don't desire to be thin anymore and just want to reach a healthy BMI so I feel I can take it safely. I feel in control and don't think I've binged from the bin in 20 years or so. When my eating was disordered I would look at thinspiration pictures all the time and desire to be bone-thin. That's completely gone, but I do still want to be slim (BMI 20 to 22 would be small enough for me now). I was 27 BMI when I started mounjaro.

So I can tell you. Despite having had bulimia for 15 years in my teens/20s, and not being obese at the time of ordering mounjaro, it was still super easy to obtain.

I'd be gutted if I wasn't allowed to have any more mounjaro. But for the sake of the younger version of me and thousands of girls (and boys) just like I used to be, I really do think a GP appointment face to face is essential.

Well said.

In an ideal world @HottWaterBottle it would be lovely for everyone to have a proper face to face with a GP before any prescription. I have two chronic conditions for which I receive medication and should be monitored. I can't remember the last time I saw a GP! I've also had an acute illness in the last 12 months and requested medication and received it without even a telephone consultation with the GP.

The medication black market is so widely available and sophisticated these days, that I doubt seeing a GP would prevent the abuse by those who are desperate to get their hands on it either.

Weight loss injections aside in a more general sense it's practically impossible to get certain medications (anything other than paracetamol and aspirin apparently 🙄) in this country without jumping through some serious hoops it's the infantilisation of an entire nation. Yeah I'm sure someone will point to the opiate epidemic in the usa but there's plenty of other countries that are more relaxed about prescribing and don't have major drug addiction problems.

I had a freaking infected wound cellulitis and was worried it would turn septic couldn't even go to the pharmacy to buy antibiotics without being told "you need to go to a GP and get a prescription" people have literally died of sepsis in this country because they couldn't get antibiotics.

Another point in case is the panorama documentary about grown adults paying with their own money to go to private GPS and get diagnosed with ADHD. Which led to calls for that to be "cracked down on" holy shit why do certain people feel so entitled to tell grown adults what they can do with their own money and life.

Its obviously better to get ritalin prescribed by a doctor than go out and buy amphetamine off the street. Butt out of other people's business and stop being so easily swayed by shit you watch on the boob tube.

Laxatives prevent you gaining weight from the food you’ve eaten.

No, they don't. Complete myth. Google it.

Why would it not be sterile?

Its the same as the other 4 injections from the pen, it can be measured?

honestly I disagree if the process is followed. Gp prescribes, GP surgery has responsibility to review and have a pharmacist for this, pharmacy receives prescription they have a resp to review, and speak to patient and follow up if on new meds. SO in the process there are plenty of checks just often these people don't do this follow up well, GPs on work to rule is putting pressure elsewhere at the moment

What about:

Pharmacy prescribes, GP surgery is notified immediately and as a matter of course, has responsibility to review (either GP or GP's in-house pharmacist or even practice nurse/admin) and notify prescribing pharmacy if there is any reason medication should not be issued. This way GPs time is not tied up in the prescription process for a medication that does not need it in the vast, vast majority of cases, but checks are in place.

Incidentally, I believe this is the process that will be put in place at some point in the next year. More and more prescribing pharmacies are doing this anyway, including ones that used to give the option of not notifying GP. Anecdotally from posts on Reddit, even pharmacies that say they won't notify in fact are now doing so.

Pharmacies are doing this to protect themselves, not patients. It is a commercial decision not a moral/ethical one, so you can be sure that they WILL all be doing this. They cannot afford losing their license/bad publicity for not demonstrating due diligence in keeping to the prescribing guidelines.

Every single post on here where an OP is asking for a pharmacy that does not notify GP for whatever reason ('my relative works for GP and I don't want them to know' blah blah) will be someone attempting to bilk the prescription parameters.

Absolutely and it happens in many cases already, starmer also made a speech telling gp’s they had to review when they got notifications. Gp’s will be told to check more formally. They are right now supposed to enter it into the patient record every time they get notified, that the patient is now on this drug.

i also feel this is the right route and the one that will be solidified as the best way forward.my gp is fully aware, its on my records and I spoke them before I even started. Some gp’s are shit though.

the demand for these 20 min consultations is just the big pharmacy chains trying to cash in and take the smaller on lines out of business. And they know that. They aren’t idiots.

im fairly horrified every time I see these posts saying who will prescribe without telling my doctor and even worse, won’t want a pic. And there is always someone willing to roll in and advise. For me, that needs to stop.

I agree also the referral codes are fucked up and seriously need to stop

Oh me too, I can’t beleive the spamming of medexpress ones on here.

For those who aren't paying attention... (not you!).

GPs don't prescribe just for weightloss. You have to be referred into the specialist weight management service for that. It's then a last resort for them to prescribe it.

@Finallydoingit24 sorry but you're talking rubbish. I don't have private healthcare or use a private GP, that is completely against my principles (and my budget!).

I have an NHS GP who spent ages with me discussing this first, going through the pros and cons and then referred me to the practice nurse who showed me how to inject myself.

Im not obese but have diabetes. The NHS DOES allow GPs to prescribe to control blood sugar when other options have failed, as in my case. I do think the NHS should be allowed to prescribe in cases of obesity when other methods have failed. The cost saving in the long term should outweigh the initial cost.

Okay but you omitted that it was for diabetes in your OP which is a pretty major omission. Yes they can prescribe for that, but NOT for weight loss and you know very well that the vast majority of people here are using them for weight loss, not diabetes so how does you saying you go via your GP help anyone exactly?

@Finallydoingit24 you're my missing the point.

I'm saying I think it should be prescribed for weightloss via GPs. I would not want to rely on a fairly unregulated market to gain access to a drug which you inject and it stays in your system

I think there should be criteria around obesity and that the drugs should ONLY be available via the GP or a specialist NHS clinic so that people are properly monitored.

The fact that it can be done in cases like mine, where I get proper support and clinical oversight from my GP practice, shows it is possible. At the moment there are people who take it when they are not obese or have diabetes and online pharmacies just take their money. The existence of referral codes etc is really worrying as the businesses have profit not people's wellbeing as their motivation.

I agree with this in principle but in reality this is decades away.

There are approximately 10 million obese adults in the UK ( 1 in 4 adults), thats not including those with bmi of 27 with other health issues. The roll out of these drugs to all of these people would cripple a system that is already on its knees.

To roll it out to those with a bmi of over 35 with a health related condition will take 12 years. I don't want to wait until my bmi has crept up to 35 ( was at 34.3 before MJ) and I develop a weight related disorder. So if its 12 years to roll it out to that population it will be 15 -20 years before it would be available for people like me ( and yes I have tired eating less and moving more, I could write a fucking book on nutrition but it doesn't stop me being constantly starving) .

I agree more stringent measures need to be in place but limiting it to NHS GPs is not a viable option.

@AnnaQuayInTheUk whilst it would be lovely if all those wanting to take WLI could have a full consultation with their GP, given that 30% of adults are obese how exactly will that happen?

As I've already noted, I have two chronic conditions which I receive repeat prescriptions for and should be monitored annually. Can't remember the last time I saw a GP or had a consultation! It simply isn't going to happen.

I think the economics of getting people to self fund their own weight loss treatment and not bother the already stretched to breaking point NHS will far outweigh the low levels of abuse or misuse that will happen. Obesity costs millions and millions and the WLI appear to be an effective fix.

The drug companies make money whether it is through your taxes via the NHS or directly through your earnt income when you pay for the medicines privately. They definitely won't be giving the stuff away for free, whichever way you get it!