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Harm Reduction Is flagging patients with "drug-seeking behaviour" a practice in the UK?

cezanne

Greenlighter
Joined
Feb 23, 2023
Messages
8
Of course, individual practitioners will refuse medication to someone who they perceive to be exhibiting "drug-seeking behaviour."

I have heard that in some countries, patients can be "flagged" and refused medication across different practitioners.
I'm not sure whether this is a myth or not, but is this a practice in the UK?

If it is, then what kind of behaviour is usually considered "drug-seeking"?
 
I don't live in the UK so I can't really help with that part of your question specifically, but I do know a good bit about "drug seeking behavior" in the medical field.

My wife works in a position where she trains new doctors. Apparently, what they are teaching doctors in school now is that if anybody comes in asking for any type of narcotic, it's drug seeking. Most doctors (unless they are pain specialists, or just really good at their job, which aren't many), don't really understand the subtle differences in narcotics, and are scared to death to end up on the news being responsible for a death, so they won't prescribe narcotics at all, even in cases of very clear, legitimate, pain. They don't understand the difference between sending somebody home with three 5 mg Vicodin, and a bottle of a hundred Roxy 30s. It's very clear to US how those drugs are different, but to them they're all just narcotics, and unless you want to be on the news, should be avoided prescribing at all costs.

My wife says she has to explain to doctors all the time that if somebody is requesting a few Tylenol 3s, or a Vicodin or two for dental pain (that's her field, and there's a whole lot of VERY real pain in that field), that it's most likely not drug-seeking because those wouldn't have any effect on an addict. Both of us having heavily used opiates in the past, we understand that, but most don't, even doctors.

They also seem to think that if somebody expresses ANY sort of enjoyment from the drug, then it MUST be drug seeking behavior. If you get four teeth pulled, and then express any excitement for taking a painkiller later, it's grounds for having your prescription not given to you. Anybody who's used an opiate before sees why that's fucking dumb.
 
I don't live in the UK so I can't really help with that part of your question specifically, but I do know a good bit about "drug seeking behavior" in the medical field.

My wife works in a position where she trains new doctors. Apparently, what they are teaching doctors in school now is that if anybody comes in asking for any type of narcotic, it's drug seeking. Most doctors (unless they are pain specialists, or just really good at their job, which aren't many), don't really understand the subtle differences in narcotics, and are scared to death to end up on the news being responsible for a death, so they won't prescribe narcotics at all, even in cases of very clear, legitimate, pain. They don't understand the difference between sending somebody home with three 5 mg Vicodin, and a bottle of a hundred Roxy 30s. It's very clear to US how those drugs are different, but to them they're all just narcotics, and unless you want to be on the news, should be avoided prescribing at all costs.

My wife says she has to explain to doctors all the time that if somebody is requesting a few Tylenol 3s, or a Vicodin or two for dental pain (that's her field, and there's a whole lot of VERY real pain in that field), that it's most likely not drug-seeking because those wouldn't have any effect on an addict. Both of us having heavily used opiates in the past, we understand that, but most don't, even doctors.

They also seem to think that if somebody expresses ANY sort of enjoyment from the drug, then it MUST be drug seeking behavior. If you get four teeth pulled, and then express any excitement for taking a painkiller later, it's grounds for having your prescription not given to you. Anybody who's used an opiate before sees why that's fucking dumb.
Thank you for the insightful response. Very depressing. It's terrifying that in the future I could be denied medication because I did too much research.

I have the impression that the UK was more progressive with drugs, it's just the legislation that hasn't kept up. But who knows if this applies to medicine.
 
Thank you for the insightful response. Very depressing. It's terrifying that in the future I could be denied medication because I did too much research.

I have the impression that the UK was more progressive with drugs, it's just the legislation that hasn't kept up. But who knows if this applies to medicine.
Yeah, it is a sad state of affairs.

The problem with controlling narcotics is a double-edged sword. Yes, it does probably prevent some new addicts from being formed, but it also prevents people who are in legitimate pain from getting the help they need. Not everybody who takes a couple of Percocet becomes an addict.

I think in order for patients to get what they need, legal rescheduling of drugs, and who can prescribe those, would need to be done.

If I'm a chronic pain patient who needs hundreds of milligrams of morphine per day, I should probably be seeing a specialist who is very specifically trained with narcotics, the doctor should be trained specifically for "heavy" narcotics. Make stuff like that unable to be prescribed by regular physicians in any real quantity. It shouldn't be hard to get if you need it, and the regular doctor shouldn't have to worry about if he's going to get into trouble for prescribing it, because he's referring to a trained professional with narcotics.

Then make the "lesser" (cut with Tylenol or IB or whatever) narcotics more freely available in small prescriptions from regular doctors.

If you go into the dentist with tooth pain, they try to fix it, prescribe you a blister 5-pack of Tylenol 3 or 5/325's, and tell you that if it continues to hurt you need to go see somebody who's trained in the use of narcotics. Same deal, go to the ER with back pain (which is probably the most common BS excuse for drugs), and the most you would possibly walk out with is that small blister pack, which should be very effective for legitimate pain until you can go see your specialist, while also not running a very high risk of addiction, or abuse potential. It would also keep people from wasting the emergency rooms time.

My wife did some continuing education courses on pain management techniques. Apparently a combination of an NSAID, Tylenol, and caffeine is just as effective as 10mg of morphine. If you add 1-3 mg of morphine to the mix, it's as effective at killing pain as like 5x the dose of just morphine (Don't quote me on those numbers, their ballpark, but not too far off)

Personally, I think you should be able to buy any of the "lesser" narcotics that can't be injected or snorted over the counter. They sell Sudafed, why not sell codeine? Dumb.

I'm not sure if it's still the case, but up until at least 2018 you could buy codine over the counter in the state of Virginia. As long as it's under certan total amount, and contains a certain mg/mg ratio of a "cut" like APAP or guaifenesin. I don't remember the exact numbers but it was something like 250 mg per bottle or container. You have to sign the same Sudafed registry book, and it's 1 box or bottle per day. One of the stores had a pricing glitch that made it 97 cents, they never fixed the glitch, and I bought it for years at 97 cents a bottle. Good times.

Drug use should also be decriminalized, if all else fails and you want to medicate yourself, that's your god-given right.
 
Yeah, it is a sad state of affairs.

The problem with controlling narcotics is a double-edged sword. Yes, it does probably prevent some new addicts from being formed, but it also prevents people who are in legitimate pain from getting the help they need. Not everybody who takes a couple of Percocet becomes an addict.

I think in order for patients to get what they need, legal rescheduling of drugs, and who can prescribe those, would need to be done.

If I'm a chronic pain patient who needs hundreds of milligrams of morphine per day, I should probably be seeing a specialist who is very specifically trained with narcotics, the doctor should be trained specifically for "heavy" narcotics. Make stuff like that unable to be prescribed by regular physicians in any real quantity. It shouldn't be hard to get if you need it, and the regular doctor shouldn't have to worry about if he's going to get into trouble for prescribing it, because he's referring to a trained professional with narcotics.

Then make the "lesser" (cut with Tylenol or IB or whatever) narcotics more freely available in small prescriptions from regular doctors.

If you go into the dentist with tooth pain, they try to fix it, prescribe you a blister 5-pack of Tylenol 3 or 5/325's, and tell you that if it continues to hurt you need to go see somebody who's trained in the use of narcotics. Same deal, go to the ER with back pain (which is probably the most common BS excuse for drugs), and the most you would possibly walk out with is that small blister pack, which should be very effective for legitimate pain until you can go see your specialist, while also not running a very high risk of addiction, or abuse potential. It would also keep people from wasting the emergency rooms time.

My wife did some continuing education courses on pain management techniques. Apparently a combination of an NSAID, Tylenol, and caffeine is just as effective as 10mg of morphine. If you add 1-3 mg of morphine to the mix, it's as effective at killing pain as like 5x the dose of just morphine (Don't quote me on those numbers, their ballpark, but not too far off)

Personally, I think you should be able to buy any of the "lesser" narcotics that can't be injected or snorted over the counter. They sell Sudafed, why not sell codeine? Dumb.

I'm not sure if it's still the case, but up until at least 2018 you could buy codine over the counter in the state of Virginia. As long as it's under certan total amount, and contains a certain mg/mg ratio of a "cut" like APAP or guaifenesin. I don't remember the exact numbers but it was something like 250 mg per bottle or container. You have to sign the same Sudafed registry book, and it's 1 box or bottle per day. One of the stores had a pricing glitch that made it 97 cents, they never fixed the glitch, and I bought it for years at 97 cents a bottle. Good times.

Drug use should also be decriminalized, if all else fails and you want to medicate yourself, that's your god-given right.
Your thoughts mirror mine exactly...

I thought that in the future I might fall victim to chronic pain and that opioids might be the solution. If denied, it's not like I would give up on living pain-free—I would just buy opioids from the same places I usually do. Except, because I would need to spend much more to maintain a pain-free state, I would start cutting costs; starting with pharmaceutical formulations, then moving to pressies because they are half the price, then moving to heroin because it's another ten times cheaper. Then, all it takes is for me to lose access to my usual "safe" sources, and I would be buying cut heroin from the streets to stop myself from going into WDs. I guess this is exactly what has happened in the US after doctors were forced to suddenly stop giving out opioids.

As you suggest, it would save me a whole lot of risk if I could buy my weak opioids OTC now, even with how infrequently I use them. I'm still not sure about the full legalisation of strong opioids (i.e. oxy OTC) because it would create "new" addicts as you said... but I would much rather be buying oxy from pharmacies than taking my chances with alternative sources. I guess the question is whether creating a small number of oxycodone addicts is justified if it means a huge number of heroin addicts get a safe supply. I am leaning towards yes... I would be interested in your opinion.

The systems in some places where addicts can get a clean supply of opioids seem to work very well, but I guess it still means that people such as myself, who use infrequently and aren't addicted (yet?) would be stuck with street drugs if we wanted something stronger than tramadol. I suspect such a system would over time mean that demand drops, profits drop, and dealers stop selling, so I would never have had the chance to try oxy in the first place.

I made this post as I was considering seeking an ADHD diagnosis so I didn't have to self-medicate. I've learnt that ADHD meds aren't really prescribed to adults here in general, so I've abandoned that idea, but I wonder if it would be worth it if the situation was different. I suppose I'll just continue doing what I'm currently doing, which is doing the most I can to ensure my drugs are safe, and praying that I don't one day forget a step and end up dead...
 
Of course, individual practitioners will refuse medication to someone who they perceive to be exhibiting "drug-seeking behaviour."

I have heard that in some countries, patients can be "flagged" and refused medication across different practitioners.
I'm not sure whether this is a myth or not, but is this a practice in the UK?

If it is, then what kind of behaviour is usually considered "drug-seeking"?
In the UK if you are prescribed any DFM (dependence forming medication) you are already scrutinised. That means that even your pharmacist can flag on the system if you are coming in to collect a script that is not due.

If you have past medical history in the UK of rehab or dependance issues then it will be on your file for all to see.
 
In the UK ime if you go private you can get pretty much what you want within reason...NHS no fucking chance.
Thanks for the information.
Unfortunate for me: it's outside my budget...

In the UK if you are prescribed any DFM (dependence forming medication) you are already scrutinised. That means that even your pharmacist can flag on the system if you are coming in to collect a script that is not due.

If you have past medical history in the UK of rehab or dependance issues then it will be on your file for all to see.
Thank you, that's very helpful.
 
Your thoughts mirror mine exactly...

I thought that in the future I might fall victim to chronic pain and that opioids might be the solution. If denied, it's not like I would give up on living pain-free—I would just buy opioids from the same places I usually do. Except, because I would need to spend much more to maintain a pain-free state, I would start cutting costs; starting with pharmaceutical formulations, then moving to pressies because they are half the price, then moving to heroin because it's another ten times cheaper. Then, all it takes is for me to lose access to my usual "safe" sources, and I would be buying cut heroin from the streets to stop myself from going into WDs. I guess this is exactly what has happened in the US after doctors were forced to suddenly stop giving out opioids.

As you suggest, it would save me a whole lot of risk if I could buy my weak opioids OTC now, even with how infrequently I use them. I'm still not sure about the full legalisation of strong opioids (i.e. oxy OTC) because it would create "new" addicts as you said... but I would much rather be buying oxy from pharmacies than taking my chances with alternative sources. I guess the question is whether creating a small number of oxycodone addicts is justified if it means a huge number of heroin addicts get a safe supply. I am leaning towards yes... I would be interested in your opinion.
I think that could be fixed by recognizing addiction as a chronic problem, that has the potential to be solved by heavy prescription narcotics. Oxys shouldn't be over the counter, you should be able to go and do a doctor and tell them that you're addicted to them and have the appropriate prescription written without having to jump ridiculous hoops. I see narcotics as a valid treatment for narcotic addiction.

Things like Suboxone should definitely be available over the counter though. How many of us have done something incredibly stupid for a $10 bag, that would have much rather walked into CVS and bought a sub just to be well? As somebody who used to commit crimes for dope, there's a bunch of times when I would have much rather just gone and legally bought a Suboxone instead. I'm 99% certain that it probably would have prevented a 2+ year prison stint for me.
The systems in some places where addicts can get a clean supply of opioids seem to work very well, but I guess it still means that people such as myself, who use infrequently and aren't addicted (yet?) would be stuck with street drugs if we wanted something stronger than tramadol. I suspect such a system would over time mean that demand drops, profits drop, and dealers stop selling, so I would never have had the chance to try oxy in the first place.

I made this post as I was considering seeking an ADHD diagnosis so I didn't have to self-medicate. I've learnt that ADHD meds aren't really prescribed to adults here in general, so I've abandoned that idea, but I wonder if it would be worth it if the situation was different. I suppose I'll just continue doing what I'm currently doing, which is doing the most I can to ensure my drugs are safe, and praying that I don't one day forget a step and end up dead...
I read about some program in Europe that was actually prescribing medical heroin to addicts that was very efficient at preventing overdoses and crime. I've always said, it's not the opiates themselves that are the problem, it's not having them that's the problem.

Make availability and affordability of narcotics easier, and I believe that crime, as well as illicit fentanyl use and overdoses would decrease substantially. Why buy some sketchy street powder when you could get reasonably priced, perfectly dosed, pills from the pharmacy, that you KNOW to not be tainted, or support the gang that shot your friend's kid on accident with the money they used from the dope that we bought to buy the gun.

It's a hard pill for people to swallow, pun intended, but drug use is a part of human existence, and to deny and criminalize that is completely futile exercise. Bullshit laws like this have turned to drug use into a criminal activity, and make people who have physical / mental health issues into legitimate felons. There's no other option but to legalize them in some form or another in order to remove the "criminal" element from drug use and distribution.

Drugs have been around since the beginning of human history, and only seemed to be a problem when the government gets involved...
 
Yes, i would like morphine tablets please, the methadone you have given me all these years does not work. I prefer not to take that and buy heroin. However, if I buy myself a few morphine tablets, use them sensibly, orally. I don't want to buy heroin. I feel fine, know not to take more,.

Oh no, you can't have them. Bounce back to the druggie service, and then see what they say. Prove yourself to them and then come back to us.

Why won't they just help me and give me medication that works? Any tips on what to do? At my age now I'm getting body aches as a thing too, I just want to be able to function and get the best out of myself and my money. Yes, the pods do work, but it'd be nice if the nhs would help me as I ask rather than offer me them anti anxiety formulations. Fuck off, I know what works for me. Give me morphine.

I clearly am not a drug seeker if you read my notes. 12 years ago I went and asked for a few mogadon to help me sleep. I've been getting 5 every couple of months all them years, I've not got any for over 9 months. Still have 2left in the house from the last "collect". Never mind, been thru some right bad times, no sleep. Nope. Not touching them moggies, that's how the bad naybore go t talking to me, the moment of weakness the day after the moggie.
 
In the UK if you are prescribed any DFM (dependence forming medication) you are already scrutinised. That means that even your pharmacist can flag on the system if you are coming in to collect a script that is not due.

If you have past medical history in the UK of rehab or dependance issues then it will be on your file for all to see.
Oh, that's a bad thing, because I can talk doctors under the table, as regards pharmacology, and other that locums they know I will humiliate them about their ignorance. Locums who don't know I couldn't give a fuck about. If they don' know their job, I'll rip them a new one. I just want adequate treatment (and that goes for my family, as well). I don't care if I look like a scruffy hippie. You don't fuck with my family, regardless. Don't believe me, and I can become a twat of unbelievable proportions. My family are endlessly important. Mylate wife's doc's were horrified by.it shouldn't have to be that way.but some doc's think they are demi gods. Fuck them. My wife died through negligence/arrogance. Not going to happen again. My stepson, deserves help through arrogant twats. Lost his mam at 31 (and my wife, who I adored). Money never replaces lives and I've been tolddocs will bullshit me out of legal action. They do not know me and if they need a lesson in humility, so be it. My stepson lost the most important person in his life, through negligence, sofuck any little arrogant twat with an MD. My family comes first. I'd give every penny I own to get my wife back.
 
In the UK if you are prescribed any DFM (dependence forming medication) you are already scrutinised. That means that even your pharmacist can flag on the system if you are coming in to collect a script that is not due.

If you have past medical history in the UK of rehab or dependance issues then it will be on your file for all to see.

I'm getting conflicting information about what all this may mean for me when I eventually come up for my ADHD assessment. Assuming I get the diagnosis, I'm pretty sure I will.

Regarding medications, on the one hand I'm seeing information about getting prescribed ADHD medications improves drug taking behavioural outcomes for patients, and they recognise that 50% of formerly undiagnosed ADHD patients self-medicate. In fact I think that could be one box ticked in favour of a diagnosis, as it can be a symptom of undiagnosed ADHD.

But then there's all that stuff about if you have a 'past medical history in the UK of rehab or dependence issues then it will be on your file for all to see' and warning of you will never get anything potentially dependence forming prescribed if you do have that sort of history on your file.

I'll have to see what happens. I guess it will depend on the views of those people i encounter during and after the process. They have so much power over my outcome.
 
If you have past medical history in the UK of rehab or dependance issues then it will be on your file for all to see.

I managed to stick a big picture of "The General" standing to attention in my medical fies for just this eventuality
 
I once asked my psychiatrist for clonazepam. He denied, and now I can't get a prescription for any benzo (not even oxazepam, which I was previously prescribed).

So, now I know - it's not a good idea to ask for medications with abuse potential.
It's bullshit that it works like that, but that is absolutely how it works.
 
Oh, that's a bad thing, because I can talk doctors under the table, as regards pharmacology, and other that locums they know I will humiliate them about their ignorance. Locums who don't know I couldn't give a fuck about. If they don' know their job, I'll rip them a new one. I just want adequate treatment (and that goes for my family, as well). I don't care if I look like a scruffy hippie. You don't fuck with my family, regardless. Don't believe me, and I can become a twat of unbelievable proportions. My family are endlessly important. Mylate wife's doc's were horrified by.it shouldn't have to be that way.but some doc's think they are demi gods. Fuck them. My wife died through negligence/arrogance. Not going to happen again. My stepson, deserves help through arrogant twats. Lost his mam at 31 (and my wife, who I adored). Money never replaces lives and I've been tolddocs will bullshit me out of legal action. They do not know me and if they need a lesson in humility, so be it. My stepson lost the most important person in his life, through negligence, sofuck any little arrogant twat with an MD. My family comes first. I'd give every penny I own to get my wife back.
You know the same people as me, ask them if they want to get in contact. Fuck ķnow'@ I'd love to...
 
3 1/2 pints of Guinness, a load of speed and a wardrobe on my shoulders and I'll be happy to fuck over the demi-gods (or so they think), with an MD. Most are fucking well overpaid
 
PS also the whole 'prescription painkillers to street heroin' alleged pipeline is a bit of a red herring, because while it may be true that a fair few later addicts start their opiate career with prescription pills, statistically the vast majority of such people start off with PILLS NOT PRESCRIBED TO THEM, given by a friend or got on the black market. So there's a genuine 'drug seeking' mentality there already, it's not like huge numbers of legit pain patients suddenly turn into junkies when they never did before.
 
Oh, that's a bad thing, because I can talk doctors under the table, as regards pharmacology, and other that locums they know I will humiliate them about their ignorance. Locums who don't know I couldn't give a fuck about. If they don' know their job, I'll rip them a new one. I just want adequate treatment (and that goes for my family, as well). I don't care if I look like a scruffy hippie. You don't fuck with my family, regardless. Don't believe me, and I can become a twat of unbelievable proportions. My family are endlessly important. Mylate wife's doc's were horrified by.it shouldn't have to be that way.but some doc's think they are demi gods. Fuck them. My wife died through negligence/arrogance. Not going to happen again. My stepson, deserves help through arrogant twats. Lost his mam at 31 (and my wife, who I adored). Money never replaces lives and I've been tolddocs will bullshit me out of legal action. They do not know me and if they need a lesson in humility, so be it. My stepson lost the most important person in his life, through negligence, sofuck any little arrogant twat with an MD. My family comes first. I'd give every penny I own to get my wife back.
Yes. I am only just learning this skill with all these creatures of the devils work. Ha ha. I enjoy telling incompetent high paid state slaves to do their jobs better
 
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