Chronic Pain - UK (Europe) v US

[fath87]

I´ve been a chronic pain patient for just over a year now, and my impression seems to be this:

I respect the US, and this is just a foreigners impression through reading on the internet and the media, but doctors in the US seem to jump straight to stronger opioids. I guess it might have something to do with not having a public health service, and financial incentives being involved? In my experience, and I'll be humble and say that I have not been on opioids longer than around 18 months, there is utility in the weakest opioids that need to be used before moving up the scale. In the UK the controlled drugs (basically all of them except DHC, Codeine and Tramadol) generally have a high threshold re prescriptions.

On the internet I read things like "Oxycodone has really helped my Fibromyalgia pain, but my doctor doesn't want to increase my dose because we just increased it to 40 mg", or something along those lines. It comes up so often that I suspect that the US really does have a huge problem with opioids. The first thing to grasp is that the chronic pain does not go away, and wandering up the scale to fast makes people way too physically addicted, for some it can have an adverse effect on their family as it makes them abuse it as well. 30 - 50% of the pain will come back, and you will become tolerant to a much stronger drug.

I will now stress that being a CPP sucks and it is the suspicion, engagement with drugs that are controlled and the controlling of pain that relies on these drugs that sucks! I do not want people to suffer, I understand their pain, and I am not judging. The American overprescribing just seems extreme. I read a comment on a YouTube video (it is just one of countless anecdotes) of a British woman who had a Fibromyalgia dx, where the American woman said that she was surprised she wasn't on something stronger than Tramadol as they hand them out to anyone who wants in the US.

Let me just stress that these are completely anecdotal and based on the internet! I am just chucking it out there to start a discussion, I am completely open to be convinced that my impression is based on random findings and media hysteria.

EDIT: I have btw tried most of the mainstream oral opioids inc. Oxycodone, Buprenorphine, Morphine ++.

 

[LucidSDreamr]

I had chronic pain for 8 years until spine surgery fixed it. took opioids for 5 of those years, now i am on none. I can tell you that because I was under 30 most of the time....opioids were impossible to get even with an MRI showing my herniation. I did find doctors eventually that gave them to me after having a 3 year history of CP and visiting probably 30 different doctors and having to drive 2 hours to see a doctor aquanted with a family member (just percocets or hydros though). Never was offered something strong like roxis or fent (in my case fent) until after having gone under the knife (still had horrible pain for a year after surgery).

There are many scumbag docs in the us running pill mills...its just our capitalistic ways. Despite what you read on forums like bluelight though....legitimate doctors are super tight with the opioids right now. Believe me, you need to have a really good "bad" medical record. And even if you get a script you stand about a 50% chance that no pharmacy will fill it for you...and this is every month so you basically risk withdrawal at the end of each month.

 

[fath87]

It is a shame if the whole country suffers from something that might not be an issue in other parts of the country. People should be given opis for legitimate pain, but it is the way it is done. Thanks for your input.

Percocet is Oxycodone though, and was kind of what I was touching on; that strong opioids seemed to be used as a go to. Even though it has less of it in each tablet than other formulations it is the same drug. I am not saying at all that you shouldn't have those drugs, or anything along those lines. I am just saying that you would have thought Codeine and Tramadol were utilised to the max. Oxycodone is the last step on the oral ladder, but Americans seem to be very familiar with the drug. I am guessing if you asked a Briton on the street of London if he knew what Oxycodone is your hit-rate would be much lower than in say Florida or California. Again I am just going of impression, and also to start a debate. I respect other countries, and not slagging off your country.

How do you view say codeine? How do US doctors generally prescribe codeine?

 

[fath87]

There are countries in Europe that are much stricter than the UK, which I feel has a sensible approach. I know countries in Europe where doctors are really afraid of prescribing codeine or tramadol even, because the authorities are breathing down their neck all the time.

In Britain you can buy OTC APAP/Paracetamol and Ibuprofen formulations with 12.5 mg codeine and/or 7.5 DHC. They will however only dispense one pack of 32 tablets at a time, and if they see your face coming in regularly I would guess they'd deny selling it to you. A prescription will never be questioned.

 

[Felonious Monk]

How do you view say codeine? How do US doctors generally prescribe codeine?

They generally don't prescribe it. I guess children or people who request it specifically (worried about other things being too strong). I know my Aunt gets it for her knee specifically because she's worried about hydro being too strong (and she used to do heroin so she knows what hard dependency is like).

I'd say the U.S. approach tends to be all or nothing. Codeine is prescription too, so once you're getting a script most docs would just write for hydrocodone. And it seems so similar to oxycodone that I think they just get switched around and prescribed instead (especially now that they're the same restriction--Schedule II). I've always been overly psyched when I could walk into a foreign pharmacy and purchase opioids (have done so with codeine and hydrocodone), but I can imagine it would be WAY less exciting if I lived there--would normalize it.

Medical marijuana also has some effect. States like Florida, and now Missouri, Utah, Massachusetts, etc. that have really bad pill problems don't have medical marijuana (and their neighboring states don't leak out enough). A study showed that opiate ODs shrink by 25%, and prescribing often shrinks even more, especially in states like California with a liberal program.