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Differences in prescriptions and use from country to country

I also found this article http://www.alternet.org/drugs/how-g...s-can-backfire-spectacularly-and-kill-privacy about how government being more strict with prescriptions can backfire.


In the USA there is an epidemic of opiate deadly OD , fueled by people that get addicted from prescribed pill.
In the last few months there has been a crackdown with new legislation passed:
https://www.google.it/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#tbm=nws&q=opiate+bill

I have been reading on forums who consists primarily of people from the United Kingdoms. Apparently, it is next to impossible to get a benzo prescription here.

Again about different cultures in different countries, that sounds crazy to me as in italian
Here doctor was ( * ) pretty pretty thrifty with opiate ( basically only a cancer or hospital setting thing), but it was always easy to get a benzo script. Your family doctor usually he give you almost without asking why you need.

( * ) Today is changed, prescription is much easier. Probably what we still lack is doctors trained in pain management.
 
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I tried to get some answers in the meta thread, but they seem dead sometimes.

I was wondering why meth-amphetamine are so more popular in US than the Crack Cocain?
  • How much cheaper is meth compared to cack?
  • Is meth more pure that crack?
  • Does a meta high last longer than an crack high?
  • For x addict, would 1 gram of meth-amphetamine last him longer than a gram of crack?

Crack in Europe
In Europe crack is expensive. Just to come with one example:
3,5 g Heroin <snip>
5 g meth-amphetamine <snip> and
3,5 g crack cocaine <snip>

It is from the same vendor who have a very good reputation and a lot of feedback stating high purity of products).

What would a gram of high-grade meth cost in the US? With is it so expensive in Europe? I thought we had plenty of high end laboratories in Holland, Poland, The Czech Republic, Spain etc. One sign of this is the very pure MDMA. I have tested a lot and it was around 84% pure where mostly the remaining 15% was leftover MD-P2P that wasn't washed out properly and a % for water and other things. My point is, the labs exist, why not use them for meth?

Considering that cocaine has to travel further to reach Europe that is has to reach America cocaine should be more expensive in Europe creating a market for high-end alternatives?

Safety
Is crack more dangerous than meth or is it the other way around.

Which chemical is easiest to OD on? And which chemicals is easiest to attemt to cure an '
od (Hospital providing, benzo, propofol, some thing that would slow down you heart beat and hydrate you.
 
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Benzo's
Indeed interesting articles.

I have been reading on forums who consists primarily of people from the United Kingdoms. Apparently, it is next to impossible to get a benzo prescription here, which is probably why the RC market grew so fast and so big. Now, that RC benzo's are no longer an option in the UK I would fear that we see a lot of people going to their doctor to get help with their addiction. The RC market in the UK and how it turned out might end up being a triumph card for people advocating against legitimizing drugs.

Do anyone have some statistics about the prescription of benzo pr capita in different countries?

I also found a report stating that the prescriptions of benzo's pr capita is twice as high in Denmark as in Sweden (though a little old) this could also be one of the reasons for the thriving RC market in Sweden?

Pain killers
I found this map showing the difference between opiats in different American states
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I also found this article http://www.alternet.org/drugs/how-govt-crack-downs-drug-prescriptions-can-backfire-spectacularly-and-kill-privacy about how government being more strict with prescriptions can backfire.

Damn. That charts pretty close to what my perceptions would be... It seems like Appalachia (Sp?) and the American South get a lot more flak for being hooked on Opioids (Hillbilly Heroin etc.) Then again, it's just taken as normal for the Northeast to be hooked on and have access to Opioids - Heroin as opposed to pharmaceuticals, which I feel these regions are more known for.
 
I can tell you a bit about the UK. The NHS is a postcode lottery, which simply means the type of service you get will differ depending on where you live, but there are definitely trends that extend to the majority of NHS services.

Benzos

The vast majority of the NHS is strictly anti-benzo. You will have much better luck getting benzos from a private doctor than the NHS. Private doctors are similar to America from what I can tell. But private medical care is a premium service most can't afford.

If you do get a benzo prescription it will likely be diazepam. That is by far the most commonly prescribed benzo in the UK with others being very rare. Alprazolam, while popular in the US, is literally impossible to get on the NHS. It is not approved as a medication in their guidelines. Only private doctors can prescribe it, but even then the highest dose is 0.5mg. Benzos that are technically available include clonazepam, lorazepam, temazepam, nitrazepam.

As for the street market for benzos, that is an interesting one. It used to be all about diazepam but the RCs had a big influence on the benzo scene. Xanax bars are being sold in the UK now despite never being a prescription drug here. They're gaining popularity mainly for being cheaper and more potent than diazepam.

Z-drugs are as hard to get prescribed as benzos. Zopiclone is the main one that is prescribed, we do not really use Ambien. Zops are available on the street too but have a more limited market compared to benzos.

Opiates

Pharma opiates are generally very limited in the UK. Most NHS services will give you only codeine, dihydrocodeine, tramadol, and oral morphine, with the last being saved for really bad cases. Oxy exists but only for cancer patients. It is very very rarely prescribed and virtually non-existent on the street. We do not have hydromorph, oxymorph, hydrocodone.

There does not seem to be much difference between the NHS and private services when it comes to opiates. They both prescribe the same stuff.

Most commonly it is codeine and dihydrocodeine that get abused. Both are available over the counter so that helps too.

Stimulants

Ritalin is relatively commonly prescribed, but usually only to kids. We've only recently started treating ADHD in adults and still don't do it well. Elvanse (Vyvanse) and generic dexamphetamine are also available but rarer. As with the benzos, you have a much better chance of getting this stuff if you see a private doctor. A private doctor can also prescribe Adderall while the NHS can't, but an Adderall script is like £600 a month so as you can imagine no one bothers with it even if they have private healthcare.

No prescription stimulants are common street drugs. UK stimheads prefer coke.
 
Hey all, australian here.
Interesting topic. The main ones you mentioned , ritalin, adderal, xanax and the opiates are all extremely controlled in Aus. In fact the amphetamine derivatives (dextro and such) , ritalin and xanax are all schedule 8, which puts possession without an authority at the same level as heroin/cocaine, meaning convictions and jail time. To get a script for those you need to be entered onto a government database and be under the care of a treating psychiatrist.
As for the opiates, codeine/paracetemol combos are easy to get from a normal doctor and if you complain of constipation he MIGHT knock you up to tramadol but if you have any fantasies of getting Oxycontin or Hydrocodone you will need to book in for some kind of surgery. I had a pin inserted into my wrist, was treated with morphine in hospital, then sent home with the paracetemol/codeine (500/30) tabs. For a broken arm!
I understand that the hillbilly heroins are thrown out like candies in the states. Or at least, thats how it seems to us here.
 
Forgot to mention... benzos. About 10 years ago i was in a car accident and told the doctor i couldn't sleep because of the stress. He sent me off home with 50 valium. Predictably, i got hooked, he bumped me up to xanax (this was before xanax was rescheduled to s8) and started a gradual withdrawal program. Me being young and stupid I started the rounds of doctor shopping and ended up in a long term clinic. My point here is that in the old days benzos were a first line treatment with pretty much no regard for their abuse potential. Recently, a friend of mine went to the doctor with a genuine need for benzos and was given 7 tablets and told that if the anxiety persisted beyond the week they would switch him over to anti-psychotics (albeit a very small dose), such is the reluctance of doctors to prescribe benzos anymore. The current attitude towards benzos in australia is to avoid at all costs, much as the poster above me was saying about them in the UK.
 
World wide, my source of information is the MARTINDALE THE EXTRA PHARMACOPOEIA, RECENTLY CHANGED NAMES TO MARTINDALE,
THE COMPLETE DRUG REFERENCE, published every two years, since 2007, and originally first published in the year 1883, London, UK
by Pharmaceutical Press, the publishing division of the Royal Pharmaceutical Society of Great Britain. I have editions, spanning from
1993 until as recently as the 37th edition, for the year 2011. It is expensive. It sells in the in the USA (like the newest 2013 edition, for
in excess of $500.00 US currency, and, in the UK for a retail of about $795.00 in GBP. Since 2007, it has expanded into a heavy two
volume set, of 4.142 pages for the 2011 edition, that covers, forty (40 countries in the modern industrialized world) the 39th edt (2013)
and the very soon to be released 40th edition, how covers 41 countries, by adding Japan. This book only covers ethical pharmaceuticals
of all classes, that are under a proprietary, protected legal names.

My auto save function unfortunately did not save a very long list of ethical pharmaceuticals in the benzodiiazepines classes, the stimulant
classes, the sedative classes, and the narcotic analgesics classes, I printed, with 4 research books by my PC. I do not have the patience
to refresh or autosave that long wall of text. Sorry.
 
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Wow, that graph of painkiller prescriptions in the US is insane. I mean, 50 to 100+ prescriptions per 100 people? You guys must be pretty damn high up there.
 
Reference PHARMACY TIMES a long running USA magazine with their own website now. TOP 200 Ethical Pharmaceuticals of year 2012,
by Total Prescriptions prescribed in all 50 states of the USA for calender year 2012.

My PC continues to act up, it seems I get timed out within 15 minutes, and all data, if lost, I was at 90% completion, of the stats on
pain medications sales from Pharmacy Times calender year 2012, in the USA when, I just lost all data. Title Top 200 Drugs for 2012.

I will continue to give just general data as my list from Pharmacy Times magazine, is 7 pages long single spaced.

Name of Drug MFG Number of prescriptions written/refilled DEA Class

1. Hydrocodone with APAP Actavis 56,118,000 III
3. Ditto Mallinckrodt 44,967,000 III
5 Ditto Qualitest 27,621,000 III
35 Oxycodone with APAP Mallinckrodt N/A II
44 ditto Actavis N/A II
52 Tramadol HCI Amneal N/A Non Controlled Status
83 Tramadol HCI Zydue N/A Ditto
88 Tramadol HCI Teva N/A
139 OxyContin Purdue N/A C-II
150 APAP (Tylenol) + Codeine Qualitest N/A C-III
163 Oxycodone HCI Mallinckrodt N/A C-II
191 Hydrocodone with APAP Amneal N/A C-III

NOTE THE USA DEA RE-SCHEDULED ALL FORMS OF HYDROCODONE IN OCTOBER OF 2013 to a much
tighter class, "the tightest class of controlled drugs" from a C-III to a C-II, thus meaning no more
refills no phone in prescriptions from MD's offices, or no Fax scripts to any USA pharmacy.
 
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@Kittycat5

Hello,
Just some info to attempt to focus on answering your question on this thread on 8-08-2016 #51 Ref: Stats in USA on pain med
prescription fills 2010 to 2014, IMHO.

1. From calender year 1997 (USA) until 2012 (USA) 15 years in a row, "Hydrocodone with Acetaminophen" both in Generic form,
as well, as the original patent holder for Vicodin (Abbott Labs) held the number one selling ethical prescription drug.
Source: IMS National Audit (as printed in Pharmacy Times, and, on www.IMSHealth.com.

2. In calender year 2013, Hydrocodone, primarily a USA/Canada only narcotic med, fell, in script fills to no 2, with a drop off by
5.89% decrease, placing no 1 with the hypothyroid med "Levothyroxine" a/k/a "Synthroid" as the top selling drug in the USA.

3. In calender year 2014, Hydrocodone with APAP, took a further drop in scripts filled @ USA pharmacies, with a drop of ten million more
less prescriptions filled compared to top year 2012. Source: Pharmacy Times, and IMS Health Institute national pharmacy audits.

4. Heroin overdoses resulting in death, doubled from 5,000 to 10,000 deaths, a historical record, between 2010 and 2014. The USA
media blame the USA war on pain medication former over-prescribing as the main cause. Heroin deaths have quadrupled since
the year 2002. Source CNN.com

5. When Purdue re-formulated Oxy Contin at the end of the year 2010, the sales, have been slowly declining ever since, Purdue changed
the formulation in a effort of curb abuse of Oxy Contin, introduced in the year 1996. All forms of Oxy, including Oxy + APAP "Percocet"
to all generic versions of oxycodone with APAP, or pure Oxy ER generic, and Roxicodone, have taken a dip also in sales, since 2012.
 
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@Kittycat5,

Of the top 20 top selling ethical prescriptions, either generic or brand, in the USA, in the past 6 years, 14 of the top 20 drugs, have
remained on the top 20 lists. Source: Pharmacy Times, and, IMS Health Institute.

reference pain meds, interestingly, "Tramadol" generic, entered the top 20 sales, as a pain reducing analgesic, in the calender year
2013, and 2014, with a 2.3% increase in sales, from 41.9 million prescriptions filled and refilled, to 44.2 prescriptions filled. Of the
50 states in the USA, some individual states, have enacted state laws to make the former "Ultram" mfg McNeal, patent long
expired, as tramadol, as now a controlled substance, while, other states, are considering legislation, to regulate, the former, all
non controlled drug. IMHO, I am not sure of the DEA Federal class as of this thread. (citation needed).
Tramadol was no 19 in the top 200 drug sales for calender year 2014, outselling, former long running Tylenol with Codeine, or,
any generic pill with various amounts of codeine, or dihydrocodeine, both a controlled substance in USA,
outselling generic Percocet, Percodan, Dilaudid, Fentanyl, brand or generic Morphine, (Avinza), and even,
the long running Endocet, or Phenophen, always with Butibital, a C-IV, or with added Codeine, making it
a C-III, as Foricet, with Codeine. Darvon and Darvocet N50 and Darvocet N100, and Darvon 65 was
withdrawn from all US manufacturing production about 5 years ago, available for nearly 50 years.
 
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In Finland the most abused opioid is buprenorphine in it's various forms. Can you believe in that?

I abuse oxycodone and I am like some weird albino cavemonster when it comes to drug psychiatrists trying to treat me since they have so little knowledge out of anything else than bupe when it comes to opioids...

Check out Reindeerspotting if finnish drug culture interests you people.
 
@Mr.Root

Tramadol, introduced, in 1994, underpatented name ULTRAM, MFG was Ortho-McNeil Pharmaceuticals. When the patent expired, in the
year 2011, Tramadol sales fell out of the top 200 brand, and top 200 generic sales for the 2008, with total tramadol sales with APAP,
3,147, 654 scripts filled in calender year 2008, and, no 138 in generic drug sales, and with brand sales, tramadol, under patented
protected sales, Ultram Extended Release, mfg Ortho McNeil, had a ranking of no. 193 with 1,174,557 rx fill and refills during that
same year. Generic pure tramadol did not even make either list of the top 200 drug out of REDBOOK listing of over 100,000
drugs, and, PDR's listing of over 4,000 drugs advertised in calender 2008.

With the USA rescheduling DARVON a 50 year old C-IV controlled substance, under the names by founder Eli Lilly, such as Darvocet
N50, Darvocet N100, Darvon 65, and Darvon Compound, and dozens of generic competitors, in the calender year 2010, all sales of
the chemical name containing Propoxyphene with APAP had sales of 20,411,962, the no 2 selling pain reliever, behind no 1 selling
Vicodin by Abbott a/k/a hydrocodone with APAP with 121,265,610 prescriptions filled and refilled during calender year 2010. in 2011
it fell to zero, update, now TRAMODAL has risen from sales of around 4 million per year now to 40 million prescriptions per year in
the USA. Our concerned DEA has now placed any form of Tramadol, as a C-IV, controlled substance, and, it was the no 2 selling pain
med in the top 200 generic meds in calender year 2014, I expect the sales to fall, like hydrocodone has, as, it was upgraded to a
C-II narcotic in Oct 2013, and sales are falling by then millions of annual scripts filled. IMHO it is foolish to schedule a med that
was introduced in 1994, as a non controlled substance, to now a C-IV, like a Class C in UK, on Tramadol. I used to get handfuls of
it when I was married for 19 years to a RN who brought me samples in the mid 90's of this pain reliever that did nothing for me for
pain IMHO.
The elimination of Darvon, Darvocet N50 with APAP, Darvocet N100 with APAP ,Darvon Compound in 2011, has left 20,411,982
Americans now without a 50+ year old proven C-IV pain med, out in the cold. No wonder, Tramadol, has risen in sales in 2 years
from 4 million brand and generic to now over 40 million prescriptions for Tramadol in any form. The Aug 2014 ruling by the USA
DEA to place it in a C-IV likely will slow down the sales now. I call it IMHO the USA war on prescription pain meds by the DEA !!!

@Mr.Root

Tramadol, introduced, in 1994, underpatented name ULTRAM, MFG was Ortho-McNeil Pharmaceuticals. When the patent expired, in the
year 2011, Tramadol sales fell out of the top 200 brand, and top 200 generic sales for the 2008, with total tramadol sales with APAP,
3,147, 654 scripts filled in calender year 2008, and, no 138 in generic drug sales, and with brand sales, tramadol, under patented
protected sales, Ultram Extended Release, mfg Ortho McNeil, had a ranking of no. 193 with 1,174,557 rx fill and refills during that
same year. Generic pure tramadol did not even make either list of the top 200 drug out of REDBOOK listing of over 100,000
drugs, and, PDR's listing of over 4,000 drugs advertised in calender 2008.

With the USA rescheduling DARVON a 50 year old C-IV controlled substance, under the names by founder Eli Lilly, such as Darvocet
N50, Darvocet N100, Darvon 65, and Darvon Compound, and dozens of generic competitors, in the calender year 2010, all sales of
the chemical name containing Propoxyphene with APAP had sales of 20,411,962, the no 2 selling pain reliever, behind no 1 selling
Vicodin by Abbott a/k/a hydrocodone with APAP with 121,265,610 prescriptions filled and refilled during calender year 2010. in 2014
Vicodin and all generic of hydro with APAP sales have fallen by 60 million prescriptions, thanks to our DEA.
Hydro with APAP is as tightly controlled now as Demerol, Morphine, Dilaudid, and, Oxycontin. Tramadol
is a non controlled substance so far in Mexico, and some other EU countries, I understand, so far. IMHO
no wonder Tramadol sales risen in calender year 2013 and 2014 from 4 million to 40 million sales of
scripts per year. Time will tell now that the USA DEA has controlled Tramadol as a C-IV like Alprazolam!

@MrRoot,
One correction, Propoxyphene, is now in the USA a Schedule I, meaning it is illegal to manufacture this 50 year old drug in any form,
C-I is a schedule set aside for no meaningful purpose, for the USA medical practicing field, like, Heroin, Methaqualone, LSD, and,
MDMA (Ecstasy) and MDA. If history repeats itself, it will be gradually withdrawn from all of the industrialized world in the next decade
or two. Similiar to the disappearance of once widespread barbituates, Glutethimide, (Nembutal, Tuinal, Doriden), hypnotics like
Placidyl, removed from the USA in 2002, and Canada, in 2006. Stimulants, like, a 50 year history of Benzedrine, Preludin, Biphetamine,
the latter two withdrawn by the mfg due to a USA stigma causing poor sales, and, the mfg volunteering to withdraw the med, and
another pain med "Pentazocine HCI" 10 years ago legal in 21 countries, now, only 8 countries left in the world who mfg this C-IV,
pain med, introduced, in the USA in 1967.
 
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Propoxyphene is not schedule I. It was withdrawn from the market by the FDA, not rescheduled by DEA, due to serious cardiac electrical conductance issues even at therapeutic doses. For most (sorry Dixie I know you were one of the few it worked for), it didnt do a damn thing anyway and could easily be replaced with Tylenol with Codeine or others.

Im still missing the point of your posts Zachery. Its no surpise Vicodin and its generics fell out of first place. Not only was it placed in a stricter schedule, it now cannot be refilled because of its status.

Tramadol was hit far less as C-IV, unless state law prohibits, can be refilled and combined with the "less abusable" lower schedule (total bullshit anyway, Xanax is C-IV as well. Nobody abuses it right?) sets many doctors mind at ease.

Vicodin rescheduling had very little impact on the shift to heroin from pharmaceutical opioids. It was Oxycontins rescheduling and the DEA strengthening its attempts to crackdown on Rx drug abuse.

Can you make a comparison to similar situations in your country Zachery? I see you mentioned different schedules of tramadol in Mexico but can you give us some examples of how these schedules affect patients lives or more data on classes of drugs there vs elsewhere?
 
@Kittycat5

I owe you a apology for stating that the USA DEA had rescheduled Propoxyphene as a Schedule I. I was incorrect, as, you stated, the
FDA of the USA had the brand name, and the many generics of Propoxyphene withdrawn, around 2010/2011. Mucho Gracias.
 
No apologies my friend. I think you have something to add here just trying to tease it out. Are you indeed in Mexico?
 
Kittycat5

I just shut my PC down, and then decided to turn it back on. I am apparently semi literate with the rules with your excellent
harm reduction forum. I have been actively involved with internet harm reduction forums since 1998, non stop.

Perhaps I am a bit frustrated. Honestly I typed to you personally, nearly a 40 minute synopsis of comments, to directly address
your sincere questions, and, damn if, I did not have to re-register my IBM Thinkpad and when I did, re-register, then, his
refresh, I lost, 4 paragraphs of data I specifically sent to you less than one hour ago.

I am in the USA, but have a trip beginning later today, from the SE USA to Puerto Vallarta, Mexico, where I have a condominium
for some R & R.

My frustration was attempting to give you references from Physicians Desk References dating back to 1966 to 2011, publisher,
PDR Network LLC, + 5 editions of MARTINDALE THE EXTRA PHARMACOPAEDIA, LONDON, UK listing the ethical medications
in 41 countries from the modern industrialized world, each edition since 2005, weighs about lbs and has over 4,400 pages of
pharmaceutical data, and, from my multiple editions of the PLM DICCIONARIO DE ESPECIALIDADES FARMACEUTICAS, FOR
the country of Mexico with Grupo I II and III medications. Plus, my Verispans Vector One Audited Reports from the USA
REDBOOK with every ethical pharmaceutical in audited sales from very reliable audit USA firms.

I see I had to refresh once again, and my summary still got cut off.

hasta manana!

ZacherySwan (will be out of the country for 7 to 10 days)
 
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It's quite funny walking into a pharmacy in Malta.

One could buy pure codeine or DHC, if they liked, without a prescription.

Contrast that with Sweden where codeine is banned from OTC.

Good thing I'm not using these anymore, because I'd be taking advantage of this.

People seem way happier in Malta as opposed to Sweden.

Not because of the drugs, but because of the freedom and philosophy here.

It's so much more laid back and friendly - and, contrary to popular belief, not every person is addicted to opiates in spite of their availability - in fact, the pharmaceutical opiate abuse rate here is relatively negligible, from what I can tell
 
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