Differences in prescriptions and use from country to country

[Ignio]

After having followed several forums "populated" by people from different countries I have noticed how different the use of prescription medication is from country to country.

In the US Hydrocodone (Vicodin) and Hydromorphone (Dilaudid) seems to be very popular medications and prescribed a lot. In Denmark, however, we do not have access to these two types of medication. On the other hand we have access to Ketogan (Ketobemidone), which seems to be used only in Scandinavia.

The drug company Roche produces a lot of benzodiazepines. For my example I am gonna mention Diazepam, Clonazepam and Flunitrazepam. Some years ago in Denmark and Sweden Roche suddenly stopped selling Diazepam and Flunitrazepam and now only sells Clonazepam under the name Rivotril.

Alprazolam (Xanax) is often prescribed in the US from what I can see and it doesn't seem for me that it is that hard to get? The same is true for Ambien in my experience. In Denmark Alprazolam and Ambien is very rarely prescribed. Diazepam, Clonazepa, and Oxazepam seems to be the most common benzo's here.

Adderall is another example. It seems to by used wildly in the treatment of ADHD. In Denmark, until recently, it was basicly impossible to get dextroamphetamine and it is still very rarely used. Here Ritalin is the main medication used for treatment of ADHD.

What is the cause of this difference? I should think that a lot of research supports that Hydrocodone and Hydromorphone is effective for pain treatment, But why then isn't it AT ALL available in Denmark?

I know the Danish market is a peanut compared to the American market, but the producers of Hydrocodone and Hydromorphone could still get some more customers by introducing their products here.

Can You mention more examples of widely different used and prescription in different countries?
And why do we even see this differences?

 

[Kittycat5]

I think you hit on all the main ones. Of course each country has different drugs of all classes approved but many are rarely used.

Hydrocodone is a uniquely American one though. Besides it being actually approved for use, until very recently it was not in our highest level of restricted drugs (C-II) meaning prescribers felt a bit easier prescribing it, could phone it in, and give refills.

Oxycodone would be one I would add. While I know it is available in many places, I doubt the sum total of everywhere else compares to American use.

As to why, there are many reasons. First and foremost is the structure of the healthcare systems. Its no secret we have less nationalized healthcare here so the American market is the cashcow for pharma as they dont have to negotiate for prices.

Second is differences in regulatory structure. We have only the FDA here with one procedure (well not exactly true but it is the same for everyone regardless of how they apply). The EU has EMA but member states can choose to not allow drugs they deem unsafe or not effective if they choose. Our states can do this but for the most part do not. And of course we have our friends at the DEA. They are the grandfathers of deciding which drugs are "good" and "bad" for arbitrary reasons at best.

Pharma itself plays a huge role. We have quite possibly the largest pharmaceutical industry in the world and they have money and political clout. They know the FDA is perpetually unfunded and understaffed so they basically fund them themselves. We also lead the world in direct to consumer advertizing of drugs to the point that nobody realizes they are basically putting poison in their bodies. The TV said I need it so it must be true type thing. They play dirty in so many ways that they basically use the American public as some grand experiment all in the name of profit.

I know much of this applies elsewhere but the money and scale in America is greater hence our seemingly never ending supply of novel and not necessarily better drugs.

 

[Vagina Lover]

We see differences because each country has its own culture and protocols for prescriptions.

I came from Sweden, where they demonise drug misuse, through Amsterdam, where they prescribe heroin, to Malta, where there is very limited illicit drug abuse, as far as I can tell.

From the top of Europe to the bottom, there are differences in approaches for prescriptions, as well as what is available.

 

[George27]

Etizolam and Nimesulide are pretty common here in Italy, but they are not even approved in the USA.
We use more DHcodeine, less Xanax etc
I think that, not alway but often, these are just oddities without a clear reason.
Or as VL states it "each country has its own culture and protocols for prescriptions"
For example, here paracetamol ( acetominophen) is mainly for fever management not pain management.

 

[Ignio]

Etizolam and Nimesulide are pretty common here in Italy, but they are not even approved in the USA.
We use more DHcodeine, less Xanax etc
I think that, not alway but often, these are just oddities without a clear reason.
Or as VL states it "each country has its own culture and protocols for prescriptions"
For example, here paracetamol ( acetominophen) is mainly for fever management not pain management.

Which company produce the Etizolam that is sold in Italy?

 

[Ignio]

I think you hit on all the main ones. Of course each country has different drugs of all classes approved but many are rarely used.

Hydrocodone is a uniquely American one though. Besides it being actually approved for use, until very recently it was not in our highest level of restricted drugs (C-II) meaning prescribers felt a bit easier prescribing it, could phone it in, and give refills.

Oxycodone would be one I would add. While I know it is available in many places, I doubt the sum total of everywhere else compares to American use.

As to why, there are many reasons. First and foremost is the structure of the healthcare systems. Its no secret we have less nationalized healthcare here so the American market is the cashcow for pharma as they dont have to negotiate for prices.

Second is differences in regulatory structure. We have only the FDA here with one procedure (well not exactly true but it is the same for everyone regardless of how they apply). The EU has EMA but member states can choose to not allow drugs they deem unsafe or not effective if they choose. Our states can do this but for the most part do not. And of course we have our friends at the DEA. They are the grandfathers of deciding which drugs are "good" and "bad" for arbitrary reasons at best.

Pharma itself plays a huge role. We have quite possibly the largest pharmaceutical industry in the world and they have money and political clout. They know the FDA is perpetually unfunded and understaffed so they basically fund them themselves. We also lead the world in direct to consumer advertizing of drugs to the point that nobody realizes they are basically putting poison in their bodies. The TV said I need it so it must be true type thing. They play dirty in so many ways that they basically use the American public as some grand experiment all in the name of profit.

I know much of this applies elsewhere but the money and scale in America is greater hence our seemingly never ending supply of novel and not necessarily better drugs.

OxyContin and OxyNorm (oxycodone) is used as much here in Denmark as it is the states.

I just wonder why the US would ignore a drug like Ketobemidone when it is SO effective in the treatment of kidney stones due to how it relaxes the soft musculature. And simultaneously I wonder why we in Denmark wouldn't make so efficient a pain kiler available as Hydrocodone. After my initial post I actually have to correct myself. I found that hydromorphone is available in Denmark now. Sold under the names Jurist and Paladin. But I have NEVER seen them prescribed or on the black market. I follow it very closely. But at least I learned something today.

Pain patients in Denmark are often treated with OxyContin or Morphine for strong pain and tramadol and codeine for milder pain. Fentanyl is almost only used as IV in the ambulance and at the hospital. Fentanyl patches are only given to terminal cancer patients. Then there is a few who get treated by Buprenorphin either in sublingual tabs or patches and even fewer with methadone. I just think that people should have as many opioids and opiats available as possible, so they can find the one that works best for them and not have a limited range of choices due to some ...... thing we can identify. But I know some people with chronic pain where neither oxycodone or morphine works very well, but this is the only choices their doctors will give the. You can't imagine the battle I had with my grandfathers doctor to get the doctor to give my grandfather Ketobemidone as he suffered from really, really bad pain. Each time one had to pass the pain was so bad that they had to commit him and give him IV meds, and you know how dangerous it is for old people to get admitted to hospitals necessary due to risks for injection etc. After I got him on the Ketobemidone that almost remove the pain and he have not had to be admitted to the hospital since.

I also find the Adderall / Ritalin very strange. As well as the crazy amounts of Xanax being prescribed in the US (or is this just a prejudice I have from american moves and series?)

 

[Kittycat5]

Whats strange about Adderall or Ritalin in your opinion? And Xanax is given out quite frequently, so you are being prejudiced. As far as ketobemidone, it wasnt really used much here and was scheduled as a C-I with the initial Controlled Substance Act (read my first comment about DEA). Does it relax smooth muscle on its own though?

 

[Ignio]

In Denmark it has almost been impossible to get Dextroamphetamine even i the worst cases. Ritalin has been the mainsolution. If Ritalin isn't enough here in Denmark they start to make them drowsy with anti-psychotics, gababentin etc. as Dextroamphetamine is nearly impossible to prescribe (though some changes are underway here now as I understand). In Ritalin doesn't cut it for people, it often results in them trying to medicate with hash, benzo's and so on to try to be more calm thus getting addicted and ending up with a double diagnosis (addiction and ADHD).

I have an impression that Adderall is the first solution in the US and given to even kinds down to the age of 10. But to be honest my knowledge is build on a solid foundation.

I was under the impression that it is best to start treatment with Ritalin and if that doesn't cut it then go to Dextroamphetamine. So that is the story behind me finding the Adderall/Ritalin solution strange. Does it make sense for you?

 

[George27]

Which company produce the Etizolam that is sold in Italy?

The commercial name is Pasaden and it's made by Bayer
Now I've made a research and it's sold also as Depas by BPG

Ps
Adderal=racemic mixture of strange amphe salts , not dextro
In Italy Ritalin is extremely uncommon and there is no amphetaminic at all ( not even in the black market)

 

[Ignio]

Whats strange about Adderall or Ritalin in your opinion? And Xanax is given out quite frequently, so you are being prejudiced. As far as ketobemidone, it wasnt really used much here and was scheduled as a C-I with the initial Controlled Substance Act (read my first comment about DEA). Does it relax smooth muscle on its own though?

In Denmark Ketobemidone is sold under the name Ketogan which is a combination of Ketobemidone and Dimethylaminodiphenylbuten. I must admit I don't know what is is that makes the smooth musculature relax (Haha did I just call smooth musculature soft musculature in my first post? ). But Ketobemidone is effective for kidney pain and it is known to be effective where other opiats and opioids fail.

 

[dopemaster]

I am kinda interested in which countries are following the USA lead in tamper resistant pills, like making them out of plastic.

So OCs became OPs, Palladone (hydromorphone) became Exalgo, and well Opana (oxymorphone) just changed formulas.

My dr tried to give me morphine with nalaxone in it and I was just like hell no, I will just take something weaker if it is like that.

I guess the trend of putting weird unneeded chemicals in medication is rather alarming seeing how many people end up in the hospital with cellulitis from missing and IV shot of those pills and it is the formula. Is is an ugly thing to see.

Just seems to be rather inhumane because drs know damn well when their patients iv but really it is more the pharm companies fault and they seem to have legal immunity here.

 

[Kittycat5]

In Denmark it has almost been impossible to get Dextroamphetamine even i the worst cases. Ritalin has been the mainsolution. If Ritalin isn't enough here in Denmark they start to make them drowsy with anti-psychotics, gababentin etc. as Dextroamphetamine is nearly impossible to prescribe (though some changes are underway here now as I understand). In Ritalin doesn't cut it for people, it often results in them trying to medicate with hash, benzo's and so on to try to be more calm thus getting addicted and ending up with a double diagnosis (addiction and ADHD).

I have an impression that Adderall is the first solution in the US and given to even kinds down to the age of 10. But to be honest my knowledge is build on a solid foundation.

I was under the impression that it is best to start treatment with Ritalin and if that doesn't cut it then go to Dextroamphetamine. So that is the story behind me finding the Adderall/Ritalin solution strange. Does it make sense for you?

I was guessing this was the case. I have read that some agency (forget which) is now recommending more frequent amphetamine use across Europe. I see it as a positive both for those with ADHD and those who enjoy stims as European amp paste has a pretty bad rep. (This could be my Euro prejudice though )

But limiting treatment to just methylphenidate is as dumb as us not having Ketogan. And Im pretty sure it is the dimethylaminodiphenylbuten that relaxes smooth muscles and acts as an antispasmodic but we dont have that either.

 

[George27]

You can't imagine the battle I had with my grandfathers doctor to get the doctor to give my grandfather Ketobemidone as he suffered from really, really bad pain.

Never heard of this stuff.

Wiki says:
Ketobemidone is mostly used in the Scandinavian countries, with Denmark topping the statistics

 

[Ignio]

I was guessing this was the case. I have read that some agency (forget which) is now recommending more frequent amphetamine use across Europe. I see it as a positive both for those with ADHD and those who enjoy stims as European amp paste has a pretty bad rep. (This could be my Euro prejudice though )

But limiting treatment to just methylphenidate is as dumb as us not having Ketogan. And Im pretty sure it is the dimethylaminodiphenylbuten that relaxes smooth muscles and acts as an antispasmodic but we dont have that either.

It might be the dimethylaminodiphenylbuten that is the cause of the relaxation. I will look into that shortly. By anyway, it is empirically shown that Ketobemidone have been able to treat pain in a high number of cases where all other opiats and opioids did not work. So there is something that distinguishes it from other opioids.

And I have to say, Ketobemidone it BY FAR the most euphoric opioid I have EVER tried. It is simply impossible for me to describe it. Of cause the high is similar to other potent opioids, but it is so much more. This is both true for oral ingestion but also for IV. I would say in its one special way I would prefer Ketobemidone IV from heroin IV. But that is probably because it is hard to find very clean heroin, whereas the Ketobemidone is pharmaceutically clean. But it is simply an amazing opioid. I am embarrassed to say it, but one night my grandfather called and was in so much pain due to kidney stones that he wanted me to come over because he thought he would have to go to the hospital. He was prescribed oral and anal tablets of Ketogan as well as a few funny syringes that he could put on his thigh as press a button and it would give him an IM shot. I gave him one of these when I arrived and some time after he fell a sleep. He had four left and I took one as I left the next morning informing him that we used two during the night. I managed to take it apart so I could take the Ketobemidone IV. It was the best thing I have ever tried without comparison. In the black market here where I am from, the Ketogan tablets with 5 mg Ketobemidone and 25 mg Dimethylaminodiphenylbuten easily cost the same as a 40 mg OxyContin and most people would probably need above 20 mg Ketobemidone to feel something. A group of my friends call the tablets "The provider of angel wings" as they feel like they can fly and feel like an angel
I think I read once that Ketogan as removed from markets (beside the Scandinavian country) because Ketobemidone was simply so euphoric compared to other opioids that the euphoria outweigh the pain relief it gives. But I am not sure.

If you ever get a chance to try it, make sure you do

 

[Ignio]

I am kinda interested in which countries are following the USA lead in tamper resistant pills, like making them out of plastic.

So OCs became OPs, Palladone (hydromorphone) became Exalgo, and well Opana (oxymorphone) just changed formulas.

My dr tried to give me morphine with nalaxone in it and I was just like hell no, I will just take something weaker if it is like that.

I guess the trend of putting weird unneeded chemicals in medication is rather alarming seeing how many people end up in the hospital with cellulitis from missing and IV shot of those pills and it is the formula. Is is an ugly thing to see.

Just seems to be rather inhumane because drs know damn well when their patients iv but really it is more the pharm companies fault and they seem to have legal immunity here.

In Denmark we haven't seen the many attempts to change the pills to make them harder to abuse.


The most common extended release oxycodone is the original OxyContin (produced by Norpharma here) with OC printed one one side and the amoung of mg in the pill on the other side.

The most common instant release oxycodone is OxyNorm also produced by Norpharma.

Of cause there are different producers available, but you can always just ask for the exact producers product you want. As of yet, I haven't seen any oxycodone you couldn't crush in order to snort of shoot. I have heart of ONE producer of Oxycodone though where it is said that the pill can't be put in water for IV use, that is called Reltebon and produced by Actavis.

I have never seen a morphine + nalaxone combi here. All the morphine tablets we have contain morphine only.

 

[Ignio]

I was guessing this was the case. I have read that some agency (forget which) is now recommending more frequent amphetamine use across Europe. I see it as a positive both for those with ADHD and those who enjoy stims as European amp paste has a pretty bad rep. (This could be my Euro prejudice though )

But limiting treatment to just methylphenidate is as dumb as us not having Ketogan. And Im pretty sure it is the dimethylaminodiphenylbuten that relaxes smooth muscles and acts as an antispasmodic but we dont have that either.

You are correct about the bad state of the purity of Amphetamines in Europe.
In 2014 a report was published where the average purity of street strugs seized in Denmark was shown. The purity of amphetamine on average is 5% and has been so for 10 years. The purity of cocaine on average is 25%. Heroinbase 18% and heroin chloride 38% (down from 60+ 10 years ago). The additives is coffeine, creatine, diltiazem, hydroxyzin, levamisol, lidocaine, paracetamole, phenacetine, procaine amongst others.

The average purity of amphetamine is 5%!!!! I can't even believe it. Why does people buy that shit? Amphetamine here is yellow, it is in some form of plasticine / paste form, and it smells like shit. It is NEVER white, dry and odour free. It is not even hard to see that it is shit, I just suppose people don't know how pure amphetamine in its different forms look, feels and smells.

Add to this that meth-amphetamine is never available up here and you have absolutely no where to go to get something like this other than Ritalin (or cocaine of cause, but that is in a whole other price range). A lot of the RC stems would be much much better than the amphetamine here.

 

[Keif' Richards]

An interesting thread. I've traveled a bit and really enjoy experiencing the similarities and differences from culture to culture and for me, learning about where I was almost always involved finding the right people to get me high. Good times and bad times unfortunately

I'm moving this thread over to Drug Culture, as it just barely doesn't meet the right content requirements for BDD. But, as I said, a very cool thread and hopefully we get some more posts over in the other sub-forum.

BDD --- > Drug Culture

 

[Ignio]

I have one more thing to point out. This is more related to the Danish health care system than to pharmaceutical companies.

I Denmark when you get accepted in maintenance treatment each local authority "kommune" (Denmark is distinguished into regions and under each region you find several "kommuner") is responsible for your treatment. In each kommune there is a daily center for addicts where they can come and go as well as there are what I think you would call rehab place where you are full time. In this daily center you get appointed to a doctor who is responsible for the prescription of methadone and buphrenorphine and then you collect your methadone/burp once or twice a week. If you have other addictions like benzo's, Lyrica, Ritalin etcetera you "normal" doctor outside of the addiction regime is responsible for handling this. We do not pay anything for for the things we get form the addiction center (not methadone, not therapy etc). We do however pay for the medicine our own doctor prescribes. This arrangement of cause cost the government a lot of money. So they spend a lot of money of trying to prevent addiction in the first place, on cognitive and behavioral therapy, as well as what they pay for the medications. So treatment centers here have an interest in getting us of medicine as it costs them money.

As far as I can understand from the US the place they prescribes you the methadone is also where you get it and you have to come each day to get your dose? You also pat for your dose or your insurance do which make it beneficial for the center to keep you on methadone for as long as possible and on the highest possible dosis as this will earn them more money. Where is the incentive for these centers to get you clean?
(I might have misunderstood how the US system works)

 

[Kittycat5]

It is true there are less than reputable places that treat methadone patients as nothing more than a never ending revolving door of money but I think that is not the norm (although I have read this may be increasing but that is anectodal at best). Methadone is pretty cheap. Im not 100% sure of what or how rehab or addiction centers bill for it but imagine everything else they do be it therapy or other medical treatments earn them much more than the drug itself.

Btw, Ive quit opioids but if could get an exotic like ketobemidone I may break my abstinence.

 

[bingey]

You are correct about the bad state of the purity of Amphetamines in Europe.
In 2014 a report was published where the average purity of street strugs seized in Denmark was shown. The purity of amphetamine on average is 5% and has been so for 10 years. The purity of cocaine on average is 25%. Heroinbase 18% and heroin chloride 38% (down from 60+ 10 years ago). The additives is coffeine, creatine, diltiazem, hydroxyzin, levamisol, lidocaine, paracetamole, phenacetine, procaine amongst others.

The average purity of amphetamine is 5%!!!! I can't even believe it. Why does people buy that shit? Amphetamine here is yellow, it is in some form of plasticine / paste form, and it smells like shit. It is NEVER white, dry and odour free. It is not even hard to see that it is shit, I just suppose people don't know how pure amphetamine in its different forms look, feels and smells.

Add to this that meth-amphetamine is never available up here and you have absolutely no where to go to get something like this other than Ritalin (or cocaine of cause, but that is in a whole other price range). A lot of the RC stems would be much much better than the amphetamine here.

Funny you describe high purity amphetamine base which is indeed often off-white due to contaminants , the synthesis is not the problem though as most cooks come up with stuff higher than 70% in the megalabs in Easter Europe, no the problem is that racemic amphetamines are best suited to oral use yet ignorant users insist on snorting it like the coke they can't afford. Pure or almost pure speed is a paste because it's very hygroscopic so if you want a product that dumb white chicks can snort straight out of the bag you are going to have to cut it to 30/20 % purity.

And meth reputation (which is often high purity ) is way worse . So what is your point again. Also I'm surprised some people made mod in here without reading the op just replying to the quoted bits.