My point should be quite clear. Written in the first line of the post. You are correct about the bad state of the purity of Amphetamines in Europe. Whereafter I reference a paper from the Danish government showing the average purity of seized street amphetamines. And then we hypothesize about whether this low purity is connected to next-to-none prescription use of Adderall etc. in Denmark.
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DC Moderators: ghostfreak | VerbalTruist
Differences in prescriptions and use from country to country
- Thread starter Ignio
- Start date
Pure amphetamine can not remain dry in a non arid environment.
Ah so you are saying Europe has poor amphemine. Well I thank God for that. Just look at the ravages of cheap high purity methamphetamine overseas and might just be good for our overall reputation as an economical union.
Sprout
Bluelight Crew
Swing by the Eurotrash Drug Discussion sometime... We have a slight habit of attracting speedfreaks.
Also, OP: you may wish to take a read through our Regional European Amphetamine Quality Discussion thread.
Hydrochloride salt Amphetamine absorpts A LOT of water from the air yes. This makes it near impossible to crystallize, but not totally impossible. If amphetamine hydrochloride is pure it would be color-less crystals that shines when light in put towards it.
I write that amphetamine should be white as the yellow color paste you often see is due to mistakes from the producer. Another byproduct of this is that it containes a lot of iodoephedrine, which makes people move their jar constantly.
But I agree with you that we might have been lucky avoid that meth-problem you have in the US.
I write that amphetamine should be white as the yellow color paste you often see is due to mistakes from the producer. Another byproduct of this is that it containes a lot of iodoephedrine, which makes people move their jar constantly.
But I agree with you that we might have been lucky avoid that meth-problem you have in the US.
Kittycat5
Bluelighter
So Ive been looking at data. I will use Denmark and the US as Ignio is the creator of this thread and Danish and I am American. As I suspected, the US leads in oxycodone both on a mg per capita basis (199mg) as well as overall global consumption at 73% as of 2013. Denmark's mg per capita is around 46, which is 5th overall in the world in this stat. I did not see the number on total percentage of consumption, but given population differences it is considerably lower. However, Denmark actually is tops in per capita hydromorphone use at 33mg per and the US is only around 6.6. For Fentanyl we are basically tied at around 1.6mg. Of course, the US still consumes more of each in total, but it appears these two are not as uncommon in your country as you were thinking.
http://www.painpolicy.wisc.edu/opioid-consumption-data
http://www.painpolicy.wisc.edu/opioid-consumption-data
I am really, really surprised by the the high use of hydromorphone in Denmark. Back in the days I was the go to guy for prescription pain killers, and I NEVER had or saw hydromorphone. In Denmark it is only produced under two names and it is extremely expensive compared to for instance oxycodone.
Could it be because that hospitals in Denmark use a lot of hydromorphone that Denmark are ranked so high on the list? So it us use in hospitals of hydromorphone that is the cause and not prescriptions given to people through pharmacies. Another explanation might be that the use is high is hospices and nursing homes which I wouldn't see. There most be some explanation why Denmark is the country using most hydromorphone and yet, it is never available on the black market. Can anyone else point to any explanations to the cause of this?
I am very surprised by this. Very interesting data Kittycat5.
Another interesting question is that a pattern emerge when you look through the data. A few of the same countries in the the top 5 of most use of 'x' opioid pr. capita. So in these countries significantly more pain killers are prescribed than in other countries? Is this the right conclusion?
(And then a little side question: What does OP stands for?)
Could it be because that hospitals in Denmark use a lot of hydromorphone that Denmark are ranked so high on the list? So it us use in hospitals of hydromorphone that is the cause and not prescriptions given to people through pharmacies. Another explanation might be that the use is high is hospices and nursing homes which I wouldn't see. There most be some explanation why Denmark is the country using most hydromorphone and yet, it is never available on the black market. Can anyone else point to any explanations to the cause of this?
I am very surprised by this. Very interesting data Kittycat5.
Another interesting question is that a pattern emerge when you look through the data. A few of the same countries in the the top 5 of most use of 'x' opioid pr. capita. So in these countries significantly more pain killers are prescribed than in other countries? Is this the right conclusion?
(And then a little side question: What does OP stands for?)
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Iraq
So as a lot of you know, I've done a little bit of globetrotting, teaching English in the process and my last post was in Duhok, Iraq in the Kurdish Autonomous Region and, being a drug addict, my first day off the plane consisted of scoping out the legal drug market. The illicit drug market would have to be cultivated over time through relationships.
So, the pharmacies in the city (pop 350,000) are all pretty much the same deal. There are about 20 in the center of the city in the main Bazaar/Souk. A couple of pharmacies turned me away and said I needed a prescription for the drugs I wanted. I was surprised honestly, until I realized that every pharmacy had a Doctor more or less "built in" to the structure. You would see the Doctor ($20) one time and tell him what you needed. My first go around, to be safe I just said Methylphenidate, Diazepam and Lyrica (yes, they have Lyrica in Iraq) no Opioids or anything, although Codeine is available over the counter in unlimited quantities. Everything was cheap, cheap and no one seemed to care at all about what I was picking up.
Next as I'm buzzing from my first pick-up, I decide to go for what I'm really after, sweet, sweet Opioids. So I went to a different Doctor (they don't have a prescription monitoring service, surprised?) and told them I had a bulged disc and that I took "pain medicine" for it. I threw out the name Hydromorphone, but he had never heard of it. When I said the word "Morphine" they guy looked a little bit disgusted and suggested I check myself into the hospital. I said no thanks and just picked up a second script of Methylphenidate and Diazepam, which again, was no problem at all.
So in short, you can get everything you want aside from Opioids in Iraq. Well, there's Heroin and Hashisha everywhere, but you need to speak a little bit of the language to make this happen. I had a fun time and kept it all within reason. I will say that for all 6 prescriptions, I paid less than for my Doctor's appointment. Very reasonable.
So as a lot of you know, I've done a little bit of globetrotting, teaching English in the process and my last post was in Duhok, Iraq in the Kurdish Autonomous Region and, being a drug addict, my first day off the plane consisted of scoping out the legal drug market. The illicit drug market would have to be cultivated over time through relationships.
So, the pharmacies in the city (pop 350,000) are all pretty much the same deal. There are about 20 in the center of the city in the main Bazaar/Souk. A couple of pharmacies turned me away and said I needed a prescription for the drugs I wanted. I was surprised honestly, until I realized that every pharmacy had a Doctor more or less "built in" to the structure. You would see the Doctor ($20) one time and tell him what you needed. My first go around, to be safe I just said Methylphenidate, Diazepam and Lyrica (yes, they have Lyrica in Iraq) no Opioids or anything, although Codeine is available over the counter in unlimited quantities. Everything was cheap, cheap and no one seemed to care at all about what I was picking up.
Next as I'm buzzing from my first pick-up, I decide to go for what I'm really after, sweet, sweet Opioids. So I went to a different Doctor (they don't have a prescription monitoring service, surprised?) and told them I had a bulged disc and that I took "pain medicine" for it. I threw out the name Hydromorphone, but he had never heard of it. When I said the word "Morphine" they guy looked a little bit disgusted and suggested I check myself into the hospital. I said no thanks and just picked up a second script of Methylphenidate and Diazepam, which again, was no problem at all.
So in short, you can get everything you want aside from Opioids in Iraq. Well, there's Heroin and Hashisha everywhere, but you need to speak a little bit of the language to make this happen. I had a fun time and kept it all within reason. I will say that for all 6 prescriptions, I paid less than for my Doctor's appointment. Very reasonable.
I'm really thinking that it's not so represented on the Black Market in Denmark because they use it more in the hospital setting. It's advantageous to administer Hydromorphone by injection due to its high bioavailability, as most of us know, maybe this makes prescribing it in oral form not financially feasible for the national health system? For instance, Oxycodone has pretty good oral Bioavailability and thus is prescribed orally frequently. This is just a guess though.
Kittycat5
Bluelighter
It is very likely as the data does not distinguish where it is used. It is trying to measure the overall availability of opioids distributed but not necessarily dispensed. But I would think places arent just stockpiling it for no reason.
weekend addiction
Bluelighter
Anybody else in America get temazepam? Seems like its mostly a European\Aussie med doesn't make it to 'Merica! very often. My regular doc is cool as hell and started me off on 20, 15mg pills as needed. That was a damn nice start didn't even waste my time with Ambien or Vistaril or a number of other shitty things he coulda gave me.
Like most of my fellow BL'ers, I'm pretty well experienced in buying drugs and pharmaceuticals of all shapes and sizes in the US and I've actually never known anyone who gets Temazepam, let alone seen the actual pills. That gives you an idea of how rarely it's prescribed. It gets a lot of hype, that's for sure. I'm not a "benzo guy" but I'd love to try them at some point to see what all the fuss is about.
SKL
Bluelight Crew
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International variations in prescribing practices are very interesting indeed. In the U.S. there are even significant regional differences; however, with the increased emphasis on "evidenced-based medicine" and close monitoring of prescribing practices, more uniformity is probably being seen. My bupe doctor, who I saw for years several years ago, had at the time no problem prescribing me pretty much anything and everything including dexedrine, Valium, temazepam, Lyrica, whatever, in addition obviously to suoxone; now on returning to him he is reluctant even to prescribe a benzo with a z-drug, let alone a benzo for anxiety plus second hypnotic benzo for sleep. Did he change his practices by choice, education, experience, whatever? No, but he knows he is now being watched closely by the state and the DEA. This sucks majorly. A few doctors really screwed it up for the majority. Going beyond the field of controlled substances, the general trend of "evidenced based medicine" is also an unfortunate one in many ways, it encourages "inside the box" thinking and use of algorithms with a limited amount of treatment options and little room for change.
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weekend addiction
Bluelighter
^Yep I think doctors should be giving a bit more leeway. No government agency should be running around telling people they are over-medicated or taking the wrong meds. Should be between a doctor, the patient, and maybe the practice the doctor works for but not some DEA agent that's never met the patient and couldn't give two shits about their care.
SKL
Bluelight Crew
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The only good thing about the e-prescribing (all Rxx in the State are now done electronically, you don't even get paper rx when you leave the doctor's office you just tell them your pharmacy) is that I can call him up and get things changed or ordered without needing an office visit, which was the case for first C-II and then all controlled substances. But now all he needs to do is enter it into the computer. He can also see everything else that I'm getting, so doctor shopping is dead. Also pharmacies used to never really check ID even for serious CDS, even multiple ones, even at corporate chains, now they do and actually keep copies on file, so the days of collecting prescriptions under different names are dead, too. But we're getting off topic ...
Opiates in particular there seems to be a lot of variation place to place, largely I think due to worries about abuse. Ketobemidone I've only heard about on Bluelight, it's Schedule I in the U.S. as are many opioids which are not used in clinical practice here, but may be elsewhere. Judging from what I've read it does have quite high abuse potential, but putting it in a category above oxymorphone and oxycodone seems a bit much, although basically all the opioids not used clinically are Schedule I here, and ketobemidone might have some clinical applications for which it would be particularly well-suited due to it's unique properties.
There's a similar situation going on with benzos, although their not being C-I/II makes some analogs (like etizolam although not technically a benzodiazepine) "not illegal" (not-not-legal, but importation being a gray are and sale being a no-no) and not subject to the analog act; bromazepam, one of my favorites, however, is scheduled, but is not used in clinical practice, which I find unfortunate, it's very Valium-like in it's nice balance of anxiolytic, hypnotic, and muscle-relaxant qualities but with a more manageable T½, it is a favorite of mine but at best a rare treat now (I once got a large batch from overseas and used it extensively at therapeutic doses, haven't had any in years), it is however used with some frequency in Europe and elsewhere.
Opiates in particular there seems to be a lot of variation place to place, largely I think due to worries about abuse. Ketobemidone I've only heard about on Bluelight, it's Schedule I in the U.S. as are many opioids which are not used in clinical practice here, but may be elsewhere. Judging from what I've read it does have quite high abuse potential, but putting it in a category above oxymorphone and oxycodone seems a bit much, although basically all the opioids not used clinically are Schedule I here, and ketobemidone might have some clinical applications for which it would be particularly well-suited due to it's unique properties.
There's a similar situation going on with benzos, although their not being C-I/II makes some analogs (like etizolam although not technically a benzodiazepine) "not illegal" (not-not-legal, but importation being a gray are and sale being a no-no) and not subject to the analog act; bromazepam, one of my favorites, however, is scheduled, but is not used in clinical practice, which I find unfortunate, it's very Valium-like in it's nice balance of anxiolytic, hypnotic, and muscle-relaxant qualities but with a more manageable T½, it is a favorite of mine but at best a rare treat now (I once got a large batch from overseas and used it extensively at therapeutic doses, haven't had any in years), it is however used with some frequency in Europe and elsewhere.
Kittycat5
Bluelighter
Its not that uncommon. Last list I saw Mylan's temazepam was around the 150th most dispensed rx by number of prescriptions in the US and that is just one manufacturer. But I dont get the fuss either. Its functional for me (it helps my heart not feel like it will explode on stims) but I like that it specifically does not make me sleepy. Maybe higher doses. Never really taken more than 30mg.
SKL, I get what you mean, but what alternative do you suggest to evidence based medicine? Fields like psychiatry and pain management are still more of an art and the practioners of them should not be constrained as much, but it is rather dangerous in much of anything else to not go with the best data and treatment guidelines elsewhere.
And dont get me started on e-prescribing. Its much better than in its infancy but in many ways makes my job more difficult.
SKL
Bluelight Crew
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I was mostly talking about these fields. Things like heart attack, stroke, and the whole ACLS protocol are very much in demand of algorithms which there are proven to save lives; in something like ID there's room for art but algorithms are often useful and in that field important to conserve antibiotics against resistance, etc. Oncology is another one where there is a balance (probably favoring algorithms but with a space for intuition and art.) Clinical experience and intuition in a lot of cases trump EBP/algorithms in non-emergent situations in more areas than you might think. In some other things, such as a lot of subspecialties in surgery, there is still space for art. There are several different ways, to take an example at random, to do a thyroidectomy, and I'm not sure if there's a great deal of evidence regarding the very specific differences in surgical technique relative to outcomes as it's a rather obscure thing, but if I had to get my thyroid done, I'd go with a particular surgeon who I used to scrub for years ago, assuming he's still in practice, even though his procedure was slightly different than the norm, because I knew him to be an artist in the operation room particularly with the suturing done after the removal of the thyroid, for which he had a rather unconventional technique.
Yes, at an extreme degree.
http://www.economist.com/blogs/graphicdetail/2016/05/daily-chart-22
http://www.economist.com/news/leade...ther-people-dont-get-enough-ecstasy-and-agony
( if from the link you can not see the full article, look for the title in google and open it from google)
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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
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.
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