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Experiences of Addiction and the Medical Profession

pjd555 said:
I'm not about to become the go to guy for doctor shopping but I would recommend to anyone that NICE guidelines are a matter of public record and accessible free of charge. It might annoy the doctor but brandishing the guidelines and asking "What part of what you are suggesting accords with the evidence based guidance provided by NICE?" NICE and NICE International are highly respected organisations and the World Health Organisation works with them to improve healthcare globally. Incidentally, Labour want the law changed so that doctors must follow NICE guidance.
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Thing is the NICE guidelines are only guidelines, the doctor does not have to stick to them although they would be more liable if they did something outside the guidelines and something bad was to happen.

During my last Subutex detox I was given codeine and Britlofex, this is not in the guidelines but the doctor was good enough to see that I was genuine.
 
Like many on here I have done cold turkey too many times to remember and it dosesn't work for most people as you need a support network to help - unless you have had a short time of it. 2 months? meh i did more than a year once but the lure of unadulterated bliss is too much for most of us that and any thing in your life that goes wrong, lose yer job,gf etc and you reach for comfort and once you've wrapped yourself in cashmere nothing else touches the sides. Good luck to you mate keep us updated on your clean time.
@Englandz well done mate i missed the earlier posts
..the military have styrettes(sp) of omnopom
 
5StarSquatHotel said:
Thing is the NICE guidelines are only guidelines, the doctor does not have to stick to them although they would be more liable if they did something outside the guidelines and something bad was to happen.

During my last Subutex detox I was given codeine and Britlofex, this is not in the guidelines but the doctor was good enough to see that I was genuine.
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I know and I think doctors need to be kept up to date on best clinical practise and be forced to consult NICE. I had a patient once and asked in passing how her husband's wound infection was doing. She told me he couldn't take time off work and went into a private walk-in centre and had been prescribed another antibiotic a couple of days before. He didn't use his usual pharmacist who would have refused to issue the prescription because it was a quinolone (why?) and he was a controlled epileptic. You need a very good reason to choose a quinolone antibiotic in epileptics and there are none because quinolones have high GABA affinity and render anti-convulsive medications next to useless. I told the woman to call her husband and get him to stop taking the medication and get me the name and number of the doctor. The doctor had issued a handwritten private prescription and if she had used a computerised system she would have seen the MHRA warning. He had filled in his patient history form and declared he was an epileptic. The drug was inappropriate for anyone with his condition but she prescribed a branded product dispensed from the in-house pharmacy because of the high mark up. I asked the doctor WTF she was doing ignoring my patient's history and she had no answer. That man drove to and from work on a motorway and could have killed tens of people.
 
5StarSquatHotel said:
Thing is the NICE guidelines are only guidelines, the doctor does not have to stick to them although they would be more liable if they did something outside the guidelines and something bad was to happen.

During my last Subutex detox I was given codeine and Britlofex, this is not in the guidelines but the doctor was good enough to see that I was genuine.
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The use of Lofexidine is covered by NICE by reference to the NTA Orange Book and codeine can only ever be justified (and is an allowed line of treatment) in the final stage of buprenorphine withdrawal. If that was the context your doctor was following an accepted protocol.
 
I asked for lofexadine when coming off my pain meds but my Gp said only people in addiction services can prescribe that for opiate dependence and withdrawal.

The fact I was a pain patient who was choosing to come off his pain meds made me intelligible (wtf??)..

Anyway I got clonidine instead which works quite well so all was not lost.my last Gp was an utter, utter dick.

Even though I don't take Recreational drugs and never have he would insist in drug testing me when I saw him for any appointment.... He was the only Gp to ever do that in my 20 years of being in pain management...

He was a terrible doctor too.....Absolutely clueless
 
pjd555 said:
The use of Lofexidine is covered by NICE by reference to the NTA Orange Book and codeine can only ever be justified (and is an allowed line of treatment) in the final stage of buprenorphine withdrawal. If that was the context your doctor was following an accepted protocol.
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But wouldn't prescribing codeine be counter productive in that it could be a potential trigger to opiate addicts?

Evey
 
pjd555 said:
http://cks.nice.org.uk/benzodiazepine-and-z-drug-withdrawal
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Nice, thankyou.

Sounds like you are an extremely understanding professional, unfortunately not all are so accomodating. The NICE guidelines may well suggest not pressuring the patient, the reality of what actually happens is a different thing entirely though. Certainly in the area I'm in at the moment it's essentially impossible to get a maintanence script for benzos, you're given a script on the understanding that you will taper. When I was on opiate maintanence in London they had an agency changed whilst I was there and when the new agency took control of the unit most everyone was being pretty forcibly funnneled in to tapers.

I think you're looking at the situation with rose tinted glasses a little here, forced reduction is a pretty widespread policy even if the guidelines suggest otherewise.
 
Magnevibe said:
But wouldn't prescribing codeine be counter productive in that it could be a potential trigger to opiate addicts?

Evey
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When your at the very, very end of a taper codeine is a lot either to finish the taper with than either methadone or subs..you switch from the buyer to the codeine then slowly taper that...that way when you do eventually jump the crash isn't as severe....

Personally I would just say fuck it and jump.and get the unpleasant part over with but that's just me....
 
THECATINTHEHAT said:
Nice, thankyou.

Sounds like you are an extremely understanding professional, unfortunately not all are so accomodating. The NICE guidelines may well suggest not pressuring the patient, the reality of what actually happens is a different thing entirely though. Certainly in the area I'm in at the moment it's essentially impossible to get a maintanence script for benzos, you're given a script on the understanding that you will taper. When I was on opiate maintanence in London they had an agency changed whilst I was there and when the new agency took control of the unit most everyone was being pretty forcibly funnneled in to tapers.

I think you're looking at the situation with rose tinted glasses a little here, forced reduction is a pretty widespread policy even if the guidelines suggest otherewise.
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What the guy is saying may be spot on in terms of guidelines but your right an informed progressive thinking GP like him is the exception not the rule....
 
Unfortunately it would seem that not all doctors (especially GPs) are as clued up or understanding as pjd555. There was a Dr at my local surgery (now thankfully retired) that had a total God complex. What he said was law, full stop. He diagnosed my 6 year old daughter with scabies - which turned out to be a minor case of eczema. But we'd already disposed of her mattress and all bedding before we found out. He also told a colleague of mine that she wasn't pregnant, only to have her turn up 8 months later with a new baby! I'm afraid I have very little faith in GPs...

Oh, and the same GP told me to my face that it was MY fault my son was suffering from fecal impaction.. WTF?
 
When you get a bad one it knocks you faith for life..

Sometimes I think that a GP would welcome an informed debate with a fellow medical professional but some resent any kind of patient input terribly.... They see it as some sort of challenge to their authority...... Which it isn't....
 
F.U.B.A.R. said:
Unfortunately it would seem that not all doctors (especially GPs) are as clued up or understanding as pjd555. There was a Dr at my local surgery (now thankfully retired) that had a total God complex. What he said was law, full stop. He diagnosed my 6 year old daughter with scabies - which turned out to be a minor case of eczema. But we'd already disposed of her mattress and all bedding before we found out. He also told a colleague of mine that she wasn't pregnant, only to have her turn up 8 months later with a new baby! I'm afraid I have very little faith in GPs...

Oh, and the same GP told me to my face that it was MY fault my son was suffering from fecal impaction.. WTF?
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Obviously that's all terrible, but you're describing only one person. Out of how many doctors nationally? Or even in your town?

I met this one guy that's a total arsehole, but I wouldn't judge the entire population of the UK by those standards.

Of course not all GPs are of a high standard. You are allowed to change doctors.
 
F.U.B.A.R. said:
Unfortunately it would seem that not all doctors (especially GPs) are as clued up or understanding as pjd555. There was a Dr at my local surgery (now thankfully retired) that had a total God complex. What he said was law, full stop. He diagnosed my 6 year old daughter with scabies - which turned out to be a minor case of eczema. But we'd already disposed of her mattress and all bedding before we found out. He also told a colleague of mine that she wasn't pregnant, only to have her turn up 8 months later with a new baby! I'm afraid I have very little faith in GPs...

Oh, and the same GP told me to my face that it was MY fault my son was suffering from fecal impaction.. WTF?
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Sometimes a chinning really is required:X Don't know how you kept calm mate.
 
felix said:
Of course not all GPs are of a high standard. You are allowed to change doctors.
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Unfortunately that's not always feasible. Out here in the sticks you don't necessarily get a choice cos there is only one available - particularly if you don't drive. My GP surgery has gone to shit since they got to pick and choose what they are willing to treat. Although they can't actually refuse patients as such, in pracice they can and do cos they simply will not treat certain types of condition (no treatment for any mental health conditions whatsoever, for example). For those of us that don't drive we have no alternative and simply go without treatment.

This happened to me recently when I had a psychotic epdisode which earned me a week in a psychiatric unit. I was discharged with a fortnight's worth of the prescribed meds and told to simply go to my GP for repeat prescriptions until my outpatient appointment with the consultant psychiatrist who prescribed said meds. None of the GPs at my local surgery would issue a repeat prescription - not even when told to directly by the prescribing consultant - because of this "we don't treat mental health issues" policy. It's more or less blind luck that I didn't have another episode of psychosis and end up hurting myself or others.

Unfortunately, my experience with GPs over the years has rarely been very good. The odd one now and then is an absolute star and goes out of their way to help but most either don't seem to give a shit and are just going through the motions or almost seem to go out of their way to make the situation worse :\
 
They need to start working nights again like everyone else in healthcare...

Unfortunately in the real world people don't just suddenly stop getting sick after 6:00.. Try getting a doctor.to come out to your house out of hours nowadays....

Fucking no chance..
 
warriorOnTheEdge said:
Sometimes a chinning really is required:X Don't know how you kept calm mate.
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Basically because I'm not like that - I tend to respect people that are supposed to know better. But sometimes they really test your bleeding patience... (Yes, I would have loved to chin the cunt coz his attitude was just begging for it).

Also, Felix, its not just the one GP that has lead me to this conclusion - its a lifetime of snap diagnoses with no question that they are ever in the wrong. My brother in law died two years ago from a brain tumour. Despite many trips to his GP, all they ever said was 'its just a headache, take some paracetamol'. When he died the GP actually came creeping round to my sister in law's house to 'apologise'. Thankfully that old cunt has now retired (no doubt with a very healthy pension) - but should have been struck off long before then.
 
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Yea when my five year old had an earing infection n was screaming with the pain I had to take her to A n E out of hours. To be fair though they were goid with her n prescribed her antibiotic there n then, which cleared it within a few days.

Evey
 
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