I took a risk by being honest w/ my pain doc...

[4DQSAR]

How much Tramadol were you taking that put you in the hospital?

Just two every six hours. I was prescribed tamsulosin both times but crucially, even after two hospitalizations, my former GP refused to swap me on to simple Co-codamol 30/500. So I had to go out and buy a compound analgesic [P] and extract the codeine. It was many years ago but at the time UK doctors were all being told that tramadol was non-addictive (which isn't true) BUT crucially, IS dysphoric so would not be abused.

But pretty soon desperate junkies had worked out that consuming a LOT of tramadol would at least ameliorate AWS hence the lesser of two evils.

Even the BNF stated that 50mg tramadol = 30mg codeine so even if people did some homework, they would assume that a 10 strip of tramadol was the same as a 10 strip of codeine. Some were fine, but many were not.

In 2014 tramadol was responsible for 240 deaths/annum and even now it's only dropped to 218 per annum which is still 14% of deaths due to drug intoxication with only H and 'benzodiazepines' being responsible for more.

I used the inverted commas because a lot of things are being sold as benzodiazepines are misrepresented. Initially it was somewhat benign with fake diazepam containing other benzodiazepines but latterly we have seen nitazenes and so on all appearing.

I strongly suspect that at the height of prescribing, many doctors were so happy to find this new, seeminly unabusable alternative that many people were and still are selling their prescription. Heck, if someone can get 200+ pills a month for £10 and can sell them for £200, they will. There seems to be a lingering belief that 'if it works - don't change it. Even I was shocked that years after the outcry over tramadol-related deaths, it's still being prescribed.

I should add that as far as I know, UK doctors are now told NOT to prescribe tramadol to new patients so I imagine the problem will 'age out'. But the fact we can solve it at a stroke bugs me. Resolve it and prescribe 25mg of the MOR enantiomer or even just 20mg of O-DMT.

 

[Psynaught]

Just two every six hours. I was prescribed tamsulosin both times but crucially, even after two hospitalizations, my former GP refused to swap me on to simple Co-codamol 30/500. So I had to go out and buy a compound analgesic [P] and extract the codeine. It was many years ago but at the time UK doctors were all being told that tramadol was non-addictive (which isn't true) BUT crucially, IS dysphoric so would not be abused.

But pretty soon desperate junkies had worked out that consuming a LOT of tramadol would at least ameliorate AWS hence the lesser of two evils.

Even the BNF stated that 50mg tramadol = 30mg codeine so even if people did some homework, they would assume that a 10 strip of tramadol was the same as a 10 strip of codeine. Some were fine, but many were not.

In 2014 tramadol was responsible for 240 deaths/annum and even now it's only dropped to 218 per annum which is still 14% of deaths due to drug intoxication with only H and 'benzodiazepines' being responsible for more.

I used the inverted commas because a lot of things are being sold as benzodiazepines are misrepresented. Initially it was somewhat benign with fake diazepam containing other benzodiazepines but latterly we have seen nitazenes and so on all appearing.

I strongly suspect that at the height of prescribing, many doctors were so happy to find this new, seeminly unabusable alternative that many people were and still are selling their prescription. Heck, if someone can get 200+ pills a month for £10 and can sell them for £200, they will. There seems to be a lingering belief that 'if it works - don't change it. Even I was shocked that years after the outcry over tramadol-related deaths, it's still being prescribed.

I should add that as far as I know, UK doctors are now told NOT to prescribe tramadol to new patients so I imagine the problem will 'age out'. But the fact we can solve it at a stroke bugs me. Resolve it and prescribe 25mg of the MOR enantiomer or even just 20mg of O-DMT.

You sound extremely knowledgeable about drugs...which probably got you into trouble with your doc, LOL. They hate it when their authority is challenged.

My specialty is TRT and HRT related compounds. I see a world famous TRT doc, but the things he is doing were pioneered by people like me 30 years ago. At first he was put off, but now we get along fine. When my pharmacy started charging me $120 for a bottle of testosterone (this was over 10 years ago, so more like $190 in todays dollars) I started making my own. This really pissed him off, LOL.

I am still feeling crappy from Covid although I was feeling better today. Tramadol would make me feel better, it actually kind of perks me up, but I doubt I will touch any opioids besides maybe a little but of Kratom.

 

[KurtAurelius]

Glad to hear it. I even found a human study in which O-DMT was compared to tramadol and it turned out that about 20mg of O-DMT (also referred to as the M1 metabolite) was as effective as 50mg of tramadol and produced far fewer side-effects.

I should add that as far as I know, UK doctors are now told NOT to prescribe tramadol to new patients so I imagine the problem will 'age out'.

Fucking hilarious to come full circle and to take this long, how we can trust doctors and whoever approves drugs when they make unnecessary mistakes like this..

I’m not sure how recent Tramadol was synthesised and whether they understood its full pharmacological profile (perhaps missing the fact its metabolite was responsible for the pain killing?) but how can they readily approve such an atypical substance? Then realise they made such a mistake lol..

I know I’m moaning to the void, it’s quite clear that it’s wishful thinking but still.

Alongside the fact that Tramadol is a Class C compared to Codeine as a B. Of course the classing is arbitrary anyway but it won’t be treated as such. I believe benzos and steroids are class C being the most addictive (benzos) and basically damaging (steroids)

I liked tramadol as a naive user but it was odd and information was readily available to its risks when I messed about with it (8-10 years ago)

Someone recently found some and offered me but I had to decline, as I wasn’t risking dual norepinephrine activity for a buzz that would be weaker than Codeine.

(And just a recollection I had, that someone I know was prescribed tramadol, as breakthrough management, while already on 60mg codeine twice a day for a while, and on a fuck ton of psych meds, heavy stuff like quetiapine and likely other mood stabilisers and psych meds.
I can’t presume to be an authority but that doctor is a fucking moron? Why not just use DHC instead of adding Tramadol, to Codeine, as won’t they compete, plus the potential interactions of the tramadol on the laundry list of other shit this person takes? It was so long I didn’t see all of it!)

 

[Survival0200]

I also prefer codeine over tramadol. Tramadol is just a fast-acting antidepressant. With codeine you get real sedating opiate euphoria. I would be sooo happy if I lived in a country where you can by low dose codeine/paracetamol without prescription (or even DHC/paracetamol!).

 

[Thankful_for_this_place]

I had a blood test yesterday because I had a bug as far as im aware they don't check for any drugs and if they did they would surely have to tell you before hand .I didn't even know they would ever check for kratom .everyone thinks the US has a poor health care system and the nhs is something special .the nhs is falling appart, it takes 2 weeks to even speak to a doctor on the phone never mind an appointment, it's the biggest shambles of a supposedly free health care system .

I get what you mean as I'm in the USA and I had to wait years and years to get recognized that my condition, which usually doesn't cause bad enough pain to require an opioid, and that mine is severe enough to require 1, then finally be going to a pain clinic that doesn't seem to be acting like their hands are tied in helping me. This place has helped me so much and I learned stuff and I post some and I am inspired by the stories and experiences of everyone and we have an ok health system if you don't require long term treatments especially if it involves opioids. You have to jump through hoops of fire holding an elephant without falling or touching the hoop and pray and stand on your head with your arms and legs and mouth set at just the right position at the exact micro second to get treatment. Lol my humor but at the same time that's what it feels like. Especially now that we had the opioid epidemic and the biggest obvious logical problem with that is 98 percent of the people who were involved aren't going every 30 days to a pain clinic and willingly participating in every single thing we are required to do to be seen every 30 days. Did the true victims of the whole years long across political parties and that I personally knew a few people who were abusing opioids get recognized or did it benefit them? Not at all. It was used to control people who do everything the right way and do what they are supposed to do day in and out.. As the op said our treatment options are taken away from us. A little bit different from Kraotam, I think I spelled that right, but same principle

 

[Thankful_for_this_place]

Fucking hilarious to come full circle and to take this long, how we can trust doctors and whoever approves drugs when they make unnecessary mistakes like this..

I’m not sure how recent Tramadol was synthesised and whether they understood its full pharmacological profile (perhaps missing the fact its metabolite was responsible for the pain killing?) but how can they readily approve such an atypical substance? Then realise they made such a mistake lol..

I know I’m moaning to the void, it’s quite clear that it’s wishful thinking but still.

Alongside the fact that Tramadol is a Class C compared to Codeine as a B. Of course the classing is arbitrary anyway but it won’t be treated as such. I believe benzos and steroids are class C being the most addictive (benzos) and basically damaging (steroids)

I liked tramadol as a naive user but it was odd and information was readily available to its risks when I messed about with it (8-10 years ago)

Someone recently found some and offered me but I had to decline, as I wasn’t risking dual norepinephrine activity for a buzz that would be weaker than Codeine.

(And just a recollection I had, that someone I know was prescribed tramadol, as breakthrough management, while already on 60mg codeine twice a day for a while, and on a fuck ton of psych meds, heavy stuff like quetiapine and likely other mood stabilisers and psych meds.
I can’t presume to be an authority but that doctor is a fucking moron? Why not just use DHC instead of adding Tramadol, to Codeine, as won’t they compete, plus the potential interactions of the tramadol on the laundry list of other shit this person takes? It was so long I didn’t see all of it!)

Tramadol dint work for me atall

 

[Thankful_for_this_place]

Wow! I just logged in after a long time & I'm surprised anyone was still following this thread lol! Things are... better than they were when I last posted. I am still seeing this guy. After the last appt. I posted about, he has been magically nicer to me! As of last wk., I have just been restored to my prior dose of 15 mg 5/day after (very annoying) gradual increases. Now that I am back up, I've begun gathering info on potential new providers.

I have continued to supplement w/ 7-OH as I have found this has provided great relief & is keeping me from taking more oxy. However, I am trying to taper off of the gabapentin. A recent study came out that suggests gabapentin may increase the risk of dementia & mild cognitive decline by more than half! I brought this up at my appt. the day after the study came out in Regional Pain & Anesthesia. He looked annoyed & wasn't interested in discussing it w/ me at all. He just asked if I wanted to taper. Dick. I seriously hopes he takes this study into consideration when he is thinking about treatment options for his patients.

Also, did everybody see the FDA's remarks on restricting 7-OH/kratom products this wk.? FUCK. Chronic pain sufferers literally have their treatment options taken away, 1 by 1, & I'm scared!

I'm so glad you are doing better and you are getting treatment finally for your pain and I will keep that in mind about the gabapentin. I took it sometimes to help my pain but I don't fancy mental decline so I will take it less even now. This is another reason why I appreciate this place. You can find out so much by reading what other people talk about and say!

 

[4DQSAR]

You sound extremely knowledgeable about drugs...which probably got you into trouble with your doc, LOL. They hate it when their authority is challenged.

It very much depends on the doctor. It's my experience that a good doctor will, if asked a question they cannot answer, will admit ignorance. A VERY good doctor will find out and next time you see them, reply in full. An EXCELLENT doctor will find the answer and call or E-mail their answer.

Only the bad doctor fears that someone altering the power dynamic by questioning them produces negative outcomes (for doctor and patient).

My advice is simple - if your doctor fears questions, ask yourself what else they don't know.

The doctor who gave me static first took a six month leave for mental health reasons (I really wasn't asking difficult questions) and then, as I'm told, became an aromatherapist. I suggest the effacacy of most alternative medicines relies on that power dynamic.

 

[lost weekend]

I get what you mean as I'm in the USA and I had to wait years and years to get recognized that my condition, which usually doesn't cause bad enough pain to require an opioid, and that mine is severe enough to require 1, then finally be going to a pain clinic that doesn't seem to be acting like their hands are tied in helping me. This place has helped me so much and I learned stuff and I post some and I am inspired by the stories and experiences of everyone and we have an ok health system if you don't require long term treatments especially if it involves opioids. You have to jump through hoops of fire holding an elephant without falling or touching the hoop and pray and stand on your head with your arms and legs and mouth set at just the right position at the exact micro second to get treatment. Lol my humor but at the same time that's what it feels like. Especially now that we had the opioid epidemic and the biggest obvious logical problem with that is 98 percent of the people who were involved aren't going every 30 days to a pain clinic and willingly participating in every single thing we are required to do to be seen every 30 days. Did the true victims of the whole years long across political parties and that I personally knew a few people who were abusing opioids get recognized or did it benefit them? Not at all. It was used to control people who do everything the right way and do what they are supposed to do day in and out.. As the op said our treatment options are taken away from us. A little bit different from Kraotam, I think I spelled that right, but same principle

I agree the NHS simply won't prescribe anything to ease pain and suffering apart from those horrible ssri etc that take weeks if not months to actually work if they even work atol ,they will hand them out like sweeties no questions asked because they know they can't be abused .you litterly have to be falling apart at the limbs before they prescribe pain medication .I was lucky because I havnt been to the doctors in 10 years or so and he was kind enough to prescibe codeine for a genuine pain in my gut.they will prescribe to the over 55s as there face fits and there seen as low risk for abuse .

 

[4DQSAR]

Codeine as apposed to dihydrocodine is active in it's own right. It has anticholinergic properties so if you have an upper respiratory tract infection where you eyes and nose are both running and you have a cough, it works.

It's been years since I last saw it but in the UK we even had J Collis Browne's Mixture for a stomach complaint and it did help. I wonder if the (small quantity) of morphine in it was designed not to be absorbed into the bloodstream but to act on the intestine instead.

 

[lost weekend]

Codeine as apposed to dihydrocodine is active in it's own right. It has anticholinergic properties so if you have an upper respiratory tract infection where you eyes and nose are both running and you have a cough, it works.

It's been years since I last saw it but in the UK we even had J Collis Browne's Mixture for a stomach complaint and it did help. I wonder if the (small quantity) of morphine in it was designed not to be absorbed into the bloodstream but to act on the intestine instead.

The codeine he prescribed was to stop a stomach complaint and pain.i explained I'd tried immoduim and it didn't help which was true. The codeine certainly worked as I think immodium even though it contains an opioide dosnt cross the brain blood barrier so dosnt ease pain only stops you running to toilet but not in my case .but I'm naive with how drugs work so could be talking out my ar#e lol.the mixture you speak of was apptly named

 

[4DQSAR]

The codeine he prescribed was to stop a stomach complaint and pain.i explained I'd tried immoduim and it didn't help which was true. The codeine certainly worked as I think immodium even though it contains an opioide dosnt cross the brain blood barrier so dosnt ease pain only stops you running to toilet but not in my case .but I'm naive with how drugs work so could be talking out my ar#e lol.the mixture you speak of was apptly named

Man, that stuff only made it worse in my case, Terrible griping pain in the gut.

I know loperamide used to be sold in quite large quantities in the US and deperate opioid-dependent individuals were necking down lirerally hundreds of capsules at a time.

Loperamide has this really dangerous two-phase dose-response curve. It can freely pass through the BBB but the ABC transport pumps it back out again. Until you overwhelm that transport and it then becomes centally active. I've read a few tales of people who consumed 200mg and we fine (well, at least not sick) only to become extremely ill when they increased the dose by only a small amount.

The fact that there are forensic reports on cases of fatal loperamide toxicity should hint at the risks.

Someone I knew gave us all the full rundown of how they had been taking 100 capsules and were OK but decided 'as a treat' to just top that up to 240mg. They ended up in hospital with compartment syndrome and other really serious issues. They only survived because a friend turned up, heard the TV but couldn't get anyone to answer the door. Police of whoever had to kick down the front door to get them into the ambulance and on to the ICU.

 

[4DQSAR]

BTW the patent on loperimide shows that the ratio between the antidiarrheal and analgesic effects being a whopping x615.

I mean, holy cow, people eating so many caps. Just imagine necking 120 of them. I mean, doesn't doing that FEEL wrong becuase by design almost every medicine is designed so 1 or 2 capsules (or pills) is the appropriate dose. It's psychology so consuming more than two doesn't seem 'normal' although as I write this, I realize that normal can mean different things to different people.

 

[516CAZ]

I get what you mean as I'm in the USA and I had to wait years and years to get recognized that my condition, which usually doesn't cause bad enough pain to require an opioid, and that mine is severe enough to require 1, then finally be going to a pain clinic that doesn't seem to be acting like their hands are tied in helping me. This place has helped me so much and I learned stuff and I post some and I am inspired by the stories and experiences of everyone and we have an ok health system if you don't require long term treatments especially if it involves opioids. You have to jump through hoops of fire holding an elephant without falling or touching the hoop and pray and stand on your head with your arms and legs and mouth set at just the right position at the exact micro second to get treatment. Lol my humor but at the same time that's what it feels like. Especially now that we had the opioid epidemic and the biggest obvious logical problem with that is 98 percent of the people who were involved aren't going every 30 days to a pain clinic and willingly participating in every single thing we are required to do to be seen every 30 days. Did the true victims of the whole years long across political parties and that I personally knew a few people who were abusing opioids get recognized or did it benefit them? Not at all. It was used to control people who do everything the right way and do what they are supposed to do day in and out.. As the op said our treatment options are taken away from us. A little bit different from Kraotam, I think I spelled that right, but same principle

Your analogy is quite accurate!

 

[Smyth2]

I took 40mg of loperamide one day and then 40mg loperamide the day after and it caused the worst constipation I have had in all my life. It doesn't get you high but it causes the worst constipation imaginable. I did not poo for 3 days and had to go a couple of days without eating.

However, I hear that using loperamide with cimetidine or grapefruit juice is more effective than taking lope on it's own. I might try this out.

 

[4DQSAR]

I took 40mg of loperamide one day and then 40mg loperamide the day after and it caused the worst constipation I have had in all my life. It doesn't get you high but it causes the worst constipation imaginable. I did not poo for 3 days and had to go a couple of days without eating.

However, I hear that using loperamide with cimetidine or grapefruit juice is more effective than taking lope on it's own. I might try this out.

Honestly - don't. I would have thought a CYP2A4 would reduce activity as N-demethylation leads to a more active metabolite.

Why would anyone in the UK stoop to (lots of) loperamide when compound analgesics containing codeine are on the next shelf in the pharmacy. And no, I do not refer to that awful CWE. Read the solubility data of each of the three compounded non-opioid analgesics... or should I say NSAID.

 

[helpingout]

Honestly - don't. I would have thought a CYP2A4 would reduce activity as N-demethylation leads to a more active metabolite.

Why would anyone in the UK stoop to (lots of) loperamide when compound analgesics containing codeine are on the next shelf in the pharmacy. And no, I do not refer to that awful CWE. Read the solubility data of each of the three compounded non-opioid analgesics... or should I say NSAID.

Stoop to saying the quiet part out loud? Which nsaid, soluble in what, to what end, for curiosity, not in the uk

 

[KurtAurelius]

Stoop to saying the quiet part out loud? Which nsaid, soluble in what, to what end, for curiosity, not in the uk

I could be wrong, but I believe ibruprofen is basically insoluble in water. I use to just chuck nurofen plus in lukewarm water, leave for ages and then get shit loads of stuff come out of the filter. I used to even weigh it to see how close it would come to the amount in the tablets and I never got any complaints from my body lol.

 

[Psynaught]

Honestly - don't. I would have thought a CYP2A4 would reduce activity as N-demethylation leads to a more active metabolite.

Why would anyone in the UK stoop to (lots of) loperamide when compound analgesics containing codeine are on the next shelf in the pharmacy. And no, I do not refer to that awful CWE. Read the solubility data of each of the three compounded non-opioid analgesics... or should I say NSAID.

You can get codeine in the UK?

I had gum surgery (extremely painful) and my dentist prescribed some (and boy did I need it) but I have suffered through other procedures (done by MD's) with no pain meds at all.

The last was a Cytoscopy. They shove a small camera down your penis all the way to your prostate. I got nothing! Not making this stuff up. It was like something out of a Nazi death camp.

 

[516CAZ]

You can get codeine in the UK?

I had gum surgery (extremely painful) and my dentist prescribed some (and boy did I need it) but I have suffered through other procedures (done by MD's) with no pain meds at all.

The last was a Cytoscopy. They shove a small camera down your penis all the way to your prostate. I got nothing! Not making this stuff up. It was like something out of a Nazi death camp.

OMGgggggh I've also had cytoscopy & I'm a woman. It was fucking awful.