UK prescribing of controlled drugs is utter madness, seems like it is utterly rudderless.
I can only presume that the situation in the US has put the frighteners on the people responsible for NICE guidelines and that there has been some sort of drive to ensure the same doesn't happen here. Whilst that is in some ways the correct thing to do (although a socialised healthcare system removes a lot of the catalysts involved in the US situation so we are not really comparable) it no doubt also means that a large number of doctors will just abandon any sense of their own judgement and start refusing treatment they should be providing because they are scared.
Again though, for me this all goes back to the pharma companies. This is the pattern that I see:
1. Pharmaceutical company develops drug that is effective at dealing with a certain condition or set of conditions, but realise that it also comes with a set of potentially very damaging side-effects.
2. Pharmaceutical company seeks to maximise the sales of this drug by minimising the recognition of these damaging side-effects through engaging in questionable research and testing procedures, aggressive marketing techniques, misleading or understating important information, highlighting it's benefits in comparison to a previous generation of drugs, perhaps even marketing it for conditions where it is not really all that effective etc
3. Doctors who work within governmental guidelines and procedures assume that the structures in place to ensure the safety of new drugs are sound and start prescribing freely if the medical community's paradigm is that it is ok to do so (which is entirely reasonable).
4. X number of years later it becomes clear than this new generation of drugs are actually not as safe as we were led to believe, and oh now we have this massive contingent of unwell people that we have to spend loads of money tidying up due to this drug. We also feel like we have been duped and lied to in regards to this drug.
5. People involved in controlling prescribing guidelines think oh shit look at this mess we've caused we need to prevent this from ever happening again let's tighten up the guidelines considerably and campaign to create a change in attitude amongst doctors to achieve this.
6. Doctors understandably become mistrustful or wary of this drug and start prescribing it far less, perhaps even when they really should be. Humans have a tendency to see things in black and white and whilst you have to have a reasonable level of intelligence to be a doctor it doesnt mean that you're not human and prone to misjudgment, especially when they know the personal consequences of one decision being wrong are are essentially nil (not prescribing opiates when a patient genuinely needs them) and the personal consequences of the alternative decision are potentially gigantic (over prescribing of opiates).
7. It's worth noting that in particular newly qualified doctors who have grown up in the field around the consequences of these drugs and likely had very limited experience working with patients who have benefited from them. To them this drug now represents a danger to the patient that they understand very well, a danger to themselves if they misprescribe that they understand very well, and a profile of benefits that they dont understand very well at all. Obviously they're not going to reach for that drug, and anyway by now........
8. Of course the pharma companies have a brand new shiny generation of drugs, and the whole process starts again.
This is all bang on, but what frustrates me is that those who make the guidelines and the docs who then prescribe based on them don't stop to exercise a reasonable level of caution towards marketing claims made by the company trying to sell you something.
I mean if Apple tells me the iPhone is the best smartphone ever and an iPad can replace my laptop I won't just blindly say "well you guys must be right, why would you lie?" and fork over my money. I will do some research, look at alternatives, and come to my own conclusions.
But apparently it is too much to ask for medical professionals who are literally responsible for the health of patients to do the same when handing out psychoactive drugs?
Don't get me wrong I do not expect every GP to take the time to do this, they are very busy people, but what about those at NICE who write up the guidelines to begin with? What about each CCG who then set local guidelines? What about the roles of NHS trusts? What about the fact that the whole reason we have GP practises with multiple docs under one roof is so they can encourage each other to make responsible prescribing decisions?
I also find it pretty mad that the vast majority of GPs seem to have zero pharmacological knowledge. And again I don't expect them to be chemists or something, but shouldn't they have at least a basic level of knowledge of what it is they're prescribing to their own patients? It seems most of them just google your symptoms, look in one of their huge dusty books at what meds they should use for those symptoms, and just hand you a script.
If they had some simple pharmacological knowledge they also wouldn't be so taken in by marketing claims from pharma companies. Pregabalin being an excellent recent example. I was scripted it years before it was controlled. Back then every doctor I met couldn't wait to throw the stuff at me and jack me up to the max dose. I questioned if this was a good idea because the side effects were pretty bad and I read the withdrawals were too. I was told nah this is safe, it's new, it's non-addictive, blah blah blah... this was of course bollocks. But I was being told this by everyone from GPs to top psychiatrists who really should fucking know better.
Oh oh oh but don't ever prescribe 5mg diazepam because ur gonna get addicted and die in a gutter somewhere but have 600mg pregabalin and whatever SSRIs you want and here's a quetiapine script on top just in case. THIS IS ALL PERFECTLY FUCKING SAFE.
Sorry for the rant but the amount of hoops I had to jump through just to get a prn benzo script was utterly insane and I am truly of the belief if I got it earlier in life I'd be in a much better position now. And what really gets me is they were more than happy to give me pregabalin and quetiapine all day long and told me how safe they fucking were.
How the fuck is it that I know more about psych meds than most fucking doctors? I shouldn't, they should know far more than me!
Probably warrants its own thread and don't wanna derail this but I tell with no hyperbole that a decent hit off some concentrates (say a 30)mg dab that would likely give 20mg ish thc mimimum, can be every bit as effective as say 20mg oral morphine. It also hits quicker (all pain dissolved within 10 seconds) and relief can last up to 3 hours. Not all strains will do that for me though, not many infact. But when you find one that does then it's a massive result.
I have to be very careful with my GP. I've socially engineered a relationship with him over the last 20 years to the extent that he will sometimes lean back, pad in hand, and literally say "Just tell me what you want..."
Not sure about its own thread as the painkilling properties of cannabis are well established at this point and, in the US at least, rapidly becoming mainstream medicine. The UK is just behind but still we're making slowwwww progress.
I have a good relationship with my GP as well which is why I was so shocked at what happened. No problem getting my other CDs on repeat. But apparently I'm a possible opiate addict now? I definitely don't want that in my notes so I'm gonna have a calm open chat when the corona shit has died down.
