What do you think the future holds for Opioids & pain management?

[CheerUpSleepyJean43]

Happy Father’s Day everyone, I hope everyone is enjoying their Sunday Fundayyy! Anyways I’d like to get some opinions from those of you that have more knowledge and experience on Opioids/Opiates and Pain management. Where do you think we are headed as a society in treating pain management, pain Med addiction and prescribing guidelines? Its really crazy how long the medical system has favored Opioids/Opiates for pain treatment. It’s almost like there’s no other option for people in pain besides corrective surgery.

Do any of you see a new group of pain meds or treatment on the horizon anytime soon? I have several friends here in Connecticut, NYC and Jersey (where the laws filling guidelines are becoming heinous) whom take Opioids in order to just get out of bed due to chronic pain. Also I am Transgender and I am firsthand witnessing the epidemic of post-op Trans people getting hooked on pain pills as well. Just the other day I received a text that one of our friends had just turned to street smack most likely Fentanyl due to its rule over the street market. That is one of my reasons for being hesitant to get any voluntary surgery.

If we’re going to stick to Opioids for pain management which most likely seems to be the case for now; then how can we reverse the cycle of pain patients using on the streets? Like get people back into the Doctors office and get them on a safe long term Pain Med regime or wean others off who would like to be drug free. Like I’m not saying that we should go back to the Pill mill ways, but I’d rather see people using trusted Pharmaceutical grade meds instead of playing Russian Roulette with street drugs. Honestly if it were up to me, I’d start decriminalizing drugs and try putting street level dealers out of business if thats even possible. But I’m realistic as well and know it’s not that simple, especially in the U.S. lol

The only Pain medication experience I have was a 15 day supply of Demerol from a broken foot about 10 years ago. The doc had his reasons for choosing Demerol, though I forgot why specifically. At the time I didn’t realize Demerol wasn’t generally common and was Elvis Presley’s No. #1 favorite choice; sorry I’m a history buff.lol

Leave your thoughts below, I’d love to hear all of your different ideas and opinions. Also don’t be worried to leave a thought about how you think we should go about prescribing anti-anxiety meds due to its role in the current OD rates and Opioid epidemic. How do you think politicians are treating the Opioid epidemic in comparison to past epidemics such as the 60s-70s Heroin epidemic or Cack epidemic of the 80s-90s.

 

[Wilson Wilson]

What superior alternatives exist for pain relief? Cannabis works for many people, but in many others it does not. If medical marijuana isn't working for someone, opioids are simply the best option for pain relief. There are neuropathic painkillers like pregabalin too, but they only work for specific types of pain which is why they're not licensed for post-op use as opioids are.

The simple fact is that opioids are the most universally effective pain relief medications that currently exist. The fact that Purdue and other Big Pharma companies in the US abused the system to get them prescribed unnecessarily does not make the substances themselves bad. Plenty of people get significant benefit from being on them. I was absolutely thankful for being given opiates when I had surgery because without them I was literally screaming in agony.

The balance that needs to be struck is in how readily long-term opioid prescriptions are handed out. If someone is recovering from surgery they usually only need a month or two worth unless there is some kind of complication in the healing process. Additionally, the weakest opioid possible should be used. If a patient is able to get relief just from codeine then that should be what they're given. The problem with the US is they kept handing out oxycodone to people who would have been fine on much less potent medications. If this is followed the addiction rates would be much lower. Codeine is really not too great and has a ceiling dose. Much harder to abuse than oxy. And due to lack of potency, very very unlikely to cause an OD.

Chronic pain is where you have blurred lines and grey areas. A lot of doctors are now scared to script strong opioids even to cancer patients. Frankly I think if someone is suffering from cancer, potential addiction to painkillers is the least of their concerns and the focus should be on relief. In most countries (and previously in the US before OxyContin) potent opioids were reserved primarily for cancer and similarly serious conditions. If long-term scripts for potent opioids were only given out on this basis, again you greatly reduce the amount of potential addicts.

But then you have people who simply suffer chronic pain and opioids help them live a normal life, keep their jobs, and so on. This is where it gets complicated. Some of those people can stick to medical doses of opioids long-term, not build much tolerance, and live their lives. Others will be more prone to abuse, higher doses, tolerance buildup, and so on. There is no one answer for this. You need to let doctors judge each patient on a case-by-case basis instead of trying to create a one-size-fits-all policy.

However there's another issue right there, brought to light by the opioid epidemic of the US: can you even trust doctors? Leaving the doctors to their own devices is exactly what lead to pill mills in the first place after all.

I can tell you in the UK there is absolutely no "opioid epidemic" even though you can very easily get codeine and dihydrocodeine, in low doses OTC or in prescription strength doses from online pharmacies who operate private prescription systems. The main reason for this is that if you want stronger opioids like oxycodone the vast majority of people will go through the state run NHS which has strict regulation on how and when opioids and other controlled drugs can be prescribed. Therefore in the whole country there are only 1.5 million oxy prescriptions handed out per year - which includes all forms from lowest dose IR to highest dose XR - out of a population of over 63 million.

They're far from perfect but usually they do strike a good balance between providing painkillers to those who actually need them and making sure they're not just handed out like sweets. But you will never get a system like that in the US. So you too need to strike a balance between regulating how doctors script opioids while still making sure those who need them can get them.

 

[CheerUpSleepyJean43]

What superior alternatives exist for pain relief? Cannabis works for many people, but in many others it does not. If medical marijuana isn't working for someone, opioids are simply the best option for pain relief. There are neuropathic painkillers like pregabalin too, but they only work for specific types of pain which is why they're not licensed for post-op use as opioids are.

The simple fact is that opioids are the most universally effective pain relief medications that currently exist. The fact that Purdue and other Big Pharma companies in the US abused the system to get them prescribed unnecessarily does not make the substances themselves bad. Plenty of people get significant benefit from being on them. I was absolutely thankful for being given opiates when I had surgery because without them I was literally screaming in agony.

The balance that needs to be struck is in how readily long-term opioid prescriptions are handed out. If someone is recovering from surgery they usually only need a month or two worth unless there is some kind of complication in the healing process. Additionally, the weakest opioid possible should be used. If a patient is able to get relief just from codeine then that should be what they're given. The problem with the US is they kept handing out oxycodone to people who would have been fine on much less potent medications. If this is followed the addiction rates would be much lower. Codeine is really not too great and has a ceiling dose. Much harder to abuse than oxy. And due to lack of potency, very very unlikely to cause an OD.

Chronic pain is where you have blurred lines and grey areas. A lot of doctors are now scared to script strong opioids even to cancer patients. Frankly I think if someone is suffering from cancer, potential addiction to painkillers is the least of their concerns and the focus should be on relief. In most countries (and previously in the US before OxyContin) potent opioids were reserved primarily for cancer and similarly serious conditions. If long-term scripts for potent opioids were only given out on this basis, again you greatly reduce the amount of potential addicts.

But then you have people who simply suffer chronic pain and opioids help them live a normal life, keep their jobs, and so on. This is where it gets complicated. Some of those people can stick to medical doses of opioids long-term, not build much tolerance, and live their lives. Others will be more prone to abuse, higher doses, tolerance buildup, and so on. There is no one answer for this. You need to let doctors judge each patient on a case-by-case basis instead of trying to create a one-size-fits-all policy.

However there's another issue right there, brought to light by the opioid epidemic of the US: can you even trust doctors? Leaving the doctors to their own devices is exactly what lead to pill mills in the first place after all.

I can tell you in the UK there is absolutely no "opioid epidemic" even though you can very easily get codeine and dihydrocodeine, in low doses OTC or in prescription strength doses from online pharmacies who operate private prescription systems. The main reason for this is that if you want stronger opioids like oxycodone the vast majority of people will go through the state run NHS which has strict regulation on how and when opioids and other controlled drugs can be prescribed. Therefore in the whole country there are only 1.5 million oxy prescriptions handed out per year - which includes all forms from lowest dose IR to highest dose XR - out of a population of over 63 million.

They're far from perfect but usually they do strike a good balance between providing painkillers to those who actually need them and making sure they're not just handed out like sweets. But you will never get a system like that in the US. So you too need to strike a balance between regulating how doctors script opioids while still making sure those who need them can get them.

Speak the truth man, you nailed it! It really seems that most of the US Opioid problem stems from OxyCodone prescriptions, besides the street Fentanyl causing too many ODs. From what I understand about Fentanyl in the American medical system, is that it’s usually only used in a medical setting if Morphine fails to comfort the patient. My friend had a chainsaw accident when the chain snapped and tore up his arm something fierce, resulting in surgery. He was prescribed Hydrocodone/Acetaminophen and it seemed to do little in comforting him, but that’s what the docs felt comfortable in giving him. I agree that less potent Opioids should be chosen over OxyCodone, it’s not right to leave someone in pain and left to self medicate. Aren’t there any other Opioids besides Hydrocodone, that doctors could give out? That OxyCodone has proven to be a monster.lol

It’s funny with Medical Marijuana, because when the idea of legalizing it surfaced to actually becoming a possibility, I was under the impression that it really would help those with chronic pain and steer them off of Opioids. Then reality hit and I thought about how the pain relieving qualities aren’t even in the same categories. My cousin takes Lyrica for nerve issues related to Rheumatoid Arthritis, though like you said it’s only good for that kind of thing. I think that Americans are finally realizing that in scrutinizing doctors for writing out Opioids to valid patients isn’t the direct cause of this epidemic. Our problem in the US may of started with mass marketing and overprescribing of OxyContin; though the Opioid epidemic has almost turned into a Fentanyl/Heroin epidemic.

Yeah I’ve watched documentaries about drug use in the UK and it’s sooo different! Like in Ireland, there’s people doing lines of Pregablin acting like it’s the bomb. Or folks tweaking for Valium, which actually struck me as odd. In the USA people love their Benzos, which are handed out like candy (though rules are getting tougher); but our Benzodiazepine crisis is basically centered around Xanax, Ativan and Restoril addiction or the problems of combing them with Opioids. Most recreational Benzo users don’t seek out long acting Benzos like Valium and Klonopin, though they’re still a popular choice for those whom actually suffer from Anxiety/PTSD. My doc only prescribes Xanax for a certain amount of time because it’s a DEA fav for monitoring. She once told me that when she has to finally alert the patient to switch Benzos, they break down or leave. Valium and Klonopin still have much abuse potential, but from being on Valium for over a year, I can tell you that it was good for daytime anxiety.

Getting into

 

[Wilson Wilson]

It's funny what you say about Xanax because all of a sudden the Xan hype has reached the UK too because of how hyped up it is in US media. It's not actually prescribed on the NHS but what we have is either pressed bars or blister packed 1mg tablets diverted from the EU.

The benzo scene here is very different because Valium was very widely prescribed before the late 90's and so is the most popular benzo in the UK. It also used to be easy to get temazepam and nitrazepam but both are rarely handed out now. At that point there was a big class action lawsuit regarding Valium addiction which the NHS lost so they got scared about prescribing benzos in case anyone gets addicted. Now they make it almost impossible to them at all even if you have panic attacks. It's ridiculous really, and that combined with most people not even getting any mental health care, means you now have a lot of young people especially self-medicating with Xanax from the street or darknet.

So now you kind of have two benzo scenes: the teens and young adults doing Xanax and the middle aged peeps doing Valium. Plenty of both going around, and unfortunately plenty of fakes going about for both too.

Amongst the benzo connoisseurs they tend to use a nice wide range: etizolam still has a fanbase, then there's the classic Vallies, Xans (blister packs rather than pressed bars), Rivotril (clonazepam), lorazepam, temazepam, nitrazepam (aka Moggies) as the main ones.

When it comes to opiates, the main pharmas we get are codeine, DHC, and tramadol because they are the most widely prescribed. Sometimes you can get Oramorph too if you know someone with a script. Oxy usually comes as the brand Longtec here (they are actually the OG Purdue crushable formula) but is very hard to come by, I've only met three people who were able to supply it, not including darknet vendors who charge a much higher price. I used to get strips of OC80's for a great price off a mate with a script but I lost that plug now.

Most people here who want stronger opiates tend to just go direct to smack. We have #3 so you can't snort it only smoke or shoot. We don't have as much of a fentanyl issue here compared to the US but sadly it is a growing problem. But the police take fentanyl very seriously which is one drug policy I do agree with.

Main issue in the US I see if you've done the same with opioids as we've done with benzos: because there was an addiction problem you've made it hard to get the meds even for people who actually need them, the pendulum swings the other way from handing them out too easily to making them virtually impossible to get for anyone. A middle ground needs to be struck in both cases so those in need can get them.

 

[Wilson Wilson]

It sounds like an extremely different drug culture, I remember watching a documentary about the Temazepam epidemic there in the 90s. It always seems like one Benzo ruins it for the rest.lol Vice recently did a segment on the UK hip hop scene and how the youth are taking those red Xanax bars pressed by dealers.

When it comes to Schedule II - Schedule IV prescriptions in America, it all depends on the type of drug. Like right now Schedule IV Benzos like Xanax seem to be more taboo and monitored than obtaining Schedule II Amphetamines or Methylphenidate. Also Methamphetamine is still obtainable legal prescription here brand named Desoxyn, it’s just a matter of having a doctor willing to write the script. From 2011-2016 I even had Barbiturates (Butabarbital) as my anxiety medication for over 6 years. Even though, Phenobarbital and Butalbital combinations are usually the only Barbs one comes across in the US, it’s still possible to get a script for rare ones here.

Americans have a bittersweet history and relationship with sedatives. Since the early days of Chloral Hydrate and Barbs, we’ve always thought of them as a necessary evil. They always talk about passing new prescription guidelines for Benzos, though it is quite clear that politicians have failed in the war on Opioids. People don’t want to do the same for Benzos, not to mention their withdrawal can be even deadlier than Opioid WD. I wouldn’t be surprised if Xanax became our next Quaalude as in outright banning the stuff eventually. But I don’t see Benzos going anywhere in America unless something new and better comes around.

I would like to think that we’re heading towards meeting in the middle on Opioid prescriptions in the US. People in chronic pain desperately need them in order to continue their lives just as there are certain people who end up locking themselves in their room 24/7 unless they have Benzo assistance. Like you said earlier, people don’t always need a 30-90 count of potent Opioids/Opiates. One time I was in line at the pharmacy and this fat lady was screaming at the top of her lungs at the pharmacist because he wouldn’t dispense her Fentanyl patches to her. I don’t think that stuff should be available outside of the medical setting period. I can’t believe how many folks were getting Fentanyl patches prescribed to them for long periods of time.

Yes very different drug cultures especially when it comes to pharmas. The pharma scene has always been bigger in the US because it's simply been easier to get prescriptions (historically at least) while in the UK abusable meds have been more strictly controlled as soon as they got popular on the street. Now pressed bars have become a thing suddenly we have a "pharma" scene again.

Oh yeah those "red devil" bars were a thing for a while. The original ones were actually very good quality presses containing 5mg alprazolam. Literally such a good press they seemed pharma with the shine and they were hard to break and evenly dosed. They all came from one darknet operation, the same one that started pressing regular 2mg bars here in the first place, all top quality, but the vendor got busted and since then the bars going about in the UK have been of... varying quality to say the least. No bars in the UK are legitimate pharmas and many don't even contain benzos at all recently but they're in demand anyway.

What's especially funny to me is that "lean" is also high in demand and stupid teenagers will pay dealers a big markup for it even though you can legally buy codeine syrup OTC here very cheaply and have been able to for decades.

The scheduling and prescription patterns don't always match up here either. Benzos are schedule 4 which is the lowest, but prescriptions are monitored very tightly. Stimulants for ADHD are schedule 2 but in practice are far easier to get scripted than benzos.

Only time I've come across barbiturates is when the vet gave phenobarb to my cat. I've never known a person to be prescribed them these days and never seen the rare "good ones" like secobarb.

In Australia it seems they have practically done that already with Xanax, and it's not on the NHS at all here, so it seems like it's the way things are going. But if so it'll only fuel the market for presses even further. China certainly has no problem pumping out kilos of alprazolam.

As for fent patches yeah the NHS is reluctant to give those out as well. They seem to be using bupe patches instead. The trend here seems to be more towards prescription of synthetic opioids over regular opiates driven by the (imo misguided) belief that they're less abusable. Tramadol was uncontrolled until not too long ago. But I think they've worked out they're just as abusable and more dangerous (e.g. tramadol causes seizures) and tend to stick more to morphine for take home scripts. However it will differ throughout the country as each local CCG makes its own guidelines. Some parts of the country hand out oxy surprisingly easily. Other parts don't give it out at all. It's part of what we call the "postcode lottery" where because each area's NHS service is run independently, the type of care you get can vary greatly. Different prescription patterns, varying levels of access to specialists and other treatments, etc.

 

[Wilson Wilson]

Oh yeah if you're curious here's what an OG red devil looks like. Impossible to get these now just those shitty fake represses.

 

[Shortec Stublue!!]

We have the advantage of being able to see our future, as whatever goes on in the US now (excluding guns) will be our reality in ten years.

So for example: We can predict one day we will have Oxy’s etc with tamper proof efforts, and things we enjoy over the pharmacy counter now, have an equivalent DEA crackdown. Just like we watched super size McDonald’s in confusion, and oops suddenly we have giant Big Macs too lol.

 

[Wilson Wilson]

We have the advantage of being able to see our future, as whatever goes on in the US now (excluding guns) will be our reality in ten years.

So for example: We can predict one day we will have Oxy’s etc with tamper proof efforts, and things we enjoy over the pharmacy counter now, have an equivalent DEA crackdown. Just like we watched super size McDonald’s in confusion, and oops suddenly we have giant Big Macs too lol.

Unless Purdue/Mundipharma standardises the tamper-proof oxy worldwide I can't imagine them appearing in the UK. Remember the only reason they work in the US is because Purdue's patent got extended so only their coated ones are available. In the UK we already have several generics so making one brand tamper-proof would be literally useless as you can ask the pharmacy for a specific brand and they have to order it for you. So anyone who wanted the abusable ones would just choose a generic without coating. The only exception is if the doctor writes a specific brand name on the prescription, but brand name meds are more expensive for the NHS so there has to be significant benefit to the extra cost. The vast majority of NHS scripts are written with the generic name.

Not to mention that to get a new formulation approved means spending more money on clinical trials. There's no reason to do that here because there's no widespread oxy abuse and therefore no demand for anti-abuse oxy in the first place. They only did it in the US because they were practically forced to with how widely abused they are.

Purdue actually did get Targin (oxy/naltrexone tablets) approved in the UK on the basis that it decreases constipation compared to regular oxy but the NHS basically never prescribes it because it's much more expensive than generic oxy and there's not been much evidence it actually does reduce constipation so they recommend scripting generic oxy XR + a separate laxative instead which is already standard NHS practice for most opiate scripts.

The main thing though really is that oxy abuse is so rare in the UK that the NHS would not spend more money on tamper-proof brand name pills even if Purdue did spend the money to bring them to market, so I just don't see it happening unless oxy somehow becomes widely prescribed in the UK which... how would that happen under the NHS especially with the NHS and NICE fully aware of what happened in the US?

I can see diverted oxy becoming more common on the UK black market, it's already happening, but most of that is Toroxycon which is a generic from the Indian company Torrent, very crushable and smokable and chewable, although does gum up a bit in the nose. Regardless very much abusable.

 

[Shortec Stublue!!]

Good points well made pal, you certainly know your stuff. I think also country size helps us, as we are a small population. Any which way you make my heart sing Sir as I loves me Oxy’s ??. Right about the fast food culture etc though eh?

 

[Wilson Wilson]

Good points well made pal, you certainly know your stuff. I think also country size helps us, as we are a small population. Any which way you make my heart sing Sir as I loves me Oxy’s ??. Right about the fast food culture etc though eh?

Haha cheers I like to think I know a little. Gave my gran some advice on what to ask her consultant in hospital about pain relief and the consultant asked where she got all that info, she said her grandson, then the consultant literally asked if I was a doctor! ?

Bang about fast food though sad but true. We're now the most obese country in Europe.

 

[Shortec Stublue!!]

Yeah I get that sometimes with my Grandad, if you don’t research yourself they just roll out the same old shit. I have finally got him switched from Oramorph, to liquid Oxy. He has a stoma bag and fistula and as you’ll know oral morph is a shocking BA. he is like a different man now. Shocking all the options available they never even suggest.

Whether it’s supersize food or supersize TVs we catch em up after a while. You have reassured us all that our opioids are safe Amen brother ??

 

[Wilson Wilson]

I'm happy for him, I love the Oramorph myself but you're not wrong about the BA, something like 20% oral so if I had a script I'd end up taking way more than I was scripted to get any pain relief from it. Liquid oxy is a big step up! Glad it's helping him live in comfort. Was trying to get my gran on oxy too since they tried basically everything else to no effect but the local CCG seems unwilling to script the bloody stuff even to a sick old lady.

No worries mate I am confident there will be no significant change in how strictly the NHS treats opis. Only possible change I can see is perhaps a crackdown on how they're doled out for back pain. It'll always be a postcode lottery too but ultimately if someone has a clear legitimate need for pain relief they don't have much to worry about once they have secured a repeat script especially if it's a referral from a specialist. Wish all the best for you grandad. And hope when I'm old they still hook me up with oxy.

 

[Shortec Stublue!!]

Thanks mate, glad you are looking out for your Gran too and hope she is comfortable also. May I ask is she treated for a condition specifically? did she/you manage to get things moving with her consultant?

Yeah you are spot on about repeats and having the tick of approval from a specialist. Gp’s can be a bloody nightmare, over the years they have referred my for clarity and then questioned the consultants decision.

Just the other day I literally had to staple my Gastro review letter to a med request form to get the Shortec I was due but not yet on repeat. It is surprising how easy controlled substances are doled out once you are greenlighted!!

 

[Wilson Wilson]

Thanks mate, glad you are looking out for your Gran too and hope she is comfortable also. May I ask is she treated for a condition specifically? did she/you manage to get things moving with her consultant?

Yeah you are spot on about repeats and having the tick of approval from a specialist. Gp’s can be a bloody nightmare, over the years they have referred my for clarity and then questioned the consultants decision.

Just the other day I literally had to staple my Gastro review letter to a med request form to get the Shortec I was due but not yet on repeat. It is surprising how easy controlled substances are doled out once you are greenlighted!!

Nah she's still having problems getting what she needs. Hospital fobbed her off with co-codamol! So now she'll speak to her GP again who gave her buprenorphine last time. They seem to be doing anything to avoid oxy. But she doesn't react well to opis in general, gets a lot of side effects and not much relief, so I recommended a few alternatives to ask the doc for and also recommended her to try out CBD which she seems keen on. Hopefully that helps her out at least a little. It's funny she used to be against using cannabis for medicine, now opiates are not doing the trick and she's in serious pain she is finally taking it seriously, but only now that it's finally becoming more legitimate in the UK.

GP's are often nightmares with this stuff yeah. Thankfully my current one is absolutely amazing and very understanding and we've known each other for ages so there's trust there. I have a set of pretty decent scripts. But yes once a specialist has referred a certain med for you, a GP might be a pain but ultimately the specialist always overrules the GP. So as you say you're basically "greenlighted." It also helps if you have a record showing you've had controlled drugs on repeat for a while and never given any indication of abusing them. Then a good GP will help you out in upping doses, switching meds around, etc. That's certainly been my experience. You've proven your trustworthiness at that point so they don't feel the need to cover their arses.

Hopefully you have no trouble getting your Shortec on repeat!

 

[Shortec Stublue!!]

Yeah my Mum gets Co-codamol 30/500 but they work great for and have for ten years at the same dosage strangely. With Old folk they have different mindset, taught to tough it generally and had to a lot of the time, so tend to see dr’s as not to be questioned.

At the minute my OxyContin is at 15 and shortec 20, hoping for a rise next appointment. I take Amitriptyline also which is a miracle for my colitis and sleep. I have always found benzos are an uphill battle to get not sure if I mentioned that.

 

[ChemicallyEnhanced]

I've seen those Xanax bars many times from UK vendors, but not in person as I never go out to clubs or anything since I stopped drinking, for obvious reasons. They're 5mg bars and usually referred to as "Red Devils", again, for obvious reasons.

 

[Shortec Stublue!!]

There has Been a massive “Pharma” problem in Scotland last few years, with gangs and general addicts being flooded with fakes alpraz, Diaz and Clonazepam into the likes of Glasgow and Edinburgh. Also I believe Gabapentin and Pregabalin are to be if not already scheduled due to NI and Scotland in an epidemic of gabapentoid addictions.

Whenever anyone mentions things like barbiturates, I think of an old mate who still finds these things and also wait for it..........South African Methaqualone (Qualudes) in 2019 ????

 

[ChemicallyEnhanced]

There has Been a massive “Pharma” problem in Scotland last few years, with gangs and general addicts being flooded with fakes alpraz, Diaz and Clonazepam into the likes of Glasgow and Edinburgh. Also I believe Gabapentin and Pregabalin are to be if not already scheduled due to NI and Scotland in an epidemic of gabapentoid addictions.

Whenever anyone mentions things like barbiturates, I think of an old mate who still finds these things and also wait for it..........South African Methaqualone (Qualudes) in 2019 ????

Oh how I miss my barbiturates!
Definitely legit, though, I was prescribed them by my GP.

 

[Shortec Stublue!!]

Have you seen Patrick Melrose? If not it is A Benedict Cumberbatch Sky Atlantic Series!! He literally has everything tranquiliser and barbiturate based to hand, and also The qualudes I mentioned, Also they are portrayed in Wolf of Wall st as brutally potent Gaba agonists!!

 

[Wilson Wilson]

I managed to get a clonazepam 2mg script off the NHS like a fucking boss mate