Posted by JahL on July 12, 2005, at 17:13:48
In reply to Re: Opioids as a treatment of last resort. » JahL, posted by ed_uk on July 11, 2005, at 14:38:55
Hi Ed.
> I'm pretty sure he *can* prescribe you a sch 2 opioid - if he's willing risk upsetting the pharmacy!He retires in one month. Perhaps he doesn't want to jeopardise his fat NHS pension? I start afresh with a new pdoc next month and so I suppose we'll see how sympathetic he is to my predicament.
> Even controlled drugs can be prescribed for 'un-approved' indications in the UK. For example, morphine oral solution is often used to treat severe cough due to lung cancer.
Maybe he's worried about how it'd look. I've heard the old 'do no harm' chestnut a couple of times. They see a youngish, ostensibly fit and intelligent guy, but with a history of drug use, and they think 'addiction risk'. The fact that I already take Methadone does not help my cause.
> When I was working at a local hospital...
I wondered if you had some kind of medical background...
> >He tells me that the hospital pharmacy would immediately flag it up and that he would have some serious explaining to do.
>
> Perhaps. He could give you a prescription to take to a 'community' pharmacy though. That's what I always asked my pdoc to do when I was taking lofepramine + citalopram. The hospital pharmacy made such a fuss...Yeah. I've also found hospital pharmacies to be an ordeal. I have a good relationship with my community pharmacist tho'. Perhaps it might be an idea, to start with, to gauge what her reaction would be to such a prescription.
> At the moment, I'm working in a pharmacy attached to a GPs surgery. All our methadone patients are 'addicts'. I wouldn't ask your doc for methadone, it's not really used for non-addicts except in terminally ill patients.
I actually take 'diverted' (and unwanted) Methadone - I have long been aware of the prescribing restrictions and so have never asked for it. However my pdoc is aware I take it, appreciates the difference it makes, and essentially has no problem with it. I only take 5ml daily, which appears to be the optimum dose for me. I originally took it just to see if opioids would help my condition, but it benefitted me almost instantly and I have taken it for around 5 years now w/o any tolerance issues.
> Morphine, oxycodone or fentanyl could be better alternatives. Oxycodone and fentanyl are licensed for chronic non-maligant pain. Since oxycodone has acquired a reputation for being associated with abuse, your doc might be more comfortable prescribing fentanyl (Durogesic DTrans patch).
>
> I know you've tried codeine. Have you tried dihydrocodeine?No. It's got to be worth a go though, in the absence of anything more potent. I'll ask.
> Tramadol is also used quite a lot, it's not scheduled, have you tried it?
Yes, years ago. No benefit - or side effects - at all.
Thanks for your as always invaluable help Ed.
J.
poster:JahL
thread:500631
URL: http://www.dr-bob.org/babble/wdrawl/20050712/msgs/526803.html