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Opioid medications becoming limited in the UK?

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  • Waylay
    Waylay Community member, Scope Member Posts: 973 Pioneering
    @EmmaB
    Most chronic pain patients never have any problem with addiction. Dependence (physical) can occur, but that's just when you get withdrawal symptoms if you stop taking it. Addiction involves a psychological component, which often shows up as a craving for the med, needing it to the point that the patient will allow other parts of life to fall away, etc. 

    Opioids help some people with chronic pain, but you have to try them to find out whether you're one of those people. I can't take NSAIDs anymore (naproxen, diclofenac, ibuprofen, etc.) because they damaged my stomach badly, nor can I take paracetamol (caused acute liver failure about 8 years ago). Tramadol really helps me, to the point that I would be much, much more limited without it. I don't take it some days, and take more or less depending on how much pain I'm in. Every few months I go off of it for a few days, just to make sure. I get a few minor withdrawal symptoms, but they're just kinda annoying. 
  • EmmaB
    EmmaB Community member Posts: 263 Pioneering
    Hi @Waylay
    You might find this article interesting... I think the medical profession is going to have to wake up to the fact that their prescribing has become lazy, uncreative, and  ineffective, not to mention that it doesn't help let alone cure many people who end up on a horrendous cocktail of medication (then wonder why they still feel rubbish...). 

    https://www.madinamerica.com/2018/12/anatomy-of-an-opioid-epidemic/

    This opportunity prescribing problem is similar to the psychiatric medication problem. In my experience the fundamental problem is that we are not treating the root cause of people's problem which are life's circumstances, especially trauma of some sort...

    Best wishes for 2019 and let's hope thinhtturth around on this front.

    Emma
  • Waylay
    Waylay Community member, Scope Member Posts: 973 Pioneering
    I agree completely about not treating trauma! I was diagnosed with Borderline PD several years ago. I go to a programme for it two days a week. We aren't allowed to talk about anything bad from our pasts, despite the fact that most of us have significant histories of trauma (we talk about these things when out of smoke breaks). I've recently been re-diagnosed with Complex PTSD, which fits me much better than BPD. Unfortunately there's no treatment available. Great. I'm very lucky to have a very good counselor who charges me 10GBP/week, and is helping me to talk through all this stuff.

    I'll add that the benefits system is making many of us (in the BPD programme) MUCH worse. Living in poverty, constantly worried about losing our benefits, etc., is really stressful. My odyssey over PIP last year seems to have re-activated my worst C-PTSD symptoms, too.

    IMHO, that article is part of the problem. Many chronic pain patients, like me, are helped by opioids. We remain on the same doses (I have for many, many years), and our pain doesn't increase (except when stress, flares, etc. cause it).

    The opioid epidemic is massively overblown. When institutions such as the CDC report numbers, they almost always combine deaths due to prescription opioids with deaths due to heroin/fentanyl overdoses. (They also assume that all deaths with any amount of opioids involved are overdoses, when in many cases the dose of opioids wasn't lethal. Additionally, they assume that all overdoses are mistakes, when some are on purpose (chronic pain patients are at high risk of suicide).) But combining prescription opioid deaths with heroin deaths is the biggest issue.

    The addition of fentanyl to heroin is the main driver of the increase in deaths. Of course some doctors have been overprescribing opioids. Giving someone oxys for a sprained ankle is ridiculous (this happened to a friend of mine - he didn't take any). This kind of prescribing is irresponsible. These prescriptions often get stuck in a medicine cabinet and forgotten, and can be grabbed by curious teenagers, etc. Leaving these kinds of meds around the house is also irresponsible.

    So yes, definitely get rid of doctors who run pill mills. Yes, educate doctors on when opioids are necessary, and how many should reasonably be prescribed. (Giving a month's worth of pills for wisdom tooth removal or post surgical pain isn't a good idea. Give a couple of days' worth, perhaps a week, depending on the situation. Don't give them for a sprained ankle!) Yes, educate patients on the dangers of leaving opioids around the house - get them to hand them in if they have any left.

    But don't punish pain patients! Banning the prescription of opioids except in cases of terminal disease is cruel and not supported by the evidence. Some chronic pain patients NEED these meds to function - I do. Without them I'd be bed-bound most of the time, in agony. Life would not be worth living. Many pain patients in the US are killing themselves when they're forced off opioids - not because of withdrawal, but because living with that amount of pain day in, day out is not worth it.

    My thought is that it's easier for the government to blame prescription opioids, and to go on a crusade against them, than for them to fix the much more serious and complicated problems driving the epidemic. People addicted to street heroin, particularly with the introduction of fentanyl, need complex interventions. Why are they using the drugs? Generally trauma, difficult lives, poverty, etc. Sorting that kind of thing out is much more complicated (and expensive). Why are more people taking these drugs? Because society is falling apart, poverty is everywhere, lifestyles are spiraling downward, and all many people see in their futures are lifetimes of penury and poverty. Fixing that takes massive investment in society, in how the system works, huge changes so that the US values all its members, etc. That's way too much. So blame the prescription opioids. That's easily dealt with, and they can crow about it on TV while chronic pain patients suffer and die.





  • Waylay
    Waylay Community member, Scope Member Posts: 973 Pioneering
  • EmmaB
    EmmaB Community member Posts: 263 Pioneering
    Hi @Waylay

    Your long post was really interesting.  I think a lot of people are misdiagnosed with BPD when really it's cPTSD which is because of a worrying lack of awareness in the medical profession.

    It's great you've got a good counsellor; many of the counsellors who work with trauma are saying that to work with it you need to work through the body as that is where the trauma gets trapped [and that's is what causes the physical symptoms], it's a fascinating approach but one the NHS is some way off incorporating!

    I think the bottom line is that it's complicated.  If people could get the right treatment right at the start then they might well not progress to pain meds/opioids and that is where we are going wrong big time.  

    Bio-chemically there just doesn't seem to be a place for long term opioid prescriptions... but there is a placebo effect with any medication.

    Did you ever see The Doctor Who Gave Up Drugs, fascinating stuff:

    https://www.youtube.com/watch?v=kBVCFDAkMFo

    https://www.youtube.com/watch?v=iFIlGODWM2E

    What would be great is more people with experience of these issues working with others with the same issues.

    All the best.

    Emma

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