Opioids Whats up with DHC prescribing in the UK?!

[kaosisallwesee]

After several years of being opioid free my health has gone to shit. Not only has the original issue reappeared (severe left knee pain), which resulted in posture and mobility abnormalities. Because of this the pain has spread to my hip and lower back. I've also developed neuralgia in my jaw, I assume from a persistent tooth infection. Bottom line is that I'm in a fair bit of pain with parenting and work making it worse.
Earlier this year I moved with my partner and child back to Lincolnshire, and registered with my old doctor again who originally treated my knee pain (damage and large tear to the lateral meniscus). They prescribed 240mg of codeine a day.
I've never got much analgesia from codeine at prescribed dosages, and to avoid over use asked if I could fuck off the 240mg of co-codamol a day and switch to a much lower dose of dihydrocodeine.

At first I had a phone appointment with a prescribing nurse and I was told its not available in the UK at all. I explained that I'd been issued it before multiple times, albeit several years ago, and that I had a family member who received it from the same surgery. Said she wasn't sure and that I'd need to speak to a doctor.
So I got a call back from my GP who at first said it was only for severe cancer pain etc... and not used at all in general practice. I'd looked into the NHSs recommendations for prescribing DHC and it said it was commonly used when codeine hasn't been effective before trying stronger pain killers such as tramadol and morphine. I explained this and he offered me 200mg of tramadol a day and 120mg of codeine a day. Tramadol makes me feel like I'm on really dirty speed, and can't safely operate machinery at work. So that's a no.
Then I get a call from a different doctor asking how they could help?! I'm pretty confused, but explain the situation again. They prescribed some naproxen and say to see if it helps, despite my reluctance I accepted. I find ibuprofen hard enough on my stomach, naproxen is like fire, even with food, ranitidine etc... 45mins later I get a text come through from the same doctor. It said that they'd looked into the prescribing of DHC and that they'd be happy to accept my request and prescribe some, if the naproxen doesn't help. Luck would have it that doctor won't be back in until Tuesday next week. So the request has gone to a different doctor with the notes from my previous discussion and text message. Just seems a massive fuck about.

Why was it so hard to find a doctor who was open to prescribing it? I was offered pretty big doses of codeine and tramadol, but DHC seemed like a no go area for all the docs I spoke to without a lot of prior consideration. Just seems odd.

 

[MsDiz]

Seems really odd when they have paramol for sale OTC in pharmacies. 500mg paracetsmol/7.46mg of DHC.

 

[December Flower]

I'm also wondering why they aren't prescribing Acetaminophen..? Are you allergic?!

I mean I'm aware that you are in constant pain, but taking Opioids will likely just increase said pain(over time). You will just dampen your pain receptors, while increasing your opioid tolerance, further and further, until you need more than you can get from the hospital, but still need it to do basically anything. This means: once you are NOT taking opioids, your pain will come back 10 times as bad. Is this what you want?

I know what I'm talking about, I have a gastrointestinal motility disorder and a chronic tenosynovitis, in combination with mild to medium Arthritis, leaving me in constant nonstop pain.

But I don't take anything, and rather develop my neurons by "waiting out the pain". It's become so unrecognizable in time. I know the pain is still there, but I just don't "think" about it, so I don't feel it, really. Listen to the Karate Masters: "Pain is just weakness leaving your body" Don't bring shame upon famuru by running from your pain. As always my advice is to meditate and stay as natural as possible. Paracetamol/Acetaminophen if you just can't. Large doses of CBD help a lot, best applied as oil directly on the affected area.

 

[kaosisallwesee]

paracetamol isn't prescribed as it cost 50p for a box of 32, its also in co-codamol which I was prescribed. I understand all that, previously prescribed them for over a decade and understand the science pretty extensively. I am fully aware its a short term solution until I see a specialist. I'm not having a go but I don't agree with the "stay as natural as possible" part. Makes no sense when codeine is natural...
And yes, odd indeed. I was only asking for 60mg a day, otc max dosage is 59.68mg. The issue then is cost and availability, pharmacies will only sell it a few times then tell you to go see your doctor.

 

[MsDiz]

paracetamol isn't prescribed as it cost 50p for a box of 32, its also in co-codamol which I was prescribed. I understand all that, previously prescribed them for over a decade and understand the science pretty extensively. I am fully aware its a short term solution until I see a specialist. I'm not having a go but I don't agree with the "stay as natural as possible" part. Makes no sense when codeine is natural...
And yes, odd indeed. I was only asking for 60mg a day, otc max dosage is 59.68mg. The issue then is cost and availability, pharmacies will only sell it a few times then tell you to go see your doctor.

Look, I’d see what this new dr is like that has been left with your case. Ring them and explain. Say you’d really rather not be on tramadol that you’ve had unwanted side effects from it and maybe say you have taken paramol and just need a higher prescribed dose as you clearly have a lot of issues that need attention.

Be honest as you can. I always find the sensible drs at least can tell when you’re just looking something to genuinely help.

 

[kaosisallwesee]

New doctor refused to issue it without even speaking to me, got reception to do it for him and pass on the message that I shouldn't be on opioids at all... Which yes, I agree with. But only if they address the problems causing me pain, which they're pretty reluctant to do. Been waiting months for a referral to come through only to find out my previous doctor never followed through, so I'm back to square one. Only option now is to wait until Tuesday and speak to the doctor that said they would issue it. I can request some more codeine but don't want to because I'm pretty sure it'll be held against me on Tuesday in regards to dhc... Beyond fucked off with all this now, its been years of battling the NHS to do something, instead I've had a single mri in the past 8 years and hardly even a physical exam, everything has been done with words and words only. They're happy to throw 100s of 30/500s at me a month but don't want to actually address the problem or prescribe effective pain relief. Now I've got a nice weekend of feeling like my knee, hip, back, and jaw are going to explode. I just hope that other doctor follows through and doesn't just change their mind before Tuesday.

 

[LoginNotSecure]

A private consultation and a prescription will probably cost you under £200/250. Save you a load of trouble.

 

[G_Chem]

I'm also wondering why they aren't prescribing Acetaminophen..? Are you allergic?!

I mean I'm aware that you are in constant pain, but taking Opioids will likely just increase said pain(over time). You will just dampen your pain receptors, while increasing your opioid tolerance, further and further, until you need more than you can get from the hospital, but still need it to do basically anything. This means: once you are NOT taking opioids, your pain will come back 10 times as bad. Is this what you want?

I know what I'm talking about, I have a gastrointestinal motility disorder and a chronic tenosynovitis, in combination with mild to medium Arthritis, leaving me in constant nonstop pain.

But I don't take anything, and rather develop my neurons by "waiting out the pain". It's become so unrecognizable in time. I know the pain is still there, but I just don't "think" about it, so I don't feel it, really. Listen to the Karate Masters: "Pain is just weakness leaving your body" Don't bring shame upon famuru by running from your pain. As always my advice is to meditate and stay as natural as possible. Paracetamol/Acetaminophen if you just can't. Large doses of CBD help a lot, best applied as oil directly on the affected area.

Acetaminophen is far from natural and toxic long term on the liver compared to opiates. Large doses of topical CBD are expensive and ineffective via that ROA.

-GC

 

[December Flower]

stay as natural as possible

paracetamol if you can't

those sentences are a punctuation mark away from each other.


I'm aware of the dangers, but the danger of opioid addiction is much larger than the liver damage, at least in my opinion. We're talking chronic pain here, and I'm asking OP if he really wants to add opioid dependance to that list.

I'm still advising OP to stay clear of any medical drugs, I've seen too many go the wrong way, but I'd rather risk liver damage(that usually only occurs in too high doses over long periods of time) than opioid addiction. Just me, maybe. Best way would just be to take the pain.

 

[Ismene2]

Not sure if opiate addiction is as bad physically as liver damage from NSAIDS flower, heroin is one of the most benign drugs known to man - causes no organ damage and if you overdose by twice the amount you should take you just fall asleep for a few hours. Take twice the recomended dose of paracetomols and you can kill yourself.

 

[kaosisallwesee]

I woke up at 8 this morning to my phone ringing, it was a new doctor from the same practice. Shes asked how she could help and I explained again. I explained codeines mechanism of action as a pro-drug and why I think I don't get any analgesia from it. She acted like it was just my opinion and asked me to prove it. I asked for an email address to send some info to and referred her to several journal articles explaining the CYP metabolism of codeine and why it may not be effective in all patients. She called back and said in light of the info I'd provided along with her own investigation, she'd prescribe 60mg of dhc a day along with meloxicam and ranitidine, and send it to my nominated pharmacy. I thought thank fuck, a doctor that listens and isn't too stuck in their ways to consider unfamiliar meds, finally I can play with my daughter again, get on with work, and stop with this constant battle for effective pain relief.
She then called back again saying that she didn't realise I'd recently been issued co-codamol so wouldn't issue the dhc. I told her I ran out the other day and was hoping to get an alternative sorted before the weekend. She still refused but said she could prescribe tramadol!? I refused, and she asked why? I explained the snri/ssri properties and that I didn't want to take an antidepressant along with an opioid, along with the negative side effects I get. Again, she seemed a bit clueless about its mechanism of action but agreed that some people get negative side effects etc...
This is what really confused me. I asked her why I could go to boots and buy dhc/paracetamol, but I can't get that same dosage on prescription when they're open to scripting 240mg of codeine or 400mg of tramadol a day? And she said she wasn't aware of any otc product containing dhc. Told her to look up paramol. And was told if I wanted to self-medicate with that I was free to do so, but she wouldn't prescribe it, and that my only other options are codeine, tramadol, or wait until Tuesday when the other doctor returns.

I'm fairly sure the MHRA has just put out guidelines that say GPs should no longer prescribe common drugs of abuse, eg, DHC, gabapentin, benzos etc... I've even seen several practices change their policy, effectively banning the scripting of: diazepam, dihydrocodeine, gabapentin, morphine (or any of its alternatives), nitrazepam, tramadol, pregabalin, zopiclone/zolpidem and temazepam.
Like they've just decided pain management is no longer necessary in treating chronic conditions. Its no wonder people turn to street drugs or dodgy online pharmacies.
Sorry for the essays, but the whole situation has me confused and frustrated, needed to vent it all out.

 

[kaosisallwesee]

Not sure if opiate addiction is as bad physically as liver damage from NSAIDS flower, heroin is one of the most benign drugs known to man - causes no organ damage and if you overdose by twice the amount you should take you just fall asleep for a few hours. Take twice the recomended dose of paracetomols and you can kill yourself.

I was literally told 4,000mg of paracetamol is safe even in long term use, and far better than being dependant on opioids. I sent her a few NHS articles regarding the dangers of long term paracetamol and NSAIDs use. Especially in patients with the potential for cardiac issues (Granddad died of heart attack, father just had a heart attack and has previously had a mini stroke, and I have slightly high BP) due to a rise in systolic BP. Both also makes my stomach feel like it rotting away. All they want is a nice clean patient record with minimal opioid prescriptions, regardless of who suffers for it.
I blame America, all this shit is because opioids were over prescribed there and now the UK is worried about going down the same path.
I've even read that there's talk of banning all otc codeine/dhc products, making the script only. Wonder what that'll do for the number of patients requesting stronger pain meds.
Its all madness.

 

[kaosisallwesee]

I hate that having any medical knowledge is held against you when speaking to a doctor in the UK. They act like I shouldn't know anything, and if you do its seen as suspicious. I don't want to tell them about my education because again, they act like you're saying you know more than them.

 

[THECATINTHEHAT]

I find this very unusual, my medical record is about as dirty as they come and I have no trouble being prescribed DHC. Literally every single time a doctor has written me a codeine script I've said 'can I have dhc instead it makes me much less nauseous' and I dont think I've ever been denied.

If had my shoulder reconstructed a few years back and all I have to do is walk in to the doctor's and say can I have some dhc and some naproxen please and they write it out every time.....other than when I was in hospital after surgery bizarrely, where they tried to send me away with ibuprofen.

Now that really is fucking madness, they had just cut off a piece of bone from one part of my shoulder and screwed it down somewhere different with two massive titanium screws. They wanted me to stay overnight and I didnt want to so they tried to just boot me put with nothing, think I ended up saying they would need the police to get me to leave the hospital without sensible painkillers in the end and they relented.

God only knows what was going through the mind of the person who made that decision though. I discharged myself and then when i woke up the day after the local anaesthetic they had injected straight on to the radial nerve had worn off and it was possibly the most pain I've ever been in, took me a good 20 minutes to actually sit up and get out of bed.

 

[kaosisallwesee]

I find this very unusual, my medical record is about as dirty as they come and I have no trouble being prescribed DHC. Literally every single time a doctor has written me a codeine script I've said 'can I have dhc instead it makes me much less nauseous' and I dont think I've ever been denied.

In my experience its unusual too. As I said in the OP, I've not been on anything for a number of years. The initial diagnosis was that I had damage/tear to the lateral meniscus on my left knee. They took 2 years to arrange surgery and prescribed codeine and then dhc at max dosage for those 2 years. I had an arthroscopy 9 years ago. It helped for a few days and then started getting worse again until it was worse than before. Had another MRI and said there was possibly a small cyst in my knee, but that is all I ever heard about that. They continued to prescribe dhc/codeine.
Fast forward 5 years. The issues were still there, but I had a nice low exertion laboratory job and didn't feel the need. Now, I lost that job and had to go back to carpentry, which is where the problems started again. Every doctor at my practice seems to think dhc is like oxy and only used in cancer pain.
What fucks me off most is that none of these doctors have even seen me in person, ever. They're just going by what their guidelines and policies tell them rather than the wellbeing of the patient.

 

[entheologian]

Not sure if this helps but I would call dhc "co-dydramol" when trying to get prescription

 

[monstanoodle]

I'm getting terrible back pain again, which is twice this year.
Last year (symptoms I get at least once every year) I was fine getting a script for some 30mg DHC's.
But this year my GP who would be fine with most everything was totally against it (in the nicest / "don't trust you" way possible).

I've not used anything heavy for over a year n a half now, maybe more, but they've really shut the door on people needing pain relief!
I've smothered myself in Anti-Inflammatory shit = Nothing. I've tried oral versions = Nowt....

I think they expect past substances abusers to try get high off something that ACTUALLY WORKS (which is rubbish) - so stretches can be accomplished to make the situations better.
I've had to lie down for weeks to get back to normal while I could be doing exercise, housework etc.
Sorry, but it's bow-locks