UK/US dosages of prescription meds

[monkeygone2heaven]

this is embarrassing to post here...

swim recently moved to the UK. her GP (general practicioner in the UK) is clueless about opiate dosages -- she was taking vicodin/hydrocodone or oyxcontin/oxycodone in the USA for the past 4 years for chronic pain PRN. swim does not take these daily so as to not develop tolerance/dependence as she has a condition which is long-term (forever). she increased dosage the first year but constant ever since so has been pretty good in terms of management... she uses about 1-2 times a week as needed but has not had any in months.

based on her medical reorts, her UK doctor prescribed codeine at the same milligrams, swim was suspicious that OTC codeine can be as effective for a pretty serious pain condition. but did not want to be a pain. but she was right, codeine doesn't work as well. swim had to take 10 tablets to feel just the tiniest pain relief but at that point also nausea.

swim needs to speak with doctor but basically needs to show GP oxycodone and hydrocodone is not the same as codeine and suggest an alternative. this GP is allright when you go to her with suggestions (e.g, also expects swim to find out the best doctors to refer herself to). basically swim's medical care is in her hands. swim is kinda used to this and have had little problem in the past. but when swim looked for opiate equiavalents between US/UK, it's another story. it's not like antibiotics or something where you can find the equivalent name and it's not tripterol but imprimpteryl... swim has had a hard time with this. or maybe it's embarrassingly obvious and she's not been able to see the obvious.

if anyone can help, swim would very much appreciate it. now swim enjoys a recreational dug or two, but in terms of opiates, it's not her "recreational" choice... (mainly the nausea stops it from moving in that direction)...
she does have a chronic pain problem... which will tend to get worse as the cold weather comes in and she still has not figured out her meds situation...

so your help would be especially appreciated.

thankssss.

[radiometer]

google "opiod equivalence chart."

SWIY will find numerous documents to choose from, from experts, showing that this doctor is an idiot (which he is if he thinks that hydrocodone and codiene are equipotent - don't tellhim that though, it probably won't help SWIYs cause much! ). Print some out and bring them to him.

[mickenator]

Swim has been perscribed dihydrocodeine for about 5 months now for cronic pain and as they use them regularily they find them ineffective and has tried to get others with similar strenght but with no luck. I think that doctors here are loathe to prescribe anything much stronger unless you are dying. I suppose is all you can do is what swiradiometer has suggested but be polite and smile and pretend not too know loads about what you want.

[radiometer]

I'm curious: which drugs are typically used in Europe for pain, after codiene and DHC have proved ineffective for the patient?

[monkeygone2heaven]

ah! thanks... good search term, i was trying simialr things but not hitting the right pages...

yeah dr is an idiot, i didnt know what to say when she suggested OTC doses of codeine to a chronic pain patient with my illness!! but i didn't want to appear "drug-seeking" -- heaven knows opiate-wise i've had my pick and don't want to go there...

[monkeygone2heaven]

i can't seem to edit my post, what i mean is of course, swim. erhhh..!

[ningbar]

a useful tool for discussing pain and meds with your GP is the "World Health Organisation Analgesic Ladder"

its a 3 stage plan for deciding on treatment for pain

http://www.patient.co.uk/showdoc/40000178/

swiy should point out that they feel they should be on the top rung of the ladder (where they would be prescribed morphine/oxycodone/hydrocodone

cheers
Ningbar

[monkeygone2heaven]

thanks ningbar! good printout...

swim can post her experience with UK pain medicine system in due course. i US was lucky to have GP with brains/knowledge who was great and helped manage pain well. much better than "world renowned pain clinic" one could say!

on the other hand, as much as one can complain about the US, i appreciate its healthcare workers now that i am away... here in the UK (and Europe as a recent trip to a different country swim took suggests) swim feels like it's 20 years backwards like who still has to deal with the "drug-seeking patient" stereotype versus the "big bad doctor"??!! it's not like anyone wants to be a pain patient!!

it's quite bit uncomfortable when one's been in the loop longer than the doctor and needs to tell them what to do or else you'll get nowhere. if swim wanted opiates US pain clinics have open doors once you have certain diagnostics, it's like "come play!".. but you really don't want to go there at swim's age...

thanks for the input, very useful

[Forthesevenlakes]

This may be old news to SWIY, and I know the advice SWIM is about to give is all over the forum, but swiMonkey, please use the "cold water extraction" technique if SWIY is taking over the counter codeine. It will get rid of the acetaminophen in the medication so that SWIY does not damage her liver; this is a very real risk when taking 10 pills of OTC codeine. Search for it in the forum, theres some good pages that tell swiy how to do this.

so europe doesnt have pain management clinics? Interesting...swiy may have to go to a couple different doctors if she is not getting the help she needs. This is not "doctor shopping" as long as swiy is not getting prescriptions for the same medication from 2 different doctors. Online pharmacies could also prescribe hydrocodone, swiy may want to look into if any ship to Europe, SWIM guesses they do though. They require medical records which shouldnt be a problem if SWIY's condition is well documented.

If SWIM has time later he'll look up info on chronic pain and send you what he finds, its nuts that doctors wouldnt take swiy's condition seriously enough to move her up to hydrocodone or oxycodone at least, if not morphine or hydromorphone.

[monkeygone2heaven]

hi thanks very much F, swim's definitely heard of CWF but has not done it due to laziness. if the access to actual pain meds takes long and she has to resort to codeine again, that may have to happen though... thanks for the reminder.

this doctor is keen to refer swim to the pain clinic (and neurology and wherever else swim wants because doc is also aware of her imcompetence...) there is a pain clinic swim can be referred to (swim is lucky to be in London) ... but the whole attitude is different to the US where a GP will give anyone some vicodin while they wait for their pain clinic appointment, it's not like it's a big deal!!

swim will see how it goes, she is used to not taking meds regularly but it's been hard to not have available for breakthrough pain..

swim should not bash the whole UK system before seeing the pain clinic experience but general MD's/GP's in US were definitely more educated about pain in her experience. the GP here was not even aware of the use of anticonvulsants in pain medicine!

[radiometer]

^ In light of that post, I retract my "idiot" accusation with regards to SWIYs doctor, and will replace it with "misinformed."

[monkeygone2heaven]

errmm, oh no ...don't take it back. swim kinda liked the politically incorrect conversation we had there! plus she'll never know we called her an idiot so it's like a "white insult"

[Forthesevenlakes]

Due to meddling by the DEA, it seems like fewer doctors in the US are willing to prescribe even weak painkillers to many people. SWIM has seen lab rats come out of having oral surgery with 12 5 mg percocets, as if that would help them for a whole week! But SWIY may just be dealing with uninformed/misinformed doctors as radiometer says, and if SWIY presents the facts (or alludes to switching care providers), they will be more willing to help. It may just be that SWIY's doctor hasn't really encountered many pain patients.

There are other medications that can potentiate opiates as well, for both painkilling and recreational effects. Searching for "opiate potentiation" on the forum should help SWIY figure out the options available that could help if she's stuck with codeine at the moment. SWIM will also mention that the well-known grapefruit juice potentiation DOESNT work with codeine, but other forms of potentiation will.

And use that CWE if swiy keeps taking codeine! SWIM is just lookin out for ya.

PM me over the weekend if SWIM doesnt post anything, swiMonkey, it'll remind him to look stuff up.

[Psych0naut]

Originally Posted by radiometer

I'm curious: which drugs are typically used in Europe for pain, after codiene and DHC have proved ineffective for the patient?

Usually tramadol or maybe dextropropoxyphene, though in SWIMs country DHC isn't prescribed.
After that one needs to be in a lot of pain if he wants to get stronger opiates prescribed.
After tramadol, morphine is usually prescribed and if that provides insufficient pain relief, then oxycodone, fentanyl or methadon is prescribed.
It is very, very hard to get anything stronger than tramadol prescribed in the Netherlands, and even tramadol is not easy to get.
Usually the stronger opiates are only used during and/or after surgery, or for terminal patients, or when they are needed beacause of special medical circumstances.Buprenorphine and the fentanyl derivates are only used for post-operative pain.

After some searching, this was the list of opiates prescribed in the Netherlands:codeine, morphine, tramadol, dextropropoxyphene, oxycodone, buprenorphine, fentanyl, methadon

[monkeygone2heaven]

swim has just heard that in Europe you can buy hydrocodone (the opiate in Vicodin, Lortab etc) as "Biocodone" --- anyone know about this? apparently it's mostly prescribed as cough medicine (like good ole morphine in the day...)

there is this common belief that oxycodone is so much more potent than hydrocodone. in swim's and other pain patients' case this is not really the experience. hydrocodone is cheap and generics are available and hence prescribed way more often. perhaps this is where the percept comes from. swim actually quite liked "Tylenol with Codeine" which because the name sounds wimpy, noone thinks is a potent opiate. but it's the same as Vicodin = opiate + acetaminophen.

while swim agrees US doctors are perhaps over-prescribing opiates, if we have to compare vices, her opinion is that it doesn't hurt too much for someone who doesn't really need it to "enjoy" a few extra pills after tooth surgery or something (no refill!)... whereas the European way is potentially denying actual chronic pain patients pain relief... swim really has been having a good pain period so she's managed OK. but delaying a pain prescription for so long from a chronic pain patient due to either this paranoid practice, or as in my case, incompetence... how can that be good?

anyway, rant over... if anyone knows about Biocodone, please let know.

[rabbi]

Regarding biocodone -- it is hydrocodone bitartrate, the opiod in Vicodin, Lortab, and Norco. I am a chronic pain patient who is prescribed Norco (10mg hydrocodone/325mg "acetaminophen" aka paracetamol) by my US doctor. I spend about half the year in Belgium, however, where there is no equivalent cocktail, though until a few months ago, biocodone was available here with a prescription.

Biocodone was a controlled substance under Belgian law, and for some reason it was pulled from the market recently. (Unusual for the Belgian system, as drugs are usually replaced at the beginning of the year when the new formulary is published. Also, none of the pharmacists I spoke to about this had received a notice that the drug was being taken off the market -- they just found they weren't able to restock.)

This was problematic for me, as stopping the opiate treatment am on would result in my pain rendering me incapacitated. My doctor suggested alternatives of ethymorphine (codethyline erfa) or thebacon (Acedicone). My pharmacist said that ethymorphine is only really good for treating cough or acute pain, as tolerance is developed quickly, and there is an analgesic ceiling. Thebacon, however, has the same sort of analgesic properties as hydrocodone (in fact, it is very similar, chemically.)

In my experience, 7.5mg of thebacon (Acédicone) is equivalent to 10mg hydrocodone. If this is available in the UK, you may consider suggesting to SWIM that they ask about this pain killer, and take it in conjunction with an appropriate dose of paracetamol. (Be careful not to exceed 2 grams of paracetamol/day, especially if you are taking it regularly!)

Also, note that thebacon aka Acédicone is Schedule I in the USA. (Looking at the chemical structure, I suspect it could be turned into diamorphine fairly easily, and perhaps this is why.)

I do not know what would happen if you had a valid doctor's prescription for thebacon (as I do) and tried to import it to the US if you were visiting. I am not interested in finding that out myself (though I'd like to know what the regulations are for this sort of thing.)

Reputation Comments on this post:

good start.