Posted by ed_uk on July 11, 2005, at 14:38:55
In reply to Re: Opioids as a treatment of last resort. » ed_uk, posted by JahL on July 10, 2005, at 18:32:20
Hi Jamie,
>My pdoc is adamant not that he won't prescribe it, but that he can't.
I'm pretty sure he *can* prescribe you a sch 2 opioid - if he's willing risk upsetting the pharmacy! 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. When I was working at a local hospital, an elderly woman with advanced Parkinson's disease was prescribed diamorphine (heroin) to relieve her depression. She couldn't swallow, the doctor prescribed a diamorphine infusion.
>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 and made me wait for ages so that they could find out why I was on two ADs at once. The 'community' pharmacy just dispensed it straight away.
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. 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? It's a schedule 5 opioid like codeine - GPs prescribe tonnes of it. Someone came in with a prescription for 900 dihydrocodeine 30mg tablets last week! Dihydrocodeine also comes as a 12hr controlled release tablet. Tramadol is also used quite a lot, it's not scheduled, have you tried it?
Kind regards
~Ed
poster:ed_uk
thread:500631
URL: http://www.dr-bob.org/babble/wdrawl/20050611/msgs/526225.html