The lack of pain relief medication available in Thailand

[Groove]

A little while back someone posted in the Australian Aged Pension column, asking, what is it like getting treatment for pain &/or Paliative care in Thailand. Well my advise should have been: That if someone &/or an Aussie living in Thailand thinks they may need to receive Paliative care and treatment for pain later on & in old age, well don't go to &/or stay in Thailand, because it is a national policy of Thailand to severely restrict the issuing of pain relief. If one begs hard enough one may be lucky enough to get the old fashioned treatment of Morphine Sulphate tablets. These are called a"High Alert Drug" in other words I think this means that all the government departments are allerted to who has and is receiving morphine. As I previously said, the Thais think of pain relief as uneccesary and sort of like a luxury or an indulgence. I've had 4 heart attacks in the last 6 years inside of Thailand, and with the severe head pains I get from the lack of blood getting to my brain, even I have trouble getting pain relief and would need to change hopsitals and doctors so as to plead for it, overwise I usually lye down in bed for most of the day to try and alleviate my pain. One has to humiliatingly beg for pain relief in Thailand, only to get brushed aside. No, belive me, Australia's hopsital service is one of, if not, the best in the world. The last time, being a short time ago that I was in an Aussie hospital, after ringing 000 before (5am, as I couldn't even get out of bed and got taken to hospital by ambulance in the month of May, where I layed for the next 4 days because I could not walk or get out of my hospital bed, being paralysed with Gout of the feet and legs that had been brought on by the change in cold weather, and no one could even touch my feet without the most excruciating pain being received due to this servere Gout, and the 1st thing the hospital staff asked as I arrived and was wheeled in on a stretcher was, "Are you in pain. Do you need pain relief?" (That would never happen in Thailand) I was in severe pain and could have received a shot of morphine because I should have said yes, but no, I was brave and held out, but during my 7 nights stay in this Aussie hospital I received plenty of good cheering, powerful pain relief medication, so much I was even "high", but no, back to the Thais, they seem to really admire brave soldiers who can handle the pain, so if you are not strong and are in pain virtually daily, then stay in Australia where it is your right not to have to handle pain, where they give you morphine shots for severe pain, prescribe Codeine, Panadeine Fort with doctor's scripts, even Extra Strong etc, etc for pain relief without a prescription, well they did 2 years ago anyway, but if one hasn't got oodles of money, well the public Thai Hospitals, I wouldn't even consider sending a dog to Thai government hospital and because they are so expensive, then I don't even know if Thai private hospitals issue sufficient pain relief, and if one was desperate and considered using the black opium market (as they say there is stacks of illegal Opium sold, then one could find one'self in a Thai Prison cage with 100 other inmates who all sleep together on the concrete floor, but the Thai hopsital staff are absolutely fantastic and run off their feet, but the Thai hospitals where the staff have to work in are dingy, totally overcrowded hell holes, and ask for pain relief? Forget it 

[faraday]

I had my hip replaced over a year ago at a government hospital.

 

I was given Pethidine, & when that didn't relieve the pain, morphine. On discharge, I was prescribed Ultracet which is Tramodol & paracetamol.  The pain was kept under control.

 

However, 18 mos ago, my fil was dying & he appeared to be in pain, but was not given any Opiate drugs.

 

Then, look at America, with their prescribed drug problems, & perhaps you can see the logic (?) behind their thinking.

 

 

[Lungstib]

Strange, I was recently and unnecessarily given Tramadol for mild knee pain. But its true that after a m'bike crash and the following op to my crushed leg, pain relief was offered for just 2 days and the following week was awful.

[lopburi3]

Actually after operation last month I was encouraged to use morphine self administered IV at Vejthani Hospital (did not use first night out of ICU but not in real pain - did use twice second night due pain of dvt pneumatic leg bands (indeed much more pain from them than from operation) - very happy to leave hospital next day and actually get some sleep.  

 

But well recall two years earlier at another hospital had issues just getting a morphine pill once IV system removed (which I had not used) - nursing issue as doctors fully supported use.

 

Use of such medication is an issue here (probably dating back to Opium Dens that we westerners seemed to support).  But believe use is gaining acceptance and more concern is being paid to pain issues (it seems to be first question of any nurse now).   Pain is not fun in any country.

[Sheryl]

Palliative care is most definitely a very weak aspect of Thai medical care.

 

Pain management short term while in the hospital after say surgery is usually ok if in a private hospital though initial dosage might not be enough -- thais are unusually sensitive to pain killers and also of course of lower average weight so standard doses will be lower than would be in the West

This is also true if any type of sedation.

 

In a government hospital the situation is not as good and will require advocacy. If it is not a clear cut situation like advanced cancer or fresh post op surgery, even with advocacy may prove impossible to get anything other than tramadol or NSAID.

 

Chronic pain management/outpatient pain meds are problematic even at private hospitals and one is well advised to get under the care of a pain specialist.

 

I fully agree that anyone needing end of life palliative care is better off returning to their home country. Those unable/unwilling to do so will need to be very proactive and seek out a pain specialist as their primary doctor, and be sure to have an Advanced Directive (living will). Otherwise may face both inadequate pain control and unnecessary life support measures that prolong suffering as those are still the norm here even in terminal situations.

 

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[Jeffkp]

I wanted to get some mild tranqs to help me quit smoking and the doctor was very reluctant. I was give an appointment to see another doctor and when I entered her office, she asked why I wanted to see her.  I told her I didn't as I had no idea who she was. She told me she was a psychiatrist and asked why I wanted drugs. She eventually agreed to give me 10 days worth and wanted to see me again in two weeks.

I got the meds and immediately canceled the next appointment.

Very strange experience.

[Arkady]

Over the years Thailand has shifted from selling virtually everything OTC to being quite restrictive.  When I first came here even slimming pills containing amphetamines were available OTC, as were tranquilizers and all type of codeine based preparations.  Paracetamol with codeine is now restricted and there is no longer any cold medicine such as pseudoephedrine available, except in hospitals.  In the pain killing department, Tramadol was available in pharmacies without restriction until recently.  You might want to ask a pharmacist, if you are interested because I seem to recall they only limited the sales to small quantities OTC rather than completely banning it.  Whichever way, a partial restriction would inevitably lead to a complete ban eentually.

[IAMHERE]

I hope people that buy into the idea of thailand a medical hub come across this post. I'd hate to have to go thru that pain when simple medication could have fixed it.

[Lacessit]

I usually bring back from Australia one prescription ( plus doctor's letter ) of endone, which I keep in reserve in case I have  gall bladder pain. For some reason, morphine has absolutely no effect on me. Fingers crossed, customs/immigration haven't stopped me - yet.

[George Aylesham]

My experience at the Rajavej Hospital in Chiang Mai was good and after a bad fall nine months ago I was given a morphine injection immediately and these continued after the operations. On leaving I asked the surgeon for meds (codeine) which he gave me without question, though I did not in fact need to use all of them. However I have given a copy of my living will to my doctor and this specifies palliative end of life medication. This will of course will give her cover in case of query from the medical authorities.

Edited October 13, 2018 by blackcab
Removed all bold font

[Caine]

Gout, only one cure for that lay of the booze, you sound very unhealthy to me.

[Sheryl]

I usually bring back from Australia one prescription ( plus doctor's letter ) of endone, which I keep in reserve in case I have  gall bladder pain. For some reason, morphine has absolutely no effect on me. Fingers crossed, customs/immigration haven't stopped me - yet.

You can get a permit allowing you to bring it in with you. Go to

www.permitfortravelers.fda.moph.go.th

TV members who have gone through this process report it to be pretty smooth with quick response from the FDA.

Then no need to worry.

30 day supply is the rule but if it is prescribed as say " every 12 hrs if needed" that is 2× 30 = 60.

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[JoeInSurin]

Almost all pharmacies sell 50mg Ultracet. Ultracet  is 37 mg tramadol with 13 mg paracetamol. Works great for my athritis. I buy mine at the pharmacy in Tops market. 190 baht for 10.

[lopburi3]

3 minutes ago, JoeInSurin said:

Almost all pharmacies sell 50mg Ultracet. Ultracet  is 37 mg tramadol with 13 mg paracetamol. Works great for my athritis. I buy mine at the pharmacy in Tops market. 190 baht for 10.

That is not what MIMS says it contains:

Tramadol HCl 37.5 mg, paracetamol 325 mg

 

It is also classified as a dangerous drug and requires a 1st class pharmacist on duty full time (almost no pharmacies have this) and all sales are to be recorded.

[oobar]

11 minutes ago, JoeInSurin said:

Almost all pharmacies sell 50mg Ultracet. Ultracet  is 37 mg tramadol with 13 mg paracetamol. Works great for my athritis. I buy mine at the pharmacy in Tops market. 190 baht for 10.

You are getting ripped off.  A sheet of 10 tramadol capsules (50mg) is available for as low as 25 baht.  Have never paid more than 35 baht.  Paracetamol is even cheaper.  Find another pharmacy. 

[JoeInSurin]

8 minutes ago, lopburi3 said:

That is not what MIMS says it contains:

Tramadol HCl 37.5 mg, paracetamol 325 mg

 

It is also classified as a dangerous drug and requires a 1st class pharmacist on duty full time (almost no pharmacies have this) and all sales are to be recorded.

It is  tramadol and 325 mg paracetamol. I stand corrected. I've bought it at most pharmacies I've asked. Never been recorded ever. Readily available.

Edited September 21, 2018 by JoeInSurin

[Crazy Noobie]

I go to the Ram Hospital here in Chiang Mai and have never had a problem on obtaining pain medication. I made a appointment to see a Doctor and told him I was taking Oxytocin in the USA and I know in Thailand they don't offer it, but I need a pain medication. He gave me Ultracet ( 30 days worth) and some morphine for back up. I went every month to refill for over 2 years with no issues at all.

Just recently I take a lessor strength pain medication. The doctor never questioned anything. I think in Thailand, it depends on who you see and what Hospital you go to, as they all are different. I hope it works out for you.

[JoeInSurin]

11 minutes ago, oobar said:

You are getting ripped off.  A sheet of 10 tramadol capsules (50mg) is available for as low as 25 baht.  Have never paid more than 35 baht.  Paracetamol is even cheaper.  Find another pharmacy. 

Very true except it's almost impossible to get 50 mg tramadol without a prescription. For some strange reason they sell Ultracet over the counter with no problem. 

Edited September 21, 2018 by JoeInSurin

[oobar]

Just now, JoeInSurin said:

Very true except it's almost impossible to get 50 tramadol without a prescription. For some strange reason they sell Ultracet over the counter with no problem. 

Again, check with other pharmacies.  By law, an adult can purchase 2 sheets (20 capsules) without a prescription.   I live upcountry, and there are at least three pharmacies in the market where it is available.

[JoeInSurin]

There is only one pharmacy where I live that will sell 50mg Tramadol. 50 baht for 10. He is also a physician so he can sell it. All other pharmacies in town have told me. Prescription only, go to hospital.

[Groove]

1 hour ago, Lacessit said:

I usually bring back from Australia one prescription ( plus doctor's letter ) of endone, which I keep in reserve in case I have  gall bladder pain. For some reason, morphine has absolutely no effect on me. Fingers crossed, customs/immigration haven't stopped me - yet.

Absolutely right, bring in as much Endone as you can. I did and especially if you are wheeled through customs on a wheelchair, and Targin. No they only have the old fashioned drugs here. I mean it is possible to get Morphine Sulphate 10mg tabs here but one has to absolutely and humiliatingly beg for it, and one can tell they think you are nothing more than a common drug addict, and they'll laughingly fobb you off with flipping Tramadol like you are a naughty child. This is becoming a real big issue for me and one feels like telling the schoolchild, lecturing, patronising, doc to F*** off, yeah bring Panadeine extra strong, Panadeine Forte, and if you have an overseas doctor's certificate stating you are to be allowed through Thai customs, then especially at an airport, there's nothing that Thai customs can really do to stop you, unless you have stacks, and then go through in a wheel chair, as pain in country like this where so much disrespect is given to us and our big bodies that feel pain, I mean you almost feel like hitting the grinning idiots, yes I got successfully treated with Harvoni for Hep C in Australia in 2016, I've had 4 heart attacks in Thailand since before turning 57, 6 years ago and had a chronic gout attack in QLD in May 2016 where I couldn't even get out of my hospitsl bed for 4 - 5 days and yes returning to one's home country seems a better alternative than trying to beg and plead to apathetic Thais Drs for pain relief.  

[JRUSA]

3 hours ago, Arkady said:

Over the years Thailand has shifted from selling virtually everything OTC to being quite restrictive.  When I first came here even slimming pills containing amphetamines were available OTC, as were tranquilizers and all type of codeine based preparations.  Paracetamol with codeine is now restricted and there is no longer any cold medicine such as pseudoephedrine available, except in hospitals.  In the pain killing department, Tramadol was available in pharmacies without restriction until recently.  You might want to ask a pharmacist, if you are interested because I seem to recall they only limited the sales to small quantities OTC rather than completely banning it.  Whichever way, a partial restriction would inevitably lead to a complete ban eentually.

I get tramadol Otc whenever im having back pain....

[ThaiPauly]

Be very careful of Tramadol.

 

I was taking it for about 3 months for stomach pain and when I did not need it anymore the withdrawal symptoms were terrible. My whole body was shaking.  My wife took me to one hospital where they gave me a shot of Valium, that was OK for an hour but then it was back, they gave me another shot , then packed me off to Suan Prom (Right /wrong name- got bars on the windows.) Anyway after a 5 hour wait in agony I saw the doc who prescribed me some pills, which helped a little but not enough.The following morning my wife went out to the back of beyond and got a bottle of methadone which was all that they would let her have, but it was all I needed. After I had finished it in 2 days I was over it. My Doc prescribed me a lot of tramadol to take on an upcoming trip to the UK, I have since returned them, I will stick with Sulphadene thanks. The withdrawals are not worth it...in my case anyway.

 

Other than that I have never had any trouble getting pethadine or morphine in hospital  in CM when I have asked a doctor for it. They won't just keep on giving it, but will give you enough to settle you down a bit

[cookieqw]

2 hours ago, JoeInSurin said:

There is only one pharmacy where I live that will sell 50mg Tramadol. 50 baht for 10. He is also a physician so he can sell it. All other pharmacies in town have told me. Prescription only, go to hospital

i buy 600mg tabs of ibuprofen, but i dont suppose that is in the same class as the stuff you guys are talking about

[Issanjohn]

If you desperately need pain control the private hospitals around where I live anyway will give you a morphine shot and send you home with codeine pills or the little morphine pills.

 

I'm retired military and I used to be an extremely hard core runner and athlete but now I deal with a lot of pain and my body is pretty well broken down.  Although I'm doing the indoor stationary bike at home now and I'm taking all my old vitamins again such as fish oil and others.  And I still deal with pain but I'm feeling a lot better because I quit taking all of that damn medication a few months ago.  You may have an addiction problem I did.  For the past year I got severely addicted to codeine it does happen.  I had a local pharmacist who was selling me as much codeine as I wanted under the counter whenever I wanted for over a year probably longer than that I lost track of how long I was taking it.  I developed a tolerance to it and I was taking up to 1000 milligrams a day.  Well a few months ago apparently that pharmacist was shut down and I'm not surprised because I saw him selling tramadol to teenage kids before.  That turned out to be a blessing in disguise for me because I got myself off of it and I don't take it anymore nor do I want it anymore.  I've been off it for a few months now I don't count days like a lot of people do after recovering from the habit I'm not looking back.  I actually went through some pretty nasty withdrawal symptoms for a few weeks after I quit cold turkey, vomiting, diarrhea, rapid heartbeat insomnia stuff like that and it's not fun but I managed to beat it on my own. I'm still dealing with pain but I'm already feeling a lot better since I quit habitually taking it.  I won't touch it again unless I'm having surgery or something.  Opioids are very hard to get off of after you've been on them for a prolonged period of time.  Eventually it would have probably killed me if not from an overdose eventually it leads to organ failure.  Now I'm actually exercising again and I actually feel like going out and doing fun stuff again instead of just sitting around the house in a daze most of the time.  I've been doing the stationary bike at home and a little bit of weight lifting as much as I can without aggravating my back. We also go out kiacing on the lake which is nearby as well whenever we can.  It's great because I feel so much better now and I'm getting back out again.

 

When my back flares up I still might go to the local clinic and get a steroid shot once in a while but besides that no more medications or drugs of any kind.  Once in awhile I still might get a little bit of diazepam legally from a doctor because I have had an extremely bad sleep disorder for years I mean like can't sleep at all but I'm rarely taking that anymore either because I'm trying to avoid all medications.  I know from experience that you can't be in the kind of physical shape that I used to be in and would like to be in again and be on drugs it just doesn't work.  I also strayed from my very strict diet when I was addicted to codeine so I'm back on my diet again as well I'm reclaiming my life.  

 

Anyway you might want to try not getting prescribed narcotics if at all possible I never want to be hooked on anything ever again.  I never thought that would happen to me but it did.  And getting involved in the underground market as you say would be an even worse idea because with street drugs you have no idea what you're actually getting at least with prescription drugs you know what you're getting but I know from experience that they can be just as addictive as street drugs.  I don't blame that pharmacist for selling it to me because I knew what I was buying I knew the risks I'm just glad that I was forced to get myself off of it.  Originally when the crooked pharmacist was shutdown I thought about seeking the drug out through other means and other pharmacies I'm sure I could get it elsewhere to include the hospital but not in the quantities that I had become used to.  That's when I started thinking rationally like "what the hell am I doing" and I realized that I was on my way to becoming a junkie, so I decided that it was time to just tough it out so I did.  I toughed out a few weeks of being very sick while I went through the withdrawal symptoms but I made it through and now I very rarely take any medication at all.  I still take a diazepam maybe once a week if that because I've had an extremely serious sleep disorder for years but I've greatly cut back on that to because I'm trying not to take anything at all but when you have legitimate medical problems sometimes you can't always totally avoid all medications.  But at least I get the diazepam legally prescribed to me and I have hardly taken any diazepam at all lately in fact I haven't taken any diazepam in over a week now.  Diazepam I don't really have a problem with it doesn't make me feel euphoric or high it allows me to sleep when I can't which is almost all the time I still struggle with it and pain but sometimes you have to tough it out because these drugs are highly addictive and it can happen to anyone.  Diazepam is a benzodiazepine medication and codeine, morphine, and the other opioid pain medications are narcotics so there's a big difference.  I don't have any other substance abuse problems the codeine addiction was the first time I was ever addicted to anything.  Once I finished the withdrawal process it was easier than I thought to stop.  Before that I was taking tramadol for a while but that stuff makes me sick if I take it now so I sort of graduated to codeine for a while after I encountered a pharmacist who would sell me as much as I wanted whenever I wanted.  Lucky for me she was shutdown or else I'd probably still be addicted to it.  She didn't get arrested one day I went to her shop and apparently she was being audited or something like that but not by the cops.  I think she might be going out of business now because I went by her shop out of curiosity a few times and now she's often closed before she was always open but now she's rarely ever open.  She knows she was wrong but I honestly hope nothing bad happens to her because I know what possibly could happen to her in this country and she doesn't deserve that.  Maybe she should be in another line of work or a different type of business but I don't think she should be locked up because I knew what I was buying.  Although I came close to saying something to her one night when I saw her selling tramadol to teenagers but I decided to mind my own business.  I think she probably got reported I'm guessing some mother or father probably caught their kid with something she sold them and she probably got ratted out by some kid she was selling to.  When I used to buy codeine from her I was always afraid that would eventually happen because I've seen her selling to other people drugs like tramadol, Xanax, and of course codeine and apparently it did but at least she's not going to jail as far as I know and I'm glad it happened because I really needed to get off of that crap which I did.  I feel so much better now that I'm off of it and healthier.  Anyway I would try to avoid all narcotics as much as possible if I were you.  The way you and some other people write about it I imagine that there are others in here who have the same problem I did for a while if so try to think about it rationally I didn't start to think about it rationally until my supply was upruptly cutoff.  Then I started thinking about where I could find it elsewhere which was when I realized that I had a problem that I needed to deal with and I dealt with it very well and I did it without anyone's help.  

[uhuh]

Nowadays tramadol is hard to find. 

There are multiple threads about it. 

Yes,  tramadol is cheap if you can find a pharmacy selling it to you).

Ultracet is not cheap but easily available. 

[uhuh]

Even in private hospitals pain medication in Thailand is insufficient and hopelessly obsolete, because no modern iv painkillers exist in Thailand. 

They use morphine (side effects! ), Ketorolac (obsolete as it damages the kidneys), and iv tramadol (makes you vomit).

 Abdominal surgery is very hard to perform if you have this choice of pain medication. 

Don't start to talk about palliative care. ..

 

Ordinary Thais, of course,  die at home in pain.  All they can get is oral paracetamol

 

BTW many rice farmers suffer from a "broken back" when old. 

The only treatment is paracetamol.

 

 

[Issanjohn]

14 minutes ago, uhuh said:

Nowadays tramadol is hard to find. 

There are multiple threads about it. 

Yes,  tramadol is cheap if you can find a pharmacy selling it to you).

Ultracet is not cheap but easily available. 

Almost all pharmacies around here still sell tramadol althouth I've heard that it's being more regulated now. 

[Shouldhaveknownbetter]

Does anyone know if its a better situation in a neighboring country.  It scares the hell out of me to think my last few days on this planet could be in complete utter pain.  If that is the situation in Thailand I pray I never get cancer.

[Sheryl]

Does anyone know if its a better situation in a neighboring country.  It scares the hell out of me to think my last few days on this planet could be in complete utter pain.  If that is the situation in Thailand I pray I never get cancer.

Good hospice services in Singapore.

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