Opoids Pain Management

[kmw]

Hey all, hope everyone had a good NYE,

 

I've finally decide to post as I've had enough of mixed answers from pharmaceutical staff, doctors that have own clinic's, and also hospitals,

 

in my mid 30s I have a condition that is acute and ends me up in ICU generally 2-3 times a year and is ongoing chronic at least once per month,

 

I go to Bangkok Hospital as that's where my insurance recommends me to go,  but my insurance premiums for both in and out patient are starting to go through the roof as Allianz pays out about 1 million thb per year against a 100k policy and that was for last year, i need to renew my policy in the next few months so I am looking around yet probably won't change as they have me trapped.

 

The medication I need is

Tramadol 50 - can get anywhere 

Oxycodone 5

Oxycodone nalaxone / targin 10/5

Morphine (rather fentanyl, as that's what I get in Australia, hospital would not give as out patient so Morphine as a replacement)

 

Ive had this condition for 3 years and am able to manage my own pain, I know Morphine I can only get at the hospital and rarely use the immediate release tables, however with Oxycodone, visited a few pharmacies and some freely give out tramadol and some don't, the mark ups on the medication I need is day light robbery at Bangkok Hospital,  I've visited 3 doctors so far, one said no, only hospital, and the other said yes, but he would need to order it from a government supplier list and needed to obtain some kind of authority, then i come back and pick it up, yet could not provide a price but said maybe he would providez, and the other said maybe as he need to check a few things and asked me to come back in a week again, probably the same as the other but he was very tight lipped about the whole thing,

 

I can easily get these medications at Bangkok Hospital, I used to have to go every month but now they are giving me 2 months supply because I keep telling my doctors I hate the place and threaten to leave,  so it's starting to get expensive, each trip roughly cost me monthly roughly 15-17k per month and about 25k every 2 months,

 

So I would like to know is thier a cheaper way to obtain this medication outside the hospital? Locally in Chiang Mai? As I know it's much cheaper, for example tramadol at Bangkok Hospital charge me 576 thb, where I can get it around the corner for 60thb.

 

All the doctors/clinics were surprised that I have this medication as out patient and all didn't know about Oxycodone nalaxone/targin so were taking photos of me, my passport, medical certificate,  and the drugs themselves, I honestly felt like a criminal, 

 

So what's the go with opiates here and are they only restricted to hospitals? I travel back to Sydney a few times a year and can easily obtain this medication with my GP and it's even subsidies under Medicare and other schemes,

 

Ive attached photo of the meds 

 

Any information would be greatly appreciated as I've been going around in circles with independent doctors and clinics over the last few weeks,

 

Thank you in advance 

 

Edited December 31, 2019 by kmw

[jimmybcool]

Sorry to hear about your condition and hassle.  I can't offer any help or advice.  I can tell you that it is getting harder for people with ongoing conditions to get opiates here in the US,  In the past people with legitimate pain (proven via MRIs) could get prescriptions that refilled every month for 3 months or more.  All they had to do was visit the pharmacy and refill it.

 

Not any more.  And doctors that specialize in pain management are being scrutinized to make sure they aren't giving out prescriptions when an alternative exists.  In the end major hassle here too.

 

Pity.  For those who are using these drugs for a legitimate purpose it gets harder to get because some people abuse them.  Best of luck finding an answer.

 

[madmen]

Thailand is not the place for pain management. I'm going to base myself in oz Under the Medicare and PBS umbrella and visit  LOS as a tourist

[bkk6060]

I suggest you try Cambodia for your requested meds.

[samuttodd]

One thing that might be a helpful way to use less medicine and incur less expense is to invoke the help of an opiate potentiator.

 

Hydroxizine is a cheap antihistamine which is also a strong opiate potentiator,   which means,  that to get the desired pain relief,  you will only need a fraction as much opiate medication.

 

Be careful with it,  because it will make your opiates hit with much more force,  so maybe do half as much opiate and 25-50 mg of Hydroxizine.

 

 

Hope this helps.   It sucks to hurt.

Edited January 1, 2020 by samuttodd

[Lacessit]

You are better off getting the meds in Australia, and bringing them in with a doctor's letter. Although Thailand is very restrictive on opoids, and you run the risk of having them confiscated, or worse.

Is the condition you have addressable with other options, such as surgery?

[seajae]

I was on 2 x 200 tramadol slow release a day plus oxycodone as well when needed when the pain got really bad  which was often, 20 years later I was a walking zombie and fully addicted, body was suffering badly too. I ended up biting the bullet and started to wean myself off them with the help of the doctor(took a real long time too), finally got down to 1 x tramadol 50 a day but couldnt get past that till a friend put me onto "cookies" made with trim off his plants, a few months later and I was totally off all medication (and cookies). While the pain is still there I manage it without using any opiates and only use muscle relaxants and pain killers now, even than I only take them when pain levels get really bad so I am not taking them all the time, I take ta muscle relaxant if I am going to go over to out land and do anything with the trees which helps stop a lot of the pain building up and the pain killers I only take when I can no longer handle the pain. I actually feel much better for it though and will never use opiates again

[samuttodd]

Opiates are outstanding for pain relief,   but unless you are fixing to die soon from a terminal illness,  there is a point of diminishing returns with them.

 

Any more than 5 days in a row will cause dependance in most folks,  and tolerance can happen in just 3 days.  Without the meds,  you feel like absolute <deleted>.    Like a terrible flu.       You'll wish you were dead,  but being dope sick won't kill you.    

 

Unlike Benzodiazapine or ethanol withdrawl which can kill you as dead as a bag of hammers..

 

 

[Sheryl]

By law only hospital pharmacies can provide morphine and oxycodone. Tramadol as you already know, can be bought at a pharmacy.

 

I suspect it is the oxy that is costing a lot - they have had to import it as there is nto yet any registered brand in Thailand and certainly none locally made.  The morphone is locally made and should be cheap even at a hospital.

 

I suggest you get under the care of a pain specialist if not already.  There is just one at CM Bangkok hospital:

 

https://www.bangkokhospital-chiangmai.com/en/find-doctors/?doctor_name=&all_specialty=ss_52&center=

 

If bringing opiods in from Australia you are limited to 30 day supply and must have a permit which can be gotten from  the Thai FDA narcotics division, email  [email protected]    for info

 

When I say 30 days that would the maximum according to how the script is written so if it says" 1-2 tablets every 4 hours as needed" that is 2X6X30 = 360 tablets

 

 

 

 

 

 

[kmw]

Hi all, thanks for all your replies,

 

I have tried all other options, anti histamines, SSRI, Bezos, anticonvulsants, etc they dont work as well as the Opoids, an yes have tried hydroxyzine hydrochloride and it does give it a bit of a boost, but I think when you start mixing medication its a downward spiral, 

 

When it comes to my acute condition I will be in ICU and they IV me with fentanyl and morphine, does not work, the pain subsides only very little, so always end up being sedated, 2 weeks later im awake and fine/discharged,

 

For the ongoing chronic, I somewhat seem to manage this, I dont want to be addicted so I dont take the opiods at times, just normal OTC stuff, and maybe one oxycodone to at least give me a few hours sleep, as chronic last generally between 3-4 days, 

 

As one poster said it makes it harder for genuine people like myself get access to this type of medication outside the hospital

 

bangkok hospital have no issue giving me these meds as have been with them for the last 3 years, its always a drive in drive out, 

 

I really would like to change hospitals, so am thinking about going to RAM or any other private or even semi private, but they are not just going hand out this medication will probably need to see several doctors and start from scratch.

 

Also yes I just checked my December visit, 

Targin cost 3,366 thb

Morphine cost 150 thb

 

Yes I also travel back to Sydney once or twice a year and my local GP takes care of everything, I always get 2 months supply and run the risk of half of it being confiscated on arrival, but have been lucky so far.

 

I still have hopes that one of these local clinics will be able order and then deliver as they both said it will be much less then half of what im currently paying,

 

Will keep you all updated, 

 

Also I think LOS has bigger problems to tackle such as drink driving, alcohol, ice/meth, etc, but thats a totally different can of worms,

 

Again thanks for your reply

 

 

[Sheryl]

7 hours ago, bkk6060 said:

I suggest you try Cambodia for your requested meds.

 

You cannot get morphine legally in Cambodia except at a hospital.

 

Really the only difference between Cambodia and Thailand as far as legal opiods go  is that Codeine can be gotten OTC in Cambodia. But the OP is on stronger stuff.

 

Note that bringing opiods from Cambodia to Thailand, need FDA permit and 30 day rule applies. Could get in very serious trouble indeed otherwise.

[Rimmer]

A troll post has been removed

[DogNo1]

OP: Feel free to not reply but I'm curious about the identity of your illness????

[kmw]

23 minutes ago, DogNo1 said:

OP: Feel free to not reply but I'm curious about the identity of your illness????

Have pm you 

[Sheryl]

1 hour ago, kmw said:

Hi all, thanks for all your replies,

 

I have tried all other options, anti histamines, SSRI, Bezos, anticonvulsants, etc they dont work as well as the Opoids, an yes have tried hydroxyzine hydrochloride and it does give it a bit of a boost, but I think when you start mixing medication its a downward spiral, 

 

When it comes to my acute condition I will be in ICU and they IV me with fentanyl and morphine, does not work, the pain subsides only very little, so always end up being sedated, 2 weeks later im awake and fine/discharged,

 

For the ongoing chronic, I somewhat seem to manage this, I dont want to be addicted so I dont take the opiods at times, just normal OTC stuff, and maybe one oxycodone to at least give me a few hours sleep, as chronic last generally between 3-4 days, 

 

As one poster said it makes it harder for genuine people like myself get access to this type of medication outside the hospital

 

bangkok hospital have no issue giving me these meds as have been with them for the last 3 years, its always a drive in drive out, 

 

I really would like to change hospitals, so am thinking about going to RAM or any other private or even semi private, but they are not just going hand out this medication will probably need to see several doctors and start from scratch.

 

Also yes I just checked my December visit, 

Targin cost 3,366 thb

Morphine cost 150 thb

 

Yes I also travel back to Sydney once or twice a year and my local GP takes care of everything, I always get 2 months supply and run the risk of half of it being confiscated on arrival, but have been lucky so far.

 

I still have hopes that one of these local clinics will be able order and then deliver as they both said it will be much less then half of what im currently paying,

 

Will keep you all updated, 

 

Also I think LOS has bigger problems to tackle such as drink driving, alcohol, ice/meth, etc, but thats a totally different can of worms,

 

Again thanks for your reply

 

 

 

What is costing you is the Targin and I don't think changing hospitals will help much if at all.

 

Indeed Bangkok Hospital is so far the only place in Thailand I have heard of as even having this, the product is not yet registered in Thailand and they have to import it themselves. It is also an expensive brand name drug, no generic available.

[kmw]

Thanks for your reply, yes the Oxycodone Naloxone / Targin thats makes it expensive, its just a long lasting Oxycodone, as just taking a single Oxycodone only works for a few hours so its pointless for sleeping,

 

The rest of the expenses are for doctors, vitals, hospital charges, etc

 

Your probably correct that Targin being needed to be imported hence the price wont change much, however I do know Bangkok Hospital mark ups are massive on anything and everything, take example the Tramadol, so im hoping I can get Targin at a medical clinic, even if only slightly less, I will still save 1000 thb per doctor for a 5 minute chat while she types up the script for me to collect from the inhouse pharmacy.

[Tayaout]

I'm late 30s and have chronic pain from my right knee to my shoulder due to a ski accident. When it comes back, it's so bad that I can't sleep nor find any position that make me feel better. I went to Bangkok and got a prescription for marijuana oil. Surprisingly, it fix my pain 100%. I tried between 1-8 drops. 2 drops work for me and has almost no psychoactive effect. It takes 2-3 hours before feeling the effect. It's best taken at the end of the day since it make me feel sleepy. Pain relief last 1-3 days. I would try this before opioid since it's not addictive. I don't remember the exact cost but it's very cheap even tho they insisted on prescribing me traditional Thai medecine. Now that I got a prescription, I can order 1 marijuana oil bottle via line for 1870 baht including shipping. It's been over a month and I used about 50% of the bottle. 

Edited January 1, 2020 by Tayaout

[kmw]

7 minutes ago, Tayaout said:

I have chronic pain from my right knee to my shoulder due to a ski accident. When it comes back, it's so bad that I can't sleep nor find any position that make me feel better. I went to Bangkok and got a prescription for marijuana oil. Surprisingly, it fix my pain 100%. I tried between 1-8 drops. 2 drops work for me and has almost no psychoactive effect. It takes 2-3 hours before feeling the effect. It's best taken at the end of the day since it make me feel sleepy. Pain relief last 1-3 days. I would try this before opioid since it's not addictive. 

I have actually thought about that, but when I was young and tried it, we call it pot in Australia, at both times I just kept on vomiting, they call it greening out, so am a bit scared, if my illnless was external I would give it a try but I have issues with an internal organ, so I'm not sure if marijuana oil would penetrate that far, but will ask one of my doctors next time about it, thank you for your recommendation

Edited January 1, 2020 by kmw

[Chivas]

On 1/1/2020 at 4:12 AM, samuttodd said:

Opiates are outstanding for pain relief,   but unless you are fixing to die soon from a terminal illness,  there is a point of diminishing returns with them.

 

Any more than 5 days in a row will cause dependance in most folks,  and tolerance can happen in just 3 days.  Without the meds,  you feel like absolute <deleted>.    Like a terrible flu.       You'll wish you were dead,  but being dope sick won't kill you.    

 

Unlike Benzodiazapine or ethanol withdrawl which can kill you as dead as a bag of hammers..

 

 

So my 19 years on Tramadol means I'm in trouble somewhat !

[PPMMUU]

I strongly agree with Sheryl that you need a proper pain specialist.

 

Your combination of pain medication is weird.

[kmw]

3 hours ago, PPMMUU said:

I strongly agree with Sheryl that you need a proper pain specialist.

 

Your combination of pain medication is weird.

Yes I do see the pain specialists at Bangkok Hospital, she only works on Fridays, and then oncologists are the other person in the hospital that can prescribe these types of pain killers, and also I have several specialist in Sydney that I keep in contact with, the only reason Bangkok Hospital were able to provide these opoids as out patient is because they spoke to a few of my doctors in Sydney, 

 

The pain specialists was also offering me fentanyl patches, in replacement for then targin, however I don't want to go down that path, as that's the strongest pain medication available and probably the most addictive,

 

Also the combination of medicine they give me may sound weird, but I don't take them all at the same time, I've had this condition for about 3 years and know what is around the corner, 

 

I did have to use one of the immediate release Morphine tablets the other day, didn't like it at all, cognitive functions were all out the window, they gave that to.me as they were unable to give me just a normal 5mg of Oxycodone,

Edited January 5, 2020 by kmw

[kmw]

Just got back from Bangkok Hospital, targin has gone up in price to 187 for unit and morphine the same,

 

As you can see the doctor i spoke to was the pain specialists at Bangkok Hospital, and it's in my best interest to self medicate as inpatient has set me up for a bill of around 800k thb 3 times every year so far, so being out patient is 1/4 the cost,

 

She even decided to give me a full two months worth based in the worst case scenario if me needing both morphine and Oxycodone/nalaxone every single day, even though I told her chronic is not daily but usually ranges between 1-3 times per months, and also told her I had about half of the medication from December, yet she insisted I have just a bit more just incase,!!! Incase I want to be an addict? Jeez

 

I have a feeling she rotates hospitals and is paid in some kinda bonus structure in relation to how much over priced medication she can sell, 

 

Oxycodone/nalaxone I can get a pack of 20 prescribed by my GP then off the local pharmacy and the cost is about aud 25

 

I did also ask her about other hospitals and she said only private will be able to but it's unlikely they will right off the bat not agree to hand over the amount Bangkok Hospital will, 

 

Anyway enough of my ranting just really sucks that people that need to manage pain thier really is no option here in Thailand unless your willing to pay or your insurance is willing to cover, mine does but my yearly premiums over the last 3 years have been going up 17% due to it now being a pre existing condition, 

Edited January 6, 2020 by kmw

[Sheryl]

Most doctors do work at more than one place and since she is there only limited days she surely does, likely works at the government hospital but it is also true that they will not hand out pain meds as willingly (some actually make you come once a week and pee in a cup each time to prove you aren't selling the meds!) and  they for sure will not have Targin.

 

Doctors do NOT get a bonus  for drugs they prescribe and far from intentionally gouging you, her behavior suggests she is doing the opposite since by prescribing a larger amount she saves you consultation fee and hospital fees...and makes less profit herself as a result.

[SteveK]

Targin (or Targinact as we call it in the UK) isn't even that good. You're paying through the nose for it, you could get stronger pain relief for a tenth of that cost.

[AverageBloke]

1 hour ago, kmw said:

Just got back from Bangkok Hospital, targin has gone up in price to 187 for unit and morphine the same,

 

As you can see the doctor i spoke to was the pain specialists at Bangkok Hospital, and it's in my best interest to self medicate as inpatient has set me up for a bill of around 800k thb 3 times every year so far, so being out patient is 1/4 the cost,

 

She even decided to give me a full two months worth based in the worst case scenario if me needing both morphine and Oxycodone/nalaxone every single day, even though I told her chronic is not daily but usually ranges between 1-3 times per months, and also told her I had about half of the medication from December, yet she insisted I have just a bit more just incase,!!! Incase I want to be an addict? Jeez

 

I have a feeling she rotates hospitals and is paid in some kinda bonus structure in relation to how much over priced medication she can sell, 

 

Oxycodone/nalaxone I can get a pack of 20 prescribed by my GP then off the local pharmacy and the cost is about aud 25

 

I did also ask her about other hospitals and she said only private will be able to but it's unlikely they will right off the bat not agree to hand over the amount Bangkok Hospital will, 

 

Anyway enough of my ranting just really sucks that people that need to manage pain thier really is no option here in Thailand unless your willing to pay or your insurance is willing to cover, mine does but my yearly premiums over the last 3 years have been going up 17% due to it now being a pre existing condition, 

I'm just asking out of interest, does the Targin work much better than taking say 200mg of Tramadol ? 

[SteveK]

1 tablet of Targin 10/5 contains 10mg of oxycodone as the active painkilling ingredient. 

 

10mg of oxycodone is equivalent to 150mg of Tramadol. So 200mg should work better in theory.

Edited January 6, 2020 by SteveK

[samuttodd]

This may help you figure out some medicine equivalents for a dose.    For example,  Hydrocodone is worth 1,   Tramadol is worth 0.1.   So it would take 10 mg Tramadol doses to equal 1 mg Hydrocodone.

 

 

This may help you figure out some medicine equivalents for a dose.    For example,  Hydrocodone is worth 1mg ,   Tramadol is worth 0.1mg.   So it would take 10mg  of Tramadol to equal 1mg Hydrocodone.

 

 

Edited January 6, 2020 by samuttodd

[kmw]

6 hours ago, AverageBloke said:

I'm just asking out of interest, does the Targin work much better than taking say 200mg of Tramadol ? 

I don't really take tramadol, perhaps every now and then 2 x 50mg, but what is important to me is sleep, so not needing to wake up every few hours to take some tablets, also targin has the anti constipation elements, I guess one could take tramadol at 200 I'm sure thier are long release options but then would need additional medications to pass stools, trust me you get very clogged up,

 

I'm also on other medications as well, trust me you don't want to know, so it's all a juggling act unfortunately,

 

The pain doctor also started going on about self injecting fentanyl into the back and patches but I stopped her in her tracks, 

4 hours ago, samuttodd said:

This may help you figure out some medicine equivalents for a dose.    For example,  Hydrocodone is worth 1,   Tramadol is worth 0.1.   So it would take 10 mg Tramadol doses to equal 1 mg Hydrocodone.

 

 

This may help you figure out some medicine equivalents for a dose.    For example,  Hydrocodone is worth 1mg ,   Tramadol is worth 0.1mg.   So it would take 10mg  of Tramadol to equal 1mg Hydrocodone.

 

 

Thanks that is interesting, would you happen to know of a ER extend realease version?  As we know it's only been in the last several years that big pharma have started to look seriously at ER and anti abuse methods of administration

[samuttodd]

i PICKED UP SOME TRAMADOL E.R. 200 MG tabs at the big pharmacy next to MBK.  They were 250 a 10 pack.    You can use the e.r. tabs and cut them in quarters and they will absorb like a standard release once they have been cut.

 

It was 250 bhat for 10 200 mg E.R tabs.

 

 

Get some hydroxyzine 25 mg tabs and take 50 mg with the pain meds,   It will help you sleep and give you better pain relief,   Especially with an opiate.    The hydroxyzine is an old fashioned antihistamine,   mild tranquilizer.    It is not addictive,  and shouldn't develop a tolerance to it.

 

  I am not certain if the Tramadol is potentiated as well with the Hydoxyzine,  but certainly it will make you very sleepy. 

 

Good luck with your pain.

Edited January 6, 2020 by samuttodd

[samuttodd]

I think the Targin will work better than tramadol (especially if you take the Hydroxyzine with it.)