ONCB is pushing for stricter controls on over-the-counter sales of Tramadol

[webfact]

ONCB mulls strict controls on addictive analgesic
PIYANUT TUMNUKASETCHAI
THE NATION

BANGKOK: -- The office of Narcotics Control Board (ONCB) is pushing for stricter controls on over-the-counter sales of Tramadol, a prescription drug that was blamed for the recent death of a teenager.

"The Public Health Ministry and the Food and Drug Administration must strictly control the sale of analgesics that contain addictive substances," ONCB senior adviser Narong Rattananugul said yesterday.

He was speaking in response to reports about the teenager who died after consuming Tramadol mixed with a carbonated drink to get high.

"In fact, Tramadol cannot be sold without a doctor's prescription, but some pharmacies apparently defy this regulation," Narong said.

Lethal mixture

He explained that the medication could induce effects similar to morphine, but weaker, though when it is mixed with caffeinated soft drinks, the effect becomes stronger.

Dr Anek Yomchinda, chief of the Central Institute of Forensic Science, warned that Tramadol overdose could cause deaths.

"So far, some 17 to 20 Tramadol-related deaths have been reported," Anek said.

While relevant authorities have become more cautious about the sale of Tramadol, they are pursuing the idea of removing kratom (Mitragyna speciosa) from the list of narcotics.

Anek said it had been agreed that the ONCB would be the main agency to study the idea and that it would be discussed with relevant agencies next week.

"We are not saying that kratom is useful in all aspects, but it would be useful if we know how to use it correctly. Foreign countries often use less harmful narcotics to |fight more dangerous drugs," he said.

Meanwhile, Army chief General Prayuth Chan-ocha urged relevant authorities to exercise proper control over the use of kratom if it were to be legalised. He said that kratom leaves could be precursor materials for some harmful narcotic mixtures.


-- The Nation 2013-08-30

[jaltsc]

"So far, some 17 to 20 Tramadol-related deaths have been reported," Anek said.

And...How many alcohol related deaths are there each year? Just as long as they don't restrict his drug of choice.

[seajae]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

[marcusd]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

[sms747]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

[GeorgeO]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

I tend to agree, but that is because I am a responsible person who seeks medication for a very painful and degenerative osteo-articular condition, and it is very annoying for me to have to go and see an orthopaedic specialist who will tell me something I already know, charge me THB 1,000 for the privilege, and provide me with the necessary medication at about four to five times the market rate...!

It is, however, clear that there are many people out there who have little concern for their own personal health, to the extent that they deliberately mix dangerous drugs with caffeinated drinks for the very purpose of getting "high". If such drugs are readily available over the counter, then this does shift some of the blame on to pharmacists, regardless of their good intentions.

All in all, I would prefer to see necessary painkilling drugs available over the counter, provided an individual could show that he/she has had medical treatment for the same complaint in the recent past. A youngster coming in to purchase drugs associated with elderly complaints, such as degenerative osteo-articular disease, should be immediately turned away by any discerning pharmacist.

[Bottlerocket]

If it's not tramadol it'll be a sock covered in glue in a bag. People just like to get high and sometimes they die. Just like people die from alcohol. Even people who don't drink alcohol get run over by drunk drivers. They talk about legalizing kratom but wouldn't dare mention legalizing the better plant, cannabis.

[onni4me]

As a non-regular Tramadol user I like to say something about this. Yes, it is similar group of alkaloids as heroin or morphine but so are also nicotine and caffeine. It is a strong pain killer which I use for my back. I broke my back in a car accident a decade ago and the agonizing pain sometimes reminds me that I was very lucky.

One thing is sure. It is NOT making anyone hooked unlike morphine for instance. That anyone can actually read from the packaging and on Wikipedia.

I think eating paracetamol instead would not be any help for my decade long problem. And I don't want to see any more doctors. I've seen them in hoards last decade. Those who want control everything, I just say that adult people can choose themselves whether they need a prescription or not. This case was about a user that obviously was not taking it for hurt.

[indyuk]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

I would like to point out that Tramadol is not a Narcotic it's a synthetic pain medicine and a very useful script for dental pain because of its incidental calming effect.

Tramadol is very useful in the treatment of 'Non-Specific Systemic Pain' (NSSP)

It is not possible to 'get a high' from Tramadol.

Tramadol is a boon to people that need a suitable remedy for 'Restless Leg Syndrome' (RLS)which gives many people insomnia.

Tramadol is especially useful for those confined to their bed for a week or more. No other medicine is so effective for RLS.

The patent for Tramadol has long since expired, it is relatively cheap and is available and widely used worldwide with few reports of abuse or addiction. Tramadol is however mildly addictive if it is abused.

[seajae]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

I would like to point out that Tramadol is not a Narcotic it's a synthetic pain medicine and a very useful script for dental pain because of its incidental calming effect.

Tramadol is very useful in the treatment of 'Non-Specific Systemic Pain' (NSSP)

It is not possible to 'get a high' from Tramadol.

Tramadol is a boon to people that need a suitable remedy for 'Restless Leg Syndrome' (RLS)which gives many people insomnia.

Tramadol is especially useful for those confined to their bed for a week or more. No other medicine is so effective for RLS.

The patent for Tramadol has long since expired, it is relatively cheap and is available and widely used worldwide with few reports of abuse or addiction. Tramadol is however mildly addictive if it is abused.

I suffer from severe lower back pain and constant sciatica after a work accident, tramadol(slow release) was the only pain relief that had no side effects on me, I took it along with medication(zoloft) to control mood swings caused by the pain as it only took the edge off it. Doctors(several over the years) explained it to me as a synthetic derivative of morphine and that morphine would be the next medication if it didnt work on me. It is very addictive once you are taking bigger amounts, it took me 18 months to be weaned off it and I had to use "special cookies" to help at the latter stages to actually stop it all together. One doctor actually tried to get me to go cold turkey but I ended up in hospital in a pretty bad way and they were horrified at what the doctor had done so your claim that it is not addictive is a very bad one, unless you have been on it at the rates I was on you have no idea.

[Billion]

I use a combination of tramadol and paracetamol. Tramadol is a weak painkiller similar to tylenol with codeine and on my blister pack says. ”non-narcotic analgesic"

If they want to restrict tramadol then I think they have to restrict paracetamol too. Abuse of paractamol can cause liver damages. Tramadol may provoke withdrawal syndrome similar to alcohol or benzodiazepine withdrawal when quitting the drug. Therefore it’s necessary not to overdose tramadol.

I take tramadol 3 times a day as pain reliever, 50 mg each time. However some restrictions have to be done for under aged people about tramadol and perhaps paracetamol also. This is my opinion!

To seajae, a friend of mine had lower back pain with sciatica and he was treated with Neurontin because of the small amount of side effects.

[Halion]

Oh shit the horse has bolted. Lets pretend to close the stable door.

[seajae]

I use a combination of tramadol and paracetamol. Tramadol is a weak painkiller similar to tylenol with codeine and on my blister pack says. ”non-narcotic analgesic"

If they want to restrict tramadol then I think they have to restrict paracetamol too. Abuse of paractamol can cause liver damages. Tramadol may provoke withdrawal syndrome similar to alcohol or benzodiazepine withdrawal when quitting the drug. Therefore it’s necessary not to overdose tramadol.

I take tramadol 3 times a day as pain reliever, 50 mg each time. However some restrictions have to be done for under aged people about tramadol and perhaps paracetamol also. This is my opinion!

To seajae, a friend of mine had lower back pain with sciatica and he was treated with Neurontin because of the small amount of side effects.

Doctors tried me on all possible combinations for the first 2 years after the injury but this was the only ones that had no ill effects on me, strangely enough the combination of the 2 is supposed to be bad for you but they worked well on me, go figure. Now I take nothing and put up with the constant pain but when it does get unbearable I take a mobic(anti inflamatory) before going to bed, doesnt do a real lot but its not addictive. Keeping my eye out on the de listing of kratom, have heard that tea made with it is great for pain relief and not addictive in small amounts.

Edited August 30, 2013 by seajae

[annabel]

"So far, some 17 to 20 Tramadol-related deaths have been reported," Anek said.

And...How many alcohol related deaths are there each year? Just as long as they don't restrict his drug of choice.

these guys are sooooo Stupid ! Why not then just ban all medecine .. all pain killers / all muscle relaxants/ all anti inflammation medications just to mention a few...!

If someone is determined to hurt themselves they will find a substance to do so .... Eshh !

[annabel]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

And also not get totally ripped off by these ludicrous hospitals like CMR who was charging me 84 Baht for 1 bloody pill and found I could buy it outside for 52 Baht !!! only 32 Baht difference .. ! WTH!!!

[annabel]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

I tend to agree, but that is because I am a responsible person who seeks medication for a very painful and degenerative osteo-articular condition, and it is very annoying for me to have to go and see an orthopaedic specialist who will tell me something I already know, charge me THB 1,000 for the privilege, and provide me with the necessary medication at about four to five times the market rate...!

It is, however, clear that there are many people out there who have little concern for their own personal health, to the extent that they deliberately mix dangerous drugs with caffeinated drinks for the very purpose of getting "high". If such drugs are readily available over the counter, then this does shift some of the blame on to pharmacists, regardless of their good intentions.

All in all, I would prefer to see necessary painkilling drugs available over the counter, provided an individual could show that he/she has had medical treatment for the same complaint in the recent past. A youngster coming in to purchase drugs associated with elderly complaints, such as degenerative osteo-articular disease, should be immediately turned away by any discerning pharmacist.

Anybody who seriously want to get proper medication can find out about all of this on the Net ... there is a wealth of information out there to guide you and if you really care for yourself you will research it and then decide... However I do agree that in certain cases mainly ddepression, anxiety and so forth it would be better to consult a professional as these meds are on a different level altogether .....

[annabel]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

I would like to point out that Tramadol is not a Narcotic it's a synthetic pain medicine and a very useful script for dental pain because of its incidental calming effect.

Tramadol is very useful in the treatment of 'Non-Specific Systemic Pain' (NSSP)

It is not possible to 'get a high' from Tramadol.

Tramadol is a boon to people that need a suitable remedy for 'Restless Leg Syndrome' (RLS)which gives many people insomnia.

Tramadol is especially useful for those confined to their bed for a week or more. No other medicine is so effective for RLS.

The patent for Tramadol has long since expired, it is relatively cheap and is available and widely used worldwide with few reports of abuse or addiction. Tramadol is however mildly addictive if it is abused.

It is even recommended in the USA / Canada for pain relief in dogs with severe arthritis / joint problems and it works beatifully //// I give it to my dogs and it has helped them sooo much !

[lee b]

anything can be bought over the counter here

[Bagwan]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

This might be the case if you know what you are doing but begs the question how many know what they are about? I would not contest that many Thai doctors are a danger to their patients but whatever makes you think that pharmacists are more professional and knowledgeable than they, and as knowledgeable as they should be? Do you really trust a pharmacist who would break the law just to make a few extra shekels? Whose interests do you think they put first?

It is said that a lawyer who represents himself in Court is a fool. Anybody who prescribes for himself is a bigger one IMO.

[bangon04]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

Don't Thai doctors always add a big bag of antibiotics to every prescription, regardless of if it is relevant?

[banglassie]

I've been on Kratom for about 11 years (For the most not within the borders of Thailand). Sometimes for a few weeks, some times for a year. And I never experienced any problems to quit using it. Apart from weak head aches and restless legs. Kratom works well for RLS as well, and is less addictive than Tramadol by far.. To those who try to say tramadol is not addictive it's simply wrong, you can be on a 100-300 mg a day and get away with it quite easy if you don't have a history of opiate/opioid abuse. The biggest problem in these amounts is the SNRI effects, which can be really annoying. But people who abuse tramadol use to take it in 500-1000 mg/day. And at those doses it can be very addicted as well as a bigger heath hazard than morphine (specially because of the SNRI effects that makes you prone to epileptic-like seizures. So to legalize Kratom seems Very reasonable to me, specially since the reason for banning it in the first place because it helped people stop using opium...

And as for OTC or not I think we have proved more than enough what happens when things get banned. People start to sell it on the black market or people search for alternatives, which in this case might be yaba or smack... Not really a good substitute...

But then again benzos have been scheduled for quite some time in Thailand now, and you can still find them OTC, specially in the south on the islands...

Today it's Tramadol, next comes Lyrica and Gabapentin.. just wait and see..

Edited August 31, 2013 by banglassie

[TheWizardofRnR]

I have been on Tramadol for over 5 years , you call yourself a Medical Professional???

You can't spell tooth right , but Paracetamol doesn't work for everyone , neither does Codeine.Neither take care of my Peripheral Neuropathy or my recent Shingles attack . I was a Medic one time myself but your opinion claiming medical know how is a joke!!! My arthritis and Neuropathy occurs daily , but I usually don't take the Tramadol until I feel the pain. It's my way of knowing that I take the Tramadol for the right reason ! If they take this away from consumers , the Abusers will only find another possibly more dangerous and Addictive way , of getting their kicks.

I recently posted a response to another medical product that Thailand should possibly make accessible for medical users !

http://www.thaivisa.com/forum/topic/663912-60kgs-of-marijuana-seized-by-pattaya-police/

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

[ToddWeston]

As a licenced Pharmacist - this should be Doctor or Pharm D only - it's habit forming and without proper consultation can create real havoc for some patients.

Perhaps this should be moved over to the health forum ? for specific answers as to the ramifications of self prescribing.

[kandi]

As somebody with a chronic back pain I'm not too happy to see that since this news regulation has become effective, 90% of the pharmacies all around Bangkok have stopped selling tramadol. The rest "only" gives out a maximum of 20 pills (1000mg) which is certainly enough for most, but I'm on 300-400mg daily and like to buy in advance so I don't need to go to the pharmacy every day.

So, what can I do?

[robblok]

As a licenced Pharmacist - this should be Doctor or Pharm D only - it's habit forming and without proper consultation can create real havoc for some patients.

Perhaps this should be moved over to the health forum ? for specific answers as to the ramifications of self prescribing.

Though I normally agree with you all this regulation bothers the people who are responsible. I get tired of all those things that curb the rights of responsible people because some people cant handle it.

[elektrified]

I was on 400 mg of tramadol a day for 20 years, drank alcohol with it etc and never had any severe effects apart from the fact its addictive. Took me a while but I am now off it, for pain it does its job.

As a Medical Professional I have always been amazed how easy it is to obtain drugs in Thailand across the counter from ex rice farmers who have no idea of the interactions...long term effects or side effects.

My friend was given this as a first line for a toith pain... when paracetamol would have done the job.

I agree. Doctor only drug... this can be dangerous used with other medications without correct knowledge

I doubt that a Thai Pharmacist was an "ex-rice farmer". 5 years of university for a B. Pharm degree or 6 years for a Pharm D. degree. Get real. Not a very well thought out remark from a "Medical Professional".

[tiger2]

Sorry electrified but you're the one who needs to get real--"5 years of university for a B. Pharm degree or 6 years for a Pharm D. degree"...<deleted>??? Most of the clowns behind the counter can't even spell the names of the drugs they are dispensing...

What alternate universe are you living in?

[elektrified]

Sorry electrified but you're the one who needs to get real--"5 years of university for a B. Pharm degree or 6 years for a Pharm D. degree"...<deleted>??? Most of the clowns behind the counter can't even spell the names of the drugs they are dispensing...

Not where I go. In fact, 2 pharmacists I know in Chiang Mai are also M.D.'s.

[uptheos]

one of the best aspects about Thailand is being able to buy what you want over the counter without the need for a clinic trip. Most pharmacists here are just as good, if not better than doctors anyway.

The way doctors dish out antibiotics, I would think they have very little knowledge on drugs and don't understand the consequences of so much antibiotic use.

[ginjag]

Tramadol has some side effects, for a percentage of people it prevents arousal in males, It actually could be a form of contraception.