Palliative Care in Thailand (or the lack or)

[connda]

A good friend of mine in the US had a bad motorcycle accident. Pain killers are an important part of his care, because he has been in serous pain.

Here's a comment from him today:

Great day. Only one "break through pain pill" today. And that was after Physical Therapy.

Here's my comment:

In Thailand, a "break thru pain pill" is Ibuprofen. When I had Dengue Fever (nicknamed "break-bone fever" because of the pain), asked the doctor for codeine or another stronger pain killer and he flat refused. Here's a fact: in Thailand, government hospitals are allowed 400 grams of morphine per year and private hospitals are allowed 40 grams. Pain killers like codeine are discouraged or simply not prescribed. Groovy, huh? This isn't the place to get hurt or to die slowly. I'm over 60 and I start to think about this stuff now. Suffering to death without pain medication, that could be available, but isn't because of government mandate. Amazing Thailand!

I've read the treads of people who really need palliative care, but can't get it, or if you can, it's under dosed. What do you do, as a retired or aging foreigner? Go back to your country that has one of he most expensive health care schemes in the world -- not an option. Go somewhere where opioids are prescribed? Can't afford it -- not an option. Die in writhing agony -- that seems to be the answer here in Thailand.

No one should have to die in agony, but damn, I picked the wrong country to get married and retire in. If I'm ever diagnosed with a terminal and painful end, what's my options? .38 or 9mm? Helium? What other options are there? Die a brave death?

[sustento]

"I've read the treads of people who really need palliative care, but can't get it, or if you can, it's under dosed. What do you do, as a retired or aging foreigner? Go back to your country that has one of he most expensive health care schemes in the world"

Not everyone is from the country that has one of the most expensive healthcare systems in the world.....

[connda]

"I've read the treads of people who really need palliative care, but can't get it, or if you can, it's under dosed. What do you do, as a retired or aging foreigner? Go back to your country that has one of he most expensive health care schemes in the world"

Not everyone is from the country that has one of the most expensive healthcare systems in the world.....

I do understand that. Other foreigners have other options. Just not for me and others out there like me.

I envy those how have the option to return to a country with National Healthcare that addresses end-of-life care.

Edited November 26, 2013 by connda

[sustento]

Sorry - I didn't mean to be rude.

[Sceptict11]

"Here's a fact: in Thailand, government hospitals are allowed 400 grams of morphine per year and private hospitals are allowed 40 grams. Pain killers like codeine are discouraged or simply not prescribed"

Where, exactly, was this information obtained ?

[liddelljohn]

My neighbour from UK has cancer ,he brinsg his morphine ampules scrips from UK twice a year enough for 3 months stay , he has a special medical permit in his passport and letters from his doctors in UK and thai authorities have no problem with that . but not all countris follow international; medical guidelines for scrips such as UAE so one has to be aware .

[Sheryl]

Palliative care is without question the weakest aspect of medical care in Thailand; things are literally 50 years behind the times.

This fact has been recognized and there are some starting efforts to think about/address it but the momentum is rather weak.

Particularly lacking is appropriate pain management at home for those who prefer to die there (who wouldn't?) or have non-fatal diseases that cause chronic pain. In hospital it is better (at least for the terminally ill) , but it is very unfortunate for people to have to be hospitalized solely for pain management, and unnecessary in this day and age.

[connda]

Sorry - I didn't mean to be rude.

No problem. I didn't take the comment as rude.

[sms747]

Thanks for bringing this topic up I had no idea things were this bad. For some reason I felt pain relief would be more liberal here, probably due to the lax sales of things in pharmacies. Quite a worry for some of us in the future.

[Sheryl]

Indeed it is. I've got my fingers crossed they modernize this before my time comes, as like I suspect many of you, I would want to die in my own home, not in a hospital and not having to travel back to the farangland to go into a hospice. My home, here in Thailand.

[sms747]

Hope your time is a long way off-this forum would not be half as useful without you!

[PHP87]

I've asked this question before as I have Chronic Pain due to multiple impairments/injuries.

My Pain Management doc here in the US prescribed me Methadone, and I get a 30 day supply from the Pharmacy for about $30 USD.

Methadone is apparently available in Thailand as I have seen pics of a Methadone Clinic in Chiang Mai.

I've tried to find out information about cost, but I have heard the private clinics are more expensive than government clinics and daily visits are not required.

I've heard about $200 USD per month and 2-3 visits to the clinic per month.

I've also asked people on this forum for help with finding more info, but no luck.

I will hopefully be retiring to Chiang Mai soon, but I need to get my medication issue sorted out as well as a few other matters.

I will likely live in Chiang Mai for several months to get a real world idea of what my monthly spending will average, then perhaps head further south to Koh Samui if it's in my budget while having enough to save and for emergencies.

If anyone can contribute any useful info, please feel free to post.

There is a huge stigma attached to the use of Methadone, but not everyone taking it is a heroin addict as it is an inexpensive, effective pain med and does not require higher doses to achieve the same level of pain relief as other opiate pain meds do.

For us older people with numerous chronic pain issues, it is heaven sent. It does not get you "high" but it does improve quality of life for those with chronic pain issues.

Thanks.

[PHP87]

"Here's a fact: in Thailand, government hospitals are allowed 400 grams of morphine per year and private hospitals are allowed 40 grams. Pain killers like codeine are discouraged or simply not prescribed"

Where, exactly, was this information obtained ?

http://www.medsch.wisc.edu/painpolicy/publicat/monograp/asia.htm

[Sceptict11]

"Here's a fact: in Thailand, government hospitals are allowed 400 grams of morphine per year and private hospitals are allowed 40 grams. Pain killers like codeine are discouraged or simply not prescribed"

Where, exactly, was this information obtained ?

http://www.medsch.wisc.edu/painpolicy/publicat/monograp/asia.htm

An "old" reference hopefully things have got better. It still does not address your issue.

You will have noted from that reference that access to narcotic medication is very restricted across the whole of Asisa

[PHP87]

Old reference, does not address your issue, then the next paragraph you state the reference says narcotic meds are restricted across Asia.

Is the reference old, or is it valid?

And Thailand has different restrictions on meds than other countries in SE Asia.

Again, you're not helping. You're just littering threads with negativity and without any useful info.

IDK if you live in Thailand or in SE Asia, but I hope you never have to deal with severe chronic pain because it would change your snarky attitude in a hurry.

[Sceptict11]

There is no point in becoming aggressive.

I am not "snarky" yes the ref. is old and you will note that I also expressed the hope that that the situation is improving.

Thailand and Asia is years behind the West in terms of treating chronic/terminal pain . FACT.

I hold out no great hope for you receiving , here, the reassurance you seek.

This is the last response I intend to make on this thread.

[PHP87]

I really don't care. I'm going to utilize the "ignore" feature as your posts are snarky, negative and you post words in quotations that make offensive insinuations.

You remind me of some of the doctors I used to have that would prescribe Motrin 800 for Sciatica, or a few Codeine #3 if they were feeling generous that day.

Like I said, why don't you just come out and say what you mean?

Sorry you can't see how your replies come across to people asking a simple question.

But don't bother replying as I won't see it.

[Sheryl]

OK, cut out the flamefest. PHP87, please see my reply in the other thread. Methadone is no longer available in Thailand.

Unfortunately the situation re pain relief in Thailand has not changed or improved in recent years.