Conflicting information on availability of pain medication

[buddhaland]

Before moving to Ao Nang this past Novmember, I knew that medical treatment and procedures were generally very inexpensive. And just about everywhere I have gone in the world (every continent including Antarctica) both prescription and OTC pain medicines were no particular problem. Here it has been a very expensive and confusing nightmare.

I got here with a month's supply from my pain doc at home - 90 15mg morphine sulphate; 90 Norco (like Vicodin but with much less harmful Tylenol) and Tramadol ER.

The Dr. here told me that Tramadol is over the counter - it is prescription in the U.S. And he said local doctors like him can't prescribe the morphine or vicodin-like drugs - and that I would have to go to the Phuket International Hospital to be seen by a doctor there to get those other prescriptions, as well as one for my ulcerative colitis which no one here has ever heard of.

So I made an expensive trip to Phuiket Town armed with reams of records from my U.S. doctors, including records from my pain doc who had been treating me for years for several excruciating pain conditions including cervical radiculopathy, bulging discs, a cracked vertebra, and degenerative disc disorder, as well as really bad arthritis in my thumb joints that render use of my right hand nearly impossible sometimes.

The doctor in Phuket was just the kind of specialist I needed, and after viewing my extensive records from the States and a new xray, he did prescribe the morphine sulphate - but only 60 for the month instead of my accustomed 90, no Norco, vicodin or anything like it (extremely useful for frequent breakthrough pain), and 60 paracetamol with codeine at a lesser strength and twice the price of the ones that many pharmacies sell quasi-legally. Cost for the doctor visit, including x-ray - around 3000 Baht. Cost for the prescriptions - about 18000 Baht! I almost fainted!

The next time I went, I cancelled the colitis medication (so far, so good, thankfully), and he again prescribed the morphine and paracetamol with codeine - and suggested I try 10 Lyrica (pregabalin), a controlled substance in the states,, but over the counter here (?!). This time the prescriptions were about 10000 Baht, through the hospital pharmacy.

The Lyrica actually did seem to help - so I emailed the doctor and asked him if there was some way he could somehow get the prescriptions monthly to me (say, by faxing them to the doctor here in Ao Nang or to an orthopedist in a hospital in Krabi) and save me the added expense of the trips to the hospital (though my xray and a new MRI indicated I will soon need a new operation on my spine.). He told me that the Lyrica is over the counter here, and that I should have no problem getting the opiates at a hospital in Krabi, which directly contradicts what the local Dr. here in Ao Nang told me.

So - I now know I can get Xanax, Tramadol, Lyrica and other american prescription medicines over the counter here (though with the exception of the tramadol, I can't really afford them in helpful amounts. Even the Paracetamol with Codeine, which is really cheap and over the counter in Canada and many European and other countries, is tricky to find here, and for what it is, crazy expensive. (12 bucks for a bottle of 125 in Canada, vs. about a dollar a pill here!)

I am here on a one year B visa, (ESL teacher) - but can't live with the pain without affordable and available medications that work on my pain.

Does anyone know, before I commit to trying a hospital in Krabi, if the doctor here (can't do) and the Orthopedist in Phuket (can get here at hospital with no problem) is right? I still may not be able to afford the appropriate medications - but at least if I can get them here without the expenses of going to Phuket, that would help a lot - I could at least keep some of the opiates around for the really excruciating days.

And does anyone know why here only some doctors can prescribe and some can't? Or was the doctor here just blowing smoke? I thought in terms of being able to prescribe, a doctor is a doctor, In the states, even Physician Assistants and Certified Nurse Practitioners can prescribe anything....

If you have any information that will help me with this issue, I will be really grateful!

[thepool]

Narcotic medication can only be prescribed by a hospital doctor and dispensed via a hospital pharmacy.

Xanax (a benzodiazepine) is not legally available except via a doctors prescription and from a hospital pharmacy. Illegal purchase/possession can result in severe legal consequences.

What you have been told is correct but many hospital doctors are extremely wary of prescribing restricted/controlled medication for outpatient use.

I believe serious difficulty will be experienced in obtaining restricted/controlled medication in Krabi.

Edit

Spelling error

Edited March 3, 2014 by thepool

[Sheryl]

As above. Opiates cannot be legally obtained in Thailand except at a hospital pharmacy, and cannot be mailed to you. Laws regarding these drugs are much more restrictive in Thailand than in the West. And Thai doctors tend to be very hesitant to prescribe opiates, so you might indeed have a problem at a local hospital especially if the doctor is not of the appriopriate specialty to be able to assess the need in your case.

Neither Vicodin nor Norco available in Thailand.

Lyrica is indeed OTC. Tramadol was, there have been unconfirmed reports that it is now more restrictive though the reports are inconsistent and it is still listed as OTC (but limited to pharmacies that meet certain criteria).

Xanax and all other benzos are also controlled substances, and legally available only from hospital pharmacies, so likewise more restrictive than in the West. Foreigners have been arrested in Thailand for buying OTC, it is illegal for both buyer and seller.

So I am afraid you are stuck having to go back and forth to the hospital for your meds other than the Lyrica and tramadol. That said, what you are paying sounds excessive and I suspect that it is because the doctor is prescribing imported name brands. next time specifically request a locally made generic. There are cheap local brands of Alprazolam (xanax), paracetemol (tylenol) + codeine and morphine. Hopefully the hospital in Phuket will carry them.

[buddhaland]

Hi - thanks for taking the time to wade through my way too long message.

Two important things, though - my most important question regarding conflicting information I have received was not addressed:

The private doctor I originally saw in Ao Nang told me that only at that specific Phuket International Hospital (or I think he also mentioned Bankok Phuket Hospital) could I get my prescriptions filled. He was very clear that I would be wasting my time to see a doctor at any hospital in Krabi. HOWEVER, the orthopedist I have seen in Phuket and who will ultimately do my next cervical surgery to try to relieve the pain, emailed me and said, and I quote, "you can get your pain medications prescribed in hospitals there in Krabi." Who is right? I think I just read that there is a new hospital in Krabi that is more of the quality of Phuket International Hospital. Maybe that is what he was referring to. But here's the thing: I have over ten years of printed medical records from both my General Practitioner and my two Pain Specialist M.D.s in Seattle, including both hard copies and discs of all of the MRI's I have had over the years. They are very detailed about the many operations (two laminectomy/discectomies so far, literally dozens of facet injections, nerve blocks, Radio Frequency neuroablations, etc. And finally, a very complete long-term record of which medications I have taken over many years, with no dependency problems. Why would these extensive records not work to convince ANY doctor (unless, of course, he doesn't read English) that I a) suffer extremely, b)have an extensive history of injuries and operations and procedures for those injuries which have not put a dent in the problem. Those medications are manufactured and are available (even in Thailand) for a reason. What the heck do Thais who are seriously in pain deal with it? Meditation and yoga have actually helped me a little bit over the years, and I am still a practitioner. But I hate to think that my inability to obtain the things I need to function will force me to abandon what otherwise has been a wonderful adventure. Are there any nearby countries where I could take my chances on obtaining these medications in a more straigtforward and humane way?

BTW - Lyrica is a prescription med in the states because it has a potential for abuse that compares to opiates - but I can walk into ANY pharmacy here and buy it - just can't afford it often enough to really help.......One of the primary reasons I moved here in retirement was for the inexpensive but reportedly good health care. Too bad I didn't research medications as well as I did other aspects of health care here.

Thanks again for your help.

Edited March 3, 2014 by Sheryl
discussion of illegal activity removed by moderator

[thepool]

Sorry the advise received is accurate.

The local hospital doctor can prescribe narcotics, the issue revolves around whether the doctor is willing to do so. Perhaps the private doctor consulted knew what the local situation is and gave good advice.

The nearest country in which pain management practice is likely to reach Western standards is Singapore.

Lyrica is expensive as it is an imported medication for which I believe there are no generic equivalents. (Lyrica has a lower risk of abuse than the "benzo's" !)

I really urge that you do not enter the world of illegally purchasing restricted/controlled medication. The police have been known to operate sting operations in order to apprehend people. Do not end up facing criminal drug charges in Thailand!

Had you made inquiry here prior to coming the Thailand you would have been told about the problems associated with obtaining narcotics.

[bobo42]

Educated guess, but I think you will be probably be able to get some controlled pain meds at most private hospitals. Though, as you can probably tell, there is no guarentee that you will get exactly what you want, or that a particular doctor will be cooperative. I haven't had a reason to procure any of the controlled medications for pain, but my wife has been given both valium and xanax before (which are also controlled here) - and she has received those with ease at a very small private hospital in the small town where we live.

I know you said you're tight on funds, but it shouldn't cost you more than a few hundred baht for a consultatio - it might be well worth the money to try it. Just keep your visit to a consultation, don't let them add-on any tests or other medications until you've found out whether they are even able to give you the types of medications you need, and you should be able to come out pretty cheaply. I would bet that other smaller hospitals might be cheaper for the meds too, but they will probably still be quite expensive as compared to home.

[Sheryl]

Hi - thanks for taking the time to wade through my way too long message.

Two important things, though - my most important question regarding conflicting information I have received was not addressed:

The private doctor I originally saw in Ao Nang told me that only at that specific Phuket International Hospital (or I think he also mentioned Bankok Phuket Hospital) could I get my prescriptions filled. He was very clear that I would be wasting my time to see a doctor at any hospital in Krabi. HOWEVER, the orthopedist I have seen in Phuket and who will ultimately do my next cervical surgery to try to relieve the pain, emailed me and said, and I quote, "you can get your pain medications prescribed in hospitals there in Krabi." Who is right? I think I just read that there is a new hospital in Krabi that is more of the quality of Phuket International Hospital. Maybe that is what he was referring to. But here's the thing: I have over ten years of printed medical records from both my General Practitioner and my two Pain Specialist M.D.s in Seattle, including both hard copies and discs of all of the MRI's I have had over the years. They are very detailed about the many operations (two laminectomy/discectomies so far, literally dozens of facet injections, nerve blocks, Radio Frequency neuroablations, etc. And finally, a very complete long-term record of which medications I have taken over many years, with no dependency problems. Why would these extensive records not work to convince ANY doctor (unless, of course, he doesn't read English) that I a) suffer extremely, b)have an extensive history of injuries and operations and procedures for those injuries which have not put a dent in the problem. Those medications are manufactured and are available (even in Thailand) for a reason. What the heck do Thais who are seriously in pain deal with it? Meditation and yoga have actually helped me a little bit over the years, and I am still a practitioner. But I hate to think that my inability to obtain the things I need to function will force me to abandon what otherwise has been a wonderful adventure. Are there any nearby countries where I could take my chances on obtaining these medications in a more straigtforward and humane way?

BTW - Lyrica is a prescription med in the states because it has a potential for abuse that compares to opiates - but I can walk into ANY pharmacy here and buy it - just can't afford it often enough to really help.......One of the primary reasons I moved here in retirement was for the inexpensive but reportedly good health care. Too bad I didn't research medications as well as I did other aspects of health care here.

Thanks again for your help.

You can get the meds at any hospital that is a provincial level facility or higher. A district hospital would not have morphine usually. But a doctor at the hospital wpuld have to prescribe and this might prove dsifficult especially in the absence of an orthopedic specialist. But nothing ot lose by trying.

Nearby countries: codeine is OTC in Cambodia,and readily avail;able in 30mg/500 para formulation but morphine not and hard to come by. Basically the situation for pain meds is difficutl b to buy meds, be sure to have prescriptions on you in case there is an issue with customs coming in. throughout SE Asia. Lyrica is alos a little less epxensive in Camb than in Thailand. If you do go to Camb to buy meds, be sure to have prescriptions on you in case of issues with customs on the way back in, especially re the codeine.

I would not characterize health care here as inexpensive. Outpatient care is generally affordable but not inpatient. If you don't have insurance, a major illness/accident can easily run to many millions of baht.

Again, it is illegal -- seriously illegal -- to obtain benzos without a prescription and penalties can be serious.

[fifthcolumn]

Not entirely certain this is not a troll post (33 posts).

But a lifetime in Asia dictates me to inform you that if your needs cannot and will not be met anywhere in Asia on a casual basis. Cambodia and Thailand will be the best hope for you to obtain your narcotics.

I find it odd you have such a list of such strong narcotics. More odd, that you have some neccesity to move her with such needs.

Honestly, I think you are a head case or a troll. I am no doctor but I seriously doubt a doctor is going to perscribe Xanax with narcotics.

It is so difficult to obtain narcotics and sleep aids in Thailand, hospitals often perscribe Xanax for sleep and low level pain. Xanax is clearly not a pain reliver.

Expect the rest of your life tied to a city and hospital that not only has these meds but will administer them. Expect that you will go back thrubany and all tests and exams each time, each hospital regardless of paperwork or prof. advice from abroad.

If I needed these medicines there is no way I would live in Asia. Also, if you forget or run out of mefs while traveling there is no way you will be able to obtain them.

Sounds like a prison sentence. You sound like you need proper medical help, stay home. Please.

Xanax + Tramadol - yeah, right...

And you were hoping to get what out of living here?

Edited March 4, 2014 by fifthcolumn

[Sheryl]

Above post is unnecessarily harsh. And not too well informed.

Benzos such as xanax are often used in orthopedic conditions for their muscle relaxant properties.