pain killer problem

[liddelljohn]

I have a long term health issue and require pain relief , for last 28 years my UK doctors have prescribed me either codiene or dihydeocodeine ,, as they dont clash with my other health issues

i CANNOT take many normal OTC NSAIDs or other drugs such as paracetomol due to severe reactions ,, I am not addicted to opiates a months supply usually lasts me 3 months or more

a few days ago i had a bad fall and now am in terrible pain ,, Pattaya Bangkok want to give me drugs which i am allergic to and will not prescribe the ones that i am safe to take ,, my supply from Uk is running low and i am likely to run out of medication within 14 days ...

any idea where i can get the meds that i require ??

[Sheryl]

This is a common problem here, Thai doctors are VERY reluctant it prescribe opiates for outpatient use. Even in-hospital, they are under-used. This is true even for cancer patients. Adding to the problem are stereotypes of farangs as drug-seekers. As you have apparently encountered, the preferred approach here for pain relief is NSAIDS.

An additional problem is that the range of opiates available in the country is much more limited than in the West. Vicodin and the like are not available, nor is dihydrocodeine. AFAIK codeine is available in analgesic-strength only in combination with combined with paracetemol, obviously a problem if you are allergic to paracetemol.

Can you tolerate tramadol? As this is often used here and is available, in fact available without prescription in larger pharmacies.

Otherwise, your best recourse is to (1) get documentation of your condition and long term meds from your doctor back home and then (2) see a pain specialist. If you really can't tolerate codeine + paracetemol and tramadol is insufficient then about the only thing available here they can give you would be morphine. It will definitely take considerable documentation to get that for prolonged outpatient use.

Even in best case you will be given limited amounts and forced to come back at least monthly for refill. In the government hospital pain clinics, patients not only have to come very often (I think weekly) but also pee in cups to prove they are taking the meds, I guess as opposed to selling them.

[liddelljohn]

i have shown them my medical certificates even have a letter of authority for transiting with opiates as well as all my other meds .. they dont seem to understand the situation ,,,,and keep trying to give me NSAIDS

i dont know anything about tramadol i will do some research

thanks

[liddelljohn]

I just did a web search on tramadol and its totally contra indicative and can cause seizures with one of the other medications i take every day so it seems too risky to use ,,,

i will try another medical centre , and see what they can offer , if all fails I may have to return to UK early ...

[Langsuan Man]

Well not to point fingers but your problem along with many others here is a result of the misguided war on drugs and you are just another casualty

But it is also a problem in the US, since the DEA has mandated that no refills are allowed for Schedule 1 drugs and patients must go to the doctor every month to get a new RX, which is causing a massive problem for older Americans on Medicare who can ill afford a monthly doctors visit

What really frosts me is that this is a Drug Enforcement Agency rule and when did they become practicing physicians ?

Get the government out of my bedroom and medicine cabinet (end of rant )

[Sheryl]

I'm not sure what "rule" you refer to. There is no law or rule preventing Thai doctors from prescribing narcotics, including narcotics for outpatient use. Dispensing them is limited to hospital pharmacies, which is an inconvenience and ups the cost, but beyond that the problem is not with laws or rules but physician behavior. Records have to be kept and submitted to the Thai FDA Narcotic division, but similiar surveillance of prescribing patterns is done in the US and does not seem to inhibit doctors from prescribing when indicated. For some reason -- and I think this is cultural - the fact that records are made renders most Thai physicians petrified that they will somehow 'get in trouble" though I have never heard of that actually happening to anyone and have no reason to think there would be a problem for non-fraudulent prescribing. These sorts of rules are meant to weed out doctors operating "drug mills", not to police bona fide medical practice.

In this instance the problem seems to include a failure to take seriously his drug allergies - which is also a common problem among Thai physicians along with their reluctance to prescribe outpatient narcotics.

OP - your problem has nothing to do with hospital but rather with specific doctor. As mentioned, you will do best to see a pain specialist, preferrably one trained in the West. This may require a trip to Bangkok. Though as mentioned, your paracetemol allergy creates a problem in terms of what drugs exist in country since all the analgesic-strength codeine here is combined with para.

I don't know what your trip to Thailand is for, but if it is just tourism you might consider spending some of the remaining time in Cambodia instead, as codeine is over the counter there. (And it's worth visiting!).

[Langsuan Man]

Well not to point fingers but your problem along with many others here is a result of the misguided war on drugs and you are just another casualty

But it is also a problem in the US, since the DEA has mandated that no refills are allowed for Schedule 1 drugs and patients must go to the doctor every month to get a new RX, which is causing a massive problem for older Americans on Medicare who can ill afford a monthly doctors visit

What really frosts me is that this is a Drug Enforcement Agency rule and when did they become practicing physicians ?

Get the government out of my bedroom and medicine cabinet (end of rant )

[cooked]

I met a guy in Vientiane that was there to buy codeine. Sad state of affairs.

[inbangkok]

A few things I can confirm from personal experience.

Some of the international hospitals in BKK do have codeine pills that do not contain paracetamol and are pure codeine phosphate, but they are 60mg strength. You can also get 10mg codeine pills that are blended with glyceryl gualocolate or something similar. These are prescribed to suppress serious coughing. Some Dr.'s will prescribe these for pain as well if you require a low dose, or in some instances this is the only form of codeine the hospital pharmacy may stock so you will be directed to take several for pain relief.

The only other options for outpatient, instant release opiate/opiod painkillers in Thailand are Tramadol and Morphine syrup. Tramadol can still be found at many pharmacies, while Morphine is only in hospital pharmacies. And instant relief Morphine is only available in a cough syrup style solution you have to measure with a spoon or cup.

I have never had any problems with obtaining whatever I need but I also have a very good relationship with my Dr.s as well as medical records and prescriptions from back home verifying my need for these types of meds.

The bottom line is that I agree with Sheryl that you will probably need to make a trip to BKK and see a pain specialist at one of the top hospitals and explain your situation. There is a good chance they are going to want to see your records from your home country confirming you are indeed allergic to NSAIDS and paracetamol.

You have to understand that walking into any Dr.s office, even in the USA, and saying, "I want opiates because I am allergic to OTC drugs" is going to be a tough path to get to the end of. You are going to have to explain the situation very carefully and thoroughly, or get your records showing you have been taking these drugs for over 20 years.

[inbangkok]

I just did a web search on tramadol and its totally contra indicative and can cause seizures with one of the other medications i take every day so it seems too risky to use ,,,

i will try another medical centre , and see what they can offer , if all fails I may have to return to UK early ...

You should really confirm this with a pain specialist rather than google. The risk might be statistically insignificant. Just a suggestion.

[liddelljohn]

Im not on holiday here i spend 8 moths of the year here with my wife kids etc i am long term expat,,,

[Sheryl]

I believe the pure codeine tabs are now off market in Thailand. Possible that some places still have it on the shelves though.

The cough supressant preparations have codeine mixed with other things, which can be an issue especially if a larger doiage of codeine is needed 9as it usually will be for pain) because that means an above therapeutic dose of the other meds i nthe compound. Terpin hydrate etc.

Short-acting oral morphine is now availabe in tablet form here (Kapanaol). There is also a sustained release capsule (MS Continus) which would generally be more suitable for chronic pain. But if OP has been getting adequate pain relief with just codeine, a shame to have to move to morphine.

OP - other option might be pentozacine (available in tablets and oral syrup)

[inbangkok]

I believe the pure codeine tabs are now off market in Thailand. Possible that some places still have it on the shelves though.

The cough supressant preparations have codeine mixed with other things, which can be an issue especially if a larger doiage of codeine is needed 9as it usually will be for pain) because that means an above therapeutic dose of the other meds i nthe compound. Terpin hydrate etc.

Short-acting oral morphine is now availabe in tablet form here (Kapanaol). There is also a sustained release capsule (MS Continus) which would generally be more suitable for chronic pain. But if OP has been getting adequate pain relief with just codeine, a shame to have to move to morphine.

OP - other option might be pentozacine (available in tablets and oral syrup)

Kapanol is not short acting morphine. I have a box of it in my cabinet and used to take it. it is a slow release formula which is supposed to last 24 hours. I can send you a pic of the box and the info if you would like, or here

(https://www.gsk.com.au/resources.ashx/prescriptionmedicinesproductschilddataproinfo/1670/FileName/D4E6028BC5078E853AE78B6A0151AF0E/Kapanol_PI.pdf).

I also have left overs of MS Continus which is also a slow release formula (supposed to last 12 hours). Both my pain docs (and another I speak with) have confirmed that the only instant release morphine in Thailand is in syrup forum.

As for the 60mg being taken off the market, my Dr told me two months ago they are available if I want them, but I don't take that high of a dose usually so I declined. But I cant say for sure if they are left overs or not.

How many of the 10mg tablets would be a problem? My Dr. said that 30-60mg a day is not an issue.

Edited December 7, 2014 by inbangkok

[Sheryl]

If Kapanol is sustained release then indeed, only syrup (and injectable) now available for short-acting. Which is quite limited indeed.

30-60 mg is a perfectly normal pain relieving dosage for codeine, the problem with tabs that contain 10 mg is that to get 30-60 mg of codeine out of them you'd also have to take 3-6 times the amount of all the other ingrediants, since these are compounds used for cough.

[jimcooper1]

yes 30-60 mg is a perfectly normal pain relieving dosage for codeine is ok with that.

[inbangkok]

I just received 30 mg codeine tablets with 10mg of Phenyltoloxamine at my hospital pharmacy. Apparently there are more variations of Codeine in Thailand available. Seems to be luck of the draw what pharmacies have what and when they have it.

[Sheryl]

There are plenty of preparations containing 30 mg of codeine but all are mixed with something else (and all are controlled substances.).

Phenyltoloxamine is an antihistamine and will accentuate the sedative properties of codeine when combined with it. It also accenuates the cough suppressent property of codeine (hence its labelling in Thailand as a cough preparation) but also has muscle relaxant properties so this combo can be useful for people with pain of musculo-skeletal origin.

However AFAIK it would not be safe to take 2 tabs at once (in order to get 60mg of codeine, a common dosage when used for pain relief) as it would recommended dose of the phenyltoloxamine.

[rodknock]

tramadol; i have been to numerous pharmacy's and not been able to get tramadol. the big pharmacy on soi 77 says no have. the pharmacy at soi 15 says no have.

i used to be able to get it at save-on drug, 2strips, but they no longer have it. i have been to 4different stores. i sure would like to know where it is available.

i have been using ultraset, but the cost is high for 10tabs=180baht.

can some one reccommend pharmcy's to try.

[inbangkok]

tramadol; i have been to numerous pharmacy's and not been able to get tramadol. the big pharmacy on soi 77 says no have. the pharmacy at soi 15 says no have.

i used to be able to get it at save-on drug, 2strips, but they no longer have it. i have been to 4different stores. i sure would like to know where it is available.

i have been using ultraset, but the cost is high for 10tabs=180baht.

can some one reccommend pharmcy's to try.

Keep looking......there are pharmacies that still have it in BKK.

[liddelljohn]

I finally got a doctor in phayathai hospital to prescribe me codeine ,,, with much hassle . its only 30mg but better than nothing ,,only 30 pills and 2000 baht ripoff price too...

[inbangkok]

I finally got a doctor in phayathai hospital to prescribe me codeine ,,, with much hassle . its only 30mg but better than nothing ,,only 30 pills and 2000 baht ripoff price too...

Pure codeine, or are they mixed with something?

If they are Tylenol #3 (brand name), then that is the going rate.....not really a rip off.

[bkkbudddy]

liddeljohn,

After reading your post, it seemed that you are addicted to narcotic medications! Or, you're physically and mentally dependant for whatever reason! You should go back to UK to resolve your dependency before coming back to Thailand. Also, Thailand's pharmaceutical prices are reasonable compare to western countries! Thais also need to make a profit!

Good luck

Edited December 19, 2014 by bkkbudddy

[inbangkok]

liddeljohn,

After reading your post, it seemed that you are addicted to narcotic medications! Or, you're physically and mentally dependant for whatever reason! You should go back to UK to resolve your dependency before coming back to Thailand. Also, Thailand's pharmaceutical prices are reasonable compare to western countries! Thais also need to make a profit!

Good luck

Who the hell are you to say something like that? You know nothing about this man or his condition........

[Sheryl]

Let's keep it civil, please

None of us (other than the OP himself) have enough information about his condition to draw any conclusions about his use of pain killers.

He did mention that an amount prescribed to him for 1 month generally lasts him for three, which is hardly suggestive of abuse or addiction.

It should also be understood that some people with chronic pain do sometimes develop physical dependency/tolerance to the pain killers they are prescribed and that this often cannot be avoided, and should not be viewed in the same category as the addiction developed by "recreational" users.

A closer reading of OP's posts will; also disclose that his problem was not that doctors in Thailand were not willing to prescribe him pain medication but rather that they seemed to do so without taking into account his history of allergies/ contraindications in light of his other meds/medical problems. This is, in my experience, a common problem in Thailand. I have a close friend who is allergic to NSAIDs and it has proven nearly impossible to prevent Thai doctors from ordering them for her nonetheless.

[infinity11]

In the states and i am SURE in asia, if i am not mistaken it originates in asia, some pain management professionals are using acupuncture

it is suppose to be affective for many ailments, i tired it a couple times, meh, and the needles DID hurt

your results may vary

it might be worth a try?

when it comes to physical pain, IMHO anything goes if it helps and hopefully doesn't create more or different problems

[inbangkok]

In the states and i am SURE in asia, if i am not mistaken it originates in asia, some pain management professionals are using acupuncture

it is suppose to be affective for many ailments, i tired it a couple times, meh, and the needles DID hurt

your results may vary

it might be worth a try?

when it comes to physical pain, IMHO anything goes if it helps and hopefully doesn't create more or different problems

There is no hard scientific evidence that acupuncture even works, much less as well as narcotic medications for chronic pain relief.

I tried it a handful of times as well.... Did not do anything for me.

Some people claim it works.... But many professionals will say it is the placebo effect rather than acupuncture offering the relief.

Edited December 22, 2014 by inbangkok