Thought you guys might find it interesting to read about how we do it in Australia.
Some of the things we do are better than in the US, some worse, some just different.
1. We have a national health service.... the government insures everybody for health and sickness. You can chose your doctor, the government pays a set rate per visit, some doctors accept this as full payment, others charge about $10 or so extra
2. We have a national pharmacuticals plan..... the government subsidised drugs, and is the sole buyer, so drive prices quite low. They insist on price being linked to effectiveness. You pay the first $30 per script, the government pays the rest. Low income earners pay only $5. There is a list of covered drugs, drugs for trivial conditions arnt covered (nasal decongestants, hayfever remedies etc)
3. Most pain management is conducted by PCP's. Provided they obtain a second oppinion they can prescribe six months opoids at a time (one months supply and 5 repeats) Pain clinics at major hospitals are usualy used for terminal cancer patients or those who dont respond to opoids
4. The Australian equivalent of the DEA has no role to play in the medical use of narcotics.... it is soley a health department matter. To prescribe a narcotic for more than 4 weeks, a doctor has to notify the health department.... they supervise prescriptions to check for reckless prescribing or people obtaining scripts for more than one doctor.
5. because we are a small market, we have a somewhat smaller range of drugs than the US. The biggest lack I see is there is nothing between the weak narcotics (codeine/tramadol) and the potent ones such as oxycodoene and morphine.... no hydrocodone, or dihydrocodeine. Codeine Paracetamol isnt a controled drug, neither is tramadol. Indeed, we can buy tablets containing 500mg paracetamol and 15mg codeine over the counter.
6. We seem to love paracetamol/acetamonophen.... it is used for virtualy every pain patient, in a dose of 100mg 4 times a day, as a base which is built on, even if you are on Oxycontin or Kapanol, you will still be told to take regular paracetamol.
7. Chronic pain is still badly understood and treated by many doctors.
Last edited by aussiejono; 05-18-2008 at 08:19 PM.
God bless the Aussie's! I swear if I hit it rich i'm heading out there. I have alot of friends over there and would love to live there. I love their medical program! It has Awsome sauce written all over it! Thanks for the post.
I appreciate your post about Medical Care there. I have friends on some of the Message Boards from Australia. I am curious about how the doctors there treat Arthritis. If a patient has arthritic knees that need to be replaced with implants, would they be approved for surgery quickly or be put on a waiting list for a long time? Would their age matter? Thank you.
I think both countries could learn a lot from each other. We do seem to each have our good points and bad. It's nice to hear how chronic pain is handled in other areas of the world.
I am also curious about wait times for tests and procedures. I live somewhat close to the Canadian border and I know many Canadians come down here to the states for certain types of medical care. They also have a National health plan, but the wait times are long. The flip side is that many Americans go north to Canada, for prescriptions because they are a fraction of the price we pay here.
"I have a question as a result.....In your opinion then, is most pain "under" treated.....Because Docs don't want to go to the Oxy level?
Is pain "over" treated....Because Docs go to the Oxy level due to no mid line, therefore most people are given meds they don't need which causes problems?"
Used to be that it was usualy undertreated, Panadeine Forte (paracetamol 500mg/codeine 30mg) 2 tabs 4 times a day, was the most that many GP's would prescribe.
Now, they are more likely to use IR codeine or tramadol for accute moderate pain, SA Tramadol + an NSAID for chronic pain, and step up to low dose SA oxycodone or morphine if tramadol doesnt cut it, and trtrilate dose to pain.
I guess that taking low doses of oxycodone doesnt cause many more problems than high dose hydrocodone. The abscence of hydrocodone is strange, because virtuualy all other drugs avaliable in the US are used here (however, hydro isnt used in the UK either)
"I think both countries could learn a lot from each other."
got that right!
Last edited by aussiejono; 05-18-2008 at 10:11 PM.
CPM, waits can be long for less urgnt stuff - it is doen on a triage basis, tatoo removal usualy waits longer than cancer!
Tests arnt rationed, but "evidence based medicine" is widely practiced.... doctors dont do tests just to keep patients happy or cover them selves from litigation any more, they only do them if there is reliable benifit that they are going to be useful.
There isnt rationing of tests or drugs by the government.
In the US, hudrocodone is what's referred to as a Schedule III drug so long as it's mixed with acetaminophen and dosed no higher than 10mg per tablet. If it is used alone it is a Schedule II drug with tighter prescribing regulations than Schedule III meds. How is hydrocodone scheduled in Australia?
Here we have compounding pharmacies, who have access to raw hydrocodone. There are no pharmaceutical companies making short or long-acting hydrocodone when it's the only drug in the mix. However, these compounding pharmacies are free to manufacture tablets or elixirs with hydrocodone as the sole entity, as I wrote before as a Schedule III drug. Do you have compounding pharmacies and can they provide hydrocodone?
I think I know why Australia and the UK don't use hydrocodone. I think they simply substitute morphine or diamorphine for it, since 10mg of hydrocodone is essentially equal, milligram for milligram, to 10mg of morphine. As Ex wrote, it's unfortunate that you don't have hydrocodone easily available. It acts a little differently in the body than does morphine, and suits many people better than even the stronger opioids.
Did you know that Tasmania is one of the largest manufacturers of oxycodone? They have enormous poppy farms and are one of the largest producers of poppy straw, from which all the natural and semisynthetic opioids are derived. They specialize in the production of thebaine, from which oxycodone and buprenorphine are made.
In Australia, hydrocodone is an S8 poison (same as morphine and oxycodone)
Codeine and dihydrocodeine are S4 poisons (same as antibiotics, blood preasure pills etc)
In doses upto 15mg per tablet/30mg per dose, codeine is an S2 poison (avaliable over-the-counter from a pharmacist)
We do have compounding pharmacies, indeed, all pharmacists have to be able to compound as part of their training and registration. I guess the fact that hydro is the same schedual as morphine means there isnt much incentive to market it.
That said, 60mg codeine is = to 7.5mg hydro, so we arnt missing out on that much.
Yes, i knew tasmania was a major world supplier of opium productts.... strange considering it is so cold down there.
I beleive hydrocodone is aproved in Australia (it used to be sold as Hycomine Cough Syrup) and i know dihodrocodine is, just nobody has chosen to sell them.
I agree, Australian doctors seem to have embraced evidence based medicine than the US (can you imagine any Aussie doctor prescribing a combo of aspirin, caffine abd a barbiturate for headache?!!)
I havent got a pain management doctor, just a good, understanding and compotent GP.
My pain is controled by SR Tramadol 200mg and Celebrex 200mg twice a day, with Panadeine Forte, 2 tabs when needed for breakthrough pain. I have found tramadol great, no sideefects, and very effective.
Guess my pain, while chronic, isnt as severe as a lot of you guys - I am one of the lucky ones.
Re compounding... my mother was a pharmacist (she retired alst year) and she regularly used to compound Mist Morhhine Sulph for cancer patients, and one cancer specialist still used to have a preperation of tinct opium BP compounded sometimes. Compounding tablets was uncommon, but liquids was fairly stock in trade.
Last edited by aussiejono; 05-20-2008 at 07:28 PM.
chronic upper back/nec/shoulder pain..... no cause ever found, pysico and chiro give some temporary relief.
Re tramal and dependence, I stopped once after taking 200mg twice a day for about six months.... felt a bit jittery for a day or two but thats all. I just did it because i wanted to see if i could.
Some days i take 6 ot 8 Panadeine Forte as well as the tramal and celebrex, other days none.
Accordign to bline studies, 7.5mg of hydrocodone is = to 60mg codeine, so I dont see it having huge benifits over codeine in low doses, or over oxycodone in high doses..... given the lack of diference, and the fact it would be an S8 drug here, there probably isnt much of a market for it, even if they could get it on the PBS
Last edited by aussiejono; 05-21-2008 at 12:31 AM.
...Accordign to bline studies, 7.5mg of hydrocodone is = to 60mg codeine, so I dont see it having huge benifits over codeine in low doses, or over oxycodone in high doses..... given the lack of diference, and the fact it would be an S8 drug here, there probably isnt much of a market for it, even if they could get it on the PBS
I'm not arguing with the numbers but with the notion that it wouldn't have much benefit. Some opioids, hydrocodone and meperidine are examples, activate different "pathways" in the CNS. One of the pathways is referred to as "excitatory" meaning it tends to cause the user to have the opposite of sedation, a feeling of being jacked up. In many this can add to the overall analgesic effects of the drug. I know it works that way for me. When I take two 10mg hydrocodone tabs I tend to feel "up." Maybe high is another word. This goes away after chronic use, but for the short term it is a profound effect. There are many abusers who claim that without it they can't get through the day because it speeds 'em up and makes them feel better. This is one reason it's so hard to get off of this drug.
However, euphoria is considered one of the therapeutic effects of opioids, along with analgesia and anxiolysis. Many of the opioids do not activate this excitatory pathway, so I do think there may well be patients for whom hydrocodone would work better than codeine or tramadol.