Discussions that mention morphine

Pain Management board


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.
[QUOTE=aussiejono;3574191]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.

Yes, that is quite a gap. A real shame because a hydrocodone based product has a wide range of uses.

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?

or

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?

Thanks for sharing these differences. I enjoy learning about new things.

Ex
"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?

or

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!
aussiejono,

I'm also curious about the hydrocodone.

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.

steve
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.