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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by ed_uk on December 12, 2004, at 20:47:50
Parenteral diamorphine is widely used in the UK for the treatment of severe pain associated with terminal illness. How do the Americans justify not using diamorphine when they use other potent opioids such as oxycodone, hydromorphone, morphine and fentanyl.
Hey, why am I even asking, since when were drug laws logical!!
Ed.
Posted by ed_uk on December 12, 2004, at 21:07:33
In reply to Diamorphine (heroin), posted by ed_uk on December 12, 2004, at 20:47:50
PS. I know diamorphine has a more rapid onset of action than morphine after IV injection but so does fentanyl (and certain other opioids as well).
Posted by ed_uk on December 12, 2004, at 21:08:49
In reply to Re: Diamorphine (heroin), posted by ed_uk on December 12, 2004, at 21:07:33
.... I guess the reason is more historical than anything else.
Posted by TheOutsider on December 13, 2004, at 10:26:28
In reply to Re: Diamorphine (heroin), posted by ed_uk on December 12, 2004, at 21:08:49
As you know Ed I also live in the UK.
On behalf of our American babblers I will respond by asking why we don't use Oxicodone and Hydrocodone?
I work in a hospital as a porter and it seems to me that the pain control is not great. Either people seem to get Ultra strong painkillers like morphine, or they seem to get weak painkillers like paracetamol and ultram, with a little codein thrown in if they're very lucky!
There seems to be no middle ground!
Posted by ed_uk on December 13, 2004, at 10:53:25
In reply to Re: Diamorphine (heroin), posted by TheOutsider on December 13, 2004, at 10:26:28
Hi,
Hello TheOutsider,
You are absolutely right that pain control is often inadequate in England, this also seems to be the case in most countries. You are also correct that hydrocodone is not marketed in the UK. Oxycodone, however, is available in the UK. In fact, a friend of a friend is currently taking oxycodone in an English hospital :-(
Opioid analgesics USED in the UK include.....
Morphine (MST continus, MXL, Zomorph, etc.)
Diamorphine
Oxycodone (Oxynorm and Oxycontin)
Hydromorphone (Palladone)
Fentanyl (Durogesic)
Codeine
Dihydrocodeine (DF118, DHC continus etc.)
Tramadol (Zydol, Zamadol, Dromadol etc.)We don't use oxymorphone or hydrocodone but we have adequate substitutes so we don't really need them! Similarly, the Americans have many adequate substitutes for diamorphine (heroin).
Paracetamol (called acetaminophen in some countries) is used by the bucket load. The standard dose is 1g four times a day, lower doses are the norm in some parts of the world.)
The NSAID diclofenac (Voltarol) is an exceptionally popular analgesic in England. Celebrex is used less frequently.
Ed.
Posted by jerrympls on December 13, 2004, at 18:00:22
In reply to Re: Diamorphine (heroin), posted by ed_uk on December 13, 2004, at 10:53:25
No offense, but I'd hate to be stuck w/ pain in the UK! My pdoc had me on fentanyl to see if it would help my depression - but the dose was so low I couldn't tell. I was also on hydrocodone too.
In many U.S. hospitals and urgent care centers, if you go in with your back out they most always give you muscle relaxers and hydrocodone! (that is my experience anyway).
Anyway, I still think doctors are too opiat-o-phobic. God forbid we feel "good" for a couple hours! They're so worried about addiction and then withhold these meds from those who really need them.
Jerry
This is the end of the thread.
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