Worried about withdrawing from DHC Continus

[D95GAS]

Due to a spinal injury some 20+ yrs ago, I was put on Dihydrocodeine Continus, 60mg tabs 3 times a day.

GP has just been reissuing the prescription for the last 20 odd yrs without really discussing these meds with me, or about changing for another drug.

Now after 20yrs they just suddenly stop the prescription, stating Dihydrocodeine is on the "Red List" and therefore cannot be prescribed outside a hospital.

I cannot see how this has SUDDENLY come in when 29 days ago they issued the script without issue.

I have spoken to the surgery about the dangers of jus stopping this drug after so long, there is massive withdrawl symptoms.

If I miss 1 tablet, I can literally drop like a stone within an hour or two.

Happy to come off them, BUT, IMHO has to be controlled, not just sudden stop.

Has anyone else come across this issue with the "Red List"?

Are others being prescribed these by their GP?

Anyone got any information on what I could replace them without to help with withdrawl?

Desperate for some helpful information before I go see the GP and thrash this out.

If the withdrawl symptoms had been explained to me 20yrs ago, I would have never gone on them, very addictive.

[Bevvy]

I have dihydrocodeine on my repeat prescription and no one has advised me that it’s no longer available. I have to say though I haven’t used it for ages. I now take duloxetine for nerve issues and tramadol when I get breakthrough pain.

I 100% agree with you that they mustn’t be stopped suddenly but decreased very slowly. Also I would want to know what it was going to replaced with. Also I’m afraid I would argue that has kept pain away effectively for 20yrs so……..

[D95GAS in reply to Bevvy]

Many thanks for your response Bevvy.

I have no doubt in my mind that there are 100's of people being prescribed DHC via their GP. Unfortunately this seems to be a new GP, not from the UK.

I just have to gather as many facts as I can to prove he is wrong, and what they intend to replace it with, and what program are they going to put together to ween me off these.

This has come at the wrong time of my life and is causing so much stress, clearly he has not looked at my notes otherwise he would undstand the length of time they have been prescribing, IMHO the surgery has failed to manage me effectively and not put me in this situation.

[Bevvy in reply to D95GAS]

Is it not possible to speak to a different gp at the surgery? Over the past year or so I have had some issues and have mainly been consulting the senior gp who runs the practice. Other GPs have tried to alter some of my medication but I have always referred them back to him!!

[D95GAS in reply to Bevvy]

I have every intention on insisting on a speaking to a senior partner of the practice this morning, these new doctors clearly dont read all my notes to find out my history, they just do a knee jerk reaction when they see the prescription.

[DollyDutchGirl_1946 in reply to D95GAS]

I have Dihydrocodeine on repeat, as I take it - along with two paracetamol x 4 times a day. Also 70mg Amatriptyline early evening to help me sleep through the night. No problems from my GP or pharmacist….

[PainConcernHelpline Moderator Community Champion Pain Concern]

Dear D95GAS

I am a forum moderator at Pain Concern. I have just been reading through your post.

I am wondering whether you could speak to your pharmacist and see if they could shed any light on the reducing the meds. Pharmacists are extremely knowledgable, and it may provide a different route to information.

I have included a link to Pain Concerns Self-management Navigator Tool. Healthcare appointments can be stressful and generally we are never prepared. This tool will help you bring up concerns and worries at your healthcare appointment.

painconcern.org.uk/the-navi...

Best wishes

Pain Concern

[D95GAS in reply to PainConcernHelpline]

Hi Mod,

Thanks for taking time to respond. I have downloaded a couple of the forms you linked to and I think they will be very useful, I will take them with me to see the GP and then my next course of action will be to try and see the pharmacist to see what they advise.

This is all at the wrong time for me to be through this, recent loss of my wife, then diagnosed with Prostrate Cancer, its all getting too much.

The practice needs to work for me, rather than them looking at any cost implications for the practice, which is what this feels like.

Many thanks.

[Bevvy in reply to D95GAS]

Sorry to read this. Feel for you. My father died recently and it is difficult. Will be thinking of you and hope you are able to get an appointment today. Let us know how you get on.

[MyStar86]

you can buy it over the counter so that I don’t understand it’s under the brand name paramol

lloydspharmacy.com/products...

Might not be as strong as prescription but:

Each tablet contains Dihydrocodeine Tartrate 7.46mg and Paracetamol 500mg xx

[cyberbarn in reply to MyStar86]

as long as people remember that you can't increase the dose to match the dihydrocodeine on its own because of the paracetamol in it.

[MyStar86 in reply to cyberbarn]

That’s very true I was just saying it’s still available over the counter so a gp can’t say it’s a red box drug if you can buy it otc but anyone taking it otc would need to know they could only take x2 tablets at a time due to the paracetamol. Thank you for pointing it out for others as I just thought they would know that but it’s best to mention that point.

[cyberbarn]

You may want to read the NICE guidelines on this, in particular the information in the box marked "Important safety information" with the March 2020 information in it.

bnf.nice.org.uk/drugs/dihyd...

It shows that the clinician should be agreeing a tapering plan with you for a start, not just stopping.

The reason why new doctors will be more likely to de-prescribe as they refer to it, is because they are more likely to have read the most recent guidance.

[MSTKing]

hello - I’ve been through this with my morphine. It’s a big problem.

[CharlieJ22 in reply to MSTKing]

This is an unfortunate effect of the opioid crisis in the USA that many GPs or the local Clinical Commissioning Groups are hell bent on either reducing or eliminating opioid prescriptions in General Practice due to current research in the US being very risk averse due to the nature of their legal system. The consultants at hospital pain clinics still have a wider authority to prescribe them. According to my local CCG the slow release pain killer I take, Palexia SR ( Tapentadol) is a "Black Drug " I.e. unsuitable and/or unsafe for use in General Practice. It was initially prescribed for me by a pain management consultant from one of the most cutting edge orthopaedic hospitals in the world. Fortunately the senior partner I see at my GP Practice has a wife who is a Palliative Care consultant and very familiar with the drug and so is he. Due to this he is very willing to continue prescribing it and defending this to the CCG as it's been the most effective painkiller I've tried and has zero side effects for me as well as not having any of the addictive properties and side effects of morphine for me even after 6 years of taking it. A GP can choose to ignore the so called "traffic light" prescribing guidelines of their CCG but most salaried GPs rather than partners seem reluctant to do this.

By all means see a Senior Partner, but also ask for a referral to a pain management clinic as they have more options.

[Morganalefaye]

I was prescribed codeine phos in 1972 for the pain and severe diarrhoea following a resection of the bowel after a severe bout of Crohn’s, and have been on them ever since! I was taken off the codeine phos in 2014 and put on Zapain for severe osteoarthritis and a second bowel resection. I’ve never taken more than the prescribed dose and often take less, but still I suspect that my body is so accustomed to the codeine that in real terms it probably has very little effect on my pain which is pretty hard to bear a lot of the time.

At one point I was put on dihydrocodeine but oddly didn’t get on well with that. What’s the difference anyway?

(Please note that in 1972 one could buy a huge bottle of 500 codeine over the counter at Boots!)

I had no idea about the addictive qualities of codeine phos. I thought it was some type of derivative of codeine especially formulated to control diarrhoea.