im reading alot on here about gabapentin and opioids for RLS. I'm in the states and they simply WONT prescribe any opioid since drug abuse is such a problem.. My best friend was involved in a serious car accident several years ago that left her with multiple issues and chronic pain; she does take gabapentin but has been refused any of the "big" pain mgmt drugs.
Is this not a major problem in other countries?
They do prescribe low dose opioids in the USA. The top RLS experts are all there and all prescribe them for refractory RLS.The US foundation campaigns regularly to ensure patients continue to receive them.
Have a look at Dr. Winkelman's opioid study at Massachussetts General Hospital.
The Mayo Clinic Algorithm also makes it clear opioids are helpful for refractory RLS if gabapentin and pregabalin don't help.
Dopaminergic drugs are no longer first line treatment.
But, yes, many doctors are throwing the baby out with the bath water!
Seems to depend on where you are. In the states it seems to differ from Dr to Dr. They are under huge pressure from their authorities/ licence boards.
It is absolutely crazy, but as many things in this life, the responsible people suffer for the stupidity of the idiots who mismanage and abuse such things as alcohol, medications, guns ( unfortunately not in the US 🙄) and many more.
There are Dr 's in the states who will prescribe opioids- Mark Buchfurer for one, I'm sure there are others. It's just a question of finding one.
I'm sure the RLS organisation in the USA has a register of such dr's if you contact them ?
Good luck.
They do have a list of doctors recommended by a patient, but not all will prescribe opioids.
Medicine and politics are so enmeshed in the U.S. that it's become extremely detrimental to patient care. The DEA and the Drug War are so powerful here that doctors and pharmacists are fearful that they may lose their licenses even when it would seem obvious that many patients are being undertreated. Steps are being taken in an attempt to reverse this situation, but progress has been "painfully" slow.
Very astute observation! I’ve recently moved from Illinois to Florida. In Illinois, my doctor had no problem prescribing opioids for treating my RLS. When I moved to Florida, my new doctor insisted on taking me off. After being on the news because of pain clinic abuses Florida enacted draconian laws on monitoring opioid prescriptions. Doctors are scared to prescribe them fearful of losing their licenses. It’s tragic because people that really need them can’t get them because of drug abusers.
I never abused opioids.. I took them exactly as prescribed for almost a decade and never asked for more, yet I’m paying because others abused them.
I'm sorry to hear that your Florida doctor caved to the pressure. Have you been able to secure any other doctor to reinstate your opioid prescription since then? If not, what are you doing in order to be able to sleep? A relocation to FL may be in my future, so my interest in your situation is more than just curiosity.
I do remember a Florida patient on these pages a couple of years ago who said that he had found a prescriber in that state, so perhaps it's worthwhile to keep on checking around. I'm in Nevada but have to go to CA to see my RLS doctor.
What they call an opioid epidemic in this country isn’t entirely because of overprescribing opiates by doctors but mainly because of heroin and fentanyl being imported through the porous borders and ending up In our cities. I was on a grand jury in Chicago and discovered that heroin sells for $4 a gram! There’s a glut of it on the streets. Yet the DEA targets doctors because they make easier targets than drug dealers
People who research the topic understand that the Drug War actually hurts society MUCH more than it helps.
I mostly agree but I also acknowledge it’s a super complex societal problem. One may also argue it is a supply / demand problem but I also see it as a survival problem in which mostly city youth engage in distribution and consumption of drugs due to scarcity of jobs and the breakdown of family. Either way the war on drugs has been a failure and something else must be tried.
I certainly agree with you on that.
Hello Fleur29 I live in the US and I have been taking low dose Methadone for over 3 years now. tbh getting my prescription filled is no picnic. Due to ignorance, I am often treated like an addict at pharmacies. I carry a copy of the RLS opioid white paper study with me to help educate the medical community.
Hello, I’m in Arizona and take a low dose of methadone with a very low dose of pramapeil . I was using cvs for my medication and ran into issues with insurance coverage for the methadone i told them I would just pay for it myself, the pharmacist said that there contract with the insurance company would not allow them to do that. I switched to Walgreens and just said I don’t have insurance, Walgreens really didn’t want to give me methadone either, they gave me 20 questions on why I changed pharmacies and ended up calling my doctor they reluctantly fill my prescription. When I was dealing with the frustration of not being able to get the methadone from cvs I always had to keep in mind that I needed to act calm, they automatically think negative of people on methadone, don’t make a scene. I lived in Texas for a few months and it was even worse there, I went weeks without my medication.
I had the same experience with my insurance not paying but my CVS has no problem at all with me paying out of pocket for it. I guess that’s something I should be grateful for. I have learned that pharmacies make independent choices in rules. For me it often depends on which pharmacist is working on my refill day. Ridiculous.
I'm in Canada, but the medical system is also subject to the opioid scare. General practitioners (GP) can't prescribe opioids, they have very stringent regulations for this. Only specialized clinics can (such as pain clinics and sleep clinics).
I don't know for the US, but in Quebec, Canada it was just a matter of waiting long enough to get an appointment at the sleep clinic so they could demonstrate empirically that my sleep pattern was so bad that it required an opioid. But I also had to try Pregabalin and a dopamine agonist (Pramipexol) before getting there.
As for Gabapentin or Prebagalin. A GP can prescribe them. It's first line treatment for RLS.
After 10 years on Tramadol I find it is less effective and was hoping for Buprenorphine as prescribed in the US. My GP dismissed it saying the US are in a mess with opioids and he wouldn’t prescribe it!
Have you had your ferritin tested? Improving it to 100 or more helps 60% of people with RLS.
Neither gabapentin nor opioids treat the cause of rls but are merely attempts to hide the symptoms. I have eliminated my rls by enuring my diet contains as few inflammatory foods as practically possible and working on supplementing my diet with foods which help nerve health, things like ensuring that I get enough iodine, omega 3s and vitamin B12.
This situation is really upsetting. Addicts ruin it for people that NEED the drugs. I've got serious allergies and have to get a prescription for pseudoephedrine because meth is rampant here. And on the flip side, last year a boy that my son (who is 17) played baseball with died from an overdose.
Something needs to be done, but I don't know what
😟
Pseudoephedrine makes RLS worse in most people. Have you tried flonaze?
I am just getting over a bout with Covid (caught it on a cruise) and my only symptom is severe nasal congestion. I found that instead of pseudoephedrine that we RLS sufferers cannot take, I can (we can) take Phenyleprine. It’s generic, over the counter and works great.
That's good to know. Thank you.
I take Flonase everyday, along with singulair, Zyrtec and symbicort. For the most part, allergies are controlled unless the pollen is particularly bad. In may, we had such an event and I missed 3 days of work.
Hello Fleur29,
You are right! Most Dr's won't prescribe opioids unless you get lucky and find a Dr. that follows the Mayo Clinic RLS protocol.
My Dr. Is fearless and will prescribe Methadone to help with the withdrawal symptoms .
Contact your RLS Foundation for Dr.'s that Know and Follow the Mayo Clinic advise on augmentation and Mirapex withdrawal.
All the Best - David
On the other side of the coin, there is still a huge problem with some doctors overprescribing opioids. My husband is a physician, and we are aware of a number of "pill mills" in our state of Kentucky. It seems that getting the Medicare/Medicaid payment (sometimes boosted by a rural health bonus) for taking 2 minutes to write a prescription is too much of a temptation for some. We know of one "practice" that sees 70-80 patients a day. No way they are actually providing care. Thankfully one especially heinous offender just lost his DEA license... but it wasn't on the news because he's too well connected with the powers that be...
That said, I'm suffering because of the abuses of others too. Any and all paradigms put me in need of methadone, but my doctor won't prescribe it until I run the DA gauntlet, complete, of course, with another torture session in augmentation. It's driving my doctor husband crazy. Could he prescribe methadone for me? Technically, yes, but we both deem that dangerous ground, and he would run the risk of being lumped with the offenders in spite of a reverse KASPER that shows his very low incidence of prescribing opioids. (For him, prescribing opioids to a patient involves a long-term commitment to seeing that they are used properly, effective, and brought to termination whenever possible.)
Change doctors.
Opioids and Cannabis
B12 and almost off Requip. 
RLS - lying down during the day 
Gabapentin Schedule
