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Getting prescriptions for narcotics

+1 vote

Hi, I’m an expat currently living in Costa Rica – when we moved medical was number 1 on our list (in order of importance) we got all the right answers but forgot to ask some pretty important questions we took for granted – never again – how difficult is it getting prescriptions for narcotics and are they expensive. I suffer from severe back pain and spend $700 a month for my pain meds!!!!! Time to go!! LOL. But certain countries just don’t have certain drugs – can anyone enlighten me about the way Thailand doctors and pharmacies view narcotics? Thanks for anyone’s time and response – PURA VIDA!

asked Dec 14, 2017 in Health
by website-user (7,010 points)

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2 Answers

+1 vote
 
Best answer

From what I gather, narcotics won’t be very expensive, but getting a doctor to prescribe them might be difficult:

Codeine for example is a 'class II controlled narcotic drug' in Thailand, putting it on similar footing with morphine, cocaine, and ketamine. If a doctor at a Thai hospital prescribes it, the hospital pharmacy will be able to provide it to you in small quantities. However, due to abuse, doctors are usually reluctant to do so.

Diazepam (Valium) is a 'class IV controlled narcotic drug' and thus potentially easier to receive a prescription for. Still, a similar problem might apply.

Keep in mind I’m not a pharmacist or a lawyer, so take this with a grain of salt. Best check with a local health provider, your embassy or an insurance company or broker (if you like, I can put you in touch with someone).

answered Dec 14, 2017
by website-answer (38,870 points)
selected Dec 14, 2017 by website-user
+1 vote

As I just had a bout with kidney stones, I can tell you that they don’t really have the narcotics you probably are used to ( I assume). The well qualified and competent doctors at a mid-tier hospital did not know what hydrocodone (vicoden), oxycodone (many names) or percocet were. There were only two options… OTC Tramadol (not strong and kinda nasty) and straight up morphine pills (not a good way to take morphine). It may be due to the potential abuse or other, but the hospitals (possibly the country?) do not have the opiods that are generally used for daily pain management or severe acute pain (my situation). They are missing that middle road (though dangerously addictive) of opiods. Overall it seems you either get a IV of morphine or nothing. The treatment I had is generally done either with heavy sedation or a general in the U.S., but they just gave me a NSAID (weak anti-inflammatory) and told me I could handle it lol. I did, but would much rather have had a real narcotic as they were shocking me for an hour haha. Opiods are pretty much taboo here outside of Morphine in the ER or admitted section.

Also, thanks Karsten for this article and the many other well researched articles. You helped me find a gym I really like (Design Your Body) and helped with banking issues. I really appreciate it!

answered Dec 14, 2017
by website-answer (38,870 points)
Glad to be of help. Thanks for sharing your experience, What route did you (or the doctors) eventually choose for pain management? Hope you’re feeling much better!
Sean, I talked to a Thai anesthesiologist about the case you described and received the following input. It might help shed some additional light on the situation:

“It seems the patient was going through ESWL (http://www.m.webmd.com/a-to-z-guides/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones).

According to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684259/,
despite reports of various studies comparing different analgesic techniques during ESWL,[7,9,10] guidelines for pain management during the procedure are not established. General anesthesia may be preferred in following conditions – children, extremely anxious individuals, when a lengthy treatment is anticipated.

The patient’s description is correct in that Thailand lacks intermediate opioids. I actually think it’s a good thing considering how the US for example is facing a lot of problems with opioid addiction in form of these not so strong and less restricted opioids.

If you actually had ESWL however, it is internationally common to use strong opioids, like the IV morphine you mentioned (or of the same family). NSAIDs are usually used as adjunct, sometimes with opioids, sometimes with numbing agents.”

Hope this helps!
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