GP will not increase to 2x 300mg per day

[DOT COTTON]

Sarah, May I speak to you in PM?

[NinjaKitty]

Hmmmm I find this one interesting, Being in the UK but in Scotland my prescriptions are free i pay no fee whatsoever (wether you work or not in Scotland aqll your meds are free etc)

My Psychiatrist has told me though that and i quote
"If a patient has substance or alcohol abuse history, or has or still is is using illicit drugs or prescribed drugs at a higher dose than recommended it is at the prescribing Dr's discretion if he/she will prescribe a higher dose or not, also folowing on from that pregabalin is NOT usually prescribed to anyone with a previous alcohol or drug habit due to the possibility of said patient needing a higher dose"


so basically my dr;s have all told me that if previous drug or alcohol dependancy or abuse has been a problem in the past it is for the safety and reputation of the prescribing dr to admisiter what dose they deem fit, in the UK the GP's manifest states that pain medication, benzos, anti depressants should be given at the smallest dose required and for the minimum time necessary, maximum prescribing time for benzos is 6 weeks max, anything over that is down to a psychiatrist to prescribe, as for pregabalin my GP will not increase my dose without the say so of my psychiatrist.

So from what i know and what i have learned is that the Dr has to cover ther eown back prescribing these meds to people with previous issues with drugs or alcohol due to GP protocol.

Kitty xx

[MyNameIsTerry]

Hmmmm I find this one interesting, Being in the UK but in Scotland my prescriptions are free i pay no fee whatsoever (wether you work or not in Scotland aqll your meds are free etc)

My Psychiatrist has told me though that and i quote
"If a patient has substance or alcohol abuse history, or has or still is is using illicit drugs or prescribed drugs at a higher dose than recommended it is at the prescribing Dr's discretion if he/she will prescribe a higher dose or not, also folowing on from that pregabalin is NOT usually prescribed to anyone with a previous alcohol or drug habit due to the possibility of said patient needing a higher dose"


so basically my dr;s have all told me that if previous drug or alcohol dependancy or abuse has been a problem in the past it is for the safety and reputation of the prescribing dr to admisiter what dose they deem fit, in the UK the GP's manifest states that pain medication, benzos, anti depressants should be given at the smallest dose required and for the minimum time necessary, maximum prescribing time for benzos is 6 weeks max, anything over that is down to a psychiatrist to prescribe, as for pregabalin my GP will not increase my dose without the say so of my psychiatrist.

So from what i know and what i have learned is that the Dr has to cover ther eown back prescribing these meds to people with previous issues with drugs or alcohol due to GP protocol.

Kitty xx

Yes, its possible but in the case of the OP, the GP has said that the dose they are currently on cannot be increased due to the 'health board' which is incorrect as there is plenty of evidence that the trusts disagree. If the GP stated it was due to a previous issue with substance misuse or alcoholism then it would be a different discussion.

My GP has said to me that he couldn't increase Citalopram beyond the standard dose or 20mg or Duloxetine beyond the standard dose of 60mg and I have no previous history of substance misuse or alcoholism. So, GP's can get things very wrong as well despite the recommendations that NICE give them or their own local trusts.

[hanshan]

Although I believe that honesty is the best policy, the doctor may find it easier to quote some fictitious board ruling outside their control, rather than say it is their own judgement (for whatever reason).

[MyNameIsTerry]

Although I believe that honesty is the best policy, the doctor may find it easier to quote some fictitious board ruling outside their control, rather than say it is their own judgement (for whatever reason).

In the UK, by not making the patient the first responsibility, not the trusts or NHS, the GP is in breach of "Make the care of your patient your first concern" from the GMC's booklet.

I don't disagree with you hanshan, a GP make act in this manner to avoid conflict with patients but this is wrong and I'm sure its a breach of more than one of the GMC's requirements on top of this one e.g. trust, patients should have a say in their treatment, etc.

[hanshan]

I'm assuming that the doctor's decision is based on their belief in what is best for the patient.

However, patients aren't lumps of wood. They are living people who may well disagree with the doctor's decision. In this case, it was clear that DotCotton was going to disagree, because he/she went in asking for an increase in the dose.

I'm assuming (again) that the doctor has 10 - 15 minutes to sort this all out. I'm not trying to justify white lies or fibs, just explain why they might happen.

[yenool]

Yes, its possible but in the case of the OP, the GP has said that the dose they are currently on cannot be increased due to the 'health board' which is incorrect as there is plenty of evidence that the trusts disagree. If the GP stated it was due to a previous issue with substance misuse or alcoholism then it would be a different discussion.

But the OP said in a previous thread that they had been taking more than the prescribed dose of medication and going through one month supply in one week.

The OP also said

"I have a history of drug addiction and now lyrica seems to be the next fix."

The GP is seeing these two facts and not wanting to prescribe a higher dose of medication for these reasons. To avoid conflict the GP has used the "max dose" and "health board" argument.

Honesty is the best policy but personally I can't say I blame the GP, it cannot be easy to say to a patient in effect "I'm not giving you more because you have a history of drug abuse and are probably abusing this med". In the GP's eyes however tactfully put they may be fearing conflict and potentially violence.

And in my (admittedly unqualified) opinion I really don't think prescribing more of something the OP has described as "the next fix" is in the OP's best interests anyway.

[MyNameIsTerry]

I'm assuming that the doctor's decision is based on their belief in what is best for the patient.

However, patients aren't lumps of wood. They are living people who may well disagree with the doctor's decision. In this case, it was clear that DotCotton was going to disagree, because he/she went in asking for an increase in the dose.

I'm assuming (again) that the doctor has 10 - 15 minutes to sort this all out. I'm not trying to justify white lies or fibs, just explain why they might happen.

Most likely hanshan, my GP has 10 minutes as a double slot. I know you are explaining the possibilities.

However, I think our doctors need to be truthful with us because once they become exposed, they lose our trust. Plus it allows less scrupulous doctors to keep patients in the dark for more selfish/self serving reasons.

---------- Post added at 03:02 ---------- Previous post was at 03:00 ----------

But the OP said in a previous thread that they had been taking more than the prescribed dose of medication and going through one month supply in one week.

The OP also said

The GP is seeing these two facts and not wanting to prescribe a higher dose of medication for these reasons. To avoid conflict the GP has used the "max dose" and "health board" argument.

Honesty is the best policy but personally I can't say I blame the GP, it cannot be easy to say to a patient in effect "I'm not giving you more because you have a history of drug abuse and are probably abusing this med". In the GP's eyes however tactfully put they may be fearing conflict and potentially violence.

And in my (admittedly unqualified) opinion I really don't think prescribing more of something the OP has described as "the next fix" is in the OP's best interests anyway.

I agree, its not going to be an easy discussion but doctors should be pretty used to difficult situations. Plus the GMC don't agree with that approach.

[hanshan]

Hi yenool and MyNameIsTerry,

I read through both your posts, and agree with both!

[yenool]

Most likely hanshan, my GP has 10 minutes as a double slot. I know you are explaining the possibilities.

Wow, that doesn't sound good. My GP has 10 mins as standard and never makes me feel rushed when I have difficulty explaining the issue.