Diamorphine is given IV/IM/SC - not orally - which generally means that its use is confined to a short period in the first few hours/days of a hospital admission until the patient can be switched to oral medication. Noone is sent home with diamorphine unless they are end stage palliative and they are on a home syringe driver to get it.

OTOH oxycodone is almost always orally administered which means patients stay on it for longer in hospital and are commonly discharged with a prescription for more.

The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine.

I read this recently:

Drug wholesalers shipped 780 million prescription painkillers to West Virginia over a six-year period. In a state of 1.84 million residents, the shipments amount to 433 pain pills for every man, woman and child in West Virginia.

http://www.nbcwashington.com/news/local/Drug-Wholesalers-Shi...

Although tablet formulations of diamorph also exist

>The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine.

My experience as a medical student on elective in the US was this - I couldn't believe the quantities of opiates prescribed cf. Australia

But people in UK do get oramorph, which is a liquid oral morphine.

Patients (and addicts) state there is a particular euphoria that oxycodone has (and diamorph/heroin) that morphine doesn't really have. Of course oral morphine does cause addiction, but oxycodone just seems to have greatly increased rates.

It's pretty well known that opioids for short term pain pose little risk of addiction; but opioids for long term pain are a bad idea.

For long term pain opioids don't treat the pain, and they risk addiction.

That's why we have things like "Opioids Aware": http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

> "For long term pain opioids don't treat the pain"

I imagine if you or someone very close to you had severe chronic pain your ill informed opinion would soon change.

This is an odd question, but for people with chronic and essentially untreatable pains (which is many people, particularly older ones): What is the problem with being addicted to opiates if you are going to take them to manage that pain for the rest of your life anyway? I would want the opiates at that point.

The opioids do not treat the pain!

You end taking life threateningly high doses of opioids, which are not working to reduce your pain.

People with chronic pain need other interventions - rapid access to specialist pain clinics being most important.

> The opioids do not treat the pain!

That's not so black and white. They work to some extent as long as dosages don't keep escalating and use is intermittent. Even the link you posted says as much.

Thank you, I didn't know this. I thought they worked long-term

Are you a chronic pain sufferer?

Yes, I was.

I don't understand why "give people with chronic pain rapid access to specialist pain management clinics, rather than just dumping them on ever increasing opioids" is a controversial statement.

"specialist pain management clinics" isn't a treatment.

I know a chronic pain sufferer and according to her opioids are of short term help but make everything worse in the long run. Unfortunately there are not many ways to treat chronic pain.

What's the better alternative?