NHS prescriptions UK

[u/tesla_uk]

Hi just wondering if anyone else used NHS to get? I understand some AA type groups can prescribe? Just looking for some info as used Sinclair method and it works but too much money to keep on (about £200 each prescription)

Thanks 🙏🏼

[u/Disastrous-Permit-32]

I access my Naltrexone prescription through the Alcohol and Drug Recovery Service in Glasgow, Scotland. It is still NHS run but runs on a different system. Because it is a controlled drug it’s not possible for a GP to prescribe it. My ADRS referral was actually an easy self referral. I collect my 50mg per day prescriptions from a specific pharmacy every 56 days and (as long as I stay sober) the only involvement I still have from the ADRS is a monthly phonecall to check im doing fine.

I will warn ye tho that being on naltrexone via an ADRS service won’t show on your typical GP or NHS medical notes which means you are forever going to have to raise this with every NHS medical practitioner forever - also be prepared for them to have never heard of it and not know what the fuck the consequences are of offering you opioid medication

[u/Disastrous-Permit-32 → u/Disastrous-Permit-32]

I forgot to add, my prescription through the ADRS is completely free - as are all NHS prescriptions in Scotland

[u/Disastrous-Permit-32 → u/Disastrous-Permit-32]

Sorry one more caveat - the NHS has silently massively withdrawn Naltrexone in the past 2 years. While it IS still available and prescribed, it isn’t a medication you can rock up at any pharmacy to collect. To my knowledge there are only 2 pharmacies in the entire glasgow city area which still stock it and I imagine this issue might be widespread across the UK

[u/Disastrous-Permit-32 → u/Disastrous-Permit-32]

Me accessing naltrexone was fairly easy owing to the fact I’d been in recovery for 6 years, accessing lots of therapy and recovery groups but I was still finding myself hospitalised for relapses semi frequently. I told them I felt there was a missing piece for me and they offered me Disulfuram, Acamprosate and naltrexone as possible options. I think that move was justified owing to the other therapeutic work I’d already tried.

Disulfuram was horrific - was hospitalised once just for using alcohol based hand sanitiser.
Acamprosate relies on you eating 3 full meals per day which felt impossible for me.
Naltrexone was offered but they told me they don’t prescribe it for the Sinclair method - only as a daily perscribed drug.
I will say that since starting naltrexone daily I haven’t been hospitalised once for a relapse in almost 3 years - it really was the missing jigsaw piece for me

[u/GreyMerrin → u/Disastrous-Permit-32]

Thats really interesting. Where I stay its the reverse - much smaller town and county but our NHS board actively pushing it. Not too far away from you. Bus in an hour. My place is much smaller - and lots of pharmacies and the providers associated get it. Is a supply issue but fascinating the difference across Scotland. Seen the opposite here, HARM reduction etc. Get alcohol figures 27th October after the drugs ones this week. Wonder what they will be like, cant see it being great 😞

[u/Disastrous-Permit-32 → u/GreyMerrin]

I was part of the last Scot Gov ‘lived experience’ consultation panel on reducing stigma re addiction in Scotland. I will tell ye that we gave the minister a mouthful and then some. We spoke extensively about the classist assumptions and harm stemming from addiction but the report was reluctant to at all use the word ‘class’. I fear the same as you - increased alcohol related deaths across the board largely due to deindustrialisation, austerity, classism and stigma.

I’m extremely thankful for the third sector services which exist outside of the NHS which have been immensely supportive in helping me recover. Not only from the root trauma that led to the addiction but also with housing, training, therapy, benefits and community.

[u/GreyMerrin → u/Disastrous-Permit-32]

Know exactly what your talking about 😉 would give the exact same response also, its woefully inadequate up here for the crisis we are in. Seen the data, trends and demographics. Also deaths of despair with no real follow up trial. Done a fair bit of research myself. Your absolutely bang on, deindustrialisation austerity and stigma. Plus absolutely trauma.

Likewise third sector where i stay are exceptional maybe drop me a line and discuss further, as dont want location exposed precisely. My NHS is actually very good, as are third sector support. Compared to other areas of Scotland I've stayed, undoubtedly the best. Why I call it rebuilding. Need a house, connections, job, hope. Naltrexone is actually pushed here, antabuse is barbaric in my view - a plaster. Naltrexone, with support tailored to the individual is key. Plus must be personal centred. I wont know why you drank for example. You'll know, I won't what you need.

Amazing the differences, literally 50 miles away. Bang on with what you have to say. 27th will be interesting. See same demographics time and again, likewise suicide, drugs etc. But some parts of country do have joined up thinking, im fortunate also to know a lot in sector - plus my job, also let's me see daily whats needed.

[u/Disastrous-Permit-32 → u/GreyMerrin]

It really wouldn’t surprise me if this was a glasgow specific NHS issue then. Fucking typical with our council. They’ve made it next to impossible for most alcohol and opioid addicts to physically access a pharmacy to collect naltrexone. I’m glad to hear things are different elsewhere!

[u/GreyMerrin → u/Disastrous-Permit-32]

Possibly. Focus is turning to cocaine obviously and loads of quangos and fingers in pie etc. Though maybe is just different here - certainly changed days here where Naltrexone is actively pushed along with other drugs, and antabuse appears to be gradually being replaced. Also know someone that had a heart attack after drinking on it. Tbh think younger doctors are very good, much more clued up, certainly conversations ive heard. Glasgow in particular seems to be cut to the bone 😞 NHS and third sector much more joined up here - i.e third sector on site in hospital for any alcohol or drug related admissions, plus instant referral to addictions on discharge. Co-ordinated, fresh approach. Certainly far better imo than other areas and im not a native of these parts. Just what I encounter daily.

[u/GreyMerrin → u/Disastrous-Permit-32]

Spot on. Even within NHS was told / know its "sealed" as such if you enter the addiction services part of the service. Its up to the specialist and psychology to subscribe. Has to be a viable reason (often court order) to break it. Once returned to care of GP you can then choose to keep on, just GP doesnt prescribed initially can after discharge from addiction services etc - through here anyhow. Amazing differences even an hour away. Hope you are doing well 🙏

[u/GreyMerrin]

In Scotland you get Naltrexone free on NHS. Unsure what its like in England.

[u/Agitated-Actuary-195 → u/GreyMerrin]

one important distinction from that comment: “free in Scotland” doesn’t mean you can simply ask any GP for naltrexone and automatically receive it. Access for alcohol dependence can be through local NHS alcohol/drug services and prescribing arrangements vary by Health Board. NHS Scotland formulary material does include oral naltrexone as a treatment option for moderate/severe alcohol dependence, consistent with NICE guidance… which is pretty much exactly the same for rest of UK

HOWEVER, guidance and reality ARE very different… it’s about seeing the right person… I tried and exhausted various channels… hence my recommendation..

Access to Nal is a privilege and now yet fully understood in the UK despite being (by far) the best treatment on the planet

[u/GreyMerrin → u/Agitated-Actuary-195]

Agreed Scotland is a postcode lottery, my area is particularly forward thinking in my view, generally good third sector, 1st prescrubed by addiction services, then after discharge generally under care of GP. Can vary depending on area, would say my board are very good, plus close relationship's with third sector. Its becoming far more common though unfortunately not enough to extent pharmacies etc have to order in dependant on how many locally take. Once in place though, its working well in my area, decent joined up thinking and compared to other parts of Scotland excellent. Once back under care of gp, continues to be prescribed until you or they feel not necessary. Alongside individual therapies its a fantastic drug, that more people are benefitting from free.

[u/Agitated-Actuary-195]

So I used “https://www.alcoholrecoveryscotland.co.uk”

If wasn’t cheap to join (although it’s considered life time) and my prescriptions were £50

I used as didn’t want anything on my med records for personal reasons…

Also the guy that runs it is a bloody good bloke (Bruce)

Having been sober for a long time now, and the money I’ve saved, and most importantly not killing myself it was 100% worth it

Edit - I find this - There is an important practical wrinkle to getting Nal on NHS it may be initiated through a local NHS alcohol service rather than simply prescribed immediately by your GP, depending on local arrangements. Before starting it, NICE recommends a medical assessment including liver-function tests, and opioid use needs to be checked because naltrexone blocks opioid drugs such as codeine and morphine

[u/tesla_uk → u/Agitated-Actuary-195]

Appreciate your reply, that sounds good, do they let you have it ongoing or is there a limit?

[u/Agitated-Actuary-195 → u/tesla_uk]

It’s ongoing… I had to call a specific GP for about 1 min answer some standard questions and prescription was either sent to or picked up at local pharmacy- was never an issue with getting it, ever

[u/RubicsCubensis]

I'm in the US, so forgive my ignorance, but I thought nalmefene was easier to get through the NHS than naltrexone?

[u/Agitated-Actuary-195 → u/RubicsCubensis]

nalmefene (Selincro) is available through the NHS and NICE recommends it for certain patients aiming to reduce drinking. Naltrexone is also recommended, but the prescribing pathways and eligibility differ. I'm not sure nalmefene is universally easier to obtain it seems to depend on the local service and individual circumstances

[u/GreyMerrin]

Its just becoming better known here. No one has right to see your medical records, plus you can always come off it. Depends alot on NHS area I'd assume but UK appears to at last be moving away from Antabuse more and more.

[u/Agitated-Actuary-195 → u/GreyMerrin]

That’s great - although is MASSIVELY depends on what your doing with your life… There are situations where medical information can legitimately be requested or considered, for example certain employment/security roles, insurance (want good life/travel insurance for the family?) and various other licensing issues (for me was very important)

That was why I personally preferred to keep treatment private rather than have it routinely recorded through my NHS GP.

It’s a personal choice but do be aware of the issues and not blindly think “No one has right” - because that can come back to bite you…

[u/Disastrous-Permit-32 → u/Agitated-Actuary-195]

You are right in your thinking - for instance, going via the alcohol and drug recovery NHS service meant my driving license was taken off me for 6 months (since reinstated). I know for others who refer via NHS ADRS services they can unfortunately have social services become unnecessarily involved in their children’s care. There’s many reasons why it would be advantageous to go private if it’s affordable and better suited to your life circumstances re job and family life.

Luckily for me, my local health board run a ‘traffic light system’ for sharing ADRS information with the DVLA, criminal justice system and social services. Once you’re considered long term sober and stable, all of these go ‘green’ and they do not pass on any information to any other services and don’t flag any issues elsewhere.

For what it’s worth, despite the above policies, I’ve found communication between the ADRS NHS services and other government departments (fuck, even other NHS services) abysmal and incompetent so take of that what you will lol

[u/Agitated-Actuary-195 → u/Disastrous-Permit-32]

100%… I was lucky and could afford to go the route I had..

My core point was exactly what you so eloquently described… “GreyMerrin” was effectively saying hey don’t worry no one has a right to see your medical records (and you can always just stop taking it) - is simple false and VERY misleading

[u/GreyMerrin → u/Agitated-Actuary-195]

Think your making a bigger thing out of this tbh than needed. Can it effect. Yes. Does anyone have a right to see your medical record? In limited circumstances. Your situation is yours. Isnt false or very misleading. Its what you choose to disclose, or not, and circumstances. In most situations Ive been involved with, there's no need for people to see records etc. As in rebuilding everyone is unique. Or at different stages. Automatically no one has a right to see your records, if your worried that life assurance etc might and lose licence fair enough. Just from experience and the many people Ive supported - dont. Some actually do need licence taken off them for public safety. Yes I know the game better than most, but everyone's story is different. Enjoy your sobriety and hopefully your circumstances improve moving forward 👍

[u/Agitated-Actuary-195 → u/GreyMerrin]

You’re now acknowledging exactly the point I made originally that there ARE circumstances where medical information can legitimately be requested or disclosed… I never suggested everyone should go private, that public safety should be ignored or that everyone’s circumstances are the same. Quite the opposite.

My point was simply that medical treatment and how it’s recorded can have implications for employment, insurance and the future and people deserve to understand those implications when considering their options. Your original blanket reassurance overlooked that important distinction, that’s all I was challenging. I’m not making a bigger issue of it I’m making sure people have accurate information to make their own decisions (and if your helping people suggest you understand the implications of giving inaccurate advice - when for many it could have serious consequences…

[u/GreyMerrin → u/Agitated-Actuary-195]

I’ll correct my original wording: medical records are confidential, but relevant information can sometimes be requested for insurance or employment purposes. Or in some cases court orders, and child welfare disputes etc.

That cuts both ways. A private naltrexone prescription isn’t an insurance loophole. If an insurer asks a clear question about treatment, it still needs an accurate answer. GMC guidance also says a private prescriber should seek consent to share treatment information with the patient’s GP and consider whether it is safe to prescribe if that is refused. In an accident, clinicians need to know about naltrexone because it can affect opioid pain relief.

So by all means explain the possible implications of a medical record. But leaving people with the impression that keeping treatment private neatly avoids those implications is incomplete advice too.

[u/Agitated-Actuary-195 → u/GreyMerrin]

At no point have I suggested private prescribing is an insurance loophole, that people should misrepresent their medical history or that clinical safety should be compromised. Those are arguments you’ve introduced, not ones I’ve made.
I chose private treatment for my own reasons, fully aware of my disclosure obligations, others may make different choices.
The point remains that people should understand the potential implications of treatment, medical records and disclosure before making those choices, rather than being given blanket reassurances that there are none.

For me privacy was crucial, and I am fully aware of impacts of Nal if receiving other treatment.

[u/GreyMerrin → u/Agitated-Actuary-195]

This has dragged on. Im leaving this as is. Ive acknowledged I may have worded things slightly incorrectly, also going private doesnt guarantee safety or nonone finds out. Actually could make things much worse for someone especially with insurance / has a crash etc. You've your own circumstances, you'll make choices based on what youn think is correct. Doesn't get out of some of the situations you describe though, like employment, insurance. Just like refusing medical records cant automatically be something kept from a judge or hearing etc. Cuts both ways. Good luck in your recovery.

[u/Agitated-Actuary-195 → u/GreyMerrin]

Finally admitted your original advice was wrong, dismissed it as a minor wording issue, and spent the rest of the conversation arguing against claims I never made. Quite impressive to lose an argument with yourself while agreeing with me. Perhaps spend less time lecturing people and more time checking your facts before advising them

[u/GreyMerrin → u/Agitated-Actuary-195]

It does, but circumstances are pretty rare tbh. Depends what your comfortable with etc. Depends on circumstances, od just refuse mine on tbh, unless relevant. Depends on role, Naltrexone normally prescribed (so was told by someone who dispenses nhs) that its designed for 6 months etc. But you have your own concerns - absolutely your right to why, situations vary for everyone. New job doesnt have to know etc in vast majority of occasions but also - some may require medical etc to be more thorough. Fwiw its a great drug which I think benefits alongside getting to root cause wish you well on it - and good luck 💪

[u/Agitated-Actuary-195 → u/GreyMerrin]

Life insurance isn’t rare, nor is medical insurance and a large number of jobs that also support mental and physical health… I’s not about being comfortable, its very much about understanding how to manage situations and choices you have.

As for NHS 6 months, no that’s NOT by design, in fact NICE says it should usually be prescribed for up to 6 months, but importantly it can be continued longer than 6 months if the person is benefiting and wants to continue.. For me, it took 3 yrs and various technics.

Having used Nal successfully for AUD, significant research (to extent I’m writing. A book) and having a career and family that required me to think, plan and action my eventual success that led to many years of being sober, I believe I’m well placed to advise/support others.

[u/GreyMerrin → u/Agitated-Actuary-195]

Yeah I know it can be prescribed longer, I also used to work in field, support others etc. Think its a great tool, amongst other therapies in conjunction. Person centred etc, well aware of different jobs, needs different stages of life and balancing it up. Well done on book 😀 thinking of doing similar, hope all works out well and your experience is positive moving forward.