Pain management and pain medication in the Philippines. The Philippines has one of the more restrictive regimes in the world regarding medication for moderate to severe pain. If you’re considering retiring in the Philippines or having medical treatment there, this is something you should be aware of. Perhaps you’re perfectly healthy now, but as a retiree in the Philippines you may not always be so. We know this from personal experience. Carol had major abdominal surgery in Manila, was in quite severe pain, but was only given Advil-type pain medication despite her being in agony and her requests for something stronger.
The Philippines has its own “war on drugs”. It does not seem to be especially successful in combating the main illegal drug “shabu” (methamphetamine), but it has imposed such onerous requirements on doctors and pharmacies that for all practical purposes, strong pain medications are not generally available except through pain management specialists in the larger cities. To prescribe opioids in the Philippines, a doctor must apply to the Philippine Drug Enforcement Agency for an S2 license. Then the physician must purchase special “yellow” prescription pads from the department of health for P200 per pad. The DOH threatens penalties of 12 to 20 years in prison for “unnecessary prescriptions.” The death penalty may be imposed on doctors or pharmacists if they are found to have improperly prescribed pain medication. Is it any surprise that only 4% of the 86,818 physicians possess this license?
The sad fact is that most Filipinos in severe pain can’t afford pain management specialists and do not get effective pain medication except over the counter drugs. I was at the small drug store in Tigbauan when someone came to get ibuprofen (Advil) for a relative dying of cancer. Many or most Philippine cancer patients die in agony. A survey conducted by the Philippine Cancer Society indicates that 65% to 75% of the 37,623 cancer patients who die annually experience unrelieved pain. According to the International Narcotic Control Board, straight-laced Singapore doctors dispense 220 times as much morphine to cancer patients as do Philippine doctors.
There are cultural differences.Filipinos may accept severe pain as part of living and dying.Few foreigners would like to face such a fate.My sister died of cancer when she was young. Even with Demerol the pain was terrible.Combating drug abuse is a worthy goal, but a system that keeps pain medication from patients in severe pain is unconscionable.
If you live in the provinces there will probably be no physician able and willing to prescribe pain relievers and almost certainly no pharmacy which will dispense them. This means frequent trips to a pain management clinic in the nearest city which has one. This was so unworkable for the terminally ill mother of one foreigner that they had to leave the Philippines. There was a recent report of an American in such terrible pain from prostate cancer that he killed himself.
The maximum number of controlled substance pills is capped at thirty per prescription, even if multiple pills are needed per day. Prescriptions expire if not used within thirty days. Some physicians may write multiple prescriptions so that the patient need not come in so often.
As is true elsewhere, doctors are suspicious of writing prescriptions for controlled substances and drugstores careful about filling prescriptions. Be sure to bring detailed information from your home country doctor about your condition and medications. This will reassure your new Philippine physician.
As noted above, Carol had surgery at Manila Doctor’s Hospital. Overall, our experiences were very good. You can read the whole story HERE. The one disappointment was the adamant refusal of our surgeon to prescribe adequate pain medication, even after major surgery. No compulsory instruction in palliative care is available in any Philippine undergraduate medical program. If you are having surgery, we suggest making the hospital’s pain management specialist a part of the health care team before your surgery.
Our one beef regarding Carol’s care was inadequate post-operative pain medication. This is not the fault of the hospital. It has to do with Philippine paranoia about using opioid medications, even for surgical patients. Post-op Carol was given a NSAID “Arcoxia”. It’s similar to Celebrex or ibuprofen. Arcoxia is not approved for use in the U.S. because the manufacturer has not been able to convince the FDA that it’s effective or safe. Carol suffered due to lack of effective pain control. A few days of opioid pain killers would have been far more effective and safer than the Arcoxia. The idea that should would have become a drug addict from three or four days of morphine is ridiculous.
Dental surgery. If you have dental work in the Philippines, no matter how severe, the dentist will almost certainly not provide pain medication. You will be sent to Mercury Drug to buy an Advil-class NSAID drug
Since this post was first written in 2008, a couple from the U.S. visited us. One of them had severe spinal pain. They were interested in life in the Philippines, but were concerned by what they read on this site and elsewhere about pain management and pain medications. To their credit they contacted pain management specialists in the Philippines and then came to the Philippines to meet with doctors and do their own “due diligence”. What they learned in encouraging, at least for those that live in or near a city with a pain management specialist and who can afford the medications. Thanks to them for sharing their experiences. Here is their report.
Pain Management in the Philippines, our experience
“I have been reading the responses here and on other sites as well for several years in respect to pain management and medications available in the Philippines. My wife and I have been considering a move to the Philippines; she unfortunately suffers with severe pain and most likely will for the rest of her life so the issue of pain management is a major issue. Due to the many conflicting comments we have read, we decided to visit the Philippines, meet Doctors and find out how this applies to us.
We made contact with the Pain Management Society of the Philippines and based on our potential locations got a recommendation to a Doctor and subsequently have received several more referrals in the Metro Manila area and Bacolod.
February/March 2010 we spent 18 days in Iloilo, Panay and met with the referred Doctor an Internal Medicine – Pain & Palliative Care Medicine, at Iloilo Mission Hospital. The Doctor was very interested in the medical documentation we brought with us and reviewed our case, she spent almost an hour and a half with us on the first visit. She reviewed the medications used in the U.S., Lortab / Hydrocodone 10mg/500 4 X daily (for Pain), Soma / Carisoprodol (Muscle spasm) 350mg, 3 X daily, and Methadone (Pain) .05mg 2 X day. Pretty powerful stuff and we are not thrilled about them but there is a real need.
The Doctor explained that these medications are not available in the Philippine’s, we discussed the attitudes of the Philippine Government and Medical professionals in the country and what is being done to make changes there. She explained the controls for pain management drugs and what is available and how it can be prescribed and used.
We were prescribed Morphine Sulfate 10mg 6X daily for the pain management aspect and Lagaflex 20mg, 3 X daily for the muscle spasms and we discontinued all the U.S. prescribed medications.
I mentioned to the Doctor that I have read that such prescriptions are only available for 8 days at a time; she explained how the prescriptions and strengths are controlled. With the Morphine Sulfate at 10mg, the maximum number of tablets is 100 at a time. If the prescription is for 5mg the max would be 200 and with 20mg, maximum would be 50 tablets.
So with a prescription of 10mg, 100 tablets, at 6 X per day we have 16 days with each prescription.
Lagaflex is similar to Soma but not the same, it has different compounds and works in a different way but is intended to have a similar effect.
We found the combination of both medications a bit too strong and reduced the Lagaflex and then discontinued it for most of the time. Laura found sufficient pain control with just the Morphine.
We got a 6 day prescription on the first visit to see how the change might affect her and returned for a follow up visit and refill. In all we saw the Doctor three times during our stay in Iloilo and Tigbauan, each visit the Doctor spent a long time talking with us and showed a real concern.
We brought a letter back with us describing the care provided and medications prescribed for our Doctor here in the U.S., he of course wasn’t interested in what was prescribed there and explained that the Morphine available here is not available in the same dosages and would not be able to prescribe its use at this time.
So, we were able to meet my wife’s pain management needs in the Philippines and to have the care of skilled and caring Doctors.
The Doctor even suggested that if we wanted to move to Bacolod there is a good Pain Management Doctor there. We met with the Nurse that is assisting with the Medicare program being offer in the Philippines and were given 7 referrals in the Manila area. There are many other Pain Specialists in the country and the assistance we received from the Pain Society was invaluable.
We feel the change in life style we can achieve in the Philippines may lead to a better overall health aspect and ultimately be able to reduce the level of medications necessary.”
Pain Society of the Philippines
The Garden Heights Condominium, Unit 205
269 E. Rodriguez Sr. Avenue 1102
Quezon City, Philippines
0063 2 721 2700