I've never been a fan of extended release Opioid medications. This isn't from a recreational user's standpoint, it's from the standpoint of having years of experience in managin pain. I have several reasons for my aversion to this type of medication. Firstly, it's a belief that is shard by many of my peers and well, society at-large, that the constant rebranding and releasing of these "new and improved" formulations of medications that have been around for over a hundred years (if we're talking Morphine/Opium, thousands) is solely aimed at stealing market share and evergreening products for the sole purpose of milking them as long as they can.
For instance, Amphetamines have been around for over a century, but their heyday really started in 1933 with the introduction of the Benzedrine inhaler as an OTC medication. Benzedrine was, of course, racemic Amphetamine. Well, about 30 years or so later, people started realizing that these were extremely powerful stimulants, so they took Benzedrine inhalers off the "free for all" status it had been enjoying. Than, pharmaceutical companies rebranded their products in "safer" forms. A drug called Obetrol was released, which was a "proprietary, safe" blend of Amphetamines and Methylated Amphetamines. The dosage was more controlled and "engineered", but was still just a relatively random concoction of Amphetamines. Bottom line, they got a patent and they made bank.
In the early nineties, Obetrol was rebranded as Adderall with a slight change in the formula, allowing Shire Parma to acquire a new patent on a drug that was essentiall decades old.
My tirade? No we have all of these arbitrary formulations that benefit the pharmaceutical compaines drastically compared to the benefit to the patient. I can see why having an extended release formulation might be handy for some, but the exponential cost difference seems to completely negate this. Extended release formulations also rob you of what little control you have over your pain management. I would push hard for nothing but instant relase Hydrocodone. It will be much cheaper and give you better control over managing your pain.
It would be a different conversation if the er/ir pricing scheme were more reasonable, but it's not. We pay these pharm firms so much money to make minute changes to drugs that were invented 100 years ago. Things like Hysingla, Zohydro and so on are nothing more than an attempt by these firms to make a few extra bucks on drugs that are more or less "in the common domain" as it were. At any rate, I would get an older, more reasonably priced alternative like MSContin if they insist upon an ER medication.
I just woudln't spend money unnecessarily on these newer medications. Get something cheaper and more well known like MSContin or even Methadone. If that's not an option, I would suggest using entirely IR medications to control your pain. I feel like older people with less knowledge of drugs will receive more benefit from less dosing, but for veterans like us, I think we understand enough to medicate our own pain when needed. Just my .02 cents.
I say an advertisement for a drug that treats Pseudobulbar Affect. It's brand new, trademarked and rather expensive. What are the ingredients? What makes it so expensive? Well, the drug is Dextromethorphan/Quinidine in one pill. That's it. The Dextromethorphan can be bought by the pound online and prescriptions for Quinidine should be easy peasy to get, yet these Pharma giants have no problem combining the two in one pill, calling it a completely new medicine and charging hundreds per month per prescription. What research did they do that was so expensive that warrants such a high price? Both drugs were already well known and studied and the quinidine itseld is only present to make the Dextromethorphan longer-lasting (I think).
You just need to be careful. The wrong doctors can be in complete cahoots with the crooked pharmaceutical industries and again, the bad ones, have no problem essentially defrauding patients in the name of kickbacks from these pharma firms. This is why it's so important for us to do our own research.
This is just personal advice, from a non-MD, with personal experience in the field of treating my own pain. If you require a long-acting Opioid, Methadone is highly effective for pain, cheap as shit and is available as a generic everywhere. A few cups of coffe could pay for a month's worth of Methadone. For breakthrough pain, stick with the usual Hydrocodone/Oxycodone ir type of routine, those also should be quite cheap.
Don't let them trap you into thinking you need to newest, greatest formulation. Opioids have changed very, very little over the past thousands of years. The newer Opioids, have changed very little since their proliferation in the late 19th - eraly 10th century. There's no need to get all esoteric about it.
