Chronic pain patient recently has had a reduction in medication. I have questions

[MaddieR]

Hi everyone:

This is my first post and I am hoping to get some true information rather than the b.s. I get from other places. I was taking 600 mg. per day of ER Morphine and 12 Oxy IR 30's for breakthrough pain. I have a chronic pain condition and was getting this prescription by a physician. Unfortunately, due to recent law restrictions in the law my physician was forced to lower the dosage and eventually getting me off the medication entirely. I have been reduced to 360 mg. of morphine daily until today. Instead of getting 240 mg. of morphine which in 2 weeks would be taken down to 120 mgs. and no medication for breakthrough pain, I was given a prescription of 6-30 mg. oxy IR daily and no morphine. My question is am I going to get by with the reduction in the medication or should I insist of getting the morphine? I am already having issues with my pain returning. I don't think that is a factor for my physician at this time. He is more concerned with keeping his license. Let me know what you think. Thanks so much for your help. Sincerely, MaddieR

 

[jamesBrown]

WOW! You were on a high dose of opioids. What is causing your severe pain?

First of all, there are A LOT of factors that determine how well you are going to handle a reduction in your pain meds....many of which we have no way of knowing. So, at best, you are going to hear guesses from us on BL.

Also...I noticed you mention that you were "already having issues with my pain returning". I took this to mean that your pain was gone before, or it wouldn't have been able to return. In response to this I must say that if you are being treated for moderate to severe chronic pain that requires high dose opiods, your pain medication SHOULD NOT take away all of your pain. There is more than one reason for this, not least of which being the fear of turning a patient into an addict.

It sounds to me like you might need to look for a different doctor. 600mgs Morphine ER PLUS 360mgs Oxy a day is A LOT of pain medication. Perhaps you never needed that much medication to begin with....especially if it was taking away all of your pain. But I don't know the details of your situation.

But as far as simply advising you on how well you will most likely handle this change in medication....my answer is that it will SUCK. Without knowing a lot more detail about your medical situation I cannot give you more heads up than that. Although there are MANY threads/posts on BL that deal with how to handle opioid WD. Just UTSE.

This should help...
http://www.bluelight.org/vb/threads/569872-The-Opioid-Withdrawal-Megathread-and-FAQ

 

[Methacodone]

Holy shit!! 600mg Morphine and 360mg Oxycodone daily!? DAMN. I thought my opiate doses were too high.

Hey man if they're going to take you off of opiates completely with those super high doses, it wont be healthy for your body going through such severe withdrawal...

I would recommend you to either seeing a suboxone doctor or go to a methadone clinic... and at least detox yourself properly.

 

[Slow_Mobius]

Can you ask your doctor for some comfort meds like pregabalin or benzos?

I agree with James Brown. Those were huge doses. If you really need that much pain medication, you should still be able to get an equianalgesic dose from a more potent opioid

 

[DixiChik]

I can't imagine any doctor prescribing those doses. Most doctors titrate pain meds (if you get them at all) and insist on other modalities to decrease pain. I can't fathom how you function on such high doses, but I am considered opiate naïve. I can't tolerate pain meds that would even slightly "lessen" my pain.

I'm not at all sure you are for real. Lots of trolls here lately. If you are, I mean no offense. Your doctor should have his license revoked IMHO if he led you down this path to NOWHERE.

 

[tacodude]

He's saving his own as IMO. Those are outrageous doses (my highest was oxymorphone 60 mg via 10 mg ir 4x-6x and day and 120 mg oxycodone via 30 mg ER 2x, 1x, 1x dosing schedule) and that was a lot.

Don't let them push you in an addiction facility's force them to do a proper slow ween not such a rapid jump. Especially if it wasn't your idea to push the dose so high.

 

[LucidSDreamr]

I've never heard of a prescribed dose that high. what is your condition?

You sound like a person that goes by the rules, outside getting illegal drugs and cheating piss tests I don't really see any option for keeping the pain in check while dealing with the withdrawal from the dosage drop.

DXM is useful for dealing with withdrawal and potentiating opiates, but you doctor may be piss testing you for it so be careful.

Kratom I doubt would add anything to ease the withdrawl with the tolerance you have, plus may be tested for in piss, but it might take a slight edge off of your withdrawal if you add it to your meds

lyrica does help take a slight edge off of spine pain in my experience.

 

[Methacodone]

IMO this is a troll ...
aint no way in HELL any doctor would RX 600mg of Morphine and TWELVE Roxy 30s a day...

The DEA would NEVER approve those kinds of doses to ANYONE.

If anything, the doctor would've RX'd something stronger in smaller doses.. such as Fentanyl, Opana, or Methadone.

 

[Slow_Mobius]

IMO this is a troll ...
aint no way in HELL any doctor would RX 600mg of Morphine and TWELVE Roxy 30s a day...

The DEA would NEVER approve those kinds of doses to ANYONE.

If anything, the doctor would've RX'd something stronger in smaller doses.. such as Fentanyl, Opana, or Methadone.

The DEA doesn't control the doses that any doctor gives to any specific patient. The FDA will issue maximum and minimum dosages, but they can still be exceeded at the doctor's discretion.

The DEA would step in if they believed the doctor was acting as a pill mill, but that's usually when they see absurd pain medications being prescribed to many patients + evidence of collusion. However, some doctors and pharmacists won't dole out pain medications for fear of getting into trouble by facilitating addiction or illicit activity. Hell, I had a pharmacist refuse to fill my prescription for 10 mg of ambien because she said she thought i could OD..... true story

If OP is really struggling with those dosing issues, I wish them the best of luck :/

 

[Methacodone]

Yeah sorry I got the FDA and DEA mixed up..

FDA is what I meant to put down.

 

[jamesBrown]

He's saving his own as IMO. Those are outrageous doses (my highest was oxymorphone 60 mg via 10 mg ir 4x-6x and day and 120 mg oxycodone via 30 mg ER 2x, 1x, 1x dosing schedule) and that was a lot.

Don't let them push you in an addiction facility's force them to do a proper slow ween not such a rapid jump. Especially if it wasn't your idea to push the dose so high.

Actually, depending on the level of pain and the type of condition being treated, I wouldn't be surprised to see pain meds at those levels. Although to be fair, at analgesic doses that high, I would expect to see a doctor prescribe fentanyl instead of morphine. There are many reasons for that, not the least of which is the high level of side effects morphine causes in comparison to other opioids.

I, for one, was prescribed 200mcg/hr fentanyl every 48 hrs along with 48mgs of Hydromorphone daily.....for almost 6 years. This was for pain caused by spinal damage(including nerve damage) and it only took away about 30% of the pain AT MOST( not enough to get me out of bed ). I'm not sure but the levels of opioids I was on may be more than the levels the OP is on as far as the level of equianalgesic properties between the different medications...I'm not gonna bother doing the conversion bc it doesn't matter.

...I'm just trying to make the point that there are plenty of people [CORRECTLY]prescribed levels of opioids that high for legitimate reasons. Many of them are COMPLETELY disabled or in hospice care, but there are still many.

 

[peapie32]

Is it a general practitioner who has been doing this or a pain management doctor? In my state recently any GP who has been treating a chronic pain condition with pain meds, is no longer allowed and has to refer the patient to a pain management specialist. So perhaps get a referral to one of those because at those levels I cannot imagine any doctor cutting it that drastically.

 

[bhamonion]

I am a severely burned person from an electrical contact at work. 13,500 volts AC. 50% 3rd and 4th degree burns, the ER dr. said he could count my vertebrae thru the burn. Several amputations.
Anyway, that was 14 years ago and today, with a pain doctor I take 40 mg of opanaER a day and 30mg of opanaIR for breakthru. I was taking morphine ER & IR but due to side effects at that level for years (trembling-almost like Parkinson's and weakness) they moved me to a opana regiment.
I feel that this doctor has made me a addict. When I was on the Morphine I always had some left over of both. Now here I am 3 days before refill and I have 1/2 of a opana IR left.
Also the doc said that I'm 50% over what I should be on due to this new reduction law. Anyone know where to read it?
Anyway I can see where MaddieR could get that high of a dose if it was a a regular doc with no experience at pain management because a pain doc would never prescribe you that much.

 

[Felonious Monk]

bhamonion, it's likely because opana is quite ineffective when taken orally (call it ironic, call it what you will)--which is why many people snort or inject them (NOT recommending this, it will make your problem worse). Though in comparison, morphine isn't a whole lot better at oral absorption but I believe it is improved (and the pills are better standardized in terms of efficient release as they've been around longer).

You might see if it's possible to switch to an oxycodone regiment. You'd have to go to higher mg, but it would be equivalent dosages in efficacy. Oxycodone is MUCH more effective orally, and the ER pills, OxyContin, actually do work reasonably well for extended release (though probably more like 8-10 hours versus the advertised 12).

There is no "reduction law." Just the DEA cracking down subjectively, as well as new GUIDELINES from the CDC and FDA.

Edit: Yes, I'm basically saying your Dr is misinformed or lying to you--unless it's a VERY recent state law that has somehow completely flown under the radar. Oxycodone vs oxymorphone would still be better, even at half dosage, because it's more effective as a pill.

 

[LucidSDreamr]

^ i thought that the FDA refused to go along with the CDCs guidelines

 

[boostemente]

IMO this is a troll ...
aint no way in HELL any doctor would RX 600mg of Morphine and TWELVE Roxy 30s a day...

The DEA would NEVER approve those kinds of doses to ANYONE.

If anything, the doctor would've RX'd something stronger in smaller doses.. such as Fentanyl, Opana, or Methadone.

It's certainly not impossible, although highly improbable. About 4 years ago my doctor lost his license because he was prescribing extremely high doses. I personally was scripted 360 30mg oxycodone and 120 80mg oxycontin per month from 2010 to mid 2012. Towards the end (around the time oxycontin switched to the non crushable formula) I was switched to 720 30mg oxycodone per month with no ER med. Don't believe me? PM for pics of my old script bottles. All that came off all that was a nasty dope habit when the doctor couldn't write for these insane quantities. Yeah, I hit the junky lotto with that doc and probably have a better chance at winning the real lottery before ever finding another doc to repeat that regimen. But the point is don't hate on the OP. Doctors like that do exist if you get lucky and know where to look.

 

[Slow_Mobius]

^ i thought that the FDA refused to go along with the CDCs guidelines

To my knowledge, they supported their findings but theyre not necessarily implementing the CDC prescribing strategy. The FDA has been relatively conservative.

However, I do want to point out the the DEA has increased the restrictions on total opioid pain medications that can be manufactured, so significantly less opioid pain medication will be available overall. Therefore, the doctor isn't necessarily wrong, and he might be thinking about rationing pain meds in the bigger picture.

 

[tacodude]

I doubt there is a reduction law and again the Dr is lying to save his own ass. We can't discuss that here though as it's legal discussion and against the rules.

As others said opana sucks orally and only the old ER ones had any use nasally. The IRs are good IV giving long term relief without any feindish IV rush especially the Roxanne brand genetics, but I don't recommend switching to IV. Tell your Dr that you want the morphine as it was more efficient and got through between appointments. You have very real legitimate pain and to take you off the medication while probably not illegal is beyond immoral and against the better judgement of your health care needs, which should be their only concern not whether or not the doctor should worry about the amounts your scripted coming into question as there should be acceptable answers to those questions.

In the meantime try poppy seed tea I'm sincerely nuts about a brand I just picked up, which is a lot better than the red Baron easy to find at a whole chain of stores that is still worthwhile to use in lbs rather than 1/4 that amount with the first brand. Trust me it will help a lot to make poppy seed tea. You throw them in something like a 2 liter or water bottle and shake them with lukewarm water and the cap shut. Then drain the tea by screwing the lid open just a bit, but not enough to come off and flip the bottle upsidedown and squeeze to get all the water out while holding the cap so it doesn't open and let the seeds out. You should probably filter truth a coffee filter too, but is not necessary. You want clean unwashed, untreated, and organic seeds that at higher potencies need a cup of seeds for a good batch while a bad brand need near a lb of seeds.

Keep us updated and I wish you the best. Kratom is also another option, but I think poppy seed tea would work best for you especially as morphine is the best for you

 

[thyjuliette]

Welcome to The Club!

 

[thyjuliette]

The AMA is the entity that disagreed with the CDC Guidelines. The AMA stated that these Guidelines (NOT laws!) are hurting the chronic pain sufferers. Someone needs to challenge the CDC to take back their fucked up Guidelines. Is there any way a Class Action Suit could be waged against the CDC??? I am severely suffering due to the CDC Guidelines, as are many of my friends.