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Sublimit
19-04-2010, 04:59
Hi all. For all of you that have had a bad injury or experienced chronic pain in the past, What meds have you been prescribed? and what have you found most effective?

Codeine and tramadol are obviously the most common ones, but i'm wondering about the less common....I've had a painful tear of the lateral meniscus in my knee and have been seeing my gp for pain management for a few months. I've also had an opiate addiction when i was younger. so i've personally used quite a few opiates

When it comes to strong pain relief i've noticed personally and from people i know that Oxycodone is prescribed 90% of the time, Endone or Oxycontin in various strengths... So what other opiates do doctors prescribe?

I've been given Buprenorphine - Norsepan patches which wasn't effective....
and have even once used Dihydrocodeine - Rikodeine for pain relief!

Hydrocodone - Vicodin.... we don't get this in Australia?
Hydromorphone - Jurnista ER - apparently gp's prescribe this here?
Oxymorphone - Opana ? from what i've read we don't get this

Fentanyl - has anyone had this prescribed for chronic or breakthrough pain?

Mr Blonde
19-04-2010, 05:02
Hydrocodone we don't get, I'm pretty sure same with oxymorphone... hydromorphone not sure, I've maybe heard of it in a hospital setting or something.

Fentanyl... I think leftwing was prescribed that once?

phase_dancer
19-04-2010, 05:16
Fentanyl - has anyone had this prescribed for chronic or breakthrough pain?

A close friend has been on patches for ~ 21/2 years now for chronic back pain. He's now on the highest dosages and finds it's no where near as effective as it once was. Due to the dysphoria it creates, he was prescribed Venlafaxine about 6 months ago. Trouble is, when fentanyl no longer relieves him, he'll have no other choice but to be prescribed morphine, and as he's only in his mid thirties his dr is naturally reluctant to prescribe that just yet.

Sublimit
19-04-2010, 05:44
A close friend has been on patches for ~ 21/2 years now for chronic back pain. He's now on the highest dosages and finds it's no where near as effective as it once was. Due to the dysphoria it creates, he was prescribed Venlafaxine about 6 months ago. Trouble is, when fentanyl no longer relieves him, he'll have no other choice but to be prescribed morphine, and as he's only in his mid thirties his dr is naturally reluctant to prescribe that just yet.

Thats interesting, but unfortunate for your friend. so the strongest patch releases 100 micrograms of Fentanyl an hour.... thats a lot! if my calculations are correct that is the equivalent to taking 200 mg of Oxycodone a day.

Was your friend taking Oxycodone before the Fentanyl?

phase_dancer
19-04-2010, 05:52
No he went from really high doses of Tramadol to bup, which left him in a rather serious state of withdrawal. His dr is the veterans doc in this area, (my friend's ex Navy) but surprisingly, the dr didn't seem to have much else to offer at the time. I recommended he ask about fentanyl, which at first allowed him to move around like he hadn't in years. Sad it was so short lived.

Sublimit
19-04-2010, 05:55
Hydrocodone we don't get, I'm pretty sure same with oxymorphone... hydromorphone not sure, I've maybe heard of it in a hospital setting or something.

hydromorphone i'm interested about. i believe jurnista was added to the PBS in may 2009 which is a extended release form of hydromorphone. obviously not commonly prescribed, but i have read that it is being considered for opiate replacement therapy

Sublimit
19-04-2010, 06:08
No he went from really high doses of Tramadol to bup, which left him in a rather serious state of withdrawal. His dr is the veterans doc in this area, (my friend's ex Navy) but surprisingly, the dr didn't seem to have much else to offer at the time. I recommended he ask about fentanyl, which at first allowed him to move around like he hadn't in years. Sad it was so short lived.

Tramadol to Bupe is ok if you're not in a lot of pain, and you don't have any stronger opiates in your system.... but in my experience Bupe is not good for pain relief, but does have a nice opiate recreational value to it.... and personally think its a great drug for heroin addicts, i can't believe methadone is legal! the government needs to re think that one.

From what i was reading was basically saying the reason for considering jurnista ER(Hydromorphone) for opiate replacement program was much better quality of life than methadone.

Regarding your friend, he sounds like he's in an awkward situation... maybe he can get morphine prescribed? He shouldn't have to be taking an AD because of the Fentanyls effect on him, although i personally take Mirtazapine myself and think it's great after trying so many other AD's

phase_dancer
19-04-2010, 07:57
Regarding your friend, he sounds like he's in an awkward situation... maybe he can get morphine prescribed?

The problem is his condition isn't directly life threatening, meaning he could well live for 40+ years. If he goes on morphine now, his quality of life down the track will be shit if he has to up his dose as he's had to do with past medications. The effexor worked great for him for the first few months, and tbh, he sounds ok atm, but that stuff can be nasty on it's own, so we're hoping he's one of the lucky ones for which it continues to work.

Sublimit
19-04-2010, 10:53
^^^^

maybe suggest to your friend to look into Hydromorphone.... like i said the PBS approved this recently and from what i've read it seems ideal for your friend. It seems like a realistic alternative given your friends condition and i wouldn't think there'd be a problem. either way, your friend deserves quality of life and i hope that he does find a good solution

one Jurnista ER(24hours) 64mg tablet is the equivalent of 131.5 mcg/hr of Fentanyl.... Although i've had nither, i'd imagine that the Hydromorphone would be a lot superior from what i've read. just something you might find interesting:)


from wikipedia

Hydromorphone is used to relieve moderate to severe pain and severe, painful dry coughing. Hydromorphone is becoming more popular in the treatment of chronic pain in many countries. Hydromorphone displays superior solubility and speed of onset, a less troublesome side effect profile, and lower dependence liability as compared to morphine and diamorphine (heroin). It is thought to be 8-10 times stronger than morphine, but with a lower risk of dependency. Hydromorphone is therefore preferred over morphine in many areas ranging from the emergency department to the operating suite to ongoing treatment of chronic pain syndromes. However, other studies have suggested hydromorphone is less than twice as potent as hydrocodone or oxycodone and therefore just over twice as strong as morphine via oral administration.[3]

Hydromorphone lacks the toxic metabolites (e.g. norpethidine) of many opioids related to pethidine and some of the methadone and tends to cause less nausea than morphine. It is a common alternative for those who tend to have hallucinations from fentanyl administered in the form of skin plasters and other dosage forms.

In addition to the above, hydromorphone usually proves to be the first alternative of choice to morphine and fentanyl in severe chronic pain

phase_dancer
19-04-2010, 11:31
Yeah, thanks Sublimit, I'll look into it and will definitely mention it to him.

hyroller
19-04-2010, 11:54
Haven't heard of any fentanyl prescriptions personally, most I know about this substance is a few folks dying from taking heroin it was laced with (not here though, overseas)

leftwing will be one of the better authorities on the subject matter... if you dig up (so to speak, don't think you'd have to look far!) some of his recent threads you may get some indication :)

Sounds like a rather unfortunate predicament for your friend p_d, on a side note :\

MrIbis
19-04-2010, 12:02
yeah all the hydro-opioid analogues look grand infact.. superior in everyway to their counter-parts.. especially in terms of pain relief, and euphoria

phase_dancer
19-04-2010, 12:07
Sounds like a rather unfortunate predicament for your friend p_d, on a side note

Yeah, not so good. He was once an aspiring DJ, and a good hand on a sound and lighting crew. But he has a fabulous wifey and unconditional support from his friends, so things aren't too bad.

elz
19-04-2010, 12:09
hi i just wanted to add that im currently taking jurnista for pain 20mgs and it works albeit u dont get high, but it does work for pain, would like to increase tho to 32mgs, i think that would be ideal for me but i have to convince the powers that be this

Sublimit
19-04-2010, 14:48
hi i just wanted to add that im currently taking jurnista for pain 20mgs and it works albeit u dont get high, but it does work for pain, would like to increase tho to 32mgs, i think that would be ideal for me but i have to convince the powers that be this


Wow! this is the one that i'm most interested in... especially for pain relief..as you say it works great. If you don't mind me asking... were you on oxycodone before, and what pain was the jurnista prescribed for?

20mg of Hydromorphone 24 ER jurnista is the equivalent of taking 40 mg Oxycodone twice daily which i think would be perfect for my own pain atm in a perfect world! ive a good relationship with my GP so who knows...

leftwing
21-04-2010, 09:32
hydromorphone i'm interested about. i believe jurnista was added to the PBS in may 2009 which is a extended release form of hydromorphone. obviously not commonly prescribed, but i have read that it is being considered for opiate replacement therapy

dilaudid is available for prescription in australia as well. the jurnista are the new OROS system to deter abuse. i hadn't heard about it being considered as part of the ORT scheme, do you have any links to that? i've wanting to mention the jurnista brand of hydromorphone to my doctor for a while now - although i would prefer dilaudid;)


Hi all. For all of you that have had a bad injury or experienced chronic pain in the past, What meds have you been prescribed? and what have you found most effective??

as i've answered in another thread i've used (in this order, i'm only 24 btw)
NSAIDS

Codeine/doxylamine succinate - not a write off like it get's. if it were supplied more liberally in its pure form it would save a lot of peoples livers. good for breakthrough

Tramadol - great, even when my tolerance is through the roof to other traditional opiates.

Norspan - Buprenorphine Patches - worked brilliantly! max dose, had allergic reaction to silicone in the adhesive so changed to

Durogesic - Fentanyl - again i had a problem with the adhesive. opiates being water retentive i sweat a lot more on fentanyl than most other opiates in general and had trouble with the adhesive working properly. i tried many makeshift ways of taping them on. worked fantastic, best with bupe. was able to stay on a stable dose for most the time without raising dose that often.

Oxycodone - started on oxy for a couple of months until my doctor recommended switch to morphine. worked great, tolerance builds rapidly though

Morphine - currently been on it for around 5 months but have slipped further into addiction than ever - picked up a nasty IV habit on top. i find i also still use scripted Tramadol for pain along with codeine, muscle relaxants and benzodiazepines. the morphine class of drugs work well in regards to my pain. only problem with codeine is i have to redose 4-5 times a day which adds up to a 20 pack of pure 30mg tabs - not viable for around the clock, but good for breakthrough.

i'd rather be living pain free, dependent and addiction free.

Sublimit
26-04-2010, 21:57
@Leftwing hey i didn't realise dilaudid was avalable here... regarding jurnista being considered for ORT well i know it is in some European countries and from reading http://en.wikipedia.org/wiki/Hydromorphone#Formulations this (second paragraph).... but i can't find any information about it being used specifically for ORT here yet.

I'm sure your doctor would be well aware of hydromorphone and jurnista for chronic pain maintenance, you should ask him! I recently went from 5mg oxycontin to 10mg for my knee injury, but when i see him next i'm going to be asking about jurista for sure.

Thanks for your summery BTW, you seem to be in a great deal of pain to be prescribed some of those, what sort of pain are you suffering from if you don't mind me asking? sorry to hear about your tolerance to morphine and IV habit developing... I know about that all too well as i'm now 27 and first IV'ed heroin when i was 21, but never had an experience with opiates prior to first using heroin... my interest in other opiates is a result of myself trying to suppress my addiction to heroin. with the 10mg oxy i bought some wheel filters and some 3ml barrels and gave them a go, but really isn't worth it unless i was given stronger oxy pill... i've never had morphine(only the small amount my liver makes me when i use codeine:p) but would like to someday try it... do you get MS contin? i think someone offered that to me once but i didn't know what it was at the time!

I agree that tramadol is good and find it useful in decreasing my tolerance to stronger opiates as it has good analgesic property's for me, but almost no recreational value IMO

megawoof
27-04-2010, 00:48
what you have to consider about hydromorphone when taken orally its very poor ive had the jurnista 16mg tablets and your right there virtually anti-abuse proof rock hard coating on outside when sliced in half half the pill is grey filler i think other half is waxy white you can only eat them i know we are not talking about abusing meds but for people with chronic pain i still would have oxycodone hands down than oral hydromorphone

Sublimit
29-04-2010, 18:11
what you have to consider about hydromorphone when taken orally its very poor ive had the jurnista 16mg tablets and your right there virtually anti-abuse proof rock hard coating on outside when sliced in half half the pill is grey filler i think other half is waxy white you can only eat them i know we are not talking about abusing meds but for people with chronic pain i still would have oxycodone hands down than oral hydromorphone

Thats partly why i'm interested in it, because being a recovering H addict i tend to abuse things like pharmaceutical opiates. with a recent scrip of oxy i was snorting, iv'ing and even stuck em up my arse... just because i could, and subsequently went through 60 10mg pills in 4 days, but with this Jurnista pill, there wouldn't be the urge to do any of that, just take it as prescribed and responsibly... However, i read someone say in another forum that they can be abused by putting the pill in a cup of water for several says and viola! evaporating the water down to a shootable quantity etc.. don't quote me on that. from what i've read, iv hydro is grouse.

So oral hydromorphone's oral bio isn't that great.... how did you find the 16mg pill over 24hrs? from reading your post you seemed pretty underwhelmed

so has anyone been prescribed dilaudid before? i honestly thought that wasn't available here... i guess doctors here aren't going to prescribe hydromorphone as a first line chronic pain med anyway, and i assume the only way would be from not responding well to more traditional opiates, or to ask for it like i'm thinking about doing on my next visit to the gp.

i want to try as many as i possibly can%) responsibly.... and maybe not so responsibly=D

nabollocks
01-05-2010, 23:07
Bupe is ok if you're not in a lot of pain.

Sorry, but that is bullshit. I have been on many different opiates/opioids over the past 10 years, and buprenorphine is hands down the best opioid I have used for prolonged pain management. (Used every day)

For long term PM you want the following:
1. Low abuse potential;
2. Long halflife;
3. Minimal effects on your GI tract;
4. Minimal effects on your immune system;
5. Minimal effects on your cognitive function;
6. Minimal CNS depression.

If you can find me another opiate drug apart from fent that even comes close to the profile of buprenorphine I would be very interested.

Short acting opiates are fun, but they will end up biting your in the arse... sooner rather than later.

symmetry
03-05-2010, 10:48
does anyone know what kinds of medications i'd most likely be prescribed (if any) after shoulder surgery, and how much? i take it they're weary of prescribing too much, just hoping it's not like a completely worthless amount, like only a few days worth

getreal
03-05-2010, 10:59
Codeine and tramadol are obviously the most common ones, but i'm wondering about the less common....I've had a painful tear of the lateral meniscus in my knee and have been seeing my gp for pain management for a few months. I've also had an opiate addiction when i was younger. so i've personally used quite a few opiates
Hey just to give my opinion here. Any opiate that you are going to take will end up being a long term addiction. Is your pain always going to be there? Is there no chance it will get better? Unless you're willing to w/d later,(again) I'd look for something else. Maybe an anti-inflammatory? You've admitted previous abuse habits..........just looking out for you!

For long term PM you want the following:
1. Low abuse potential;
2. Long halflife;
3. Minimal effects on your GI tract;
4. Minimal effects on your immune system;
5. Minimal effects on your cognitive function;
6. Minimal CNS depression.

^This is good advice.

Sublimit
03-05-2010, 14:58
Sorry, but that is bullshit. I have been on many different opiates/opioids over the past 10 years, and buprenorphine is hands down the best opioid I have used for prolonged pain management. (Used every day)


Short acting opiates are fun, but they will end up biting your in the arse... sooner rather than later.

I'm sorry you took offence to that, but you must realise that everybody is different and everybody is going to have their own opinions and experiences on what works best for pain. That bit of text you quoted me on was solely from my own experience on Bupe... maybe i could have worded it a bit different, but anyway...

So let me elaborate on my experience with Buprenorphine...

firstly, from my experience with various opiates, i seem to believe the ones with the 'longer' half life's are in fact harder to come off and not the other way around like you suggested, and interestingly enough, the hardest WD i've ever gone through was coming off bupe... Simply because of the length of the time it took for me to feel better. Now comparing that with Heroin, well of course the WD might be more intense, but after 3 days i feel normal and i can handle it without other drugs, or without relapsing however, when i came off bupe i remember thinking on the third day that it will be over soon... but as it turned out it was only the beginning and by 6 days of cold turkey i had relentless incredible lower back pain which took well over a week to subside and probably 2 weeks to feel normal(i was on a moderate dose and reduced to a small dose, i think i was at 2mg a day when i jumped off it and went to Queensland)

No i wasn't on Bupe for pain management at the time. it was when i went on it for opiate replacement several years ago, so i guess i'm not judging it from my 5 or so months on it, but more recently i was prescribed it in the form of a Norspan patch, 5mg ones which release 5mic grams an hour... Well i find it funny you say it has less abuse potential because after 2 days i ended up chewing another patch and subsequently got 5mgs in an hour and got a nice little buzz from it that lasted a long time, but unfortunately (for me) not much pain relief.

I assume your experience with Bupe is from the patches, unless you're on a Subutex or Suboxone program, which in your case wouldn't be such a bad idea seeing as its so effective for you. but for me those patches don't suffice, they have abuse potential and unless i go back on a program and get something like 12-15mg of bupe each day, then i don't see it managing my pain, and i'm not willing to go there again because i have better options for getting sufficient pain relief from more appropriate opiates which atm my doctor is happy to prescribe Oxycodone, and hopefully Hydromorphone in the near future...

Sublimit
03-05-2010, 15:31
does anyone know what kinds of medications i'd most likely be prescribed (if any) after shoulder surgery, and how much? i take it they're weary of prescribing too much, just hoping it's not like a completely worthless amount, like only a few days worth

It all depends on you.

I don't want to give the wrong advise, but if you're genuinely in a lot of pain then you should be prescribed accordingly, however, your doctor may be reluctant to prescribe anything decent if you have a history of drug dependence/abuse in which case i'd suggest seeing a new doctor.

It can also depend on how old you are too, and to a lesser extent on how you present yourself.... it's always good to be honest, but sometimes you have to avoid saying "i have a tolerance to opiates as i used to abuse them" because 9 out of 10 times you'll be looked at like you're just wanting to get high instead of needing sufficient pain management

So my advise to you would be; wait until you have surgery and see how much pain you're in.... If you get prescribed something like tramadol and are still in pain then you need to go back to your doctor and tell him. during the procedure you should be given something for pain then, and i'm just guessing it should be endone which is oxycodone. if thats the case, and if you found it to be sufficient then you could suggest that to your doctor and see what he says... you could even show him the diagnostic report of your surgery and it should have what they gave to you for pain on it.

good luck.

Sublimit
03-05-2010, 15:43
Hey just to give my opinion here. Any opiate that you are going to take will end up being a long term addiction. Is your pain always going to be there? Is there no chance it will get better? Unless you're willing to w/d later,(again) I'd look for something else. Maybe an anti-inflammatory? You've admitted previous abuse habits..........just looking out for you!
.

Hey i appreciate the advise and to answer your questions.

No, my pain won't always be there(i hope)

Yes, I'm waiting to have an MRI in a couple of weeks and possibly a subsequent operation... how long it will all take is not certain, but it's in the process.

NSAIDS are not for sever chronic pain, ive talked about using them in conjunction with opiates with my doctor, and are currently taking some Ibuprofen, but again, it's not that good for you to these things for long periods of time and my doctor knows this... the only reason why opiates aren't %100% suitable for me is my affection for them, and i know i need to show them more respect... myself too for that matter.

woamotive
03-05-2010, 15:52
I've been prescribed tramadol. Then vicodin, percs. Now I get 120 oxy 15's a month.

The 120 oxy 15's are prescribed for chronic pain/arthritis/etc. Also, for one month I was given 60 20mg oxycontins in addition.

Last month I was given 60 15mg morphine sulfates (before the switch to oxycodone). I like where I'm at now, best ;) .

symmetry
03-05-2010, 18:45
It all depends on you.

I don't want to give the wrong advise, but if you're genuinely in a lot of pain then you should be prescribed accordingly, however, your doctor may be reluctant to prescribe anything decent if you have a history of drug dependence/abuse in which case i'd suggest seeing a new doctor.

It can also depend on how old you are too, and to a lesser extent on how you present yourself.... it's always good to be honest, but sometimes you have to avoid saying "i have a tolerance to opiates as i used to abuse them" because 9 out of 10 times you'll be looked at like you're just wanting to get high instead of needing sufficient pain management

So my advise to you would be; wait until you have surgery and see how much pain you're in.... If you get prescribed something like tramadol and are still in pain then you need to go back to your doctor and tell him. during the procedure you should be given something for pain then, and i'm just guessing it should be endone which is oxycodone. if thats the case, and if you found it to be sufficient then you could suggest that to your doctor and see what he says... you could even show him the diagnostic report of your surgery and it should have what they gave to you for pain on it.

good luck.

hey, thanks for the advice

i don't have any history of drug abuse or dependence (or none that anyone knows about or has been medically recorded)

i have epilepsy and tramadol has a record of provoking seizures and it's very important i don't have a seizure post-op so i doubt they'll prescribe me that

i'm sure oxy has a recorded history of provoked seizures as well, but i've tried it before with no problems, nor with fentanyl

oh well, see what happens i guess. just looking to get active again as quickly as possible after the surgery and have heard that it can be painful

nabollocks
03-05-2010, 19:21
No i wasn't on Bupe for pain management at the time. it was when i went on it for opiate replacement several years ago, so i guess i'm not judging it from my 5 or so months on it, but more recently i was prescribed it in the form of a Norspan patch, 5mg ones which release 5mic grams an hour... Well i find it funny you say it has less abuse potential because after 2 days i ended up chewing another patch and subsequently got 5mgs in an hour and got a nice little buzz from it that lasted a long time, but unfortunately (for me) not much pain relief.


There are a couple of things I would like to address in your post:

1. When used as maintenance drugs, both buprenorphine and methadone do not 'seem' to attribute any pain relieving properties. This has been covered in the literature many times. We are speaking two different languages here.

2. You should not have ingested that Norspan patch. Check the BA of oral Bup. 5mg is a very low dose of the Norspan patch, and should only be used as a starting dose. It is normal for people to be prescribed up to 40mg/week. Therefore I think you were a little fast to write off the patches.

For the record, I have had both Norspan and Suboxone, and am currently on Suboxone for pain management.

rachamim
03-05-2010, 20:48
Personally, I became an opiate/opioid addict because of an injury. At age 17 I took pieces of a bullet through the underside of my chin, through my jaws and up into my sinus cavities. Within 11 months I took a shrapnel injury from a mortar shell. It was the 2nd wound that got me addicted though I had still been coping via medication on the 1st wound.

I was given morphine, the gold standard for analgesia.

With analgesia subjectivity has so much to do with it. Some substances like tramadol (Ultram), nabulphine (Nubain) and butorphanol (Stadol) are entirely subjective medications that only even effect (both with analgesia AND psychoactivity, i.e. "The high") some people. For example, with the latter 2 women are more likely to gain benefit than males, etc. Go figure.

Anyway, codeine IS morphine. Your body metabolises it (primarily) into morphine via O-demethylation so it is again, subjective to a high degree. In addition, codeine (and also buperenorphine) have metabolic ceilings. Codeine's is usually 600 mgs. Above that dosage and you can eat it all day with no greater effect.

Then you have to consider medications that utilise paracetemol (aka "APAP/acetemenophine), and/or caffeine which also have a real effect on analgesia.

The point? A thread like this is great to kill time, even somewhat interesting to read for many but will have absolutely no role in helping you to find a med that works for you.

rachamim
03-05-2010, 20:53
Symmetry: Yes, tramadol DOES cause ulcers but ONLY in excesive dosages in which case just about any medication can have the same effect. For some reason the American FDA (Food and Drug Admin) latched onto that adverse side effect (maybe as a raison d'etre in pushing for controls on a substance that would have been the only opioid (debatable classification) without any controls whatsoever. Instead, it is now classified with nabulphine as Unschedualed (in the US) but with FDA controls. A lot of games get played.

If I were offered Tramadol I would be angry because of its spotty utility, and I would use the "seizures" spiel to get a truly worthwhile substance but in the end it is safe within prescribed dosages.

rachamim
03-05-2010, 21:06
I have to chime in on methadone and bupe since, in re-reading this thread, I saw a well written post talking about MMT/MAT (Opioid Substitution Therapy) and analgesia...

Methadone , as the poster stated, will have no effect (actually will always have a very minimal 1 but anyway) when given for analgesia to a patient on methadone maintenance. This is true of any substance to which your body has been aclimated. You need to exceed the dose BUT this CAN be done with methadone as well as with any substance.

In other words, IF the poster was saying that IF a patient on methadone maintenance was hoping for analgesia ON THEIR MAINTENANCE DOSAGE, then they would be sorely disappointed.

This is true, as I said, of any opiate/opioid. A knowledgeable pain specialist (granted they are rare indeed) can take the maintenance dosage into effect when dealing with a protocol for analgesia.

Bupe, as I mentioned in my first post, has a metabolic ceiling so it is really rotten for long term pain treatment.

Now, another reason why neither bupe nor methadone should ever be prescribed for analgesia in any scenario; Both subnstances have insamely long half lives. Both substance analgesic AND psychoactive properties are roughly 1/3rd their half life in duration.

Said plainly, if you are unacclimated (have no "tolerance") and dose on 30 mgs of methadone at 7 AM, by 7 PM you will not have any noticeable psychoactive or analgesic benefit.Your next schedualed dose would be 7 AM the following day. That leaves you with 12 very pensive hours and when one is in pain, or abusing/misusing their medication this is a surefire recipe for re-dosing. Since the half life is roughly 36 hours for methadone, you are in a very dangerous position IF you re-dose in only 12 hours.

This is why methadone ends up killing more chronic pain patients than any other opiate/opioid (when last I checked which granted must have been 2008).

Prescribers and patients were in love with it because unlike, say morphine which requires redosing from, between every 4 and 12 hours , methadone was once a day and has 100% bioavailability orally (versus 33% for morphine, etc). When people started dropping in the US, some practicioners began rethinking that new found love affair.

Suprisingly, neither the FDA now the DEA rang the alarm and "busines" continued as usual.

Crankinit
11-05-2010, 09:08
Hey I know it's not strictly on topic, but since this thread is about pain management, has anybody tried baclofen as a muscle relaxant to help with back pain? Having basically given up on any effective short term cure, I raised the subject of pain meds again with my doctor and she mentioned it as something that might be worth a shot. I'm a little sceptical, since I tried norflex (orphenadrine), which provided moderate pain relief but was also heavily sedating (almost too much to be of any use), but apparently baclofen is less problematic in that regard. I did some reading, but most of it was in regard to baclofen's role in drug replacement therapy for alcoholics, and not as an analgesic.

Sublimit
13-05-2010, 17:31
is one pack of endone an authority script?

leftwing
14-05-2010, 02:11
Hey I know it's not strictly on topic, but since this thread is about pain management, has anybody tried baclofen as a muscle relaxant to help with back pain? Having basically given up on any effective short term cure, I raised the subject of pain meds again with my doctor and she mentioned it as something that might be worth a shot. I'm a little sceptical, since I tried norflex (orphenadrine), which provided moderate pain relief but was also heavily sedating (almost too much to be of any use), but apparently baclofen is less problematic in that regard. I did some reading, but most of it was in regard to baclofen's role in drug replacement therapy for alcoholics, and not as an analgesic.

i'm prescribed baclofen as a muscle relaxant in combination with valium on top of my morphine and tramadol for my spinal condition. i don't have a bad word to say about, unless you go taking absurd amount trying to get high - its not recreational in the least; it will leave you knocked out, motor skills wiped out, and just a down right disgusting feeling altogether. it's also an extremely effective anti-anxiety medicine too, on par with valium imo.

you're right that it'sb een trialled in alcohol replacment, that's the main literature i found on it when researching before having it prescribed. it's not an analgesic, its a muscle relaxant.

FWIW - i've never experienced any withdrawal symptoms upon ceasing it.

here's MIMS info, it's long so i put it in NSFW

Baclofen Alphapharm Pty Ltd
MIMS Abbreviated Prescribing Information
Section: 5(c) Muscle relaxants
Consumer Medicine Information: Available
Pregnancy Category: B3
Sport Category: Permitted in sport
Uses/Indications: Centrally acting muscle relaxant (antispastic agent). Suppression of voluntary muscle spasm in MS, spinal lesions of traumatic, infectious, degenerative, neoplastic or unknown origin causing skeletal hypertonus, spastic and dyssynergic bladder dysfunction. Not recommended in Parkinson's disease or spasticity assoc with stroke, cerebral palsy, rheumatoid disorder
Precautions: Convulsive (eg epilepsy), psychiatric (incl history) disorders; confusional states; cortical, subcortical brain damage, significant EEG abnormality; peptic ulcer incl history; cerebrovascular disease eg stroke; hypertension; respiratory failure; hepatic, renal impairment; monitor respiratory, CV function; porphyria; alcoholism history; diabetes; urinary sphincter hypertonia; spasticity dependent upright posture, balance in moving; abrupt withdrawal; high dose; elderly; pregnancy, lactation, children < 16 yrs
Adverse Reactions: Sedation, somnolence; GI upset; psychiatric, visual disturbances; hypotension; decr cardiac output; lowered seizure threshold; myalgia, muscular weakness, hypotonia; dizziness; impaired alertness; respiratory depression; dysuria, enuresis; dry mouth; hyperhidrosis; rash; pruritus; paradoxical spasticity; incr blood glucose; others, see full PI
Drug Interactions: Alcohol; CNS acting agents incl TCAs, MAOIs; Li; hypoglycaemics incl insulin; antihypertensives; levodopa + carbidopa; diazepam
CLOFEN (Tablets) Prescription required. S4 This product may cause drowsiness.
Baclofen; lactose; white scored; gluten free;
Dose: Should be taken with food. Individualise dose; admin in greater than or equal to 3 divided doses (adults). Adults: initially 15 mg/day; may incr by 15 mg/day every 3 days; usual optimum range 30-75 mg/day; max 100 mg/day, see full PI. Renal impairment: 5 mg/day; see full PI
Pack: 10 mg [100] Brand substitution is permitted. : PBS/RPBS (Rp 5) PBS: $32.08
Pack: 25 mg [100] Brand substitution is permitted. : PBS/RPBS (Rp 5) PBS: $60.09

Clofen 10 mg

Clofen 25 mg


MIMS Full Prescribing Information
Section: 5(c) Muscle relaxants SECTION NOTES
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Composition
Active. Baclofen.
Inactive. Lactose, microcrystalline cellulose, anhydrous calcium hydrogen phosphate, sodium starch glycollate, anhydrous colloidal silica, magnesium stearate.
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Description
Chemical name: (3RS)-4-amino-3- (4-chlorophenyl) butanoic acid. Molecular formula: C10H12ClNO2. MW: 213.7. CAS: 1134-47-0. Baclofen is a white or almost white powder which is slightly soluble in water, very slightly soluble in ethanol (96%), practically insoluble in acetone and in ether. It dissolves in dilute mineral acids and in dilute alkali hydroxides.
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Actions
Antispastic agent. Baclofen is a derivative of gamma-aminobutyric acid (GABA).
Pharmacology. Baclofen is an effective antispastic agent with a spinal site of action. Its mechanism of action and pharmacological properties are different from those of other antispastic agents.
Baclofen also has central sites of action given the adverse event profile and general CNS depressant properties.
Baclofen depresses monosynaptic and polysynaptic reflex transmission, probably by various actions, including stimulation of GABAbeta-receptors. This stimulation in turn inhibits the release of excitatory amino acids (glutamate and aspartate) in guinea pig preparations. Neuromuscular transmission is not affected by baclofen.
Baclofen exerts an antinociceptive effect. The clinical significance of this awaits clarification. In neurological diseases associated with spasm of the skeletal muscles, the clinical effects of baclofen take the form of a beneficial action on reflex muscle contractions and of marked relief from painful spasm, automatism and clonus. Baclofen, where indicated, improves the patient's mobility, making for greater independence and facilitating passive and active physiotherapy. Baclofen stimulates gastric acid secretion.
Pharmacokinetics. Absorption. Baclofen is rapidly and completely absorbed from the gastrointestinal tract. Maximum concentrations of unchanged drug are achieved in plasma in two to four hours after an oral dose.
The onset of action is highly variable and may range from hours to weeks.
Distribution. The distribution volume of baclofen amounts to 0.7 L/kg. In cerebrospinal fluid, the active substance attains concentrations approximately 8.5 times lower than in the plasma.
Baclofen is bound to plasma proteins to the extent of approximately 30%.
Metabolism. About 15% of the baclofen dose is metabolised in the liver. Deamination yields the main metabolite, beta-(chlorophenyl)- gamma-hydroxybutyric acid, which is pharmacologically inactive.
Excretion. Approximately 70% of baclofen is eliminated in the urine in the unchanged form. The plasma elimination half-life of baclofen averages three to four hours. Within 72 hours, approximately 75% of the dose is excreted via the kidneys, approximately 5% of this quantity being in the form of metabolites. The remainder of the dose, including 5% as metabolites, is excreted in the faeces.
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Indications
Suppression of voluntary muscle spasm in multiple sclerosis and in spinal lesions of traumatic, infectious, degenerative, neoplastic and unknown origin, causing skeletal hypertonus and spastic and dyssynergic bladder dysfunction.
Baclofen is not recommended in Parkinson's disease or spasticity arising from strokes, cerebral palsy or rheumatoid disorders.
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Contraindications
Known hypersensitivity to baclofen or any of the components of the formulation.
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Precautions
Abrupt discontinuation. Anxiety and confusional states, hallucinations, psychotic, manic or paranoid states, convulsions (status epilepticus), dyskinesia, tachycardia, hyperthermia and, as a rebound phenomenon, temporary aggravation of spasticity, have been reported upon the abrupt withdrawal of baclofen, especially after long-term medication. Except in overdose related emergencies or where serious adverse effects have occurred, treatment should, therefore, always be gradually withdrawn by successive dosage reduction over a period of approximately one to two weeks.
If withdrawal symptoms occur, restarting baclofen therapy and withdrawing over a longer period may help to resolve withdrawal problems.
Mental disorders. Patients suffering not only from spasticity but also from psychotic disorders, schizophrenia, depressive or manic disorders or confusional states should be treated cautiously with baclofen and kept under careful surveillance, because exacerbations of these conditions may occur.
Epilepsy or other potential convulsive conditions. Caution is needed in patients with epilepsy or other convulsive conditions, cortical or subcortical brain damage or significant electroencephalogram (EEG) abnormalities, since ingestion of baclofen may cause deterioration of seizure control and EEG changes, and may precipitate convulsions. In patients with epilepsy and muscle spasticity, baclofen can be used under appropriate supervision, provided adequate anticonvulsive therapy is continued.
Lowering of the convulsion threshold may occur and seizures have been reported occasionally after cessation of baclofen or with overdosage.
Other concomitant conditions. Baclofen should be used with caution in patients with the following.
Peptic ulcers or with a history of peptic ulcers;
cerebrovascular diseases or respiratory, hepatic or renal failure (due to increased risk of central nervous system, respiratory and cardiovascular depression);
porphyria;
history of alcoholism;
diabetes mellitus (baclofen may increase blood glucose concentrations); and
hypertension (see Interactions).
Changes in muscle tone. Baclofen should be used with caution in patients who use spasticity to maintain an upright posture and balance in moving. If an undesirable degree of muscular hypotonia occurs, making it more difficult for patients to walk or fend for themselves, this can usually be relieved by adjusting the dosage (i.e. by reducing the doses given during the day and possibly increasing the evening dose).
During treatment with baclofen, neurogenic disturbances affecting emptying of the bladder may improve, whereas in patients with pre-existing sphincter hypertonia, acute retention of urine may occur. The drug should, therefore, be used with caution in such cases.
Impaired renal function. Since baclofen is largely eliminated by the kidneys, a dosage reduction is advised to avoid drug accumulation (see Dosage and Administration).
Impaired hepatic function. Because baclofen is partially metabolised in the liver, patients with impaired hepatic function should be periodically monitored with laboratory tests (see Dosage and Administration).
Use in the elderly. See Dosage and Administration.
Carcinogenesis, mutagenesis, impairment of fertility. Carcinogenicity and mutagenicity. A two year carcinogenicity study in rats found no evidence that baclofen had carcinogenic potential at oral doses up to 100 mg/kg/day. An apparently dose related increase in the incidence of ovarian cysts and of enlarged and/or haemorrhagic adrenals at the highest two doses (50 and 100 mg/kg/day) was observed in female rats. The clinical relevance of these findings is not known.

Ovarian cysts have been found by palpation in about 5% of the multiple sclerosis patients who were treated with oral baclofen for up to one year. In most cases these cysts disappeared spontaneously while patients continued to receive the drug. Ovarian cysts are known to occur spontaneously in a proportion of the normal female population.
Baclofen did not induce mutations in bacterial or mammalian cells in vitro, lacked DNA damaging activity in the sister chromatid exchange assay, and had no clastogenic activity in the nuclear anomaly test.
Use in pregnancy. (Category B3)

In two teratogenic studies in pregnant rats, baclofen has been shown to increase the incidence of omphaloceles (ventral hernias) in fetuses, at a dose of 20 mg/kg/day, which is maternotoxic. The relevance of this finding to humans is unknown. At the same dose there was also an increased incidence of incomplete sternebral ossification in the fetuses.

In mice, no teratogenic effects were observed at a dose of 81.5 mg/kg/day given via the diet or up to 40 mg/kg/day given by gavage. At 40 mg/kg/day by gavage, a delay in fetal growth was associated with maternal anorexia. The lack of maternotoxicity seen in the dietary study suggests that the dose used was inadequate.

In pregnant rabbits, oral doses up to 10 mg/kg/day were manifested as a sedative effect. Skeletal examination of fetuses revealed a marked increase in the absence of ossification of the phalangeal nuclei of fore limbs and hind limbs.
There are no studies in pregnant women.

Use in lactation. Studies in lactating women are limited to one patient. In this particular case, available evidence suggests that baclofen is found in quantities so small that undesirable effects in the infant would have been unlikely.
Use in children. Baclofen should be given with extreme caution to children under 16 years, as only limited data are available.

Effect on ability to drive or operate machinery. Baclofen may be associated with dizziness, sedation, somnolence and visual disturbance (see Adverse Reactions) which may impair the patient's reaction. Patients experiencing these adverse reactions should be advised to refrain from driving or using machines.
The patient's ability to react may be adversely affected by sedation and decreased alertness caused by baclofen. Patients should, therefore, exercise due caution when driving a vehicle or operating machinery.
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Adverse Reactions
Unwanted effects mainly occur at the start of treatment, if the dosage is increased too quickly, if large doses are used, or if the patient is elderly. They are often transitory and can be attenuated or eliminated by reducing the dosage. They may necessitate withdrawal of the medication.
In patients with a history of psychiatric illness, cortical or organic brain disorders, or with cerebrovascular disorders (e.g. stroke), as well as elderly patients, adverse reactions may be more serious.
It is often difficult to distinguish whether some of these are drug effects or manifestations of the diseases under treatment. Psychiatric manifestations can occur in acute or chronic toxicity due to baclofen.
Lowering of the convulsion threshold and convulsions may occur, particularly in epileptic patients (see Precautions).
Certain patients have shown increased spasticity as a paradoxical reaction to the medication.
The following frequency estimates apply. Very common: greater than or equal to 10%; common: greater than or equal to 1% to < 10%; uncommon: greater than or equal to 0.1% to < 1%; rare: greater than or equal to 0.01% to < 0.1%; very rare: < 0.01%.
Cardiac disorders. Common: cardiac output decreased.
Rare: arrhythmias, palpitations, chest pain.
Vascular disorders. Common: hypotension.
Rare: dyspnoea, ankle oedema.
Gastrointestinal disorders. Very common: nausea (particularly at the start of treatment).
Common: gastrointestinal disturbance, constipation, diarrhoea, retching, vomiting.
Rare: colicky abdominal pain, anorexia.
Hepatobiliary disorders. Rare: hepatic function abnormal.
Nervous system disorders. Very common: sedation, somnolence.
Common: respiratory depression, lightheadedness, lassitude, exhaustion, confusional state, dizziness, personality changes, vertigo, headache, insomnia, euphoric mood, depression, muscular weakness, ataxia, tremor, hallucinations, nightmares, myalgia, nystagmus, dry mouth, tinnitus.
Rare: paraesthesiae, dysarthria, dysgeusia, syncope, dyskinesia, coma, taste disturbances.
Very rare: hypothermia.
Eye disorders. Common: accommodation disorders, visual disturbances.
Skin and subcutaneous tissue disorders. Common: hyperhidrosis, rash, pruritus.
Renal and urinary disorders. Common: pollakiuria, dysuria, enuresis.
Rare: urinary retention, nocturia, haematuria.
Reproductive system and breast disorders. Rare: erectile dysfunction, inability to ejaculate.
Miscellaneous. Rare: nasal congestion, weight gain.
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Interactions
Where baclofen is taken concomitantly with other drugs acting on the central nervous system, or with alcohol, increased sedation may occur (see Precautions). The risk of respiratory depression is also increased.
During concurrent treatment with tricyclic antidepressants, the effect of baclofen may be potentiated, resulting in pronounced muscular hypotonia.
The concurrent use of baclofen with monoamine oxidase inhibitors (MAOIs) may result in increased CNS depressant and hypotensive effects. Caution is recommended and dosage of one or both agents may require reduction.
Aggravation of hyperkinetic symptoms may possibly occur in patients taking lithium.
Since baclofen may increase blood glucose concentrations, dosage adjustments of insulin and/or oral hypoglycaemic agents may be necessary during and after concurrent therapy.

Since concomitant treatment with baclofen and antihypertensive agents is likely to increase the risk of hypotension, the dosage of antihypertensive medication should be adjusted accordingly.

In patients with Parkinson's disease receiving treatment with levodopa plus carbidopa, who additionally required use of baclofen, there have been reports of mental confusion, hallucinations, headaches, nausea and agitation.
Studies in rats indicate that the agonistic effects of baclofen on gastric acid secretion are potentiated by diazepam.
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Dosage and Administration
Treatment with baclofen should always be started in hospital using small doses which are then gradually increased stepwise. The optimum daily dosage should be individually adapted to each patient's requirements, so that clonus, flexor and extensor spasms, and spasticity are reduced, at the same time retaining enough muscle tone to permit active movements, and avoiding adverse effects as far as possible.

Abrupt discontinuation of treatment should be avoided (see Precautions).
Clofen should be taken during meals with a little liquid.
Adults. In adults, Clofen should be given in at least three divided doses daily.
Dosage regimen. As a rule, treatment should be started with a dose of 5 mg three times daily, subsequently increased at three day intervals by 5 mg three times daily (i.e. the dosage regimen is 5 mg three times a day for three days, then 10 mg three times a day for three days) until the optimum response has been attained. In certain patients reacting sensitively to drugs, it may be advisable to begin with a lower daily dose (5 or 10 mg), increased by smaller steps at longer intervals. The optimum dosage generally ranges from 30 to 75 mg daily, although occasionally in hospitalised patients daily doses up to 100 mg may be necessary.
If no benefit is apparent within six to eight weeks of achieving the maximum dosage, a decision whether or not to continue treatment with baclofen should be made.
Impaired renal function. In patients with impaired renal function or undergoing chronic haemodialysis, low doses (i.e. approximately 5 mg daily) should be used. Signs and symptoms of overdosage have been reported with doses above 5 mg daily in this setting (see Overdosage).
Elderly. Since unwanted effects are more likely to occur in elderly patients (due to increased risk of renal function impairment and CNS toxicity), a very cautious dosage schedule should be adopted and the patient kept under appropriate surveillance.
Toxicity due to baclofen may be taken for uraemic encephalopathy.
Children. Baclofen should be given with extreme caution to children under 16 years, as only limited data are available.
Monitoring advice. Since in rare instances elevated AST, alkaline phosphatase or glucose levels in the serum have been recorded, appropriate laboratory tests should be performed periodically in patients with liver diseases or diabetes mellitus, in order to ensure that no drug induced changes in these underlying diseases have occurred.
Careful monitoring of respiratory and cardiovascular function is essential especially in patients with cardiopulmonary disease and respiratory muscle weakness.
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Overdosage
Symptoms. Prominent features are signs of central nervous depression: drowsiness, impairment of consciousness, respiratory depression due to absent respiratory movement, coma.

Also liable to occur are: confusion, hallucinations, agitation, accommodation disorders, absent pupillary reflex; generalised muscular hypotonia, myoclonia, hyporeflexia or areflexia; convulsions; peripheral vasodilatation, hypotension or hypertension, bradycardia or tachycardia; hypothermia; nausea, vomiting, diarrhoea, hypersalivation; elevated lactate dehydrogenase (LDH), aspartate transaminase (AST) and alkaline phosphatase (ALP) values. A deterioration in the condition may occur if various substances or drugs acting on the central nervous system (e.g. alcohol, diazepam, tricyclic antidepressants) have been taken at the same time.

Adult patients have ingested up to baclofen 1,125 mg and survived. Ingestion of 1,250 to 2,500 mg by one patient was fatal. Serious poisoning has occurred with doses of 150 and 300 mg in adults.

Treatment. No specific antidote is known.

Supportive measures and symptomatic treatment should be given for complications, e.g. hypotension, hypertension, convulsions, gastrointestinal disturbances, and respiratory or cardiovascular depression.
Symptomatic treatment should include the following.
Elimination of the drug from the gastrointestinal tract, e.g. administration of activated charcoal; if necessary, saline laxatives.
Since the drug is excreted chiefly via the kidneys, generous quantities of fluid should be given, possibly together with a diuretic.
Measures in support of cardiovascular functions.
In the case of respiratory muscle weakness, administration of artificial respiration.
In the event of convulsions, diazepam should be administered cautiously intravenously, paying attention to increased muscle relaxation, and possible respiratory insufficiency, if the patient is not already being artificially ventilated.
Contact the Poisons Information Centre on 131 126 (Australia) for advice on management of overdosage.
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Presentation
Tablets (white, flat bevelled edged, marked G on reverse), 10 mg (marked BN/10): 100's; 25 mg (marked BN/25): 100's.
Clofen 10 mg; Clofen 25 mg.
Storage Store below 30 deg. C. The tablets should be kept out of reach of children.
Poison Schedule S4.
Date of TGA Approval or Manufacturer's Last Amendment 28/05/2007

leftwing
14-05-2010, 02:20
@Leftwing hey i didn't realise dilaudid was avalable here... regarding jurnista being considered for ORT well i know it is in some European countries and from reading http://en.wikipedia.org/wiki/Hydromorphone#Formulations this (second paragraph).... but i can't find any information about it being used specifically for ORT here yet.

I'm sure your doctor would be well aware of hydromorphone and jurnista for chronic pain maintenance, you should ask him! I recently went from 5mg oxycontin to 10mg for my knee injury, but when i see him next i'm going to be asking about jurista for sure.

Thanks for your summery BTW, you seem to be in a great deal of pain to be prescribed some of those, what sort of pain are you suffering from if you don't mind me asking? sorry to hear about your tolerance to morphine and IV habit developing... I know about that all too well as i'm now 27 and first IV'ed heroin when i was 21, but never had an experience with opiates prior to first using heroin... my interest in other opiates is a result of myself trying to suppress my addiction to heroin. with the 10mg oxy i bought some wheel filters and some 3ml barrels and gave them a go, but really isn't worth it unless i was given stronger oxy pill... i've never had morphine(only the small amount my liver makes me when i use codeine:p) but would like to someday try it... do you get MS contin? i think someone offered that to me once but i didn't know what it was at the time!

I agree that tramadol is good and find it useful in decreasing my tolerance to stronger opiates as it has good analgesic property's for me, but almost no recreational value IMO

i've got spondylolisis to my L4, L5 and S1, as well as sclerosis on both my facet joints, plus a slight case of scoliosis (curvature of lower back). so yeah, i got a pretty bad back. my dad has the same problem and being hereditary out of his 3 sons i got the worst of it. my older brother has scoliosis as well as my younger brother but they don't suffer much pain at all

and yes, i get mscontins, i'm prescribed 120mg/day (2 x 60mg), 75-100mg baclofen, plus tramadol as needed and 10mg valium/day or as needed.

i'm pretty happy on my current regime so don;t think i;'ll ask about jurnista for a while yet, though i have an appointment today so may bring it up to see his thoughts.


is one pack of endone an authority script?

no, repeat scripts require authority if required for more than a months use.

Sublimit
15-05-2010, 12:01
^^^
Arhh sorry to hear about your condition Leftwing, but yeah your regime seems like it would suffice... how did your appointment with your GP go? did you bring up Jurnista? and if so, what did he say about it?

the reason why i'm asking about endone being an authority script is because i basically want to know if i see another doctor and get some endone would that get me in a lot of trouble...

since i started this thread my doctor has given me 3 authority scripts, 3 packs of 5mg oxycontin, then 10mg and then 20mg... 60 tablets at a time, and every time i've came back around 2 and a half weeks and said that i've needed to use more than prescribed and he's understood and up'd the dosage accordingly.

i live in a share house and a few days ago i had 2 packs of 20mg oxycontin (40 tablets) stolen and i really don't want to go back to my doctor and tell him this because he's been great with my pain management and the last thing i want is him to think that i'm an untrustworthy person... i've been contemplating seeing another doctor to get sufficient pain management just enough until i'm due to see my regular doctor again, and thats the reason why i'm asking about what is and what isn't an authority script.

i don't want to get in any trouble and if i see another doctor and get one pack of anything... even 20mg oxycontin it isn't an authority script right? only if it's more than a months worth.. i really don't know what to do, but i know i don't want to go to my regular doctor and tell him what happened, i'd rather avoid that as much as possible, but i'm not even sure if going to a new doctor will get me in any trouble... i know if it's an authority script i will, but if it's just a restricted script i won't... i've been searching the PBS site trying to find this information out but it's not really giving me much of an idea

what should i do??

Crankinit
15-05-2010, 12:43
what should i do??

Beat the hell out of whoever stole them, for starters. Shits not cool.

Sublimit
15-05-2010, 12:48
Beat the hell out of whoever stole them, for starters. Shits not cool.

yeah i would if i knew who took them... i have a pretty good idea of who, but i can't prove it... i'm over living with these young pricks that have no respect for other peoples property

Crankinit
15-05-2010, 12:50
I'd buy a safe or something bro, no way I'd live in a sharehouse without somewhere secure I can lock all my valuables and illicits.

Sublimit
15-05-2010, 13:09
yeah thats good advise... i trust the people i live with, but when someone throws a party and invites around wankers then thats when i need eyes in the back of my head... but yeah,, moving out in a month back home with the folks so hopefully this won't happen again

madmick19
15-05-2010, 15:08
heya sublimit, you are heading into treacherous territory with your pain management. Froim my experience with GP's they are not specialists in pain management, see if you could get a referral to a pain management specialist.

Running out of your medication early is not necessarily a good thing, plus it shows you are on your way with buidling a tolerance. This will impact your ability to access breakthrough pain medication. Ask for a referral to a pain management/addiction medicine specialist for review. They generally understand opiates better than any GP i've come across.

theres a line that many people on prescription opiates cross between addiction and effective pain management without seeing it. where effective pain management becomes dependance and addictogenic like behaviours

madmick19
15-05-2010, 15:37
Australian trends in opioid prescribing for chronic non-cancer pain, 1986-1996 (http://www.mja.com.au/public/issues/jul7/bell/bell.html)
The clinical impression is that dose escalation may be more likely in patients taking the potent, short-acting drug dextromoramide, and less likely in those taking low potency codeine or long-acting methadone. Despite the small numbers (see Box), the difference in the proportion of patients taking these different drug types whose opioid dose escalated approached significance (P = 0.053).

Thirty-three patients (32.4%; 95% CI, 23.4%-42.3%) were still receiving S8 opioids five years later (although many were receiving a different S8 opioid in 1996).

Twenty-six of the 102 patients (25.5%; 95% CI, 17.4%-35.1%) received escalating doses of opioids: 21 of the 33 patients who were still receiving opioids on authority in 1996, and five of the 69 people not receiving opioids on authority in 1996 (chi-squared = 44.69; 1df; P < 0.005). Patients receiving opioids for the full five years were more likely to escalate their dose (odds ratio, 22.4; 95% CI, 7.1-71.0). It is unlikely that escalation was simply a function of patients beginning with a low initial dose of opioid. Converting initial doses to equivalents of oral morphine, the group whose doses did not escalate began with a mean dose of 80 mg of oral morphine per day, while the group whose doses did escalate began with a mean dose of 87 mg per day.

madmick19
15-05-2010, 15:42
Thought these might be some handy numbers for people, if you want a referral to a pain/addiction specialist in your area; it might be worth contacting these S8 licencing bodies to find out where the major addiction/pain specialist clinics are.

Prescribing drugs of dependence: State and territory contacts

ACT Pharmaceutical Services Section, ACT Health: 02 6207 3974
ACT Opiate Treatment Service ACT Health (http://www.health.act.gov.au/c/health?a=da&did=10038160&pid=1058841069): 02 6244 2591

NSW Pharmaceutical Services Branch, NSW Health: 02 9879 3214

NT Poisons Control Unit, Department of Health and Community Services: 08 8922 7341, www.health.nt.gov.au

QLD Drugs of Dependence Unit, Queensland Health: 07 3896 3900

SA Drugs of Dependence Unit, Drug and Alcohol Services, Department of Health: 1300 652 584

TAS Pharmaceutical Services Branch, Department of Health and Human Services: 03 6233 2064

VIC Drugs and Poisons Unit, Department of Human Services: 1300 364 545, www.health.vic.gov.au/dpu

WA Drugs of Dependence Unit, Department of Health: 08 9388 4985

Sublimit
15-05-2010, 18:08
heya sublimit, you are heading into treacherous territory with your pain management. Froim my experience with GP's they are not specialists in pain management, see if you could get a referral to a pain management specialist.

Running out of your medication early is not necessarily a good thing, plus it shows you are on your way with buidling a tolerance. This will impact your ability to access breakthrough pain medication. Ask for a referral to a pain management/addiction medicine specialist for review. They generally understand opiates better than any GP i've come across.

theres a line that many people on prescription opiates cross between addiction and effective pain management without seeing it. where effective pain management becomes dependance and addictogenic like behaviours


i appreciate your advise very much Madmick, but it's not a case of running out(this time) as the 60 20mg oxycodone was sufficient in managing my pain, but i lost 40 of them due to someone stealing them... and all i wanted was a temporary solution until i'm due to see my regular doctor. i didn't want to go back to my doctor and tell him this because it would be possible that he wouldn't believe me and i don't want that to happen

before i saw this doctor, the 2 previous ones knew about my past H addiction and wouldn't prescribe me any opiates apart from tramadol and codeine which didn't suffice at all, so i went to my current doc and said i had a drinking problem and showed him my diagnostic report of my knee that i had an mri for several years ago, which i re injured and have subsequently booked myself in for another scan which i'm going for this monday, and he's happy to prescribe accordingly, first went from 60 5mg and now i'm on 20mg oxy twice daily.

i don't understand the links you posted regarding the vic drugs and poisons unit DHS... it doesn't have any reference to any pain specialist(not that i can see anyway), besides you need a reference from a doctor, who i'm going to see about that anyway.

madmick19
16-05-2010, 09:48
good points sublimit,

yes you do need a referral to see a pain specialist, but knowing who they are and where they are can spped up that process for you. Ididnt find the pain managment clinics numbers for each state, but i know that when people are prescribed S8 Drugs the GP should need to have authorisation ( a simple process by Fax) from the state and territory bodies who i listed above. If you call them you would get an idea where the pain clinics are more generally in your state, or who are alternative doctors you may also be able to see. i wasnt able to finad a nice listing like this (http://healthengine.com.au/search.php?q=Pain%20Management) for aus more generally

Once you got the details it is possible to ask your GP for a referral to see them for a second opinion. Just to ensure that you are getting the best availble treatment for what you have.

Also im a big believer in having open and frank discussion with doctors, they in the end are there to service us- not the other way around. hopefully you can build a good relationship with your GP where you can tell him about your previous heroin use. Should it not be a problem than there are various physical indicators which would actually confirm this during his examinations of you.

madmick19
16-05-2010, 09:52
also since this is a harm reduction and holistic based websit i though it worthwhile chcking a copy of the Pain management page taken from the better health webiste (http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pain_management?OpenDocument) talks about the additional things you can do without drugs . In counselling for addiction and pain meditation and mindfulness practices can achieve massive gains for people.

The main causes of pain include medical conditions (such as cancer, arthritis and back problems), injuries and surgery. Sometimes, the cause of the pain can't be found or there are no available treatments for it. In other cases, the cause may be remedied, but the associated pain lingers on. Chronic pain is defined as pain that persists for longer than three months. At any given time, around one third of Australians are in pain. Management strategies include pain-killing medications, and complementary therapies (such as acupuncture and massage). Studies suggest that a person's outlook and the way they emotionally cope with chronic pain influence their quality of life. It has been shown that people who learn self-management skills lower their levels of felt pain. It is important to learn these skills, and to deal with the associated stress and depression in constructive ways.

The epidemiology of pain
A Brisbane study in 1986 found that certain groups are more likely to suffer chronic pain than others. The findings of this study were similar to research findings from other countries. Selected statistics include:

* The incidence of pain rises with advancing age.
* Women are more likely to be in pain than men.
* The most commonly reported pain is back pain.
* The most severe pains include those of the back, head, neck and leg.
* The pain is constant for around one fifth of people.
* The cause is unknown in around one third of cases.
* One fifth of cases were caused by work-related accidents.
* Most people surveyed had suffered chronic pain for longer than three years.
* Seven out of 10 people sought professional help.
* The most common source of professional help was the family doctor (80 per cent).

Pain-killing medications
The type of medication you are prescribed depends on your pain. The issues you need to discuss with your health care professional include: the location, intensity and type of pain; which activities ease or exacerbate it; the impact your pain has on lifestyle factors, such as appetite and quality of sleep. Medications for chronic pain are best taken regularly. If your pain is well managed, you are less likely to take large doses of painkillers, and the risk of side effects is reduced.

The medications available for the management of chronic pain include:

* Aspirin and aspirin-like drugs
* Paracetamol
* Opioid drugs, such as codeine and morphine
* Local anaesthetics.

Long term use of some medications can have side effects which affect a person's quality of life. They may also lose their ability to reduce pain. Some studies have shown that medication can undermine the value of developing self-management skills. This occurs because the person believes they are coping better with pain due to the medication, not because they may have learnt effective coping skills.

Complementary therapies
Numerous studies have found that certain complementary therapies are effective in pain management. Some of these therapies include:

* Acupuncture - a component of traditional Chinese medicine. Acupuncture involves the insertion of slender needles into specific points on the skin.
* Massage - better suited to soft tissue injuries and should be avoided if the pain originates in the joints.
* Relaxation techniques - including meditation and yoga.
* Transcutaneous electrical nerve stimulation (TENS) therapy - a minute electrical current is passed through the skin via electrodes, prompting a pain-killing response from the body.
* Cognitive-behavioural therapy - this is a process of learning to change how you think and, in turn, how you feel and behave about pain. It is part of a process of self-management of chronic pain.

Coming to terms with chronic pain
Sometimes, chronic pain cannot be relieved. Suggestions on how to emotionally handle this difficult and distressing situation include the following:

* If all medical avenues have been exhausted, don't raise false hopes by searching fruitlessly for a cure.
* Accept that your pain may not go away and that flare-ups may occur. Talk yourself through these times.
* Find out as much as you can about your condition so that you don't fret or worry unnecessarily about the pain. Fear makes cowards of us all!
* Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.
* If painkillers can't ease the pain, don't increase the dose - take fewer or none at all, in consultation with your doctor.
* Improve your physical fitness, eat healthy foods and ensure you get all the rest you need.
* Don't allow the pain to curtail your life more than necessary - if you miss activities you used to do before the pain, try reintroducing those activities in a gently paced way. You may need to cut back on these activities if pain flare-ups occur, but it will be possible to increase slowly again as you did before.
* Concentrate your efforts on finding fun and rewarding activities that don't exacerbate your pain.
* Seek advice on new coping strategies and skills from an occupational therapist.

Where to get help

* Your doctor
* Occupational therapist.

Things to remember

* At any given time, around one third of Australians are in pain.
* Management strategies for chronic pain include pain-killing medications, and complementary therapies (such as acupuncture and massage).
* Studies suggest that a person's quality of life is influenced by their outlook, and by the way they emotionally cope with chronic pain.
* Seek advice on new coping strategies and skills from an occupational therapist.

You might also be interested in:
Acupuncture.
Cancer pain management.
Fibromyalgia.
Headache - treatment options.
Headache and medications.
Massage.
Pain-killing drugs.
Physiotherapy.

Sublimit
16-05-2010, 13:17
good points sublimit,

but i know that when people are prescribed S8 Drugs the GP should need to have authorisation ( a simple process by Fax) from the state and territory bodies who i listed above.ly

i thought there was a difference when it comes to schedule 8 drugs as in the GP needs to get "authorising" of an "authority script" but with regards to a "restricted script" on the PBS all the GP needs to do is be essentially satisfied to prescribe it when necessary, without any authorisation of any kind, afaik.

I asked earlier and got confirmation from Leftwing about endone aka 5mg oxycodone and if one prescribed pack would need to be authorised as an authority scrip, but apparently only a months supply would fall under an authority script, but one pack falls under "restricted benifit"http://www.pbs.gov.au/html/consumer/product/restrictions?publication=GE&code=8464L&brand=OxyNorm

i am still a little confused about the whole criteria for prescribing and medicare and the pbs's exact procedure, but it is interesting to learn about it non the less





Also im a big believer in having open and frank discussion with doctors, they in the end are there to service us- not the other way around. hopefully you can build a good relationship with your GP where you can tell him about your previous heroin use. Should it not be a problem than there are various physical indicators which would actually confirm this during his examinations of you.

i would like to agree with you on that one Madmick and generally i am an honest person, i pride myself on honesty and it's a quality i look for in people, but when it comes to doctors and being honest well i personally think it depends on the doctor, but a lot of the time it has gone against me in the worst way were one doctor has even outright lied to me.... recently, when i injured my knee, i went to a doctor that someone recommended to me for being understanding when it came to pain management, and also the practice was close to the box hill hospital, which i was going there with my pending reference from what i though was a good gp... so i come in on crutches, with a diagnostic report of an mri i had 7 years ago when i first injured my knee, as well as the actual mri images in my backpack, and told her that i'm in a lot of pain can you give me a referral so i can take it to the ER room, oh and i have an ongoing H addiction that i've managed to overcome recently. would you be able to manage my pain sufficiently? my answer was "it would be illegal for me to give you anything because you have a history of heroin abuse" i was shocked and asked her if that was discrimination. she mumbled a few things trying to tell me that it wasn't discrimination and sent me on my way with a referral.

now i don't like the word junkie, but i look like a normal person and wear respectable clothes and i'd like to think that i'm well spoken.... my doctor thats known me for most of my life is a great doctor and he know everything about me, but i knew that i would be better off seeing a brand new doctor because of my last experience... so the day after i went to the hospital i had a search on the net and i noticed a lot of people saying good things about a doctor that was close to where i live... so i managed to make an appointment that day, came in with my crutches and my referral from the hospital and with my 7 year old diagnostic report.

now because i hate dishonesty i felt to tell him i had an addiction of some sort that i'm wanting to overcome. i told him that i had an alcohol problem, and he gave me 50 valium lol, but i also said that when i was in the hospital they gave me endone(which was on the report) and i even said to him" the endone worked well but i doubt you'll give me that" well he smiled and subsequently wrote me a script for a pack to my surprise and delight, so i go back a week later and say i need another, but this time he said it would be my last because i have an addictive personality,,, well in the mean time i went back to the hospital and booked myself in for an mri which was to be 5 weeks time. so sure enough i go back to him and confidently say i need you to manage my pain, i deserve quality of life, my addiction is behind me etc. and he subsequently gave me 60 5mg oxy's, 2 and ahlf weeks later i go back and ask to increase the dose. bang! 60 10mg oxy's and then again now i'm on 20's, but this time he said he won't want me to go higher,

but now that i had 2 of those packs stolen, i'm thinking about either just asking him to slightly increase the dose and just wait it out, or tell him the truth which i'm reluctant to do because of obvious reasons)i'm sure they get story's like that everyday) or, see another doctor and get small scripts(restricted benefit) to hold me until i'm due to see my regular gb.... i know it's risky business to see another doctor, and hypothetically if i get an authority script(which i doubt because it would be my first visit) then i'd be in a lot of trouble, but i don't see the harm in seeing another doctor if he was to prescribe me a pack of endone... even if it was tramadol, i wouldn't run the risk of being labelled a doctor shopper and i wouldn't have to put up with WD symptoms, pain on the other hand i would

bit of a catch 22, or a double edged sword

What are peoples experiences with GP compared to pain management specialists for PM???

Sublimit
16-05-2010, 13:20
wooo only 5 posts away from the coveted bluelighter status WOOO

Crankinit
16-05-2010, 13:32
Yup, the sad fact is that the medical system discriminates hugely against drug users, past and present, and even when the treatment is absolutely necessary, having any kind of controlled substance prescribed becomes a thousand times harder if a doctor knows about your drug use. Not to mention the fact that a lot of doctors look down upon, or straight up disrespect or are rude to, drug users. I'd say anyone is well within their rights to lie about their drug use when talking to a doctor, you have to do what you can when you're working with a broken system.

Sublimit
16-05-2010, 14:11
Yup, the sad fact is that the medical system discriminates hugely against drug users, past and present, and even when the treatment is absolutely necessary, having any kind of controlled substance prescribed becomes a thousand times harder if a doctor knows about your drug use. Not to mention the fact that a lot of doctors look down upon, or straight up disrespect or are rude to, drug users. I'd say anyone is well within their rights to lie about their drug use when talking to a doctor, you have to do what you can when you're working with a broken system.


well i'm glad i'm not alone in that respect, i think it must be a taboo for doctors to prescribe opiates to people who admit that they had an addiction to them in the past... it's like they feel liable, or assume the patient is going straight to the street to sell them???

why would anyone thats in pain being prescribed pharmaceutical grade opiates sell them for money or heroin.... i guess there is a minority of drug seekers that con doctors into getting drugs for that purpose, but it ruins it for everyone else and the majority of legitimate people that need PM are suffering and finding it harder and harder to get sufficient analgesia.

when i was using H regularly, not once was i offered any pharmaceutical opiates except for bupe, and benzo's(which are sold very cheap afaik)