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Pain meds..Doctor's office, pharmacies, and the DEA

B

Biomed Tech Guy

Bluelighter
Joined
Jul 22, 2024
Messages
22
Over 100,000 DEATHS a year from illegal fetenyl, funding gangs, criminals, MURDERERS, crossing the open border, and funding the most EVIL activities imaginable...
BUT
Pay $300 a visit even with excellent medical insurance because I've been so grateful to have found a pain management doctor that doesn't treat me like a heroin addict, not that I'm claiming to be "better" than that stereotype, and get a legal Rx.
Then
Because the ONE pharmacist who gives a shit about his customers is on vacation, NONE of the other pharmacists know how to or can't be bothered to order enough or order in the way the one on vacation does to have ANY oxy in stock.
Oh-if only they knew first hand what being physically dependent, for pain management and to prevent withdrawals was like.
So since the usual location I use of the national chain is out, the circus begins.
I was fortunate to find one of the 3 stores in the chain actually had 15s in stock, because I've had to get half as many 30s and cut them in half, just because the Roulette wheel landed on "15" instead of "30" this day.
Next is call the doctor's office, and leave a detailed message: Please move e-Rx to this location, AND change from 60 x 30s to 120 x 15s.
Oh, and I have another 24 x 30s, or 48 x 15s that have to be split on a 2nd Rx because my insurance won't cover more than the 60 or 120 each month, and I use GoodRx to reduce the cost of the smaller script.
That was at 9:15 AM this morning.
Finally around 6:30 PM I see the doctor's office fixed a mistake where they had changed the 60/30s to 120/15s, but completely ignored the new location.
By the time I see this, naturally the office is closed, and the insurance company needs a prior authorization (per the pharmacy) which of course couldn't be requested of the doctor's office until tomorrow.
So I give up on insurance covering it, and I am a Gold GoodRx member, and that will save me another $20.
So instead of paying $10 using my medical insurance, because I have no idea when there may be someone at my doctor's office to process the PA, I call the pharmacy to give them my info.
The last insult?
The person on the phone looks up my info, and then asks me about the quantity and mg of both pain meds I'm prescribed EVERY month for YEARS, and makes some shitty comment about "I don't know if "they" (whoever "they" are) will flag that amount.
After getting that blade between my ribs, she went ahead and took the info, and I'm going to get what usually costs $10 for $60, and it's 7 PM.
It's disgusting what pain management patients have to go through, but the fentanyl just POURS in, enriching killers and otherwise horrible criminals, and in the meantime, I and others like me get treated like the fentanyl pushers should.
 
I agree with this wholeheartedly. It is utter BULLSHIT what we chronic pain sufferers have to go through - forced to feel embarrassed and ashamed and wondering if we will be judged by those at the pharmacy - just to be provided with the medication that we are legally prescribed.
And don't even get me started on if we ever should need to go to the ER for ANYTHING.
 
FYI 5mg and 10mg formats are far more commonly prescribed. You can even ask the clinician for two pills instead of one on the basis that you will try to just use the 10s i.e. use the minimm amount that works for you. In the UK at least, a clician would consider that requiest as a sign that you understood the potential long-term issues of taking oxycodone and that you would activelly seek to keep the dose as low as possible.

I get a mixture of two strengths and if I manage to skip using one of the lower dose pills - that's a win. I don't give them to anyone else given I'm not a doctor, but always having spares is a good thing. A couple of years ago my cleaner mistakenly threw away a strip of the lower strength pills but I was OK, I had spares.

I ALWASY have a plan B, plan C and plan D in my head. Then I run through possible scenarios and have it worked out in my head how I would deal with it. Stuff happens. Pharmacies get robbed, clinicians themselves are subject to illness. So I plan assuming that my meds may NOT turn up on the day I expect.
 
Plan B for me has been Kratom alkaloid tablets, ever since I discovered them last year when I was in Hawaii, knew that even with my best efforts I may run out of my Rx, and unfortunately I did on a Friday morning, not leaving until Sunday.
In an utterly desperate frame of mind, I set out to a head shop about 10 minutes away that opened at 8 instead of the one a block away that opened at 9. In my opinion THAT was a literal blessing because when I laid all my cards on the table, Rx strength and quantity per day, the employee showed me a pack of red H tablets and said that would be exactly what I needed to get through. I had only had experience with the "gold" powder capsules and they had never helped much.
The alkaloid tablets were a miracle and got me through with flying colors and have ever since.
 
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Omg it's fucked up in the US in regards to pain meds. I'm from the UK and I'm prescribed 30mg 4x a day. I request my oxycodone on the NHS app on my phone and I collect them from my nominated pharmacy 48 hours later, the pharmacy even texts me when it's ready to collect, simple! I've NEVER had any problems.
 
evo4ever said:
Omg it's fucked up in the US in regards to pain meds. I'm from the UK and I'm prescribed 30mg 4x a day. I request my oxycodone on the NHS app on my phone and I collect them from my nominated pharmacy 48 hours later, the pharmacy even texts me when it's ready to collect, simple! I've NEVER had any problems.
Click to expand...

That is a high dose for the UK. I mean, it suggests you are in a bad way. My own pain clinic alwaays drilled into me to take when needed and not to think 'it's poll--o-clock, take a pill' BUT the sheer dose does sugggest something particularly unpleasent.

Don't presume fumbles do not happen - they DO. I learnt that the hard way hence my cautious usage (and not wishing to increase the dose). If one is in severe pain, the very last thing you want to hear is the pharmacist explaining that there is a back-order at the wholesale level - which, sadly, happens. You need to have a few days in hand to cover this situation.

Don't be arrogant about it - while my pharmacy will ALWAYS get my epilepsy medication if it means someone driving 100 miles (since without it I die), pain meds do not have that level of certainty. The logic is, I assime, the pain won't kill you.
 
4DQSAR said:
That is a high dose for the UK. I mean, it suggests you are in a bad way. My own pain clinic alwaays drilled into me to take when needed and not to think 'it's poll--o-clock, take a pill' BUT the sheer dose does sugggest something particularly unpleasent.

Don't presume fumbles do not happen - they DO. I learnt that the hard way hence my cautious usage (and not wishing to increase the dose). If one is in severe pain, the very last thing you want to hear is the pharmacist explaining that there is a back-order at the wholesale level - which, sadly, happens. You need to have a few days in hand to cover this situation.

Don't be arrogant about it - while my pharmacy will ALWAYS get my epilepsy medication if it means someone driving 100 miles (since without it I die), pain meds do not have that level of certainty. The logic is, I assime, the pain won't kill you.
Click to expand...

I've got a severe neurological pain condition in my left arm and I've had multiple surgeries with no success which means I've got it for the rest of my life. To start with I was only on Pregabalin but it was insufficient so my doctor put me on Oxycodone as well and it took multiple dosage adjustments to get it right. I've been on the same regimen for years and I've never ran into any stock problems with the pharmacy. Up to now they've been 100% reliable.

I understand what your saying about "the pain won't kill you" but you've got to take "quality of life" into consideration too.
 
evo4ever said:
I've got a severe neurological pain condition in my left arm and I've had multiple surgeries with no success which means I've got it for the rest of my life. To start with I was only on Pregabalin but it was insufficient so my doctor put me on Oxycodone as well and it took multiple dosage adjustments to get it right. I've been on the same regimen for years and I've never ran into any stock problems with the pharmacy. Up to now they've been 100% reliable.

I understand what your saying about "the pain won't kill you" but you've got to take "quality of life" into consideration too.
Click to expand...

Yeah - it's entirely possible that your genetic makeup means that your body doesn't produce much CYP2D6. About ½ the analgesia produced by oxycodone is it's (much more) active metabolite oxymorphone. So for you, 120mg may only provide the analgesia most people would get from just 60mg. But obviously I'm not going to ever ask some anything personal as a key element of BL is that we can remain anonymous.

I 100% agree with you that it is a quality of life issue but having actually had oxycodone due on a Thursday and my discovering that it wasn't a local shortage but national because the NHS buys at that level - so one truck breaking down or being delayed at Dover and you have no analgesics for a few days - unless you hang on to a few spares.

The fact that someone might have been prescribed oxycodone for a decade or more and so is more or less certain to become physically dependent isn't considered. I don't know what 120mg/day to nothing for four days would do to someone, but I suspect it would not be pleasent.

BTW the NHS is now beginning to move people on >80mg of oxycodone/day onto Oxelina XL as the patent runs out. These have the distinct advantage of acting for 24 hours but obviously you cannot take less. So if it is a 'rest of your natural life' pain situation, those might be a good thing for you.

I just councel taking the minimmum required so my dose hasn't changed in over a decade and because those few spares can also double as emergency analgesia. I've only had cause to do it once - but was jolly glad I had a bit of 'headroom'.

BTW neurological pain is an odd one. Years ago a GP or pain clinic might have considered methadone or Diconal (dipipanone + cyclizine) for that class of pain but now it does seem like they got a BIG discount on oxycodone. Methadone (for pain) is now the reserve of a tiny group of consultants while Diconal is still feared by tutors. I highly doubt it would ever end up on the street but when it did in the 1980s, man it was a disaster.
 
4DQSAR said:
Yeah - it's entirely possible that your genetic makeup means that your body doesn't produce much CYP2D6. About ½ the analgesia produced by oxycodone is it's (much more) active metabolite oxymorphone. So for you, 120mg may only provide the analgesia most people would get from just 60mg. But obviously I'm not going to ever ask some anything personal as a key element of BL is that we can remain anonymous.

I 100% agree with you that it is a quality of life issue but having actually had oxycodone due on a Thursday and my discovering that it wasn't a local shortage but national because the NHS buys at that level - so one truck breaking down or being delayed at Dover and you have no analgesics for a few days - unless you hang on to a few spares.

The fact that someone might have been prescribed oxycodone for a decade or more and so is more or less certain to become physically dependent isn't considered. I don't know what 120mg/day to nothing for four days would do to someone, but I suspect it would not be pleasent.

BTW the NHS is now beginning to move people on >80mg of oxycodone/day onto Oxelina XL as the patent runs out. These have the distinct advantage of acting for 24 hours but obviously you cannot take less. So if it is a 'rest of your natural life' pain situation, those might be a good thing for you.

I just councel taking the minimmum required so my dose hasn't changed in over a decade and because those few spares can also double as emergency analgesia. I've only had cause to do it once - but was jolly glad I had a bit of 'headroom'.

BTW neurological pain is an odd one. Years ago a GP or pain clinic might have considered methadone or Diconal (dipipanone + cyclizine) for that class of pain but now it does seem like they got a BIG discount on oxycodone. Methadone (for pain) is now the reserve of a tiny group of consultants while Diconal is still feared by tutors. I highly doubt it would ever end up on the street but when it did in the 1980s, man it was a disaster.
Click to expand...

Sorry I don't understand what your getting at here, are you saying I shouldn't be on Shortec (oxycodone)? Also, according to medical literature only a very small percentage of oxycodone is converted to oxymorphone which means the vast majority of analgesia is provided by oxycodone and not it's metabolites.
 
About 10% of any dose of oxycodone is converted to oxymorphone but the latter is some x10 more potent as an analgesic hence my stating that roughly ½ of the analgesia is provided by the oxymorphone.

BUT it entirely depends on the CYP2D6 enzyme - some people are classed as 'super metabolizers' and almost 100% is converted while some people are classed as 'poor metabolizers' and convert very little. But for the vast majority of people, it's around 10%.
 
4DQSAR said:
About 10% of any dose of oxycodone is converted to oxymorphone but the latter is some x10 more potent as an analgesic hence my stating that roughly ½ of the analgesia is provided by the oxymorphone.

BUT it entirely depends on the CYP2D6 enzyme - some people are classed as 'super metabolizers' and almost 100% is converted while some people are classed as 'poor metabolizers' and convert very little. But for the vast majority of people, it's around 10%.
Click to expand...

Medical literature also states that the analgesia provided by oxymorphone is clinically insignificant because the conversion of oxycodone into oxymorphone is so small. So what your saying is inaccurate, look it up.

Read this..

"However, despite the greater in vitro activity of some of its metabolites, it has been determined that oxycodone itself is responsible for 83.0% and 94.8% of its analgesic effect following oral and intravenous administration, respectively.<a href="https://en.wikipedia.org/wiki/Oxycodone#cite_note-KlimasWitticke2013-74"><span>[</span>74<span>]</span></a> Oxymorphone plays only a minor role, being responsible for 15.8% and 4.5% of the analgesic effect of oxycodone after oral and intravenous administration, respectively.<a href="https://en.wikipedia.org/wiki/Oxycodone#cite_note-KlimasWitticke2013-74"><span>[</span>74<span>]</span></a> Although the CYP2D6 genotype and the route of administration result in differential rates of oxymorphone formation, the unchanged parent compound remains the major contributor to the overall analgesic effect of oxycodone.<a href="https://en.wikipedia.org/wiki/Oxycodone#cite_note-KlimasWitticke2013-74"><span>[</span>74<span>]</span></a> In contrast to oxycodone and oxymorphone, noroxycodone and noroxymorphone, while also potent MOR agonists, poorly cross the blood–brain barrier into the central nervous system, and for this reason are only minimally analgesic in comparison"
 
link.springer.com

Updated Clinical Pharmacokinetics and Pharmacodynamics of Oxycodone - Clinical Pharmacokinetics

Global oxycodone consumption has increased sharply during the last two decades, and, in 2008, oxycodone consumption surpassed that of morphine. As oxycodone was synthesized in 1916 and taken to clinical use a year later, it has not undergone the same approval process required by today’s...
link.springer.com link.springer.com

Also read the articles cited. The figures do vary which is to be expected if the sample size is small. But note the figure of 10% given. But don't forget - these are PLASMA levels. The brain also converts oxycodone to oxymorphone... but I don't have a reference where cerebrospinal fluid was analysed.

Wikipedia is not considered a reliable source.


Above is a link dealing with genotypes.
 
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I found a more recent one. As you can see, 10% again... and the fact that the action of oxymorphine is now not considered more important than was previously thought. They address the issue of the brain also O-demethylating oxycodone. They also assign a value to the various data points which while subject to bias, does help when a paper uses a small number of test subjects and/or the results are ambiguous. But if the paper uses them, it's good practice to read all of the citations.

But do you see the change from 'no it doesn't' to 'well, maybe it does' to papers stating it's an 'important metabolite in the analgesic activity'? But obviously I don't read everything so if you have a later citation showing I'm wrong, I will be led by the data. It matters not who supplies the best data, only that we have it.
 
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Biomed Tech Guy said:
Over 100,000 DEATHS a year from illegal fetenyl, funding gangs, criminals, MURDERERS, crossing the open border, and funding the most EVIL activities imaginable...
BUT
Pay $300 a visit even with excellent medical insurance because I've been so grateful to have found a pain management doctor that doesn't treat me like a heroin addict, not that I'm claiming to be "better" than that stereotype, and get a legal Rx.
Then
Because the ONE pharmacist who gives a shit about his customers is on vacation, NONE of the other pharmacists know how to or can't be bothered to order enough or order in the way the one on vacation does to have ANY oxy in stock.
Oh-if only they knew first hand what being physically dependent, for pain management and to prevent withdrawals was like.
So since the usual location I use of the national chain is out, the circus begins.
I was fortunate to find one of the 3 stores in the chain actually had 15s in stock, because I've had to get half as many 30s and cut them in half, just because the Roulette wheel landed on "15" instead of "30" this day.
Next is call the doctor's office, and leave a detailed message: Please move e-Rx to this location, AND change from 60 x 30s to 120 x 15s.
Oh, and I have another 24 x 30s, or 48 x 15s that have to be split on a 2nd Rx because my insurance won't cover more than the 60 or 120 each month, and I use GoodRx to reduce the cost of the smaller script.
That was at 9:15 AM this morning.
Finally around 6:30 PM I see the doctor's office fixed a mistake where they had changed the 60/30s to 120/15s, but completely ignored the new location.
By the time I see this, naturally the office is closed, and the insurance company needs a prior authorization (per the pharmacy) which of course couldn't be requested of the doctor's office until tomorrow.
So I give up on insurance covering it, and I am a Gold GoodRx member, and that will save me another $20.
So instead of paying $10 using my medical insurance, because I have no idea when there may be someone at my doctor's office to process the PA, I call the pharmacy to give them my info.
The last insult?
The person on the phone looks up my info, and then asks me about the quantity and mg of both pain meds I'm prescribed EVERY month for YEARS, and makes some shitty comment about "I don't know if "they" (whoever "they" are) will flag that amount.
After getting that blade between my ribs, she went ahead and took the info, and I'm going to get what usually costs $10 for $60, and it's 7 PM.
It's disgusting what pain management patients have to go through, but the fentanyl just POURS in, enriching killers and otherwise horrible criminals, and in the meantime, I and others like me get treated like the fentanyl pushers should.
Click to expand...
That sounds so frustrating and unfair. You’re doing everything right, but still get treated like a criminal while illegal fentanyl causes so much harm. You deserve better care and respect
 
evo4ever said:
When I drink grapefruit juice which inhibits P450 enzymes I get more and longer lasting pain relief, explain that.
Click to expand...


Because it increases the levels of oxymorphone in the body?

'Grapefruit juice inhibited the CYP3A4-mediated first-pass metabolism of oxycodone, decreased the formation of noroxycodone and noroxymorphone and increased that of oxymorphone.'
 
Where exactly is this going and what are you trying to make me do? Can you prove wiki's data is unreliable?
 
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Not at all. I was demonstrating that over time, as more researchers studied the analgesic action of oxycodone, they got to understand it's metabolism and the fact that it's analgesic activity more complex than was once believed.

BTW although personal experiences are of value, researchers use cohorts because medicines rarely act in a uniform manner among different individuals. But if grepefruit juice works for you, that's good.
 
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