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

[4DQSAR]

At the end of the day I'm getting good pain relief from oxycodone and that's all that matters. Plus oxymorphone is unlicensed/unavailable (banned more or less) in the UK.

That is the important thing and as I said, if grapefruit juice works for you, that's a good thing. Nice to know you have a backup plan.

 

[evo4ever]

That is the important thing and as I said, if grapefruit juice works for you, that's a good thing. Nice to know you have a backup plan.

Sorry but I don't need a backup plan, so I don't know what your getting at. This is starting to feel like ridicule now.

 

[4DQSAR]

Fine. I can assure you no third party was involved in any ridicule there may have been present. But I hope you understand that calling someone a liar because of YOUR ignorance isn't a good look.

 

[Biomed Tech Guy]

Anyway..

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

It's gotten worse since that post you replied to. While I had complaints about that pain management clinic that I've been with for about 10 years, and Walgreens blacklisted him for filling his Rx's, my last visit there about 6 weeks ago resulted in me leaving with my paper Rx scripts, but knowing that CVS had also put him in blacklisted status.
So starting an hour+ away from where I live, I began stopping in various pharmacies to try to get my Rx meds...
"Out of Stock" We don't have those, the warehouse is out, we can't get them, I'll try ordering them but check back Monday (5 DAYS after my appointment) and the one that made me want to break heads: "I called Walgreens and I'm not comfortable filling those Rx meds for you" AFTER the counter clerk said "Yes, we have that and will fill it" and WROTE ALL OVER THE PAPER RX SCRIPT! which makes it even harder to get the next place to fill it.
So it was 6 weeks ago I gave up on that doctor, because I can't get his scripts filled. Fortunately I have worked for a lot of docs, and I called one that same day who works with pain management patients. He was able to see me that day, and I told him the situation. He was critical of no doctor in my past having "tried" alternative pain relief methods, and I let him know that was true BUT I had been able to work and have a physically active life because of the opioid meds I've been prescribed.
He duplicated the meds and quantity I had paper scripts for, tore up the paper scripts, and VOILA! I was able to get them at Walgreens.
BUT
That's NOT what will continue. I've already been informed they're going to rapidly step down my opioid dose, they completely eliminated the Morphine Sulfate ER (2x day at 100mg each) and one of the "test meds" I took for 3 days I had to stop talking because it really scrambled my ability to think straight. So I'm already having problems with pain.
It just proves that it's all BULLSHIT because they wouldn't fill my long term doc's Rx scripts but would fill the exact same thing from another doctor.

When I drink grapefruit juice which inhibits P450 enzymes I get more and longer lasting pain relief, explain that.

I have some grapefruit juice left and it's hard to say whether it helps prolong or intensify the effects of my Rx opioids but logically it should.
I've been using Kratom alkaloids to get enough pain relief, and I'm grateful for its abilities BUT I've developed a high tolerance for that so that's driving the cost up to use it.

 

[4DQSAR]

The US is in the fortunate position of there being factories producing oxycodone tablets. But it does strike me that in the US where writing a prescription and filling a prescription both make a profit someone, there must be a bias for doctors to prescribe more. I'm guessing that the DEA is now seeing that but they don't seem to care that the outcome will be people turning to street drugs i.e. bad outcomes.

I mention this only because I get far less and while the consultant at the pain clinic was happy to titrate to the dose I'm on, they reflected on the fact that with pain medication, expectation management is important. The goal isn't to make someone pain free, only to allow them to perform viral functions such as sleeping.

I do wonder if people suddenly having their prescription stopped overnight are turning up in ER rooms having suffered a tonic-clonic seizure due to sleep deprivation. I only got my pain medication because I began to have seizures due to lack of sleep. I don't think you can fake an ECG. But if it happens, I don't know whose responsibility it would be.

Seizures can kill so clearly if the insomnia is due to AWS, I don't know how a US clinician would respond.

I've mentioned this before but it appears that clinicians downplay physical dependence. After all, if you just take the pills as needed, they don't do anything but help with the pain. I suspect they consider pain and AWS not to be life-threatening.

But whatever the cause, I always P|RESUME that I cannot simply assume that my medication will arrive on it's due date thus I keep spares. I guess people in the US CAN get kratom products... but I suspect they will soon be banned, IF I were in the US, I would stock up on those 7-OH mitragynine vapes. But I have several other fallback positions.

One month my cleaner threw away a strip of 14 tablets. Well, to be accurate I think there were 12 left in that strip. Stuff happens and even in the UK doctors are suspicious if you ever reorder early. I've also been burgled FOR my medications and luckily I keep one strip in one place, the rest somewhere else. Blind trust in the system ALWAYS working seems a bad plan. Better to have something and not need it than to need something and not have it.

 

[Biomed Tech Guy]

the DEA is now seeing that but they don't seem to care that the outcome will be people turning to street drugs i.e. bad outcomes.

So IMO, politicians in the USA where I live hear the "horror stories" and of course the political party propaganda, and as happens FAR TOO OFTEN they "do something"...
The biggest problem with them "doing something" is that usually they DON'T DO the BEST thing, the effective things, or the right things.
Fentanyl was POURING in, much of it from what I see on the FLASHY "news" clips in the form of fake oxy ir 30mg pills.
As far as I know I never got any of those, but I don't want my point lost.
Government agencies clamp down on legitimate pain management facilities and providers like doctors licensed specifically for pain management.
Lawsuits are brought that make for big, splashy "news" broadcasts about different pharmacies and big pharmacy chains (like Walgreens) being sued for "filling excessive opioid scripts", but "excessive" is another LIE, more BULLSHIT, because I can GUARANTEE none of those pharmacies filled ANY scripts that weren't LEGIT.
In turn, they allow themselves to run low or OUT of stock, and that moves up the wholesale chain so it's hard or impossible for other pharmacies to get them.
Meanwhile those of US WHO SUFFER are left with ALL BAD choices.
Another way of saying that politicians and government doing "something" about the "opioid crisis" IS KILLING PEOPLE because they can't be bothered to do the RIGHT things, and are DRIVING pain patients to the streets and other permanent solutions to a horrible albeit temporary problem.

 

[4DQSAR]

Can a US citizen seek medical care in Canada or Mexico? Just yesterday I learnt that REAL OCs are ending up in the UK but were prescribed in Poland. All I can say is that the person who mentioned it sounded like they were using a LOT of oxycodone and TBH I worry for them. Sooner or later Polish doctors WILL be stopped and what is then left? Back to krokodil? I don't know, but I figure neither of US would want to go there.

 

[4DQSAR]

Just because my wife bought some, I consumed a full 1l of ruby grapefruit juice a few hours before my OC. so far I cannot tell even the slightest difference. But if it works for others, then fine. It's always good to consume less so you have a few spares in case you drop or lose a pill (which over a decade I presume a lot of people have done at least once).

Drug Interactions with Grapefruit Juice | British Journal of Medical Practitioners

www.bjmp.org

Above is a brief discussion on the interactions.

What I find interesting is that they list whole classes of compound and it's not clear to me if it's one, all or an interaction between them that is responsible for the activity. While more research might reveal more, I cannot help wondering if some bright spark has found a supplier of these naturally occuring compounds, has played with them and figured out what is and is not important.

Because in a cohort study, consumption of quite modest amounts of grapefruit juice increased the area under the curve by x1.7.

Now while clearly NOT in the league of the infamous Doriden (glutethimide) which induced CYP2D6 so almost 100% of any codeine, dihydrocodeine, hydrocodone or oxycodone consumed would rapidly be converted to their (much more potent) 3 O-desmethyl conterparts i.e. morphine, dihydromorphine, hydromorphone and oxymorphone... it's still going to make a significant difference.

Now here is a cute loophole in the drug laws of every nation I've checked, if a given chemical taken alone has no psychoative effect, it isn't a drug. So if some bright spark were to find a glutethamide homologue that would retain the CYP2D6 induction capacity of glutethimide but without the psychoactive nature of it's parent, a capsule containing a mixture of 'grapefruit extract' (on packaging) and the glutethimide homologue... that would be rather a gray area.

So does such a homologue exist? Yes, yes it does. One can raise the LogP so it won't cross the BBB.

 

[Flynnal]

This story is yet another reason why so many support the notion of voluntary euthanasia and doctor-assisted suicide. But then again, this is caused by assholes in the supply chain of proper pain relief.

What happened to bodily autonomy? What happened to the right to decide what happens to your body? I see that the current administration is on a roll, trying to dismantle so many things we've taken for granted for decades. I really fear for America's future. And I say that in the strongest and most sincere terms.

 

[4DQSAR]

It could be the cruel way to push those seen as 'a burden' into taking their own lives. I mean, it's a bit smarter than the Nazis who outright murdered anyone who wasn't actively supporting the economy.

Roger Mellie, when quite frail and ill announced 'I wish to live as an abuse and die is an anachronism' i.e. to ignore the rules until it becomes clear the rules are wrong.

 

[Them Witches]

The voluntary euthanasia and doctor-assisted suicide, even being held to signed agreement contracts, can sometimes "stain" a doctor's reputation. We have been running thin on reasonable minded people willing to walk in the shoes of the patient suffering. Like in most cases, the blame falls back on the doctor. Typically it is the patient's family members that feel guilt & shame for not participating and not supporting the patient. Placing blame on other's is a false way to rationalize and justify their own actions & choices.

If a person wants to go, then let them go. In almost all cases the patient has a good reason for reaching the decision and choice. This is why I am nice to people because I never know what is going on in that person's life. They say we all put our pants on the same way each morning but this was referred to getting up and going to work. It is the silent struggles of a person that needs attention and love. We all would be better people if we focused on being supportive, listening, and not "one upping people." More people would hold doors for people and say & do nice things to people.

 

[4DQSAR]

OK - day five of consuming grapefruit juice.

My conclusion is that for me at least, it increaes the side-effects of codeine and oxycodone but doesn't seem to improve the analgesia by a noticable amount.

I found myself consuming more caffeine because I was falling asleep and found myself forgetting things or getting confused during tasks I have repeated every day for over a decade i.e. for as long as I have been prescribed codeine and oxycodone.

I can understand why an elderly person would be at increased risks of falls and other injuries due to the impact of the side-effects.

I cannot comment on 'euphoria' as neither drug has ever produced euphoria. In fact anxiety is my dose-limiting side-effect and to be fair, I am less anxious.

But that's just one person and on one occassion. So while data, alone it has very limited utility.

 

[phenethylo J]

Can a US citizen seek medical care in Canada or Mexico? Just yesterday I learnt that REAL OCs are ending up in the UK but were prescribed in Poland. All I can say is that the person who mentioned it sounded like they were using a LOT of oxycodone and TBH I worry for them. Sooner or later Polish doctors WILL be stopped and what is then left? Back to krokodil? I don't know, but I figure neither of US would want to go there.

Alot of the pharmacies in Mexico have been taken over by the cartels who force to sell the same fake fent cut pills they push on the street. Also fake heart meds and other various pharms that may just contain some inert filler. If they refuse the cartels will burn down their business and possibly torture and/or kill them and their family.

I'd also refrain from buying for any online pharmacies claim to be Canadian run; allot are actually run by Chinese companies who sell the same fake crap.

 

[deficiT]

Basic Drug Discussion -----> Drug Culture

 

[Them Witches]

OK - day five of consuming grapefruit juice.

My conclusion is that for me at least, it increaes the side-effects of codeine and oxycodone but doesn't seem to improve the analgesia by a noticable amount.

I found myself consuming more caffeine because I was falling asleep and found myself forgetting things or getting confused during tasks I have repeated every day for over a decade i.e. for as long as I have been prescribed codeine and oxycodone.

I can understand why an elderly person would be at increased risks of falls and other injuries due to the impact of the side-effects.

I cannot comment on 'euphoria' as neither drug has ever produced euphoria. In fact anxiety is my dose-limiting side-effect and to be fair, I am less anxious.

But that's just one person and on one occassion. So while data, alone it has very limited utility.

I am going to try the grapefruit juice for multiple days like you.

Cimetidine Tablets are supposed to increase blood plasma levels of Oxycodone. I am not crazy about taking anti-acid drugs for no reason.

magnesium was tried and that didn't change anything.

Clonidine, Ativan, and Vistaril PAM are my favorites to enhance the effects of Oxycodone.

 

[4DQSAR]

Many others say grapefruit juice (or, specifically, 4 natural compounds IN grapefruit juice) 'enhance' the effects of codeine and oxycodone. The theory is supposed to be that the enzyme that N-demethylates the actives (moprhine, oxycodone and oxymorphone) into their N-nor metabolites is inhibited.

But while it may well increase the 'side-effects', I'm not sure if it actually enhances analgesia. But if someone is going through AWS because they simply have no medicine, maybe it works?

I am just one person so it not working for me isn't an indication that it doesn't work for others. I suspect it's what effects you seek to enhance. For me, analgesia is the ONLY thing I seek. If I can walk, that's enough.

 

[Cream Gravy?]

I guess people in the US CAN get kratom products... but I suspect they will soon be banned

What makes you say that?

At various state levels there have been bans or at least restrictions. Federal ones haven't taken hold at all though. My state is planning to ban 7-OH and any non kratom leaf powder products because people who don't know better are getting hooked. Seen that with my own eyes... boy if they knew what true addiction was they wouldn't bitch about kicking 7-OH.

 

[Esperighanto]

This entire thread is a great example of how Americans can fundamentally not rely on our system's capacity to access medications. I've had, and known people who have had severe and life threatening reactions to not being able to access epilepsy meds, diabetes things like insulin or clean needles, ostomy supplies, my grandmother used to struggle to access meds for dementia/Alzheimer's and later on cancers and the sort. It's why I always stress Americans to have a significant backup, for pain relief 7-OH substitutes for opioids well, phenibut for gabapentin, etc.

 

[Cream Gravy?]

for pain relief 7-OH substitutes for opioids well

Is it really that strong? A coworker got hooked on it, we're allowed to use kratom at work of all things (gotta love loopholes), and he offered me half a tablet once but I passed, not wanting get actuallyu 'high' at work seeing as a teaspoon every few hours of white maeng da does me right for motivation and knee pain. One of my other coworkers tried a tab who has a higher kratom tolerance too and he damn near nodded out (not safe at my job lol) so I always passed. Then I watched that original coworker kick 7-OH tablets and he seemed to be going through pretty strong WDs.

I've heard the tabs are like $10 a pop at the local shop so I've never bought them, but I'm wondering if I should try and stock up on some before they're gone. I have a decent amount of bupre, O-DSMT, and an assortment of 5-10 pills of original real deal pharma dope like hydromorphone and hydrocodone and the like hidden in my safe where I don't touch them in case of emergencies.

 

[tryptakid]

Is it really that strong? A coworker got hooked on it, we're allowed to use kratom at work of all things (gotta love loopholes), and he offered me half a tablet once but I passed, not wanting get actuallyu 'high' at work seeing as a teaspoon every few hours of white maeng da does me right for motivation and knee pain. One of my other coworkers tried a tab who has a higher kratom tolerance too and he damn near nodded out (not safe at my job lol) so I always passed. Then I watched that original coworker kick 7-OH tablets and he seemed to be going through pretty strong WDs.

I've heard the tabs are like $10 a pop at the local shop so I've never bought them, but I'm wondering if I should try and stock up on some before they're gone. I have a decent amount of bupre, O-DSMT, and an assortment of 5-10 pills of original real deal pharma dope like hydromorphone and hydrocodone and the like hidden in my safe where I don't touch them in case of emergencies.

If you're not someone who is going to binge out on opioids and cause yourself a problem, they're not a bad thing to have around for emergency use (pain, cough etc). They're pretty strong as far as legal things go, they definite have the potency of hydrocodone, but they're shorter acting. (2-3 hours vs. 4-6 hours).