Opioids Are most doctors prescribing Schedule IIs enrolled in TIRF REMS to RX fentanyl pops?

[NativeAddiction]

My doctor just switched me from 20mg Opana ER 2x day to duragesic 50mcg patch every 3 days. I have been taking the oxymorphone hydrochloride 5 mg (generic for Opana IR) PRN -t.i.d. Now that I have switched to the fentanyl patch the Opana IR is no longer effective, most likely due to fentanyl being much stronger. I want to ask my Dr. to switch me to the Actiq (fentanyl citrate) oral transmucosal lozenge (fentanyl lollipop) in lieu of the Opana IR since it is no longer working.

I have been reading about Actiq and in March the FDA put in place a new access program called TIRF REMS that all doctors prescribing buccal/transmucosal fentanyl must be enrolled in, as well as doctors enrolling each individual patient (which really just requires them to inform patients of risk, read medication leaflet and sign a form). I am just wondering if most doctors who prescribe Sched. II narcotics are enrolled in this program or if many are not prescribing this med because of the hassle of the program. I know there is all kinds of lawsuits and crap going on against Cephalon because of drug reps being told to market Actiq to Drs for Off-label uses.

Although 90% of Actiq prescriptions are written for off-label uses and the only FDA approved use is for cancer pain, I wonder if my Dr will RX this or even is enrolled in the risk mitigation access program. If he is not and doesn't prescribe Actiq, what the heck should I try to switch to that is immediate release for breakthrough pain that is going to be comparable to a fentanyl short acting? I don't know of anything that will be stronger than Opana IR that ISN'T fentanyl and worry now that I am going to have a problem controlling breakthrough pain, as the Opana IR worked moderately well for breakthrough while I was on the Opana ER (mainly because the ER didn't control my pain at all)

I have been on pretty much every other IR med and found Opana to work the best up until now. Does anyone have any experience with Drs RXing Actiq off label to them or know of an IR med better than Opana and comparable in strength to fentanyl? The hard part I have already figured out, my insurance will cover the Actiq with a pretty low co-pay, now I just have to find out if my Dr is enrolled in the TIRF REMS access program and will RX the Actiq. My Dr is really good and knows my pain level, I am on a narcotic contract and get urine screened every visit so he knows I adhere to prescribing guidelines with my meds. Any help or suggestions greatly appreciated!

 

[Jktm]

I'm not sure on this, and most here probably aren't either, but I would be careful if you do get Rx'ed Actiq...a lot of people have had their teeth rot out from these things (it's worse than meth mouth) and they were brushing their teeth everyday...If you do, I would recommend brushing about 15-20 minutes after every time you use the lollies...

 

[NativeAddiction]

Jeez I read about this but I thought it was just children who were prescribed Actiq and weren't caring for their teeth properly. But it can't be much worse than a regular lollipop right? I read it was just because it contained a lt of straight sugar?

 

[Noise]

I don't know the odds of you getting prescribed Actiq, but if you DO... I hope you have amazing insurance, because those lolli's are expensive as fuck. I'm talking thousands, not hundreds...

 

[Coraline]

We really can not tell you if your dr or any dr will prescribe the medication to you.

This is a discussion that should be taken up with your dr.

I have only heard of the lolly pops being prescribed to two patients in my career. One was not a cancer patient and the other was a terminal ill patient.

I would really think about hard about taking fentanyl. It's one of the strongest drugs out there. After your body becomes tolerant to the drug there are not many you can take anymore.

I know it's hard, but have you considered reducing your tolerance? Taking longer breaks between doses or lower doses at a time? Everyone is different. It took me a week to be comfterble with my decrease in medication use.

I don't know your condition or pain level but I'm sure your suffering and I know what's that like.
I wish you luck in finding pain relief.

 

[Survival0200]

Fentanyl breakthrough pain medications are truely reaaaally expensive, so I'd probably recommend a cheaper alternative.

 

[NativeAddiction]

As stated above, my insurance covers the lollipops with only a *no prices* copay for 30 day supply. I have private insurance through my employer. Which is ANOTHER reason I have to keep my pain under control, if I going to have insurance and be able to pay my rent I have to be able to work! I just started a physical type of rehab for my pain and I am going to a new rehab dr next month (been on the waiting list 3 months, suppose to be really good) I would say fentanyl is definitely a last resort medication, as I have been missing a lot of work and school due to uncontrolled pain.

This is my first week on 50mcg fentanyl, and my dr was going to raise or lower depending on my body's response to it, and I am still in a little more pain than I was hoping. I am expecting to live with a certain level of pain, but there is no reason to be on fentanyl if it is not lowering my pain to a tolerable level. I don't really want to go up to 75mcg which is why I was hoping I could use the lollipops for breakthrough, because then I would only have to take them when I couldn't tolerate the pain any longer, instead of being on a steady extra dose of 25 more mcg/hr. Trust me, this is something I struggle with every day thinking about, as I know ANY type of heavy duty narcotic is difficult to taper of eventually.

I also used to be an IV heroin addict, which is one of the biggest reasons it is difficult to control my pain, even though I have been clean for quite some time my body still has a high tolerance to every kind of opiate medication. Of course I never in my life would have thought I would have to deal with severe chronic pain, but such is life and it is rediculous to say if, had I known that, I would never have "chosen" to be a drug addict. I consider myself fortunate to have a doctor who understands my level of pain and knows when I am suffering and understands the need to account for quality of life in pain management.

I am also extremely lucky that I have no desire to abuse my medicaton, and I am in a place in my life where I understand that I need to be able to control my pain, but keep my medication at the lowest dose possible while being able to handle as much pain as I can, it certainly is a balancing act, as at present I am still in considerable pain and need my medication to be adjusted so my pain is at a more tolerable level, but I don't want to go up on the patch dose.

As far as I know Opana IR is one of the strongest IR medications, and I don't know what else is going to help for breakthrough pain as I have tried everything else and it seems the fentanyl has lowered the IRs ability to help breakthrough pain. This is all really frustrating, as it seems the fentanyl, while still not lowering my pain to a tolerable level yet, even at this point has worked better for around the clock pain control than any other long acting I have tried. I will be going to grad school soon and I know I can't start school without my pain more under control, as I need to be able to fully focus and dedicate myself, and I am struggling right now even showing up to life on days when my pain is really high. I wish I had more options but I pretty much have exhausted everything else. If I could lower my pain level even by 15% it would be life changing.

 

[macd610]

The only thing I've found that works for my bt pain is doses in excess of 60mg oxycodone ir. Fentanyl will REALLY Do a number on your tolerance, as others have stated. I did ask my doctor about the lollipops once, And his reaction was, "I haven't perscribed that before and it seems pretty weird and I'm not going to start now."
EDIT: Forgot to mention I'm on 100mcg Fentanyl patch

 

[Jktm]

Jeez I read about this but I thought it was just children who were prescribed Actiq and weren't caring for their teeth properly. But it can't be much worse than a regular lollipop right? I read it was just because it contained a lt of straight sugar?

I don't know if they use fentanyl in children...I thought it had to be adults. It would be a really bad idea to give a drug filled lollipop to a child and expect them to stop eating it when they stopped feeling pain.....

And you gotta think that it's not just sugar in the pop (if it's even sugar, not completely sure on the ins and outs of these things). There's active ingredient in there as well and some type of binding agent. Just search the web with actiq and teeth and you'll get loads of results.