chronic pain opiate user with new sandoz patch - hydro for breakthrough

[PSUalum]

I am a long time pain clinic patient who has tried everything...just got what was supposed to be duragesic patch 25m with an additional 120 (per mth) 10 mg hydrocodone for breakthrough pain...pharmacy gave me sandoz patches (1 mth supply 72 hr patches), which i hear not as good as duragesic and not 3 days good,...anyway, i am taking tons of the hydro because the patch does nothing. the first one fell off, tried to tape it back on, didn.t work. i get super dry skin in winter, so doesn't stick, and that was upper arm, but i put a new one on left flank area...stayed on, but i still felt nothing days later. (i read duragesic website saying 20 hrs and 72 hrs are dosing peaks and paid attn. at those times, but nada). when hydro wears off i get the gut pain, sweats, etc. of opiate withdrawal. read all the stuff regarding gumming or smoking...tried to scrape off stuff with my teeth from the used ones but i didn.t get anything off it (even the one that was new). some bitter tastes and didn.t swallow, but no real effects. even though i have had many scripts from dilaudid pills w/morphine ER pills, percs, oxycontin, various hydros/vicodins etc. in all combos...plus adding stuff as needed from ER visits and friends, most recently i was taking morphine pills (30mg/15mg 2xs day + 10 mg hydro 4xs day) as script, plus extra 20 mg oxycontin and 5 mg IR oxycodone 2xs day when available from ER or friends, my tolerance is super high. i have kidney disease (UPJ obstruction/hydronephrosis over grade 5 and have had stints/kidney stones/infections in kidney/bladder/blood...was sceptic 6 mths ago, in hospital 1 week...super high BP due to pain...migraines as a result of all, too...i have days of complete inability to get out of bed except for ER... go every mth almost, and the IV dilaudid i get there works (for 1/4 day), with the zofran for nausea, but i am never pain free. IV toradol really helps but i cannot get it too often due to my high blood pressure. i don.t get sleepy from most drugs, and only take 1 valium at bed when needed (benzos don't do much for me at all). i drink vodka to help, but not too much. i cannot get back in with pain clinic doctor re these new patches for prob 15-20 days... i need to see actual MD, not just a PA, to change Rx (it is 1 anesthesiologist and 1 doctor on the sign for clinic but i have never actually met the man clinic is named for). this clinic takes forever to get appt...have to go 1 day every mth and takes literally like 4 hrs...they test me with the new oral sticks to see i am taking my meds, not selling them or taking illegal drugs... which i have been in trouble for having no morphine or hydro when i run out...hence why i go to ER so often...anyway, my question is, how can i get through with these patches...i already took half my 120 hydro in week (going to run out and have to get percs from ER), but only used 3 patchs of the 2 boxes prescribed me. also, what should i ask for instead of patches? i like 20 mg oxycontin (i take 1/2 my friend's 40s) and would like 5 or 10 mg IR oxycodones instead of hydrocodone/vicodin or regular percosets w/ tylenol are good, too, if used with oxycontin. what are other good options? i can get by on 20mg oxycodone 2xs day with 5-10mg breakthrough pills at least 3xs day (5-10 mg w/the 20s am and pm, then the oxycodone alone around 3pm). i have been taking meds for 3 yrs nonstop (off and on more than that, with my first big surgery being 2006), so the tolerance is big, even though i am a thin woman. i do have height though, (5'9", 138lbs), as well as health, aside from kidney and high blood pressure (although when i suffer with pain med probs, like not a good build up in my system, i get too skinny...don't eat and throw up when i do, don't get good fluids which leads to urinary tract infections, bad for kidney probs...). i mostly need tips on how to use the sandoz 25 m patches to get me through next 3 weeks or less (as in how to get them to work faster/better, how often they REALLY last, not the 72 hr. BS for generics, how to get it off the patch and suck/eat/whatever it to get results)...Also, would it make a huge difference and work if it was NOT generic brand? would insurance cover that? (i am 1/2 time grad student single mom with MA med asstnce in PA)...Basically, ANY info you people have would be GREATLY appreciated. I have a science/healthcare based B.S. degree, so I have the basics, just need some specifics from voices of experience!...thank you all...PLEASE excuse grammar and punctuation...really am PSU grad thanks fellow travelers!

 

[effie]

The problem is, by somehow ingesting the fentanyl faster (by smoking/gumming) you'll obviously get through your supply a lot faster.. and then have to explain to your pain meds doctor why a months supply didn't last a month. I think it's quite reasonable to bring up other things that might work (eg oxycodone) but that's a discussion for you to have with your doc. There are stronger patches too which might suit you better. Fentanyl is generally a good opioid for people with kidney disease.. I'm sorry you're having such a rough time at the moment though

Sandoz patches are the matrix not the gel type, right? (Just a square of sticky plastic, not with a gel reservoir..) They can't really be smoked easily, you're basically just smoking plastic and it doesn't really work. Sticking some to your cheek/gum gives you faster absorption from transdermal, but it can be dangerous as you can't titrate how much you are taking like you can with smoking and it makes overdose more likely. I appreciate you have a high tolerance, but I feel I have to warn you - fentanyl is insanely strong and as there is 72 x 25mcg plus a bit extra of fentanyl per patch, it can really take people by surprise when they use the patch in a different way to transermal and release a load of fentanyl into their system quickly. If you are going to try this, please be very careful and try a really small amount first.

There are several threads on fentanyl in the Other Drugs Directory if you haven't already seen them.

Overall I don't think it's wise at all for a pain patient to start abusing the meds that they need to treat their pain (and by abusing I mean using in a different manner to what was prescribed) as you don't want to risk being dropped by your pain doctor - but I understand your difficulty and I'm so sorry the patches aren't working for you just please be careful!

Good luck, I hope you get on top of your pain soon

 

[PSUalum]

Edited...just checking

My edit...just testing site...

 

[PSUalum]

I do not want to smoke it...i just wanted it to work a little, to not take too many vicodin due to the tylenol quantity...i called the pain clinic and told them i don't like it and do not want this treatment. i am waiting for new appt., problem is i may be out of luck until next previously scheduled appt., due to overwhelming number of pain patients. i won't get dropped because i have been honest, i saved every plastic piece and wrapper, and like i said, i told receptionist/nurse that i am having multiple probs with this therapy, when i called for new appt. the anesthesiologist/pain MD that gave me this script told me to call if it didn't work or if i had any problems. i always try to stay on top of this, as i have had alot of problems with pain clinics and MDs in the past...1 clinic Dr. left town in the dead of night after screwing everybody, one Dr. had to stop prescribing due to attempted suicides by patients, basically, you name it, this area has seen it all. the nature of the business and the rural area PSU is located in doesn't help. Thank you for the reply!

 

[effie]

Ahh I'm so sorry you're having such a difficult time! I would avoid smoking that type of patch, so I'm glad you don't want to go down that route - cutting off a piece and sticking it inside your cheek or under your tongue would release the fentanyl faster so you could try that but start with a really small piece and work up to test your response. Fentanyl has a really short half-life so obviously although it will be released faster and your blood concentration will be higher, the effects will be much more short-lived than wearing the patch. I'm sorry I don't have a better answer to give you.. I hope you can get an appointment soon, sorry to hear about all the problems with pain doctors in your area.. very glad to hear you have a good relationship with your current one though.

Good luck there are quite a few chronic pain patients on this forum who have found it hard to get their analgesia sorted or have had difficulties switching medications, so you are not alone. Probably a silly question but have you tried non-opioid painkillers (eg gabapentin or pregabalin (Lyrica) especially for nerve pain - I appreciate you probably can't take NSAIDs due to your kidney problems) and other methods (hard to be more specific without knowing the cause of your pain but things like physio, TENS, nerve blocks etc) or ways to help you handle your pain better (therapy, meditation etc) ? I don't mean to suggest you haven't tried everything, just thought I'd mention them as you say you've been struggling with your pain control for a long time..

Oh - and if you are taking a lot of Vicodin and ingesting more than 3-4g APAP in 24 hours (1-2g in one go), do a cold water extraction (CWE). It removes all the APAP but leaves the hydrocodone. CWE megathread

Also here is the chronic pain management megathread..

 

[muvolution]

you should check out a Sympathetic Nerve Block if your pain is local, especially in your back. Well, mine is my ankle, which is destroyed from skating + snowboarding pro for a while... it works soooo good. Seriously. You gotta try it. I was at 180 x 10mg Oxymorphone a month to even function (contradiction in terms, you can't function on that level of dope) and I have probably cut my equivalent opiate dose to 1/4 in 6 months with those injections.


Basically, they put you under, stick a giant fucking needle into your spine wherever the nerves for the localised pain branch out, shoot you up with fentanyl and midazolam depot shot that lasts a month or so, then wake you, you go home and party like a fuckin rockstar.