Opioids For real pain managment, do the mylan fentanyl patches suck?

[opiatekrzy]

i am pretty tolerant to opiates, as a user for the past 15years, i went from hardcore heroin addict, to methadone maintenance at ridciolously high doses, on and off suboxone program for 5 years...people swear that dilaudid is the bomb, well whenever i have IVed dilaudid, i would get a 4sec. rush literally, and no after buzz, went to complete sober, so i suppose my body handles different opioids different. when i was using fentanyl, from slapping it on my arm, getting way to sedated, even with a heavy tolerance i had to put it off, from trying to smoke it, and g etting no effect, from shooting 1/4 of a 25patch, i would black out everytime i pull the needle out, and wake up a few hours later, same with my girlfriend, i shot her up, and we both woke up the same time frame freaking out at eachother not knowing what the fuck just happened. regardless of my stupid high tolerance, fentanyl is so powerful most folks cannot abuse this drug without severe caution, it is reported that 200grams of fentanyl is enough to supply 200 million people with a good hit..shit just is too unreal and i dont condone in it, not euphoric at all..i was on 180mg of methadone, and slapped half of a 25patch on, the next morning i had to take it off cuz i got way too sedated, yet the week before i injected 14 bags of heroin at once , and only got a rush for a few seconds and the heroin high was completely vanished...from what i hear, is it true fentanyl is used to put patients under for surgery in gas form???? its so short acting that as soon as they discontinue the gas, and hit the patient with a reversal there back to normal..it sjust an evil , drug that i wont accept as the opioid family

 

[bennyZA]

^^^^ Damn dude, we are seriously different... I slap a 25mcg patch i don't even feel a thing. Literally. I do not even notice it. I do not get sedated, etc. However, when I slapped 12.5 on my gum, wooooooaaahhh. Not only was it intense, but it was really euphoric. Not heroin euphoric, but still... I got a good nod, a good itch, but I didn't feel like I was going anywhere near the danger zone. 180mg of methadone however, that'd probably put me in the hospital.
Probably one of the big differences is that I don't IV.

 

[opiatekrzy]

^i was at a methadone clinic, i was on 180mg for quite some time to begin with....i never understood why i couldnt achieve any euphoria out of fentanyl, its the only opioid i dont get along with, that and dilaudid, its a waste...i would shoot dilaudid 4's one after another, only to get a 3second rush, following complete soberness....no after buzz, NOTHING....i had like 10 pills, and kept shooting one after another cuz i had a bad tooth ache, shit was so wack, 3 sec rush, no buzz afterward..anyone else have this problem?

 

[bennyZA]

dilaudid, its a waste...

Everyone who does opiates fucking LOVES dilaudid, but I don't even get high on it. I just immediately puke, even if I snort. I really mean it when I say immediately. So much so that when I go to the hospital, which is often because of my injuries, they give me morphine instead of dilaudid cause on my sheet it says I'm allergic. I wish I wasn't, but whatever.

Back to the fent, when I finally took 50mcg it was 4 12.5mcg's. This Friday I'm going to get the actual 50mcg patches. A couple ?'s. Are they bigger than the other patches, I would assume they are, but since it's in the plastic I could also be wrong. The other question, is it stronger than 4 12.5's? I've heard that taking 1 patch of 50 is much stronger than 4 12.5's. I'm really happy about this, not because I'm getting a powerful opiate, but because I'm finally getting the pain relief I deserve. Something I never got because they consider me an addict - which I am. I am a little worried that I might gum them again, but I didn't with the rest of my 12.5's so I'm not to worried.

 

[Cadamec]

I can only speak for the Mylan brand patches. Since the drug is contained in the adhesive and spread out evenly using something they call matrix technology, the patches are larger as the dose goes up. The 50's are twice the surface area of the 25's.

Still trying to find the right dose for me without buzzin my ass off. The 25's are enough for me not to lean heavily on my BT meds. The 50's are strong enough for me not to need my instant release meds for breakthrough, but make me stoned and my breathing a little bit shallow. Gonna have to ask the doc about doing a 25 and a 12.5 together. It's inherent potency seems to make titrating the right does just for pain a challenge.

 

[bronson]

Moving this BDD --> OD as the discussion is now more about what's best for pain management, than the originally basic question the OP asked.

 

[tricomb]

This is not generally an allowed topic since it's blatant brand discussion.

However for the time being I'll allow it to remain open (but please know that it will likely inevitably be closed, please review the OD guidelines if you want to go over all the reasons why.) for the time being, because in my best judgement, fentanyl is a drug that could seriously injure or likely worse, kill someone who's trying to abuse it; Moreso than most other drugs covered in this section, due to the exponentially higher risk of fatal CNS and respiratory depression, and the essentially complete lack of reliable harm reduction tactics when it comes to their abuse.

"For real pain management" I've used the mylan patches along with just about every other brand with great success but it is far too potent a narcotic for me, and because I require multiple other CNS depressants currently, it would be a suicide wish to be on patches even if they could provide me with a more stable steady state concentrations of pain medication for my chronic pain syndrome, it is NOT worth the risk IMO.

Fentanyl Citrate should be like, the last last LAST LAST resort. It's my last resort, I know the likelihood is high that one day my pain will not be adequately controlled via oral pain medication and I will not use Fentanyl Citrate until I have absolutely no other choice. I've simply seen them kill too many people, people who were addicts, people who were innocent chronic pain patients.

If you have even the slightest thought or curiosity about tampering with your fentanyl citrate transdermal delivery systems, it is NOT the drug for you and you would be MUCH better off discussing alternative options with your prescribing physician.

If you have to tamper with your patches to get adequate pain relief, they are NOT doing their job correctly and to get this taken care of, you need to raise this issue with the prescribing physician, not with internet forums. Your doctor has the power to legitimately address your pain concern without you having to risk your life and the lives of everyone around you. Do not tamper with fentanyl transdermal delivery systems / fentanyl citrate patches.

 

[Cadamec]

Thank you, tricomb. I agree. I have only heard of two other drugs that are more potent and they are not approved for human use as far as I know and they are analogues of fentanyl.

Fucking with the patch's gel, chewing it, or doing anything to potentiate it is about the stupidest thing I can think of to do. It is designed to deliver MICROGRAMS per hour; not milligrams. It is potent as hell. That does not leave room to screw up.

Somehow, I knew years ago I would wind up on it. Cost and/or side effects made some of the slightly lesser potent pills not an option since the doc has pushed for ER meds. Something to talk about on my next visit. I have never felt I was on more a slippery slope than I am on this drug.

The 25 is not enough and the 50 is strong as hell. With the 50, I don't need my muscle relaxers, my xanax, tyleneol, ibuprofen, or dilaudid IR for breakthough all day. Has anyone cut one of the matrix technology ones in half to get to the desired does. i.e. Cut a 25mcg in half to make two 12.5's? I want to try 37.5 to see if that is what is going to produce the desired result. Since the drug is contained solely in the adhesive and the dosage is determined by the size of the patch, I don't see why this would not be a viable way to test without risking an OD.

 

[tricomb]

As I said, no need to tamper with the patch. Cutting even the plastic matrix patches constitutes abuse, and like you said there is NO room for error.

Yes they're a helluva lot safer than the old-school gel patches, but the whole reason they make fentanyl citrate commercially in patches formulated 12.5mcg/hour, 25, 50, 75, up to 100mcg/hour is to avoid the necessity to cut any patches.

If 50mcg/hour is too much for you, but 25mcg/hour is not enough, ask your doctor about getting RX'd some 12.5mcg/hour patches. They are not as well-known but they exist, for this very purpose, and if all you needed was a 25mcg/hour patch + a 12.5mcg/hour patch, like I said, fentanyl is pretty much the last line of treatment for us chronic pain patients and there are not many options left once you exhaust the fentanyl. The only stronger narcotic approved for human use is indeed a fentanyl analogue, Sufentanil which goes by the trade name Sufenta.

I've only ever heard of it being given during end-stage terminal disease or during/post-op for EXTREMELY opioid dependent individuals, and It's rarely if EVER given outside of the hospital setting, or one where they have mechanical ventilation and a crash team equipped to revive you, should your O2 levels begin to drop below ~91-94%, God Forbid.

Some of the best around-the-clock analgesia I've ever experienced was from the 12.5mcg/hour patches, worn as directed.

Note: I must add that even though I thought I was heavily tolerant to opioids and by all my calculations, I could have tolerated a 50mcg/hour patch, well, let's just say that I'm here today because I didn't trust an online converter with my life. The online converter said I should/could be on a 50mcg/hour or higher patch, but the 12.5mcg/hour patch had me feeling THIS close to an overdose. Don't underestimate this drug!

 

[Cadamec]

I decided patience was the better route. My PM doc has me now at 37mvg. A 25mcg patch and a 12mcg patch concurrently. I will let you know how my pain management works with this dose. We are very close I think to dialing in a a solution to my pain that is productive and safe.

I hope anyone with real pain treats their pain meds as medicine and finds other things to "party" with safely so they do not screw up being able to obtain the meds they need to function without debilitating pain. That is my philosophy and it works so far.

 

[BlueberryfishY]

i've been doing 50mcg patches for 2 weeks now, not every day but every other day cause of the price, fent is amazingly powerful unlike anything i have ever tried, the other day i took a 50mcg patch made by watson, opened it up, pushed all the gel up with my thumb, cut a little piece off the end, and squeezed every last bit of gel under my lip all at once, it took about 10mins, on top of that i was on 10mg of kpin, 2mg of ativan, and 4mg of xanax. 7 hours later i woke up half on my chair half on the floor, bit the shit out of my tounge, didnt realize what happened til i finally snapped out of it, i dont remember anything but black, just black, for some reason i it would have been nice not to have woke up.

 

[Cadamec]

i've been doing 50mcg patches for 2 weeks now, not every day but every other day cause of the price, fent is amazingly powerful unlike anything i have ever tried, the other day i took a 50mcg patch made by watson, opened it up, pushed all the gel up with my thumb, cut a little piece off the end, and squeezed every last bit of gel under my lip all at once, it took about 10mins, on top of that i was on 10mg of kpin, 2mg of ativan, and 4mg of xanax. 7 hours later i woke up half on my chair half on the floor, bit the shit out of my tounge, didnt realize what happened til i finally snapped out of it, i dont remember anything but black, just black, for some reason i it would have been nice not to have woke up.

That's an overdose, my friend. You are lucky to have come back from it and post about it.

Are you breaking into the gel regularly? Please don't. I am guessing you got lucky. That kind of dose is lethal. Doctors do not administer that kind of dose without monitoring their patient and having life support systems available.

 

[midnight11]

I'd seriously recommend ANYBODY using fentanyl patches who doesn't believe they're working "enough" for their pain should absolutely NOT alter the patch in any way to obtain a faster / more acute dosage. I know a lot of people have written threads about the process of extracting the fentanyl from the patches, ways to potentiate / speed up their effects, etc, but I think it's INCREDIBLY dangerous to mess around with these things. I've known a few people who have had pretty bad episodes after altering theirs due to fent's strength, and definitely don't think it's worth the euphoria / desired level of analgesia. PLEASE, if you're in chronic pain and require a fent patch but believe it's not as effective as it should be, speak to your doctor about this issue and try to figure out if the dosage is overall too low, or if you're experiencing episodes of acute and severe breakthrough pain that makes you feel this way. If it's the latter, your PM dr can likely prescribe an instant-release tablet or preparation that will solve your issues.

 

[midnight11]

i've been doing 50mcg patches for 2 weeks now, not every day but every other day cause of the price, fent is amazingly powerful unlike anything i have ever tried, the other day i took a 50mcg patch made by watson, opened it up, pushed all the gel up with my thumb, cut a little piece off the end, and squeezed every last bit of gel under my lip all at once, it took about 10mins, on top of that i was on 10mg of kpin, 2mg of ativan, and 4mg of xanax. 7 hours later i woke up half on my chair half on the floor, bit the shit out of my tounge, didnt realize what happened til i finally snapped out of it, i dont remember anything but black, just black, for some reason i it would have been nice not to have woke up.

THIS is the reason I'd say NEVER try to alter the dose fentanyl patches deliver and / or how fast they deliver it. WAY too dangerous, not to mention the potentiation risks with that quantity of benzos in your system. If you're going to alter the patch in this type of way, at the very least cut it into quarters, use one at a time, and wait at least 15 minutes before using another. It's just dumb to alter a multiple-day-dispensing formulation of one of the most potent analgesics on the market.

 

[Cadamec]

THIS is the reason I'd say NEVER try to alter the dose fentanyl patches deliver and / or how fast they deliver it. WAY too dangerous, not to mention the potentiation risks with that quantity of benzos in your system. If you're going to alter the patch in this type of way, at the very least cut it into quarters, use one at a time, and wait at least 15 minutes before using another. It's just dumb to alter a multiple-day-dispensing formulation of one of the most potent analgesics on the market.

I disagree with this advice. again. Fentanyl is very powerful medicine. Even in a surgical environment, it is delivered in MICROGRAMS. To ROA it in a non prescribed manner can lead to overdose, especially if other drugs/alcohol are on board. You run a great risk of delivering too much. Additionally 15 minutes is not enough time to gauge a reaction to the drug.

The advice in the above post does not seem informaed and is contrary to advising harm reduction. This shit is too potent to be playing with in that manner.

 

[bennyZA]

I know this post is pretty old, but as the OP I'd like to update people on my feelings about this medicine (after a month of use and not abuse!)

So, at my pain clinic my Dr. is very careful about prescribing to people with addiction problems - like me, sorta - but he is very understanding about the fact that a lot of "abusers" often abuse because the pain is so bad, like me, then it spirals into addiction. So I was upfront and honest about not wanting to be an addict but also that I really, really need pain killers. I broke both shoulder and shattered my knee, had 3 surgeries in 4 years and I'm having major shoulder reconstruction in a few months. So I NEEDED pain relief.

So, in regards to the fentanyl patches: My doctor is trying to prescribe them more because contrary to popular belief, they're not the most powerful or last resort. It maybe that they are in mcg doses, but the whole point is that you can get a lot of pain relief on a small patch. Oxycontin is far more powerful and addictive, so is MScontin, Opana, etc (yes, I have tried them all). Not only does fentanyl last for 3 days, making it convenient for dosing, but it also has the pain killing effects without too much wooziness and not that much euphoria. After trying to gum thing once, I never felt the desire to abuse the patch. My doctor believes that fentanyl patches - in one way shape or form - will be the future of narcotic pain relief. I mean, taking 1 12.5mcg patch is like taking a few vicodin over the course of the day. That being said, it seems to be an exponential dose/response curve. 25 is not that much stronger than 12.5, but 50mcg is way, way stronger than 27.5mcg (does that make sense?)

You gotta put a lot of effort into abusing them, and the recreational value is very low. They are super effective for pain relief (once you find the right dose). Most important - to me - is that you don't have to walk around with a bunch of pills with everyone asking you "let me get one." The real drawback, as everyone has said, is the high risk of OD from recreational abuse. So, I think that as the patches are perfected, fentanyl will become a go to drug for pain relief. I can't comment on the withdrawals because I don't get dope sick (I know, I know, everyone thinks I'm lying but I quit subs cold turkey and oc's without getting dope dick at all). The best part for me though: I'm no longer super depressed about my life, the pain was causing the depression. After a month, I feel so much better.

Just don't use these to get high!!!

 

[andrew812]

I am a chronic pain patient who had had Achilles tendon surgery on both legs and feet and severe nerve damage and chronic out of control pain. I've been on opiate pills for 5 years. After months of debilitating pain only getting worse my doctor/surgeon prescribed me 12.5 fentanyl patch. After two months of dialing in my dose im on the 75 MCG/h patch for 5 months now. It's the generic patch and my pain has never been more under control than it is now. Its a god send. it's not for everyone and you must be careful v but it's changed my life. I've been told I'll be in pain the rest of my life. And k know ill have to gradually increase my dose. but as a chef working 50 hours a week its revolutionised vmy life!!!:]

 

[andrew812]

^sounds like you're taking too much if you're puking, etc. tobacco will cause that as well though. but you're right - fentanyl isn't euphoric at all; it's extremely heavy and sedating and that's about it.

take it easier by dropping your dose and you may find it a little more enjoyable.

as a chronic pain patient who has used the patches for an extended period of time in the past i can assure you it's the bees knees for pain management.

Amen on that. Makes life livable