Opioids Pain Docs and Injectable Pain Meds

[Eva 33]

For several years, I've been prescribed morphine injectable for a serious health condition. In 2002, my neurologist first prescribed morphine injectable for at-home use, so that I could avoid going to the dreaded E.R. to try to manage my excruciating pain. I was SO thankful!

In 2009, my neurologist referred me to a pain management doctor. My pain management doctor increased my IM injectables, to the point where I was allowed to take 3-4 shots per day (if needed). I am in serious and constant chronic pain, so I really do need it to keep me out of the E.R. Morphine injectable is also relatively cheap, and it is very effective for my pain (only thing that gets my pain down to nearly a zero, at least for 4 hours or so). It's the only way I can have anywhere near a 'normal' life.

Now, my long-time pain doctor is retiring. Since I have never abused my meds at all and my doctor has deemed me to be a 'stable' person, my pain doc didn't think it would be all that difficult for me to find a new pain doc who would be willing to prescribe morphine injectable.

Well, I tried seeing two new pain docs, and they both FREAKED OUT when they saw that I am on injectable pain meds. Despite my well-documented medical history, apparently no doctor in the current USA regulatory environment wants to take the risk of prescribing at-home injectables, even in SMALL amounts.

In desperation, I called my pain doctor. He told me that the recent DEA crackdowns have ALL pain docs VERY nervous, and that prescribing injectables is too 'out there'. HE was willing to do it, but finding a NEW doctor who will prescribe injectables? He says it may well be impossible. I explained that I need SOMETHING to keep me out of the E.R., and my doctor wholeheartedly agreed that I SHOULD be able to have at-home injectable pain meds. It's just the darned new regulations that are messing things up.

The only alternative to at-home injectables would be something like Actiq (fentanyl lollipops). Unfortunately, Actiq is super-expensive and most insurance plans (including mine) refuse to cover it. It's the same story with Subsys (sublingual fentanyl). Back in 2009, my doctor never was able to try me out on Actiq, due to insurance refusing to cover it. Additionally, the FDA put a black box warning on Actiq and Subsys, saying that prescribing these meds for my condition was 'contraindicated'. NO doctor (including my great pain doc) wants to defy the FDA and prescribe off-label.

For 15 years, I've had something to control this horrible pain, and now it's being taken away from me. (It's the same story for ALL chronic pain patients---the current 'climate' is extremely hostile to pain patients and pain meds). Pain 'pills' don't touch my pain when it gets excruciating.

I've never used heroin, but I can understand how a chronic pain patient might be desperate enough to try it, if no other pain meds were available. I don't have the time or the money to waste on the E.R.; they DO NOT want people coming to the E.R. for pain control.

I find it very sad that the DEA is forcing legitimate chronic pain patients into considering doing heroin or just giving up altogether because the pain is too severe to go on living. I don't even want to THINK about how much I used to SUFFER before I had at-home injectable pain meds. The prospect of NEVER, EVER having a strong short-acting pain medication available to use in a crisis is terrifying. I'm currently conserving the morphine so that it lasts as long as possible, but it's not going to last forever.

I don't know what pain patients are supposed to do in a crisis, because the E.R. is awful. I'm not going to go through countless hours of waiting and get billed $2,000 just for the hope of MAYBE getting 4 hours of pain relief.

 

[BasX]

Why don't you just get on fentanyl patches? If you are really using for pain, there are alternatives. Morphine is good IV because it has such a low bio-availability using any other method, but there are alternatives that would just just as effective if not more effective...

If you are really looking to IV, well then you can't say you're ONLY looking for pain relief. Saying you are considering street heroin as an alternative for legitimate pain issues is ridiculous. If you're really intent on injecting morphine, get some capsules and and micron filters. There are plenty of posts here that will guide you through injecting capsules safely. Just remember that morphine pills almost all gel-up and can't really be injected safely, so you are looking for capsules with beads (they are higher dose anyway). I forget the name of the best one for this purpose... comes in 200mg red capsules... total memory blank here, but Kadian was pretty good too. Just remember MICRON FILTERS ARE ABSOLUTELY NECESSARY.

 

[tacodude]

Do not inject sustained released pills as earlier poster suggested. You can inject immediate release formulations preferably with a micron filter.... I would even recommend oxymorphone 5 mg IR roxxane lab formula. They dissolve on contract with water and can easily become a shot in minutes.

I feel you and wish the best for you. Again if a doctor prescribed an immediate release formulation you could just make a shot out of those.

 

[subotai]

it sounds like fentanyl patches might be your best bet if you are unable to continue your current pain management prescriptions, which Ill be honest, you probably wont.

Even if youve been on them for a long time, there is just too much pressure on doctors by federal agencies like the DEA anymore that they (especially newer doctors) are afraid to prescribe anything that could cause them to obtain more scrutiny from the aforementioned agency

In my opinion, it all comes down to presentation. Doctors seem to have no problem prescribing pills that are meant to be taken orally but anything that comes in an already abusable form (ie: your morphine injections. whether theyre meant for IM or not, you can still IV it), are being phased out

As far as making a shot out of Immediate Release pills, I would not recommend this because prolonged shooting up of morphine pills does nothing but give you a 10 second high for 5 minutes of work and completely wrecks your veins to the point where shooting up substances that would actually be worth the time and effort becomes hard.

I would not advocate you start using heroin to replace you legal pain meds because you would not know how strong it is or what it is cut with and therefore would most likely find yourself in one of two positions:

1. dead
2. getting no relief because it is weak heroin and your tolerance is pretty high

I wouldnt say its a crazy idea though, Id just try the fentanyl patches first

 

[UpInFlames]

The only issue I can see with the fent patches, at least in the US, is that not all ins cos cover them, and those that do, often have a very high co-pay. Unfortunately, they also are very expensive.

My late friend, who died of cancer last month, was on fent patches for quite a while. She was not able to afford the co-pay on the patches, so a few of her friends/relatives, and I pitched in to pay the copay every month so she could have the med.

 

[Kittycat5]

Is your doctor who is retiring maintaining his medical and DEA license? Many do and he could temporarily write you scripts (no more than a few months for his protection) until you sort this out. In fact, if he isnt retired, he legally can do this now.

Many plans do have normal copays for fentanyl patches. So call your plan and ask if going that way.

 

[tacodude]

Honestly if you can obtain micron filters and use a fresh one every pill you prep into a shot it could be the best way to go. Again though only if you practice harm reduction methods every time. This only works with immediate release pills and will not work with sustained released pills.

 

[rhun]

I'm going to keep this open because it sounds like OP is in a really tough position and I'm sure many others are too. But let's make sure this doesn't get turned into a "what should I say to my doctor to get prescribed X" thread. And as always, let's keep it HR related.

 

[chase_in_56ace]

You are in an incredibly tough position here. I've been seeing a pain doctor for legitimate chronic pain for around four years now so I felt like I'd chime in. First of all, the other posters saying thay you're gonna have a very hard time finding a doctor to continue your regimen of injectables are extremely correct. The DEA is not only putting pressure on doctors. Nowadays the DEA is giving ludicrous amounts of authority to pharmacists. Even if you could possibly get another script for injectable morphine, it will be less than half the battle won. Finding a pharmacist to fill it will be virtually impossible, at least where I am in Florida. Pharmacists will literally lose their licenses by agreeing with the wrong doctor. Your path is now from a VERY leniant doctor (lets be honest... You're looking for one borderline RECKLESS) to a mail order pharmacy for injectable morphine. You have virtually no chance.

COMPLETELY DISREGARD ANYONE IN THIS THREAD DIRECTING YOU TO IV KADIAN, ms contin, OR ANY OTHER FORM OF MORPHINE IN PILL OR CAPSULE FORM.

Shooting morphine pills is extremely wasteful and the pain relief wont even be REMOTELY the same. And its stupidely dangerous.


Fentanyl patches are your ONLY option. Even with a high dose oxymorphone script you need to sniff or shoot to get pain relief from them. Get the patches. Figure it out bro. Dont go down the dark road of heroin addiction.

 

[Tinker55]

We have pharmacists here who would certainly know better than I, but they do not have ANY authority. Insurance companies including governmental programs have basically forced pharmacists to sign a contract that to get paid for a month supply of any Schedule II, they can't fill another script in that period. Even if a patient pays out of pocket. I once had half a script of pills stolen-filed a police report, brought it to my PM people and was given a replacement script. Guess what? Pharmacies wouldn't fill it because they already filled the 30 day supply. I won't explain how I managed, but I was infuriated that after a genuine documented loss, I could not replace the script.

Try the patches. If you have a genuine script, you might be able to shop around on price. DO NOT IV this stuff!

 

[BasX]

I apologize for what I had recommended in that second post. As pointed out, you should not inject extended release formulations. The reason I mentioned capsules specifically in this case is because basically ALL the morphine pills (even immediate release) I've encountered had some anti-abuse measures built in, most commonly gelling up. You really don't want to inject any sort of gel.

The capsules on the other hand (at least the ones I obtained) tend to have a more 'mechanical' mechanism for sustained release, which are defeated upon crushing and have no exotic binders. I always found these (when done properly) produced what I considered a much safer result than any morphine pressed pill I have found. But yeah, you don't want to inject extended release pills in general.

 

[chase_in_56ace]

We have pharmacists here who would certainly know better than I, but they do not have ANY authority. Insurance companies including governmental programs have basically forced pharmacists to sign a contract that to get paid for a month supply of any Schedule II, they can't fill another script in that period. Even if a patient pays out of pocket. I once had half a script of pills stolen-filed a police report, brought it to my PM people and was given a replacement script. Guess what? Pharmacies wouldn't fill it because they already filled the 30 day supply. I won't explain how I managed, but I was infuriated that after a genuine documented loss, I could not replace the script.

Try the patches. If you have a genuine script, you might be able to shop around on price. DO NOT IV this stuff!

If pharmacists only get to fill X number of CII scripts a month, they have all the authority as they excruciatingly decide who to turn away. Nowadays you have an injury, print out your previous med history from the pharmacy, have a new MRI done, pay out the ass for a doctor's visit, finally get prescribed, spend $1000 in gas finding a pharmacy that has your meds in stock.... Put your script on the counter below a little mountain of scripts for an antibiotics.... A few NSAIDS... A muscle relaxer.............

.......... 180 30mg IR oxycodone......


Pharmacist (with eyes bulding wide open): "Wbat color are your shoes?"

You: ..... "Brown, why!!!???"

Pharmacist: "Nope... Cant fill this. Sorry "


Maybe not that extreme but anyone really filling CIIs out here can feel me.

 

[Kittycat5]

We have pharmacists here who would certainly know better than I, but they do not have ANY authority. Insurance companies including governmental programs have basically forced pharmacists to sign a contract that to get paid for a month supply of any Schedule II, they can't fill another script in that period. Even if a patient pays out of pocket. I once had half a script of pills stolen-filed a police report, brought it to my PM people and was given a replacement script. Guess what? Pharmacies wouldn't fill it because they already filled the 30 day supply. I won't explain how I managed, but I was infuriated that after a genuine documented loss, I could not replace the script.

Try the patches. If you have a genuine script, you might be able to shop around on price. DO NOT IV this stuff!

Pharmacist here. Where are you speaking of? I could actually see this being the case in states like FL, WV, KY and others, but where I practice, I have authority to dispense or not whenever I feel justified. Sure there is procedure to follow, but if one of my long term PM patients in good standing came in and said KC5, my meds were stolen and my doc gave me a new script, I will pay cash, I would do it in a second. If next month, I get the same story, well then that patient will be waiting until I do my due dilligence. And I wont say I never refuse a new customer with a large quantity of high doses pain meds, normally I just do what is expected, and fill it, and make notes to monitor for a few months to make sure we arent taking on someone who is not a legit PM patient.

 

[Tinker55]

Thanks, Kitty, I'm in MI. And have NO history of early refills, dr shopping etc. The pharmacy was actually in the same building as my PM group. After the script was refused (i had the police report and asked them to call upstairs to verify), and I did an alternative, I was told the same thing by several other pharmacists. I was also told that if it happened again or there was another genuine loss, the prescribing doc should write for a difference dose-for instance, 6 a day vs. 4.

If you're interested, I can identify the insurers who have used this contract. Medicaid certainly has.