On Butrans patch 20mcg three years now I'm in withdrawl and need advise

[SunkissedGirl]

Hi everyone. So I have been seeing the same pain management doctor for three years. As the practice got really overwhelmed by patients they hired an APRN to see patients too. I was ok with seeing her instead of the doctor. So three years ago the Doc put me on a butrans patch and hydrocodone. Right now the hydrocodone are 10mg each take 4 a day. The butrans patch is 20mcg wear for 7 days.


I am now going through withdrawl from the patch because I go there on Monday and see the nurse and I get the scripts. Both had a do not fill until on them. I noticed when I got home the patch script do not fill had to be a mistake. I had put my last patch on, on the 21st so due to be changed/filled the 27th. Mind you I've been changing my patch on the 7th day and counting the day you put a new one on as day one... For years and NOT ONCS had an issue with the dates not being on the same day it needed to be changed.until now. It says do not fill until July 1st. I called saying I am due to put a new patch on this is a mistake. They were relaying messages from the nurse to me. She basically said "if" I think I'm going to have withdrawals go to the ER. I was pissed. My dad is already in a hole bc of my IV infusion treatments. I'm under their care and I told them how is it that after three years suddenly the fill date is not on the same day as the day I need to change my patch!? They had no answers and said there is nothing they can do. I feel very upset and feel that as a patient of three years I'm being neglected. I know the doctor can help me if he really cared to. I am having chills, sweats, no desire to eat not to mention the pain I feel.

What should I do? Should I call them today and say I want to speak to the doctor as to why this isn't making sense after all this time and going to the ER for withdrawl help especially bc I'm a type 1 diabetic is unacceptable. I'm under your care. It's at the point where bc the nurse yesterday had no solution I am trying to get subutex to get me through till the 1st. As a type 1 diabetic I need to be able to eat and take care of that and withdrawals are making it harder and harder.

 

[SunkissedGirl]

Can someone hopefully move my thread to the right place so hopefully I can get some advice. Also if my doctor refuses to help me and I'm able to get the 8mg suboxone strips I should probably only need a small dose? Maybe 2mg or less? I'm not sure how a 20mcg butrans patch equates. Also should I stop taking my hydrocodone if I take the suboxone? Idk much about precipitated withdrawals. Or much about suboxone. Thanks

 

[Jabberwocky]

Definitely call your doctor and speak to them in person. Try not to be upset with them as you calmly explain exactly what you told us - you been using this for years so why the sudden change without telling you?

Either get your normal meds (and have your doctor's office call your pharmacy to clear it up) or get them to fax scripts for gabapentin and clonidine to your pharmacy so you can deal with the withdrawal if they aren't going to prescribe that stuff any more. Those medications do nothing more than treat the symptoms of opioid withdrawal, which you seem to be experiencing. The ER generally will not treat opioid withdrawal (IME) and, apart from being cost prohibitative, is a totally inappropriate use of emergency medicine services.

I'm sorry to hear you are struggling with this. If you get Suboxone strips use very, very low doses. Like 0.5mg or less (although you might have to take it more than once a day). Taking 1-2mg doses would be dumping much more of the medication into your system much faster and in greater amount than the patch would. Hence my suggestion of lower dosages multiple times a day (I bet you could get away with 0.5mg twice a day).

 

[SunkissedGirl]

So apparently they are having issues with insurance approving it to get filled. They had the doctor yesterday make it so the script could be filled and then the pain office manager drop my script off at the cvs. I thought I would finally get my medication but insurance said they needed the doctors approval! So the nurse approved it for expedited approval but it got denied. I called insurance myself to appeal it but in the email they forwarded me it said doesn't meet urgent requirement bc it says it's for topical pain/scar therapy. Wtf the nurse put in its used for that!! Of course it would be denied for expedited approval. Then lower in the email it said my diagnosis of osteoarthritis but they left out my scoliosis. In no way is it used for scar therapy. On the box it says used for moderate to severe pain that needs around the clock therapy. They/she should have put that in the approval. This is such a nightmare. If it will go through for Saturday then I think I can make it but idk what these issues are all about. I don't want there to be an issue Saturday and not be able to reach the pain management office.

Also I took hydrocodone earlier today but now I want to take some suboxone bc I'm starting to feel cold and chills. Idk if it's safe to take some yet or if it will cause precipitated withdrawals? My body is used to being on bupe and hydros at the same time obviously. I was going to take 1 or 2 mg soon.

 

[Jabberwocky]

You body is used to very little buprenorphine (very little) being introduced into your system at once though (I mean, what how many mg/hour did you patches deliver?).

I'd use the hydrocodone/buprenoprhine however you normally would (if you have buprenorphine already in your system it shouldn't be a big problem), but I'd strongly suggest your trying less than 1-2mg of buprenorphine to start. Higher doses of buprenorphine might make it more problematic when used to treat pain along with other more traditional full agonist pain meds.

EDIT: I see you were taking the 0.02mg per hour (or day or whatever) patches. 0.02mg is obviously a hell of a lot left than 1mg or 2mg, which is why I suggest trying 0.5mg at most to begin with. 2mg of buprenorphine right after taking some hydrocodone has the potential to put the user into precipitated withdrawal.

 

[tacodude]

If they are 8 mg strips I found looking at it wide side horizontal splitting it into 4 columns of 2 rows of even wow tab size squares (like the size of water color paper Lsd sheet tabs if they were cut properly, which might be a bit smaller than blotter art paper although I can't say for sure) and then cut those squares into 4.

Another way to dose it sneak is volumetric measurement. Mix the 8 mg strip with 8 mg water till it dissolves completely. Every 1 ml is 1 mg. Use 0. 1-0.25 ml to start.

 

[ConstanceG]

I personally miss my butrans patch, especially with the war on opioids right now. I find it baffling they are soo expensive, when they are really difficult to abuse or use recreationally. I did a healthy taper off of them. What I found however that helped my pain was subutex...same med just different ROA. I found 1 8mg subtext was enough to last nearly a week, broken into little tiny pieces under the tongue. I then tapered from there, and it was much easier.