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Opioids PM Paitents: Dealing with Docs, Earning Trust, Scenarios & Helpful Tips

streetpharmacist84

Bluelighter
Joined
Aug 10, 2015
Messages
75
Ill get the thread going and share some of my go to tactics and ways of dealing with my doctor.Warning: Drug Seekers Trying To Get Info to Scam Doctors. I Know My Shit and Will smell you a mile away, so fuck off. I wont even tell you I know ill just give you bunk information so that you get thrown out and laughed at at your DOCTOR. People like you make it hard for paitents like us to get what we need, which is the reason we have to play games at our doctors. A quick background on my disability. I have been rear ended twice, once at 80MPH and once at 30MPH. I have fell numerous times snowboarding from at least 20 feet in the air resulting in several trips to the hospital and a missing tooth and broken collarbone. I was born with a spinal hemangeioma that is intertwined with my vertabrae, spinal cord and muscles at my L4 to L5 vertabrae area. Its a benign tumor mass of blood clots that is non operable that was only discovered a few years ago. Up until then because of my age and difficulty confirming my injuries I had a hell of a time getting relief. As a paitent and because of my severe condtitions and young age I have had extensive experience in jumping through all the hoops pain patients go through to get the specific medications, doseages of said medications, and earning the trust of you provider that's essential. Unfortunately, I have found that its essential that you play their game, even when they are denying what you know you need. I have found myself asking many times for an increase, a certain med, etc. only to have the doctor tell me its dangerous........when they do this as hard as it is I know, Ive got to telll them if they think its dangerous then I don't want it and trust their opinion. Other scenarios include that month you twisted your back at work and your out a week early, even if it means withdrawl........you absolutely 100% cannot tell them you took extra, or youll be discharged 99% of the time. I have went as far as to call my doctor, and take the time to explain them what happened. Then asked their permission to take extra so that I can function......and surprisingly he has told me he understands, and to come in when your close to running out and Ill take care of it. You might be surprised but not only is asking respecting the risk they are taking prescribing them to you, it shows that your concerned about your health. One scenario that Im currently facing (and putting on the back burner) I have two teeth that need pulled and am super nervous about getting dental surgery as far as management of pain is concerned. When I had my wisdom teeth removed I wasnt using opiates daily, only as needed and rarely anything more than a 10/325 percocet or hydrocodone (at the time, I always thought they were about the same) occasionally a low dose of morphine or maybe taking two at once. When I got those teeth pulled I was on state health care and had to be awake.......living nightmare. I was fortunate enough at the time to have a friends mom who was chill and gave me some liquid morph so that I could be comatosed. I now have insurance, but have other dental work that needs done besides the extraction so I want to strech out my 2000 dollar limit of getting cavities fixed etc, rather than paying 100 bucks a piece to pull teeth with an anesthesiology bill for 1500. So, obviously am going to bite the bullet and go through it again.......except this time nothings gonna put me in a comatose, im tolerant. When I have talked to the dentist he says with the amount of pain meds im prescribed you need to go through your doctor because he is not qualified to help me in that department and if something happens its on him. Any suggestions folks? Currently right now, for pain management purposes I am on 30mg Oxycodone IR 5 to 6 times daily, Hydrocodone 120 per month with the privilidge of my doctor telling me to use them however I need, no more than 8 in one day or 120 per month, and rotating every few months soma 350s and valium 10mgs for spasms because it seems like I get better relief when do that. Another important factor to consider is cannabis really helps me potentiate my opiates, as well as replace the hunger they take away. I cant smoke after dental surgery so I was wondering what the rest of the PM Paitents out there have done in the past. Thanks guys.
 
please make paragraphs, I will literally lose my mind if I try to read that... I know that sounds bad, but I have a lot of psych issues and I am OCD as fuck because of it.
 
Break up that wall of text and people might read your post

periods dont = paragraphs
 
Thanks for the advice guys, Im new to the forum never done this before. Just trying to help and be helped. In the future ill keep that in mind
 
Uhm... I finally made it through that. If you can't find a way to pain relief with what you are already on there is nothing else out there really except fent that is going to help you. That is what we like to call in the professional world a "fuck ton" of medication. You are going to have to lower your tolerance plain and simple. This is why they warn you not to get you tolerance this high because when it comes to surgery you are fucked. You need anesthesia plain and simple. Then you need to re-evaluate some life decisions. I am not blaming you for your injures and in-born diseases, but I can promise you that you are not living any kind of life with all that shit on board.

Talk to your PM doc about fent or dilaudid, or something. Or maybe try to somehow get your tolerance back down... There really is no answer for this man, you really are in a hole... and I don't know that I can say you put yourself there, because you probably were not educated on pain meds to know that no matter the pain you don't let it get that high. This is a no win scenario man. My heart goes out to you.
 
Hey street...You can hit "edit" on your post, add paragraphs and spacing between. I'm a newby greenhorn, too. I don't convey in 140 characters or less. I'm considered "too typative". I try to break my novella length posts into "chapters". :\

WTTW...Be careful not to "lose" your entire post during "edit". :X

JMO, but folks who truly NEED your information will take the time to read it. You can easily make the necessary adjustments to make tracking easier.

It's okay...Don't take it personal. Keep posting. :) I don't have any suggestions for your impending surgery. I'm in research mode for my CP issues. I hope you find some answers.
 
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Thanks bro that truely is it too, at first I went to hard on em way back in the day, and over the last 5 years Ive slowly went from 6 norcs a day to the 30's and still six norcs. And to be honest I could of been on that from day one but I knew better this time around and played it out as long as I could. I have never gotten relief from the extended release versions of Oxycodone, Morphine Etc until the dose is so high and lasts so long it doesnt work out in my life situation. I may be disabled but I also have a 14 month old little girl that I am the at home parent for. I cant be popping some 160mg oxycontin or use a fentanyl patch because If I need to drive or just not want to be so clouded because my daughter is fussy Im stuck with IRs. I have a really legit doctor that goes to bat for me so in essence I can get really whatever I want. Which isnt really surpising with all the problems Ive had. Man I totally agree about the quality of life thing. I quit being a drug addict years ago now only to come full circle and face a chronic pain issue that cant be surgically fixed and no matter how responsibily you use this shit....if you do so regularly your an addict. I remember back when I thought coming down from a week of a couple 5mg vics a day was death......and I stopped using them. Now that Im older and wiser I know what opiates do, Low T, lack of appetite loss of sex drive, lower than normal motiviation the list goes on. Ive holding out hope that one day in the future surgery becomes available. You mentioned in the professional world? DO you practice medicine? Ive been on the cusp of asking for a patch, eliminating the Hydros and use the 30's for breakthru. However my concern is I dont really want to up my overall intake, rather Im just at the level of tolerance that I could most likely handle a lower grade fent patch that would last all day. Over the last year the meds arent covering me for the whole day, and I hate waking up after 8 hours of nothing.....so Im definatley seeking something long acting I just dont want to be zombified, and fent is the one opiate Ive never tried
 
Well the thing with fent, is that with the doses you are taking it wouldn't be too much of an upgrade. You would likely have to be on the higher dose patches anyways. But I was thinking it would be a good idea, one for your sanity... long term pain control where you don't have to dose a million and a half times a day. Also, that much apap daily MUST be doing damage to your liver.

If you haven't had your liver checked out in a while you probably should. So getting on the patch and scrapping the norcos and using the 30s for breakthrough may actually give you the chance to decrease the amount of 30s you take daily just because the actually pain should be taken care of by the patches. And then REALLY just take the 30s when really really needed, so that you can hopefully get down to a sustainable dose. If it were me I would absolutely talk to my PM doctor about this. I am actually quite lucky, my pain management is easily controlled by 8 mg subutex.

I mean I still feel level 5 pain nearly everyday BUT I would rather that than be on a med where my tolerance was actually going up everyday. But you are way past that now, so I would focus on quality of life as much as possible. The patches may also have the added benefit of making you less cloudy because while they are EXCELLENT analgesics they don't tend to make you that foggy. So your child would be in better hands. I will do my best to support you brother. You have earned my respect. Please keep me updated on any progress you have with your PM doc. God bless and good luck.
 
Keeping in mind though that fent us the strongest drug of all, & if like myself, the patch doesn't cover your pain well & you & your doctor decide to up it...where will you be in a few years? What is next?

Sure you can wear a 100mcg patch, then slap on another when that stops helping,- but you're young too & have so many years left!

Have you tried methadone tablets? They also have a long half lijfe & the dose stabilises & gives good pain coverage once titrated to the right level. Apparently ;)

Usually, unpleasant side effects from long acting opiates such as MS & oxycontin wear off within a Couple of weeks. Could you try to organise that you don't need to be driving for this long?

When I needed dental work,-regarding my chronic pain & a good chance of a flare up, my doctors chatted & decided on general anaesthesia for me as well as running a line of ketamine to keep me as pain free as possible.

How about physio & psych,multidisciplinary appts. There's so much more to chronic pain than medications & how to talk to our doctors.

Rtp
 
Mad and runt, I agree with both of you. Although I'm relecutant to get on the FENT, at the same time if I could just wear a patch all day, I would definately be less likely to say fuck it and pop an extra. Im pretty good with my meds but Im not different than anybody else. Most people struggle with the addiction/dependancy.......whatever you call it, if they are long term paitents anyways. I have tried methadone before, and I do agree that it works pretty well. That is on my list of things Im gonna discuss with my doctor at my next appointment. Another plus side to the patch is that I would have to manage less pills. It gets annoying having to get them out 6 times a day, keep them under lock and key and make sure my daughter cant get into them. A box of patches I use once a day would be way, way eaiser and as MAD pointed out I could maybe even reduce the amount of 30s I need. Maybe thats wishful thinking cause honestly the meds im on barely get me through the day now, not the night. I take amtriptyline to prevent migraines and help me sleep, but when I wake up I have nothing on board....and that sucks. So at this point, Im definately ready to ditch the norcos and finally change over to something longer acting, at the very least something I could take 2 to 3 times daily, or the patch. I think Id rather try some dilaudid or something first just because Ive had it before, and as RUNT pointed out FENT is very much at the top of the list and it might be better for me to keep off that until im at least 40, im only 31 now. But at the end of the day Im gonna take whatever is nessecary cause I dont want to ever go back to getting what I need from the streets. I left all that behind about 6 years ago when I got married and received INS I have a daughter and Im not trying to catch a case or be around heroin and shit. Shady ass people.
 
Maybe by rotating your opiates you could take just the one pill a day, eg: hydromorphone, at a lower dose, taking cross tolerance into account.

Fent patches last three days,- well, that's what the doctors say. Some allow 48hr changing. I recently asked my PMdr why he'd mentioned before that he's "liking fentanyl less & less"? He'd replied that abuse & a rapid increase in tolerance were his main concerns, citing that he'd really prefer to save it for terminal patients.

If you have a good relationship with your doctor there's nothing wrong with discussing options of dose or medicine changes. I recently asked my PM to change me from oxy to MS Contin (I'd accidently been given a dose in hospital, he was aware of it), he had no probs in doing so, & again in changing me back when he could see it definitely wasn't working for me. Even on that day thank god. He just called my doctor & said could she write my oxy script, I'd be there in an hour to collect it.

What is your current prescribed total daily amount in mgs? About 180 of oxy?

Sorry, but I really can't read that wall of writing again, as the others said, if you wanna get this thread rolling could you please edit it with paragraphs?

I'm not in the States, we don't get quite as large of a range of opiates to choose from, eg: oxymorphone, Vicodin, norco's,- are a few that come to mind.

Is surgery, I'm guessing for your back, after the accidents, just not an option right now? Or have you already had failed spine surgery?

Rtp
 
my hemangeioma is not operable, and my current dose is 180 30s and 120 norcos. and that not all that is wrong, 2 rear end accidents @80MPH and @30MPH, 1 triple roll over and numerous times in the hospital from extreme snowboarding accidents some of which were 20 to 30 ft airborne. Luckily, the worst that actually caused an immediate injury while on the mountain was the loss of a front tooth and a broken clavical. I suspect there is lots of whiplash from it though. A hemangeioma is a tumor made of blood clots......normally they will cut and dissolve case closed. Hemangeiomas can occur anywhere. Mine is intrewoven between my spinal cord vertabrae and muscles..........and could kill me if operated on. Its a fucked up place to be let me tell you. I legitimately need opiate pain relief, but if I were to use as much as my body tells me Id never get relief nothing would work anymore.......which Is why I havent asked for dilaudid or fent patches. Ive had my share of dilaudid before........it works really way from a bang for you buck perspective as far as duration and overall pain relief. However you want to put it, that rush of energy many of us feel from the codones is what helps my pain the most. Which is why Im torn about upping my dose to dilaudid or fent. in the perspective of long term, its a scary thing to consider because the pain wont get better......so I almost need to taper up in the same fashion as folks taper down to avoid the bulk of WDs, except my goal is to OVER TIME, get the most out of opioid pain management for the rest of my life. As was said before, theres not much I can do, and its not really my fault. I just take one day at a time, and be grateful I have the pain relief i do
 
It sounds like you definitely ought to be on long acting (LA) meds and not the IR's. What you really need is steady pain relief and not the ups and downs of IR meds. The other thing that happens when you get on a good regiment of LA meds is that you actually can function more normally on them. I'm on pretty high doses of LA meds and I'd bet you no one in the world would be able to tell I take the meds I do. Your body adjusts to them and your world actually gets more "normal". For instance, driving is not an issue at all. I've been pulled over for going a bit too fast (like 11 miles over) and the officer never knew and didn't even ask if I had done anything that night. It's just not an issue, for me at least.

Don't get me wrong, these meds do come with some side-effects that suck but as far as managing pain and pretty much being able to function, it really is the way to go IMHO. Good Luck!
 
Let me give you a little more history real quick....its relevant.

***First things first, I made a typo above, my current dose is 100 Oxycodone 30mg IR's a month (3 x daily and ten extra for breakthru incase I run out since I live in the sticks) and 120 norcos (breakthru and first line of defense for migraines)

Thanks beach, I agree. My tolerance is pretty high nobody really can tell Im on meds either. I originally turned down the LA meds about three years ago when I was still just on noros 6 x Daily. By that time I had just about every med out there, mostly from when I didnt have insurance and couldnt afford to go to the doctor. And for obvious reasons I didnt tell my doc that I was self medicating. And to be honest at the time, the norcs still worked for the most part. So anyways, about three years ago I asked for something stronger and they originally tried to put me on some OP 10's......and reduced my norcos to 3 x daily. So I did what I should and tried them out for a month. I pretty much knew that 10mg of a long acting oxycodone pill for me might as well be taking a fucking tylenol, as it would only release a mg or two at a time. So I went back and told them it wasn't working. At this point, they reffered me to pain management. They do sports medicine, GP stuff, and prescribe me all my meds from my neurologist (migraines and sleep), and my psychiatric meds as well, since Id seen the specialists for the past year and my ins only covered a few visits a year.

Lets keep in mind I live pretty far out in the counrty in a remote area......and I am the stay at home dad for my daughter, so its extremely important that I keep this doctor because otherwise, I would have to find new specialists etc. So the first pain management doctor I saw, treated me like an addict the second I walked in, examined me and said he didn't understand why I needed stronger meds. I explained to him all my car accidents, snowboarding wrecks and family history of migraines and bad backs in general. Not only did he tell me that the best medicine for my pain would be suboxone, but when I tried to ask about it he said "Look kid, I've got other paitents out here that are really sick.....I have to prioritize them. Do you want the suboxone or not. Naturally I said no I don't even understand what is can I research it for a minute. He told me my appointment was over. Now theres two other PM doctors where I live.......one denied taking me on as a paitent, and the other said that they would take me in but I would have to give up all my medication and only go through them. At this point I was really, really frustrated because it took me years of seeing neurologists, Psychiatrists, and building trust with my Doctor. And they didnt want to just switch the pain meds, they wanted to rearrange them all. They didnt agree with my amtriptyline dose (my dad has to take 225mg Im on 150), nor did they agree that I used norcos to try to knock out my migraines before going the Imitrex route. Those are probably the most effective meds I have hands down, and I suffer for 10 years before they figured this out. No way was I giving that up.

So I went back to my doctor, and explained to them what happened. He was really mad at the guy that tried to pressure me into getting on suboxone! He was like as long as your not abusing your pills, which I know your not....that was completely uncalled for and we wont be referring anyone to that guy ever again. He at this point said "look, I dont mind being your pain management doctor, I've done it for many patients in the past and I have practiced pain management in a sports medicine setting. What meds have you took in that past post wreck on injury that worked?" I told him if he's asking what I think, I would like to try 4x 10mg Oxycodone IR's for my base pain med, along with 3 norcos a day for breakthru pain and migraine control. He said "well, I think you could handle 4 x 15mg Oxycodone Ir's a day, along with the 4 x norcos for breakthru and migraine, but try to be as frugal as you can with the norcos and see how it goes. At this point, my pain is about a 4 on the scale, and that was fine for about a year in a half. That year in a half later, he asked me what my pain was and I told him more or less a 5, and thats fine with me.....but if there's anything else to try im fine with it. He asked me about going up to 20mg IR. I said that would be great, and hopefully my pain would be down to about a 2....I dont like being numb can hurt yourself worse. So I took it down to like 5 pharmacies and none of them carried 20mgs, not only that but it was a special order and really expsensive. I asked the pharmacist what he reccomended. He said either up the amount of 15's to 6 x daily, or just go with 3 x 30's daily and reduce your norcos to three. Got back to my docotor, and he was fine with it. A year after that approximately, he gave me 10 extra 30's a month and re upped my norcos to 120, because he knows I live out in the sticks and he dosent want me to run out since I cant at least have refills on the norcos anymore to tide me over a few days. And thats it, sorry for the lenghty comment, but I want the best advice I can get. Its only been the last two months my pain is back pain is creeping back up to a 3 to 4 pain level. Normally I would be fine with that but I am the sole cartaker from my daughter while my wife is a teacher, and its really straining our relationship and my ability to be a father. At this point I really don't want to up my meds anymore, I just know Ive been taking a lot of tylenol for a long time and either of these meds will last through the night....I wake up everynight a couple times. So really I would like to find some sort of LA med to take like 2 x a day, morning and night, discontinue the norcos, and just have four 30 IRs a day for breakthru pain and migraine control. I used to drink a lot and Im sure my liver isnt in tip top shape so I would really like to off the Hyrdros.

So, in conclusion, If I were to just be straight up and blunt.....like I have in the past and he's always been cool with. I would say discontinue the norcos, Increase my blues by 20 a month to 120, and I want ______________ 2 x a day for around the clock pain management. Dr Rose and I both know that I have a bare minnimum of 4 breakthru moments a day, and at this point the norcos just dont do it. But at the same time Im not trying to upgrade to a higher tolerance either.... I got a lot of years ahead of me, and I would really like to curb the tolerance factor as much as possible before going with really high end shit like Fentanyl patches or really high LA meds. I have never been on long acting meds for an extended peroid of time, because they used to make me so cloudy and groggy. But now I know I can handle them and still care for my daughter and drive. I just got to figure out what LA med to consider, without just upgrading to a higher tolerance.
 
oxycodone: oxycontin
oxymorphone: opana ER
hydromorphone: exalgo ER / palladone ER

Off the top of my head.
 
I would think the dilaudids or opanas since its completely different than what Ive already been on. I havent really had experiece with the first two but I have taken hydromorpone before. They were diladids though. Im gonna be doing some reasearch this morning. Check some coversion charts and what not
 
oxycodone: oxycontin
oxymorphone: opana ER
hydromorphone: exalgo ER / palladone ER

Off the top of my head.

Those are some good suggestions! Personally, I've had pretty good results with the Opana ER but before that I was on OxyContin (80 mg x 4) for probably 7-8 years. I would have been plenty happy staying on the OxyContin but due to my doc retiring, I had to find a new PM doc and unfortunately the new PM clinic told me "they wouldn't touch OxyContins with a ten-foot pole". That's exactly what the doc said too. To his credit though, at our first visit he immediately Rx'ed me the Opana ER equivalent on the spot and added oxycodone (15 mg x 4) for BT. This type of set-up may be just what you need to be on in implementing a LA solution.

Now, the bad news about what my doc Rx'ed me spot on. I didn't realize his intention was to reduce my level of LA meds in half over a few months. Well, within 4-5 months I was down to Opana ER (40 mg x 2), down from the 40 mg x 4. Once I got adjusted to the new regiment, I was actually pretty happy with things all in all. Hopefully if and when you make a move to a LA med, your doc will make it with a conversion that is right where you are now, and if not maybe erring on the up side. He's doing you no favors if he switches you to a good LA med but Rx's below where you currently are. You wouldn't be able to make a fair assessment of how the meds are working. You very well could report back that it's just not working when in fact, it may be the perfect med for you but due to being under-prescribed, you have no way of accurately judging it's effectiveness.

I wish you all the best with all your doc and med travels. Hit me up on PM if you have any specific type question(s).
 
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What you just said about switching docs is why I stay with mine. This is the first time I've really had to push the envelope a bit so to say, but I dont think Itll be a problem. I see him end of this month. The good thing about my relationship with him is that he knows I take a big pride in my health. And he knows when I say Ive done my reasearch its fact. for example when I told him I though I was experience LOW T from opiates hes was blown away, didnt believe me but tested it on the benifet of the doubt. It was the lowest hes ever seen. These kind of things go a long way with a doctor....its hard enough to get them to trust you let alone trust your descion making about your own health when their liscense is on the line. All the horror stories I hear about changing doctors fuck that. When and If I do have to change I want longevity in my records, as well as squeaky clean. Us pm folks have no choice but to take it seriously
 
^Id have thought that if you have such low levels of T from opiates, they're surely affecting you negatively in other ways.

Surprised your doctor hasn't began weaning you off. Just a red flag...

Back to the ER formulas, you may be able to get by with a lower dose if you take them as prescribed & stay on the twelve or eight hour cycle.

I've left a message with my PMs office to hopefully see him this week, as an emergency appt. We've spoken of ketamine lozenges previously rather than me having to be admitted for infusions.

I've had many nerve blocks, but the last one I had performed was actually a success. So now it's time for me to book in for radio frequency nerve ablation. As pre-warned, the blocks do flare up my pain & I'm wary of booking this procedure as I now take it for granted,- with the number of procedures that I've had done, that I will flare up.

Wish me luck

Rtp
 
Back to the original intentions of this thread though, my PM, after one horrendous Christmas time where my GP was away & the locum accused me of doctor shopping,( which unfortunately I get red flagged every now & then due to my "high opiate requirements", not for actually seeing other prescribers), came in to bat for me.

Writing a scathing letter to my clinic regarding the doctors there not understanding opiate prescribing laws.

Which is when I came to the realisation he actually does care about me.

Although I had to "earn my stripes", through SI injections, medial branch blocks (I was anaesthetised for these), but my fave :/ was the trigger point injections.

As I lay face down on the table I asked "how will you know if you get the right muscles?" He said "you'll tell me" lol I certainly did!!

He told me in thinner people it can hurt more, & that the needles would go about three inches deep.

Omg! Plunging a thick needle into a mass of knotted muscle would I think send most ppl jumping off the couch with a scream. Yet I endured it seven times.

OP is there anything non pharmaceutical that may benefit you?

Also, you've mentioned a psych is involved in your care, care to divulge?

Rtp
 
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