sgibson
06-16-2004, 10:27 PM
Ok here goes. I was wondering if it is legal to rx pain meds in IM/SC forms. Most of you that know me know that I have trouble with malabsorbtion so I don't respond to regular oral meds very well. I'm currently using Duragesic 50mcg and Oxycodone Hydrochloride Elixir 20mg every 8 hrs. I know I need an increase in my Duragesic. I am seeing a new PM tomorrow, I don't know if he will make any changes in my meds tomorrow or not. I'm assuming tomorrow will just be an information gathering session. For those of you who don't know, I had a lumbar spinal fusion with cages on Jan. 22nd 2004. I am currently doing PT. It's just heat and massage, but we will soon be working up to stretches and some strengthening.
As far as my malabsorbtion goes, I have had intestinal blockages and adhesions. I have had 90 percent of my stomach removed and most of my small intestines also. I have severe malabsorbtion. It is a struggle to maintain a weight of 90 to 95 pounds because I don't absorb my food. I am also severely anemic, my protein levels are also in the trash. I hardly absorb any of the nutrients in the food I eat. So it stands to reason that any meds taken by mouth also are not absorbed. My gastroenterologist has me do injections of vits because I cannot get high enough levels swallowing pills. Thats why my first PM put me on Duragesic patch. The patch has worked well for me. I have been on it almost 3 years with one short hiatus, so I don't think I have done too bad as far as increases. I know it needs to be increased now because I am having to use so much BT med. The BT meds are another problem. I use a liquid because a pill would basically pass through without being broken down. This brings me to my question. Is it legal for them to rx the same med (oxy) , if its even available in this form, in either IM or SC injection form? I'm used to giving myself injections so that wouldn't be a problem. The more I thought about it though I thought perhaps they wouldn't rx it that way due to chance of abuse. I guess if its legal and I develop a really good relationship with the new PM then perhaps he might work with me? My PCP says I am his most difficult patient to treat. But I have to say he is the best. I just wish he could be my PM.
Any suggestions Dave? I know I am going to have to educate this new guy on my insides. LOL. I always hate to do that. Docs don't like it when you know more about your condition than they do. I know there are tox screens they can run to see how much drug is actually being absorbed but I don't know if my stingy HMO will pay for that. I guess its worth a try if I can get the PM to go for it. I just want them to understand I am not trying to pull their leg. I want them to do tests to see how much I am actually getting, I don't have anything to hide. It's horrible how they make us feel dirty or like we are doing something wrong. You truly have to swallow all your pride when you become a chronic pain patient in pain management. All of our dignity disappears and for the most part we are treated like criminals from the very beginning. It's like being guilty until proven innocent. I know you all know what I mean. Ok, I turned a question into a rant. LOL. I guess I'm just a little apprehensive about this appointment tomorrow. Thanks for any information any of you can give me.
God Bless,
Sherry :wave:
P.S. I thought I might add this stomach, intestine thing is sort of a family problem. My moms sister had stomach cancer, had 90 percent of her stomach removed and the majority of her small intestines. Just like me. So I'm not really that much of an oddity. :) I remember when I was a child my mom would take her for her B-12 and Gold injections. Back then they wouldn't let you do it at home. She also had RA and DDD. When she died, we were in the same hospital only 2 doors apart. It was in January of 97. I was there for a massive DVT. I felt horrible for my mom. Her sister was dying and they were telling her that I probably wouldn't make it either. Well I survived that and a whole lot more besides.
As far as my malabsorbtion goes, I have had intestinal blockages and adhesions. I have had 90 percent of my stomach removed and most of my small intestines also. I have severe malabsorbtion. It is a struggle to maintain a weight of 90 to 95 pounds because I don't absorb my food. I am also severely anemic, my protein levels are also in the trash. I hardly absorb any of the nutrients in the food I eat. So it stands to reason that any meds taken by mouth also are not absorbed. My gastroenterologist has me do injections of vits because I cannot get high enough levels swallowing pills. Thats why my first PM put me on Duragesic patch. The patch has worked well for me. I have been on it almost 3 years with one short hiatus, so I don't think I have done too bad as far as increases. I know it needs to be increased now because I am having to use so much BT med. The BT meds are another problem. I use a liquid because a pill would basically pass through without being broken down. This brings me to my question. Is it legal for them to rx the same med (oxy) , if its even available in this form, in either IM or SC injection form? I'm used to giving myself injections so that wouldn't be a problem. The more I thought about it though I thought perhaps they wouldn't rx it that way due to chance of abuse. I guess if its legal and I develop a really good relationship with the new PM then perhaps he might work with me? My PCP says I am his most difficult patient to treat. But I have to say he is the best. I just wish he could be my PM.
Any suggestions Dave? I know I am going to have to educate this new guy on my insides. LOL. I always hate to do that. Docs don't like it when you know more about your condition than they do. I know there are tox screens they can run to see how much drug is actually being absorbed but I don't know if my stingy HMO will pay for that. I guess its worth a try if I can get the PM to go for it. I just want them to understand I am not trying to pull their leg. I want them to do tests to see how much I am actually getting, I don't have anything to hide. It's horrible how they make us feel dirty or like we are doing something wrong. You truly have to swallow all your pride when you become a chronic pain patient in pain management. All of our dignity disappears and for the most part we are treated like criminals from the very beginning. It's like being guilty until proven innocent. I know you all know what I mean. Ok, I turned a question into a rant. LOL. I guess I'm just a little apprehensive about this appointment tomorrow. Thanks for any information any of you can give me.
God Bless,
Sherry :wave:
P.S. I thought I might add this stomach, intestine thing is sort of a family problem. My moms sister had stomach cancer, had 90 percent of her stomach removed and the majority of her small intestines. Just like me. So I'm not really that much of an oddity. :) I remember when I was a child my mom would take her for her B-12 and Gold injections. Back then they wouldn't let you do it at home. She also had RA and DDD. When she died, we were in the same hospital only 2 doors apart. It was in January of 97. I was there for a massive DVT. I felt horrible for my mom. Her sister was dying and they were telling her that I probably wouldn't make it either. Well I survived that and a whole lot more besides.
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carol632
06-16-2004, 11:06 PM
I don't think anyone other than a nurse or physician is legally allowed to administer narcotic drugs IM.
Carol
Carol
smackliet
06-17-2004, 04:12 PM
are suppositories an option.
I have heard that is the best obsorption method other than IV.
I have heard that is the best obsorption method other than IV.
sgibson
06-17-2004, 10:28 PM
Thanks for your responses. I kind of figured there would be laws against rx'ing them sc/im. I hadn't thought about suppositories though. Do these meds come in that form? I hate to think about having to go that route though LOL. Oh well, the things we do to manage our pain. I just wish I didn't have such screwed up insides.
Thanks again.
God Bless,
Sherry :wave:
Thanks again.
God Bless,
Sherry :wave:
Shoreline
06-19-2004, 01:47 PM
Hey Sherry, Supositories are a great idea. It is not illegal to prescribe injectable meds. I've met a few that have them, However it really places the doc under the spot light.But learning to give yourself an IM injection is no different than giving an insulin injection only slightly deeper.
A friend in canada has been using IM morphine for years. You should also add "Centerwatch" to your list of favorites and see what's in the works.New meds in clinical trials. New patches, new delivery systems, Actiq "fentanyl" pops deliver half their opiate transmucosally, the rest is swallowed in saliva and absorbed through the gut.They also make a Fentanyl lozenge SP?
The testing of Keto opiates, synthetics is much more difficult to be acurate and it may be tough for your insurance to go for the advanced testing like GC-MS or LC-MS. Morphine, codeine and heroin are easily detected where synthetics take much more advanced techniques, those used in forensics.
They have been working on an oxy patch, The pump would also solve the problem , because meds are not distributed systemically. There is also a generic Fentanyl patch scheduled to hit the market in the next year. Definitely check out centerwatch to seee what they are working on, perhaps you can get involved in one of the clinical trials.
Good luck, Dave
http://www.clinicaltrials.gov/
http://www.centerwatch.com/
A friend in canada has been using IM morphine for years. You should also add "Centerwatch" to your list of favorites and see what's in the works.New meds in clinical trials. New patches, new delivery systems, Actiq "fentanyl" pops deliver half their opiate transmucosally, the rest is swallowed in saliva and absorbed through the gut.They also make a Fentanyl lozenge SP?
The testing of Keto opiates, synthetics is much more difficult to be acurate and it may be tough for your insurance to go for the advanced testing like GC-MS or LC-MS. Morphine, codeine and heroin are easily detected where synthetics take much more advanced techniques, those used in forensics.
They have been working on an oxy patch, The pump would also solve the problem , because meds are not distributed systemically. There is also a generic Fentanyl patch scheduled to hit the market in the next year. Definitely check out centerwatch to seee what they are working on, perhaps you can get involved in one of the clinical trials.
Good luck, Dave
http://www.clinicaltrials.gov/
http://www.centerwatch.com/
sgibson
06-21-2004, 02:14 AM
Thanks Dave. How are you? I hope you are hanging in there. How's the pump working for you? I hope they get your dose titrated soon so you don't have to suffer too much. You are a vital part of this board and you deserve so much more in life than what you have been handed. You give so much to all of us here and I for one truly appreciate it. You are a very special person. I really appreciate you taking the time to answer my question. I saw a PM on Thursday and he told me I was already on higher doses of opiates than what he would prescribe so there was nothing he could do for me. I honestly think the truth is he just doesn't want to deal with someone as difficult as me to treat. He did give me a list of docs who he said would be more comfortable rx'ing at those levels. It's a shame because I really liked this guy right from the start. Oh well, just my luck. I honestly think I will probably end up getting a pump when they come out with the smaller one. I just think it would be the best solution all around. I just have to wait for the small one because I am so thin. I also have an HMO for insurance so I don't think they will go for it. HMO's suck. I know they wouldn't go for that more expensive testing you were talking about. There is just no way. Sometimes I feel like there is help for me but it's like that "golden ring" is just out of my reach. I can see it but I just can't reach it. It is so frustrating. My pain levels are getting way out of control and I never sleep. Here it is after 1 am and I just cant go to bed because I'm hurting so badly. My husband gets so frustrated with me because I don't go to bed when he does. I try to not get upset with him because I know he doesn't understand. He and I took our children to the lake today and then came home and grilled out, so my pain levels are at the max. I pushed myself because today was Father's Day (by the way happy Father's Day Dave) and I wanted to make it special for him. I didn't want the day to be about my pain. I just want some relief.
I just want to find a doctor that understands I just want part of my life back. I know I'm a difficult patient because of my absorbtion issues, but that shouldn't keep me from getting adequate care. Sometimes I think I am just not good enough or something to get the care I deserve. I hate going to new doctors, I get anxiety attacks when having to go to a new doc. It makes me accept the first one that comes along usually. Thats probably why I don't get the necessary treatment. I know you aren't interested in all of this and I am just having a pity party for myself tonight so I will stop right now. LOL.
Thanks for the info on the meds Dave. I'm really sorry for everything you are going through right now. I have been there and it's definitely not anything anyone should have to go through. I get the feeling that you are a very strong person and I know you will get through this. Take care.
God Bless,
Sherry :wave:
I just want to find a doctor that understands I just want part of my life back. I know I'm a difficult patient because of my absorbtion issues, but that shouldn't keep me from getting adequate care. Sometimes I think I am just not good enough or something to get the care I deserve. I hate going to new doctors, I get anxiety attacks when having to go to a new doc. It makes me accept the first one that comes along usually. Thats probably why I don't get the necessary treatment. I know you aren't interested in all of this and I am just having a pity party for myself tonight so I will stop right now. LOL.
Thanks for the info on the meds Dave. I'm really sorry for everything you are going through right now. I have been there and it's definitely not anything anyone should have to go through. I get the feeling that you are a very strong person and I know you will get through this. Take care.
God Bless,
Sherry :wave:
Director
06-21-2004, 12:33 PM
Just to let you know, I was prescibed injectable Methadone in Oregon. This was due to stomach flu and I couldn't keep pills down. After that bout, I always kept a 30 ml vial of injectable med, just in case. So, no, it's not illegal for a patient or someone else to inject them. At least in some states, that's the case.
sgibson
06-21-2004, 02:54 PM
Thanks Director. I suppose I am going to have to wait until I have established a good relationship with a new PM. I had a solid relationship with my old PM. I saw him for almost 2 years. My surgeon says he doesn't want me to go back to that PM because he mainly uses steroid injections and blocks. My surgeon was surprised he had rx'ed my Duragesic patch. Surgeon said my PM must have really liked me because he didn't normally do that. Sounded weird to me. Who knows. Maybe my surgeon is getting a kick back to refer me to friends. LOL. I don't know. I'm just speculating. I would hate to think he would do that though.
I really appreciate all the good info I have gotten though. Maybe there is help for me even with my unusual circumstances.
God Bless,
Sherry :wave:
I really appreciate all the good info I have gotten though. Maybe there is help for me even with my unusual circumstances.
God Bless,
Sherry :wave:
Director
06-21-2004, 07:52 PM
Hey Sgibson...I have a very similar condition and have chronic pain. I had 60% of my stomach removed due to a perforated ulcer. Now I have IBS (diarehea type) and also pain due to lung surgery about 18 months ago. This is from nerves that were cut to get to the lung and also the two ribs they had to break during surgery (also to gwet to the lung). I had a mass that filled the entire area of the top lobe of the left lung. Because of all of this, I am on Social Security Disability and a small payment each month from my employer's disability insurance company. The small payment is due to the fact I'm receiving SS Disability.
There have been several people who have questioned the dosage of medication I have to take in order to get relief. You know the answer and I have a situation just like yours. Not quite as bad, but bad enough where meds go right through me. I do get some relief from them, but I have to take about double the normal dosage. That's why I am currently on 180 mgs of Methadone. Earlier I took Oxycontin (and also BT meds) and had a dosage of 160 mgs TID. You might be able to get some relief with extremely high doses, but if the docs will go for it the injectable meds would be better. Even better would be the pump with Morphine or Fentanyl. I think Shore mentioned this earlier.
Which way you end up going with this, good luck and I hope you're able to find some relief from your pain.
There have been several people who have questioned the dosage of medication I have to take in order to get relief. You know the answer and I have a situation just like yours. Not quite as bad, but bad enough where meds go right through me. I do get some relief from them, but I have to take about double the normal dosage. That's why I am currently on 180 mgs of Methadone. Earlier I took Oxycontin (and also BT meds) and had a dosage of 160 mgs TID. You might be able to get some relief with extremely high doses, but if the docs will go for it the injectable meds would be better. Even better would be the pump with Morphine or Fentanyl. I think Shore mentioned this earlier.
Which way you end up going with this, good luck and I hope you're able to find some relief from your pain.
sgibson
06-22-2004, 12:13 AM
Wow Director,
I don't meet very many people who are in the same boat as me. It does make treatment very tricky. I'm sorry you are suffering so badly. I have been turned down for disability and am currently in the reconsideration phase. I expect they will deny that and then comes the ALJ. I wish we could just skip the reconsideration and go straight to the ALJ. I just want to talk to him face to face. This has been such a long hard struggle for me. I see my family suffering for me not being able to work and it is killing me. They just have to keep paying the price over and over. It really takes any dignity a person might have left.
I know exactly what you mean about people questioning your medication doses. There are still docs out there that don't get the fact that the part of my intestines that absorb the meds is basically all gone. Thats why I'm the size of a ten year old child. It's just frustrating and almost enough to make one give up.
Take care.
God Bless,
Sherry :wave:
I don't meet very many people who are in the same boat as me. It does make treatment very tricky. I'm sorry you are suffering so badly. I have been turned down for disability and am currently in the reconsideration phase. I expect they will deny that and then comes the ALJ. I wish we could just skip the reconsideration and go straight to the ALJ. I just want to talk to him face to face. This has been such a long hard struggle for me. I see my family suffering for me not being able to work and it is killing me. They just have to keep paying the price over and over. It really takes any dignity a person might have left.
I know exactly what you mean about people questioning your medication doses. There are still docs out there that don't get the fact that the part of my intestines that absorb the meds is basically all gone. Thats why I'm the size of a ten year old child. It's just frustrating and almost enough to make one give up.
Take care.
God Bless,
Sherry :wave: