Hi Amsterdam, The way you describe your pain as varying so dramatically from one day to the next, I honestly think you will have the same problem with any med. The only way to combat a higher level of pain is with a higher dose. Docs tend to dose meds at your base level of pain rather than your highest level of pain., So if you pain jumps from a 3 one day to 8 the next day taking the same dose, I don't see where one brand of product is going to make a significant difference. It would make more sense to have an appropriate amount of BT meds available to manage the days where your pain is twice as bad.

Docs must use some control over your daily dose and how long it lasts. Otherwise it appears the patient is in complete control of the dose. IE if the doc says just take what you need for that day and I'll refill the script early if you have lots of bad days, He won’t be in practice long. First your insurance won't pay for it unless a change in dosing is made and secondly it gives the appearance of self-medication. The only self-medicating that is expectable is PRN use of BT meds.

Days where the base is managing your pain, don't take the BT meds, days where your Base dose isn't touching your level of pain you need something additional, The only appropriate way would be to give you the means to manage it yourself safely or leave any increase to the mercy of the mercy of the ER docs who treat chronic illness or pain very different from an acute illness.

For example if you had no history of chronic pain and woke up and your leg was numb and went to the ER, They would treat it as acute and likely do significant diagnostics right then, MRI, CT etc. However if a chronic patient goes to the doc and says my meds just aren't working today, your not going to get an MRI or likely even an Xray. Perhaps a shot to relive the pain enough to discharge you with instructions to follow up with your PM doc.

Acute problems are treated very differently than chronic, although there is the possibility that you have re injured or further injured a problem area, but ER's are not designed to find the source of a chronic illness, they are for the care of acute illness or injury. It's just the way it is.

IF you know you need an increase keep a log and show them that more often than not your pain is out of control. But simply going to the PM doc because you are having a flair doesn’t really justify increasing your base dose until the flair has ended. But if you can document the effectiveness, when it wears off, the level of pain before and after taking the meds, it gives your PM doc more info to work with than you hurt more today than the last time he saw you.

As far as Purdue keeping other products off the market, they really wanted it both ways. First they claim other products are not close enough to be called a generic so shouldn't be granted generic status. The second complaint is that these generics are too close to their product and infringe on their patent rights, So which is, too close, not close enough or whatever works to keep a competitor off the market.

I haven't taken the generic version of OC. I would bet if you stuck with Purdues’ claim that their med lasted 12 hours you would be just as unhappy without BT meds as you would with a lesser quality generic dosed 3 times a day.

Purdues' stand was so strong on the 12 hour life of OxyC, they contacted thousands of pharmacies and PM docs and told them do not right OxyC for anything other than twice a day. They still wont except a script for their patient assistance program for anything other than 12 hour dosing.

This place all liability on the prescriber and the pharmacist that fills a script in any other way than the manufacturers insisted dosing directions. Should something happen that brought about litigation. The doc didn't follow Purdues guidelines and the pharmacist had been told not to fill any script written for more than twice a day dosing. So that's where the negligence falls.. So be careful what you ask for, If you insist on name band OxyC you may have to except their other claims as well, not just the part you want to adhere too or believe. You may be trading 3 times a day dosing of a weaker med for 12 hour dosing of a med that doesn't last 12 hours.

Law suites were also brought against Purdue for what was called a false claim of 12 hours of relief to boost sales of their short acting line. Their prescribing info recommends using their SA line, OxyIR and OxyFast to fill in the gaps in coverage and relief that OxyC can't cover for 12 hours.

The insistence on 12 hours of relief passes any liability for prescribing OxyC any other way than twice a day onto the prescribing doc. The suite claimed they knew it didn't last 12 hours and recommending their specific SA brand name products to increase sales of Oxyfast and OxyIR. Neither of which have high tech or unique delivery systems. How does making liquid versions of a med make it so unique it deserves a patent , or putting their product in a fast dissolving gel cap instead of a compacted pill a unique characteristic that deserves a patent. But they both had patents for several years and that's what Purdue recommended you use if you had BT pain. They raked in billions keeping other manufacturers off the market.

Trust me, Purdue is no saint and can't have it both ways. Their product may be more effective for 8 hours, but that's not how they insist it should be prescribed and made life miserable for 10's of thousands of patients taking it when they went on their twice a day marketing campaign 4 years ago.

That claim also brought more scrutiny on docs that were prescribing it more than twice a day, gave patients a right to claim negligence on a docs part that prescribed it any other way. Any of the patients that abused it , injected, snorted and drank on top still had a claim against the doc that prescribed it differently from the way Purdue recommended.

Aside from these things, they absolutely price gouge, Oxycodone has been around for 40+ ears and the Contin delivery system was invented in 1972. Are the recouping R& D expenses on development of OxyC or simply gouging patients that can afford it the least. Be careful what you ask for and what you put on that pedestal without knowing all the facts.

IF you simply gave up and committed suicide your family would likely be quick to sue the doc for misprescribing OxyC due to Purdues' claim of 12 hour relief. They could argue you were over medicated and this was the cause of your suicide. So a doc willing to prescribe it 3 times a day is going out on a limb in a patient population 600 times more likely to commit suicide than the general population.

Was the suicide really from over medication, or from lack of relief, ability to cope and sheer exhaustion of dealing with chronic pain and the treatment we receive. Should docs base their prescribing on patient reporting or the handouts that Purdues’ vast marketing and sales team has passed out to most every PM doc and most every pharmacy they could reach to support their two fold claim of patent infringement. One Their product is the only 12 hour one so the others aren't close enough to be called a generics and 2, The other product is so close to their product it infringes on their patent rights. Which is it, not close enough , or too close?

It's human nature to want to blame somebody regardless of the stats on suicide in the CP community, especially when an attorney is telling your surviving family members the doc was grossly negligent for listening to you when you said it doesn't last 12 hours and prescribed it every 8. Is you doc negligent because he listened to you instead of Purdue?
Good luck, Dave