Hi 59, It's usually the first visit that is the most expensive and then follow ups are dramaticlly less, at least that's how it is around here. I signed up for medicare once I was eligable and although it didn't have a drug plan, untill this year, methadone was afordable. The equivelant of 600 mgs of long actiing morphine that cost 1400 a month can be replaced for 50 bucks worth of methadone a month. SO when I had no prescription insurance I would fall back to meth each time out of financial need.

Medicare has been great though, I don't know if you have medicare or mea sate funded program medicaid. Around here medicaid or medicare means certain payment, they do have to negotiate like any other doc that acepts insurance but it is pure greed that drives docs to except cash only and not discoount their prices because those that have, will pay. Honestly this kind of doc isnt the most scroupulous person you wantmanaging your health.

My concern is what repeated withdrawal is doing and has done to your heart. Geberally withdrawal isn't fatal but I know someone that dies very close to 30 after eyars of binging and then going through withdrawal. His heart was 3 times the size of a normal heart at autopsy.

You should have open enrolement for medicare once or twice a year, the plan offered through social securiurity and the price can be offset by your income. Medicare ahas been great. Aside from the hospital copay they payed for my pump and it cost about 20 bucks a month to deliver dilaudid or morphine directly to my spine where it's much more effective. The company that makes the bulk of the pumps has a a certification system for implants and can give you the name of every doc in the area that is cerrtified to implant and mange intrathecal pumps. if you contact medtronics, they are one of this sites sponsers at medtronics.com. The new pumps have larger resevoirs and can go as long as 4- 6 months between refills once adjusted to the right level.

Back wise I'm in a similar position, failed fusions and lots of broken and loose screws and rods with every attempt.Fortunately the pumps are most effective on back pain without leg pain but can still help folks with leg pain too. You may have to travel a little but it would likely be well worth it in the end.

Another alternative is methadone programs for opiate addictions. All you have to be is dependnet on opiates to qualify for once a day dosing at a meth clinic. Meth is an effective pain killer although when used for CP the meds are taken home and dosed every 4-6-or 8 hours. One dose of meth a day may not provide the greatest relief at night but it's better than what your doing to yourself. You would have to go when you have opiates in your system for them to find and verify your dependence but it would get you something 364 days a year and end the cycle of withdrawal.

If you have any questions just ask. You likely have more choices than you think. Any university or public hospital that excepts state and fed funding must except medicaid and medicare patients. If you could find a PM program based out of a hospital you would have better luck finding one to acccept your insurance. There are usually alternatives we aren't even aware of. I'm sure you remeber the days of no pain meds for anyone and docs that controlled who we saw by referral would keep patients away from docs known to use opiates even once they were available. But it's a new era where PM is likely much more available than you think.

Good luck and undertsand the folks you feel you have disapointed are just worried about what the withdrawal is doing to you and how much more you can take before it damages your heart or kills you.

Good luck, Dave