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  • Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in futre

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    Old 07-04-2008, 10:31 PM   #16
    feelbad
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    i am kind of wondering when you pain became worse,why you did not simply speak to your PM then and see what else could have maybe been added or tried since there are other types of med clases that can help with even very severe pain and many many other modalities that you can use that do not even invlove taking any actual meds of any kind to help keep things better controlled. this is what i have kind of had to do since no meds can help with some of my worst pain syndromes that just do not respond at all to narcotics. i also keep trying to find other options such as topicals and my TENS unit that seem to work much better for the harder to treat hell i have burning into my skin. i have just had alot of major side effects with things like lyrica and cymbalta and other anti S meds that are normally used for this type of pain.

    what other meds have you tried before you went to the MS and the fent? anything? is having surgery to at least try and fix some of the more profound pain genrators possible? i know with DDD,which i have very heavily in my c spine among other issues there can create its own type of pain issues.believe me, only you really know whether or not you have become addicted or not,but you were and still are way out of your docs Rxing guidelines. in my PM,considering the contract i signed when i started there and my past addiction issues,i would most likely be terminated if i decided to change my own Rxing schedule. its just not acceptable in the PM world to even go there,which i know you do realize now,but you had to have a clue that this was not the norm in what you decided to do back then either ya know?

    doesn't your PM ever require the suprise UAs or pill/med counts at times? i am asuming you signed a contract with this facility that gave then that right to do this as they felt it could be needed? the thing is,with me anyways,it IS those two big things that help to keep me compliant. i am under a bit more scrutiny and have no problem if my clinic calls me up and asks me to bring my meds in for a count or ask me to pee in a cup within the next 24 hours. this just is part of the program in most PMs. over the past four yaers since i started there,i have never gone out of my PMs guidelines with out being okayed there first for whatever reason. i just have that responsibility to my PM and his other patients if i should decide to create my own dosing schedule. hon,this IS why those rules are in place to begin with,so peole do not do what you decided to do and end up where you are right now. whether you were in just alot of pain or whatever the reason,a phone call should have been made to your PM at that point and a plan discussed as to how to go about getting better relief. that is where you made the bigger mistake. just not being honest with your PM about your true pain needs and the fact that the control,for whatever reason just was not working for you. you just cannot blame it on the pain hon,you made that choice to go this route ya know what i mean? i have pain,alot of people have very over the top types of pain,but we try and use as many little other tools to just keep it better controlled so we are not just relying on meds to do that for us. sometimes i cannot simply do the other things and i do have to rely more on my meds,but in most cases,this is never my first choice for enhanced pain control. like i mentioned above,finding other ways of handling the pain when its just simply gets way too out of control for you is just something you need to have in place. the more options you can find that actually work for you the better.

    believe me,i am not judging you or reprimanding you in any way shape or form,but this did happen by choice not because you 'had to",that is an active choice you made instead of just doing what any PM would want you to do in that situation. there is just a reason,many reasons why,espescially fent is not up to the patient to decide how to dose,and you are finding that out right now unfortuently the hardest way possible. knowing just what other methods,meds,modalities you have actually tried would help alot in seeing the whole picture here. and the possibility of a surgical intervention that could at the very least,lower your actual pain to some degree. for me, i am never ever pain free or in some areas,very intolerable levels are there that my brain has thankfully started to kind of accomodate since my original spinal cord injury created not only RSD but another nasty pain syndrome called central pain. its an actul compenasory thing that your brain does when you experience something 'noxious' that is continuous and non stop 24/7. but my other pain is very wide spread from many different injuries and a kidney liver disease that is creating huge *** kidneys for me an adding to my already severe c spine pain. this is what my oxycontin responds to the best. six surgeries later,things are still not good,but the ones i have had have also helped reduce at least some of the intensity of them. i am just wondering about that herniated disc and how much a possible surgery could realistically help you.

    i still believe honestly,telling your pain doc what happened with the fent and why you did this would really be in your best interest,now and espescially for your furture. since you do have obvious pain generators that can be docmented,i really cannot imagine that your doc would just drop you in this situation. but giving him that chance to actually help you with this i really think you do you best here. you are not perfect and you did something that becasue of pain and feeling desperate you just did. its done and you cannot change that part,but you can be honest and forthcoming and hope he takes that into consideration. this doesn't actually really "sound" like an addiction issue but you were not able to realistically control your pain at the dose you were at. i don;t know why you didn;t just speak to your PM tho,that part i really don't understand since when things are not working for you in most medical situations,changes are usually made and med adjustments,you know what i mean? if you had spoke to him aboutthis when it started becoming ineffective,alot of this just could have been avoided ya know?

    there is just a certain level of trust that has to develop between any doc and the patient,not being up front about your pain just will not give you the pain control you need in the first place. i would honestly sit down and speak with him about this situation,and admit you did something without really understanding the consequences of it. you were just in pain.but you do need to explain at least to him,why you did not tell him when it happened that your pain was getting too out of control. given the fact that this IS fent,i just would be very concerned about you trying to do this without his expert supervision and help. you just need his help and i do think if you apprached this from that angle he would see you in a different light than someone who actually was simply looking for that high. you are only dependant right now from what i can see from this,but that is something,like i said earlier that only you know yourself. there may be much closer scrtiny with any continuation of him still keeping you as his patient,but if he will still treat you,it just has to be done. you just owe that much to the PM and the other patients he has too. my monitoring is just a bit more than others,but i have passed every test and pill count so they do trust me at this point i think. given the over four years i have been there,it has proven out over time that i am totally compliant with my meds despite my past history. most of that is absolute fear of having to feel the full impact of my whole pain issues if i should decide i should 'need' tommorrows meds today kind of thing? i simply NEED every dose to be there for me on the day and time i need it. i was also only allowed two weeks worth of my meds at a time for about the first six to eight months after i started there. i had to "prove' something to them before any level of trust was going to develop. i have just been totally honest with my PM from the start as well as my primary doing his own oversight too. but i really liked the fact that all this stuff was in place. this kind of thing not being there before,with an as needed Rx,just set the stage for me to end up where i did. no real oversight or defintie rules or direction.

    when i really started looking for bettter ways to manage my pain using therepies and other modalities,i didn;t feel so afraid of the next pain flare since i do now have many other options to try before ever going to the only two alloted BT meds i have during the day. simply trying to manage very severe pain only using narcotics really does not work for most peoples pain. its a combination of things that really gives you the best coverage and management. instead of having to keep raising your intake or the strength of the narcotics,it helps alot to reduce the level of tolerance too. narcotics are simply another adjunct to manage pain. part of your pain plan and should never be totally relied upon for total pain control. it just creates alot of problems that would not be there if other methods were also being used. one BIG problem with fent is that delivery system that cannot be altered or cut in half or taken as needed,its a whole nother ballgame that just come with its own types of problems,that are just not really there as much with most other meds.even the LA narcotics.

    but given your current situation and the type of med you are currently on,you simply have to speak up to your pain doc and just be completley honest about everything. you just really do need his help with this type of med and coming off and then obtaining pain control hopefully with something other than fent. you self medicated for a reason other than addiction,he should know that among other things that you have mentioned here too.

    i realize this is very scarey for you to have to even think about doing but you DO owe it to him and yourself to just be honest here,or your pain will never really be well controlled. he needs to know what your true fent levels have been so he can help you thru this.

    i really am sorry for where you are at and having to find this all out in a very tough way, but learning from this and just moving thru it and past it,i really do think you can do this. your choices in all this are just very very limited. this is all just simply in your best possible interest right now,even tho it may not actually feel that way to you right now,it is. you simply screwed up,and hopefully he will understand this. asking about other options when you speak with him would really help. tell him about the fears you have had about all this and how really hard it has been trying to just figure out the best way to tell him and being honest about it. just tell him i really NEED your help. you just really need to get this resolved as soon as you can in order to get things back on track and actually find a tolerable pain level right now,using as many different modalities that actually work for you.

    i am kind of suprised that your doc had you on that much MS along with the fent patch,those are two very strong meds,thats all. not knowing just what other methods or meds you had already tried really kind of is a disadvantage as to try and see where you were and how you got to the fent in the first place,you know what i mean? any info there you could provide would be helpful. do you have a current MRI report that states just what level of damage is there in your spine? any cord contact or compression anywhere? where is the herniation located and the fractures that were there? **
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

    Last edited by feelbad; 07-04-2008 at 10:34 PM.

     
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    Old 07-04-2008, 11:00 PM   #17
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    Re: Help/Advice neededASAP -Fentanyl detox

    Yes, I realize I am rambling. I am w/d and my thoughts are not clear or focused. I realize I have been repetitive. I have not been fired by my pd though I have now seen him twice since this began. I believe he is suspicious but I'm not sure what he thinks I have done. Yes, I have another appointment to see him. The screw up was quite bad though it has been difficult to assess just *how* had because it is impossible to know how much Fentanyl is coming from the used patches. I have [now] read that they often have as much as 50-60% of unused medication in them after use, and I switch every 48 hrs, not every 72, so this would suggest that I am getting even more than 50-60% from the used patches.

    Quite simply, I had extra 25 and ?50 mcg patches - about two weeks worth. Morphine does not work very well for me now, but Fentanyl does. I was in a pain, not fully aware of the potency of the patches [unusual, b/c I usually research and think things through carefully before I do something. I was under a lot of pressure at work to perform and was thinking about that more than the potential ramifications of my actions]. I also had a prescription for Fentanyl which I had been slowly titrating up on [in addition to the morphine] for close to a year. When i used the new patches, I did not think my PM was going to raise my dose since he didn't seem enhusiastic about putting me on any more medication than I already had. I take 400 mg of morphine.

    If I recall correctly, for several weeks I put on 50 mcg in extra patches and dropped my dosage of morphine by 400 (at least that is my recollection - I may have used a small amt. of my morphine during this time, especially at the beginning before the fentanyl took full effect. I used conversion tables to make sue I was ok, as well as how my my body felt I ran out of extra patches after a couple weeks [also, rather unlike me not to plan, but I almost all of my attention was on my work]. I had plenty of extra morphine at this point. Since I have always taken my meds as prescribed, I had a lot extra meds [see my doctor every 28 days and get 30 days of pain meds - so I had all of the morphine I did not use while I was using the extra 50 mcg of fentanyl + perhaps somewhere close to a month's supply accumulated over the years of taking pain meds]. My pain was greatly relieved by the addition of 50 mcg of fentanyl and I was highly productive at work. My boss was actually happy with me since my production was at the level of other people [and I was also as productive as I had been before my accident] and our relationship improved. I was not in a good position with with my boss at that timebecause I could not produce quickly enough with my pain. Adding the 50 mcgs did not "cure" my pain and I still did not have the level of pain control I had during the period when I had a high level of pain control. I.e., I still had flare-ups whenever I did a task that I did not do everyday, but the duration and intensity of pain was significantly lower. I am in a terrible position with my boss now since I have lost a month's worth of worktime and he is waiting to hear from me about when I can begin working again.

    The problem [obviously this was not the start of the "problem," since that occurred when I self-medicated and did not follow my doctor's orders] occurred when I tried to go back to my prescribed dose [when I ran out of extra patches midway in the month] and switch back from 50 mcg of Fentanyl to 400 morphine when I ran out of the extra patches. Something had changed in my body and at this point. I experienced EXTREME pain - pain at a level where I could not function. I began taking large amounts of morphine to function [not from withdrawal (at least not to my knowledge, I did not feel like I was experiencing any w/d symptoms. Apparently the conversion was fine, but analgesically, the two medications had very different effects in my body. Of course, I knew this, if Fentanyl had not worked better than morphine, I would not have made a temporary switch. But my pain was much higher than it had previously been before I temporarily substituted the fentanyl for the morphine. The same prescription had allowed day to day functioning and had allowed me to work, just not as productively as other people or as I had worked in the past. I literally did not feel like I could function on a day to day basis. I added advil and tylenol, which did not make a dent. I began to take extra morphine - I was surprised and dismayed by how much morphine I had to take to function at all - in contrast to my normal 400, I know needed to take closer to 1200-1300 to function and I was still in far more pain than I had been in before. During the time I continued to take my "regular dose" of fentanyl - again, I'm concerned about giving the exact details since my situation would be recognizable to my pd. When I went back to see him over 4 weeks ago, I suggested we convert from morphine to fentanyl. He was reluctant and I didn't push. In the end, he decided to raise the dose by 50 mcg, exactly what I had done [which makes this situation even sadder - if I had been more patient [though it had been a year since I had what I considered good pain control], none of this had to happen.

    I immediately upped my dose of fenantyl but found that I was in withdrawal since I had been taking so much extra morphine to keep my pain under control. At this point, I felt worried that I might not have enough extra morphine to do a decent taper [I probably did, but I instead started using some old used patches to slow down the withdrawal]. I honestly did not have time with work [or so I thought b/c I have now missed my deadlines b/c of all of this to taper then and tried to do my work. However, I was in withdrawal and the quality of what I could accomplish was extremely low. I told my boss I was having a pain crisis. My hope was that once the new dose of fentanyl got up to a normal level and I tapered, I would be ok again. I apparently made my mp suspicious by picking up my meds five days earlier than usual b/c I wanted to start on the new fentanyl dose immediately. I ws truly hopeful that the additional 50 mcg would cover the extra pain meds I had been using to keep my pain under control. I was now using "used" patches and staying in a low level of withdrawal mot of the time to try to stay safe [tho I understand I was not being completely safe b/c fentanyl takes a while to build up to a normal level. My body was definitely confused since I was putting on and taking off, old used patches I had saved in case of an emergency. I realized relatively quickly that this was not working well b/c there wasn't any way to tell how much fentanyl I was getting. If I felt like I was going out of mild withdrawal, however, I took off a patch. I began to slowly take off a lot of used patches. However, if I had to go out for food or anything else, I put used patches on again and/or took extra morphine. I continued to do this for the month between my two visits. For my last visit, I wore a lot of used patches the day before my appt. and supplemented w/ morphine to ensure that I was not in w/d for my appt. I would not say I was my normal self at the appt. - there is a lot happening in my life on top of this and I felt guilty and scared. I am beginning to run low on extra morphine, and all of the used patches have been used more than once,sometimes two or three times. Still, I seem to be getting something from putting on old patches. I am also wearing approximately 8 patches that "were" new - ie I simply haven't taken them off after the two days. I have a hard time believing that I am still getting medication out of a patch on the 8th day but I am in w/d and don't feel like now is the time to test that theory.

    At his point, I am wearing about 150 mcg in used patches tho I doubt I am getting much from these since they have now been "used" several times. I have not taken any more of my "new" prescription than I have been prescribed. If I had "extras" I would test to see how much fentanyl I am actually getting at this point.

    Currently, I am taking valium and clonidine to help w/ the withdrawal that began last night. I worn extra patches for a couple days so that I could shop, see PM, etc. I am hoping this 2nd, larger wihdrawal[but not hue] will enable me to stop using any of the "old"used patches and just wear new ones for extneded periods of time until I can figure out how to handle this situation. I'm also hoping that it will give me a little better idea of how much F I am taking, though I will really only have an approximation.

    I am not sure if that answers all your questions. And I apologize if I am rambling and repetitive. It is difficult while in wd [though the wd is not bad right now] and when I can't see what I've written w/o scrolling up. The first problem I have i w/d is losing my ability to focus and concentrate well. This has made record keeping difficult. Regardless of the solution to the problem I choose, I may need to find a new PM because I hate the fact that I have not been honest with him and have betrayed his trust. With the amt. of fentanyl I am on, I do not see any easy way to taper if i can get to the point where I have stabilized my body by keeping new patches on for far longer than they are intended. I have called a few detox places but I don't know that they really have a plan for people with serious chronic pain. There are appear to be different camps of belief - that suboxone or even advil will work just fine once my receptors have down regulated. This would, of course, be wonderful. But no pain management doctor I have ever seen thinks I can go without meds. Of course, this is also one school of thought. But, really, if I were to detox, I would want to try to take advantage of the detox and lower my horrendous tolerance and try other methods of pain control before going back up on such a high dose of meds.

    I suppose my fairly dream right now is that one or two more mini detoxes will bring me the pt. where I can get back to work [not lose my job -which is seriously at risk now b/c of the time I have lost in the last month] and then suggest to my PM that we try a detox. It would make little sense for me to suggest this now. Sadly, just about every plan I have though of entails more deception. I hate this idea and I am also lousy and inexperienced with lying - I would probably trip myself up fairly quickly. Perhaps not if I was really careful.

    I think my Pm doctor would be angry and alarmed that I used "used patches" and that I am wearing so many. Obviously, this would kill most people, and it put him in jeopardy. So, I am sitting here without a good solution to the problem, other than the one that has been suggested, which is to talk to him. I honestly think I would be shown the door and that I would have great difficulty getting someone to treat me in the future. My PM already cautioned me about the dangers of the patch. I have another appt. to see him.

    I am not feeling clear- my mind is pretty foggy right now so I am not sure how clear or cogent my post is.

    Thank you for your advice and help.

    Confused

    Last edited by mod-anon; 07-04-2008 at 11:07 PM. Reason: removed quote

     
    Old 07-04-2008, 11:13 PM   #18
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    Re: Help/Advice neededASAP -Fentanyl detox

    Ok....I'm here to help.....But, I still don't fully understand what's going on. Let's back up.....What are you SUPPOSED to be doing? What is the exact prescription? What level patch does he have you on now? What was it previously? Is the Morphine for BT or long acting?

    To be honest, I would post on the pain mgt board because there are many very intelligent people over there than can help in addition to me. But that's up to you.

    Let's back up and keep this simple....Tell me what you were taking (exact script) and what are you now taking (since the Doc increased it).

    Ex

    Last edited by mod-anon; 07-05-2008 at 03:53 AM. Reason: removed quote

     
    Old 07-05-2008, 01:20 AM   #19
    Confused089
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    My pain became much worse over a year ago when I had an interaction between two meds - before that I was on a constant dose of oxy that worked exceptionally well. I actually felt close to "normal." I had a different PM then in a different city - he told me he understood the interaction but I later learned that he did not understand it. When I talked about my increased pain from the interaction [my understanding from reading med. jounrals is that is raised my dose by 10-15x - I had mini-withdrawals as the med left my body for close to two months [it had a very long half-life]. This is really when the pain problems got terribly out of control. Since that time, I have struggled a lot with pain and with work. I'm not sure how much I'm going to be able to type right now b/c my pain level is pretty high - it could be the withdrawal or it could be going down on the meds - really no way of telling right now except that the pain is only in the area that I usually have it - I don't know if that means it's w/d pain or not.

    I have tried oxycodone, which, as I said worked well before I had an interaction. After my accident I was able to control the pain with relatively low doses of oxy - I'm pretty afraid of surgery again since my pain went way up after my fusion, which was to stabilize my spine and [the doctor did not tell me this] apparently to treat my pain as well. I needed a much higher dose of meds after the surgery. I know the fusion is putting pressure on the discs below - I did not know [tho I knew I had a lot of back pain before my accident] that I had degenerative disc disease in my c-spine until they did MRI's and cat-scans when I had my accident.

    I really do not believe I have become addicted but I understand I was not thinking responsibly or about the possible long term effects of my actions on myself or others when I took my meds into my own hands. I was thinking about money problems and the need to perform at work so that I do not lose my job and have a financial crisis [I already have a financial crisis with my debt]. The pace has been relentless and I have worked 12+ hr days since I returned. I have felt like I was fighting for my survival. I think this is my explanation for what happened tho not an excuse. The PM has recognized this and has been very respectful of my financial constraints as well as the pressure on me to perform. Lack of money and no time off [tho I have essentially taken the last month off w/o permission since I have not been in any condition to work] is one of the reasons we haven't changed any meds or tried anything really different. The hope is that if I can just get through this period at work - which lasts roughly thru the fall, I may have more flexibility afterwards.

    The in my PM,considering the contract i signed when i started there and my past addiction issues,i would most likely be terminated if i decided to change my own Rxing schedule. its just not acceptable in the PM world to even go there,which i know you do realize now,but you had to have a clue that this was not the norm in what you decided to do back then either ya know?

    My new PM was quite relaxed and I didn't actually sign a contract. I have had one urine test and no pill counts since I started PM two years ago. But he does have a contract now and pill counts and UA's. This means I am actually short two patches, which is serious problem since we now need to bring unused meds to each appt. This wasn't in effect [tho of course I knew that wasn't something I should do, when I used extra patches. And, of course, my greatest fear is that I will be terminated and blacklisted. I definitely had a clue and have tried to do everything by the book up until now. I don't think I would have crossed the line w/o all the pressure but I am definitely not trying to excuse what I did - explain it would be more accurate.

    Not until this month did he implement pill counts, a contract and UAs. But, of course, I understood those were the terms and that I needed to abide by them. May I ask why you are under a bit more scrutiny?

    i am under a bit more scrutiny and have no problem if my clinic calls me up and asks me to bring my meds in for a count or ask me to pee in a cup within the next 24 hours. this just is part of the program in most PMs. over the past four yaers since i started there,i have never gone out of my PMs guidelines with out being okayed there first for whatever reason. i just have that responsibility to my PM and his other patients if i should decide to create my own dosing schedule. hon,this IS why those rules are in place to begin with,so peole do not do what you decided to do and end up where you are right now. whether you were in just alot of pain or whatever the reason,a phone call should have been made to your PM at that point and a plan discussed as to how to go about getting better relief. that is where you made the bigger mistake.

    I really was honest w/ my PM about my pain problems and I think he was trying to address them. But he didn't have much room to manevuer with my financial and work stituation. When he upped my morphine dose by a very small amt., I felt kind of hopeless b/c I knew morphine wasn't making a big diff. for me and that a small increase wasn't going to make any difference. I could not even "feel" the difference with a patch increase.

    I would much rather be approaching my pain from a multi-disciplinary approach - my insurance company will only pay for the meds. I have a huge deductible to do anything else. In addition, there has been *no* time as I have been working constantly.

    I think I'm going to have to finish this later b/c my pain is really getting to me and I have some mild nausea as well right now. This is day two of my 2nd [small] taper and I suspect things are just going to be worse tomorrow, but we'll see. I am trying to at least stop using any old used patches tho I am still way way out of bounds on the amt. of meds I am taking since I am leaving the new patches on for a week. I have to be at more than double my correct dose. I am kind of hoping that the patches just don't give anymore after 5 days but I really don't know. The fact that I now have to come up with two patches I don't have is going to make this a lot more difficult. I was at least trying get on a stable dose so that my body is not constantly adjusting to different amounts of medication and so that I am not using old patches with absolutely no clue as to the amount in them. So, thank you very much for responding. I'll be back on tomorrow and respond more, provided I am doing well enough to sit at the computer. I expect tomorrow to be tougher. I am now wearing only one used 50 mcg patch [in addition to all the new ones I have left on]. For myself at this point, I really want to stop using the used patches which is why I am doing this taper. After that, I need to assess the situation again, especially given the fact that I am short two patches from last month [not this month - honestly, it depends on how far back he is counting - I may be short a lot more.] Good night and happy 4th...thanks again.

    there is just a reason,many reasons why,espescially fent is not up to the patient to decide how to dose,and you are finding that out right now unfortuently the hardest way possible. knowing just what other methods,meds,modalities you have actually tried would help alot in seeing the whole picture here. and the possibility of a surgical intervention that could at the very least,lower your actual pain to some degree. for me, i am never ever pain free or in some areas,very intolerable levels are there that my brain has thankfully started to kind of accomodate since my original spinal cord injury created not only RSD but another nasty pain syndrome called central pain. its an actul compenasory thing that your brain does when you experience something 'noxious' that is continuous and non stop 24/7. but my other pain is very wide spread from many different injuries and a kidney liver disease that is creating huge *** kidneys for me an adding to my already severe c spine pain. this is what my oxycontin responds to the best. six surgeries later,things are still not good,but the ones i have had have also helped reduce at least some of the intensity of them. i am just wondering about that herniated disc and how much a possible surgery could realistically help you.

    Sorry, read some more and your injuries/disease is far more extensive than what I am dealing with.....As far as surgery, I know a surgeon might promise that by fusing another level [which would reduce my mobility substantially] and perhaps by dealing with some of the herniated discs, I might get better, but I am really wary of the cost and the possibility for even greater pain from surgery. I really do not want another surgery nor do I have any idea how I could afford it given my current levels of debt. Ok, *now* I am going to bed...It's quite late!

    One last comment, I really was upfront about the pain...it's just that he is a new PM for me and I am already on high doses and he has to work within constraints that most docs. don't have because of my work and financial situation. In a way, his hands were a bit tied.

    when i really started looking for bettter ways to manage my pain using therepies and other modalities,i didn;t feel so afraid of the next pain flare since i do now have many other options to try before ever going to the only two alloted BT meds i have during the day. simply trying to manage very severe pain only using narcotics really does not work for most peoples pain. its a combination of things that really gives you the best coverage and management. instead of having to keep raising your intake or the strength of the narcotics,it helps alot to reduce the level of tolerance too. narcotics are simply another adjunct to manage pain. part of your pain plan and should never be totally relied upon for total pain control. it just creates alot of problems that would not be there if other methods were also being used. one BIG problem with fent is that delivery system that cannot be altered or cut in half or taken as needed,its a whole nother ballgame that just come with its own types of problems,that are just not really there as much with most other meds.even the LA narcotics.

    Last edited by mod-anon; 07-05-2008 at 04:07 AM.

     
    Old 07-05-2008, 06:39 AM   #20
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    My apologies. Understood. I initially tried to distinguish my responses by using a different type color but this didn't work for some reason. Thank you for your help. I'll use quick reply in the future.

     
    Old 07-05-2008, 07:26 AM   #21
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    Re: Help/Advice neededASAP -Fentanyl detox

    I don't know how you can help me. With a taper? I am guessing it will take months to taper to my correct dosage at this point since I am wearing "new" patches for a week and am just weaning myself off using any "old" patches. I am either going to need to borrow money for a detox, talk to my PM and most likely be booted out the door and blacklisted, or taper down very slowly over a long period of time. I have to be taking at least twice my regular dose of Fentanyl, probably more, since I am keeping new patches on for a week. I can't afford to miss any more work after this w/d unless I quit. Thank you for trying to help me. I really cannot find the answer to this problem. If I were my pm, I would be furious. He has been nothing but kind and supportive and did not deserve this from me.

     
    Old 07-05-2008, 09:12 AM   #22
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    you had asked why i was under more scrutiny in one of your other posts before i answered that last one. it is becasue i was once addicted to hydro way back when(once an addict,always an addict,but there are 'active" and "non active" addicts,i consider myself to be non active). when i had to go onto some level of LA narcotic i was scared to death that i would reactivate the old addiction and so was my primary doc,but i was at the point where i was just survivng and not living life at all. i could not even physically get out of bed without having to take some level of narcotic first and then wait for it to actually hit my c spine area before i could get up for the day. so when i was referred to a really great PM,it was with their full knowledge that i did have an addiction history,thats the reason i had to be under more monitoring and i really felt too that i needed that level of accontability. i KNOW i could not have done or do this all on my own.i NEED accountability in order to just stay fully compliant or i would end up where you are right now.it scared me enough to just keep the honesty thing going with all my docs in all ways.

    one thing i saw in your last post that you did not mention before is "my past addiction history"? whats that about? did you at one time have an active addiction going with something? this could explain a few things that you did,thats all.

    while i DO totally understand your fears in all this hon,i seriously cannot see any other way that you could even possibly get good pain control at this point without involving your PM. the biggest thing i see when i read your posts is worrying about your job performence in all this. while i can understand that,you DO have to be realistic here in what you are actually able to even do with regards to work you know what i mean? when we end up in the chronic pain and or disability types of situations,it comes down to trade offs of sorts. this is where you just have to really look at what is really the underlying reasons for your pain,or your med usage and everything else that just comes into play that is keeping this nasty cycle going. certain things,becasue of your real condition just may not even be a possibility anymore ya know? i had to stop working since i really just cannot 'do' anymore,and i am just not dependable either since my body pretty much dictates what i do and don;t do anymore too.it sucked like all get out to have to start giving up the things that gave me a sense of purpose and reasons to just be here,but it had to be done. you really do need to take a good hard look at just what you are expecting of yourself with this situation and your medical issues and see what even IS relistic for you at this point.

    but you are,right now,between the rock and that hard place. you have to make some decisons here and just really try and see what IS the best possible choice for you with all this and look at it all in a very very realistic way. something just has to give. you have been living with all this ongoing crap,and not even living up to the work expectations that are there or really manageing your pain either. is this what you want for yourself at this point? you are simply surviving thru this,not living. been there done that one to death. and i did that earlier all to myself. my situation now is of course very different with things that i had done to my body parts over the years of doing my job and congenital crap i didn;t even know i had all coming to a head when i just hit 40. that was in 2001.

    what ever you decide to do or how to handle this thing it just HAS TO be with total honestly. you just have to at this point or nothing will ever get better for you. can you see this yet? yea,you screwed up,but being honest about it is the best possible thing you can do right now given the meds and your situation. you do not have to get intothe big details of using the used patches.but the PM just has to know thatthere IS a huge problem you have been keeping to yourself,when it should have been himyou told inthe first place. you can continue to avoid this and stay where you are,like trapped in hell? or you can just do the right thing by yourself and for your sitaution and your PM and let him decide the best ways to manage this situation. it wont be easy hon,but nothing that is ever worth anything ever actually is either ya know? you are IN avery real crisis here and feeling desperate,that is not a good place for us to be in. that is when other stupid things get decided when if we had just come clean,everything would have eventually calmed down and on the right track.

    i honestly would just tell your PM that you are in a situation that you really cannot believe you got yourself into and go from there. but all the while telling him that you really desperately need his help with this. just looking at what you landed you here in the first place should tell you that by not being honest with your PM really is not the way to go here right now ya know? you are looking for an easy out here and i really don;t think that is realistically even possible right now with what you have been on and where this has gotten you to. there just is not an easy way here. its alot of risk,but you have to remember who landed you here too. you have already taken some very very huge and dangerous risks just doing what you have been with both the fent and the MS. i was scared for you just reading the post you made originally. that IS a big deal hon,and so incredibly dangerous to you too.

    you just have to take that step back to really take in the full gravitiy of the situation you have gotten into and where this has gotten to at this point. there is no "easy' at this point,there just isn't. so you come clean and see what happens. but doing it all with total and complete honesty with everything that you are feeling and your fears about coming forward and possibly losing PM. if you were not afraid of this one thing,you most likely would have come forward to him a very long time ago considering what i just read you have been going thru over this whole period of time. go back and actually read that hon,i think you will see that too. fear and desperation just can make us do some really really stupid things in life. the fact that your fent and MS levels have also been unstable and all over the map and you have spent part of this time just dealing with the WDs,well you were not thinking with the right part of your brain either. you were impaired. telling the PM this as well would help. this just has to be done and you have to acept the consequences for your own actions. it may not turn out as badly as you may think it will either. like i mentioned before,they may continue your care if you will agree to be very heavily monitored thru out the process,or at least til they can trust you again.

    just an FYI here for ya since you seem to feel that your PM is actually reading this? i very very highly doubt that hon. and given just the fact that there are over 54 million people out there living with some level of chronic pain and also seeing PMs,i would highly doubt that anyone would ever read this from your docs office(like they even realistically have that level of time?) or ever even begin to actually connect you to this situation either. you are not the only one using fent and MS out there who is in a PM situation ya know?

    only you can really decide how to handle this,but if you look at what not being honest started for you,i just cannot imagine that thinking continuing to be dishonest with your PM and this situation would be even in your best interest at this point. you just don;t really know what is going to happen til you hit that road ya know? there may well be some consequences, but you will deal with them and move on from a huge learning experience. you just really need to look at where you are at and realistically see what options or choices are the best ways to go in this. i just feel in this particular situation,being honest is the only real way you will ever get out from under this in any real way hon. that is simply just where you are right now. this is of course just my own opinion based upon my experiences and knowing how PM goes and living with severe pain in my life too. like i mentioned before,if these were totally different meds,things would not have gotten to where they are now and you could be handling this very differently,but this is what you have to work with here ya know? i really do feel for you in all this,but also am hoping that you will see the right thing to do here too. i DO wish you luck with all this. please keep us posted. Marcia
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    Old 07-05-2008, 01:02 PM   #23
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Marcia, thanks for your long posts about this and your encouragement to talk to my PM. I also spoke with a counselor whom I trust and saw long ago and he said that I should talk to the PM too. I really can't imagine this is going to go well - I think I am scared too b/c I have had some truly horrible experiences with doctors when I have been absolutely honest and straightforward with them and they have treated me terribly. I actually lost a prescription with my last PM. Honestly, I filled one of the meds, could not get the other filled at the same pharmacy and somehow lost the rest of the prescriptions I had been given. My old PM was not a particularly kind or compassionate person - it felt like he was in it for the money and there was no way to contact him in between appts. But, I told his staff I had lost my prescriptions and they did nothing for me. We [my mother and I] spent 2-3 full days searching for the prescriptions - going everywhere we had been. We even called a psyhic! who told us that medications were just gone. And they were - This is actually when I got my new PM. At the time I was traveling back and forth between two cities a lot and often having to go to my PM and back to another city the same day. It was incredibly stressful as I like to take my scrips straight to the pharmacy and then take the meds straight home. My PM 's assistant refused to give me any advice or help in any way. I wasn't allowed to talk to the doctor either. We asked if we should file a police report, go to the emergency room but I was treated like I was a criminal - I hadn't lost the meds and my best guess is that the scrips fell out of my pocket in the parking lot where I got the first prescription and were then swept up and taken to trash. I.e., I don't think anyone ever used those scrips. At this point, I was mostly living in the new city anyway and wanted a new PM anyway. My instinct was still to be straight with the new PM and tell him/her exactly what had happened. After all, I had only picked up one of the prescriptions and the rest weren't filled. I talked to two different chronic pain patients and they both said don't tell the new PM you lost your meds, they will never take you. Just tell them you are starting over in a new city and bring your records. I never even got all of my old records from the old PM even though I paid for them and they insisted we use a new form - it took forever to submit the correct paperwork and they never sent the full set of new records. They were horrible to me. I had bad experiences with a couple other doctors with whom I was completely honest. So, I am coming from place where honesty with doctors has gone quite poorly for me - At some point, I came to the position that the less said the better since I was having no luck being straightforward and honest with doctors. My instinct was to be completely honest w/ the new PM but I was told not to be straight with them by other chronic pain patients [I later learned that one of them was working the system but I didn't know that at the time]. The other one was a longtime chronic pain patient and would have been honest herself in any other situation. So, I didn't start honestly with this PM - I said nothing about the lost prescriptions, and just said I was starting over in a new city. I suppose another problem right now is that I may not stay here and may have to go back and live with my parents b/c of the financial crisis I am having. Even if my PM decided to give me another chance, I very much doubt that he would consent to see me if I were living in another part of the state - he would certainly want to keep close tabs on me. I have no idea how I would find another PM at this point either. To make things worse, since I have been working non-stop, I do not have a primary care dr. at this point - there really isn't a doctor with whom I have a long term relationship. With the exception of the beg. of our relationship and what has happened during the last two months, I have been straightforward with my PM. Hmm, not completely straightforward. I do in fact have a history of alcohol addiction - I didn't write this - it got confusing because I put my responses after yours - you wrote about your addiction history. I assumed that once I wrote I had had problems with alcohol in the past, you would assume that I was not using the meds for pain. I quit drinking on my own about 3 years ago. For whatever reason, and I don't know what the reason is, I have never felt any desire or need to abuse the meds. It might be because my tolerance [prob. b/c of previous alcohol abuse) has always been very high. It might have been a different story if these meds had regularly given me the sensation of feeling high - the few times I experienced the sensation of feeling "high" when going up on the meds, I didn't like it at all and cut back immediately until the feeling went away. But, maybe it predisposed me to rule-breaking?? I was also afraid I would not be treated for my pain if I revealed that I used to drink heavily and I have managed to keep that out of my pm treatment. I really thought that my pain would not be taken seriously or that I would not be treated. So, that is obviously another issue to consider. I know you believe I should reveal it. I have been acutely aware when I felt at risk for abusing medication - depression, and apparently the drive to achieve and now -- the drive to "survive" financially and achieve, are big warning signals for me to be cautious and make sure I do not do use any substances to not avoid problems or troubles. Until this time, however, I have not abused the medication. But, the combination of having neurotransmitters that were different from abusing alcohol in the past - people who abuse alcohol tend to be more sensitive to pain and their receptors are different. When the interation between meds was thrown on top of that, the situation became really difficult. My body became used to a very high level of meds - there was absolutely nothing I could do to stop this since the drug that raised the levels took over 8 weeks to leave my body. I encouraged my PM to switch me to morphine from oxy because the interaction wasn't as great [oxycodone is metabolized by the same two enzymes that are blocked by the medication I took - which, of all the medications "out there" was one of teh worst 5 meds in terms of an interaction].

    I'm not exactly sure how I could tell the story w/o including the used patches. I would imagine he would want a blow by blow account of what happened and how in teh world I came to be wearing as many patches as I am now. I keep thinking about the *at least two* patches I am short now though and worrying about this. I would have to go back to used patches again so that I could not replace a patch for several days. If this were the ONLY problem I had to solve right now it would be pretty bad, but there has been nothing but problems for the last month and half - my financial situation has gotten much worse my work is a huge problem. I know you said you had to accept what you could and could not do, but how can I support myself and pay off my debt if I do not start performing again very soon? I hear you and I realize that my only and best option is probably to talk to my PM. I am trying to get through this withdrawal which has been relatively mild so far [day 3] and then reassess. I am grateful to you for all your advice. The other issue that is in play now is that I'm not sure that this is just my PM's decision. He has joined a practice with other PM doctors [which is why he is now using the same procedures as they do, pill counts, UAs, contracts, etc.] and as a member of the practice, I would think he would need to consult with them about whether or not the practice should take on the "risk" of keeping me as a patient. I am honestly trying to look at things from his point of view, and I just don't see why he should have a risky patient that could jeopardize not just himself but his partners practice. It would have been helpful (!) if I could have timed this a bit better [mostly levity - since this is not something I ever should have done] and "timing" is really besides the point. ou said it was highly unlikely that PMs were reading this board - I agree that it's pretty unlikely. So, I'll be more candid about my work - I disguised this slightly b/c I did not want to be completely recognizable. The timing of my mistake simply means that I stand to lose much much more from not having pain management - my work is finishing a degree that will make all the difference in my future earnings and my ability to pay off my debt. I only have until November to finish this degree and the time I have already lost is very serious. My "boss" is my principal reference for the last ten years of my life - I have no idea what I can/will do without the degree or his recommendation. I can barely pay my bills now.

    At any rate, I have heard you and I think I will probably have to talk to my PM. I will need a backup plan however in case he throws me out.

    Many thanks again for all of your advice. I am thinking about it - the LAST option on my list was to tell my PM before so everyone has in fact made some "headway" with me. I need to rest a bit more, think some more and then take some action...until this problem is resolved, I really cannot make decisions about all the other issues that have to be addressed right now [and there are many]. Thank you again.

     
    Old 07-05-2008, 01:40 PM   #24
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    I am trying to help, but you provide little to no information....What is your script? What are you supposed to be doing? You say you are two patches short if they do a count. Can't you do a wean yourself and get back on track...Even if you pick back up one patch, you may be able to explain one patch short (didn't stick or something).

    Also, patches only have 72 hrs worth of med in them....Wearing them for a week does nothing. The material left in them after 72 hrs is only filler and by products.

    I can offer help and suggestions if you'd provide some information. What is your script and how much extra are you using. We can come up with a taper to get you back on track, or a plan to talk to your Doc.

    Ex

     
    Old 07-05-2008, 03:45 PM   #25
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Executor, thank you. I have read med. journals. etc. and after the third day, 50-60% of the medication is left in the patches. I truly wish it were just filler. I don't think that the used patches would have been so effective for so long if this were not the case. I can see how we would not have a big problem on our hands if I had to go down just one patch. But, what I've read [and felt -this would be quite a placebo effect otherwise] and felt suggests that the patches are still giving way past the 3rd day. There are strict instructions to fold the patch in half and flush it down the toilet after use b/c there is still so much medication left. It took me a while to find out how much and I don't recall where I found out in the end, but depending on an individuals's absorption rate, there really is 50-60% left. However, I will have a chance to test this out.

    I take 150 mcg/48hrs. and 300 ms contin. Again, I suspect I am on close to 300-400 mcg/day b/c of the length of time I am wearing the patches. I would be incredibly happy to hear that I am not getting anything after the 4th day or even 3rd day - can you point me to a source that says the matrix patches do not deliver fentanyl after day 3 or 4?

    But, I will test teh theory out and remove a patch that has been on for a week, see if it makes a difference.

     
    Old 07-05-2008, 07:42 PM   #26
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Hi Confused

    I have just finished rereading the whole thread here from beginning to end. The very first sentence of the very first post was:

    "I desperately need help and advice."

    Gently I say to you that you have gotten exactly that, and yet have gone around the mulberry bush with all who are telling you outright that the first step must be to get to the PM doctor and tell the truth, full disclosure, no *****-footing about what has happened.

    I understand that there are time committments, money issues, worry about the future. However, what I understand most of all is that the health is in serious jeopardy here and if that is not made the top priority, none of the rest is going to end up mattering. You are hesitating making the restoration of your brain and body the top priority.

    Friend, 12 years ago, I lost part of my thigh to a rare cancer. I had 9 surgeries that involved my breast, my stomach and my leg. I spent months being in treatment with radiation and then a chemo protocol that was so rough it almost killed me. I had to learn to walk again and fight my way back. I also had kids to raise, a job I had to leave for 15 months and a heck of a lot of big time debt. The priority was pretty clear cut. If I wanted to live, everything else would just have to be put on hold while I worked and fought to get better. Had I not made restoring my health my top priority, then what purpose wopuld any of those other things served? Had I not made this my top priority, the debt would have disappered I guess, but what about the whole rest of my life?

    Perhaps you do not see it the same as I do, but I see a lot of dodging what needs to be the absolute first priority here which is your health. Your very being is in peril with the fentynal abuse. Big time peril. Honestly, anything that prevents acceptance as the drug abuse being the biggest issue is just an excuse. Nothing, nothing is more important than finding the resources to get ourselves out of physical and mental peril. Not a job, not money, not debt, not embarrassment, not fear.

    You are out of balance on the drugs and need professional help to regain the balance. Please... stop projecting all the 'what ifs' into the equation and focus the energy into what needs to be the first priority. Regain your life and you will have the rest of your life to straighten out the other issues.


    I desperately need help and advice

    Please... the request has been fulfilled by many.... don't be blind to it.

    With all hope
    reach

     
    Old 07-05-2008, 07:44 PM   #27
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Executor, I am definitely hoping for your help -as I have reviewed the pain management boards again, I am relatively certain my Pm, whom I have known for only a short time, and who has just joined up with other partners -who will also have a say in all this, will keep me on. I were him, I wouldn't. Ok, the straight info on my meds - just scared - IF my pm read the board, he would most certainly recognize me and giving the exact dosages and the changes makes it a done deal. I think it is extremely unlikely that he would read any of this. However, unlikely is not the same as impossible. I can say that this is NOT a mistake I will EVER make again regardless of the circumstances. I realize what a horrendous mess this is, my guilt, fear and the ways this is screwing my life up in other ways is not something I will forget. If I can't perform at my job, losing it and going bankrupt probably not as bad as not having pm in the future. I am terrified of the pain and the inability to care for myself as an adult.

    My experience is that a lot of primary care docs do not understand chronic pain, which is not surprising since they are not required to do a rotation in pain management.

    Previous dose 300 msc, 100 F. I was talking about pain problems - PM raised dose to 400 msc - did not help at all. Cannot use alternative methods, aside from acupuncture and I have had to cut way back b/c of financial problems. Acupuncture was helping me to get manage the pain. I have horrible pain whenever I try to do something I do not do every day or use my neck/arms in certain ways. Acupuncture and fentanyl decreased the duration and intensity of the flare-ups.

    Sadly [ie, if I had just been more patient], Dr. increased F dose from 100 to 150 [exactly what I did], still at 400 msc.

    What I did, substitute extra 50 mcg fentanyl I had for all my morphine. When I tried to go back to regular prescription, pain was excruciating and I could not function. At this point I really wasn't thinking. I was taking extra morphine so that I could function and think [I had an extra month's worth] I was astonished and frightened by how much extra morphine it took to get my pain in a place where I could actually function. I mostly went into denial and thought I would somehow?? get this down. I talked to my PM next visit and he upped dose to 150 mcg. By this time I did not have a lot of extra morphine and was really afraid that I would blow through the supply quickly since it was providing so little relief for me. This was probably when I made the fatal mistake of putting on used F patches - in the beginning at least, these patches had been used two or three days at the most. It is possible I am NOT way over my dose. However, I know that patch gives on 3rd day for sure and while it's possible that it doesn't release extra meds after 3rd day, my understanding after scouring med. journals is that 50-60% of med is left in patch. I know there is a system so that the patch delivers medication based on what is already in the depot in the skin. However, I have moved patches - no idea if that has caused them to deliver more med. after 3rd or fourth day.

    I know I have repeated some of what I wrote earlier here. I would like your help. This taper [begun Friday] to stop using any of the old used patches has been unpleasant but has not been particularly difficult [I recall my first taper being far rougher]. I would very much like to start taking off new patches that have been on for a week. But, to be safe, think I should wait until I am stable from this w/d.

    I filled meds 5 days early last month which has made my PM suspicious of me. In addition, I just wasn't my normal self. The guilt, fear and the other problems I am dealing with simultaneously affected my mood. If I had not made this mistake, I would likely have been overjoyed, since a 50 mcg increase helped ALOT.

    The new contract says to bring in all unused meds. I have now cut back on morphine to 270 so that I have 5 days worth when I see him. But that does not account for either 2 100 mcg patches - no way to get those back now or 4 75 mcg patches. Nor does it account for the fact that every month we get 30 days and I see him every 28. I used all those extra meds. I really don't know what to do about that (!). What am I supposed to say about what I did with 2 extra days of meds for the last 4 months? There wasn't any contract, pill counts, UA's or anything before he joined his partners.

    One thing I am not certain about either is whether or not I would be WAY over the cutoff point for Fentanyl if given a UA. Apparently, the max level can be as much as twice as high for some people [if you look at the graph that shows the concentration of meds after 7, 10 and 14 days.]. I know that with the matrix patches I might be able to get one back by folding it in half and going down 35 mcg [though this would be for 3 days] and then use the other 35 mcg later. I'm pretty sure I would feel this cut. I'm running out time as well as extra meds.

    I have truly tried to respond to all of your questions and then some. I would be grateful for any help you could offer. I see that you have posted on the PM board as well. Thank you in advance for any help you can provide.

     
    Old 07-05-2008, 08:09 PM   #28
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    I made a few mistakes, repeated myself, and tried to edit the post to no avail. My attempts to edit previous posts have not worked very well. I am not sure why this is the case.

     
    Old 07-05-2008, 08:41 PM   #29
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    Confused089 HB User
    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Reach, I have heard you and others. I am going down slowly. While I have not had the kind of horrendous withdrawal symptoms others have had while going off oxy or hyro. However, I am in withdrawal, which tells me I am not overdosing. I am no longer using any used patches with unknown amount of medication in them. I certainly do not like the temporary solution I have come up with. However, I am going down, not up on the meds, and at a rate that is not causing horrible withdrawal. I do not feel my health is in jeopardy right now since I am going down, not up. I do feel that my ability to control my pain in the future is very much in jeopardy. I do not disagree that I have done things that were dangerous in an attempt to resolve this situation. I do not think I am doing that now. I am putting this slow taper ahead of my work and everything. If you read the PM boards, the slightest infraction -even if you talk to your pm usually leads to being kicked out and blacklisted. So, if there is ANY way to resolve this problem safely, I would far prefer to do that. Talking to my PM was not on my list of possibilities when I first posted - it is now. I have come a lot further than you may think. However, I have not reached the position you or others have advocated yet. Until I am able to take more of these patches off, I really won't know WHAT my situation is.

    I hope you do not feel like your words have been in vain. They haven't. I really have heard what people think I should do. I'm not ready yet. I may be ready by the end of the week. I don't know. I am going down, not up and my body is responding w/ mild to sometimes medium level withdrawal.

    I can understand though how people would not want to continue to give the same advice and not have me take it and I also understand that everyone here is trying to get me to act in what they see as my best interest. I am very grateful for what I have been told. Unlike what I did before, I am really really trying to think this through and al the possible outcomes of my actions. Thank you so much for taking the time to read through all my posts and try to cut through what may be a lot of denial. I would like to hear what Executor recommends since she is on both boards and has an understanding of the PM world. I would imagine you do as well with the multiple health problems you have endured. I am sorry to hear that you have gone through so much. In my own way, I am putting my health first right now by tapering and not fulfilling my work obligations, which is likely to cause severe problems for me.

    I really believe the PM, especially given his situation, is going to toss me out on my butt and I will be no better off than I was - I do not see that as a solution to my health problems. If I am not able to taper down much further without severe withdrawal symptoms, I will certainly consider talking to the PM. Right now, I am tapering tho I am a long ways from where I want/need to be. I must sound terribly stubborn and like I have not been listening. However, I have read posts in PM that scare me to death. I will have plenty to contend with at my next visit when I do not have enough meds for a count or, at least patches.

    Thank you for continuing to post when I have stuck somewhat stubbornly to my position -again, I can only tell you that the posts I have read here have persuaded me that talking to the PM IS an option and one I am considering. You have made a difference in my thinking. But, I haven't come around to your position at this point.

    Do you take meds for your conditions? I know little about your own experience w/ PM. I can certainly understand if you do not want to take more time to post however since I have not taken your advice or that of others yet. If I were you, I might feel a bit frustrated by now about the [seeming] inability to get through to me.

    Regards,
    Confused

     
    Old 07-05-2008, 11:23 PM   #30
    Executor
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    Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Quote:
    Originally Posted by Confused089 View Post
    just scared - IF my pm read the board, he would most certainly recognize me and giving the exact dosages and the changes makes it a done deal. I think it is extremely unlikely that he would read any of this. However, unlikely is not the same as impossible.
    I guess anything is possible, but I seriously doubt one would stumble upon this and put 2 and 2 together. Candidly, I think the Doc is more likely to recognize the rambling and background information, rather than the dosing and med issue(s). Again, if you are serious about wanting help and advice, you have to cut to the chase and give relevant information....Not beating around the Mulberry bush as Reach described so well. You are concerned about being off on your counts, so we need to get a plan together to get you back on track.

    So, if I understand you right, you were on 300 MsContin and 100 patch. Then, he upped you to 400 MSC....Didn't do much because of your self medicating of extra patches....So, he upped your patch to 150, but left the MSC @ 400. Correct? If so, you've got a lot of med to vary with to get you back on track.

    Quote:
    Executor, thank you. I have read med. journals. etc. and after the third day, 50-60% of the medication is left in the patches. I truly wish it were just filler. I would be incredibly happy to hear that I am not getting anything after the 4th day or even 3rd day - can you point me to a source that says the matrix patches do not deliver fentanyl after day 3 or 4? I don't think that the used patches would have been so effective for so long if this were not the case.
    I do not have precise measurement information, but I do know that the patient prescribing information (white paper) says that some patients require dosing every 48 hours. Thus, that leads me to believe that if patients can't make it 72 hours, there isn't that much med left after using as prescribed. Additionally, this time of year, the heat causes more med to be dispensed @ a faster rate, further reducing the time amt of time the patch lasts.

    According to the manufacturer's technical sheet, your BPL (blood plasma level) raises with each subsequent application. Therefore, the fentanyl "builds" in your system. Upon removal of the last patch, it takes on average 17 hours for your BPL to fall 50%. Thus, while there may be some residual med left in the patch, most of it is really gone....What you're feeling is this "building" effect and why it appears to last longer than 3 days. I don't think Janssen would recommend 48 hr dosing if so much was left. In reality, you could take all your patches off and not feel much for at least 10-12 hours. Again, it takes on average 17 hours for your levels to fall 50%. It takes 4 half lives for the med to leave your system...In this case, 4 x 17 or 68 hrs.

    Quote:
    There are strict instructions to fold the patch in half and flush it down the toilet after use b/c there is still so much medication
    Strictly safety precautions, and for good reason. First, drug companies are very safety oriented, and secondly, there is some residual fentanyl left....On and around the patch, including the glue. This is why they recommend health care professionals wash their hands after application and removal. Because fentanyl is the most potent pain med available, it doesn't take much for a child or narcotic sensitive person to get sick. So, this is why they have the instructions...Not because a bunch is left over.

    Quote:
    I take 150 mcg/48hrs. and 300 ms contin. Again, I suspect I am on close to 300-400 mcg/day b/c of the length of time I am wearing the patches.
    Are you directed to take both per day....The 150 of patch and 300 of MSC? No way you're getting the amt of fent you list because when the patch is fully loaded, it releases the same amt per hour....Once it gets depleted, it will only release what little it has left....And won't be consistent. I was on the patch every 48 and had problems and my Doc put me on a patch a day, which was a drastic improvement....I had problems maintaining the 48 hr duration much less the time you're quoting. Just an fyi.

    If you're on 150mcg of patch each 48, then that's roughly equal to 350 - 628 of morphine each 24 hr period. According to Janssen's white paper, the 50 patch is equivalent to a range of 135 - 224 while the 100 is equivalent to a range of 315 - 404. Adding the two together, one gets 350 - 628. The range is wide due to individual differences and tolerance level.

    Quote:
    What I did, substitute extra 50 mcg fentanyl I had for all my morphine. When I tried to go back to regular prescription, pain was excruciating and I could not function. At this point I really wasn't thinking.
    Were the "extra" patches you had left over from previous months? The 50 patch is equivalent to a range of 135 - 224 of morphine. So, when you went back to all morphine, you didn't have enough morphine to provide for the 100 base (315 - 404) and the extra 50 (135 - 224) or 350 - 628 total....This is why you had it so rough. Make sense?

    Quote:
    I filled meds 5 days early last month which has made my PM suspicious of me.
    Does he know you filled early? Why do you think he's suspicious? You've been struggling with your pain and when one is in the middle of a regimen change, filling early isn't all that unsual.

    Quote:
    I would likely have been overjoyed, since a 50 mcg increase helped ALOT.
    That's because fent is so potent. As I said before, the 50 patch is equivalent to 135 - 224 of morphine.

    Quote:
    The new contract says to bring in all unused meds.
    Is this new contract due to your filling early and some of your other actions, or is this a new practice wide rule that just so happened to hit you during this time? Sounds like it's a new thing due to his partners. He's not going to go way back into time and count meds, but rather start with this last month's worth of meds. If he were to ask (which he won't) you can say that your other excess has been used due to your previous struggles and regimen adjustments. How would he know you had excess then anyway?

    Quote:
    One thing I am not certain about either is whether or not I would be WAY over the cutoff point for Fentanyl if given a UA.
    No....The UAs are approximate at best. Yes, they report concentrations, but everyone is different in how they metabolize the med. Depends highly on when you last changed, how active you are, what other meds you're taking, and etc. The main thing they're looking for is whether it's there or not....And whether you're taking unauthorized meds (from another Doc or street drugs).

    If I understand everything right, you're basically back on track with the MSC, but not the patch. You're going to have to stretch it out to catch back up. When is your next appointment? Can you change every three days (instead of two) to catch back up?

    Hope all this makes sense.

    Ex

    Last edited by Executor; 07-05-2008 at 11:30 PM.

     
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