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

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    Old 07-05-2008, 11:43 PM   #31
    Executor
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    One more thing....I highly recommend that you really should start posting over on the "pain mgt" board as there are lots of very knowledgeable posters there who have a wide array of experiences with pain mgt....And many of the issues you're caught up in right now....They could be of a big help to you I think. I just happened to stumble upon your post....I don't really participate on this board much @ all.....I just happened to see the title of your post listed in the board summary page and it caught my eye....Otherwise, I would have never seen it.

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    Old 07-06-2008, 02:17 PM   #32
    Confused089
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

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

    Executor --

    I am REALLY trying to give you the info you have suggested I give.

    While I thought I gave all the relevant info, have tried to answer each of your q's again. I am experiencing more w/d today. I have removed all of the extra used patches [which after being used multiple times should, in theory, not be giving me much if any medication and I have dropped my dose from 400 MSC to 300 MSC/day so that I have enough medication [tho I am still either 2 100 mcg patches [no way to get those back now] or 4 75 mcg patches – two of which I already told my PM I had accidently messed up. I want to have to correct amount of meds when I see my PM in 3 weeks.

    Ok, hoping this makes sense, this is the story again with as many details as I have at my fingertips now. My MP upped MSC from 300 to 400. I noticed no difference. At this point, I stopped using the morphine [all of it if I recall correctly] and used the extra 25’s and 50s I had built over a number of months [for a total of 50 mcg extra]. The relief was substantial.

    When I ran out of extra patches [after about two weeks], I tried to go back to my regular prescription and take 100 mcg F + the 400 of morphine. This is when my pain went out of control and I began taking large amounts of morphine (again, in addition to my regular 100 mcg F patch – I only used “extras” not my regular prescription when I supplemented [since I hadn’t used any morphine for several weeks and had extra, I had a lot left over]. Unfortunately, I did not keep track of how much extra I was taking, but I recall feeling very worried b/c the amount was so much higher than my normal dose – I am guessing I took a total of 900-1100 of morphine [rather than 400] to keep the pain under control. At my next visit w/ my PM, she added 50 mcg fentanyl. Shortly before this, I had begun to use “used” patches b/c I was going through the morphine so quickly. I suspect I further raised my dose during this time by accident, but I really do not know.

    I picked up the new patches [I was out] 5 days early and began to try to cut back. Unfortunately, my memory is just not great on all of this]. When I last saw her, I put extra used patches on for a few days before seeing her and then took extra morphine to ensure that I was not in withdrawal when I saw her.

    The pill counts, UAs and contract are directly related to the fact that she has joined a new practice. These are the tools used by other members of the practice. substitute the 400 mcg of morphine for the 50 mcg patch. This is when I experienced excruiciating pain and began taking my meds indiscriminately – really just took whatever I needed to take to get my pain level down to a place where I could function minimally – still had terrible headaches, etc. Maybe I was in withdrawal, but it didn’t feel like it – I did not any withdrawal symptoms except additional pain.

    At some pt. shortly before seeing my PM, I felt alarmed by the rate at which I was using my morphine and started putting on old patches to reduce my use of the dwindling supply of morphine.

    To address a few coments, I put on the extra patches b/c upping the dose to 400 morphine did not have any noticeable effect on my pain level. I did try. I was not optimistic that she would further inrease my dose.

    Probably, in order to figure out how to get my counts right, I will need to count exactly how much medication I have left and how much I am short.

    I am not sure why 50-60 % of the medication is left in a patch after 3 days [read this is med. Journals after much searching on the web], nor do I know if changing the location of the patch would cause this additional med to be released in my body [since the patch releases med. based upon what is the depot in the skin]

    In terms of a patient not making it after 72 hours, the patch could simply be delivering far less medication and putting the patient in withdrawal. Trust, me I very much want to believe that little of the med. is being released after the 3rd day, and once my body stabilizes from this withdrawal, I will test the theory by removing one of the patches that is older than 4 days.

    Once I have gotten my pill count back to where it is supposed to be [Thursday] and hopefully am completely out of withdrawal, I can experiment with substituting oral meds for the patch as well as cutting back on the patch [I will be 100 below my regular morphine dose - not much, but something]. Still I have only 100 of extra morphine to play with – if we assume that I am getting 3 days worth – I would need the equivalent of 75 mcg x 3 in morphine [ or a dose that does not induce severe withdrawal] to compensate for the loss of one patch, correct?

    I am directed to take both the fentanyl 150 mcg every 48 hrs and the 400 morphine every day. I am familiar with the half lives, though I had no figured out how much time it would take for all of the med. in the patch to leave my body.

    The extra patches I had were left over from earlier months, except the month before this, when I used folded matrix patches to try to taper down.

    After I ran out of patches, I didn’t go back to ALL morphine, I went back to my prescription 100 mcg and 400 morphine, so I am really perplexed as to why my pain levels skyrockted [aside from my tolerance to morphine – I was substituting 400 of morphine for 50 mcg of fentanyl – this should have worked fine- it’s almost more than double what the 50 mcg patch equivalent is].

    Yes, he seems to know that I filled early. He also took care to put ALL my prescriptions on one sheet this time and specify that I get the matrix patch even though I have never gotten anything else. He seems to be getting info each month on where and when I refill my meds. In this case, my pharmacy did not have the 75 mcg patches in stock and I had to go to another pharmacy to pick up the patches. I called his [old] office and his office assistant said we don’t care where you fill your prescription – as a result, I thought it was ok to use a different pharmacy, particularly since my pharmacy said they would not be able to get new patches in for 5 days. Honestly, everything tells me he was suspicious of me – tho I think he was worried about diversion not overuse. Ironic, since I wouldn’t have a clue as to where to sell meds and I just would not do that even if I had the slightest idea. Obviously, I need every last drop of pain meds for my pain as well.

    With a change in meds, I wouldn’t think filling early would be all that odd either, but I don’t have the extra 100 mcg patches I should have since I filled early. In addition, if I really wanted extra meds or were trying to divert them, I wouldn’t ask for 30 patches of the same strength. I would have more if I got two prescriptions of different strengths. Perhaps this is something I need to say to him next time. I’m not sure that he is clear that I would have 4 extra patches each month rather than two if I were using different strengths. None the less, however you do the math, I am short patches. I started my new scrip 5 days earlier than I would have started otherwise. I now have yet another problem – my parents, who have been helping me through my financial problems are having their own financial problems and are insisting that I move back to their city [same state, but far away] and that I fly up to see my pm but not tell him I am doing this. They say he will have no way of knowing where I actually live. I am trying to get back to an honest relationship with him and am pretty dismayed with this plan, but there really isn’t enough money for me to continue living here unless I can come up with more money very quickly. Not easy while I am trying to get my body stabilized or taper.

    I think that all you are missing is a complete count of my meds and the time I have to come up with one or two additional patches. Is there any other info you need? I am not sure when this w/d will be over – I am hoping it will abate considerably by Wed. or Thurs. so that I can get back to handling some of they many other problems on my plate right now and try to avoid moving to my parents’ home.

    I would really like to stay with this doctor. I think he is a good PM and I am not going to make another mistake like this, regardless of the amount of pressure I am under. I have really understood how badly I screwed up here and the ramifications of my error.

    Again, the new contract is due to the new practice. Why wouldn’t I have excess when I see the PM every 28 days and get a scrip for 30 days? My guess is that he might go back two months – to the time when I filled my scrip early. It still isn’t ok to use excess even if I am in a lot of pain, right?

    Again, I substituted close to 400 mg of morphine for the 50 mcg of Fentanyl – which is why I did not think I would have a problem switching back. I know I am repeating myself here, but when I went back to my normal prescription, I used 100 mcg and 400 morphine – it should have worked fine. The difference in analgesia [not withdrawal] was why I raised my dose of morphine at that time.

    Reazlie the UA’s are approximate. I should probably stop using the valium I am presently using now for w/ds by tomorrow since it has such a long half-life. Even after 20 days, I will still have a little left in my body. I am presently [putting one patch on every day [instead of 2 patches every 2 days so that the level stays constant since I am still wearing a patch on the third day [on beyond]. I could skip a day, certainly, but this would again throw me into w/d. After Thursday, I will be able to go back up to 400 MSC [from 300] this might help a little. In addtion, I could tape the patch so that I get half of 75 mcg – and then do the same a week later – this would not be as big a drop…If I understand correctly, I can actually cut the matrix patch w/o any problems but this is anecdotal. If so, this would make it far earlier to regain a patch or two.

    Not back on track w/ MSC since I am currently taking 100 less than normal to get my pill count back up. I can stop doing this on Wed. or Thursday if you think he is just going to look at one or two months back on the pill count.

    Ok, really, I am trying very hard to answer the questions you have posed accurately. I am grateful for your attempts to help me resolve my problem. I really really hope you are right and that the patch is not releasing meds after day 3 or 4.

    Summary:
    ON 300 morphine & 100 Fentanyl. PM upped dose to 400 morphine & 100 fentanyl. I felt no improvement.

    I substituted extra patches [from earlier months - had never used more than I was supposed to use before this so had 30 days worth of meds for 28 day appts.] So, IF i recall correctly I was taking 150 mcg Fentanyl and no morphine for several weeks.

    I ran out of extra patches and tried to go back to my regular dose of 400 morphine and 100 mcg fentnayl. Pain was horrendous and I began taking morphine whenever I could not function. Had horrendous headaches - simply could not function. Even with much higher dose of morphine [and the fentantyl] I was still in far more pain than I had been before I substituted Fentanyl for morphine.

    Began using "used patches" the week before I saw my PM b/c I was worried about how fast I was running through the morphine. PM raised Fentanyl by 50 mcg [exactly teh amt. I had increased it]. I was now in w/d b/c of all the extra morphine I had taken. Went through one w/d. Continued to supplement w/ morphine or used patches if I had to go out, shop, etc.

    Went back to PM last week. Started new taper to stop using any used patches [other than the ones I am keeping on for too long]. Have had relatively mild w/d but have been using clonidine and valium. Have had migraines, increased pain, no restless leg [prob. clonindine], shaking and bad anxiety. I am worried about using valium beyond tomorrow or the next day. Last thing I want to do is increase benzo dose by accident while doing this].

    Am short pills, which is why I went down to 300 msc/day until Thursday. When body stabilizes, will try taking off old patches. Still need a plan to "get back" 2-4 patches b/c of early refill.

    This summary isn't as complete as what I wrote above but I am hoping it is more comprehensible. Honestly, trying to give you ALL the info you need to help.

    Thank you so much.

    Confused.

    Last edited by Confused089; 07-06-2008 at 02:39 PM. Reason: Accidently left part of executor's post in my reply, added a little.

     
    Old 07-06-2008, 02:45 PM   #33
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    Quote:
    Originally Posted by Executor View Post
    One more thing....I highly recommend that you really should start posting over on the "pain mgt" board as there are lots of very knowledgeable posters there who have a wide array of experiences with pain mgt....And many of the issues you're caught up in right now....They could be of a big help to you I think. I just happened to stumble upon your post....I don't really participate on this board much @ all.....I just happened to see the title of your post listed in the board summary page and it caught my eye....Otherwise, I would have never seen it.

    Ex
    I would post on PM board, but the rules state that I cannot post there since I have misused my meds or used them illegally [ie not according to dr.'s instructions]. I suspect I would get different advice there but posting there breaks the rules.

     
    Old 07-06-2008, 04:27 PM   #34
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    Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f

    I dont know exactly about the rules on the PM board, but thats where I post, and know Reach and Ex, and I hope you can get some help. You just have to really try to give the exact info so that everyone can help you. dont take it the wrong way. If you sare afraid to post on the PM board, I can see why, becuse you abused your meds and you're afraid of the backlash. If you are trying to get back on track,then get to your doc and cry mercy.
    My head hurts after all of these posts, and I know you are struggling, but I honestly dont know where to chime in here. Just try to do your best and be candid and you'll have a ton of help~
    xoxoxox,
    IZZY'SMOM

     
    Old 07-06-2008, 05:33 PM   #35
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    Re:Fentanyl detox, pain pat. abused meds will need meds in f

    Izzy's mom,

    I am getting a bit confused about the candor issue because I have posted exact meds, times, etc. - I pasted the Executor's questions into word and went through them one by one, trying to answer each question.

    I originally intended to post on the PM board, but I the rules say I cannot post there since I have used my meds inappropriately. I am not afraid - certainly a little embarrassed, but I would be posting there if I thought I could do so without being banned from the boards. I do think people on the PM board would be more able to help with a reasonable taper. I have been trying to abide by the rules of the website and not get booted off.

    I am not surprised you are a bit dizzy after reading so many posts w/ lots of bits and pieces of information, many of them irrelevant to resolving the issue here. I was feeling quite emotional at the beginning of all this and did some venting. In addition, all of my posts have been written while in withdrawal and/or pain, which has made them far less clear than they would otherwise be.

    At this point, however, I have truly tried to answer all of the questions posed. I suspect what is missing [and I don't think this was asked] is how many meds I have left and the exact number I need to have at my next PM appt. I have not felt well enough to tally my morhpine [aside from the fentanyl] and how many short I am - it depends upon how many months I am responsible for "extra" meds. I have been checking the date I picked up my meds for the last 6 months and trying to figure out how many extra I should have. However, executor said she thought this would just be for the last month of two. It does not make much sense to me to have an appt. every 28 days w/ a prescription for 30 days and be held responsible for the extra 2 days of meds. At any rate, in going back over my records, I have found that I have been picked up my meds early [a day or two] several times and that I should probably figure if those slightly early refills should be included. I don't have the sense that people realize I am in withdrawal and not thinking clearly. I truly hope this ends relatively soon. However, I started friday, so I imagine I have more time before I am clear-headed again. If the last extra patch I was wearing was giving me any medication, then it will be longer before I am back to normal....

    Thank you for trying to help. Perhaps I should post something telling people who read this to skip all the previous messages as they are likely to confuse and to focus on only the most recent one or two posts. However, no one seems to feel that these posts are helpful either - I am being completely candid now, and in the last post, I tried to write a brief summary at the end to make everything easier to understand]. I have answered executor's questions to the best of my ability. I thought I answered *all* of her questions. I pasted her questions into word and went through them one by one, answering each question. Still, I am getting messages that I am not being candid. I have given doses, times, sequence of events and answered each question. I have some trouble writing in the small window provided as I cannot see what I have written w/o scrolling back up and I wind up repeating myself. None the less, it seems that regardless of how hard I try to give the exact info [in the last day or so] requested, no one can make head or tails of it. Again, I am beginning to think that I should wait until I am through this taper and my head is clear again before I post more if my posts are so unclear. My head is not clear, so I am not surprised that my posts are not either.

    Thank you for trying to help. I hope executor reads what I have written. If you can not understand what I have written though I don't know if executor will find it any clearer.

    Last edited by Confused089; 07-06-2008 at 05:43 PM.

     
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