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    Old 10-27-2004, 08:42 AM   #1
    KimmieVanH
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    Taper Schedule?!?

    I know there used to be a guy on here who provided excellent taper schedules. Are any of you knowledgeable enough to provide an oxy taper? Shoreline? I am currently taking 180 mgs a day. 60 mgs 3 x a day. I have 90 pills left and desperately need to taper to avoid wd's. I am NOT tapering myself, I have someone who will give me the pills when it's time. Please let me know if you can help me. What can I expect as far as wd's are concerned? Thank you.

     
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    Old 10-27-2004, 11:51 AM   #2
    twisten
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    Re: Taper Schedule?!?

    Didn't you just place a post recently about whether a neurologist would prescribe this and now you are asking how to taper off of it?? Not sure what is up here please let us know.
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    Old 10-27-2004, 11:56 AM   #3
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    Re: Taper Schedule?!?

    I just looked back and on October 19th you placed a post asking if a neurologist will prescribe it. By that post I got the impression you had never been on it yet as per this post you're taking 180 mg a day?? I'm not accusing you of anything just wondering why you would now need off of it already??
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    Old 10-27-2004, 01:00 PM   #4
    KimmieVanH
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    Re: Taper Schedule?!?

    Easy to misunderstand. I currently AM prescribed oxy by my PMD. I WANT to switch to a neurologist (I have more confidence in him). I went to my PMD on Monday and got another Rx of the oxy. Since then, I have decided that I really, really, really want to quit. I have no trust in my PMD and I feel that I need to taper alone. I have asked him to switch me to other meds and asked him to taper me off a few months ago and he actually talked me OUT of it. So, I want to do it alone. Does that help?

     
    Old 10-27-2004, 01:08 PM   #5
    KimmieVanH
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    Re: Taper Schedule?!?

    Oh! I had MS Contin (which is what i meant in my first post) and oxycontin mixed up. Maybe I need some coffee. I am CURRENTLY on oxycontin and I dislike it. I want to get off of it and I need ANOTHER PMD. Not try the Pain Management route. I don't feel that is what I have done. I really feel like I am seeing a pill pusher disguised as a PMD. Sorry for all the confusion. Basically, I do NOT want to go back to my "current PMD" because I have asked for different things before, as opposed to the oxy and he says "let's try an increase" or "maybe next time". I also asked to taper off completely and he told me that he did "not think that was a good idea". I ALSO asked him for the name of a counselor who helped with chronic pain patients and he gave me a name. Come to find out, she is the wife of a Purdue rep who just happens to be a big time oxycontin supplier for my PMD. Conflict of interest? Anyway, this is why I want to try and do it on my own. Well, have my husband hand out the meds. I KNOW I can't do it alone. Any advice would be greatly appreciated.

     
    Old 10-27-2004, 03:57 PM   #6
    twisten
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    Re: Taper Schedule?!?

    Oh, okay that makes sense now!! Shoreline is pretty good with taper plans hopefully he will be along shortly to give you some info on it. Do you have anything in place for pain relief once your off the oxy?
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    Old 10-28-2004, 06:54 AM   #7
    MomOf4VA
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    Re: Taper Schedule?!?

    No. I am calling another PMD today to make an appointment. I am hoping he will be able to help me. Until then, I just want to taper. This is KimmieVanH, btw!

    Last edited by MomOf4VA; 10-28-2004 at 06:55 AM. Reason: Wrong Login

     
    Old 10-28-2004, 05:21 PM   #8
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    Re: Taper Schedule?!?

    Hey Kimmie, If your going to to change PM docs, why not just wait and let the new doc manage the taper, You have me a little confused right now, You are taking MScontin right?

    IF you feel you went to quickly to pills before trying something else, then the new docs help with the taper could go much smoother if the new doc can help with the pain while your tapering off. If nerve blocks help or whatever modality your interested in trying, if it helps it will make the taper go much smoother. He can manage the meds, devise a taper, supply the adjunct meds and reduce your pain with other modalities so you don't have a huge spike in pain that changes you mind about the taper completely. If you taper to fast with no adjunct meds or therapy, your pain will spike and it will be that much harder to decrease your dose.

    You basically need to decrease your daily dose by 15 mgs every 4-5 days. something like 60-45-60 for 3-5 days
    45-45-60 for 3-5 days
    45-45 -45 for 3-5 days
    45-30-45 for 3-5 days
    30- 30- 45 for 3-5 days
    30- 30 -30 for 3-5 days
    30-15-30 for 3-5 days
    15-15-30 for 3-5 days
    15-15-15 for 3-5 days those days allow you to acommadate to the decrease without spiking your pain and making you sick
    Then switch to vicodin 5/500 or Norco 5/325mgs 6 times a day
    then 5 times a day and so on, slowly spreading the time interval between doses farther and farther apart while when you have less per day.

    If I had my choice that's how I would do it. If you spend 3-5 days at each interval your looking at a 45-60 day taper. 10 steps 3-5 days a piece.

    You could speed it up but the greater the percentage of the decrease the more symptoms you will experience. With adjunct meds like Clonodine and phenergan or librium, you could do this faster, But you may find 0 meds isn't an option, He may be able to help reduce your pain and reduce your meds but if you get to the point of 0 meds and find you can manage with something much less or with PT and other modalities that's great. If you can reduce your meds and use different modalities that would be good too.

    Back before oxycontin, we were told to live with it, embrace it, except and realize that chronic pain wasn't a warning signal that something is terribly wrong.

    You make a great case as to why other things should be tried before opiates. But folks know what's available, read about the use for the same condition they have and want the same instant relief they think opiates can bring. Why spend months on TP injections, learning relaxation techniques and seeing a counselor to help with coping if the pain can be relieved instantly with a pill.

    If your old doc is simply a pill pusher and doesn't care that people haven't tried any other method of pain management, he needs to be shut down, He's just creating hundreds if not more patients dependent on opiates that could have been managed in other ways.

    I don't want to play the evil advocate again and get bashed for saying that evryone with any degree of pain should have the same access to these meds as anyone else. Just because you have pain and someone else with a similar condition uses opiates, doesn't mean it's the standard of practice. When reading this people don't know alot of us that finally found relief with meds spent years and multiple surgeries before we got any relief. It doesn't entitle everyone to morphine or OxyContin.

    Just as an example, someone posted about there pinky hurting last week. I didn't see anyone respond because it seemed so rediculous. If the only advice we can give is find a doc that believes in opiates to relieve your pinky pain, something has really gone wrong with PM and the advice we are giving.

    Waking up with a kink in your neck doesn't mean you need morphine, but because it's available, and the use is no longer seen as a last resort method of pain management, It's becoming a first and only choice because why try something that may or may not work when they are convinced the same meds that work on the folks that can't function without them should be used on anyone with pain, whether it's their pinky or their spine or a tumor.

    Were going to end up going full circle, in the early 90's if you didn't have cancer pain, you didn't have a PM doc prescribing opiates to the point of physical dependence. Now it's a booming industry that anyone can through their hat into the ring and claim to be a PM doc that has the ability to write a script. Pain meds are the fastest growing segment of the pharma industry because it's so profitable and because once dependent they are customers for life. Morphine has been around for 175 years, how can any manufcaturer claim R&D makes a 200mg MSContin cost 8 bucks a piece. My pump refill with 360mgs of preservative free morphine and bupivacaine, the meds cost 13 bucks and are compounded in fla and shipped to VA. The Contin delivery system has been around since 72 and MSContin has been around since 84. They learned to synthasize all opiates and oioids in 79 and they don't have to grow or important opium to extract thybaine, It's all manufacturered in bulk synthetically.

    The meds are now over used, other methods are avoided to go straight to the big guns and soon there will be a backlash, where nobody will be able to get meds. This was part of my decision to have the pump implanted because there are too many people going straight from 3 months post op and a month of PT to Pain management with opiates. The surgeon doesn't want to deal with med requests. He now has someone to send them to and pass the buck and the complaints of pain onto a doc willing to make a living writing scripts.

    You not only have docs making a living on the scripts but patients too. I know people that sell their meds and honestly if they have enough to sell, they probably don't need them at all. But if you can make a thousand bucks on one script, get Medicaid to pay for the meds, they are doing better than any other drug dealer that has to actually pay for the drugs, smuggle the drugs, grow the drugs and then sell them. When a bottle you can hold in your hand that insurance or Medicaid paid for can make a dealer more money than having to deal with 50 people to sell a pound of pot or a couple ounces of cocaine.

    There is a real problem with diversion. Diversion comes from patients, not the pharmacists that have addictions or the techs that work there, but the thousands of patients seeking immediate relief from minor pain that would improve even without treatment, and with the people working the system so they don't have to work and can get the govt. or insurance companies to pay for their stash so they have no out of pocket expense. What other drug dealer has no out of pocket expense.

    I read a post at another forum about how upset someone was that their insurance was no longer going to pay 7k a month for 6-8 1600mic Aqtiq pops a day. This was someone in so much pain only the most potent med available worked but still managed to make it work every day. I would bet they weren't functioning when going through Fentanyl withdrawal and I'll bet they were not going to pay the 7k a month themselves. Everyone was outraged that an insurance company would do this. Can you imagine if everyone with DDD needed 7k a month in Fentanyl pops to go to work?

    The request for pain management has gotten so large in my area that now you can't just get a referral to see one of the docs at my clinic.

    They get the name of a patient form the referring doc, they send the patient a packet that looks like a book or IRS audit, includes a psych eval along with request of all the other methods of pain management and the DX. Then all the docs and NP's have a monthly meetings to decide what patients they will take on.

    If the patient is excepted and missed their eval, "first apt" they are not given another apt. Their feeling is if the patient is in such desperate need for their help, they will make it to their apt without rescheduling 3 times so it's convenient, so it's on their day off, and they don't lose a days pay to address a problem they call life altering or pain they rate as a 10.

     
    Old 10-29-2004, 08:22 AM   #9
    Pikkaso1980
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    Re: Taper Schedule?!?

    Amen, Shoreline!!!

     
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