double up on patches?

[U4Euhhhhh...]

I am on the patch and I get rx'd 15 patches(100s) a month. Also the baby dillies i was rx'd weren't helping with breakthru, so my doc switched me back to roxis for breakthru(kinda). Yes i am rx'd 240 roxi30s and 15 gel100 patches as well as 120 somas (with refills) per month. And I am still in pain too frequently. I am going to see a new pm doc on monday. I am thinking about requesting a different opi for breakthru and possibly a additional patch every two days. For example... 15 of the 100 patches and 15 of the 50 patches so that I would be wearing one if each for a total of 150 mcg per hour for 48 hrs. And also want/need the 1600 actiq pops for breakthru. So heres the Qs:
1) Is anyone here on two patches every 2-3 days? Or know of someone who is on 125+mcg/h...?
2) What would it cost for the 1600 actiq pops...they come in packs of 30, correct?
3) Does anyone here know if the generic actiq pops are available yet? i think they're called "fasliq"
Does anyone here know if the the sugarfree actic pops are available yet? called Actiq-SF
4) What would it cost for the 800 fentoras? 800 is the strongest, rite?

Much thanks to those who reply with useful info. I love you guys(/girls)...

[roxi*stardust]

<snip>
1) Is anyone here on two patches every 2-3 days? Or know of someone who is on 125+mcg/h...?
2) What would it cost for the 1600 actiq pops...they come in packs of 30, correct?
3) Does anyone here know if the generic actiq pops are available yet? i think they're called "fasliq"
Does anyone here know if the the sugarfree actic pops are available yet? called Actiq-SF
4) What would it cost for the 800 fentoras? 800 is the strongest, rite?

Much thanks to those who reply with useful info. I love you guys(/girls)...

1.) Actiq is indicated for the treatment of cancer pain. It is not reccommended for any other pain so more than likely you are not going to get an MD to script it to you, especially since the FDA put out guidelines for it. Secondly, if you do get an MD to RX it most insurance companies won't cover it unless your DX is cancer. You want to pay cash for it. Price from pharmacychecker.com: For 60 or the 1600mcg; $4399.76. Yeah that's four thousand dollars. http://www.pharmacychecker.com/Pricing.asp?DrugName=Actiq&DrugId=56152&DrugStrengthId=115763
I could not a find a price for Fentora.
Actiq contains sugar. In the package insert it warns Diabetic patients that it contains 2 grams of sugar. Here is the full prescribing info.
http://www.actiq.com/pdf/actiq_package_insert_4_5_07.pdf

I found reference to a generic but was not able to find any products or an NDC number for a product.
Sorry to rain on your parade.

Edit: Forgot about yur first question. Yes MDs do write for patches like you are talking about. Either (1) 100mg and (1) 50mcg or any combination of them. It is pretty common in nursing homes and hospitals and I have even seen it at the retail level.

[samsong]

I can only help on number 1, and yes, there are people who are scripted patches like that so that they are wearing two different strengths (the 100 plus something else), so it is not uncommon, but I wouldn't say it is all that frequent either. The problem maybe bringing it up with your doc though, like you can't say someone on O'Phile told me about it, so maybe you just ask it as a question, playing dumb, "I wish they made these patches stronger, becuase though the 100 seems to work to a good extent, it would be nice if they made 125mic or 150mic" and see how he handles that. Or jokingly say, "I wish I could wear two of these, ha, ha, ha"

The problem with asking for something a little bit out of the norm is that he may switch you off the patch all together and maybe put you on a high dose of Opana ER, which is extremely expesnive without insurance. Fine line with many docs as to getting an increase and your plan backfiring on you--has happened a few times with me and I always just wish I had never said anything, but if you have a good relationship with this guy, worst thing he may do is just increase your BTs instead of doubling you up on the patches.

[U4Euhhhhh...]

thanks roxi... I know that the actiq pops are for cancer pain, but I know a former patient of my new pm doc and he rx'ed the 800s and 1200s for (non-cancer) pain. That is the reason i was going to suggest. I do not have cancer yet, but from what I have seen this doc must not care what kind of serious pain i am in. And I have heard of patients on 2+ patches at a time, but never met any.

[20Dollarholla]

I know a girl in the late stages of cancer who has to wear 3 100mcg patches, and she is still in extreme pain. It is common for doctors to double up on patches.

The actiq for breakthrough pain is a miracle drug, and some pm docs will perscribe it to non cancer patients. My Mother had a rare nerve disorder (trigeminal neuralgia) and she was perscribed 240-270 ( 8-9 suckers a day) of the 1600mcg Actiq pops a month for breakthrough as well as MS-Contin then Oxycontin. Like Roxi said the suckers are extremely expensive although I thought it was $4,000 for her whole script not just 60. It is news to me that there is a generic brand of Actiq, I had been wondering when the patent on them was up.

[jerets]

Wow... I can't imagine going to see a new pain management doctor when you have one scripting you so much already. I know we all have our own tolerance and pain, but I feel lucky to be getting 10 50 patches per month. I've tried several times to get b/t meds and end up with nothing. I would be thrilled to get 12/15 patches per month. Be careful and good luck.

[havok]

OMFG, you are getting 240 roxis and 15 100mcg patches and you want to go see a new doctor? You have hit the fucking jackpot. I would give my left leg to be scripted with that for the rest of my life. What kind of pain are you in exactly? You better be a terminally ill cancer patient or something.

Personally I think the roxis would be the best opiate you can get for breakthrough pain, and also the cheapest. The Actiq pops aren't that good in my opinion. They barely give me a buzz. I would much rather have oxycodone or dilaudid than the Actiqs.

Hell while you are at it, why not just ask for straight fentanyl amps and IV that shit. I'm sure your doctor won't mind giving you that.

[Princess]

Wow, that's a lot of meds. I personally wouldn't change docs!

As far as actiq for only cancer patients, not anymore. It was approved for other types of chronic pain as well. I don't have cancer....my doc was gonna give me those for break thru pain on top of the patches but my insurance wouldn't cover it. He was going to look into a patient assistance program for those since I'm on the one for Duragesic already...

I think I recently read something about it on the internet too about a study done for actiq in non-cancer patients, but I could be wrong.

[reddragon3668]

I didn't take what the OP said as they were doubling up on doctors. I took it to mean that perhaps their old doctor is unavailable or something. At least, I hope that is the case.

The pops would be great. I am hesitant, though, to recommend it to someone without terminal cancer pain. One thing that freaks me out is if I exhaust all my options regards pain control, what the hell am I going to do if I end up with cancer late in life. I'll have to be hooked up to a frickin' tanker truck full of fentanyl or something... scares the shit outta of me. As a result, I've been trying to keep my pain manageable, but not over do it. I could take twice the medicine I do now.. often do..LOL But, I am trying to keep it as low as possible. I am 40 years old (almost) and there are allot of potential painful conditions out there that I've never met. Hope I don't. But, i don't want to be untreatable if I ever do. So, the morale, go as slow as you can.

Take care and I hope it works out for ya!

[HMMM...]

whooaaa.... that is a whole lot of opies right there.
Is this common in a lot of pain patients?
That even with such high doses it still is not efficient enough to take care of the pain?
Does tolerance affect the level where pain is alleviated?

[reddragon3668]

I wouldn't say its uncommon. But, yeah, that is a boat load of medicine. The OP didn't say what kind of pain they were medicating, so its hard to say.

Yes, tolerance is an issue. Some people here can take 150mg of Oxy and be right. I can take 300mg and just get a little energy. Methadone screwed my tolerance.

I just noticed that you asked if tolerance affects the efficacy of the medicine. I would say yes. Others would argue against it.

[Princess]

Does tolerance affect meds...OMG yes. That's a major problem for me. And methadone but mainly Fent really screwed mine up.

I don't know what the medical condition is for who is taking all these meds...but I have had cancer (in remission now) and have serious back issues that are here for life. I do worry about if I get in an accident or something....but in everyday life I can't live with my pain without *help*.

In regards to Actiq, my doc had said something before about that being his choice for me for break-thru because he'd rather keep me on Fentanyl all around. Maybe so other meds would help if I ever needed them? I don't know, just throwing that out there.

There are chronic pain conditions that are comparable to cancer pain, so I wouldn't say to save the Fent for terminal patients only.




I wouldn't say its uncommon. But, yeah, that is a boat load of medicine. The OP didn't say what kind of pain they were medicating, so its hard to say.

Yes, tolerance is an issue. Some people here can take 150mg of Oxy and be right. I can take 300mg and just get a little energy. Methadone screwed my tolerance.

I just noticed that you asked if tolerance affects the efficacy of the medicine. I would say yes. Others would argue against it.

[reddragon3668]

Your right, Mom. there are allot of painful conditions out there that are not necessarily terminal. In some ways, it makes it worse, cause your not sure if its ever going to end. So, when it comes down to it, you do what you got to do to live comfortable now. But, its does scare me, just for the scenario you suggested; a horrible car accident or something like that. It would take a boat load of medicine to control the pain in some of us.

I want there to be some options left, ya know? I am almost forty, and I plan on living a long time... so, what will I be on 20 years from now? Its just one of those rhetorical questions that's hard to find a satisfactory answer to.


Does tolerance affect meds...OMG yes. That's a major problem for me. And methadone but mainly Fent really screwed mine up.

I don't know what the medical condition is for who is taking all these meds...but I have had cancer (in remission now) and have serious back issues that are here for life. I do worry about if I get in an accident or something....but in everyday life I can't live with my pain without *help*.

In regards to Actiq, my doc had said something before about that being his choice for me for break-thru because he'd rather keep me on Fentanyl all around. Maybe so other meds would help if I ever needed them? I don't know, just throwing that out there.

There are chronic pain conditions that are comparable to cancer pain, so I wouldn't say to save the Fent for terminal patients only.

[Princess]

Couldn't agree more, Red. It scares the shit out of me. I'm only 34 & a single mom. It sucks, big time. I do have surgery (kidney) coming up too....wondering how the hell that's gonna go.

No ortho surgeon wants to start surgery on my back yet, starting the chain reaction in my spine. One disk now, another next year and so on. Not to mention the arthritis in my spine & scoliosis, etc. I'm screwed. Royally.


Your right, Mom. there are allot of painful conditions out there that are not necessarily terminal. In some ways, it makes it worse, cause your not sure if its ever going to end. So, when it comes down to it, you do what you got to do to live comfortable now. But, its does scare me, just for the scenario you suggested; a horrible car accident or something like that. It would take a boat load of medicine to control the pain in some of us.

I want there to be some options left, ya know? I am almost forty, and I plan on living a long time... so, what will I be on 20 years from now? Its just one of those rhetorical questions that's hard to find a satisfactory answer to.

[reddragon3668]

I really hope your kidney surgery goes well. Since I had my back surgery in 2000, I've not had any major surgeries. I have no doubt that I can be medicated well enough to control my pain if I did. Problems is whether or not the doctor will be willing to dose me enough. I am sure your doctor knows your tolerance to these drugs hopefully they will treat you accordingly.

Your doctor's wisdom regarding the back surgery is good. I now have a bulging disc above my surgery site. Since I was fused on two levels, it was an inevitability. That is where some of my pain is coming from. And, its bound to get worse with time.

I am not inclined to ever let them cut on me again. If I have any choice at all, I have underwent my first and last major surgery. It is not a pleasant experience, as I'm sure you can relate.

Take care, and once again, I hope your surgery goes well!




Couldn't agree more, Red. It scares the shit out of me. I'm only 34 & a single mom. It sucks, big time. I do have surgery (kidney) coming up too....wondering how the hell that's gonna go.

No ortho surgeon wants to start surgery on my back yet, starting the chain reaction in my spine. One disk now, another next year and so on. Not to mention the arthritis in my spine & scoliosis, etc. I'm screwed. Royally.

[ACDF2Pain]

I agree with reddragon, no more surgery for me!

As to the question about patches, I worked my way up from a 100 every 3 days to a 100 plus a 25 every two days - but tolerance and a nasty skin reaction made me switch.

[U4Euhhhhh...]

When I posted I was supposed to be going to a new pm doc. My doctor of years just stopped practicing. So i needed someone who will write me. It didnt work out with that pm doc. So now I am back to one and going thru w'ds from 100 fent patches and 30mg roxis. And I have wrestled the beast many many times before...but never have I never felt w/d like this. All kinds of things are going thru my head. Am I going to die from this synergistic w/d? What would they do/ give me if I went to the ER with my perscription history from my pharmacy and explained? How long will this intense nightmare last?
I remember seeing an episode of HOUSE and he is w/ding bad and he starts cutting his arm/wrist to take is mind of the w/d symtoms. He said something about the cutting releasing dopamine in the brain... I dunno, im not going to kill myself, but i would cut if it would help with this sickness I am facing. Is this for real, or was HOUSE trying to off himself?

[devilsdrug]

my friends script allows him to put another patch on every day and a half or two , so hes wearing 2 at a time but one is wearin out

[reddragon3668]

I know what your going through. My doctor up and died. It really revealed just how vulnerable anyone in PM really is. Your no more secure than your last appointment. Anything can happen, and since there is no continuity of care between physicians, often those within the same practice, you never know what to expect. Have your doc die, retire, or even out for vacation, and your often screwed. One person here saw a new doc due to his being on vacation, in the same practice, and that doc cut his meds in half. Said he was on too much... an arbitrary decision screwed the person's world up.

That's a scary thing and I've been through it. Didn't someone take over your doctor's patients when he retired? That is horrible to be left out in the cold with a dependency like that. I would be banging the ER's door down. You have legitimate prescriptions and I just can't imagine any doctor worth his education allowing someone to suffer for nothing more than a doctor retiring. Its not like you got cut from the practice for abuse.

I wish you well. Sorry for being so long winded, but its stuff like this that just scares the hell out of me and makes me mad as fuck. Hope it all works out for you!



When I posted I was supposed to be going to a new pm doc. My doctor of years just stopped practicing. So i needed someone who will write me. It didnt work out with that pm doc. So now I am back to one and going thru w'ds from 100 fent patches and 30mg roxis. And I have wrestled the beast many many times before...but never have I never felt w/d like this. All kinds of things are going thru my head. Am I going to die from this synergistic w/d? What would they do/ give me if I went to the ER with my perscription history from my pharmacy and explained? How long will this intense nightmare last?
I remember seeing an episode of HOUSE and he is w/ding bad and he starts cutting his arm/wrist to take is mind of the w/d symtoms. He said something about the cutting releasing dopamine in the brain... I dunno, im not going to kill myself, but i would cut if it would help with this sickness I am facing. Is this for real, or was HOUSE trying to off himself?

[Princess]

Oh my, that is horrible. If you don't have any meds or any pods, that's worth an ER visit. I'd go and take all your records, reports, script bottles/boxes, etc.

When my original family doc retired, the dude that took over cut me off everything. Of course I was only 22, but still, its just wrong to be cut off without warning or reason.

I'm so sorry you are feeling how you are....fent w/d's are the worst I've ever experienced and I do feel your pain... go to the ER...if it was a legit scipt, there's no reason they wouldn't help you (hell, even if it wasn't, I think they'd have to do something!). I'd go to the ER before I'd start cutting myself!

[Uncle Wiggly]

Hi, I'll tell you what happened to me. I hope it helps you. The first Pm doc I ever went to developed severe heart problems and had to retire. I had been his patient for several years. One day I get all call from one the office personnel telling me about the heart problem with my doc and all his patients were receiving a 30 day supply - then goodbye. I asked her about tapering down and W/D but there was no sympathy. I knew it wouldn't help me to call up the chain of command at the hospital so here's what I did.

I called one of the local television station's investigative news teams and told them about what was happening. I made the telephone call as detailed as I could - mentioning names, dates etc... Within five days I received a call from a reporter who told me he had placed a call to the CEO of the hospital and I should stop worrying.

The day after that I got a call from one of the doctors at the hospital telling me that a *mistake* had been made and there was no way I should be just cut off opiates because of the risk factor involved. They did slow taper with me. It was hell after I got down to a certain level and there was no intention of them managing my intractable pain. But it could have a lot worse.

I ended up finding a really cool PM doc who I knew from before he even got into PM. I've been with this guy a long time now and I'm doing better than I ever thought I could.

Sometimes it may seem like there's a dead-end street in front of you. But as CP patients it's up to us to be very proactive regarding our care. I hope this info helps you out. It is unethical for them to turn you out for no other reason than your doctor no longer being able to practice. There are television reporters, lawyers and newspapers reporters who thrive on getting a hold of this kind of information. Remember - it's the squeaky wheel that gets the grease. You just have to squeak to the right people. Take care of yourself.

PAX

[roxi*stardust]

I know what your going through. My doctor up and died.<snip>


Damn talk about shitty!!!

Maybe you could go to your PCP and have him/her write for your meds until you can get in with another PM doctor. If that isn't an option I would be at the ER and be asking them to get me a referral ASAP to someone because chances are even if they do give you meds it will only be a weeks supply at most, if that. Another option is hitting the nearest Methadone clinic.

[U4Euhhhhh...]

hey yall. Quick update.. I have a doc appt tomorrow at 2pm. Because of complete lack of compassion/concern for my situation/pain, I have decided to get a new PCP. I am bringing my empty bottles and patch boxes and all the med recs. I have no idea what will happen, but I am hoping n prayin he will at least write me for my patches and roxis until I can get in with a PM. I think when I am in his office I will have my new primary doc call and make a PM appt so he knows when I am going and how long I will be without meds. In the midst of this w/d I cant help but be filled with hate for doctors without compassion. I mean 'you have my records and xrays and all the legit shit and you see that i am in terrible pain and w/d and wont help me feel better/ live a (semi)normal life?..You are not a doctor. You're a fuckin inconsiderate scumbag!' Ah...I feel a little better. But I am just counting down the hours til the doc and god willing, the minutes to the pharmacy. Please pray for me. I will let yall know how it goes...

[U4Euhhhhh...]

i can not believe this shit. About two hours before I was about to go to my new PCP, I got a call from his office saying that they recieved my records and that I should find another doctor and not to waste my time and the doctors time. She told me that most of my med records consisted of narcotics stuff and I would not get anything like that at my appointment this afternoon. I said ok i want/need a referral to a PM doc, but will cancel my appointment today but I might make another appointment in the near future. So I was flippin out at work and trying to think of what I should do... I actually started calling hospitals and inquiring about weaning programs. But all the places I called did not offer any slow taper off of my fent and roxis. They only offered a 7 day detox and sub maint. These w/ds are the killer kind...I would go to the ER but I am affraid that without my actual med recs and xrays they would not to anything for me but charge me an arm and leg and sent me away with a couple percs. Even if I brought my empty bottle and patches to the ER. I mean you'd would think that some hospital arould Bmore could offer me a slow taper off of 100 duro patches(15 a month) and 30mg roxis(240 a month) and somas(120 a month). My buddy told me that goin to the ER would not be worth my time and money because they can not help me out with fent or roxi. He said the most I would ever get from the ER would be percs... Is this true? Any advice ?? What should I do (besides kill myself or get on methadone)?

[Princess]

OMFG! Are you serious??

Ok, let me calm down. I'm thinking I would go to the ER with your med boxes/bottles. You mentioned you don't have your records or x-rays. Do you have copies of your x-ray or MRI reports? I keep all that shit along with my actual MRI & x-ray films. You MUST get & keep copies for yourself. If you don't have any now...just take the empty scripts & go to the ER. Tell them to HELP you and *possibly* have them point you to another doctor.

THEN, after you get *a little* help, tomorrow (or as soon as possible) I would go to that new doctor's office (just walk in, even) and tell them you want copies of your records. You can also either call the place you had your most recent x-rays & have the x-ray report faxed to you or walk in and have them print 'em out.

Get that damn referral to a PM doctor from the asshole doctor's office. I would start with the ER. Don't do anything stupid.. Someone HAS to help you.

GOD, I'm so mad for you and I feel your pain. Honestly, I've been there. Fentanyl withdrawls are the worst thing ever.

GRRR

[WarmCyanide]

Any advice ?? What should I do (besides kill myself or get on methadone)?

killing yourself is fucked. advice will pour in from other people here. this is opiophile! youre in good hands as far as w/d and/or methadone experience. keep on keeping on.

[Princess]

killing yourself is fucked. advice will pour in from other people here. this is opiophile! youre in good hands as far as w/d and/or methadone experience. keep on keeping on.

Thanks, my sexy Cyanide (profile pic, lol).

I agree. Suicide...man, think of ONE person that loves you...picture that person at your funeral. That's enough to stop me.

Just know, w/d's don't last forever even though it feels like it. I know exactly where you are at...been there, same drug too.

Methadone, shit, if you can get some, take it! It will stop your withdrawls AND I've taken it for pain and it WORKS. Take it until you get a new dr squared away!

I hope to God you are at the hospital right now!

[roxi*stardust]

Going to the ER is not going to do anything for you but waste your time. They will not write your scripts for you. If you are in pain they will give you a shot of morphine or hydromorphone and that's about it. They maybe able to refer you to a pain management clinic or doctor though. Like I said it highly unlikely that the ER will do much for you besides the shot and a referral and maybe a script of Percs or Vikes. If you go don;t expect more than that. I would have kept that appt. at the PCP's office and asked for a referral. Once you get in to see the doctor you may find that he/she is more understanding than his/her staff. They may have been willing to at least write your scripts for a week or 2 worth of your meds. If they were unwilling to do that I would at least ask for a script of methadone to at least keep you pain free and out of withdrawal until you got in to see the PM doctor. If they won't do that you should file a complaint with the state mediacl board.

[Princess]

Going to the ER is not going to do anything for you but waste your time. They will not write your scripts for you. If you are in pain they will give you a shot of morphine or hydromorphone and that's about it. They maybe able to refer you to a pain management clinic or doctor though. Like I said it highly unlikely that the ER will do much for you besides the shot and a referral and maybe a script of Percs or Vikes. *snip

Roxi, don't you think its better for him to get a shot of morphine or dilaudid when in full blown withdrawls to the point of contemplating suicide? That's just me, but when I'm in fent w/d's I'd take a shot of ANYTHING to make me feel somewhat human.

Once here in Phx, I did get a nice shot of dilaudid and a 2 week script for 80mg a day of 'done for w/d's from the ER. Maybe I got lucky, but I think its worth a shot. The first time, however, I didn't get shit except an iv drip of 'fluids' and some warm blankets....and a script for Clonidine on my way out the door.....(different hospitals).

I just think it might buy a tad more time getting to a PM clinic or getting some methadone (if they won't script some).

That's just my opinion....

[U4Euhhhhh...]

And then there was a light at the end of the tunnel. It was a dim light, but fuck it- its a light. I finally saw my new PCP and we set up an appt with my new PM doc in about a month. And I asked him for a script for my meds until I see my PM and he said sure. Then he leaves and his assistant gave me a sheet of paper (not a script pad paper, like computer printer paper) with all three of my med scripts on there. I had never seen a script like this before. So then I started to read the paper and that fuckin doctor cut me down from 15 to 10 of the patches/month, from 240 to 90 of the roxis/month, and from 120 to 80 somas/month! I was pretty pissed when I saw this and I pointed it out to the assistant and said, "look here is my most previous empty bottles and patch boxes". Well she took them and the paper back to the doctor to get it changed for me and came back shaking her head. Then she told me that my doctor does not think I should have been on that much medication and that he is not going to change the script or write me for any higher quantity. Then she told me that I should feel lucky that I even got that much. Ummm. I have cooled down now and I am thankful that I have a little somethin to get me through the next couple weeks, but at the time I wanted to scream at her or curse the doctor out. Its not like I am trying to get him to write me for more meds, just wanted/needed a refill (which he agreed to). I left the doctors office after setting up another appointment in may and wondering if I will actually go back there again. So on the way to the pharmacy I was bitching about how bad this one Rx computer printout sucks, cause the giant pharmacy I go to for my Amide roxis, doesnt not carry the sandoz patches I like. And the Taget pharmacy (which carry the sandoz patches) do not carry the Amide roxis and watson somas. If only the doctor would have taken the 45 seconds to write 3 different scripts the ol fashion way, I would have been just peachy , but no- I have to go to the Giant pharmacy and settle for the Watson patches (which are not bad, but not as good as duragesic or sandoz brand) and then the pharmacy tells me that they do not have my patches in stock and I have to wait until friday evening. Thats fuckin 3 more days till fentage. I almost spit in his face. Then I ate a few roxis and it helped with the pain and w/d, but my mind was still craving the fent like a madman. Doesnt matter if I wear it, taste it, or smoke it, but my mind will not rest untill I am reunited with my brother from another mother (Wason Labs). Only a couple more days to go. Slowly, but surely.The light is getting brighter and closer...:abduct: