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    Hi Annette !!
    nodisc posted:
    Hi Annette !! How are you?? Well, hopefully and how's the little guy?. My two are 6 and 4 and there's another on the way! Three grandsons, wow!! Anyhow, reason for the post is once again problems with the meds and how to handle them. I'll try and keep it brief, so don't mind the frustration. I'm taking Opanas (have been going on 2 yrs) now 2 40mg and one 30mg every 12 and perc 10 for bt. This was to replace the OC tabs that I took for several yrs. Well, because of the problems with the shortages, my reg pharm (large chain) didn't have them, they always were on back order. Got fed up with this and went to the Endo website and they had a pharm locator option to assist with finding the Opanas. I'm not calling any pharm, because we all know what happens when we do!. Well, a few locations came back, I chose one of them, I've dealt with them now for a little over a year. I did have a shortage problem on one occasion, but that's been resolved. The problem now though, is that when I bring the scrips in, the Opanas always have to be ordered. Usually, it's 2 days, but now this month it was 4 days! When she told me, said fine, I'll pick em all up on Mon. I have a few spares, so thankfully I'm able to get by.The pharm mgr that was there is in another store in the chain now, he used to give me a partial, but this mgr., well she said she was reluctant to do this. The one girl that works there said oh they're expensive and I said there must be a better way. Sometimes, I feel as though they look upon me as a shady individual. But I don't know, having to deal with this every month is getting old, I was thinking about using my ins. plan and get em through the mail, if that's possible. O.K., nuff said now the questions here are, is this a common thing that happens and how do I remedy it without being sarcastic about it?? It's more than likely they talk about it after I drop them off, I worked in a pharm back in the 70's and you'd be surprised as to what you hear. We used to catch 2 or 3 of them a week trying to pass phony scrips, and because of society today, we all get the "look" when we drop em off. It should'nt have to be like this, but oh well!! Sorry for the long wind, thanks Annette in advance for responding. In the struggle, Mike
    ctbeth responded:
    Hi nodisc,
    I'm not Annette, but I hope she'll be about soon.

    I do have a couple of suggestions.

    If you sense that your pharmacist is concerned about your prescription, you could say something to the effect of, "If you're concerned about my Rx fro Opana and Percocet, I would urge you to call the prescribing MD and ask him/ her to explain to you why he/ she has prescribed these medicines for me."

    Opana (oxymorphone) is a opioid pain reliever. It is similar to morphine. It's a name brand, so quite pricey. Perhaps your MD could change your long-acting med to something similar that you can get in generic.

    Just a couple of thoughts.

    Nice to see you here,

    annette030 responded:
    I agree with Beth, Mike. I would get off of the brand name drug and onto something that does not have the problems you are having with that one. The pharmacy may not want to stock it ahead of time, in case you don't come in and fill it there, if they could not sell it to someone else, they might get stuck with it.

    I use Methadone on a schedule, and oxycodone for breakthrough pain and I give the three consecutive monthly RXs to the pharmacist as soon as I get them from the doctor, (I only started with this pharmacy in January of this year), this seems to reassure them. It is a very cheap drug here however. I went to the same pharmacy for many years before that and they only failed me one time. I asked them to call my doctor and explain it to her since I had a contract with her, and needed to get it filled promptly. They did gladly. They are not a preferred provider on my present drug insurance.

    I also have a few spares just in case, but so far have never needed them.

    Don't get sarcastic about it, just try and be cooperative and treat them like you would any other necessary medicine. Ignore "looks", it might be your own paranoia, lol. I worked in the ER and we got lots of calls from the one all night pharmacy in town about altered RXs.

    My littlest grandson is nearly 7 now, and the apple of my eye. The older one is 18 and is in the Marines, the apple of my eye comment is forbidden, in relation to him of course. Such a handsome, young man in his dress blues.

    Beth is also a RN, she is in Conn., on the other coast. She offers great advice.

    Take care, Annette
    ctbeth replied to annette030's response:
    Before one of my big surgeries, I had to see an orthopedist consult.

    He came right out and said,
    "Why are you taking all of these meds? Who prescribed all of this for you?"

    I gave him my pain management MD's name and phone number and told him that he (PM) would be most obliged to discuss his rationale.

    Really, I am NOT embellishing to make a point; it really happened.

    We are prescribed our meds by doctors who are specialists in their field of pain management.

    If other medical professionals have an issue with our doctor's treatment of us, they really need to discuss this with the prescribing MD.

    It would be akin to a primary care MD questioning us on why our oncologist prescribes a particular cancer drug.

    We do NOT prescribe these meds for ourselves; a medical doctor who, most times is a specialist in his field, makes careful assessments and formulates a treatment plan that included opiate-based medicine(s).

    If a medical professional questions your MD's judgement, he/ she should be referred to the prescribing MD.

    That usually shuts the interrogator up straight away.
    annette030 replied to ctbeth's response:
    I have also had doctors ask, but I took it differently than you did. I tell him what conditions are being treated, and give him the name of the prescribing doctor if he has further questions.

    I think surgeons and anesthesiologists should know right away everything we are taking and what we are taking it for. I wasn't there so I can't judge his tone of voice or attitude like you can. We are both nurses. I assume the doctor is just doing his job, and wants to know if we truly understand our medical conditions and medicines.

    Surgeons are arrogant, know-it-alls for the most part, at least in my experience. They need to be, to be good at their jobs. Sometimes it has been difficult for me to separate their personal characteristics from their professional ones.

    I wrote a note to one who was particularly awful at work, and mailed it on a vacation to Santa Cruz. He actually responded via snail mail, and improved somewhat on the job, at least with me.

    Giving them the name of the doctor to talk to does usually shut them up. They wants to rag on us, not the doctor.

    Are you doing okay? Have you got a date for your battery installation yet?

    Hugs, Annette
    ctbeth replied to annette030's response:
    Hi Annette!!

    Nice to "see" you.

    I finally received a surgery date of 22 April. Thanks for asking.

    The experience I related above was an ortho who was assisting my neurosurgeon in a revision of lumbar fusion.

    The ortho did ring my MD for post-op med directives, and it all turned out okay.

    We do not prescribe these meds for ourselves; if other medical professionals have issue with our prescriptions, the concerned professional can consult with the prescribing MD. That usually curtails the judgement.

    At this point in my life, I don't really care; I'm too old to care, but others seems really upset by perceived judgement.

    As the YouTube lady says,

    "Ain't nobody got time for THAT!"
    nodisc replied to ctbeth's response:
    Hi ladies! Hey, thanks for both of your responses. Annette, my brother was on methadone for quite some time, he tried getting me to switch over to it. He had to stop taking it due to other issues, so as of right now, don't know what he takes. The thing here though is that eventually, I may have to switch because of my plan. The generic for Opana is out there, but don't think it's available yet with my plan. Also, I read it somewhere that the generic formula is like the original brand name, not the new crush resistant deal. That may be why it's not available to me. But anyway, would it be a big deal switching over to methadone, I've read some horror stories of people that have. You can respond also, Beth, and btw, the pharmacists don't ask me anything, like I posted here, they give me the weird looks, and one more thing ladies, my current dose of 220mg of Opana and 40mg of perc. for bt, like, what does that equate to in a methadone dose? Strange thing here, this all started over 10 yrs ago with 20mg of Oxy 2x a day, no bt and look how much it's titrated!!! Thanks again ladies!! You are both a world of knowledge!! Mike
    broice1947 replied to nodisc's response:
    Hi Annette,

    In my 22 years of taking pain killers at one point I was on oxycontin, I think it was in the 1970's it was called numorphan it did work. But within the past two years my doctors tried me on Opana and it did absolutely nothing for me. It was terribly expensive and is out there in the pharmacies but I paid over $300.oo for 20 pills that I ended up being thrown away. I have a great tolerance for all drugs either I am allergic to them or they just don't work. I was on 350 mgs. of methadone now I am seeing a doctor who is shooting me full of cortisone and giving me only4 40 mgs. So I am in heavy withdrawal now. Ii cannot find a doctor who understands interal opaihn.
    broice1947 replied to broice1947's response:
    that was 40 mgs.of methadone a day and yes they changed the way the drug is made it isn't the old kind, neither is dilaudid. I have tried them all none worked on me.

    Good luck,
    annette030 replied to nodisc's response:
    I had no problems switching from MS Contin, generic of course, to methadone. The doctor does the calculations with the help of an online tool for just that. Then he should start you low and you very slowly titrate the dose upwards until it works for you.

    Methadone is a bit tricky, it works differently than other opioids. Don't mess with the dose on your own. I think I started at 5 mgs. twice a day and ended up on 10 mg. three times a day. I would start having pain again hours before the next methadone dose war due, so she changed it to every 8 hours instead of every 12 hours. The main thing is start low and work your way very slowly until you have good pain control. I still take 20 mg. of oxycodone for breakthrough pain. I take it generally about twice a day, sometimes more, sometimes less.

    Take care, Annette
    annette030 replied to nodisc's response:
    If your current dose of Opana is 220mg. twice a day, then your DAILY dose would be 440 mg., and the equivalent DAILY dose of methadone would be 66 mg. according to the tool I use on line. Everything is figured on a daily dose.

    That is with NO decrease for the partial cross tolerance of opioids, that is up to the doctor you use. Everything I have read says to decrease the dose by fifty percent for partial cross tolerance, so you do not overdose. That would end up with a daily dose of about 33 mg. a day, 16 mgs. twice a day, or about 8 mg. if you take it three times a day. Naturally, I did the math in my head, so it should be double checked. I do not claim to be a math wizard, lol. I generally use a calculator, but it is not handy. I think methadone comes in 5 and 10 mg. tablets.

    I continued to use the same BT meds as before I went on methadone. They worked fine for me.

    Talk to your doctor, but the main thing with methadone is start low and go up very slowly. Do not take more than the doctor prescribes, EVER. NEVER take extra doses because you have more pain than usual.

    Use an experienced doctor who has used methadone in the past with other patients.

    Take care, Annette
    broice1947 replied to annette030's response:
    Dear Annette030,

    I have been on methadone for 25 years for pain, and yes it works. I titrated myself down from 3502mgs. to 300mgs. per day. The problem is this, once you are on methadone there is absolutely nothing they can give you for break-thru pain.

    I think you know of me,, I am Joyce, the Liver transplant patient.. I am still having trouble with my pain management doctors, and have had so many steroid injections in my back and my ribs in the past 10 days. My hair is falling out.

    Look I am 66 years old and the doctor won't give me at this point ay more than 120mgs. per day. I have to stop with these shots. I need (I figure) just to be comfortable about 200-220mgs. per day.. So far he won't do it.. He wants to jab me just one more time in my spine. Then he will talk to me about alternative medications. You are very lucky to have a doctor who is willing to work with your pain. Very lucky indeed.

    Hope you keep feeling better,
    Joyce (Broice)
    nodisc replied to annette030's response:
    Sorry Annette, it's 220mg of Opana, total, 110 morning and 110 at night usually 6am, 6pm. Then the 40 of percoset for bt. There seems to be an issue here, Joyce responded posting that once you take methodone, there is nothing that they can give you for bt. What do you think?
    annette030 replied to broice1947's response:
    Hi, Joyce

    I think you made a typo, I have never heard of anyone who was on "3502mgs." of methadone per day for pain or opioid addiction. Anyway, that is neither here nor there.

    I do take oxycodone for breakthrough pain, it does work just fine. I do not know what you are talking about???

    It is true that you should not get "high" from taking opiates if your daily methadone dose is correct when treating addiction, but that is totally different. I know this because I worked at a methadone treatment place back in the 1970s where they treated heroin addiction. The daily dose was far different than using it for pain treatment though. It was also given once a day.

    If it was much higher, like you maybe, around 300 mg. a day, BT meds may not work well. But, I only take 10 mg. three times a day. I have been on daily opiate treatment for about 15 years. I have always been very careful about dosing.

    I KNOW that my BT meds do work.

    We also sent clients from the heroin addiction treatment facility to a regular hospital for medical treatment of various kinds, and we never had any feedback that the pain meds they gave them did not work.

    Take care, Annette
    annette030 replied to nodisc's response:
    Hi, Mike

    Sorry, I misread or misunderstood what your daily dose of Opana is. I assumed you would continue to take BT pain meds as needed.

    In my experience that is wrong information that BT meds will no longer work.

    Talk to a doctor that is experienced in methadone prescribing for chronic pain. I am very happy, I wished I had changed over years ago. My BT meds work just fine.

    Some doctors just do not like to prescribe BT meds if a person is on long acting meds, they just increase the long acting meds until your pain is managable. I don't know if this is what her doctor told her, or what he said.

    I think the important thing is to do what your doctor is comfortable with, or willing to try.

    Take care, Annette

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