Doctors, and withdrawls

Fyrifli, I don't have any suggestions, and I keep being amazed that Dr's do this to their patients. With Hydrocodone, I believe the Dr can fax that script in to you're pharmacy.

It's absolutely uncalled for! I'm also thinking they can add refills to your script with this med as well. I could always be wrong, but I know when I started on the Oxycodone, I then had to hand carry the script to the pharmacy, because of the class it's in. I had discussed this very thing with my Dr, and have a safety system in place, in case he is gone. As long as I'm holding to the contract I signed with him, they will get it refilled.

Drink lots of water, as this may help get you through the withdrawals quicker.

I'm terribly sorry to hear they have dropped the ball, and left you in this predicament. I would be making an appointment, and clearing the air with the Dr to say the least!

Take care,

SE

This may not be the best solution for you. But I know a coupe of times when this has happened to me, I've either been told by the doctor or took it upon myself to go to the ER, depending on how compassionate the ER doctor is they could very well write you a script for 3 or 4 days to get you to where you could go in and see your doctor (to make sure that you walk out with a script) or enough time for them to actually fax the information to the pharmacist.

when my doctor as written my months scripts then wrote the next months scripts and gave them to me just post-dated it to the day I can get it filled, And say its the day before or something then my pharmacist will give me enough of ONE of my medications not all three(2 controlled release and one instant release) so he'd give me say that days allotment of the instant release and then I would have to give him the instant release prescription in return that way he knows I wont get it filled elsewhere and leave him with a shorted supply. Then first thing the next morning he fills my prescription and no one is any wiser. Which might sound awful and someone and maybe even some of you might say oh how did you run out a day early... well I get up to 8 instant release a day, and I tend to take them actually everyday, I know thats not really protocol because then its not for breakthrough pain, its actually a scheduled medication just instant release, but my doctor would prefer not to go up on my controlled release at this point(until last time he gave me a pain journal to keep to show him if i need to go up instead of stay taking these instant release) so taking 1 extra pill every 4 or 5 days is actually not that off from the bottle. I have been with this pain management doctor for almost 4 years now and we have a very good relationship so it's alright with him, and if I tend to need more all I must do is call him and tell him over the phone and he'll ok me to take what he deems fit, which is usually what I tell him I feel I need extra. I'm in the lucky category of having a more 'liberal' doctor, if there is such a thing as 'liberal' with pain managaement lol.

I don't know how much drinking more water is going to help but if anything it will help keep you hydrated because you will lose water over withdraw, and it might flush the system somewhat faster. This can last for a few days all the way to weeks for some people, it also depends on how long you've taken the medication and what dosage the medication is dispensed at and how frequently you take it will play a major role. But like I said if you find yourself not being able to handle the withdraw dont feel shy about going to the ER, I know its not ideal, but theres not much you can do.

OH! actually! there might be more you can do...since you take hydrocodone, that can be called or faxed in. Why don't you call the office or call the hospital and they can have the doctor paged or have one of your other doctors paged and from their they can just call the pharmacy and literally it would if your pharmacy is reasonable be ready within the hour. Thats how my hospital works. All my doctors almost are affiliated with the same hospital and I can call the hospital ask who's on call for Doctor X and they'll tell me who and then I say ok can you have them paged for me, they might as are you a patient or whats the problem, just tell them your in pain. They'll page your doctor and within 10 to 15 minutes the doctor will be calling you back. They will also send your name in the page so the doctor knows who they are calling back. And the hospital will tell you or if they don't I am tellin gyou that if the doctor doesn't happen to call within like 25 to 30 minutes then have hi paged again, thats what the pager is for. If the doctor for some reason tells you that he can not call in the medication which there is really no reason he can not, then just tell him or ask him if you go to the ER and the doctor wants to talk to him is that alright if the doctor calls him to get a snapshot of your history, and your medication history. I really don't see it being any problem, because if your state is like mine, Virginia, then they might have a 'prescription monitoring program' based in your capital where there is a centralized system that only doctors can access and the ER doctor can access this program and type ur Social security number or name and birth date into it and it will bring him back anytime in the last like 3 years or something that you have recieved or filled a controlled substance, in which case he would be able to see that your are not a seeker and that you are a regularly prescribed patient that has a true need and has just happened to run out before your doctors office was able to send in a refill slip to the pharmacy, in which case I hardly find there would be a problem to write you for like I said 3 or 4 days, but now I'm realizing its sunday so you might only need 1 or 2 days, but most doctors will give you usually 1 day extra-room incase you can not get into your doctor or something else comes up.

But if I were you I'd definetly have your doctor paged, I think a lot of us on HW go on the assumption or atleast presume that a great many of us are on controlled release medications which probably about 95% of them are a schedule 2 drug, in which case you would need to hand pick up the script and hand drop off the script to the pharmacy, because of risk of something being changed or the script copied, which is why they have such things as watermarks and special paper and ink they use. But thats why I think no one else has picked up on that you can always have your doctor paged.

Don't be shy about paging your doctor either, thats what that pager is for, if they are in a practice of multiple doctors then it might work as only one of those doctors being on call for that weekend or holiday, where as if its during the week then all of the doctors handle their own patients during the nighttime hours of paging. And you can page a doctor to as him, 'I have a fever of 101.3, what do you recommend that I do about it?', when surely everyone knows to take some tylenol, but it doesn't matter how 'simple' or 'stupid' something is for paging your doctor, theres actually nothing stupid about asking any question about your healthcare, plus... you can always fall back on 'hey you DO pay their salary, and your WHY they can afford and appreciate that great weekend fun their having at your expense!'

So go ahead and be pro-active and give your doctor a page, and ask them if you could have them call in the prescription, or ask them could they call in 1 or 2 days until the week starts and they can get back to look at your records if they want, just explain you ran out on thursday and you had the pharmacy fax the twice and they hadn't recieved anything at all yet. This is also a reason to instead of leaving it up to the pharmacy to fax the doctors office about a refill, if it's possible you should call the doctors office one or twice per day, to keep on them about it, you dont want to leave the slightest possibility that they may happen to forget if it's a more hectic day then usual, and if they keep acting as if they remember just haven't gotten to it, then the 2nd or 3rd day you've recieved nothing, is when I would actually show up at the office that way they can see your face, and their should really be no way that they forget you after that, and plus they might get tired of hearing from you then and rush it along. OR they might go ahead and grab the doctor between patients and bring it up to him, then if they forget, then you know who's fault it actually lands on, him, because if everyone in the office knows including him then ultimatly Id say the fault lies with the doctor.

And by the way I'd bring this up to the doctor, not in a confrontational way obviously, but just to show that your concerned. Withdraw can actually be dangerous to some, some people have seizures and other serious health issues from the lack of something the body is extremely used to.

Sorry If I've offended absolutely ANYONE on this post, on this thread, on this forum, or on HW, I simply know what it feels like to go through a withdraw especially from narcotics. It's seriously something that besides the awful and extremely painful and actually irritating physical problems, there are serious and dramatic mental issues that accompany these withdraw symptoms, such as major depression and anxiety attacks, which leave you feeling loathesome and helpless and completely alone.

I truely feel for any such person having any single one of these symptoms, so for someone to have them all is just unbearable, and it really becomes a strain on the body and mind.

Post Edited (CrohnsPatient) : 5/22/2011 12:02:14 PM (GMT-6)

I need to correct a few things that are in this thread. The majority of withdrawal symptoms are easily treated with some simple over the counter medications such as immodium to manage any diarrehea and some tylenol to manage the headaches and body aches, as well and a simple hot shower or warm bath will help with the muscle fatigue  and cramps. In fact, in immodium has medication that also eases stomach cramps. In fact , some of the over the counter flu medications work wonders for someone going through withdrawal to manage the symptoms.

Withdrawal does not cause major depression or some of the other things listed. It is a physiological response, not a mental one to a sudden discontinuation of medication. With the exception of three or four medications currently used for pain management- withdrawal symptoms last at most a week.  Dosage, or duration of time taking the medication has nothing to do with the intensity of withdrawal. Someone taking 5 mg of oxycodone can have just as bad a withdrawal as someone taking 500 mg of oxycodone. It just depends in large part how they think that withdrawal will be.

If you believe all of the horror stories out there about withdrawal then it will be that much more miserable, but if you view it as a short duration "thing" that you may have to go through that is more like the flu than not, and it will be over soon, you won't have as bad a time as you might otherwise. Withdrawal also does not cause seizures unless you are taking anti epiletics or benzodiazepeines. Those are only a few medications that I am aware of that can  cause seizures if abruptly withdrawn as far as medications that we pain patients take.

Most PM practices have a policy that they will NOT call in or refill prescriptions on the weekends, no matter what, so calling them is going to get the original poster red flagged for calling. The same thing could happen if they go to the ER and get medication prescribed. Withdrawal is not a good reason for going and getting a new prescription from another doctor.

I hate seeing these myths perpetuated about withdrawal, because it makes it sound so horrible and long lasting, when in most cases , it is simply a matter of it being  uncomfortable, and very, very much like the flu, and of a short duration....seizures, mental problems, etc, are all myths perpetuated that have nothing to do with withdrawal because it scares people about what might occur during it.  Withdrawal can be uncomfortable, achy, cause stomach and intestinal upset, but it will not kill you or cause some of the other problems that I have seen attributed to it. If you have an  underlying medical condition that may be exacerbated by withdrawal that is a different story and you need to be monitored by your physician in that situation.

 

Hi fyrfi I'm sorry to hear that you're going thru this he**. I just went thru it about a month ago. It's horrible. I didn't know what to do for it, so I just suffered for the week and a half until I got my patches again. I am doing something different this month though. The patches are due to be refilled next Saturday, so I'm calling tomorrow to tell them that I need my meds refilled. My advice is that you do the same thing next month also. I sure hope that you get them tomorrow so that you don't have to suffer any longer than you have to.

I hope you feel better really soon.

love and soft hugs
Loretta

Just want to show what can happen such as symptoms of withdraw, and also how durations and dosage dose play a role in withdraw.

Symptoms of withdrawal from opiates include, but are not limited to, Physical Symptoms: tremors, cramps, chills, perspiration, priapism, tachycardia, itching, restless legs syndrome, flu-like symptoms, rhinitis, yawning, sneezing, vomiting, diarrhea, weakness, nausea, dizziness, dehydration. PSYCHOLOGICAL SYMPTOMS: dysphoria, malaise, cravings, anxiety, insomnia, depression.

Other less common but more serious symptoms are cardiac arrhythmias, strokes, seizures, suicide attempts.

Depending on the quantity, type, frequency, and duration of opioid use, the physical withdrawal symptoms last for as little as forty-eight to seventy-two hours (for short-acting opioids such as hydromorphone [Dilaudid] and oxycodone after short duration lower-dose use), and as long as thirty to sixty days for long-acting opioids such as buprenorphine and methadone, respectively, after extended high-dose use.

I hope all turns out well for you today and that you get your scripts. There was no sense in you have to wait like that when it would have taken the doctor probably less then 5 minutes to call in that refill. I dont know why he doesnt just give refills on the bottle if you've been taking this medication continually for a period of time then I would think it would be easier to just give refills...its not as if you could get it filled early and stock up on them or hoard them and get addicted.

Chrons,
I don't mean to be argumentative but simple, straightforward opiate withdrawal for a chronic pain patient, does not involve all of the things you listed. Straightforward opiate withdrawal for a pain patient is a lot different than it is for someone who is abusing medications or opiates. While there are some shared symptoms, the mental depression, agitation, etc occur far more often in someone who has a history of abusing medications and is commonly referred to as PAWS- post acute withdrawal syndrome. This occurs in some people who have a history of abusing medications or street drugs.

This is straight from emedicine.com This is the standard opiate withdrawal symptom list that the majority of us would experience in the event that there is a sudden stoppage of our pain medications.


•Opioid withdrawal
◦Patients experiencing opioid withdrawal can usually provide an accurate history of their usual dose, of the timing of their last dose, and of any other current symptoms. The clinical problem is in differentiating symptoms associated with opiate withdrawal from symptoms that may reflect an underlying medical illness.
◦In general, opioid withdrawal does not directly cause life-threatening symptoms, seizures, or delirium.
◦Opioid withdrawal syndrome may resemble a severe flu-like illness. The syndrome is characterized by rhinorrhea, sneezing, yawning, lacrimation, abdominal cramping, leg cramping, piloerection (gooseflesh), nausea, vomiting, diarrhea, and dilated pupils.
◦Altered mental status, disorientation, hallucinations, and seizures, which are characteristic of DT, are not seen in opioid withdrawal.
◦The half-life of the opioid causing withdrawal syndrome determines the onset and duration of symptoms. For example, heroin and methadone withdrawal symptoms peak in 36-72 hours and 72-96 hours, respectively, and may last for 7-10 days and at least 14 days, respectively.

Hi Crohn,
Yes, some of the symptoms are shared, but the extended withdrawals only happen with drugs such as methadone or suboxone/subutex. Seizures, major anxiety, depression, cravings,arrhythymias etc, only happen in someone who has an abuse history or is going through alcohol withdrawal. It won't happen to anyone who is having a "standard withdrawal" from discontinuation of opiate pain medication therapy.
PAWS ( post acute withdrawal syndrome) is where the anxiety, depression, cravings, and even seizures may happen, but again, that is only with certain drugs/alcohol withdrawal.
The half life of opiates has everything to do with the short time frame that most of us will experience if we suddenly , for any reason stop taking our pain medications. And it is also what make methadone and suboxone type medications withdrawals linger a bit longer, but even those will lessen over a week and improve after that. For the majority of us here, we will only experience flu like symptoms, for some it will be a bit more intense than others, but that is all that we will experience when it comes to opiate stoppage.
Wiki is a good general source but there is a huge difference in the types of withdrawal that we go through as pain patients and the withdrawal that someone who has substance abuse problems will experience. I read the information that was on Wiki and it was talking about withdrawal in substance abuse, not opiate discontinuation in pain management. That's why I went to emedicine to look it up, since it is research/medically based and a reputable medical site. I usually look up medical stuff there or pubmed.
I think that sometimes , we read or hear from someone what might happen if we stop taking our medications, but we don't know their history of medications, and whether there is any abuse of them in their history, so we think that we all are going to go through these long , drawn out horrible withdrawal effects, when it has little to nothing to do with stopping opiates for our purposes. I used to read forums where they talked about stopping opiates and all of the horrible withdrawals etc, and it scared me half to death. Mind you, I've been in pain management on and off since 1995-2003, when I went into it for RSD in my arm,shoulder and hand. Then went back into it for my back, pre surgery, the first time (2005) and then constantly since then, and I have taken myself off many of the medications over this experience of mine with pain management, including methadone three times, and never had more than a horrible flu like feeling for a few days, even with the methadone and it's long half life.
I also know that people are going to have different experiences in stopping medications and I don't ever recommend doing without the supervision of your prescribing doctor, since only they and you know what other conditions you have or medications that you are taking that might come into play in stopping medications, it is the only safe way to do it. A doctor can give a patient a tapering plan that , if done correctly, won't even cause the flu like symptoms that we would get if we stopped abruptly or went too fast in reducing our dosages.
Take care,
Sandi

I believe at one time or another we (cp patients) have all gone thru this.  The very few who use narcotic meds, not for relief of pain but for a buzz, but those of us who rely on the meds for some type of relief of the unending pain we feel everyday.

At this point in time, if you dont go to a pm doctor with every bit of paper work, mri's, ct's etc that you have, it is difficult if not impossible to get the help we so desperatley need.  I am so sorry you are going thru all of the pain of withdrawl plus the pain you were prescriped to take for your pain.

In the 11-12+ years I have been dealing with doctors, I have been to hell and back.  In the beginning of my journey of constant unbearable pain, I had the most wonderful gp doctor in the world.  During my time with this doctor, he moved his practice three times, I along with hundreds of other loyal patients of his took our records and made whatever move we had to so that we could stay with him.

Unfortunatley the last move he made was to a very large and (he told me) financially for him something he could not pass up.  He had two children to put thru college, and although I totally understood his reasons, I cryed anyway.  He is working at a large retirement home that is two minutes from where I live, but alas, at the time I was not at the age requirement needed to buy a condo at this large and very lovely retirement community.  The other thing even when I reach the age (which I am rapidly approaching), I cannot afford to move to the retirement community he is working in.

So, in Dec of 2006, we gave me a hug and two months worth of prescriptions until Icould find a pm doctor.

Before he left he told me the doctors who were moving into the office he once had, were great doctors, and I would have no problem getting the meds I needed.

This was the beginning of a nightmare that lasted until March or April of 2010.  At last I found a doctor who would and could listen.  I will not bore you with the many (I hesitate to call them doctors), persons who treated me (and there were many) but this doctor I have found now is great and even better than great.

I take public transportation, each month I take 2 buses and 3 metro trains to reach my doctor, and I gladly take this trip, he is so worth it.  I hope and pray you will find a doctor who will not torment you with the threat of withdrawal and all that goes with it.

You deserve better, you are worth every bit of the attention you should be given.  If you do not get the results from the doctor and pharmacy you have now, its time to find another.  I will be praying for you and hoping you will be doing better real soon.

I hate this...My doctor sure takes her time calling in refills for anything I might need. Its fine I get it you have 999999999999 patients because your an Internist but at least give me the courtesy of being prompt. I mean how hard is it to call in a script after I've talked to you on the phone (yes the MD not the nurse)! If its an issue then just put refills on it which shouldn't be an issue if your planning on keeping the patient on the drug for a while.

I have also stashed away some extras just for this exact reason. I may replace my patch on the 4th morning 2 times a month instead of the 3rd day just to have 2 days to play with. It doesnt do me any good for pain levels but I dont have much choice. My PM office is only open 9-3 and I work 8-3, 40 miles away. For me to get there I need to sneak out early or take a half a day.

You can have your narcotic meds delivered mail order, at least Express scripts and Medco. I used to do a 90 day supply of my Duragesic thru the mail. Of course your doctor needs feel comfortable with doing this, and I can see why some may not be OK with this. I believe they send these fedex with a signature required, its been a while since I did it with those meds. The dr can the mail early (I dont think they took the fax for these) and they will ship it overnight before you run out. It worked really good when I did it. Its worth checking into to make things easier. I still saw the dr every 2-3 months, he just dated them for when I should mail it.

Thanks..I edited my post...don't know why I put the Schedule 1...LOL...

Shell's idea to everyone to have a few pills extra to keep around in case of these type of issues is a great idea..

Glad that you are taken care of Medical