My Pain Management doctor is being told what to give....

I spoke with my pain med doctor and I was told all medications are going to be compared to the amount of morphine it equals.I really don't understand this. So if you are taking 30mg oxy's 2-tabs 4x a day that will equal 360mg's of morphine which according to my doctor is now to much for a patient to take daily. They are using a drug calculator from this site to do the conversions. http://www.globalrph.com/narcotic.cgi This is not good.... From when I first became sick in 2007 and started taking pain medication and even though I was diagnosed with a serious bone disease in 2008 my pain meds have steadily decreased and my pain has steadily increased...I just don't know what to do except maybe find another doctor..I really don't know why they are using morphine as the marker for all other pain meds. I just don't believe the reasons my doctor gave me to decrease my meds. Also I am one of there original patients that started in this office in 2008 and have never had a problem with anybody there.
The bottom paragraph is from my other post.

When I went in for my appt. my doctor told me she was only going to have me use 60mg's of methadone..No breakthrough. I couldn't believe what I was hearing and was upset but I have such a good relationship with this doctor I just didn't want to make waves..

This is what she told me and the reasoning behind the drop in medication. she told me they measure all opiate use to the amount of morphine. So 60mg's of methadone equals 225mg's of morphine according to the calculations they use from this site. http://www.globalrph.com/narcotic.cgi and according to them that's enough medication.
She also told me because of my shoulder replacement surgery in the next couple of months My pain would be easier controlled with my decrease in meds. But when I had the chest surgery and the other hip and shoulder replacement this didn't come up and they were able to control the pain with me on the 90mgs of methadone and oxycodone for breakthru. I really think someone from upstairs is making my doctor decrease the amount of meds being prescribed and this is from the fallout from the Florida fiasco and all of the problems with the Oxy's..Thanks Randy

Hi I'm new to this but i though i would try it to see if i could get some new resources for my condition i have. see if anyone had any ideas i havent though of yet. i have been diagnossed with have
a condition called new daily persistant headache with chronic migrains an i have tried all kinds of meds wanted to see if anyone had any other sudjustions

That is just crazy! The below is information from that website!!!

GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

It's just a cheesy website...not anything that a single reputable Dr. relies on...

Conversions are so much more complicated as the cross tolerance rate is from 25-75%! As well as metabolism, other medical factors of patient and other medications.

Seriously Randy...I would be running to another Dr. This all just seems completely bogus about all this information they are giving you about using a Morhpine conversion from that website as some gold "standard" now.

That still doesn't answer the question where she came up with the magical Morphine amount to compare everything to.

I agree with you and think that she is either in trouble with the state or DEA and is having to slash all her patients medications....or is leaving soon to transfer her patients over.....something....

It just doesn't make any logical sense. I would be calling around and hope you can get a new PM Dr. asap!

My head is spinning....LOL...

Well now it doesn't make any sense what she is doing as if it were issues with the state or DEA then she wouldn't change you back without a moments hesitation...

I mean...what happened to the bogus excuse about the morphine equivalent and using that website????

Obviously it's good news for you....but I would not be staying with a Dr. who is so flippant about opiates like this and goes back and forth with all these explanations and changes just because....

I'm still concerned for you though on why she is now prescribing taking the Oxycodone at 6 a day....Then it isn't for breakthrough medication as I wrote previously...It's a maintenance med and if you take the max each day you have nothing for actual spikes in pain.

So...If it were me...I would be finding another Dr. still as this one is not making much medical sense:(

LOL Maryann:)

I know I can tend to be blunt at times so I hope those that may not know me as well..please understand I truly am trying to help and I do this by asking a lot of questions...Lol..

The actual abbreviation is HIPAA (two As)...it stands for the Health Insurance Portability Accountability Act.

The answer in a broad way is that yes, the DEA can get access to any patients medical records or any Drs. office records if they choose to or need to based on an investigation.

The only way a Dr. can prescribe an opiate is with an actual DEA license number..This is listed on every prescription. The DEA (Drug Enforcement Agency) is responsible for monitoring and enforcing all laws that pertain to controlled substances.

So, when many of us use them as an example...we are saying that many Dr.s are feeling more pressure out there because of so many overdose deaths, abuse, and rogue pill mills/Pharmacies/Drs. due to prescription opiates.

As I've written in other threads...the DEA is a federal agency, and then there are individual state laws/regulations that have to do with controlled substances.

So..it could be there was an issue with one of this Drs. patients and they overdosed...and now she is being so careful about opiates....but now that Randy has updated us...that doesn't seem like the reason as there isn't any reasoning to her methods..

I still don't understand the completely bogus excuse about that "website" that no Dr. would use for their prescribing.

The other thing that people need to be aware of is the Prescription Monitoring Program. This is in effect now in 42 states and growing each day. This tracks you by name anywhere in your state when you fill a controlled substance. This helps prevents those who try to "Dr. shop" . As an example...if someone gets a prescription from their regular Dr..then goes to an Urgent Care across town and tries to get another prescription. They can use this system to pull up your name and know that you just filled the other prescription.

Sorry if this was too much of a tangent but wanted to explain a bit...

I agree with Matt, with that kind of strained relationship, I would seek to find a more compatible doctor, if you have that as an option.

David in SC

SB, I should of explained myself a little better. They don't use that exact site but when the conversion was mentioned about the morphine being the X-factor in all of there prescribing opiates I asked what chart or how they were coming up with these numbers I was shown this site and they told me this was an example of what was being used but was very familiar to there conversion chart. I still don't understand why they are using this. According to my conversion I was using an equivalent of 450mg's of morphine daily.I really think this could be a dangerous thing for many CP pt's because of our long term use of opiates and every person does have a different tolerance to all opiates.
I hope this helps explain it a little better... Thanks Randy

I know this sounds a little crazy but I was there Oct 1 and this is what I was told 60mg's of methadone daily and that's it.. I asked about my breakthru and the answer was no. So on Oct 5,2012 I called the office and told them I had to speak with the doctor ASAP. I told her I can't do 60mg's of methadone daily and thats it. she asked my what my symptoms were and she told me to be specific as possible. I told her and she told me she was going to increase the methadone back to 90mg's daily and 5mg's of oxy's IR 6xdaily. she told me to come in Monday morning to pick-up the new scripts.. For 2 weeks it's been the twilight zone of medication. I really don't know why or what was the reason but it's fixed....

Randy...even when you keep giving more explanations...it still doesn't make any sense..LOL

Why a reputable Dr. would show you this online non medical website for a patient to "use" or look at and say it's how they calculate their conversions...is just irresponsible of them..

Again...conversions cannot be done from a chart like that because of the cross tolerance rates and so many other factors.

And I have never heard of a Dr. using a specific Morphine equivalent to dose all their medications because you are not asking to take that much Morphine per day! I would be asking why/how she chose this random Morphine number as her new "ceiling".

Morphine is less potent than many other medications...So it makes no sense..the whole point is to dose appropriately based on the medication chosen.

It would be like randomly taking someone's Oxycontin dosage and compare it to how many doses of Hydrocodone (Vicodin) and say because it goes past a certain number it isn't appropriate!

A conversion chart is only to be used when moving a patient FROM one medication to another..

The reason I am so adamant about this is because your Dr. is not making any sense and giving you all these bogus excuses....She has randomly been switching your dosages willy nilly without reasoning..

I mean..if she was taking up this new idea and saying..You can only be on 60mg of Methadone because it equals to x amount of Morphine....Then within two seconds she decides..nahh...ok...I'll up that by 1/3 to 90mg and add in a whole other 30mg of Oxycodone!

You say you talked to the Dr. herself yesterday? Why would you have to give her your "symptoms" when you just saw her on the 1st and you've been seeing her for years???

The reason many of us are so concerned is when a Dr. starts to do or say things that don't have any rhyme or reason to them...that is a place where I would not want to be as you are the one who is stuck in the middle here.

Aren't you already going through withdrawals with such a major drop in meds over these last weeks and you can't even pick up this new prescription until Monday? I mean...you were on so much more Oxycodone and Nucynta and for the last 5 days you have only been on 60mg of Methadone and nothing else...

I haven't heard you mention about withdrawals which is pretty amazing!!!

**Just wanted to comment on your first post when you are talking about an Oxycodone dosage of 30mg...2 pills....4 times a day...I'm not sure where you got those numbers? If that is Oxycontin.....most  Drs. have chosen a specific milligram...then dose it at one tablet....up to 3 times a day (every 8 hours)...So they would be given either a 30mg or a 60mg...to be taken 3 times a day so either 90mg or 180mg total.

If you were talking about short acting Oxycodone in 30mg(Roxicodone)...again...I don't know anyone who would be dosed that much for breakthrough medications as that would be 240mg of short acting Oxycodone each day. That would be highly unusual.

I know on your other post I did say that your previous breakthrough meds were more unusual that most people and that if she was worried about that...then most Drs. will just move up the long acting med to cut back on the short acting..

Post Edited (Snowbunny21) : 10/6/2012 7:38:11 AM (GMT-6)

Hi there ride-a-bike...If you look at my first post back yesterday at 9:57am...I took the information from the website directly.

I have been in PM for over 11 years and my PM is actually rated one of the top 40 in the US...He has never used this website nor recommends anyone try to use this as I keep mentioning...the cross tolerance is so varied along with so many other things with each patient that it is not accurate.

A good PM will know how to calculate conversions and make decisions about each patient and their pain needs in regards to medication.

Please site where you read this "recent medical literature" that shows this Morphine milligram.

And even then...literature is just that...something written by someone. We have so many members here around the US (among other places) that are on so many different types and dosages of medications that have nothing to do with that Morphine equivalent.

The majority of all deaths that are associated with opiates is when there is abuse of the medication. Taking too much, mixing it with alcohol or benzos or medications/illlegal substances bought off the street.

Please show us where there are reports of all these deaths of regular pain patients being monitored by REPUTABLE Drs. and that are taking their medication as prescribed.

I'm sorry if I sound a bit upset but it's very important that we don't scare new people to PM with things like this.

Post Edited (Snowbunny21) : 10/6/2012 12:26:14 PM (GMT-6)

I happen to think it's extremely important where you are getting this information from as most all of us are saying we have never heard of it. When you say "archives"...I'm not sure what you are saying...

Are you saying you read it on here, at HW somewhere as I would like to read this.

I apologize to Randy for taking this off on a tangent so I hope that you will give an update on how you are feeling as I know you don't pick up your new medication prescriptions until Monday...

 

Post Edited (Snowbunny21) : 10/6/2012 4:24:30 PM (GMT-6)

It comes down to this, all we can do here is speculate what could have neen the doctor's intention/motive, I'm sure there are good resources on the internet for doctors to use. But if a doctor is going to rely on a website instead of their years of schooling, and training, it's time to find another doctor, because there is no 'one size fits all' when it comes to medical care, and that is also the reason why doctors have to go through internships, and residency training, so that they can gain that hands on experience, in order to diagnose and treat each patient individually.

I have no doubt in my mind that there is probably a lot of validity in the statements that ride-a-bike made, we all know that there are doctors out there with "crackerjack box" MDs. I would not be in the mess I'm in if that weren't true. But all we can do is be vigilant, and as informed as possible, and steer clear of the bad doctors.

It's been a crazy month. and I do feel like I have been used as if I was in a clinical trial. I was surprised when I called on Friday 10/6/12 and she told me I was going back up to 90mg's of methadone but my breakthrough was going to be 5mg's instead of 15mg's. I do know that this clinic has a cap on the methadone of 90mg's when I first went there I was on 180mg's and they tapered me to 90mg's quickly with other meds to help with the withdrawal symptoms. I am going this morning to pick up my new scripts and I am going to ask her what was this all about. I will let you guys know what happens. Thanks for all of the advice and support. I do know that some of this just didn't make sense but I really tried to tell it the way it happened. It really didn't make sense to me either.. Randy