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Need help with oxycodone medication change

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Posted 6/5/2013 1:56 AM (GMT 0)
Hi I'm new to forums so if I am doing this wrong please tell me:). I have severe chronic pain do to SLE (lupus) and Fibromyalgia. I have been on just about every medication to treat pain and right now I am on 10 mg oxycodone 7 times daily. It's working it pretty well, but my insurance is an issue. Regardless of the medication and dosage, I can only be prescribed 120 pills a month. My pharmacy was having me pay for the extra 90 and apparently it was illegal, because I have state insurance. My doctor was able to call my provider and they filled it for this month but I'm going to have to make a change to fit within the perimeters of 120 pills monthly. My first question is do they make a 20mg immediate release oxycodone? I can't seem to find an answer online. If not, I don't like Extended Release pills but I'll have to give it a try again with OxyContin. Can anybody give me insight about how well OxyContin treats around the clock pain. I have been on the fentanyl patch, methadone, and MS Contin and they either didn't work or made me feel loopy. I am super hesitant to try another long acting medication because of this. My doctors are great and helpful, but I like to come to them informed about my options. Also, how is opana and diluadid? Do they help? Are they better or worse then OxyContin? Any advice will be appreciated. Also, I have young children and my husband works a lot so I really need to be sharp and not sleepy. Thank you for any information.
Posted 6/5/2013 2:54 AM (GMT 0)
First of all, 7 of the 10mg oxycodone a day seems a bit high w/o anything that is ER. For your first question, they do not make a 20 mg IR but they make a 15 and a 30mg IR oxycodone pill.

Second, all different types of pain medication works differently for everyone. Most ER meds take a while to start working when compared to IR medication, as in months. It took at least 2 months of straight use of the fentanyl patches for them to start working when I switched from morphine, and before that I was on Oxycodone (60mg IR per day), and for me, the patches work better without worrying about taking pills. It just depends on each person. Personally, again, the patches worked best for me and I have tried oxycodone (ER and IR), morphine, methadone. I have tried diluadid IR but not the ER. For me, when compared to oxycodone IR, it did not work as well. This is just something that is hit or miss and needs to be tried out to find the perfect balance of meds that work for you between you and your doctor.
Posted 6/5/2013 3:07 AM (GMT 0)
Hello JW!…and Welcome to the forum!

Oxycodone comes in 5mg, 10mg, 15mg, and 30mg. Oxycontin is oxycodone except as you know, its an ER med, and should be just as effective as the IR. Generally, many Dr's will switch patients over to Oxycontin, once they are taking 60mg or more oxycodone IR meds a day. That decision is, and should be up to your Dr though.

Hope that helps!

Again Welcome!

SE
Posted 6/5/2013 4:05 AM (GMT 0)
Thank you for your answers! I have a close relationship with my pain management doctor and my primary, who has taken over because its a long drive to see my pain doctor, who I was seeing for 5 years. It's interesting that both of you above^^ were saying that over 60mg should be in OxyContin form. I think the reason its been like this is that with the patch I felt like I was drunk and I was more dependent on my breakthrough meds for relief, and those were the 10mg Percocet. My doctors generally trust my judgement and since I was miserable when taking morphine and scared when I was taking methadone, they seem to understand my hesitation. Although my primary did say she wanted me to switch to OxyContin with a breakthrough med like diluadid. I should mention too that the reason I started on the 10mg oxycodone without acetaminophen was because I didnt have insurance at the time and only recently was able to get insurance.
I have read so many bad things about OxyContin, and while I am fully aware that what I am taking is the same thing just not time released, I still have some hesitation. Is there anymore of a risk to be addicted to OxyContin then there is to what I'm already taking? I'm sure its a silly question, but I'm pretty young and I grew up in the generation of hearing about the horrors of OxyContin. I will say however, those horror stories are really unfair to the people who genuinely need it. It makes me so frustrated that people in pain and in need of meds are treated like criminals from day one. No matter what you do, pass urine tests and pill counts, never lose your pills or abuse them, we still have to prove ourselves. I feel like its guilty until proven innocent, and even when proven innocent, you are still looked at suspiciously. Sorry for the little rant! I have been reading through some of the old posts and its so sad to see people not getting adequate treatment due to others bad acts. I feel so lucky that my doctors are so wonderful and respectful. I will talk to her next week about making the switch. Thanks again.
Posted 6/5/2013 4:20 AM (GMT 0)
Hello again JW!

I want to be perfectly clear here in that I in no way said that a patient who is taking over 60mg a day of Percocet should be on the ER med. What I said was that "generally" many Pm's/Dr's will switch their patients over to a ER release narcotic once the patient is at the 60mg or higher per day.

What I personally believe may surprise a few here, but in my own findings, ….it seems the best to switch meds more oft than not to help fight tolerance and dependency issues. I was on Oxycontin for a long while, and would rather not take that path again, unless it is a latter resort.

I believe that trend is changing, due to the DEA crack down, that we read in the news almost daily.

There is a difference between Addiction and dependency, and chronic pain patients who are in need of narcotic meds for pain relief are what we call dependent.

I invite you to read the "Chronic Pain 101" located at the top of our forum page here.

Enjoy the forum!

SE
Posted 6/5/2013 8:58 AM (GMT 0)
Jwa welcome to the forum. May I ask why you were afraid of the methadone? Its a really good medicine and it was only media hype that scared you and you weren't having any major problems then I would consider keeping that option open.

I don't know of any state that sets a low limit for methadone via insurance but if it did you cost would be about $10 a hundred. Much more affordable.
Posted 6/5/2013 4:12 PM (GMT 0)
Hey JWA! I was on oxycontin 30mg 2x daily. My pm switched me to Opana 40mg 2x daily because it is twice a strong. (20mg Opana =10mg oxycontin) I have really happy with the Opana. It lasts longer than the oxycontin did, but not the full 12 hours they claim. Opana is more expensive, but with insurance I only pay $12 for 60 pills.Opana is oxymorphone extended release, I have 10mg IR oxymorphone for breakthrough.As I said I am really happy with it.
Lesley
Posted 6/5/2013 4:20 PM (GMT 0)
Your doctor could just write you two scripts for Oxycodone. For example, if you take 70mgs total a day, your doc could write you one script for 90 of the 15mg IR Oxycodone that you would take 3x a day, and then write you another for 90 of the 10mg ones to be taken 3 times a day as needed.

Check with your doc first but since the pills are immediate release, it should be okay to cut the 10mg ones in half to get that one 5mg dose as needed.

My doc does something similar for me. I have one script for 5-325mg Percocet, and another script for 10mg immediate release oxycodone (without acetaminophen). That way I have some range in the amount I can take depending on if a day is good or bad.

As long as the dose is different and/or the instructions are different, your insurance should pay for both, because its not the exact same medication.

Its an option if you and your doc don't feel the need to bump you up to ER meds just yet.
Posted 6/5/2013 8:22 PM (GMT 0)
Hi nvrthesame98,
Hi, I appreciate your response. My fear of methadone came from a number of things. The first being, media hype! I have young children and I was terrified of falling asleep and not waking up. At the time my husband was a commercial fisherman and was in Alaska a lot, and my children were 7 and 2 at the time. I had already had one close call with them almost being left alone while I could have died. Luckily my mom was in town and had stopped by, and I had a grand mal seizure that was very serious. My kids were panicked and would have just watched it happen. The seizure wasn't caused by any medications or anything, it turned out to unrelated to my other situations. But since them I have been over cautious about something happening to me and my kids ending up alone.
It's not just methadone I was scared of, it was the patch too. Mine didnt stay on well and I was scared of it coming off and not noticing and it getting in the hands of my kids. I think with all meds I'm scared. That includes none narcotics like muscle relaxers and sleeping pills. I know the media blows everything out of proportion, but its hard not to hear it. Like I had said, I grew up in an area ravaged by pill abuse, and unfourtantly I have seen a lot if lives ruined and lost. People I grew up with. People I was friends with in high school who I see in town and they are different.
As for what LexiRae said, my doctor tried that. She was going to write for different strengths and they basically said nice try. The pharmacist called me (I live in a very small town), and said that he thought things were going to get difficult if I didnt make a change.
As for the opana, I discussed it with my doctor a year ago and at the time decided not to do it. Mostly because I have tried so many things and I'm tired of changing meds and finding a rythm with them. It's so tiring to go through this, as I'm sure you all know. Thanks again.
Posted 6/5/2013 10:03 PM (GMT 0)
Just a quick question for care (or anyone else who may know): Does Opana ER come in a generic form? You mentioned that with insurance you only pay $12 for 60 pills. I'm just curious because I am interested in possibly getting off my patches and trying a new ER medication for my pain, but I can only get generics, so I cannot get Oxycontin.
Posted 6/5/2013 10:26 PM (GMT 0)
Brett:

Found the following re: Opana and generics (seems like it will be available in the summer/fall):

Per the settlements with all other challengers, they have agreed not to challenge patents relating to Opana ER. Actavis launched the generic version of non-tamper resistant formulation of Opana ER (7.5 and 15 mg dosages) on July 15, 2011. Sandoz, Teva, Watson, Roxane and Actavis can sell all doses of the generic version of non-tamper resistant Opana ER from July 1, 2013. Ranbaxy is expected to launch its generic version on September 9, 2013.
Posted 6/5/2013 10:55 PM (GMT 0)
Great thank you so much. I will talk to my doctor next month and see what she says. She has recommended Oxycontin for me but since there is no generic I cannot afford it.
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