New black box label on multiple narcotic prescriptions?

I have no clue what this a nurse is talking about. Black box warnings are put on medications that that can have some potential really nasty side effects. This has been my only experience with the "black box" warning with a medications.

What I can tell you is the prescribing guidelines drs are using now are very restrictive. My guess is simply this, your Butrans is a long acting medication & your dr is going to take the instant release (Hydrocodone) away from you. This is his choice not some black box warning. Drs do not like to tell patients hey, I am going to reduce your medication. Instead they like to lay the blame somewhere else because they don't want to deal with an irate patient. I urge you to go to the CDC's website & read up on the prescription guidelines for treatment of chronic pain. If you are not convinced call your pharmacist, ask him/her if there is a black box warning!!

Take care.

I agree with Straydog’s (Susie’s) interpretation of your interaction with the nurse at your pain ohysician’s office. They are using the current heightened scrutiny of narcotic prescription practices to provide a cover for the decision to titration your from the hydrocondone. That is unfortunate if the current combination works for you.

I am on both a duragesic patch (Fenranyl) and short acting dilaudid as my daily pain medication regime. It does require authorization from my Palliative Care MD, insurance authorization and prescription review, and a newly installed state oversight committte (Oregon). I do not know if everyone has to jump through these same hoops that I do. I have been on a narcotic cocktail for avascular necrosis of my hips for about 2 years and suspect this will be an ongoing need for me.

I do know that warnings are being placed on combinations of narcotic and benzodiazepine prescriptions - to warn of the combination effects that suppress respiration.

Good luck. I agree with Straydog to read up on the CDC narcotic guidelines, initially issued in April of 2016. And continue to follow updates. It is important to be knowledgeable. The Pain network is a fairly good internet site for information. It is pro-pain patient in its writings so can be somewhat biased in that direction but is a good resource for staying informed of regulatory standings and changes.

Best wishes and good karma,
Karen

Josh, you mentioned your dr may try to push you to get an SCS unit put in. Do not agree to anything that you are not comfortable with simply because the dr recommends it. SCS units are not for everyone & they are not problem free. Do your homework before making any decision.

If your pain physician is mapping a plan to have you on the Butrans patch only and your concern is that the patch does not provide consistent pain control for the currently prescribed 7 day change of patch schedule, perhaps your MD would engage in a conversation of the Butrans patch being changed twice a week.

It is known that the effectiness of duragesic patches diminishes toward the end of the wear cycle. Ex. The Fentanyl patch that I am in is routinely prescribed to be changed every 72 hours/3 days. Not all people experience sustained pain relief through the 3rd day, with a noticeable lessening of effect. A 48 hour/2 day change cycle is an alternative prescription option. I am on a 48 hour change cycle.

Just trying to toss a possible idea for you to discuss with your MD as I can sense in your posts that you are weary and feeling unmoored.
Karen