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Purdue/dosage/PCP question

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Posted 6/11/2012 10:52 PM (GMT 0)
Hi guys
So im on oxycontin 20mg 4x a day and 5mg oxycodone for BT (only get 20 per month).
I get my oxycontin thru the purdue patient assistance... Been on this for 7 months...
Problem is, it really doesnt work very well...

I see a PCP.. Not a PM. And he told me if I need meds upped, I would need start seeing a PM... Problem
With that is, I dont have insurance, so can't afford a monthly visit to a PM.

Any advice?
Posted 6/11/2012 11:51 PM (GMT 0)
Hey Donna....

Are you saying the oxycontin isn't working.... or that you need a dose increase? If you want an increase - are you thinking you need more oxycontin or BT med?

Most PM's will want to see you monthly - especially given all the DEA stuff going on.

Does your PCP know that you don't have insurance? I would start there... most PCP's though aren't wanting to be involved in scripting narcotics.... at least that's the climate here (California).

I'm not sure what else there is to do if he won't - other than to change meds. Have you tried other things? Morphine? Etc? Do you take anything else for pain? My muscle med and nerve med are a necessity for me - as much as my pain meds.

--Tina
Posted 6/12/2012 12:32 AM (GMT 0)
Donna,

Two things strike me:
1) Oxycontin is supposed to have a 12hr duration, though I know it is often prescribed 3x daily because the last few hours wane in efficacy. 4x, though -- I haven't seen it.
2) Since you're taking 80mg through the time-release mechanism, 5mg for breakthrough is very meager. You should be sufficiently tolerant because of the dose level of the oxycontin that another 5mg of oxycodone seems trivial.

If you want to stick with your PCP, maybe discuss 20mg 3x for the oxycontin and up the breakthrough to 10mg. Since you're now taking approx 85mg/daily, if you think 20mg 3x for the oxycontin is an option, then you would have approx. 15mg for breakthrough.

If you don't think that your PCP will consider it, then maybe discuss a compromise: get a regimen set up by a PM, but managed by the PCP? So, you might only need to see the PM to consult when something needs changing, but your PCP is the prescriber?
Posted 6/13/2012 2:05 PM (GMT 0)
Sorry to hear of your troubles...If I could ask a few questions...

How often do you have to see your PCP now to get your prescriptions? Every month?

I see my PM every 3 months...but that is because I've been going there for a long time.

But if you have to get a referral to a PM...I'm sure your PCP will write all the reasons you have needed this medication and that you have followed everything by the book for the 7 months...

As others mentioned....Oxycontin was designed to be a 12 hour medication....But some Drs. choose to prescribe it every 8....But I don't think you are going to find another Dr. who will do 4 times a day..

But the real key is your total amount of Oxycodone...If they need to switch you....they would just keep the total the same.

I don't have insurance either right now...so I can totally relate...So my PM moved me to MSContin and then OxyIR for breakthrough....All generic medications...

I also take Flexeril and Ambien....both generic...

So the total for all 5 of my meds each month are $140.

And because I take two different opiates.....I get better pain control with my breakthrough medication. That's what Cogito was explaining....being on a lot of Oxycontin through the day....just adding a 5mg Oxycodone...the same med...will not produce much of an effect.

Again...if worse comes to worse....you would need to see the PM every month for a few months but then move to every 3 months......

Hopefully your PCP will work with you and a new PM if needed to help you both with your pain and your finances...

The great part about a PM is that they should also be providing you with a comprehensive plan to help your pain...Not just hand you narcotics...It's about doing many other modalities to chip away at the pain.

I do wish you luck....Keep us posted!
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