Which pain meds are considered long acting?

[Joe]

Dr. Steve,

Awhile ago I posted a question to you concerning my fluctuating pain levels cause me to have withdrawal symptoms several times a month.  Your reply was to have my oxycodone switched to a longer lasting pain med to help with the withdrawal symptoms.  My next appointment is comming up and I was wondering what pain meds are long acting so I can suggest some to my pain specialist. Someone on the thread also mentioned that oxycontin and ms contin are not considered long acting pain meds even though they are slowly released into the system because the active drug is only a short acting one itself, is this true?

Thanks,

Joe

[Brian Stevens]

I'M also a chronic-pain client, You should talk to your dr. about Duregesic patchs they contain fentnyl a very strong pain medication that is put on like a patch that last between 48 to 72 hours.  Usually you space them like the largest is 100 mcg to the lowest 25mcg.  I use a 100 on Monday, a 50 Tuesday and another 50 on Wednesday, then back to a 100 mcg.  I've had good success with thistransadermal patch. and then i use something else for the break through pain.  I hope this helps you it has been a God send for me.

[to doc dan from joe]

Brian,

Thanks for the responce, I was wondering, if I switch from an opioid pain med to the fentnyly patch will I still have withdrawal symptoms during the switch?  Also I've read on this forum that doctors are reluctant to give scripts for the patch because it is very expensive is this true?

[vickyvortex]

I know I am banned from this board, but I had to look up fentanyl to see what it was.  I happened to run across this site:  They are giving out meds to worms!!!!  check it out:  http://www.opioids.com/fentanyl/subjective.htmlv

[interested in fentenyl]

just type in www.opioids.com/fentanyl.  This seems to work better, but do not be fooled by the notice that this page does not exist on the previous site posted.

[tom to thread]

thank god I have never needed the fentanyl patch, but this is what I learned watching a PBS special on pain management for cancer patients. From what I learned on this show, plus a little net research, the Fentanyl patch is probably the single most effective treatment for chronic pain going. Yes, it costs a bunch -- apparently several thousand per month. But patients who weren't getting sufficient relief from even aggressive MS contin (morphine) and Dilaudid therapy were transformed by the patch: They were both lucid and out of pain for long durations. As far as withdrawal when switching over, I sincerely doubt it. Fentanyl is as hardcore opioid as you can get. They call it "designer heroin" on the street. If I hws facing ultra-serious, long-term pain, it's what I'd ask for, no doubt about it.

oh, hi v-vortex, good to hear from you!

[J.B. to Brian and Vicky]

This is interesting, "designer Heroine".  About a year ago I was at the hospital here and talking to my favorite addiction therapist about his mother's cancer.  He was considering taking her to Mexico for her last days(she was terminal) for pain management.  I was dumbfounded when he said that she would be better off on heroine than morphine or Dilaudid.  He stated that heroine is less sedating allowing the dying person to be lucid during their last days.  Apparently, doctors in Mexico are allowed to use elixors containing heroine and cocaine which are strictly illegal in this country as schedule I narcotics. Personally, I'm all for it and told him so. Just pondering again!

Hope all is well with you, tom.  Take care and be well!

[Frankinscense]

Fentanyl is just another very strong opiate. There are no mysterious designer opiates. Wait,maybe I do not know the definition of designer drugs. Opiates are opiates. They are either synthetic or of natural origin. The "designer" drugs are generally always a very strong synthetic>>fetanyl. Fetanyl is literally a hundred times as potent as morphine. 0.05-0.10 mg. is equivalent to 10-30 mgm's. morphine. This super strength per mg makes it ideal to use in an transdermal patch. Joe, there is a GAP in time that you must allow for the formulation in the patch to work. I cannot remember the specifics on how much time must past before the patch starts working. Ask your doctor or phamacists. I am sure they will have that information. I had a close relative on the patch and she was give oxymorphone suppositories until the patch started to work. (she suffered cancer pain)
  The other question was in reference to a long acting opiate. There a few short acting opiates that are in a slow release formulation,but they have all the disadvantages of short acting opiates. These medicines IMO are very good pain relievers but  they are very disturbing to the endorphin neurtransmiters. That is the main reasons for withdrawals and cravings. These disturbances that short acting opiates have on the neurotransmiters is what make these(IMO) undesirable for long term or chronic pain relief. All opiate/narcotic pain relievers cause this problem but long acting opiates do not spike the neurotransmitters  as short acting ones do.
                                                                  An example of a long acting opiates are methadone,LAAM, and buprenorphine. I only know details concerning methadone. IT is IMO one of the best medicine for chronic or long term pain management. Methadone has been studied and researched probably more than any other medicine. It has been used for 30-40 years w/out any negative medical concerns. Other than it can cause dependency like all opiates. (price speaking, it is very inexpensive)
                                                                  Buprenorphine sounds like THE IDEAL pain medicine of the future. Analgesia compared to morphine without as much sedative effects that morphine causes. And does not produce addiction on the same scale as morphine,hydrocodone,oxycodone,codiene and others. If all that is written about buprenorphine is true and accurate, it will be the pain medicine of the FUTURE. Pain medicine of the future will probably produce an antidepressant effect,produce analgesia,cause no sedation or nausea, and be non-addictive.
Wow! What a concept.
Best of Luck to you JOE,
Dan...

[to doc dan from joe]

Thanks for the reply,

Can my pain specialist perscibe the meds your mentioned or do I have to go to a detox center?

[Shiny]

I just read the messages about short-term pain meds and have a question.  I am having cosmetic surgery (I am know to this board hense really do not want to give my name, kind of embarrassing (sp)) anyway I'm having a breast augmentation.  I am now on Lortab twice a day and oxycontin 20m nightly.  I have been told that the surgery is quite painful the first couple of days.  My problem is what kind of pain meds I should ask for.  I will make sure I tell the doctor who gives me pain pills cause I don't want a fuss at the pharmacy.  I will probably  want a short-acting pain pill but something stronger then the 10m Lortab. What should I ask for?  I don't think I should have to use my current pain pill supply for this but don't want to get in trouble with my pharmacy.  Would MScontin be a good choice?

[Brian Stevens]

yes Duragesic is very expensive, 5 100 mcg patches are about $368 dollars a box.  The lower the dosage the lower the price.  But we have to remember that Jansen Laboratories makes Duragesic and when it's patent runs out the price will drop like a rock off the empire state building.  The cost of this medication is worth the money for me.  I broke my neck in a auto crash in 1982 and things are starting to fall apart, my back is disintergrateing and the pain is unbearable especially while I'm back at college pursuing my degree, something that I could never do without this medication.  Most insurance will pay for this medication and your pain specialist should know that there is a time frame of about 12 hours for the patch to start working so you will need PO medications for a day.  And sometimes you will need PO medication for breakthrough pain.  I've been blessed with the physicians who know me and treat me like I should be treated.  No person unless there recreational users and then they don't need a Doctor.  You can get anything heroin etc on the streets of our bigger cities and don't think that it isn't around in small towns.  Thank you Brian Stevens.

[To sick and scared from Neena]

Just curious...are you having them made bigger or smaller?  I have some experience ( not personal) but with friends.  Just a note...If you are having them enlarged, talk to someone that has large breasts naturally, like me.  They might change your mind.  It's no fun hauling these things around and being made fun of.  If you are having a reduction...I'd like to hear about it and how you are doing, because I would like to have mine both chopped flat off.  :)

[J.B. to Brian and Vicky]

I saw the same program that tom mentioned which aired on PBS recently.  That poor woman was going to be put on Durgesic patches because she simply wanted to leave the hospice and go home for her final days.  The doctors figured her dosage at 400mcg and said it would cost roughly $3000 per month. Apparently she had no medical coverage for these patches and what a shame!  Had she stayed in the hospice, her parenthetic meds would have been a fraction of that. Hopefully, for all chronic painers the patent will run out soon so money is not the major factor to consider here.  Take care, Brian.  We are all pulling for you!

[BigBadBob]

There is a long acting opiate which is extensively used in Europe but which for various reasons is out of favor in the US.  It is called Contugesic and Codicontin (I'm not sure which is generic and which is brand).  I have used both and I think that Codicontin (Dihydrocodeine Tartarate) is more evvective than Oxycontin.  It is available through certain off-shore pharmacies.  Not being sure of the rules of this BB, I will not mention names.  Just a thought.  BOB

[Frankinscense]

Are you sure it is dihydrocodeine? If it is that medicine is available in the US as Synalgos DC is not a long acting opiate and IMO is no were near as effective as oxycodone for pain.
Dan..

[Shiny]

I'm having them made bigger, I am completly flat chested and can finally afford to have them done.  Course there is the problem that I am 53 years old (they said that shouldn't make a difference) am in good health except for the arthritis (SP) and degenrating disks.  I just want to look normal with a small 34C.  As I said I know I'm going to need other meds, because I don't want to use my other pain meds. I can be e-mailed at Shiny-***@**** Thanks for your concern.

[vickyvortex to tom]

thanks for the acknowledgement!!! I am really not psycho, just had one of those weeks.  I will try to maintain.

[tom to J.B. and Dan]

First, a big Hello to my friend, J.B., hope you and Marty are doing well. Especially hoping that the new breast anti-cancer drug (tamoxifin (tamoxifen)?) is giving her the help she needs and deserves. She has been through so much already. If you're relationship with Marty is anything like my relationship with my wife, Bobbie, you must be heartsick over her continuing ordeal.

For J.B. and Dan:
For my part, I'm still weighing the pluses and minuses of methadone or ORLAAM vs. buprenorphine. There's a research and treatment group operating out of UCLA called MATRIX that has opiate-addicted individuals both detoxing and maintaining on buprenorphine. I'm supposed to get a call at home tomorrow night from the director of the program, first to see if I can get into the program, and, second, whether I can pay for the treatment (don't know the figures yet, but it's sounding more and more expensive every time I speak with them). I should know tomorrow. The protocol goes something like this: abstain from opiates the first night, then, when withdrawal really sets in, inject the buprenorphine subcutaneously (not IV or deep muscle- they're calling it "skin popping" which the heroin users are all familiar with but something this strictly oral narcotic junkie, me, will have to learn how to do); same routine second morning; same routine the third morning. After that, they evaluate you and determine where you go from there with the buprenorphine (I think maintenance consists of taking a buprenorphine/naltrexone pill every day, but I'm not clear on that - perhaps my good friend Dan has a more accurate description).

Anyway, I haven't by any means ruled out methadone maintenance as a solution for me. There are a lot of pluses compared to the minuses for this option. But it looks like buprenorphine is on the verge of legalization as an addiction treatment in California. Check out these sites:
http://www.matrixcenter.com/researchers.html
http://www.csam-asam.org/index.htm

It's just that I want to make the right decision.

I hope Dan also reads this and checks out the sites and posts his opinion. I'm wondering if any physician that's a member of this CSAM org could just as well treat me with methadone as buprenorphine (still lots of details to iron out). I have this bug in my mind about becoming dependant on the existing methadone clinic system. I would rather be treated in a way that gives me more options and mobility, because I know that once I'm on methadone, I'm really, really ON IT, if you know what I mean. I'd like to be able to get detox and/or maintenance therapy from any addiction doctor, rather than just from the methadone clinic system as it exists today. Perhaps I just need to walk into one of these clinics and see for myself what they're like.

One big problem with the MATRIX program is it's in downtown LA, making a regular commute quite a problem (although they do have an Orange County [my county] office that might be able to provide the same services, but early indications are that MATRIX only does the buprenorphine program from their LA office. At least I have two methadone clinics available to me in Santa Ana, Orange County (So Cal), which is far more do-able than the LA locations.

So, anyway, I'll keep ya'll posted and look for both your replies. Peace and good health to both my good friends.
tom

[Bob to Dan re: dihydrocodeine Bitatarate]

Dan, Just as I was ready to post this long and windy post I was disconnected.  Probably just as well.  Please let me introduce myself.  I am a registered nurse with a back-ground in addictions tx, pain management (mostly HIV+), and psychiatry.  I've been lurking on this BB for a month and like what I see.  I hope my little contribution will be helpful.  I should add that I also have chronic pain from several motorcycle accidents I no longer ride) and botched knee surgeries but manage without narcotics most of the year.  This cold, however, is killing me.  Dihydrocodeine Bitartarate (Contugesic or codicontin) is marketed as Europe's answer to oxycontin.  The strength there is 30 mg to 120 (!) mg whereas Synalgos and DHCplus are both 16 mg., far too low for effective pain control.  Also codeine doesn't work for everyone.  I find Contugesic in the 60 mg - 90 mg range one q6h to control my arthritis pain very effectively especially when a NSAID is added.  Unfortunately the medication is not available in the USA.  Hope this helps. If I can ever be of assistance, please don't hesitate to ask.

[J.B. to Brian and Vicky]

Go tom go!  If anybody can get it all figured out and decide on the best program, you will.  Tell Bobbie Merry Christmas for me!  Hope you are all doing well.  J.B.

[Frankinscense]

MMt is an option to people with addixtion/pain issues. Bupre./NX will not solve any pain issues tom. And futhermore with naloxone in the formulation will stand a chance of any med needed for occasional breakthrough pain will not work because of the blocking and I mean downright blocking that NX offers. It is put in the formulation to where if a opiate such as oxycodone,morphine and heroin and will provide ZERO effect such as analgesia,euphoria,respiratory depression and etc. It can cause a major problem. If Tom(YOU) has a traumatic injury that requires an agonist pain killer for sufficent pain RELIEF,forget it you will suffer until the long acting NX wears off. I would not EVEN consider, under ANY circumstances taking naloxone for any reason other than a overdose on agonist opiates. Also,long term use of naloxone is not recommended because of liver problems that occur.  Lastly I am not sure bupre/NX is a maint medicine. I think it is only for a short term  such as a year or so tops. AT least with Laam/methadone you can have pain relief. A person Like you and me might be on methadone for the rest of our lives. If not, I have a protocol from Dr. Payte MD that will offer an almost pain free detox using his technique to get off methadone. The average MMT patient does not know this technique. I have been using this technique and have dropped from 120mgm methadone to 45mgs very little problems with discomfort. Seriously, tom
IMO methadone is simply the best for pai/addiction problems.
Dan...
ps: write me for any more private questions. I was not able to proofread my post b/cuz I am running late for my job. See ya'll later. God Grant Us HIS mercy! Dan

[From John B. to all]

Please read my posts under Vicoden addiction/physician over perscibing. I have been talking to JB and he has been a great help. But he said I should talk to you.

       Please help me: John B.

[From John B. to all]

I thought I just would sent you my first post please read the rest of then. Thank you John B.


All of you sound like you have this drug thing figured out. And I can relate to all of you. I have been taking pain meds on and off(more on than off) now for almost 20 years, and befor that a pot smoker. For the last 3 years I have been taking percodan. I have cut way back on them now partly because I was fearful my doctor would cut me off and partly because I know what they are doing to me. I do suffer from migrains but very few, much less than I tell my doctor about or my wife. About a year ago I stopped taking them as much. I was taking about 120 pills a month. Now I take 50 about every two months. When I get them I will go through them in about two weeks. Then stay strait till my next doctors visit(in about 7 weeks)I have found that the bigest catch with these drugs are that they give you a way to feel, a way to stimulate your mind, and all you have to do is put a pill in your mouth. It is human nature to want to stimulate you mind somehow, to feel a certain emotion. Without drugs this takes reall work.

Without drugs- To fell a sence of accomplishment. One might take up a hoby, or seek a rewarding career. With drugs you can just take a pill and sit back or do something small around the house. That is just one of many examples.
After you take them for a long time you loose the ability to become self-motivated. The only way you know to feel anything is to just take your pill of chioce. Thats why when you stop them you don't feel anything, you just want to lay around the house and not face up to anything. When quiting drugs it is a whole reshaping of how you conduct your life. You have to learn how to feel happy, concerned, interested, motivated feel love. Any emotion you can posibly think of has to be relearned, all over again or sometimes even learned for the first time. It is a hard battle but I can say this. When you achieve happyness on you own rather than with drugs it is a deeper feeling, a feeling of treu happyness not the fake happyness from some drug.

My precription will come in 3 weeks and I will take it again. I am just now doing things without the drugs and doing well, but I look forward to that next fix. I hope some day I will get sick of this rollercoaster ride and quit but I am just not ready yet.

Success to all of you

[Frankinscense]

Gosh Man can't you write something different. You keep giving us the same post word for word >> over and over again. I do not understand. Are you the same? Have you made any improvements? What gives John B.? This robotic message is getting monotonous.
Dan,,

[Frankinscense]

Hey man sorry about the above post.
Anyway depression is directly caused by short acting opiates such as percodan and vicodin. They effect neurotransmitters such as endorphins that help fight pain and depressions. Continual use of opiates for twenty years can cause a syndrome known as endorphin challanged. This probably could be a direct cause for your depression. Taking A/D to treat your depression when you are taking strong narcotics could IMO counteract their effects.
Their is only one medicine to counteract the effects of long term narcotic use and that would be a long acting opiate such as LAAM or methadone. These medicines should only be used when abstinence continues to be a failure. Methadone/LAAM will be what will replace your endorphins that have been effected or depleted. Methadone is great for depression and almost works imediately.It will stop your cravings for percodan/vicodin and give you back your life. Its hard to detox off of. But why would anyone want to detox off something that gives you back your life. Look at methadone or Laam as medicine. Not as a replacement opiates. These medicines are much like insulin is to a diabetic. Or dilantin is to a epileptic. MMT has done wonders for my life and many other pill addicts. Best of LUCK John B. My peace I give you-my peace I leave you..
Dan...

[From John B. to all]

Sorry for posting the same post. I just needed to know that you read it so you know where I am. Thank you so much for tha advice. I will read up on that drug. Is this somthing that a doctor will agree with? Do you think that I will have trouble geting this med. from him? I is all knew to me. I can't believe I have let it go this long.

  SUCCESS TO YOU MY FRIEND: John B.

[From John B. to all]

It is getting down to the wire. I have 13 pills left and I see my doctor for my shoulder pain on Monday. Then I see my reg. MD on teus. I am going to try to get more percocets from the shoulder doctor and some more percodans from my other doctor. The only thing that I am afraid of is the pharmacy that I use mite question me. Bringing two scrips one day after the other. When I get back from my vacation I will ask my doctor about the methadone treatment. That really is tacking a risk being that I just don't know how he will react. I have read alot about methadone since you told me about it and there is a wide range of openions about it. My fear is my doctor (which I have been seeing now for 5 years) will just cut me off and I will be left in the gutter to blead to death. What a whole I have dug for myself.

  SUCCESS TO ALL OF YOU: John B.

[Brian Stevens]

Duragesic is a wonderful time released product.  10mg of Fentnyl is like 150mg of morphine.  So you can figure that out pretty easy.  There are draw backs as it isn't indicated for people with colitis for irritable bowel syndrome.  But I have that and it still helps immensely.  Talk to your Doc.  oxy is not the way to go, it's way to addicting.  The patches get changed every 48 to 72 hours.  Thank you Brian

[Frankinscense]

Are you positive about that dosage? That ratio could be incorrect. There are people on this forum who buy drugs on the street. If this dosage is wrong,you could be putting peoples lives at stake. I think everyone for this reason should not discuss various dosage ratios because it is not accurate science.Discussing dosages of narcotics may cause problems if you are not a pharmacist or physician. Buyer/reader of above post beware!
Dan..
                                                                   Post Script: Myself and someothers on this site are somewhat dosage savy. But keep in mind there are people here that are not well informed to the dangers of fetanyl. Fetanyl is a lifesaver to some. But it is a schedule II narcotic for a reason. Fetanyl is a very dangerous drug to someone who is an ocassional or recreational drug user and are not aware of its 72 hour pain relieveing properities. I think dosages of Fetanyl should not be discussed. It is as you say, a very potent narcotic. With this comes the danger of overdosing. Dan..

[Frankinscense]

Most all pain specialist can prescribe methadone if they feel their is a need for it. Reseach methadone with your favourite search engine. On the web their is lot of myths and untruths regarding methadone especially from non-research people. You will get a lot of untruths from other addicts and pain suffers. That is the main source of myths and untruths.   Dan..

[to doc dan from joe]

Dan,

Although my pain specialist can prescribe methadone, can I get it filled at the local pharmacy? how about some of the other long acting pain meds (LAAM, Bupremorphine etc) are they all available at the pharmacy or do I have to go to a clinic?

[Frankinscense]

Laam is srictly a medicine for opiate addiction and available through clinics who offer it. As for as I know it is not offered for chronic pain. Buprenorphine is offered for pain relief and is becoming more popular as a medicine for chronic pain because it is a schedule five drug and it is availabe at your local pharmacy. Methadone is also available with a prescription.

[Barbara]

AH HOW MUCH DOES IT COST AND CAN IT BE DONE WITH NO SIDE AFFECTS

[rhinoking]

I have been on Oxycontin every 12 hours.. tried the patch and found I dont absorb it well (something with my skin makeup) also dont like things stuck to my skin.  It is great that there are these different choices for people like us in pain and that the patch has worked well for some of us, my thought and experience is that most of these will work for any pain if the right dose is achieved, however dont fool yourself that any one opioid is more or less addictive than another... they all work more or less the same way, binding with the mu receptors although side effects can vary from one opioid to another, some have different metabolites than others (found that out with a bad reaction to Morphine due to my kidney problems) and some cost alot more than others. The only one that I would say is different is Darvocet.. seems to be almost useless as a pain med for most people.