For Dr J.. Oxy and switching to the patch

[Dezdon]

Hi Dr J
I survived bacterial meninigitis and sepsis. I have two transmetatarsal amputations. I was taking 7.5mg vics and an 20mg oxy at night for seven years. I had a osteomyltis and a bone spur surgery and my pain levels rose way up.
Then a new doctor decided for convenience, I could take four 20mg oxys a day instead of 12 other pills.
  I went on the oxys and hell broke out in my life. I am truly addicted to them. I always come up short on refill dates. . Then I switch back to vics to stay out of withdrawals and get some pain relief.
   I took my vicodin for seven years and never had a problem, not once.  
  I stopped taking all pain meds for ten days recently as I ran out and also wanted to see what my true pain levels are at. I had been on pain meds since the amputations (eight years). my pain levels were hitting sevens and eights on the pain scale that week.
  I tried to go back to the oxys after being clean and it happened again. There is something about them and me. But, when i do take the vicodons, I dont abuse them, they just dont give me that euphoric feeling and they bore me I guess.
   The vics are not strong enough for what I need. The oxys work great for the pain, but I abuse them, I abuse them bad.
What Im thinking about doing, is somehow ask my PCP to switch me to the same equivalent dose of a duragesic fentanyl patch. That way I would be away from the temptation of the having the pills just laying around for me to take at will. I could simply put on a patch and forget about it for three days.  
In your experience, what are my chances for success with getting away from the oxys by switching to the patch? And I was also cautioned that if I tell my doctor about my problem with oxys, I may get kicked off all pain meds completely. It was said its an all or nothing situation when it comes to pain meds, comply or loose it. How could I ask for the patch if you think it is doable.  
Thank you for your time Dr.
-Dez

[Jaybay]

Luckily, I never experienced euphoria with the fentanyl patch.  Felt a bit "weird" the first few days, but that was it as far as side effects were concerned.  

Unluckily, I accidentally left an old patch on when I applied a new one.  I tend to sweat the patches off in the summer and use tegaderm as a cover.  The tegaderm came off but the patch stayed on - unbeknownst to me.  Within two hours I was sweating like a pig and had to remind myself to keep breathing.  After some examination, I found the old patch still in place and figured out I was overdosed.  Not fun.  Had I been napping at the time, I may not have woken up.

[J T Junig, MD PhD]

As a matter of fact, fentanyl was my drug of choice-- but in IV form.  I picked up a bucket of the stuff every morning... and it eventually kicked me around quite a bit.  As Mr. Lucky said, it is hard to say what would happen with the patch.  For some opiate addicts, the patch is a step up the ladder to increased addiction, as fentanyl is extremely potent and can induce quite a bit of euphoria.  The slower delivery of a patch is generally safer than a short-acting pill, but some people start to 'play' with the patches-- they wear several at once, or cut them, smoke them, chew them...  or they apply heat to them so that they release the drug faster and your skin picks it up more quickly.  DO NOT DO THIS, ANYONE WHO HAPPENS TO BE READING THIS POST!!  HEATING THE PATCH OR THE SKIN BY THE PATCH IS A RELIABLE WAY TO DIE FROM RESPIRATORY DEPRESSION.

Sorry for yelling-- I had to make sure everyone heard me.

No matter what you take, you will only become tolerant to it fairly soon-- and be right back to where you are now.  The way to look at it is to use the vicodin and realize that you are at the limit of pain relief, and any more relief will have to come from something else.  You could try Lyrica, or high doses of gabapentin, or tegretol, or Cymbalta...   You could try local measures with capsaicin maybe...  maybe a TENS unit?

The problem is the seduction from opiates... they lead you to think that relief is available by increasing the dose.  But that relief is quickly taken back, and you are simply stuck on higher doses of narcotics.

When I start narcotics with patients I try to define, with their help, a 'line in the sand'-- with the knowledge of tolerance, we find a point where the limit has been reached.  You might need to do that for yourself;  you might even find that you have passed that limit, and you need to suffer through the reversal of tolerance to get to a lower dose.  Not a good solution, I know.  You are just at the point where opiates no longer offer an answer.

[lyerhc]

I am on the duragesic patch and use MSIR for breakthrough pain,  I have been on MSIR for about 30 years its been the one consistant medication in my life we added the
Duragesic Patch for a more lasting effect. The two meds together work well  together.
Without the pain meds I cannot function,with them I lead a normal life take care of my family, work, read without them I do not get out of bed socialize and do other things/ I want a normal life. and if that means taking these  meds as prescribed then that iswhat I
will do, if you can relate let me know.  Its just a shame I take thyroid, prednisone, etc, I just wish the pharmacy and hospital personal treated all my meds equally.

[mr.lucky66]

I feel for your situation and your running out early and going through withdrawl. It seems to happen to chronic pain pts. that get addicted. I used to run out of a months supply of narcotics far sooner than a few days. The patch could be a better choice or maybe not. The doctow should be able to give you some good medical insight. He's very knowlegable and an ex addict.