Extended release pain meds

[freebird63]

So much has went on with me in the last couple years and thank you so much Tuck for trying to help me out.  Here is my question, my wifes insurance, its not a very good one, but they make us pay 100% up front and then will send us either 75% or 80% depending on pharmacies we use.  But just for me if I factor in the two statin's I take for high cholestrol I have to come up with $711 bucks up front.  Now a little about me, I am unemployed, I have no income coming in and have yet to hear back about my disability.  I pay $350 for my fentanyl patches, $108 for my oxycodone, $154 for my cymbalta, valium is only like $7.00, gabbapenten is $28 bucks.  
I am trying to find or get an idea of some other extended release pain medications that I can talk to my pain doctor about.  I already know morphine does not work for me, for a while they had me on 60mg 3 times a day on the morphine and it didn't work.  The oxycontin is expensive here and for some reason my pain doctor does not like it.
So anyone out there who reads this has some other ideas of a cheaper extended release pain med please pass on the name of it.  Thank you again everyone and a special thanks to Tuck.

[yucca13]

Just wanted to address the dangers of methadone.

Methadone builds up in your body unlike other opioid medications.

It killed my 34 year old son three years ago. He was taking prescription methadone, restoril and soma as prescribed and still died.

From all of my research, it is a very risky drug.

[marycarmel]

I think some of what Weathergirl mentioned is worth looking into.  I have no insurance at the moment but my scripts are covered under worker's comp.  I have to use a certain pharmacy and on occasion they don't have what I need.  Then I have to go to another pharmacy, pay up front, and try to get reimbursed.  I call around to see where has the best price and I do it every time because it can change.  I've found Rite Aid to be one of the cheaper pharmacies and CVS to be one of the most expensive (as a rule.)

Hopefully going back on an extended release will help a little.  Cutting back on the oxycodone seems reasonable but going from 270 pills to  60 seems like a lot!  And the increase in the gabapenten seems a lot as well.  I have bad side effects from gabapentin when I get to over 1200 mg. and 1200 mg. doesn't seem to help with the pain.

Do you do anything else to help with the pain, aside from the meds?  I've been working on some meditation/breathing, which helps a tiny bit.  I also use topical prescription creams and lidoderm patches.  Alone, nothing works but in combination they can take the edge off.  Pain is still pretty high but not at the level that I get so frustrated thinking I'll have this the rest of my life.

As far as you owing the doctor money, he should still see you.  Have you talked to his billing office and let them know about your situation?  I have found, though, that surgeons tend to dismiss you once there's no more surgery on the horizon.  My surgeon did 9 operations on my hand, the second to last one being a fusion and the last one to take out hardware that was migrating.  I USED to be his favorite patient.  Now he couldn't give me the time of day.  I have to rely on the pain management doctors and I feel like I'm on my own.  I'm incorporating my primary care doctor into all of this as I feel I need someone who is really looking out for me.

Unfortunately, with chronic pain, we do have to accept a certain amount of pain and live with it.  I'm at the point that on a scale of 1 to 10, if I can be at a 4 I'm okay.  Not great but I can function.  As the pain level goes up, my quality of life goes down.

I'm geographically challenged these days.  Is there a possibility of you going to a neighboring state to see if there are any more options for pain management doctors?  If there's something an hour or so away, it may be worth looking into.

[freebird63]

Well I got to see my pain doctors PA yesterday and again I brought up methadone and he gave me the same song and dance that the doctor did.  I told him I knew plenty of people that take methadone for pain and they lilve a very wild lifestyle and it has not killed them yet.  But he more or less said his hands were tied that the doctor was the only one who would approve it and then I would have to have some other kind of workup done to see if my heart is strong enough for it.  But when I told him the short acting pain meds were not cutting it, his comment was well ya.  So the only thing he did was stick me back on ms contin 60mg 3 times a day and cut me back on my oxycodone from 270 pills to 60 pills and then he increased my gabbapinten from 900mg a day to 1800mg a day and left my cymbalta and valium alone.  There are only a couple pain doctors here in Boise Idaho and have seen one and he was worse than this one and the other one didn't even want to see me.  Have not heard not heard a word from the surgeon who did my fusion in January since April, but I think thats because I owe him money, but I find it hard to want to even make an effort to pay someone for work they did that failed and then does not even make an attempt get you back in there to see what he missed.  But I do know that there is no doctor here in Boise that will ever cut on my back again.  But then part of my back cannot be fixed, my sacrum is a mess, its a birth defect.  This has all been so frustrating for me.  That my latest update, thank you for listening, its nice to have a group like this.  Chuck

[Weathergirl21]

Sorry to hear of your troubles..

I am in a similar situation where I am looking for work, and do not have any health insurance.

I do agree with Mary above about the COBRA....By law...they have to offer you this so I would immediately check into the price for this as it can at least hold your forward until finding another insurance plan. COBRA coverage lasts up to 18 months.

Also...I would find a new PM Dr....The one I see only charges me $75 for a visit and I go every 3 months to see him.

I use Sam's club for my prescriptions. By law you do NOT have to pay the yearly fee to only use the pharmacy of the big box stores. In my area, this is less expensive than the Walmart.

I called all around to see where they had the best prices for my medicine.

For my 5 prescriptions..all generic...MorphineER (30 and 15mg), OxyIR 5mg, Flexeril, Ambien...I pay $130 a month.

That is all without insurance prices. So...it really depends sometimes on your insurance plan if it's less expensive to pay out of pocket.

Let us know how it goes and if you all signed up for the COBRA coverage...

[marycarmel]

This is so wrong.  No one should have to deal with this.  Can you at least still take your oxycodone so maybe you'll just have to deal with more pain but not withdrawal?  I can't believe they expect you to withdraw from these dosages with nothing to help.

There are not a lot of doctors here that prescribe methadone for pain management.  My pain clinic does, as they had suggested it for me at one time, but I didn't think it was the right med for me.

Do you have a primary care doctor that can help?  Maybe they'd be willing to prescribe for you until you could find a different pain doctor?  Pulling patients off a med without giving them something in its place does not seem like good medicine to me.

I wish I had some suggestions for you.  Are you still waiting to hear about the medicade?  Does your wife have the option of going on COBRA?  I know that's expensive, too, but maybe not as much as trying to pay for meds out of pocket.

[freebird63]

Can 2011 be any worse???  I was terminated from my job in 2009 because of my back.  Well last week my wife lost her job and that was our only source for insurance.  We went down to health and welfare and the lady told us that its very rare that an adult under the age of 65 gets medicade.  2 months ago because of an insurance mess up I went 2 weeks cold turkey without meds and thats something I was hoping to never have to do again, well looks like I get to do it again and then have to try and survive on no pain meds at all....  What a wonderful christmas gift.  Been looking online for any assistance, looks like they have it but not for narcotics.  I wonder what 2012 is going to be like????
Does anyone have any suggestions?????   Thank you all so much.  Chuck

[freebird63]

Well I saw my pain doctor and as per usual he pulls me off the fentanyl and does not perscribe me anything else for long acting pain relief, I ask him about methadone and he said there are way too many deaths from methadone, I got online and the numbers I seen didn't seem that high to me.  I just think he does not want to let me try it, for what ever reason I don't know but I would think that it should be up to me as he is really working for me, yes he can tell me about the side effects but by all means at least let me try it.  I cannot afford any of the other long acting pain meds as I have no income.  My pain doctor also has a real bad habit of just pulling me off meds and not giving any thought to the withdrawls, I wished there were more choices for pain doctors around here.  So now I have to try and survive on 9- 15mg oxycodone a day and its by no means even coming close to helping.

[el_em_en_oh]

I don't mean to correct you Tuck, but Opana is OXYMORPHONE, not hydromorphone, as you said in your reply above.

Just a clarification!

[freebird63]

Well my appointment went as per usual, today I saw my pain doctor instead of his PA, my pain doctor is pretty much worthless as far as I am concerned.  He took me off all extended release pain meds and would not even consider methadone, his excuse is too many people are dying from it, I really wanted to ask him if so many people are dying from it then why is it still on the market???   I am sure you all can sense my extreme frustration here.  I keep telling my wife that I want to move out of Idaho as its nothing but bad news here.  None of the doctors here will stick up for a patient, but they sure will stick up for their buddies that are in the doctor field.  I am so frustrated I could cry, they don't understand nor do they care about the pain I am in not do they care that I can no longer do the thing I use to do for enjoyment, I can't go hiking, hunting, target shooting, fishing..  I am truely sorry for venting this way.  Chuck

[Tuckamore]

Hi Again Freebird,

I am always interested in new medications and their reported effectiveness and costs. I did a bit of research on the link provided by Sandee1818 as I have not heard of this specific medication. OROS is a trademarked name owned by Alza Corporation. OROS stands for Osmotically controlled-Release Oral delivery System.

From the 2009 Article link above, " A new formulation of extended release hydromorphone utilizing the OROS® technology........There are currently thirteen OROS® commercial products available worldwide."  OROS medications: Invega (paliperidone), Adalat Oros/XL (Nifedipine), Jurnista (Hydromorphone), (Venlafaxine) ER and Concerta (methylphenidate).

Again the OROS is the term used for how the Hydromorphone is forumated and delivered. It's available in Europe but I can't find it's availablity in the US. If anyone can please let the board know. Opana ER is an extended release form of Hydromorphone (Dilaudid). Opana ER utilizes the TIMERx delivery system and not the OROS delivery system. although they are similar they are not the same.

In March of 2010 the FDA approved Exalgo (Hydromorphone) extended release which is an OROS (delivery system) drug. It appears to be the same as the one available in Europe. It's costly but again there can be payment assistance from the manufacturer of this medication.

Hope this helps a bit. Please let us know what you discover.
~Tuck

[freebird63]

Thank you Sandee and Tuck.  Will see what the pain doctor has to say tomorrow, these appointments I have always dreaded going to my pain doctor appointments because he has a reputation of just pulling me off a med and putting me on another one.  So wish me luck and will bring up that dilaudid.                                                                                                                                                                                                                      

[sandee1818]

Have you tried the extended release formula for Dilaudid? A new extended release formulation (OROS®) of Hydromorphone is available and I believe it is more afforable than the Fentanyl.
Here is link about the medication...
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697506/

I wish you the best of luck. With today's economy we have to get what we can afford.

[Tuckamore]

Hi Freebird,

It's so good to hear from you again... but very sorry to hear about your situation. I hear you!!!

As you know Morphine is one of the least expensive..... and Oxycontin and Fentanyl are two of the most expensive. Morphine was not effective for me either. If your PMP won't RX Oxy that's a moot point. However they were less expensive for awhile when the patent expired. The original manufacturer filed suit and stopped generic manufacturing.... until that goes to court in several hundred years it will remain unreasonably high priced.

Methadone is the least costly of all long acting opiates that I know of... but there's a lot of "baggage" that comes with that medications. As you know it was once only utilized to treat addiction. Some physician's won't prescribe it. In more resent years it's been used to manage chronic pain.... for some ppl it works wonders. I was prescribed it but it did little for me but give me excruciating headaches.

Opana is also costly but through some research I have discovered that they offer discounts on this drug. I believe it's from the manufacturer.... you might want to goggle this info.

Sorry I can't be of more assistance. Many of us are in the same situation. You are not alone, though I know it doesn't help your situation. Please keep in touch and let us know what you find out.

You might want to check this journal entry, if you haven't already. It offers information on prescription assistance. It may help with some of your costs. Here's the link:
http://www.medhelp.org/user_journals/show/162076/Prescription-assistance-programs-and-phone-numbers?personal_page_id=1060

Don't be a stranger... I'll look forward to hearing from you again soon.

My Best,
~Tuck