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Switching from OxyContin to Xtampza ER - dosage changes?

Long story - shortest version I can make:  I’m a long term chronic pain-er from endometriosis, pelvic pain, adhesions, etc.  I’ve been taking OxyContin 80mgs 3x daily plus 30mgs oxycodone 4x daily (or as needed) for well over a decade.  My insurance is insisting I do a one month trial of the Xtampza which I start today.  My pain was well managed on my old meds but the insurance won’t cover them any longer unless I at least try The Xtampza for the month.  My doctor is a family MD but she takes on a few trusted well vetted chronic pain patients since we live in a small rural area with the closest pain management clinic at least an hour’s drive away.  I’ve looked at the dose conversions and to get the equivalent amount of medicine I should be getting 2 36mgs of Xtampza capsules 3x daily (180 capsules a month).  She’s prescribed only 2 doses a day (120 capsules a month).  I’ve been communicating with her through this change via her nurse/assistant, leaving messages, getting calls back, etc which hasn’t been very effective so I have made an appointment to see her face to face on Friday to discuss.

I’m worried about the decrease in dose and how it will affect my pain levels.  Should I be?  It seems like a cut of this size (a full third of my old dose) is a lot. She’s always been fine with prescribing my meds, I sign a pain management contract every year and am compliant with the conditions in it.  

The last call back from her assistant is the first time I realized that she actually wants to CUT my dose downward.  I called her office because my pharmacy initially got the prescription from her with only 60 pills/month and I knew that wasn’t right. I know she hasn’t prescribed this medicine before for any other patients so I just figured she made a mistake in converting to the equivalent dose.  She then upped it to 120 pills/month so I called again and when I talked to her assistant I got a basic “take the 120 pills OR give up the 30mg oxycodone breakthrough pain meds and she’ll give you the full 180 pills”.  Either that or we’ll refer you to the closest pain management clinic.  I was gobsmacked!  I said I’ll take the 120 pills and keep my breakthrough pain med - which I need.  I’m feeling a little “Deal or No Dealed” at this point.  I made the first available appointment I could get with her and I guess by then I’ll know if the new med -  Xtampza - at the lower dose is going to work.  We’ve never discussed a lower dose situation in the 10 years + that I’ve been seeing her and I know she trusts me so I’m wondering if something got lost in translation between the assistant (someone new whom I haven’t met yet), me & my dr.

Complicating factor:  I also take Xanax (1 nightly) for insomnia & the insurance folks say that they won’t cover the Xtampza unless I discontinue the Xanax (no benzodiazepines with Xtampza). Dr. switched me from Xanax to Trazadone (which is not working) so I’ll have to discuss that with her as well on Friday.

I’m probably over emotional about this because I’m not getting proper sleep but I feel like she’s about to fire me as a patient and that worries the heck out of me.  What should I do?  Does anyone else here have experience with transitioning from OxyContin to Xtampza?

Thanks in advance for any advice you can give me.
6 Responses
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20803600 tn?1546262537
COMMUNITY LEADER
Some of these dishes are very old- and not relevant to the MME dosing used today.
More opiate doesn’t always equal better , more consistent pain management- but there are increased risks of respiratory suppression and accidental overdose.
Pain management is not about eliminating pain - an impossible idea since it is chronic- but getting a patient to a tolerable level that permits activities of daily living.
Comparing your medication dosages to someone else’s is useless and not a real comparisilon since we all have different conditions, severity and tolerance to pain.
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Avatar universal
I can’t BELIEVE the amounts of opiates people can still get! I have different for years it is so strict here in Hawaii. The max MME you’re allowed by law here is 120 MME equivalent! I came here is oxycodone 10mg 4x a day and 15 mg morphine 2x a day. Morphine doesn’t work for me no matter how high the dose. I have spondylilothesis (compressing my spinal cord btw) scar tissue on l5s1 nerves from previous spinal fusion ame spinal stenosis. I also have plantar fasciitis and root scoliosis. When I told them morphine doesn’t work for me at my new place in Hawaii all’s they did was take me off of it and didn’t give me anything to supplement it. So I different for a year until she increased me to 5 10s of oxy a day. Their neuro misdiagnosed me with post laminectomy syndrome and told me I needed a spinal cord stimulator. I knew in my gut this was wrong. I did the trial which helped but cancelled the surgery after reading and talking to tons of people that had been paralyzed from it. Once I got to the top neurosurgeon in the state, he said no you need old hardware out and new fusion to correct instability and curvature (he was like DUHHH!) when I had canceled my SCS surgery, mt pain place got mad because their anesthesiologist was going to do the surgery! My PA lowered my dosage back to 4 a day as punishment with no medical reason at all. I have ALWAYS used every topical lidocaine, cbd, ice, heat, tens, acupuncture, massage, PT…you name it I do it. Absolutely nothing helps and I’m left constantly unable to walk. My pain is BARELY reduced. I also use kratom and cbd to alternate so I lower my bodies tolerance and receptors to the oxy so I don’t become too tolerant. That is literally the only thing that has seem to help me. So basically the only relief I’ve gotten has been because I have had to help myself. The DEA needs to get out of pain practices. Their data was wrong ans what they are doing is criminal and medical negligence. I can’t believe you people are complaining. I have endometriosis, fibroids and cysts and I barely notice that pain because my spine pain is so horrific. Ibuprofen helps with pelvic pain. How are you getting like 4 times what I’m prescribed? I’m 36 and have kids that depend on me and work Pt. What a joke.
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Avatar universal
For me going from 20mgs of oxycontin to 18mgs of Xtampza wasn't much of a difference. But it doesn't matter now since I got into it with my doc. I was requesting an increase of 20mgs a day for a year and he wouldn't budge. So he decided to let me go "because I was always wanting More and More!" I left with 80mgs of oxy daily. I asked to make it 100mgs. I feel he was being very unreasonable for the pain I had. So I'm in search for a new pain doc via my new primary doc. This governmental over-reach and intrusion is over the top! It's like what I read about happening in Nazi Germany! Soooo sick of all of it!
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6 Comments
Pain management is to control pain- not eliminate it. Treatment for chronic pain and acute pain are two different standards for treatment.
Treating long term chronic pain is geared toward reducing not eliminating pain you experience all day- every day to a tolerable level.
Too often - even long term patients get stuck in a loop of expecting ever increasing doses of opiates to cope with pain levels. Doctors become concerned with decreased activity levels, respiratory suppression, and increasing dependence on opiates.
There are many ways and methods to manage temporary increases in pain- adding anti inflammatory meds, using topical creams/ointments, ice, heat, lidocaine and rest can all contribute to lessened pain levels.
Most pain management drs try to keep patients below 90 mg total daily of opiates. At times, simply changing the opiate a patient has been on to another opiate can lessen milligram increases but be very effective at reducing increased pain levels simply by changing one opiate for another.
I'd like to meet a long-time chronic pain sufferer who expects complete pain relief since I've yet to do so.   I'm in a support  group, fighting government and insurance company interference in the doctor/patient relationship (and, obviously, not successfully so far), and not one pain-sufferer expects to be pain free....ever again. They wish only to function in their lifetime.  Pinning an expectation of complete pain elimination on someone of whom you have no personal knowledge is unfair and shallow.  And if I sound angry and bitter, I am!  What has happened to the medical industry in this country, overall, the insurance takeover and governmental overreach is......indescribably untenable.
backhurtz: Who ever said I was expecting 100% pain relief? I know government intimidated doctors still use the outdated CDC guidelines to cover their butts. I've been in this game long enough to understand what's going on. It doesn't take a rocket scientist to see it. It's all VERY transparent to anyone with an IQ above 50. Iy you want ta carry water for the government and their frightened sheep (pain doctors) then that's one thing. But please don't put words in my posts that aren't there. Asking for a 20% increase for over a year seems very reasonable for opiate treatments. If you knew anything about opiates instead of the zealotry and propaganda you learned from the government's media, you'd know that our bodies become used to the medication and continually takes more to get close to the original relief.  100mgs of OXY (or from your government's propaganda/zealotry storybook), 150MMEs is WELL within a safe range for long-time opiate users who never abused his meds in any way BTW. Please get educated with scientific facts not government fiction.
Hoosier- I never said you specifically were expecting pain free. My comments ALWAYS are general in nature- to the overall community- not necessarily directed to a specific member.
I understand the frustration every chronic pain patient feels, the scrutiny we all face, the interference from our insurers and govt in what should be a private relationship between a dr and his patient.
Lashing out at me or anyone you personally disagree with is not okay- civil discussion without personal attacks is the way this group operates.
Having been  directly involved in ongoing treatment for chronic pain for over 20 years gives me a wide range of experiences and insight into how these drs view opiates, dosing, conversion and how someone comes across when it comes to increases in meds.
You may not like what I said about drs increasing opiates currently view that or treat it but it is the way it is.
Changing opiates to a different one typically increases pain relief and lowers overall daily doses as well. It allows the brain to use different receptors and those previously used by the old opiate to reset and tolerance to return to lower levels.
Modern-day doctors are very misinformed uneducated, and intimidated by a government with even less knowledge. The real experts are us, the consumers. We are the ones who actually consume these pills. Doctors and the government can only go by what they have read. Seeing idiots over-dosing on a wonderful medication isn't enough "evidience" to make such a heartless and knee-jerk decision on regulations for our quality-of-life. Law-abiding pain paients are needlessly suffering and killing themselfs directly because of these decisions made by BOTH doctors and the government! These shameful examples are because of UNDER-MEDICATION. Though they would like everyone to believe it's because of "over-medication" There is no proof of any negative affects on long-term opiate use in pain patients. Actually it's the opposite when comparing what a pain patient's health would be like under-medicated or just completely cut off!

I know 1st hand what it's like! My blood preassure is up. My pain is up. My weight is up and my depression is up all from being denied the medication that has given me a good quality-of-life. I could actually do some physical things then. My blood pressure was great while on my pain meds! I have had high blood pressure for years. I had no side-effects except for a little more drowsiness than usual, but my body was at peace with all the pain I had previously and now! So most likely, my new pain doc (if one will even take me on now) will offer injections or all the other stuff that was ineffective for me.  So I KNOW what works best for me. My body KNOWS what's best for it.

I went through 8 days of hell to get detoxed with no sleep. I had no choice really. I didn't do it to get away from those EVIL opiates that have taken over my body and mind. I did it to become opiate naive again so I could stretch out the remainer of my final month's script! I hope like hell I can find a doc who actually understands my "individual" situation! I'm not an addict. My mind didn't "crave" opiates, but my body let me know it was missing something that was there for 2 solid years 24/7 and now is gone! My body also let me know where all that pain was! It's back in full force!

This is why I and millions like me are sooooo sick of the intimidation and zealotry from the government and our own doctors who had to take the Hippocratic Oath to become one! They ALL blantantly violate their oath every day! So from active on opiates to couch-bound off of them, here I am. Government-ran Pain Management is an absolute travesty!
Bossier,
I am sorry for what you are experiencing- and I do hope you can find another doctor who reviews your records, previous treatments , meds and is willing to include your feelings/experiences in deciding what treatment protocols to use for you.
Don’t  completely discount trying a different opiate though- you might find out like I and many others have, that switching opiates can result in better pain control.
As an example- I was on a LOT of Oxycontin and Oxycodone for breakthrough ( I felt that dose was needing adjustments  too often for my comfort level)- so we switched to Opana. It provided far better overall control for me, at a significantly lower dose- the best part was I needed no adjustments for tolerance issues for two years.  Later , after another year or so- we switched me to fentanyl patches after my second surgery. Later , I opted to return.to the Opana again when I wanted off the fentanyl and had no issues with any of the conversions or effectiveness of pain control.
That’s what I was trying to convey earlier about switching opiates- it is and can be a very effective way of managing pain, keeping doses lower, and reducing tolerance/adjustment concerns.
Avatar universal
I’m still battling this.  I had an appointment with my doctor & we discussed all of the alternate meds which are covered by my insurance.  We settled on one (which required a PA) and they outright rejected it - at least in the dosage necessary to replace my current regimen.   I’m in a situation that is untenable and think the only way to reconcile it is to file a complaint with my state’s insurance commissioner.  I’ll be doing that very soon.  I thank all of you for your suggestions and comments.
Btw, I’m no longer taking Xanax and have switched to Lunesta.  I don’t sleep well but I’m at least no longer taking a benzodiazepine.
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1 Comments
Unfortunately, it’s unlikely that you will find any doctor to give you a straight 1:1 mg for mg conversion to any other opiate. As I explained in my earlier response- when converting from one opiate to another- mg for mg conversions don’t occur and aren’t the standard of practice.
You were on a high dose of OxyContin -360 mg of Oxycodone is an astronomical amount , even for a long term pain patient.
Almost every doctor you see would be alarmed at that dosage.
Long acting opiates (extended release) are typically dosed once or twice daily, and breakthrough doses are limited to two to three times daily, depending on mg strength.
I understand your concerns but at the same time- I think you may need to adjust your expectations and expect a reduction and change in dosage from OxyContin/Oxycodone  combinations may be the likely outcome.
Most of us long term chronic pain patients find changing meds periodically and keeping the use of breakthrough meds lower still affords adequate pain management , and we can adjust to them with little difficulty.
If the Xtampza isn’t working, there are other options in long acting medications such as morphine, fentanyl, and a few others.
I’d hate to see you loose access to treatment for your pain if the insurance company or doctor become concerned about the current dosage.
20803600 tn?1546262537
COMMUNITY LEADER
Conversion from one opiate to another is never a 1:1 conversion. Even in pain management practices, when converting from one opiate to another there is a reduction in dosage with the new medication. Cross tolerance issues are considered, since even in long term chronic pain patients- they typically need less of the new medication to achieve equal or better pain control using a lesser dosage. The new opiate uses different receptors and that’s why. Secondly, in order to avoid side effects , accidental overdose , drug interactions -a new medication is reduced.
A typical reduction is 20-30% of the previous dose- so it appears your doctor is doing the conversion exactly right.
Xanax is not recommended for use with opiates, since both cause sedation and respiratory suppression. I’m not surprised they don’t want you taking the amount of opiates you are on and the Xanax as well.
Trazadone can be titrated up in dose safely and effectively if the current dose is not working.
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18524847 tn?1465595901
For good or bad (and I understand often bad), pain management and especially with oxy is under heightened scrutiny.  There really is that whole situation of managing your chronic conditions while dealing with the fact you are likely addicted to the meds you've been taking.  So, the idea of changing is, I'm sure, terrifying.  We get psychologically wrapped up in our routine and it works, so why wouldn't we?  I understand how you are feeling.  I think the best you can do is to try what they are asking.  And if it doesn't work, there will be the time of re evaluation.  Totally stinks to have a month or a bit longer that may not be like you usually are in terms of keeping the chronic issues at bay.  But they are saying you have to so I would try to fight the fear and try with an open mind.  Chronic pain patients are being taken off meds around the country.  Xanax is a little bit different.  Xanax is not really a treatment for insomnia.  It really just numbs you.  There definitely better treatments for insomnia than that.  That one may be harder to continue for an insomnia diagnosis.  But you do need proper pain management.  Trazadone is usually a good choice for insomnia.  I'm sorry that isn't working for you.  Maybe the dose can be tweaked.  I'd say it is unlikely you'll get put back on xanax with this doctor.  Again, try to be open minded as to 'what else' you can do.  

I doubt your doctor wants to fire you.  Most doctors really do want to help you.  hugs
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