Avatar universal

advice from percocet to durgesic patch

I have been taking vicodin ES 750mg 90 tablets a month for the past 2 years I have chronic pain due to my bad knees. I was recently switched over to the percocet 5/325 my body was becoming tollerant to the vicodin to the point where they were not relieving the pain anymore. I had the same reaction with the percocet where I had to take 2-3 at once. I was just prescribed the duragesic patch 25mcg but have not filled the prescription, while researching on internet found the ingredients in this patch being some powerful meds that I have never experienced before and I am in fear of overdose, not being able to concentrate on my job or addiction. I also only take the pills while at work my job requires standing for 8 hours, I do not take the pills on my time off from work. The other fear that I have about the patch is I read that if you stop cold turkey you will die is that true?
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Avatar universal
Faith, I'm glad that you are feeling more confident about your medication.  I hope you are able to do the things you'd like to do like going to the gym, etc.  I also gained a lot of weight through dealing with pain and stress and having medication has helped me to be a little more active.
What I have found is that doctors prescribe the patch more frequently than oxycontin.  Some insurance also require a seperate prior authorization for oxycontin as opposed to any other medication.  It gets such a bad rap because of drug seekers and overdoses.  I've tried most of the pain medications on the market, but that's one I've never been on so I really don't know much about how it makes one feel.
I hope the patch works great for you.  I think your plan of waiting until the weekend is a good one.  That's a smart idea for anyone switching to any new med.
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82861 tn?1333453911
Don't beat yourself up!  We've all been in your shoes at one time or another.  Being on long-term opiate therapy is a big decision, but so is living with chronic pain that can destroy our lives.  

If you have enough pills to get through the week, you have a good plan.  Go ahead and fill the prescription and wait until next weekend to start using it.  Meanwhile, is it possible to talk about these issues with your doctor over the phone?  When I have a lot of questions, I type out a list and fax it to my doctor.  Then I let the nurse know what's going on so she can run interference with the doctor.  I can't tell you how many times my doctor has jotted down the answers to the questions and had the nurse either call me back or fax the sheet back to me.  Saves the doctor's time and me another copay!
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Avatar universal
Hi there,
I want to thank you all for all your advice it is very much appreciated. Yes I am very indecisive you can tell, I shouldn't let this fear get the best of me. I should have done what my doctor told me and tried the patch over the weekend while I was off from work, but no I decided to go on the internet and do research reading horror stories not on this site though, not sure how I stumbled here had to be google. I guess I'll have to go through another week of pills or pain, until I have a day off to start the patch.
Actually I could go fill the script today, just don't know how it's gonna make me feel at work I have a very responsible position that requires at least 90% of my mind and jumble lots of numbers...probably not a good idea.
Thanks for all your advice
Helpful - 0
82861 tn?1333453911
Respiration problems happen with people who take more than prescribed (overdose) of ANY opiate.  Those problems are not at all limited to the fentanyl patch and do happen with percocet and vicodin.  Since you are opiate tolerant, you don't need to be concerned about it.  Seriously, the amount of percocet you take in one day is roughly equivalent to the 25 mcg fentanyl patch.  You reacted to 3 percocet because you overdosed in the strictest sense of the word.  You took more than prescribed, against prescribing instructions, and caused a spike of the medication in your blood.  Your body said, "Enough!"  With the fentanyl patch, you won't have those spikes and you won't have symptoms of overdose.

You're at a crossroads I think.  You need and want the pain relief, but you're more willing to believe what you read on the internet instead of your doctor.  Opiates are still the best weapon we have for pain in the 21st century.  If you are adamantly against taking them, there isn't much that your doctor can offer in the way of relief.  Please talk to him about the fentanyl patch, opiate tolerance, physical dependence, and his strategy for weaning patients off opiates.  There is no point in torturing yourself with indecision and continued pain until you get straight answers from your doctor.
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Avatar universal
Wow you guys are great thanks for all your answers, I'm glad I found this site. I got hurt 6 years ago and had surgery, it was successful for about 3 years I was able to go to the gym and workout and then it got painful again caused me to gain almost 100 pounds in the past 3 years. I know that the weight gain is not making my knees any better because it's like bearing 1000lbs of weight on them. My job requires standing and that's when I have the most pain and can barely walk after a couple hours of being on my feet, that's why I only take the meds at work. When I'm off from work I simply get off my feet when I'm really in pain, but I don't have that option at work, I don't want to be dependent on the pills.
I have thought about asking my doctor for Oxycontin, but have heard alot of horror stories about that also. Friends of mine involved in car accidents were put on this and said coming off of them was awful. I have been on vacation for the past 6 days and not taken any meds I don't feel like I'm having any withdrawal symptoms.
I was afraid of what all the acetametaphine in the vicodin and percocet would be doing to my liver. When I first started on the vicodin over 2 years ago 2 or 3 in an 8 hour period were fine, then 6 month later my dosage was bumped up to 7.5mg. eventually it got to the point where I was taking 5 in 8 hours. A few months ago I asked my doctor if she could change my prescription to percocet because I felt my body was tollerant to the vicodin and they were not working for the pain. I filled the script and the pharmacy gave me the generic Watson oxycodone, the side effects were awful cottonmouth, nausea, itching, sweating after a week of that I called my doctor and she prescribed brand only which was much better on the side effects but not on the pain I followed the directions 1 pill did nothing at all, then on my break I took 2 and that was ok for a couple of hours. The pain gets worse as the work week goes by. I'm now at the point where I'm taking 6-8 in an 8 hour period which is getting expensive because I have to pay for brand and she's only prescribing 90 at a time, doesn't make any sense because whether she prescribes 90 or 180 I still pay the same price with my insurance.
The patch was actually my idea my theory was that if I could have something for long lasting pain relief I could go back to the gym and do some cardio, if I take some weight off it would be less of an impact and weight bearing on my knees.
My fear now is what was mentioned about respitory problems with the patch,  
I have breathing problems right now because of all the weight that I gained, wheezing and shortness of breath.
A couple of weeks ago on a friday the end of my work week when it seemed like 2 percocet were no longer working to control my pain I took 3 and will NEVER do that again, I felt like I was going to die. My head felt woozy, broke out in a sweat, hands were shaky, felt like vomiting it was awful, is that what the patch is going to feel like? if so I don't think that I will like it.
Helpful - 0
82861 tn?1333453911
You will NOT overdose at 25 micrograms of fentanyl.  By now, you are no longer what is called "opiate naive" having been on hydrocodone and then percocet.  Yes, if a person who has never taken opiates slaps on a fentanyl patch there would be respiratory problems and perhaps even arrest.  BUT - that is not where you are in the opiate realm.  I went from 5 to 6 norco a day to the 25 mcg patch and had no trouble.  Two or three days of feeling kind of "out there" and after that nothing but pain relief.

It's always a good thing to research any new medication that you are prescribed, but your reaction to the fentanyl patch is unfortunately all too common.  Yes, it is a powerfully potent pain medication, but the amount used is infinitessimal compared to vicodin or percocet.  The improvement here is that the patch gives you 24/7 pain management whereas vicodin and percocet leave you chasing pain peaks and valleys.  That is the difference between short-acting (immediate release) meds and long-acting (time release) meds.  

Generally speaking, the more potent opiates are prescribed in long-acting formulations and also don't contain the tylenol that is mixed with the short-acting meds.  Take over 4 grams of tylenol a day and over a long enough period, you can kiss your liver goodbye.  Given time, vicodin and percocet are far more dangerous than fentanyl, morphine, dilaudid and other long-acting opiates simply due to the tylenol content.

I'm afraid you also don't quite understand addiction.  That is a psychological problem where the patient craves the effects of opiates - a high or a buzz - and will use more and more in order to shut down mental pain and achieve a high despite negative consequences.

Physical dependence is a normal part of opiate therapy.  At this point you ARE physically dependent on opiates.  If you suddenly stop taking your meds, you will experience withdrawal - just like an addict in the same situation.  The difference is the mentality.   Pain patients take their meds as prescribed for pain management.  An addict takes them and abuses them to get high.

I have no firm statistics on deaths due to withdrawal, but my understanding is that it is rare unless there is an underlying medical problem - ususally cardiovascular or pulmonary.  Withdrawal can be truly horrifying, but it doesn't last forever and there are meds that can help with the worst of it.  Pain docs wean their patients off opiates slowly to avoid withdrawal if and when it is necessary for the patient to stop taking them.

Try not to let what you read on the internet scare you.  There is a reason your doctor prescribed the fentanyl patch for you.  You are already opiate tolerant and no short-acting medication will give you improvement by now.  It's time to go to something long-acting like the fentanyl patch.  I encourage you to discuss your fears about it with your doctor before making a final decision.   There are plenty of people on this forum who are on the fentanyl patch, so blast away with any questions!  :-)
Helpful - 0
954005 tn?1304626605
Hi! I do believe that going to the fentanyl patch would be too high of a jump...too much of an increase in pain meds.  How many Percocets do you take per day? Have you tried adding in something like motrin to help? I would think that instead of bringing fentanyl into the equation, that something like an extended release form of the oxycodone should be tried first.  A low dose of Oxycontin twice daily, with the percocets used only for breakthrough pain as needed, sounds like a better plan to me.  
As far as fentanyl causing you to die f you stop cold turkey? I do not believe that is a prevalent issue, but discontinuing it abruptly would surely cause withdrawal symptoms.  You say that you don't take meds when you are not working...are you NOT in pain when you are not working? Some medications need to build up in your system to be able to continue to be effective, so starting and then stopping medications may be affecting how they work for you.  I would ask your doctor about extended release oxycodone, with instant release oxycodone for breakthrough.  
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Avatar universal
The dose that you are being put on is a fairly low one.  I believe it's the second to lowest and should be comparable to the amount of hydrocodone you've been taking.  For many people the patch works very well and they find their pain is well controlled.  The biggest problems are with the adhesive and sometimes absorbtion.  Everyone is different, though.  
I don't believe it is any more addictive than the vicodin, perhaps less so as it's controlled-release and provides continuous level of the medication so there shouldn't be much "euphoria".  As far as concentration, I really think that depends on the person.  In my humble opinion, the chance of overdose is also very low.  It's important to avoid prolonged exposure to heat while taking the patch.  Also, in my opinion, there is a very low chance of dying while stopping a 25mcg patch cold turkey, however, you shouldn't stop any long-acting narcotic pain medication suddenly.
The biggest thing is that if it worries you, you should call your doctor.  You shouldn't do anything you're not comfortable with.  There is a lot of information available on the internet and a lot of horror stories.  It's good to educate ourselves about any medications we are taking, but sometimes we can really scare ourselves too.  
I have taken the patch and it worked well for me, in general.  We also have a good number of members here who use it and find it very effective.
I hope some of that is helpful to you.  Please feel free to ask us as much as you need to about these things and to share your advice and experience with us.  None of us are doctors, just CP patients who share our experiences and support eachother.  Welcome!
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