FDA Favors More Restrictions on Hydrocodone

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Last week, a panel of experts at the Food and Drug Administration voted in favor of new regulations on prescription pain pills containing hydrocodone. Hydrocodone is the active ingredient in name brand opioid pain relievers like Vicodin and Lortab, which contain mixtures of hydrocodone and acetaminophen. These preparations of hydrocodone are presently Schedule III controlled substances.

Any potentially addicting drug is given a Schedule designation from I through V. Schedule I reserved for drugs with little medical use and very high abuse potential, Schedule II for medications with medical uses but high addicting potential, and so on, down to level V, reserved for medications with slight risk for addiction but with medical uses.

At present, regulations for Schedule II medications like Opana and methadone are more stringent than for Schedule III medications like Vicodin and Lortab. Schedule III medications can be written with refills if the physician decides this is necessary and prudent. Schedule III medications can be called in by telephone, while Schedule II can’t be called in by a physician or anyone else, and even the written prescriptions can’t be refilled. A new prescription must be written by the doctor if a Schedule II pain medication is to be continued.

The New York Times article didn’t explain whether the FDA aims to recommend a change in the schedule designation of hydrocodone, or if new regulations will be put in place in some other way. This matters a great deal, since in some states, only physicians can write for Schedule II medications, and nurse practitioners and physician assistants can’t prescribe them at all.

Any reader of my blog knows I’m in favor of more cautious prescribing of opioids by all providers, because loose prescribing habits are one causative factor in our present epidemic mess of opioid addiction. However, we can over-react to the crisis, to the point of making it unreasonably difficult for patients with acute pain to get reasonable care.

In states where physician extenders like nurse practitioners and physician assistants aren’t allowed to prescribe Schedule II medications, the outcome could be dire. Some communities rely on these providers because there are few physicians in the area. This new decision could make it very difficult to get appropriate pain medication for even short-term use in rural areas with few physicians.

There are dozens of medical situations when it’s handy to be able to call in a refill of hydrocodone when pain extends longer than expected. If refills can’t be called in, doctors and dentists may actually decide to prescribe more pills at a time, knowing they won’t have the luxury of calling in a few more pills.

The New York Times article mentioned nursing home patients as one group who could be adversely affected by the new recommended changes. Many are frail, and unable to travel back and forth to a doctor’s office to get a new prescription each time one is needed for a chronic pain condition. In some areas, doctors come to see the patients at the nursing home facility, though not in all facilities. Home-bound patients with chronic pain would be required to travel to doctors’ offices.

Hydrocodone is the number-one prescribed opioid in our country, and certainly many pain pill addicts have used it illicitly. But by the time addicts come to me for treatment, it’s rare for hydrocodone to be only opioid being abused. Most of the addicts I admit to treatment say they may have started with hydrocodone, but switched to more powerful opioids at some point in their addiction. Perhaps hydrocodone is more of a “gateway” opioid for these addicts.

Restricting access to hydrocodone will likely reduce addiction, because studies do show that decreased access to drugs (including alcohol) decreases the number of people who become addicted. But let’s not overlook the hardships over-regulation may cause to patients with acute pain.

It will be interesting to see what happens if/when these new recommendations take effect.

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18 responses to this post.

  1. Panel prods FDA to restrict hydrocodone, ingredient in prescription painkillers
    By Stephanie Smith, CNN
    updated 10:36 PM EST, Fri January 25, 2013
    The president of Physicians for Responsible Opioid Prescribing says painkillers that contain hydrocodone, such as Vicodin, are more addictive than most doctors think.
    The president of Physicians for Responsible Opioid Prescribing says painkillers that contain hydrocodone, such as Vicodin, are more addictive than most doctors think.
    STORY HIGHLIGHTS

    An advisory panel recommends that hydrocodone be more restricted
    Panel: hydrocodone, a Schedule III drug, should be under more restrictive Schedule II
    The FDA could limit how much hydrocodone a patient could get between doctor visits
    The FDA has not said when it would act on the recommendation

    (CNN) — An advisory panel to the U.S. Food and Drug Administration on Friday voted 19-10 to recommend placing tighter restrictions on hydrocodone, an ingredient found in popular prescription drugs including Vicodin, Norco and Lortab.

    If the panel’s advice is adopted by FDA, it would put hydrocodone on par with prescription painkillers like oxycodone, morphine, and methadone — drugs with high abuse potential that can lead to severe physical dependence.

    With its vote, the advisory panel is suggesting that hydrocodone be moved from its current classification as a Schedule III drug — a drug with moderate abuse potential — to a more restrictive Schedule II classification.

    Among a wide field of potent prescription painkillers — which the Centers for Disease Control and Prevention says are fueling an epidemic of abuse in the United States — hydrocodone may have been flying under the radar among doctors.

    “Most doctors are under the impression that Vicodin (whose main ingredient is hydrocodone) is less addictive than other prescription painkillers,” said Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing.

    “When you wonder why your dentist gives you 40 hydrocodone for a toothache, or your knee doctor prescribes far more than he should, that’s because they’re under the impression that it’s not addictive as Percocet. That’s completely false.”

    Concerns about generic painkillers increase

    The panel’s advice, if adopted by the FDA, would limit how much hydrocodone a patient could get between doctor visits. It would also limit refills — from the five allowed for Schedule III drugs, to three, which is the limit for Schedule II drugs — according to Public Citizen, a nonprofit consumer advocacy group.

    But pain patient advocacy groups and pharmaceutical companies, among others, fear that reclassification will make it harder for patients to get medications they need.

    “The FDA advisory committee is considering a proposal that could make it harder for patients with legitimate health needs to obtain essential medications,” according to a statement by the National Community Pharmacists Association, which represents pharmacy owners and employees.

    Hydrocodone is the most prescribed painkiller in the U.S.: 131 million prescriptions for hydrocodone were written in 2010, according to IMS Health, a health care information company.

    That number far outpaces the medical need for the drug, said Kolodny.

    “We’ve had a medical community that has been massively overprescribing the drug,” said Kolodny. “There is very little difference between a hydrocodone molecule and a heroin molecule. We need doctors to prescribe much more cautiously.”

    But it is up for question whether rescheduling hydrocodone will deter doctors from prescribing, or make it very difficult for patients to obtain it, said Dr. Stephen Anderson, an emergency-room physician in Auburn, Washington.

    “You’d like for providers who write prescriptions for it to think twice, you’d like people who use it to think twice,” said Anderson, also a past president of the Washington chapter of the American College of Emergency Physicians. “Unfortunately I think way too many providers don’t draw that distinction very often.”

    Prescription drug deaths: Two stories

    And while Anderson does not wholly agree that reclassifying hydrocodone will necessarily change habits, he says that the move does underline a dire need to change the overall perception of painkillers.

    “Society’s starting to open their eyes that there is a problem associated (with prescription painkillers),” said Anderson. “If you make a move like this…it’s out there in the conversation about this epidemic, and that’s a good thing.”

    An FDA spokeswoman could not confirm when the FDA would act on the panel’s recommendation.

    Reply

  2. I saw a very similar article about it….Thanks for all you do Dr. Burson…..

    Reply

  3. Posted by Benjamin Keith Phelps on February 2, 2013 at 6:07 pm

    Question about the article: Since when could docs put up to 3 refills on a C-II substance? Never known that to be true anywhere.

    This is an aggravating subject for one reason, though. Back in the 80s, docs had been taught to be stingy with opioids when they were in school (presumably the 70s & prior), so many were VERY difficult to persuade – when I was in the hospital in 1993 (a pretty good distance before my addiction to opioids, which started in 1995) with a collapsed lung & they put a chest tube in, then moved it to another location (giving me 2 separate places with a stitched scar), the doc I had at MCV flat out REFUSED to give me anything but Tylenol #3. My parents (& my father is EXTREMELY cautious about taking pain meds, btw) had to finally threaten to have me moved via ambulance to another hospital if he wouldn’t give me something for pain b/c I couldn’t sleep, it hurt so bad trying to catch my breath & from the scars. The lung or the tube was lying on a nerve that made my back muscle (trapezious – spelling??) knot up intensely & immediately. That was actually how I first knew something was wrong – I was in a store & suddenly, my back felt like the muscle just suddenly had a charlie horse, so to speak. I actually had my friend that was w/me to hit me in the back w/his fist (!) to try to make the muscle go down. Well, that knocked the wind out of me & I couldn’t get it back, so then I really went into panic. Anyway, the doc, rather than prescribing something, made the anesthesiologists come up & do it. Point being, my friend in med school told me how they used to teach to be very stingy w/pain meds, as though a person needed to almost be dead before you gave them something.

    Then, in the 1990’s, they switched up & began promoting the generous prescribing of opioids for pain. Then in the early 2000’s, I think it was, the AMA made pain one of the (I want to say) vital signs in the ER (for some reason, vital sign doesn’t seem like what I’m searching for, but if it’s the wrong term, it was that they made pain something that HAD TO be assessed in the ER & treated.) If I’m wrong about that, please correct me. But now, here we are again, encouraging docs to be stingy w/opioids. I don’t want to sound like I’m in favor of not being judicious when prescribing them – Lord knows, they’ve done a LOT of damage to me in my lifetime now. BUT… I DO favor their being prescribed w/out a person having to unnecessarily “do flips & stand on their head” in the ER or at the doc’s office. While I understand that my doc @ MCV might’ve been more difficult than many other docs were at that time, he wasn’t much different than many others I was treated by back then. And I do remember doctors wanting to give you like 5 pills b/c they “didn’t want you to get addicted!!!” A single bottle of 20 tablets is not going to put one on the path to an endless addiction, in my opinion. And I say that from experience. When I was treated back then, both in 1993 & 1994 for the collapsed lung, the latter time being surgery to remove part of my lung that was causing the problem, I was put on Demerol the first time, then sent home with 30 Percocets, then 30 Vicodins, then 30 Darvocets. Then I was given Naprosyn. The next time, I was given Demerol in the hospital ER, then awakened on a morphine pump giving me patient-controlled doses every 6 min. Then I was taken off & given alternating Percocet & shots of Demerol. I was sent home with a similar step-down of medication, only having one bottle at a time of each, just as before, minus the Naprosyn. But I took them as prescribed, & at the end, when they were gone, I didn’t really think anymore about it, b/c I didn’t know how to get such things – they were not yet important enough for me to go out of my way or anything. It wasn’t until 1995 in September, I’d moved to DC & I met someone that dealt heroin, & I knew it would be similar if not identical to the morphine I’d gotten before, so I bought some. THAT’S when I had no limit to my access & went too far & got hooked very quickly.

    I understand some youngsters have access that I didn’t have, even starting out. But I think if the number of tabs are kept relatively low, & the dose amount isn’t excessive (like giving 10mg Percocets to a person w/a toothache), I would imagine the addiction issue would be a bit less. Now obviously, I know that a little more caution is needed in when they’re given at all – but I just worry that OVER-STATING the need for careful prescribing could make the pendulum swing back over to docs wanting to refuse prescribing them at all, except in DIRE circumstances, which is not necessary as it makes people needlessly suffer. My father’s completely disabled, & has been getting 40 Norco 10mg tabs every 90 days since around 1998, never filled one early, never lost a bottle, never asked for more, & in fact, often doesn’t need a new script until WAY after he was due to get one (90 days since last). Now his doc’s being pressured not to give them to him anymore. He suffers needlessly everyday, & that is painful for me to have to watch. His doc’s being told he should change him to Lyrica for his fibromyalgia, but it doesn’t work for my dad. He’s had the highest dose they prescribe! He was getting on average LESS THAN 5mg, 1 time a day. REALLY PEOPLE?? He is at the point where he wants God to take him if he’s never going to feel any better. I don’t want to have to see people needlessly suffer, & I’m SO afraid that will happen if they come at this thing the wrong way.

    Reply

    • Doctors can’t put any refills on Schedule II’s. I don’t think it’s ever been allowed, since passage of the Controlled Substances Act. If I said or implied that in my post, it’s not true.

      Reply

      • Posted by Travis on February 3, 2013 at 6:06 pm

        I don’t know what the laws state, if anything, but I know many DR’s who write and hand out pre-dated CII scripts so patients don’t physically have to return to the office every month or be reliant on the post office. Those who do typically do it for only three months, that could be what is being referenced?

      • Posted by Benjamin K. Phelps on February 5, 2013 at 12:00 pm

        I don’t know – maybe so, but that’s still not REALLY a “refill”, for all intents & purposes. But maybe they meant refill to mean the actual purpose of the post-dated scripts, which is pretty much meant to serve as the same thing a refill would. It’s kind of interesting that the FDA or DEA or both or whatever have now specifically stated that docs may legally do this, yet they refuse to allow refills, even limited in scope. I’m sure I’m overlooking something (probably something easy to see), but I can’t say that I see the difference – letting my doctor who trusts me enough to give me 3 written scripts for the next while (as long as they’re not overlapping by more than a single day or for more than 30 days’ worth of medicine), versus letting him specify on a single prescription sheet that they may give me 30 days’ worth of meds w/2 refills, which again, they automatically won’t fill a controlled substance of any schedule if it’s more than a day or 2 overlapping – & they could easily just make it law that a C-II drug refill can’t be refilled any more than 1 day in advance, just like they have to do w/the separate scripts now. So evidently I’m missing something on that 1….

      • Posted by Benjamin K. Phelps on February 5, 2013 at 10:22 am

        No Dr Burson – I know YOU didn’t – I was responding to Tonya’s post, which stated C-II’s are limited to 3 refills, which I’ve NEVER heard of in ANY state.

      • Posted by Benjamin K. Phelps on February 5, 2013 at 10:25 am

        It was in the 10th paragraph of Tonya’s post above. Also, I should point out that Tonya’s post was not Tonya speaking incorrectly – it was an article she pasted into this thread for reference.

  4. Benjamin Kieth…..its me wayover (DAWG)
    and once again great post…

    Reply

  5. Posted by Travis on February 3, 2013 at 6:03 pm

    I’m thinking a lot of the hype surrounding hydrocodone right now is due to the to-be-released Zohydro, which is going to be a controlled release high dose hydrocodone preparation as Oxycontin was to oxycodone in the 90’s. The mixture of hydrocodone and NSAID’s in 5, 7.5 and 10mg doses I think should remain CIII so Dr’s have some prescribing flexibility, though preparations of full agonist narcotics should have the CII scrutiny attached to them. I’ve personally had along with most people in their lifetimes some legit emergency situations that have been alleviated short-term by quick call-ins of hydrocodone/apap and would have likely had to suffer a great deal if l would have had to jump through CII hoops to get them at the time, so having an opioid preparation CIII makes sense to me. All the restrictions in the world will never completely eliminate RX opioid abuse, though with the advent and hopefully soon-to-come wider spread use of the Prescription Monitoring Plan I think we’ll be a few steps closer.

    Reply

    • Good points all. I’m fairly certain the FDA did not approve Zohydro, and I’ve heard rumors they are unlikely to do so in the future, because of fears of the increased dose of hydrocodone in these pills.
      Amen to the prescription monitoring programs. Live savers.

      Reply

    • Posted by Benjamin K. Phelps on February 5, 2013 at 11:35 am

      Travis, I believe the deal was (even back a year & a half ago, when I first read about Zohydro) that any stand-alone hydrocodone product would automatically be C-II b/c bulk hydrocodone is just like bulk codeine – C-II, that is. Any stand-alone opioid product I can think of that is a full agonist is C-II, no matter the potency. Of course, buprenorphine isn’t, but it’s not a full agonist. The same is true of Nubain & Stadol. If you check out Roxane Pharmaceuticals’ website & look at the list of active products, you’ll find that their 30mg & 60mg codeine tablets are both C-II, despite being a low dose if taken properly (equivalent to Tylenol #3 & #4, though #4 is considered a moderately high dose for codeine, as it’s got double the kick of #3s.) This is all b/c, of course, when given alone (w/o Tylenol or something else,) there’s NOTHING in the world to stop you from taking 20 of them if you’re an addict seeking a nod or a larger effect for ANY reason, including to hold you from getting sick. 10mg codeine products are C-IV, even. But they have to be in combo w/guaifenesin, Tylenol, or some other product. Of course, it’s also true of hydrocodone that combo products are C-III, as well (as we know). Zohydro would not fit in that description, by any means.

      Here’s my thing about Zohydro – aside from the addiction potential & the potential for another wave like OxyContin caused, is that hydrocodone is considered basically equianalgesic for purposes of conversion to other opioids. See any conversion chart. While people’s opinion about how accurate that is varies, my experience has always been that 1 (5mg) Percocet/Tylox/etc. felt the EXACT same to me as 1 (5mg) Vicodin/Norco/Lortab/etc. Again – this is NOT(!!!) to start an argument about whether you agree w/that statement, please. With that being either the case or almost the case to the point of being indistinguishable in pain relief tests by professionals – enough so to make the conversion charts state that they’re equianalgesic, why would we NEED Zohydro?? Now before you are quick to reply that it’s b/c different opioids act at varying levels on the opioid receptors, & thus, work slightly differently & different ones act better for different people, I am already aware of that, obviously, since I just said that here. BUT, hydrocodone & oxycodone are chemically ALMOST identical, w/the difference being VERY minute. I won’t go into the chemistry aspect of it, but suffice it to say that both work by being demethylated into either hydromorphone or oxymorphone in the body. Those 2 drugs are converted down to morphine & a few other metabolites that make for easy identifying in urine tests. Anyway, while there may be VERY SLIGHT differences in the receptors activation levels, it’s HIGHLY doubtful it’s enough between these 2 particular drugs to make putting Zohydro out & risking a whole new wave of addiction due to the street value of them & current addicts probably finding them very easy to find, since many docs, if not most, believe that hydrocodone is safer to prescribe that oxycodone & they believe it’s not as addictive. As we all know very well – WRONG ANSWER, big time. Many if not most of us got hooked playing around with hydrocodone & maybe to a lesser extent, oxycodone, b/c they’re the most popular drugs prescribed in the opioid class? So the risk seems to WAY outweigh the benefits in this particular situation. Were there no OxyContin available (had it never been released into circulation or proposed), I would likely think differently, as it would fill a significant role in treating severe pain, as high-dose Oxy does for those that need it.

      And as a side question for Dr Burson, I’ve always wondered why if morphine is considered the gold standard in painkillers, it’s almost NEVER given outside of a hospital – docs will give Dilaudid, OxyContin, Percs, & Vicodin 1000X over before they’ll ever give morphine. Take MS Contin for example – you never hear of any problem w/it causing a wave of abuse like Oxy Contin did. I was in total disbelief that Oxy caused such a disproportionate wave of problems when all of it began happening, since MS Contin had been out for years. I’m sure it is abused some, but not enough that you’d ever read about it in the newspaper or anything. And actually, Oxy is more potent than morphine, so it’s kind of a double-weird thing that it’s given more, considering docs are supposed to try to avoid causing an addiction whenever possible. It would seem a low to moderate dose of MS Contin would be more appropriate before Oxy Contin would, at least to me. I would not say morphine’s more addictive than most other opioids being used. In fact, it’s less so in some ways, as it causes worse histamine activation (causing severe itching), & I’ve read that it causes more slowing of the digestive system than others. The other question I have is why have I not ever heard of ANYONE being given levorphanol (Levo-Dromoran), which is actually supposed to be very good for cancer treatment & potent, from all I’ve read back when in my active addiction? I’ve read the profiles on it & they said (several) that the potential to cause histamine release was MUCH lower than morphine & others, as well as the potential to cause digestive system problems. Writing about those for morphine above is what brought levorphanol to mind. It’s thought that it can be an SSRI to an extent, working on both norepi & serotonin, so that would also make it be a possibly mild, but still nonetheless, anti-depressant. I would think that could be used to an advantage, particularly w/cancer patients (or terminally ill patients of any kind – or even accident victims that need pain medicine of the stronger variety.) These 2 questions have been the cause of much curiosity – I always want to know why things are the way they are with most anything, or how things work in general. I understand that it doesn’t actually MEAN anything, in reality, to me at this point.

      Reply

      • First, re: levophanol…I don’t know. I haven’t seen it prescribed at all, and I don’t think I ever prescribed it back in my former life as a primary care doc. It’s a great question, though.

        Second, I do see patients addicted and using morphine. It’s probably a regional thing. there are some pain clinics in my area who like to prescribe morphine, and some of that probably has gotten diverted to the black market. I do see it misused. But you are right – it did not cause the numbers of people to be addicted that OxyContin did. I think the main reason for that is OC’s marketing. In fact, the three people at the top of Purdue’s compnay were found guilty for inappropriate marketing. Many general practitioners got the idea that OC was “addiction-proof” when in fact there is no such thing. It was marketed and prescribed for all sorts of non-cancer chronic pain issues, and the risks of addiction were downplayed. In the early and mid-2000’s, we all saw the mess of addiction produced as a result.

      • Posted by Benjamin K. Phelps on February 7, 2013 at 2:06 pm

        You are actually right re: morphine… I didn’t mention that I have seen it given to the elderly a lot, or cancer patients. But in the case of other pain (except, as I said earlier, in-hospital pain treatment), I just have not seen it used hardly at all in ANY of the places I’ve lived since 1995, when I became addicted. I haven’t gotten my hands on morphine during my active addiction more than two times between ’95 & ’02. As for other opioids, I found hydromorphone/codone w/relative ease, of course, oxycodone was also relatively easy. I could get codeine easily online (or here), & all the others including heroin (but except levorphanol) were easy as pie to come up with, even if it meant writing a script for. I always knew better than to write for M.S. or levorphanol b/c w/the former, they’d know something was up, & w/the latter, they’d never have it in stock AND know something was up. It wasn’t easy to pass Dilaudid scripts, but I managed it many times w/o being caught at various places. Part of that also was that I would return to the same pharmacy a month later & continue getting there to play off the “I’ve been here before so I must be a safe bet that someone’s already verified my scripts in the past & all was okay” thing. When OC got to be SOOO over-used, I stopped having anything to do w/writing for that, as I knew it would set off MAJOR alarm bells. Many pharmacies had policies to call automatically for all OC scripts (as some had for Dilaudid scripts, & 1 in particular did for ALL opioid scripts, even the C-III & C-IV’s – I had a REAL disdain for that lady pharmacist, as you’d imagine!)

        But I’ll tell you this – since I don’t want to appear to be glorifying those days by any means (just describing how things were for someone out doing such things back in the late 90’s/early ’00’s) – I am SO elated & relieved to not be a part of that world anymore… And I NEVER want to know that blood-going-ice-cold feeling of when you’re sitting there waiting for a fake script to be finished, & you hear a police radio go off right behind you, ever again. Those days – every 1 of them – were UTTER HELL for me. I lived w/being afraid constantly, either that I’d get caught today while passing 1, or that my paper trail would be discovered & they’d link it to me, since they keep the scripts for 5 years once they’re filled. What I learned the hard way then was that NO MATTER how slick & smart you are, there’s a pharmacist out there somewhere that’s (maybe just) 1 notch slicker & smarter than you are & already has a plan to where you will never see her or any pharmacy employee get on a phone to call the police. I ran into that in Greenville when I passed a Dilaudid script & the manager walked by & the RPh told him that 1 of the printers wasn’t working. He never looked over at me or flinched. It looked as real as anything. He just said okay, I’ll have someone look at it tomorrow (this was in the late evening) & walked away. The RPh sold me the 60 Dilaudid, as she’d done before w/o problems, & smiled & told me to have a great night. As I was walking up front, I saw when the police walked in the front door & I thought “They CAN’T be here for me – NO WAY!! Somebody musta stole something. Until they headed in a bee-line straight for me. I didn’t even make them ask – I just took the bag outta my pocket & handed it to them & let them put the cuffs on. There was no need to try to run – there were far too many there. My car was in the parking lot anyway (the 1st time I parked elsewhere). But you get lazy when you’re getting by w/it. They’d have run every plate in that mostly empty parking lot besides the employees & they’d have known it was me by 15 or fewer minutes later when they saw my Driver’s License pic.

        And I had the great fortune of still being @ 20mg of methadone at the time daily… which is NOT a blocking dose, nor 1 that relieves cravings (I was tapering down w/a private doc). The jail there will not dose felons, but will dose misdemeanor inmates for up to 2 weeks. I got NOTHING. Coming off 20mg was JUST AS BAD as the times I came off 120, 90, & 100mg in jail – long story, but suffice it to say I was trying to keep a friend from being sick 1 of those times, 1 was for filling a script for Lunesta in a different name than mine so I could get it free, as I was addicted to it from a clinic prescription that had been being written for over 5 years, & the third time, I had just gotten to 90mg & still wasn’t yet stable – I’d been on for about 5 weeks, & still hadn’t even learned yet that methadone could really block opioids if I took them on top. I want to be careful to point out that it’s not that the methadone wasn’t working, it just hadn’t had a chance to in 1 case, 1 had nothing to do w/it, & the other time it was working, but I had gotten addicted to another drug besides an opioid from the clinic & thus, had addictive behaviors going on, though my opioid cravings & problems were long since under control effectively. Another long post – sorry. They always seem to run so much longer than I mean for them to once I get started.

      • Posted by Travis on February 10, 2013 at 5:20 pm

        RE: Morphine. I started my addiction career in 90’s Minneaplis with morphine via black-market purchasing pre-OxyContin. MScontin was never as widely used as OxyContin but there was an underground and still is, believe me. When I found myself later in life on my own Pain Management regime, I was on MScontin as well as OxyIR for break-through pain. I personally preferred Morphine to Oxycodone as it seemed to have a longer opioid effect if taken whole, crushed or injected; just goes to show that people even addicts can respond to opioids differently.

  6. Posted by Deborah on June 13, 2014 at 4:54 pm

    Last monthly visit with my pain management doctor, the NP seeing me, said that she would need to reduce the total amount of Hydrocodone pills I can receive per month to 120. a new FDA regulation. Prior to that I was getting 150. Before coming to this pain management I was being given 240 a month, I could take up to 8 a day. Now I’m at 4, however we increased dosage from 7.5 to 10. Next visit I’m signed up to see the other NP who I was seeing before new hire; I’m going to ask her about this. Also, think I will call my druggist and ask him.
    Has anyone else run into this problem?
    So tired of people that aren’t in chronic back/joint pain deciding what’s good for me!!!
    Thank You

    Reply

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