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Suggesting MedsI would like to know what people have experienced or the opinions of others regarding suggesting of meds to your physician. I have been working in the medical field for over 30 years and a lot of that has been side by side with various physicians. During that time I have learned that some physicians can be rather sensitive to others making suggestions to them as to what they should use (meds or otherwise) when it comes to patient care and yet others more than welcome any suggestions. From the patients side I have been dealing with chronic pain for almost as long and seeing a pain specialist for about the last three years. I do want to say that over this time he has been rather good about the willingness to switch and try different meds and combos to see what may work best. The issue is that sometimes I feel like I would like to suggest something but do not want it to come off like I am there just looking to get certain meds. I think that I have been going there enough and built up a relationship where it shouldn’t make a difference but one never knows. I am interested to hear what others think or may have experienced. I would also like to hear from any physicians as to how they feel as well. Thank you all for your comments. Also, I appolagize if this was a previous post.( categories: Discussion of Prescription and OTC Meds )
Hmm..
I'm trying to get in to my pain mgmt. doctor to ask he change my prescription from hydrocodone to suboxone. I've been on hydro for a few years now, and the last couple years I have been abusing it--badly. Sometimes I take up to 150-200 mg/day of hydro, and I'm afraid the APAP is destroying my liver. So I doctor search on suboxone.com for a certified doctor in my area, and low and behold, my doctor was the only one that popped up within 30 miles of my zip code. So that situation is a real coincidence. I'm scheduled to go in and talk to him soon, and i'm planning on telling him everything and I'm going to request that he use suboxone to help me kick my addiction as well as control my CP. I know that pain mgmt. is off-label for suboxone, but I called the Dr. office and didn't get my name, and asked about it, and I was told that he does prescribe suboxone in pt's struggling with addiction problems. I know the last thing everyone wants to read is another addiction story, but oh well. If you didn't really care, you would have skipped over it and not even bothered reading to this point.... Whatever you do, let your
Whatever you do, let your pain management doctor know what you are really taking. He may kick you out of the practice for violating your contract, but usually you get a pass or two if you are trying to straighten yourself out. My experience is limited, but Suboxone is not great for severe pain in narcotic experienced patients but may be good for narcotic naive patients with moderate pain. It is great for narcotic addiction! Your doctor may put you on a more closely monitored regimen. Weekly visits, one weeks worth of meds, suprise pill counts and UDS. Congratulations on your decision to change! I'll chime in on that too,
I'll chime in on that too, because it takes alot to step up and admit your faults and failures--especially when there is something so big at stake. It is a big thing to step up like that. I'm proud of you. Good job and good luck! I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience. First off let me say props
First off let me say props to Dr.Lois its great to have a real doctors opinion, if you accepting new patients and live in the northeast i would love to get a consul you seem like a really reasonable and good doctor or even you could pm me for some quick advice thanks. Ok now let me get to it. It is a tough spot to ask for meds. From my old pcp i saw him for years before i had pain and he was willing to listen to anything i had and would give me whatever i asked for. My new pain mgmt doctor after 2 months wouldnt listen to me when i asked him to put my on oxycontin, i told him extended release medicines work best for me, i didnt even say the work oxy, but im sure he knew what i was talking about and said those medicines are very good for you, or something similar he indian so his american phrases arent always the best. Ive been going for about 6-8 months now and am thinking about asking the new female doctor there, but its always a nerve racking thing. And if you go to the e.r. you can never ask for something unless you have been there a few times recently for the same issue or know the doctor. Just tell him last time i was here with this issue this medicine and this medicine worked, always say the other medicine first like if they gave you something for naseua, and always stumble a bit on the pain medicine like it was called uhh umm dilantin or umm diladid, hinting at dilauded usually works. But if your there for an injury and your on medicine already tell them what you taking, then tell them you took a double dose and its not working for the pain, they will usually send you home with something stronger for a few days. Recently went to my doc, I
Recently went to my doc, I have a slightly herniated disc and some bone spurs. usually I don't notice it, but once in a while I tweak it badly. Worst ever happened recently, and it obviously pinched a nerve, as my entire right arm had shooting pain which ended in total numbness in my hand. Have a stomach issue, so I cannot take oral anti-inflammatories, NSaid type things, nor can I take anything with aspirin, or any of the Celebrex, Tramadol type alternative pain options. Went to my doc and I suggested pain meds, & told him I was going to a chiropractor. He made about 4 suggestions, including pain meds. We collaboratively decided on an intramuscular shot of Toradol(anti-inflam), and some painkillers. He asked if I am a vic or perc guy, I told him the percs with as little acet as possible...b/c on days when i get sayyyy, headaches, the only pain reliever i can use it Tylenol, so sometimes I get a little too close to that threshold. So he gave me a nice scrip for some 10/325's.
I wish all docotors were:
a)--that collaboarative b)--that cool If you have been a reliable
If you have been a reliable patient for three years, I don't think you will have any trouble. I had someone ask to go on suboxone, they were afraid of addiction, but they had no addictive behaviors, and I talked them out of it, but also said if the new medication didn't work we could consider suboxone again. I had someone ask for methadone, I told them I was not comfortable prescribing methadone because I lacked experience with this drug, but would refer them to someone else, if they did not want to try my alternate suggestion. It really is a negotiation to some extent, and you have to be willing to compromise. My worst patient accepted a script for $700 of Kadian only to bring them back one week later, with the proper number of pill missing saying it wasn't working or it upset his stomach or something asking to go back on oxycontin. I flushed almost $600 of Kadian and gave him the oxycontin script. It was only months later I found out he was going out of state to at least two different states to see other doctors for pain meds. I don't know how much he took versus how much he sold, or how much was for pain and how much was for addiction. I really put an improper amount of faith in his willingness to try Kadian.  Ouch
Sorry about that Dr Lois. That must have hurt you that someone would use you like that. I hope you don't see that kind of manipulation too often. You don't deserve it. I wonder if the Kadian just turned out to be a pill that there was no demand for on the street. I've never heard of it. Again, I'm sorry you had to interface with a person like that. I personally think that it's a good idea for all of us to remain cognizant of the ramifications "to the doc" of what we are asking for from our docs. thelifeline Flushing Pills
Not to step on a doctors toe, but new health reports have surfaced and flushing pills is not an acceptable way of getting rid of them anymore, it will damage water supplies and can kill animals. Im not a big peta fan im a hunter but know that flushing them cant be good. They say now to remove the label as much as possible to hide name and information, and the drug name and fill the bottle with water and toss the night before the garbage gets taken away to minimize time "dumpster divers" have to search for old pills.  Suboxone
I can say from reading the Suboxone website it is not perscribed for pain. It is only perscribed for opiate addiction. I had a little hydro problem but tomorrow I will have my life about 90% back!! I got my first fill of Suboxone today and have not taken a norco since 8 this morning. Tomorrow I will wake up and take my suboxone and feel like a normal person again. I have had 2 friends conquer their pill addiction with suboxone and it worked very well. The most important thing is it eliminates cravings! Your mind is a powerfull thing in the pill addiction war and I cant tell you how hard it is to not want another pill when I try to wean off. Good luck with your search for the right med for your pain. I just hear people on this site talk about sub for pain and just from the website info, thats not it's intended use.  good luck!
Good luck on that opiate addiction! I know about this ALL TO WELL. I have stopped on my own, only to start again. I did the Metahdone thing, but that wasnt a good choice for me. I HAVE to take pain MEDs, so I might as well just wake up and realize this. I will have to take them for the rest of my life. Well, I dont HAVE to - but then I would be in ALOT of pain, so this is NOT a choice for me. But good luck to you, as I know how hard it is. I wish you all the best!
_______________________________________________________ KnightMetal I am not an MD. I know by experience only. Consult YOUR MD 1st! ___ For anyone who cares...
It worked. I went to my pain doc last week, explained the situation I was in, and that I wanted to be taken off of hydrocodone using suboxone as an alternative. He agreed to, but wanted me to see an addiction counselor also. So I went to the couselor yesterday--85 bucks cash--and he said that he would call my doctor however often it took for him (the doc) to keep prescribing suboxone to me. And the counselor said all I have to do is call him every couple of weeks to check in, and he will tell the doc I am having face-to-face sessions with him. The wierd part is he offered to do that at no additional charge. So i go see my pain doctor at 8:00 a.m. and he is going to switch me to suboxone, and i have complete confidence it will work. It did before. Just the pain aspect of it is what worries me. The suboxone doesn't dull the pain like hydrocodone does, so hopefully the doc will have a Plan B, because I'm not sure I do. Going back to the norcos is not an option, but I know that NSAIDS and OTC meds just don't cut it. Maybe I could use something less addictive, like Tramadol. Feel free to comment... mgjh363 in your first post
mgjh363 in your first post you say you where taking 150-200mg hydrocodone a day. How much of that was for pain relief and how much of it was to get high? Once on Suboxone you may find that you wont need any additional medication for pain with the cravings for the hydrocodone being controlled and the analgesic properties of buprenorphine. You may very well be right
You may be right, and I hope you are. I was originally prescribed, before my addiction got out of hand that is, 120 10/325 per month, and it kept my pain in check pretty well. But as my tolerance grew, my doc was not willing, at the time, to increase my dose, so I did it myself. I won't go into the how's and where's of how I compensated for my own dosage increase, but it cost a lot of money. Even that may be edited, I don't know. But once I did, my addiction got away from me very quickly and before I knew it I was taking 15 or 20 Norcos a day, just to avoid WD symptoms. My original pain is still there, but it's like a 2/10 when I have medicine. When I don't, well it's like a 6/10, and my withdraw pain is an 8/10, so needless to say it's a miserable situation. But some of you already know that. So maybe the original pain will be like a 4/10 (maybe just wishful thinking) with suboxone, and I'll just have to deal with it. Dr. Lois--If you were my doctor, what would you do? And please be honest. If you would boot me from the practice, I get it. But if you were to keep me as a patient, what would you prescribe, if anything, with the suboxone? I think your decision to try
I think your decision to try suboxone is a good one. Using suboxone for withdrawal and suboxone for pain are different. For pain, it probably needs to be dosed 3-4 times a day rather than once a day for withdrawal. The dosage for withdrawal is the lowest possible to avoid craving a withdrawal (which can be very low). For pain you may need up to the maximum dosage of 16-32mg/day. Suboxone also has an antidepressant effect which may be beneficial. If you have addiction issues and a pain level of 4-6 but you are still functional, suboxone is an excellent alternative. I don't know what type of pain problem you have, but accessory modalities like antidepressants, neurontin, lyrica, topical lidocaine, NSAID (like aspirin or motrin), tylenol, interventional pain management techniques, and/or a TENS unit can help as well and aren't addictive. Therapy with an addiction specialist or attending a group like narc-anon can help you understand what things can trigger abuse and how to deal with them. For more information on Suboxone you can register to access one of the suboxone training sites for physicians and view the course materials for free: https://www1.buprenorphinecme.com/PageReq?id=2260:27294 |
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