Nucynta question once again

[epidural man]

A few months back I posted a question about Nucynta -

I have been curious about this drug for some time - and after reading that recent article about opioid metabolism ("The Metabolism of Opioid Agents and the Clinical Impact of Their Active Metabolites" in Clinical Journal of Pain Dec 2011), it became clear to me that I needed to start using it.

Since then, I have given it to 4 people. I heard back from the first one today. It was for chronic groin pain. Anyway, he said it worked better than percocet with much less side effects. That is kinda what the drug company funded studies show as well.

Anyway, my question is this.

Even though the drug is schedule II and hits the mu receptor, I didn't treat it like I do other opioids (i.e...opioid contract signed by him and his PCM, pee testing, etc). DEA scheduling is a joke (how you have a drug in 3 different schedules based on what it is mixed with is BEYOND ME) so I don't really care much about that - but I am worried about patient safety and all that.

So...

When starting Nucynta, are you guys doing the whole opioid contract and huge opioid talk and all that?

Parenthetically, I started my first patient on Opana ER today. We will see how that goes. I think it is a 3rd cheaper than oxy at our institution - that is why I thought I should try it - in addition to the metabolism reasons mentioned above for nucynta.

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[lobelsteve]

You are confusing the science of medicine with medicolegal requirements. Nucynta is C2 and you need to treat it that way. Just because a substance has low mu affinity does not necessarily make it less abusable. Look at cocaine and meth - no mu and highly abused.

DEA says C2 so you say ICAT and UDS.

 

[facets]

I do the same, only because it is schedule 2, I have not as as of yet heard of any abuse. Make sure that long term you put them on the extended release form, because the copay coupons on the IR are only good for 3 months and most (all) of my patients cannot afford the copay on this drug.

 

[facets]

PS it usually takes several years to become aware of abuse and other problems with a drug. Many on the forum have been in practice long enough to remember when oxycontin was marketed as non addictive. There was a tremendous push by purdue, speakers and dinners, drug reps bringing lunch and slides,reps who basically never left your office because they were trying to convince you that oxycontin was the greatest thing ever. Then the abuse cases came to light, then all the tragic deaths. All new drugs are on probation with me for 5 years, thats about hoe long it takes for unseen complications to come to loght. Anybody remember Vioxx?
About the Nucynta I have had some good results with it for those esp who don't like feeling "high" and some cases of dysphoria and nightmares. The company has coupons so that the patient does not have to pay more than $20 or so, they can't use it if on Medicare or Medicaid and nobody can afford this drug without the coupon

 

[Ligament]

I do the same, only because it is schedule 2, I have not as as of yet heard of any abuse. Make sure that long term you put them on the extended release form, because the copay coupons on the IR are only good for 3 months and most (all) of my patients cannot afford the copay on this drug.

When in doubt about opioid abuse, go where to pros go to learn how to abuse opoids, opioiphile.org! Here are a few comments on Nucynta from the junkies themselves:

http://forum.opiophile.org/printthread.php?t=37072&pp=30&page=1

Nucynta?
Printable View
09-15-2011 03:13 PMx31966
Nucynta?
Anybody know anything about these? Are they good? If so what's the street value?
09-15-2011 03:16 PMDr. McKay
Re: Nucynta???
I heard they suck for both pain and euphoria . No street value at all. Maybe a few bucks if someone is desperate and is in withdrawal maybe !
09-15-2011 03:45 PMSpork
Re: Nucynta???
UTMFSE.

Just since you're a girl, I'll give you some answers, lol.

It's weak, and has weird norepinephrine reuptake inhibition, so it causes a strange wired feel.

Did I mention it's weak?

I'd steer clear.
09-15-2011 04:32 PMx31966
Re: Nucynta???
Thanks you guys! And a special thanks goes out to spork for not sporking me.

My friend got these at the doc today and thinks she's about to get rich.. gonna break the bad news.

What would you compare them to? Tramadol? Can anyone compare them to anything more common. Thank you!
09-15-2011 04:37 PMSpork
Re: Nucynta???
Hey, that's mean, I might want to spork you, depending on how you look .

Tapentadol is stronger than tramadol, and lacks significant serotonin reuptake inhibition, however, they are most frequently compared with tramadol.

While tapentadol is considered "potent" as far as pain relief goes, we all know, this doesn't make for euphoria.

Compare fentanyl and oxycodone, clearly the oxycodone is more euphoric, even if it is weak.
09-15-2011 05:37 PMsourcecod
Re: Nucynta???
**** Nucynta.

When I was buying them, I pretty much feel like I was ripped off,
as most of the people I intro'd them to did not become repeat buyers...
unless they were sick as **** and desperate (ie, not looking 4 recreation value per dollar)

http://forum.opiophile.org/showthrea...hlight=nucynta
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TAPENTADOL IS AWESOME
Printable View
10-08-2011 08:05 PMSynack
TAPENTADOL IS AWESOME
So I've recently started a trail of tapentadol - and I have pretty large tolerance (120mg intranasal oxymorphone on top of a 100mcg/hr fent patch every 48 hours). I can snort 120mg of opana er and barely feel a damn thing - but 100mg of nucynta has me feeling pretty good. 200mg has me nodding out.

It's not the best opiate high in the world - and a bit speedy, but it's the only opiate high I seem to be able to get..
10-08-2011 08:14 PMDr. McKay
Re: TAPENTADOL IS AWESOME
This is nucynta correct ?
I was told the pills had no recreational value at all.
My doc even told me the stunk, buut told me he would put me on it if I wanted.
Can they be crushed up or do you have to take them orally only ?
10-08-2011 08:20 PMryan5892
Re: TAPENTADOL IS AWESOME
I'd assume your getting high off these because they aren't really like most "normal" opiates, so less cross-tolerance and what not.

Tolerance raises quick from what I hear but I've never even seen one. I'd like to after reading this, most others say they aren't worth a ****.
10-08-2011 08:23 PMjill
Re: TAPENTADOL IS AWESOME
That sure is an unusual comment for this forum!
10-08-2011 08:30 PMqwertmonkey
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by jill
That sure is an unusual comment for this forum!
yea, I had to do a double take because at first glance I though this was an attempt at trolling...

But glad you're feelin good! Enjoy!
10-08-2011 09:30 PMPrincess Kitty
My dr gave me a sample and I was not impressed. Even if I took it with some oxy or hydro I couldn't feel it. I told my dr it messes with my heart rate and it's expensive as hell. I don't understand why it's a CII.
10-08-2011 10:39 PMJunkette
Re: TAPENTADOL IS AWESOME
I took two 75mg tabs with a little bit of heroin several weeks ago and I couldn't tell in the slightest any effects....

Also you should NEVER snort these, if you do you will have a new definition for the word PAIN. I think they've put something in them to prevent snorting and it burns like mace in your sinuses.
10-08-2011 10:51 PMblinky89
Re: TAPENTADOL IS AWESOME
this stuff was horrible for me....it was like the speedy buzz of tramadol doubled, plus a slight opi buzz....but to get enough in you to get the opi buzz to enjoyable levels, you would put the speedy effect waaay to high and it would take away and good effect. i mean, i wouldnt turn it down in wd's, but i def wont be out looking for them either
10-08-2011 11:21 PMSynack
Re: TAPENTADOL IS AWESOME
I was amazed at first - tramadol doesn't do **** for me.. I guess it's a body chemistry thing... I'm taking them orally and don't intend to inject them. I'm not judging this strictly on recreational value - while it seems to have some IMO it's working pretty well on this nerve pain.


Yes, this is nucynta.


Has no one else had a good experience with this drug?
10-08-2011 11:39 PMjill
Re: TAPENTADOL IS AWESOME
Not by the reports here,...there are several threads on Nucynta or tapentadol (by both names)...and people c/o problems with it or it not working well enough.
12-20-2011 07:19 PMbodytec
Re: TAPENTADOL IS AWESOME
i'm hoping for the nerve blocking effects...
just got sciatica from a pinched disc
12-20-2011 07:38 PMDutch
Re: TAPENTADOL IS AWESOME
Nucynta is ****ing laffs! That **** is just a terrible drug that should have been shelved from the get go. Everytime I took enough to feel high I also got trippy visuals, dry mouth, and couldn't sleep. Grrrreat.
12-20-2011 08:09 PMChipper
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by bodytec
i'm hoping for the nerve blocking effects...
just got sciatica from a pinched disc
You may want to try Epilem (Sodium Valproate) for your sciatica - a great nerve signal attenuator.
12-20-2011 08:23 PMjill
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by Chipper
You may want to try Epilem (Sodium Valproate) for your sciatica - a great nerve signal attenuator.
Chipper, sodium valproate, in the US is known as valproic acid. It it is commonly prescribed as a preventative treatment to individuals diagnosed with epilepsy. I don't think I have recently seen it used for nerve blocking effects here, but I am sure there is some 'old school' that still may try it. It has dangerous side effects of dropping white blood cells, and the marrow doesn't reproduced so it has been years (like 15) since I have been on it. And it was only a week at that, and I almost died. Did end up in the hospital. Although, I did have relief the first few days before I became very ill.


However, it is also prescribed to individuals deemed to be manic and as a preventative agent in individuals diagnosed with Bipolar disorder.
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[epidural man]

You are confusing the science of medicine with medicolegal requirements. Nucynta is C2 and you need to treat it that way. Just because a substance has low mu affinity does not necessarily make it less abusable. Look at cocaine and meth - no mu and highly abused.

DEA says C2 so you say ICAT and UDS.

Umm...

I'm not sure what I am confusing, but....I am confused most of the time so not surprising.

But I don't agree that the DEA/FDA have ANY authority on what has abuse potential. The FDA is probably the most ******ed worst run/shady organization in the government. Marinol is still classified as a scheduled substance, despite there not being any case report, self report, or clinic reporting a SINGLE case of abuse.

 

[epidural man]

When in doubt about opioid abuse, go where to pros go to learn how to abuse opoids, opioiphile.org! Here are a few comments on Nucynta from the junkies themselves:

http://forum.opiophile.org/printthread.php?t=37072&pp=30&page=1

Nucynta?
Printable View
09-15-2011 03:13 PMx31966
Nucynta?
Anybody know anything about these? Are they good? If so what's the street value?
09-15-2011 03:16 PMDr. McKay
Re: Nucynta???
I heard they suck for both pain and euphoria . No street value at all. Maybe a few bucks if someone is desperate and is in withdrawal maybe !
09-15-2011 03:45 PMSpork
Re: Nucynta???
UTMFSE.

Just since you're a girl, I'll give you some answers, lol.

It's weak, and has weird norepinephrine reuptake inhibition, so it causes a strange wired feel.

Did I mention it's weak?

I'd steer clear.
09-15-2011 04:32 PMx31966
Re: Nucynta???
Thanks you guys! And a special thanks goes out to spork for not sporking me.

My friend got these at the doc today and thinks she's about to get rich.. gonna break the bad news.

What would you compare them to? Tramadol? Can anyone compare them to anything more common. Thank you!
09-15-2011 04:37 PMSpork
Re: Nucynta???
Hey, that's mean, I might want to spork you, depending on how you look .

Tapentadol is stronger than tramadol, and lacks significant serotonin reuptake inhibition, however, they are most frequently compared with tramadol.

While tapentadol is considered "potent" as far as pain relief goes, we all know, this doesn't make for euphoria.

Compare fentanyl and oxycodone, clearly the oxycodone is more euphoric, even if it is weak.
09-15-2011 05:37 PMsourcecod
Re: Nucynta???
**** Nucynta.

When I was buying them, I pretty much feel like I was ripped off,
as most of the people I intro'd them to did not become repeat buyers...
unless they were sick as **** and desperate (ie, not looking 4 recreation value per dollar)

http://forum.opiophile.org/showthrea...hlight=nucynta
All times are GMT -6. The time now is 11:21 AM.
Powered by vBulletin™ Version 4.1.1
Copyright © 2011 vBulletin Solutions, Inc. All rights reserved.
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TAPENTADOL IS AWESOME
Printable View
10-08-2011 08:05 PMSynack
TAPENTADOL IS AWESOME
So I've recently started a trail of tapentadol - and I have pretty large tolerance (120mg intranasal oxymorphone on top of a 100mcg/hr fent patch every 48 hours). I can snort 120mg of opana er and barely feel a damn thing - but 100mg of nucynta has me feeling pretty good. 200mg has me nodding out.

It's not the best opiate high in the world - and a bit speedy, but it's the only opiate high I seem to be able to get..
10-08-2011 08:14 PMDr. McKay
Re: TAPENTADOL IS AWESOME
This is nucynta correct ?
I was told the pills had no recreational value at all.
My doc even told me the stunk, buut told me he would put me on it if I wanted.
Can they be crushed up or do you have to take them orally only ?
10-08-2011 08:20 PMryan5892
Re: TAPENTADOL IS AWESOME
I'd assume your getting high off these because they aren't really like most "normal" opiates, so less cross-tolerance and what not.

Tolerance raises quick from what I hear but I've never even seen one. I'd like to after reading this, most others say they aren't worth a ****.
10-08-2011 08:23 PMjill
Re: TAPENTADOL IS AWESOME
That sure is an unusual comment for this forum!
10-08-2011 08:30 PMqwertmonkey
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by jill
That sure is an unusual comment for this forum!
yea, I had to do a double take because at first glance I though this was an attempt at trolling...

But glad you're feelin good! Enjoy!
10-08-2011 09:30 PMPrincess Kitty
My dr gave me a sample and I was not impressed. Even if I took it with some oxy or hydro I couldn't feel it. I told my dr it messes with my heart rate and it's expensive as hell. I don't understand why it's a CII.
10-08-2011 10:39 PMJunkette
Re: TAPENTADOL IS AWESOME
I took two 75mg tabs with a little bit of heroin several weeks ago and I couldn't tell in the slightest any effects....

Also you should NEVER snort these, if you do you will have a new definition for the word PAIN. I think they've put something in them to prevent snorting and it burns like mace in your sinuses.
10-08-2011 10:51 PMblinky89
Re: TAPENTADOL IS AWESOME
this stuff was horrible for me....it was like the speedy buzz of tramadol doubled, plus a slight opi buzz....but to get enough in you to get the opi buzz to enjoyable levels, you would put the speedy effect waaay to high and it would take away and good effect. i mean, i wouldnt turn it down in wd's, but i def wont be out looking for them either
10-08-2011 11:21 PMSynack
Re: TAPENTADOL IS AWESOME
I was amazed at first - tramadol doesn't do **** for me.. I guess it's a body chemistry thing... I'm taking them orally and don't intend to inject them. I'm not judging this strictly on recreational value - while it seems to have some IMO it's working pretty well on this nerve pain.


Yes, this is nucynta.


Has no one else had a good experience with this drug?
10-08-2011 11:39 PMjill
Re: TAPENTADOL IS AWESOME
Not by the reports here,...there are several threads on Nucynta or tapentadol (by both names)...and people c/o problems with it or it not working well enough.
12-20-2011 07:19 PMbodytec
Re: TAPENTADOL IS AWESOME
i'm hoping for the nerve blocking effects...
just got sciatica from a pinched disc
12-20-2011 07:38 PMDutch
Re: TAPENTADOL IS AWESOME
Nucynta is ****ing laffs! That **** is just a terrible drug that should have been shelved from the get go. Everytime I took enough to feel high I also got trippy visuals, dry mouth, and couldn't sleep. Grrrreat.
12-20-2011 08:09 PMChipper
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by bodytec
i'm hoping for the nerve blocking effects...
just got sciatica from a pinched disc
You may want to try Epilem (Sodium Valproate) for your sciatica - a great nerve signal attenuator.
12-20-2011 08:23 PMjill
Re: TAPENTADOL IS AWESOME
Quote:
Originally Posted by Chipper
You may want to try Epilem (Sodium Valproate) for your sciatica - a great nerve signal attenuator.
Chipper, sodium valproate, in the US is known as valproic acid. It it is commonly prescribed as a preventative treatment to individuals diagnosed with epilepsy. I don't think I have recently seen it used for nerve blocking effects here, but I am sure there is some 'old school' that still may try it. It has dangerous side effects of dropping white blood cells, and the marrow doesn't reproduced so it has been years (like 15) since I have been on it. And it was only a week at that, and I almost died. Did end up in the hospital. Although, I did have relief the first few days before I became very ill.


However, it is also prescribed to individuals deemed to be manic and as a preventative agent in individuals diagnosed with Bipolar disorder.
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Thanks!
That was a fun read.

I spent too much time reading some of the other threads though. Holy crap people are interesting and live such a different life than what I am used to and have experienced. God bless the world wide web.

 

[epidural man]

You are confusing the science of medicine with medicolegal requirements. Nucynta is C2 and you need to treat it that way. Just because a substance has low mu affinity does not necessarily make it less abusable. Look at cocaine and meth - no mu and highly abused.

DEA says C2 so you say ICAT and UDS.

What is ICAT?

 

[NOSfan]

What is ICAT?

ICAT (International Cat Agility Tournaments) or ICAT (Informed Consent and Agreement for Treatment) I'm not sure which one he means

But do agree, you need to treat it like your practice treats all C2s

 

[lobelsteve]

What is ICAT?

DEA holds your registration to prescribe controlled substances and Nucynta is a schedule 2 drug. You must treat it as a C2 due to this, despite it's 1/50th MSO4 mu affinity in animal studies (published) and 1/18th in human studies (unpublished).

ICAT: Informed consent and agreement for treatment.

 

[PMR 4 MSK]

Wait until Janssen gets bitch-slapped by the DEA for marketing it as a less-abused or abusable pain drug, in spite of the C-II category. The reps will not come out and say that, but imply it every way they can.

 

[epidural man]

DEA holds your registration to prescribe controlled substances and Nucynta is a schedule 2 drug. You must treat it as a C2 due to this, despite it's 1/50th MSO4 mu affinity in animal studies (published) and 1/18th in human studies (unpublished).

ICAT: Informed consent and agreement for treatment.

I hear what you are saying. But the rules the DEA sets up are lot less stringent than what I typically do.

But correct me if I am wrong, I am sick of looking for it (and I have tried many times), but the DEA does NOT require written contract. They certainly don't require urine testing. I'm not even sure it says you need to have informed consent. In fact I learned today that you can give up to a 90 day supply of opioids.

My point was - I usually go way beyond the requirements when starting opioids (a WRITTEN contract between me, the patient, the PCM, pee testing, visit with me every 30 days, and a bunch of rules on the contract), but I was wondering if people do the same with Nucynta. It sounds like most do.

What schedule the DEA has randomly assigned the drug has nothing to do with it - that was my other point.

 

[lobelsteve]

I hear what you are saying. But the rules the DEA sets up are lot less stringent than what I typically do.

But correct me if I am wrong, I am sick of looking for it (and I have tried many times), but the DEA does NOT require written contract. They certainly don't require urine testing. I'm not even sure it says you need to have informed consent. In fact I learned today that you can give up to a 90 day supply of opioids.

My point was - I usually go way beyond the requirements when starting opioids (a WRITTEN contract between me, the patient, the PCM, pee testing, visit with me every 30 days, and a bunch of rules on the contract), but I was wondering if people do the same with Nucynta. It sounds like most do.

What schedule the DEA has randomly assigned the drug has nothing to do with it - that was my other point.

The DEA has their own set of rules and works directly with the law enforcement arm of your state medical board. They collaborate on legal and regulatory issues with pill mills, pain docs, drug dealers, etc. Your state will have published rules regarding opiate prescribing on the medical board website and a summary of all state rules is found at the Wisconsin Pain Policy Research Center. http://www.painpolicy.wisc.edu/

 

[Jcm800]

i have written Nucynta 2 times, well i mean 2 patients, and I do treat it like any opiate. I think most do.

whether or not it SHOULD be a schedule 2, it is, so i treat it the same as I do all C-2 and C3s...meaning i dont really ever prescribe it, but if i do, its the same song-dance as if it was oxycontin (which i do not have one patient on)

I hear what you are saying. But the rules the DEA sets up are lot less stringent than what I typically do.

But correct me if I am wrong, I am sick of looking for it (and I have tried many times), but the DEA does NOT require written contract. They certainly don't require urine testing. I'm not even sure it says you need to have informed consent. In fact I learned today that you can give up to a 90 day supply of opioids.

My point was - I usually go way beyond the requirements when starting opioids (a WRITTEN contract between me, the patient, the PCM, pee testing, visit with me every 30 days, and a bunch of rules on the contract), but I was wondering if people do the same with Nucynta. It sounds like most do.

What schedule the DEA has randomly assigned the drug has nothing to do with it - that was my other point.

 

[PMR 4 MSK]

The DEA has their own set of rules and works directly with the law enforcement arm of your state medical board. They collaborate on legal and regulatory issues with pill mills, pain docs, drug dealers, etc. Your state will have published rules regarding opiate prescribing on the medical board website and a summary of all state rules is found at the Wisconsin Pain Policy Research Center. http://www.painpolicy.wisc.edu/

But the DEA and State boards can and will change their wording of their "laws"/rules when they see fit to prosecute certain cases.

Simple rule - don't be a pill mill and they will likely leave you alone.

 

[emd123]

I think from a legal standpoint, the DEA considers a scheduled drug, a scheduled drug, and it's best to just jump through the usual hoops.