Oxycontin works really well for 35 year old divorced single mothers of 2-3 young children, who are depressed, anxious, on disability, morbidly overweight and non-compliant with most other medical management and use it to cope....
other than that, i think it is useless..
Fentora is a useful drug for hospice. Same with Actiq.heroin is just as legitimate as oxycontin... it just gets morphine to the brain faster...
why would fentora be legitimate when the intent is the same as heroin?
i believe heroin is still used in Great Britain as an IV analgesic intra-and post-operatively.
110 posts as a med student, and you ask a ridiculous question in a baiting format.
Ask the rest of the question or provide context.
All pure agonists are the same. Oxy has streetability.
Go browse opiophile.org and see what people like more than Oxy these days.
Because at this point you know nothing except what the media has fed you, and you've listened to posts that all should have been in Dark Orchid, you completely misunderstand the point being made.Dude, this is a *student* forum. I can't help it if you all are bigshot attendings at your own private practice clinics comparing golf club memberships. One day I wish I could get there, but until then, I have nothing to contribute except actual medical questions, since I am (wait for it) a student doctor. Not trolling - MD/PhD and just matched.
So far:* Difficult post-op who can still eat (pre-duragesic)
* Outpatient: none except MS Contin, Kadian, Embedda, Duragesic 50, Fentora, Actiq
* Don't prescribe Darvocet and Demerol bc their byproducts are toxic TOXIC.
* Methadone unpredictable
* Supplemental income
I don't see any clinical scenarios/vignettes for where it could be used other than cancer pain. Yet it's one of the most prescribed drugs ever, probably due to a lot of abuse still, but some of it has to be "legit". Therefore I'm asking circumcstances where you as practitioners would feel comfortable prescribing this for a few weeks/months/years.
OK buddy, now we are getting somewhere with this, we just needed some clarification. I don't rx Oxycontin at all. It has a very high abuse potential and has a very high street value. Are any of the other long-acting opioid formulations any more appropriate for prescribing? My opinion is no, but the argument can be made that there are other long-acting opioids that are less likely to be abused than oxycontin and the street value is not as high.I don't see any clinical scenarios/vignettes for where it could be used other than cancer pain. Yet it's one of the most prescribed drugs ever, probably due to a lot of abuse still, but some of it has to be "legit". Therefore I'm asking circumcstances where you as practitioners would feel comfortable prescribing this for a few weeks/months/years.
This is a public forum. You could be a student, but you could equally likely be a drug seeker. If that were the case, what you could be looking for is an MD/DO to provide you an appropriate scenario you and your colleagues could then present to the next unsuspecting PCP you visit when you doctor-shop to obtain narcotics. So please don't take offense or call us names, but rather understand why we are gun-shy when someone basically asks what story can I tell to get a script for oxycontin?Therefore I'm asking circumcstances where you as practitioners would feel comfortable prescribing this for a few weeks/months/years.
I agree with you, but that seems to be a point of contention on this board.Long-acting oxycodone is a third-line choice because it is very euphorogenic---hence it abuse potential. Oxycodone metabolites are active at dopamine receptors. I've had very reliable chronic pain patients ask to be taken off of long-acting oxycodone because it re-activates cravings and makes them feel "high" which is exactly the reasons others seek to abuse it...
I think the question is, whether or not you think a patient can control him/herself and self-manage their symptoms day-to-day (activity restriction/modification) without overusing their medication, because they will develop tolerance.I'm *starting* fewer and fewer patients on long-acting opioids now than 3 years ago. I'm finding that small amount short-acting (even if required daily) is better than starting opioid niave patients on LA therapy
They are paying too much. Max should be $7k for 90x80mg. Most folks can deal it out for $5k- 1 buyer less risk, less profit. Pure capitalism, with commensurate risk of jail, death, etc.... not to mention that an 80mg of 90 tablets of oxycontin can generate about 6k in profit per month.... at least according to one of my patients...
Agreed. I meant terminal cancer pain. I had a lady with metastatic breast Ca as a resident with cauda equina syndrome. She was in horrific amounts of pain. She could get what ever narcotic she wanted for me during her last weeks of life.jabreal00 ---- you have to be careful w/ the use in cancer pain as well.... there are a few cancer patients who get hooked on the stuff or start selling them to supplement the income.... this is primarily in non-terminal chronic cancer patients (remember that breast cancer patients can now live 10-20-30 years after their diagnosis).
24 hours.I'm a pre-med biomedical engineering student and I was sort of trolling through here out of general interest and have seen the several threads about the dangers of long term opiate painkillers.
What about the dangers of long term NSAID use? I know something like 1200mg/day is the initial treatment for various back/neck/joint pain. Recently I feel like I have seen ton of specials on TV about "dangers of NSAIDs" and the warnings on the bottles are getting bolded/highlighted. So how long can you manage someone's pain with 800-1200mg of a NSAID before you start having to worry about the various side effects?
I have a couple follow up thoughts because I find the whole idea of risk analysis for prescribing medications to be interesting. Coming from engineering school expected there to essentially be something like medication risk analysis actuarial tables, equations or computer models that could quantify risk based on variables like age, health conditions, BP, etc. But it seems accessing risk is more based on general guidelines with some hard and fast rules thrown in and then its up to physician's judgment. (I figured if they can develop models to estimate numerical risk for a chemical plant or stock-market, why not a person?)24 hours.
We (are supposed to, I do) warn patients when we prescribe NSAIDs, either OTC or Rx, about the potential side effects, such as nausea, reflux, peptic ulcer, elevated blood pressure, MI and CVA risk, kidney damage. Any of these can occur in any patient regardless of age or health.
The old thoughts of only worrying about elevated BP in older patients is changed by the fact that HTN is occurring more and more in younger patients, especially in the obese. Last year I had a 22 yo have 130/75 BP initially, 3 months later it was 165/95 on nabumetone.
Ulcers can occur at any age. They can and do kill people.
NSAID-induced nephropathy is more common in older individuals, making NSAIDs relative contraindicated after age 70 (controversial). I've never seen it in a young person with normal initial kidney function.
800-1200 mg of "NSAID" depends on the drug. They all have different doses. 1200 mg of piroxicam would probably kill most people. 1200 mg salsalate probably wouldn't touch much more than than a minor ache.
So the answer is "it all depends" like most things in medicine. In general, I use them for 2 - 8 weeks and then see if people can go off them.
If you have to go long-term, celecoxib is probably the safest (also controversial).
Yeah it would be helpful. I think part of the problem is research. There aren't enough studies looking at the various NSAIDs that address all of these questions... duration, numerous patient variables etc. It would take forever to conduct enough studies to be able to develop a risk stratification analysis that could be factual. We know some stuff but a lot is extrapolation and anecdotal.
However, I've wondered the same thing. How long can you keep someone on an NSAID before the risk of complications outweighs the benefit. I think too many patient variables are involved to make a general blanket statement. Tenesma where did you get 2 yrs for a young patient. Not that I disagree. Just wondering if there is any literature supporting this. And PMR4MSK, where's 24 hrs come from? I assume you're basically saying the risk is there from day one
I have a couple follow up thoughts because I find the whole idea of risk analysis for prescribing medications to be interesting. Coming from engineering school expected there to essentially be something like medication risk analysis actuarial tables, equations or computer models that could quantify risk based on variables like age, health conditions, BP, etc. But it seems accessing risk is more based on general guidelines with some hard and fast rules thrown in and then its up to physician's judgment. (I figured if they can develop models to estimate numerical risk for a chemical plant or stock-market, why not a person?)
For, example my healthy 21 y/o friend had really bad back pain and goes to PC provider. Doc says to take 4x800mg Ibuprofen/day and that its "safe" to take the dosage as long as its not for "too long".
It seems like given the fact that so many statistics and records are kept regarding medicine there should be some computer program where you could type in "21 y/o, male, BP: XX/YY, weight: ZZZ,etc." and then by comparing with some statistics data base it would show an approximate numerical risk of different side effects based on the duration of treatment. I know it sounds like a tall order for a computer program, but insurance actuaries have done analysis that seems somewhat analogous to this for a long time even without the massive computing power of today's computers.
Does this sort of analysis exist in medicine today? Would it even be helpful or change decision making if you could "put a number" on someone's risk?
Ok, we'd like that, but still would not know exactly what to do.
Say the data is crunched and shows for a particular patient, he has a 1% of an ulcer with 7 days of use of ibuprofen, 10% with 30 days, 15% with 90 days and 18 % with 180 days of use. How long should he take it? Depends on your risk tolerence. The curve is complex.
What you propose is what we do heuristically in our heads based on limited data available and our years of practice. And we try to cover ourselves for when we get sued.
If I give 1000 people an NSAID for 30 days, some of them will get ulcers - let's say 5% (50). Of that 50, probably 25% will end up in the hospital and a few of them may die of complications from GI bleed. Some of the survivors may sue me. Some of the non-survivors' families may sue me. How many? Which ones?
Do I not give NSAIDs at all since I may kill someone and/or be sued for it? Do I risk-stratify and only give it to low-risk individuals? Does the patient take on any of the liability when I advise him of the risks?
Just delurking to comment: there was a MA which showed that with respect to CV risk, naproxen is the safest NSAID.If you have to go long-term, celecoxib is probably the safest (also controversial).
Great!!!!OK buddy, now we are getting somewhere with this, we just needed some clarification. I don't rx Oxycontin at all. It has a very high abuse potential and has a very high street value. Are any of the other long-acting opioid formulations any more appropriate for prescribing? My opinion is no, but the argument can be made that there are other long-acting opioids that are less likely to be abused than oxycontin and the street value is not as high.
Why is it so commonly prescribed? There are multiple answers to this. 1) Purdue did a lot of unscrupulous advertising - does it hurt their bottom line if 3.2 million Americans abuse their medication (data from CASA report 2004)? 2) Many docs are clueless about the original indication for oxycontin - terminal cancer related-pain, so they prescribe it in a non-judicious manner. 3) Patients "in pain" will place a huge burden of guilt on docs to prescribe "something stronger for my pain" and will not relent until the doc pulls out the OC rx. 4) Many docs do not have even the slightest clue that the efficacy of opioids for chronic, non-malignant pain is weak at best. 5) Pill mills can make a boatload of cash by catering to abusers.
When someone comes in requesting it, I think of Nancy Reagan and I "Just say no."
Oxycodone is just plain nasty. I've taken it for over 10 years. I control my pain and have never gone up in dosage whatsoever. It seems to be the only thing that works for me, personally. So, I stay away from it unless I've exhausted all my options. I use a lot of herbs and supplements that sometimes help. I use acupuncture, work out religiously, and live a very healthy life style. I don't drink or smoke and am more fit than most my age. (I'm early 30's). It's a shame that all the drug seekers out there can ruin it for people who are truly responsible and don't get a high off of what should be used for severe pain. I am not a doctor but can understand why this drug is so far removed when a patient really is seeking help. There are a lot of honest people out there, I would hope. Just my 2cents.....This is a public forum. You could be a student, but you could equally likely be a drug seeker. If that were the case, what you could be looking for is an MD/DO to provide you an appropriate scenario you and your colleagues could then present to the next unsuspecting PCP you visit when you doctor-shop to obtain narcotics. So please don't take offense or call us names, but rather understand why we are gun-shy when someone basically asks what story can I tell to get a script for oxycontin?
In answer to your question, there is no circumstance where I would initiate use of oxycontin as my initial therapeutic long-acting drug of choice. There are better, safer options with far less abuse potential,
I use oxycodone often because it has less side effects than morphine and/or it is much ''comfortable'' . It is of course a much more abusive drug. When my patients are complaining of morphine/hydromorphone side effects, I can switch them to oxycodone.i only use it for cancer patients or difficult postop patients in the hospital who can still eat....when they cant eat anymore i go to Duragesic....i dont write it for any outpatients that i can think of. The only outpatients i see get MSContin or Kadian or Embedda as ext release opioids. I have one woman on Methadone and one guy on Duragesic 50 who doesnt take anything for breakthru.
Just increase the xanax to 1-2 "bars" QID and the anxiety should go away...Current Medications:
FISH-EPA ORAL CAPSULE CONVENTIONAL 1000 MG, 1 Every Day
MULTIVITAMINS ORAL TABLET, 1 Every Day
CALAN SR ORAL TABLET CONTROLLED RELEASE 240 MG, 1 po bid
DIOVAN ORAL TABLET 160 MG, 1 Every Day
VENTOLIN HFA 60 DOSE METERED, 4 times daily PRN
ASPIRIN BUFFERED ORAL TABLET 325 MG, 1 po QD
OXYCONTIN ORAL TABLET 12 HR 20 MG, 1 po tid
PARAFON FORTE DSC ORAL TABLET 500 MG, 1 Two Times A Day PRN
ALPRAZOLAM ORAL TABLET 1 MG, 1/2 -1 q8hr prn
Specialist: Steven M. Lobel, M.D.
PATIENT REQUESTS: PATIENT HAVING SEVERE ANXIETY ATTACKS AND WHEN HE ASK HIS PHARMACY AT WALGREEN, THEY TOLD HIM IT WAS FROM THE OXYCONTIN. PATIENT IS WANDERING IF YOU COULD CHANGE IT TO SOMETHING THAT WILL NOT CAUSE HIM TO HAVE ANXIETY ATTACKS.
Older patient with all meds by PCP except Oxycontin. Apparently, he is not much for the medication.
Beautiful!versatil... you obviously have a lot of knowledge...
but are you really coming on to this forum to educate board certified, fellowship trained pain specialists on the basics of opioids???
also please realize that probably 2/3 of what we discuss re: pain meds requires a certain amount of insider-scoop from day to day interactions with narcophiles... and it may be difficult for a newcomer to pick up on the nuance and sophistication of the likes of PMR/lonelobo/Mister M, etc...