Okay, since you’re clearly unable to defend what you’ve said, let’s play spot the differences, “big guy”:
Compare that bit of nonsense to the following:
None of those quotes are anywhere close to what you said in your first post. They don’t even imply what you said in your first post. None of them contain any anecdotes, nor do they project anything onto the people they are responding to. The fact that you think they support you comes across as a hilarious joke to anyone reading along.
None of them said a family member was a junkie.
None of them said the OP was probably a junkie.
None of them said its right for people in pain to have to suffer.
Try again.
OP, I’m going to second the pain clinic recommendation. Not only for access to Vicodin/Norco/Lortab, but for other, more effective and long term pain relief options, like Physical Therapy, TENS, acupuncture and other pain management techniques, especially for your dad. It’s work, yes, but it’s work that will make him feel better and stay healthier in the long run. I’ve had several patients whom I’ve referred to pain clinics and they’ve gotten so much better that I’ve had to discharge them from my services (home health nurse) because they’re no longer impaired enough to warrant my care. Those are the best discharges ever, and they don’t happen with long term painkillers alone.
If they’re on plain Medicare, pain clinics don’t need a referral from their primary care provider, but they’ll ask for one anyway. If the doctor is willing, it’s easier to get a referral, but it’s not mandatory. (If they’re on an HMO “Medicare supplement” plan, they’ll probably need that referral.)
In the meantime, ask their doctor(s) if they can take two extra strength Tylenol or a combo of Tylenol and ibuprofen instead. Most doctors will okay it if the patient doesn’t have liver problems, and studies have shown the pain relief from one of those options is very nearly as effective as hydrocodone/acetaminophen combos. One of the reasons doctors don’t like hydrocodone has nothing to do with addiction, it has to do far more with the fact that it’s just kind of a crappy painkiller.
No, please don’t. We’ll probably get a link to the 3rd page of Shel Silverstein’s The Giving Tree, only to receive incredulous responses when we don’t know what the hell he’s talking about.
Find a new doctor. Sure, try the pain clinic doctors. They may help. But find a new GP, too. I would not put up with a doctor running tests on me behind my back. Have your parents ask around amongst their friends to find recommendations. They don’t have to get into a whole thing about why they’re changing. They can just say they think your current doctor runs too many tests. They should be clear with the new docs, though - no running tests without being upfront about it.
Ahh - yes - I see your point, it would piss me off too, but there isn’t much you can do.
Not sure if you realize - or your parents do - how valuable the drugs are for diversion purposes. There are people out there scamming docs and literally making 10s of thousands of dollars a month reselling just their own pain meds (granted - usually they have to see more than one doc). They aren’t trying to see if your parents are “clean” - they want to see that your parents are taking the drugs (and not reselling them). Not sure if that makes you feel any better (they are testing also to make sure they aren’t doing other types of drugs - but that isn’t the main reason).
Drug testing and pill counts don’t really protect against the savvier people - as you can always just go on the pills a few days before - and hold back a months worth so you can pass the pill counts. From the docs point of view - it is the poor people that are most at risk for selling their pills. In many neighborhoods - the drug dealers know who are taking the pills (word of mouth - “Johnny has been in an accident”) - they get approached - and are offered pretty good money and have virtually zero risk of being caught (they sell to the same dealer every month). There are plenty of “white bread” people getting an extra thousand a month or so reselling some of their “extra” pain pills - to “help out” - well people like our parents.
ETA: FWIW - 3 pills a day of hydrocodone wouldn’t be worth thousands - at the most it would be $30 a day street value - which of course they would get less from the dealer.
I’ve posted this before, but here goes again.
Note that this approach includes a mechanism for prescribing opioids for select patients who fail other pain control interventions.
Opioids are the oldest effective pain pills.
There was, back in the early 70’s a 19th century riverboat found with its load of “patent medicine” intact. Opium in alcohol.
It works. I am highly tolerant to all pain killers - for many years, the only 2 analgesics which I knew to work were Vicoden and Demerol.
I developed Osteoarthritis in 2005 and was in excruciating pain for a year. The 5/500 Vicodin stopped working.
I was moved up to Dilaudid. Eventually, the script was for 240 4mg.
New doc put me on MS Contin 45mg P.O. 2x, 75mg at bedtime.
I want Lunesta (puberty-onset insomnia). My insurance refuses to cover it. I now use 2 different benzodiazepines for sleep.
Yes, my insurance prefers I mix a benzo with my morphine.
I get a few hydromorphones a month for breakthrough pain.
My pharmacy is starting to pull in: hydromorphone.
Not the morphine, not the benzos (although I did need to explain to the pharmacist 7 times that I knew what I was doing and did not mix the sleepers).
I can see this going fatal eventually - if I suddenly start reacting to my bedtime cocktail like a normal person.
I don’t see that happening.
The idea of a doc refusing effective medication to the elderly is obscene. Unless a script suddenly causes a spike in the availability of a diverted drug on the local market, I see no justification.
We have a discussion going on on another board (well known here) about patient satisfaction surveys and their likely results.
One of the Q’s was “How well did they manage your pain?”.
Anybody see cross-currents here?
I hope you’re not taking Dilaudid and hydromorphone together.
They’re the same drug.
Umm… I’ve been on this stuff for 5 years, yes, I’ve gotton 'scripts using both names.
I’ll go one better MS Contin is morphine sulfate in an extended-release formulation.
I used both terms so the max number of people would see a name they knew.
Try this cocktail sometime: 16 mg dilaudid x mg Ambien, 8 oz 50% EToHl.
It used to be triazolam.
Now it’s morphine, mirtazapine, and temazepam at bedtime.
Do you mean ETOH? No thanks, I’m rather fond of breathing. 
I don’t doubt that you’ve been given scrips under the brand name and generic. I just meant I hoped you weren’t taking meds out of one bottle marked “Dilaudid” and another bottle marked “hydromorphine” and taking, day, 16mg of each if your 'scrip is for 16mg of hydromorphine at a time. 'Cause…ooops! But I do see it all the time when I’m doing medication reconciliation. People, especially people on opiates, sometimes get confused when their labels change, and end up taking way too much of something, not realizing the two bottles have the same thing in them!
And then there was the guy last week who was out of his painmeds for two weeks (no $) and when he got them, decided the pain was so bad he’d take 11 at once. :eek: That was an ambulance call. He didn’t realize, I guess, that 2 weeks without them was enough to lower his tolerance so that breathing became optional at that dose. I didn’t quite have to do CPR, but he had to be carried out to the ambulance because his legs wouldn’t hold him, and his head lolled at just the wrong moment and smacked against the doorframe rather hard…wonder if they’ll give him pain meds for that. :smack:
Yeah - the opiates x alcohol is a recipe for suicide (in usedtobe’s case - twice the maximum amount you can even get as IR x twice the legal limit driving (for my weight)). Dilaudid is considered by some to be the most potent opiate available - for humans - 3-5x stronger than heroin. Combine that with alcohol (both of which can cause you to stop breathing) - would be very dangerous - especially for someone that never has done opiates (or has only done hydrocodone). Add on a benzo like temazepam - and you might as well just play Russian roulette each night.
Opiate x Alcohol x Benzo is much worse than just more opiates.
No more EToH for this boy, and:
Caution! Kids - trained professional seen in this case! Do NOT attempt this at home!
I’m not foolish enough to jump into the new med at full dosage, and I personally check each bottle’s content before leaving the store. That makes 3 people looking at them (the first 2 had to count them).
I have more horror stories of my battles to get to sleep, but I"ll let them slide.
Yes, I know morphine will suppress breathing - I watch this. If there is any adverse reaction - I have yet to take a dose which actually FORCES me unconscious - I can remain awake (and often do - which is why I have 2 sleepers) even with this cocktail.
I assume you are being tongue in cheek here. Of course you haven’t found a dose that both induced unconsciousness [and stopped your breathing] - you wouldn’t be here if you did :).
You can have one without the other, and I’ve experienced the breathing stopping - very odd as I had to actually force myself to breath. Pretty scary - as if I had been asleep - well I suspect I wouldn’t be here.
No trained professional recommended you take twice the legal limit of alcohol with your opiates. You yourself admitted you told your pharmacist seven times (inacurately) that you weren’t taking the sleeping pills with the opiates (ambien is ok). Obviously you aren’t fully listening or following what they say. I know how much it sucks not to be able to sleep. I don’t blame you for what you are doing, but checking what is given to you pill wise is not the same as following the recommendations of the docs. If you’ve been on opiates as long as you claim - you probably can recognize the pills by sight anyway unless they change manufactures 
I too haven’t always followed what they tell me to the letter, but I am fully aware of the risks - and willing to take the risk of dying in order to sleep sometimes.
I assume you are being tongue in cheek here. Of course you haven’t found a dose that both induced unconsciousness [and stopped your breathing] - you wouldn’t be here if you did :).
You can have one without the other, and I’ve experienced the breathing stopping - very odd as I had to actually force myself to breath. Pretty scary - as if I had been asleep - well I suspect I wouldn’t be here.
No trained professional recommended you take twice the legal limit of alcohol with your opiates. You yourself admitted you told your pharmacist seven times (inacurately) that you weren’t taking the sleeping pills with the opiates (ambien is ok). Obviously you aren’t fully listening or following what they say. I know how much it sucks not to be able to sleep. I don’t blame you for what you are doing, but checking what is given to you pill wise is not the same as following the recommendations of the docs. If you’ve been on opiates as long as you claim - you probably can recognize the pills by sight anyway unless they change manufactures
I too haven’t always followed what they tell me to the letter, but I am fully aware of the risks - and willing to take the risk of dying in order to sleep sometimes.
ETA: perhaps you are saying they approve your current non-alcohol related cocktail. Which is believable. It is still risky - and at some point if you are increasing doses in the future - or lose some of your tolerance - it may be 1mg too much. You can’t really “watch out for” it. You can gradually ramp up and stuff like that, but one day you might go too far.
My husband was just referred to a pain clinic, and at his first appointment the first words out of he nurse’s mouth were “We don’t prescribe any kind of medication. All medication will come from your primary care physician.”
Is this unusual? We had never been to one before, so what do we know? The doctors do procedures and may recommend things, but do not prescribe.
This. Why would someone continue seeing the same physician if they were not satisfied with the results?
I told the pharmacist that I was not taking BOTH SLEEPERS simultaneously.
The instructions on the morphine say 3x daily and the sleepers (benzo’s) are, obviously, at bedtime.
2+2=4; 3x daily + bedtime, based on an 8 hour sleep, puts the final morphine at bedtime, doesn’t it? I didn’t need to lie to anyone - there was no Q that those were being mixed. and I have never been questioned. Don’t accuse me of lying - it really is not a nice thing to say - especially when it is you who are having reading comprehension problems. And never make that accusation without independent, factual knowledge
The major point is that I never lied about EToH - and was prescribed hydromorphone and various benzos even when I was still using (it and diphenhydramine used to be able to get me asleep).
While in withdrawal, I was taking an opiate, one benzo for sleep, and another - Ativan, aka lorazepam for withdrawal.
I was not being tongue-in-cheek; if the drugs rendered me unconscious, my attempts to watch for breathing problems would have been useless, wouldn’t it?
It is probably this silly thread which caused me to not sleep last night.
You owe me 30mg temazapam.
Dilaudid - small, round, white pill with a “4” embossed.
MS Contin, 15mg: (Ellipsoid, but round) blue
MS Contin, 15mg: (Ellipsoid, but round) burgundy
I have seen two different manufacturer’s take on the MS Contin - they are both the same shape and color, but one is much larger than the other.
It is my understanding that all 'script drugs (at least in the US) are standardized as to shape, color, and markings.
Nope.
If it were some licensing thing, I’d expect my mother to have been taken off of hers. She’s had breakthrough pain forever. Then again, I have a doctor who cares more about his patients than his license, and who has no problem working with regulations in order to get what he wants. If he runs into any problems, it is always the insurance companies. I think many doctors are just too scared to do what is right. Or, at least, too scared to admit to patients that they are willingly following guidelines instead of being forced by them.
There is a huge problem with people seeing studies that say that something is unreliable or doesn’t work for everyone, and then extrapolating that no one should be able to try it. It’s why my dad’s narcolepsy is so bad, even though having twice the dose of Provigil had pretty much cured him. There’s no way the large amounts of caffeine he has to ingest is safer than letting him try two pills instead of one. But because the efficacy for that much was not established in a general population, he can’t have it. His insurance won’t cover it, and, even with insurance, it’s ridiculously expensive.
It bugs the crap out of me seeing science misappropriated like that. It is a logical flaw to think that what applies to a group in general applies equally to the individual. If something is working for an individual patient, the studies shouldn’t matter. Sure, the doctor can ask the patient to try something different, but should not have to force them. If mom and dad want to take the risk of complications, then let them. If they’d rather try other things, that’s fine.
No doctor has the right to go behind a patient’s back and do things. That’s the type of thing licenses should be revoked for. The patient, not the doctor, is the ultimate decider for their own health.
And I still suspect the whole thing is more about addicts than what Qadgap said. And if they really cared about addicts, they’d be helping them by creating a bunch of detox clinics, rather than cutting off their supply. It’s not like meth and pseudoephedrine, where the drugs are needed to make the street form. Addicts will just go back to using the street medicine if the prescriptions are made too difficult. At least with the prescriptions, you can monitor people who might be taking too much.