Doc tried to OD me on Fentanyl?

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skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 2/26/2009 6:15 PM (GMT -7)   
I originally posted this as a reply to my "Follow up with new Doc today" post but I wanted to make sure I got some feedback on this so I posted it as a new thread. Please let me know if I shouldn't have done this:


Well, maybe I was being too optimistic again. The doc wants to up my patch to 75mcgs and gave me a muscle relaxer called Baclofen. This will be the third muscle relaxer I have been put on. I had Flexeril to start (super bad heartburn for days) and then Skelaxin after that. The Skelaxin never did anything beneficial that I could tell. He also doesn't want me to take anything for breakthrough. This is going to be awesome.

This might sound like I am just in a bad mood or something but the kicker is that he gave me the 50mcgs patches initially and he wants me to up it to 75... Not a big deal except that he didn't prescribe any patches. I was told by his nurse to cut my 50mcgs patch in half and to apply 1 1/2 patches every three days. The doctor had to be on board with this because he didn't write anything out for 25mcgs patches or a whole new script for 75mcgs. I asked the nurse 3 times if she was sure that she wants me to cut my patches in half.

I always read up on anything I am given to put in or on my body. These patches scared me a little because my father was on Fentanyl when he was towards the end of a fight with cancer. So I knew these were pretty hard core and I wanted to make sure I knew about any problems that may have come up. Everything, I repeat, everything I have read states to throw the patch away if there is so much as a scratch on it. I can only imagine that cutting one in half would be dangerous.

So I asked my pharmacist (he has seen me quite often for the last year and a half) and he told me to NOT cut my patches in half under ANY circumstance. He also told me that there would be a good chance that my wife would wake up with me long dead beside her in bed. He then told me about another customer that had self-prescribed and doubled her dose of the patch and never woke up again. He was very concerned as I am sure he should be. Someone else that was less informed, after being told by a nurse, could very likely cut one of these in half and slap on a full and a half patch. Very, very, very dangerous.

My problem now is that I cannot help but wonder if these people have any idea what they are doing. Can a doctor really help me if they recommend actions that could lead to my death? How could this be so obvious to me and not to my doctor and/or his nurse?

My patches do not have a reservoir of gel in them but I do not think you are supposed to cut them regardless. Am right on this? I don't think it would sound like such a bad idea to me and also have my pharmacist tell me I could die if it was a good idea... I am not even sure how to broach this subject with them tomorrow. All this is aside from the fact that it is almost an hour one way and riding in a car hurts like hell and now I have to make the trip again with no breakthrough pain killers and without the benefit of the upgraded patch. I need to stop now, I am getting way too irritated even typing about it.


Skrape
Fentanyl Patch - 50mcgs, Norco - 10/325 x 4


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 2/26/2009 6:27 PM (GMT -7)   
Skrape,
I don't know for sure about cutting the patch, but considering how strong this drug is and what your pharmacist told you, I'd err on the side of caution. You said you read up on it - what does the manufacturer's website say?

I would also be wondering about this doctor. I can't remember if you've said this or not but is this a pm specialist? Do you have any other options around you?

I don't blame you for being concerned. I hope someone else here can help more.

But I'm here to listen.

PaLady

skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 2/26/2009 6:34 PM (GMT -7)   
Manufacturer says to discard the patch if there is even a scratch on it. Never to cut under any circumstance, etc. The pharmacist even printed off four pages of stuff that says not to molest the patch in any way. There's no way I will cut them in half. I'm just really irritated by the whole thing. Thanks for letting me vent for a bit! At least I can hope that the Baclofen may make some difference.


Skrape
Fentanyl Patch - 50mcgs, Norco - 10/325 x 4


uniquelyme
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Date Joined Nov 2008
Total Posts : 1037
   Posted 2/26/2009 7:24 PM (GMT -7)   
Oh No...Do Not Cut The Patch...It will change how the meds are delivered and how much is delivered!!! I think that nurse has a few of those patches under her skirt, if ya know what I mean??? I would def. call the Dr. and find out for sure what he wants you to do. Be careful

Me.
 
We are all in the same boat...unfortunatley it seems like it's sinking...
 
Rhonda
Post Lamenectomy Syndrome
Hemi Lamenectomy
Spinal Fusion
 
120 mg. Methadone daily
60 mg. Oxycodone daily
Lyrica as needed 

 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 2/26/2009 9:58 PM (GMT -7)   
Skrape,
Vent away! Sorry I missed that you had checked with manuf.

PaLady

straydog
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Date Joined Feb 2003
Total Posts : 13451
   Posted 2/27/2009 12:00 AM (GMT -7)   
OMG-never, never cut a patch in half, your pharmacist was right. In says that in the pamphlet that comes with the box of patches.

Oh, I think you need to see a real dr this guy sounds like a real quack....Susie


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 2/27/2009 12:02 AM (GMT -7)   
Sorry I was so taken back by this patch business. Yes, Balcofen is prescribed for people with severe spasticity, in fact some people with pain pumps have nothing but Balcofen in their pump. By all means try the Balcofen it may very well help you alot....Susie


Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 2/27/2009 12:11 AM (GMT -7)   
Wow, that's crazy. Even if that's not what the doctor planned, his nurse recommended it. If they said it to you, they'll say it to some else and put that person in danger.

Talk to the doc. If there isn't a darn good explanation, I would find another doctor. Will you ever trust him again?

Superdadu
New Member


Date Joined Feb 2009
Total Posts : 3
   Posted 2/27/2009 10:05 AM (GMT -7)   
skrape: No matter what doctor we have we always have to be our own advocate or else have a family member or friend that will be an advocate for us if we are unable to. Doctors should, but can't know everything so we always have to keep that in mind. Tell the doctor about your research and why you did not cut your patches. I think they expect patients to do their own research and should, hopefully, welcome the dialog. When I was trying to reduce the dosage of my patches I cut off tiny strips, but that was decreasing the dose, not increasing it. There are 75mcg patches so the doc should prescribe those for you. My patches decrease my pain quite a bit, but i still have it. They help me manage it and I can increase my activity.

I do so hope the patches will help you. It is such a bummer to have to try all these different medications and try to decide which side effect we can live with. Good luch working with your doctor.

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3610
   Posted 2/27/2009 2:56 PM (GMT -7)   
skrape your pharmacist is right don't ever cut those patches, Fentanyl Patches can be real tricky, so be careful! As for the Baclofen, I have been on it for well over a year now, I take 25mg every 8 hours, I can tell you for me it is much much better than the Flexeril and the Skelaxin. I have a real problem with muscle spasms, everywhere, hands, neck, legs you name it. Baclofen is the only thing that has worked for me, over time I have had to have my dosage increased, but it works! Also as an added side affect and benefit, I have also noticed, that I don't need as much percocet for break thru pain. My Pain doc, said that allot of people have reported that, the Baclofen has also helped reduce their pain. Hope it works for you too!

Good Luck
White Beard

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 2/27/2009 2:59 PM (GMT -7)   
Superdadu, By cutting the patches no matter how you cut them too much medication can get released at one time. Read the pamphlet that comes in the box there is all kinds of warnings about this whether you are trying to decrease them or whatever. If you need a decrease drop down to the 50's. We would much rather have you here than not. Susie


skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 2/27/2009 3:23 PM (GMT -7)   
Well, I called the doc and told them what the pharmacist told me and they wrote me out 5 25mcgs patches. Strange since I have 7 50mcgs patches left and now only 5 of the 25s but I see him in two weeks so it should last me. I didn't get to actually talk to the doc today so I didn't really get an explanation for the whole cutting thing. I am really hoping that between the +25mcgs of Fentanyl and the Baclofen, something will help with the back pain. These patches seem to help when I am lying down or asleep, my back is down to a 3 or so when I wake up. This is more than anything else has ever done. Once I am sitting up for any length of time, the pain kicks right back in again. Even the Norco for BT didn't touch it.

I almost get the impression that this doc doesn't like people on pills. I have seen this before but it was with a pain clinic doc that seemed to think injections would make everything fine again and disagreed with anyone taking pills for pain. I know these injections help a lot of people and I can only wish that I was one of the lucky ones.

I am nervous about only having two Norco left for BT but I do have the extra 25mcgs patch on now so I have my fingers crossed. The back pain is still bad even on the 50mcgs patch after being up for less than an hour. I think maybe I am nervous because I have always had something for BT pain ever since my accident. Tomorrow will be the first day where I have absolutely no recourse when the pain gets bad. I'm going to have to stick with a good soak and lying down with a book.


Skrape
Fentanyl Patch - 50mcgs, Norco - 10/325 x 4


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 2/27/2009 7:46 PM (GMT -7)   
Skrape sure am glad you got the 25's. Have you slapped one on yet? If not man do it, don't suffer anymore than you have to. I would also take my empty boxes in from the 25;s and 50's to show this goof that you did not have the exact same amount of patches in both strengths. This guy is a little scarey. Not only is he a little scarey but under educated in pain medications. Any time a dr or pain dr does not give his patient adequate pain mgt by way of either pills, injections, patches or whatever then they are not doing their job. There is no reason for you not to have BT meds with the patches. Hell, I have a pump that gives me my meds around the clock and my dr says you must have meds for BT. She told me when a pump dr does not give his patients BT meds he is under educated in pain medication and I truly think this is a bigger problem than most of us realize. I think we have let these drs blame it on the DEA and I think that is BS. Its the drs not being educated enough to handle pain medications and their egos are standing in the way. If I did not have a new pain mgt dr I would not be saying this. My gawd that woman has educated me in a very short while. My former dr that had my pump put in had me on such a low dose in my pump and my BT meds were nothing, even tho I complained of pain he said well you are on the strongest medication there is!! That part was true but he had me on minimum doseages,lol. I walked around bent over in pain, so he puts me in a back brace to try to get me upright. I hurt like hell but just accepted it as that is the way its suppose to be. I got use to the pain. My new dr she said she would give me a life back and I believe her. Think about looking for a better dr. Susie Oh and please take the print out from the phamarcy for him to see about cutting patches.


mom9mom
Regular Member


Date Joined Sep 2008
Total Posts : 489
   Posted 2/28/2009 1:34 AM (GMT -7)   
Skrape I just have a hard time with the nurse and or DR. telling you this.I use the patch also and I have heard so much about people O.D.ing on the patch from using to many or from it having a small scratch on it.You really need to talk to the DR. to get this straightened out before someone ends up dead.It is sad that the people on this web site Know more then the professionals.
Lost half of my small intestineJan.2008.Ilieostomy for 5 months then reverst in June 2008,Nerve damage to right leg,part of my right hip bone removed Jan. 2008,Cronic pain,hernia,infection in my back called discites,and depression.Gallbladder removed Nov,2008.Surgery to fuse L3 and L4 vertabra Dec. 31,2008.Mother to 9 kids 7 boys 2 girls and 1 stepson.4 grandsons,9 grandaughters.4 of my grandkids I inherited from my twin sister who passed away 6 1/2 years ago from a blood clot after surgery.God has given me my life back after I almost lost it.Even though its a painful and sometimes hard road to walk I take it one step at a time and give thanks to god for every step I take.


skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 2/28/2009 10:32 AM (GMT -7)   
straydog: Yes I did slap that puppy on as we were leaving Rite-Aid's parking lot! I was pretty bummed that I wasn't able to put on the extra 25mcgs patch the night before. I really didn't even want to deal with the whole thing first thing in the morning. I waited until 2:00pm to even head out to town to pick up the additional Rx. I think I just got to the point where I figured that I have dealt with this for so long, whats another 24 hours? I know this really only affects myself but I really was not looking forward to the 2 hours round trip in the car and then waiting for another half hour in the super-uncomfortable plastic chairs at the pharmacy. I ended up taking my laptop (I am a software engineer so I leave the house more times than not with my laptop under my arm) so I could work and try to keep my mind off of my back. It usually helps to try and get my mind off the pain.

There are a lot of you out here thinking the same way that I am. Maybe this guy isn't the right guy for me. I ended up with him because my old doc gave me the boot (lots of people on here warn people that self-prescribing and taking too many pain meds will get them the boot; it will) and I was desperate to find someone that would help. I ended up in the ER and got his number from the hospital referral line. They told me I needed a doc of internal medicine to help me at all. There were only four docs that fit this bill and that would accept my insurance. So this is how I ended up with this guy. I was getting real bad off (was diagnosed in the ER as having an anxiety attack) and sent away with a two day script for Norco. I should probably mention that this guy was the only one able to see a new patient within two months.

When trying to find someone that could help me, everyone needed a referral. The only way (I think) I was able to get into this guy is because the ER referred me to him. He has since received all my records from my old doc and the hospital, etc. I had a ton of blood work done (ordered from this new guy) and it is more of the same, everything looks great except my cholesterol (super-high) and as a result I am now taking Crestor. No one knows what is wrong with me and I have been told that no one would ever be able to find out what is wrong with me. This is another story all together. Anyway, even if I did try to find a new doc, I would need this guy to refer me, right? Would it not look bad to try and find another doc within a month of starting this one? A while back I made a mistake after a failed (horrific) epidural procedure and took more of my meds. In another post I did state that I told my doc over 3 visits in one month after the procedure that I was taking more of my pain meds than was prescribed and it wasn't until I ran out that he seemed to freak out on me. I still haven't been able to figure that one out but I have learned my lesson. Even when it takes weeks and weeks to see the doc again, you must suffer. In yet another post (lol) I have talked about trying to come to terms with this. I am really worried because any time doctors try anything invasive (non-medication) it makes me worse. This puts me in a hard spot. I have made up my mind that I cannot allow anyone else to put needles into my spine (regular injections, no problem.... just don't stick that thing between my vertebrae!) and I am always optimistic about trying new things but with that epidural procedure, no one believes me that it made my life hell. They all keep telling me that no one has ever had any kind of bad reaction to that type of procedure. I find this hard to believe, I cannot be the first person in the history of mankind that had more pain after a procedure like that.

I think I better stop here, I am starting to veer all over the place. My real question is if I try and find a different doc, I have to tell this guy and have him give me a referral somewhere else right? This has to look bad, like I am shopping for someone to give me drugs. I am on my first 24 hours of the 75mcgs patch and my back is not super-horrible yet. I have been taking the Baclofen now for about 36 hours and cannot really tell if there is a difference. As I said before, I have nothing for BT so I kinda have to deal at this point. I have not been sitting up to work (canted back and to the left on the couch, as usual) so I am not sure how bad it will get when working for hours and hours. I haven't mentioned before that I support five people, me, my wife, two kids and my disabled mother so not working isn't really an option for me. My doc (old one) had said he could write me a note to get me out of work but I had to laugh that one off. I am self employed so I have no sick pay, no workers comp, no vacation, no personal time, etc. I am sure you get the idea at this point. Well, I am sure this was too long and too incoherent so I am going to stop.

I want to thank all of you who respond to my posts and give your advice. I haven't directly responded to all of you but all the input is appreciated! It is just so nice to know that I am not alone in this. My wife is wonderful but I am sure at this point that her eyes glaze over and she gets that 1000 yard stare once I start talking about my back. This is not her fault, she has heard it all before and it is just more of the same. I had gotten the same way when my mother (this is before my accident) was going through her 6 surgeries and was in horrible agony for years. Man! I really need to work on keeping these posts short! Sorry and thanks.


Skrape
Fentanyl Patch - 75mcgs


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3610
   Posted 2/28/2009 12:55 PM (GMT -7)   
SKrape give the Baclofen some time, it is not the type of medication that will work instantly, are they giving you that for muscle spasms? What is your dosage? Over a 2 year period I was started off at 5mg every 8 hours, and worked up to 15mg, stayed at that for a while then had to increase to 20mg, and then up to 25mg q 8hr. which I am at now and have been for quite some time! It has been a Godsend for me for the muscle spasms, but every now and then I will go thru a period that might last for weeks, where it doesn't seem to be helping at all! So it doesn't seem to be a 100% effective a 100% of the time. But that might be just me! I do wish you Luck on this!

White Beard

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 2/28/2009 2:30 PM (GMT -7)   
Skrape,
I'm in a lot of pain today, but did want to say yes, I think you need to be careful about looking for anoher doctor considering what happened in the past - although I do recall your mention of trying to tell your previous doc. But too many docs too soon. YET the info. that was given to you was dangerous. You said this guy was an internist. What are his pm credentials? Board Certified? There may be a reason why he was the only one you could get into in a couple of months.

First, I would definitely do what you did for yourself this time - second check everything he perscribes, meds. instructions, etc. with your pharmacist. Fact is, maybe your pharmacist can give you some ideas about how to handle this - and perhaps ideas of other doctors who know what they're doing. Then maybe you might be able to move slowly in the direction of another doc. By slowly I mean sort of clearing a path for yourself so it doesn't look like you're doctor shopping. Again, that pharmacist seems like he could be a good resource.

Sorry I can't think of more at the moment, but I think you'll understand.

PaLady

skrape
Regular Member


Date Joined Feb 2009
Total Posts : 141
   Posted 2/28/2009 3:20 PM (GMT -7)   
White Beard,

He started me on 5mg Baclofen every 8 hours. He did mention that they can up that to 80mg (maximum) eventually, depending on how I handle it. I do want to clarify that he wasn't talking about increasing it very much very soon. My next appointment is in two weeks to recheck and see how I am doing with the increased patch and the Baclofen. He prescribed the Baclofen for muscle spasms even though I told him that I wasn't having muscle spasms that I can tell. Maybe he thinks general muscle tension is making my back hurt non-stop? I don't know for sure. I have read that Baclofen's effectiveness is not thought to decrease over time but the listed withdrawal symptoms if stopping the med quickly sound pretty scary. I hope that will not ever be an issue...

PAlady,

I am trying to be patient and give this doc the benefit of the doubt. There have been a couple of things (patch cutting being the biggest) that I either don't agree with or am confused about. He isn't the type that explains things very exhaustively. I am trying to keep the mindset of he is the doc, and I need to give him a fair shake. I will be double checking everything as much as I can before blindly following orders. I haven't ever had a real problem with trusting doctors but I like to make sure I am not doing anything that will hurt me, even if I am told to. I am going to try out his way for a while before trying to find anyone else. If he cannot find anything that will help, I will try elsewhere.

Also, yes my pharmacists are are really good resource for second opinions and suggestions as far as the meds go. All three of the regular pharmacists at my pharmacy have watched what I have been dealing with second hand and seem to have a pretty good idea of what I am going through.


Skrape
Fentanyl Patch - 75mcgs


mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 2/28/2009 7:18 PM (GMT -7)   
Skrape,
I'm also on fentanyl patches, a bit higher dosage than you are on...but I have never , ever read anywhere that you can cut those patches, even the ones without the gel reservoir, are not supposed to be cut. That nurse is nuts and there is no way that she should get away with telling a patient just to cut them, and stick them on. She could have killed you!!! That's why she's a nurse and not a pharmacist....not that I am getting down on nurses, most of them are very professional and would never advise a patient to cut anything without confirming it with the doctor first....this one that you were dealing with, needs to review her meds again...
As far as the baclofen goes, I am also taking that. It does take a few days for it to kick in...and just so that you know, do not ever stop taking it cold turkey. If you ever stop it, or change to another med, you have to taper down or it can cause some problems for you.

Good luck with the increased pain meds and new muscle relaxer. I hope they bring you decent pain relief.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 3/1/2009 5:27 AM (GMT -7)   
Hi Skrape,
 
You are right, I totally forgot about the other dr giving you the boot. Sorry. Well, like you say for now sort of ride it out with this guy and see where it goes. Use your pharmacist on checking any new meds given to you by him. Now, I really wonder if the nurse even talked to the dr about your patches and I now wonder if she offered her words of wisdom on her own about cutting the patch in half. I do hope you will address this on the next appt with your dr. If she did not speak with him, then he needs to know what kind of medical advice she is passing out to his patients. Please take your printout from the pharmacy with you to the next appt. Old bat she may cause someones death if she is practicing medicine on her own.
 
Yes, you are right about the referral thing. But, now I have not ever heard of needing a referral for a internist before. My PCP is an internist and when I switched to her I did not need a referral. But, I also know you needed to see a dr now, not next month. Maybe now that you are established with him it may get better who knows.  Don't forget to remind him you have less 25mcg patches than the 50's or do I have it backwards? I do know too, that your dr can have you change your patch every 48 hours instead of 72 if he is willing to do this. Alot of people only get 48 hours worth of relief. I know when I was on Fentanyl patches my first 2 days were good, but the third day was rough and by the time I could change the patch I almost felt like I was going into withdrawals. So, I do suggest being honest and tell him how long they are lasting, if you are only getting 48 hours of relief and maybe, just maybe he will switch them to 48 hours. Problem we run into is drs are under educated in pain medication.
 
Give your Baclofen some time. It primarily prescribed for patients with MS, because it is not only a muscle relaxer but works on spasticity too. After taking a fall here at home my old pain dr put me on Baclofen for 30 days because I had such severe spasms and after the 30 days I went back to my Zannaflex. It really helped me and yes you do have to be tapered off of it. You may think you aren't having spasms but I bet you are. They can really cause some pain thats for sure.
 
Who knows, this guy may end up referring you to a pain mgt dr if he see's you are not getting better. You are right, you don't need it to look like you are dr shopping.
 
Hope your meds will kick in & start working...Susie

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