12-06-2004, 19:58
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#1
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Guerrilla Chief
Join Date: Jan 2004
Location: In the land of the little people
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Withdrawal/Detox questions
Since the doc started me on the oxycontin (20mg) I was curious as to signs of detox/withdrawal as well after starting the meds how long would it take for the signs to show after missing a dose?
My problem is that my insurance company can be pricks and does not authorize the refill until the day it is needed. This could mean a lapse of 12-24 hours between doses and my concern is that after 30 days of being on the meds this might present a problem.
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brewmonkey is offline
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12-06-2004, 20:21
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#2
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
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Oxycontin 20 mg is the equivalent of 4 percocet in 12 hrs. since you'll be on it for a sustained period, the pain receptors will down regulate somewhat (become less active) which is good and bad....good, it takes longer to "need" the med to prevent 'withdrawal', bad in that it then takes more drug to give an equivalent analgesic effect....tolerance is the term for this.
As long as you have something for 'breakthrough' pain at your disposal (oxycodone or percocet or the like), it shouldn't be a problem to be off the oxycontin for several days or forever, as long as you are titrating some other med.
Withdrawal occurs after the receptors all up regulate and are no longer stimulated enough to maintain the 'status quo' of their previous condition....and alot of other physiologic things that happen that are beyond this discussion.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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12-06-2004, 20:22
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#3
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Moderator
Join Date: Feb 2004
Location: Central Florida
Posts: 3,045
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I'm not an expert but I have witnessed withdrawals off and on for 18 years. In this case it was Stadal (sp) and later on methadone. With the Stadal, the effects started approx 12 hours after the the dosing cycle was missed and peaked at 24 hours. By peaked I mean it was full blown hospitalization. This was a person on high dosages with a low pain tollerance. With the methadone the time was anywhere from 24 to 48 hours for the symptoms to start and it wasn't as dramatic as with the stadal.
Talking with the docs over the years there are a lot of factors involved like the type of meds, dosage, the persons physical and psychological state, etc. Your personal doc is the one to get exact info from to suit you. If he's a good guy he can work something out. After a while, in the case I described above, the doctor made araingments for meds to be piced up at a local hospital if things got out of hand.
But that's just my story and knowledge and I can't even fix Saca's PC for him.
__________________
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Kyobanim is offline
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12-06-2004, 20:36
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#4
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Quiet Professional
Join Date: Jan 2004
Location: Free Pineland
Posts: 24,804
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How about asking the Doc for a few samples, in case your meds are late getting approved?
Keep 4 to 6 extras on hand, just in case?
If you only hit him up once or twice a year, you should be GTG, I would think.
Do you get 30 days worth in Feb?
TR
__________________
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." - President Theodore Roosevelt, 1910
De Oppresso Liber 01/20/2025
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The Reaper is offline
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12-06-2004, 22:19
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#5
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Guerrilla Chief
Join Date: Jan 2004
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Quote:
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Originally Posted by The Reaper
How about asking the Doc for a few samples, in case your meds are late getting approved?
Keep 4 to 6 extras on hand, just in case?
If you only hit him up once or twice a year, you should be GTG, I would think.
Do you get 30 days worth in Feb?
TR
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With the lortab keeping an extra amount for things like this was not a problem because my insurance allowed me to fill up to 3 days early. They said since the Oxy falls into a different drug schedule with the DEA they do not mess around with the eaerly refill.
I called the doc today and my wife will see her tomorrow for her annual physical. What she (the doc) is going to do is write me a prescription for oxycodone for the breakthrough pain and like Swatsurgeon said it should "tide" me over during the lull in between refills.
I guess my biggest concern is like swat pointed out, while I am only on 20mg right now as we go along. After my last visit with the doc to discuss pain management we are looking at a possible "life sentence" with this stuff unless they come up with a way to fix arachnoiditis before then. That is not looking to good.
One thing I did read that was comforting was that people on oxy for pain management have a very low addiction rate (psychological) and should the time come and they can fix this I should be good to go once they ween me off it.
I do have to say though that with the oxy the quality of life in just this short week of being on it has improved tremendously. While I still watch out to not over do it I am back doing things I hadn't done in a few years. Where before I avoided having to walk to far or even leaving the house to go down to KC, I am now looking forward to getting out of the house and finishing up some Christmas shopping that I was going to do online.
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brewmonkey is offline
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12-06-2004, 22:35
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#6
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Quiet Professional
Join Date: Jan 2004
Location: Free Pineland
Posts: 24,804
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I hope that you get fixed up, and the treatment continues to work for you, my brother.
I am arthritic and on Celebrex, with an occasional Percocet for severe pain, but I am getting by.
TR
__________________
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." - President Theodore Roosevelt, 1910
De Oppresso Liber 01/20/2025
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The Reaper is offline
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12-07-2004, 06:18
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#7
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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Brewmonkey,
I'm glad you brought up the 'addiction' word....being on the medication chronically for a true medical reason, with the ability to function normally and use of the med to treat your pain relieves you of the concern for that BAD word....you are not addicted. Yes, there develops a dependence on the drug so that you can function normally. I have patients that are on 80-100mg oxycontin every 12 hrs that are driving, go to high level jobs and basically are functioning because of the pain relieve they get with the Rx.
Don't ever feel the stigma society wants to tack to your forehead about addiiction....this is NOT FOR PLEASURE/RECREATION!! The only pleasure you get is by experiencing life again pain free so that you can return to 'normal' ....keep on truckin'.
Are you on combo Tx, i.e., a non-steroidal also.....you likely should be.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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12-07-2004, 10:33
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#8
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Guerrilla Chief
Join Date: Jan 2004
Location: In the land of the little people
Posts: 761
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Quote:
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Originally Posted by swatsurgeon
Brewmonkey,
I'm glad you brought up the 'addiction' word....being on the medication chronically for a true medical reason, with the ability to function normally and use of the med to treat your pain relieves you of the concern for that BAD word....you are not addicted. Yes, there develops a dependence on the drug so that you can function normally. I have patients that are on 80-100mg oxycontin every 12 hrs that are driving, go to high level jobs and basically are functioning because of the pain relieve they get with the Rx.
Don't ever feel the stigma society wants to tack to your forehead about addiiction....this is NOT FOR PLEASURE/RECREATION!! The only pleasure you get is by experiencing life again pain free so that you can return to 'normal' ....keep on truckin'.
Are you on combo Tx, i.e., a non-steroidal also.....you likely should be.
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I am on the oxy and naproxen for the NSAID as well as amitriptyline (25mg) prior to bed time and then robaxin for the spasms. Seems with the arachnoiditis comes Reflex Sympathetic Dystrophy which causes me to jerk at times (especially when lying down) like someone hit me with the reflex mallet. It also causes a sensation at times like a bug is crawling on me, that one is wierd.
TR- I have a great doc and his nurse practitioner who are doing their best for me. They respond very well to my needs. It did take some time to get to that point but I spent a lot of my time doing research and then bringing copies for both of them on what I find. I know doc's are generally sharp people but I learned that they cannot know everything. It was once I started bringing them documents from off the web on other doc's studies of the arachnoiditis that I saw a change in my treatment for the better.
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brewmonkey is offline
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12-07-2004, 14:17
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#9
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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I'm offended!!! We do know everything there is to know on the planet that's related to every ailment, condition and problem man has endured for 4000 yrs!!!! You couldn't possibly have information available to you from any kind of source that can outperform my primitive snot locker....so there....go ahead and insult my medical bretheren again...and again...and again...I do it all of the time and it really is a lot of fun!!!!
You just have to hope the doc you put your trust, and life, in is open minded enough to accept your info and work with you on it....if not, come to me, I'll work with you. I like a new challenge every hr or so...must be why I do Trauma and critical care???
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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12-07-2004, 14:41
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#10
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Quiet Professional
Join Date: Jan 2004
Location: Tampa
Posts: 2,519
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Not much to add here...
Brewman-
Keep the faith-IN YOURSELF
Chronic ailments can be debilitating on the mind. I am even seeing it in the short term. Feelings of weakness in yourself, letting those around you "down by being sick all the time". It doesn't take long to shift your mindset when things start breaking down. Fight through it, remain the man you are.
Some of my patients on Oxy have had other side effects as well-the noodle just wasn't right. Don't be embarrassed to ask for help. There are many products easily available in order to help things do what they are supposed to do.
Intimacy is a healthy part of living, and healing. BOTH of which you need to continue doing during your meds transition.
All my best...
Eagle
__________________
Primum non Nocere
"I have hung out in dangerous places a lot over the years, from combat zones to biker bars, and it is the weak, the unaware, or those looking for it, that usually find trouble.
Ain't no one getting out of this world alive. All you can do is try to have some choice in the way you go. Prepare yourself (and your affairs), and when your number is up, die on your feet fighting rather than on your knees. And make the SOBs pay dearly."
The Reaper-3 Sep 04
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Eagle5US is offline
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12-07-2004, 18:06
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#11
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Guerrilla Chief
Join Date: Jan 2004
Location: In the land of the little people
Posts: 761
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Quote:
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Originally Posted by Eagle5US
Brewman-
Keep the faith-IN YOURSELF
Chronic ailments can be debilitating on the mind. I am even seeing it in the short term. Feelings of weakness in yourself, letting those around you "down by being sick all the time". It doesn't take long to shift your mindset when things start breaking down. Fight through it, remain the man you are.
Some of my patients on Oxy have had other side effects as well-the noodle just wasn't right. Don't be embarrassed to ask for help. There are many products easily available in order to help things do what they are supposed to do.
Intimacy is a healthy part of living, and healing. BOTH of which you need to continue doing during your meds transition.
All my best...
Eagle
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My doc was concerned as well which is why we have introduced added the AD to the meds. I do have to say in the short few days since starting the new meds there is a huge difference in how I feel. I LOVE to cook and bake, things I have not done for whatever reason in some time. I just made 2 pumpkin pies (lowfat of course) and am now roasting some chicken, potatos and carrots. Tomorrow we are going to fnish the Christmas shopping, I put up the tree and hung the lights on them. Maybe it is a mix of the meds and the season, but it feels good to be doing stuff again.
My doc has been great about approaching this from more then just the pain management angle and is always asking me questions. It does not hurt that my wife is also one of his patients and he gets to hear both sides of what is going on which I am sure helps him treat me even better as he has someone elses perpective.
Swat- my doc is someone I do indeed trust and he has been very receptive to my bringing in the information. When I was first diagnosed with spondylolisthesis and spondylolisis 2 years ago I did the same thing. Even if he does not use the information he has let me know that he likes it when a patient is involved in their care as I have been.
I would come to see you but my insurance would consider it "out of network" in which case a $5000 deductible applies then it is 80/20 rather then "in network" which is $15 co-pay to docs/specialists and $50 for ER and $50 per day in the hospital with no deductible. 
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brewmonkey is offline
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12-20-2004, 18:18
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#12
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Guerrilla
Join Date: Jan 2004
Posts: 215
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