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iSpine Discuss Opana? in the Main forums forums; I went to the pain doc Wednesday... I wanted Oxy 5's because they are so effective for me. (Remember ...

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Old 04-01-2009, 05:25 PM
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Default Opana?

I went to the pain doc Wednesday...

I wanted Oxy 5's because they are so effective for me. (Remember that in 2001 and 2002, I needed 20's for my low back pain. Apparently, the 5mg packaging that is available in Europe is not available here.

I did NOT want to go on OXY 10's because I didn't feel I needed that much medication. The doc suggested Opana 5's. I agreed.

When I went to pick up the prescription yesterday, I had the most bizzarre conversation with the pharmacist after I asked for a consult.

I asked what the narcotic equavalent is to hydrocodone.

She said, take 1 pill twice a day.

OK, what is the narcotic equivalent?

Take with food.

I can read the instructions on the bottle, what is the narcotic equivalent?

It's just like the other strong meds.

OK, what is the narcotic equivalent?

It's very strong.

What is the equivalent to hydrocodone.

It's stronger

OK, but is it 1.5 times stronger or 50 times stronger.

It's stronger

OK, but what is the narcotic equivalent.

Believe it or not, this continued until I said, "You don't know, that's OK, just say so."

She said she can look it up. I said I'd wait. She went to her computer and futzed around a bit... got out some papers.... futzed around a bit... went in back and got the package insert... nothing there.

She proceeded to go back to the "It's stronger than this, but weaker than that" routine. They were very busy and I hated to make the other people wait, but by that time, I'd been there about 45 minutes and was in a lot of pain, wanted to know and felt that the pharmacist should be able to tell me.

She continued hunting and finally told me that it is 5 to 1 times as strong as oxycodone.

"So, 5mg opana is equivalent to 25 to 50 mg of Oxycontin?"

Yes

So much for not wanting OXY 10's

I came home and googled narcotic equivalence calculator and came up with this:

Narcotic Equivalence Converter

I have no idea if this information is correct, but it comes up with the same thing the pharmacist says.

Who has experience with Opana? Please let me know and also compare to your experience with other meds.

The neck has really gotten bad and I'm now getting substantial numbness in places where I've never experienced it before. Entire left leg numb last night and much of my left upper body as well. I don't know where this is going, but I don't like it.

I love what I do, but wish it wasn't based on so much f'ing first hand experience!

all the best,

Mark
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2002 L4-S1 Charite' ADR - SUCCESS!
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Old 04-01-2009, 05:30 PM
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mark i hate to say this. but it sounds as if you should get your ducks in a row and get dr. b to work his magic on you!!
i hope you are feeling better soon. you dont want to miss any play time with the little one.
chuck
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Old 04-01-2009, 05:41 PM
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To have to go through this once is awful enough, twice is ...

I'm so sorry Mark but I guess you had to get to this point to have no more doubts.

Wishing you better days, Dale
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Old 04-01-2009, 06:12 PM
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Mark, I take Opana-ER. Hopefully you will have read the package insert, because it actually says to take it on an empty stomach. When I asked my doctor about this, she actually had not known that, and had been telling patients to take it with food.

I have no problem taking my morning dose on an empty stomach, I take it at 6:00 am, and I don't eat before 7 (in fact I'm usually not out of bed before then). For my evening dose, it becomes a little more of a pain in the A$$. I stop eating by 4:00 pm, take it at 6:00, and don't eat until after 7:00 pm.

Apparently, unlike most other pain meds, taking it with food will actually cause it to enter your system more quickly (the effect on most pain meds if taken with food is to reduce the effectiveness, Opana is just the opposite).

Anyway, it took quite a while to get the correct dosage for me. The 5mg did nothing for me. And I had heard on another spine forum, people saying it wasn't as bio-available, and for some people not effective at all. One guy really thought it was crap, but I had to say that it was working for me, once I got the dosage right. I take 20mg twice a day.

I hope it helps you Mark.
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Cathy

46 years old. 12-15 years of intermittent pain, 2 years with constant pain.

DDD, L4-5 and L5-S1, pain confirmed by discogram.
PT, ESI's, Facet injection and block, Acupuncture - all no help.

2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009.

Currently taking Opana-ER (tapering off) and oxycodone
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Old 04-01-2009, 06:19 PM
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Mark,

This conversion table should help spell everything out for you:

Converting from other opioids to OPANA ER

Scroll down the page and you will see this:

Quote:
OxyContin® to OPANA ER sample calculation

A healthcare professional with a patient on a total daily dose of 60 mg OxyContin could do the following calculation:

60 mg x 0.5 = 30 mg (approximate oxymorphone total daily dose)
Administer as 15 mg OPANA ER every 12 hours
Titrate as needed by 10 mg every 12 hours every 3-7 days
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1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.
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Old 04-01-2009, 06:20 PM
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Oh, also...did you get an Opana "coupon" card? Ask your doctor, that's who gave me mine. It saves me $25 on each prescription, up to 12 prescriptions.

Here's what it says on the card...you pay the first $20 of your Rx co-pay, the pharmacy will deduct up to $25 from any co-payment remaining balance. Oh wait, it says card must be activated by 12/31/08...I would still see if your doctor has a new edition of the card, it can really save some money.

When I first tried the Opana and it cost me $50, I decided I was going to tell my doc that I wanted to stick to percocet instead. That's when she gave me the card.
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Cathy

46 years old. 12-15 years of intermittent pain, 2 years with constant pain.

DDD, L4-5 and L5-S1, pain confirmed by discogram.
PT, ESI's, Facet injection and block, Acupuncture - all no help.

2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009.

Currently taking Opana-ER (tapering off) and oxycodone
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Old 04-01-2009, 06:23 PM
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Justin, what I had heard is that even though it is supposed to be stronger than Oxycontin, it isn't. And if your doctor just tried to use those charts to switch someone over, the person might actually need more than what it would indicate.

Frankly I don't care how it compares in dosage to other drugs, as long as the dose than I am taking controls my pain to a reasonable level.

Oh, and it scares me to think that I would be taking the equivalent of 80mg of Oxycontin (though I've never taken Oxycontin).
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Cathy

46 years old. 12-15 years of intermittent pain, 2 years with constant pain.

DDD, L4-5 and L5-S1, pain confirmed by discogram.
PT, ESI's, Facet injection and block, Acupuncture - all no help.

2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009.

Currently taking Opana-ER (tapering off) and oxycodone
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Old 04-01-2009, 06:32 PM
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Quote:
Originally Posted by treefrog View Post
Justin, what I had heard is that even though it is supposed to be stronger than Oxycontin, it isn't. And if your doctor just tried to use those charts to switch someone over, the person might actually need more than what it would indicate.

Frankly I don't care how it compares in dosage to other drugs, as long as the dose than I am taking controls my pain to a reasonable level.
Cathy,

I understand you mainly care about the drug working to control pain. However, physicians have a responsibility to patients to follow dosing guidelines. Even if the drug has decreased bio-availability and/or potency a doc must follow protocol, especially in a patient that is not currently opioid tolerant. This is just "good" medicine.

This is not because they are "withholding the dose you really need," but to ensure that the patient adjusts to the medication appropriately because there are severe risks with narcotic medications including respiratory depression.

BTW, I've heard the same thing about Opana-ER. However, I posted the link and quoted text above to provide drug information for Mark and not what patient's might prefer in terms of dose/frequency on online forums.

As always, speak with a medical professional about any adjustments to medications...they really know what they are doing and there is a step-wise method to their madness.
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1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.

Last edited by Justin; 04-01-2009 at 06:35 PM.
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Old 04-01-2009, 07:06 PM
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Oh Justin, I wasn't saying I didn't understand why you posted the information, and totally understand why a doctor needs to slowly titrate a patient onto any new drug. I didn't mean to imply that the information was not helpful or informative.

I was just saying (and kind of in a joking way), that I personally only care that whatever I am taking, works (though it seems scary to me to think that I am taking the equivalent of 80mg oxycontin - is that a high dose of oxycontin?).

I totally understand that if a person has been taking a narcotic and are switching drugs, that it is helpful and imperative to know what the equivalents are, in order to get the dosing correct. And also for the patient who is opioid naive, to slowly increase the dose until it is controlling pain.

Sorry, if I came off the wrong way.
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Cathy

46 years old. 12-15 years of intermittent pain, 2 years with constant pain.

DDD, L4-5 and L5-S1, pain confirmed by discogram.
PT, ESI's, Facet injection and block, Acupuncture - all no help.

2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009.

Currently taking Opana-ER (tapering off) and oxycodone
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Old 04-01-2009, 11:19 PM
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Hey Mark,

I started on 20mg of Opana ER for my neck about three weeks ago. 10mg 2x's a day. It has done nothing for my pain. Oxy 5's give me about 45 minutes of some relief.

However, what I did notice immediately after starting the Opana is that I am sleeping much better and that has me in a much better mood even though not out of pain. Its almost as if it has an anti depressant effect on me. (BTW I tried several AD's and none worked) I will be following up soon with my new PM doc and see what he recommends next.

I read and understand the instructions about not eating but I cannot take it without some food. I get severely nauseous when I take it on an empty stomach. I have had pretty bad constipation which none of the other pain meds ever caused me.


Keep us posted on your neck.
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Now I struggle with Neck Pain likely c5-7
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Old 04-02-2009, 12:45 AM
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Sorry to hear that Mark, especially the part about the leg. I thought you had successfully conquered the Lumbar stuff , that sucks that it has come back, in adddiion to the new neck stuff.
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Old 04-02-2009, 01:02 AM
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Cathy,

No worries at all..I knew exactly what you were saying. I just wanted to help explain (to others on the forum) why doctors prescribe the way they do. When I referred to "patients on online forums," I was talking about other online forums where people post about pain medications to figure out what the best, new designer narcotic there is to abuse.

80mg of Oxycontin is a lot. I'm on the equivalent of ~80 Oxycontin (Fentanyl patch every 48 hours) and I'm also on about 15-20mg of oral oxycodone for breakthrough pain a day. Plus, 5 other meds right now. Is your pain managed pretty well with your meds?

I completely understand the "give me whatever the heck you want, as long as it gives me relief" frame of mind.

The Fentanyl patches have been a life saver...I can't imagine that people smoke these to get high...talk about dangerous.

Quote:
Originally Posted by treefrog View Post
Oh Justin, I wasn't saying I didn't understand why you posted the information, and totally understand why a doctor needs to slowly titrate a patient onto any new drug. I didn't mean to imply that the information was not helpful or informative.

I was just saying (and kind of in a joking way), that I personally only care that whatever I am taking, works (though it seems scary to me to think that I am taking the equivalent of 80mg oxycontin - is that a high dose of oxycontin?).

I totally understand that if a person has been taking a narcotic and are switching drugs, that it is helpful and imperative to know what the equivalents are, in order to get the dosing correct. And also for the patient who is opioid naive, to slowly increase the dose until it is controlling pain.

Sorry, if I came off the wrong way.
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1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.
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Old 04-02-2009, 04:04 PM
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Since Cheryl told us about her side effects and such, I thought I would post some things I have noticed about Opana-ER.

I actually feel like I have less of an issue with constipation, with Opana-ER than I had with the percocet, or some other pain meds I've tried. There is still some constipation, but it's manageable.

But what's also interesting, is that I have been taking neurontin for some nerve pain. I have been taking the same amount for a long time, and had still been having a good deal of leg/nerve pain. In fact I would say that the leg pain was more bothersome to me than the back pain. But, when I started taking Opana-ER, my leg/nerve pain is much less noticeable. And I haven't changed the dose of neurontin. So now, my back pain is more bothersome to me, than the leg pain.

Cheryl - If 20mg isn't working, have you talked to your doctor about increasing the amount? You might even ask about trying 20mg in the morning, and 10mg at night (or the other way around, whichever you think would be more beneficial). This is why my doctor has me taking two 10mg tablets twice a day, so that if I am feeling pretty good, I can go down to one 10mg tablet.

There was one week where I was feeling exceptionally well, and was down to taking just 20mg/day, but it didn't last. And since then, for some reason my pain has been higher and requires 40mg/day.
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Cathy

46 years old. 12-15 years of intermittent pain, 2 years with constant pain.

DDD, L4-5 and L5-S1, pain confirmed by discogram.
PT, ESI's, Facet injection and block, Acupuncture - all no help.

2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009.

Currently taking Opana-ER (tapering off) and oxycodone
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Old 04-02-2009, 04:34 PM
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Default do you think...

That PMs use Methadone as a last resort pain medication? I'm on a very low dose of it (12.5mg/day) and was on MS Contin for mo. when first starting pain meds but was too constipated on it and also had burning in my shoulders and knees I thought was osteoarthritis but after d/c'ing the MS Contin that all went away quickly.

I saw that the Morphine equiv to Methadone is 15mg of Morphine to 5mg of Methadone.

Supposedly it's one of the most difficult opioids to discontinue. I've only tried decreasing my dose and had some really terrifically painful responses so I maintain (choice of words) pretty well pain wise.

It seems that the people I see that are put on Methadone (other forum) are the ones that have tried other opioid pain meds and not achieved adequate relief or those that are deemed chronic pain patients that have no surgical options (at least at the time or no known surgical options w/docs they are seeing/see).

Mark, between the pain and the additional numbness that sounds scarey. Get things taken care of as soon as you are able.
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Old 04-02-2009, 05:34 PM
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Default narcotic conversion ect.

Hi Mark,

Sorry to hear you are in pain and having trouble getting the Rx you want to relieve the pain. You said that 5 mg oxy wasn't available? Did you mean oxycontin or oxycodone? A couple months ago there was a sever shortage of 5 mg. oxycodone in my area. For a few weeks, I had to switch to percocet (which isn't ideal for me (tylenol) on the high doses I needed at that time. I ended up calling all over to find a pharmacy that had managed to stock up on the 5 mg. oxycodone that I needed. I have never been on Opana, but I did try Kadian, which I believe is similar. It helped with sleep, but not with enough with pain. Sounds like you should find a better pharmacy. It took a long time, but I finally found the perfect pharmacy for me. The pharmacist and techs are extremely helpful, non judgemental, compassionate, and willing to help. Many of us have to visit our pharmacy every 4 weeks. It shouldn't be a negative experience. We have enough to do deal with already. Keep us updated on your neck issues. Melody
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12/29/08- 3 level ADR Prodisc C in Seattle
12/21/07-Revision surgery, fusion L4/5 L5-S1
1975-scoliosis surgery,Harrington Rods, fused T2 to L4
Felt great in 20's and 30's....late 30's started having chronic neck and lower back pain. By 40 pain worsened enough to begin seeking surgical solutions.

ADR surgery much easier recovery than fusion!
This site has been a great source of information for me! I would be happy to help anyone who has questions.
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Old 04-03-2009, 04:11 AM
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Quote:
Originally Posted by melodyl View Post
Many of us have to visit our pharmacy every 4 weeks. It shouldn't be a negative experience.
I wish I only had to go every 4 weeks. I am there every week, because my scripts run out at different times of the month. I am on 5 rx's for pain and 3 rx's for other stuff. When the kids are sick, sometimes I visit the pharmacy 2 times in a day!

I agree on finding a good pharmacy, I have the best. They know me on a first name basis and are quick (you can bring in a script and be walking out with it filled in less than 10 minutes!) They can order medication and have it in early next morning. If they don't have enough medication for my script, they will give me what they have (partial fill) and let me pick up the rest later. They are the best pharmacy ever!
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Old 04-07-2009, 07:16 PM
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I am on 10mg Opana-ER 2x a day too. I didn't notice too much from it in 3 weeks. I told my pain mgmt doctor this last Wednesday when I was about to get SI and Facet Injections. He told me to wait a little to see what happens after this. Well, my right calf pain has gotten better and I will feel my back hurt through out the day. This is my 8th week of post-op, so I am sure I am not heeled all the way. He also told me no more than 3 7.5/750 hydrocodones a day for breakthrough pain. I haven't been taken them that often. Once a day usually. I am off Neurontin and on now on 60mg of Cymbalta for depression that I have gotten from all the pain and my wife leaving on the 28th. This back thing really sucked! So I am not sure which one of these medicines has been helping me. I am also taken 15mg Temazepam for sleep when needed.
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Old 04-16-2009, 12:52 AM
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Mark,
I'm sorry your symptoms are so serious. Do you have a surgery date yet?
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Old 04-16-2009, 12:57 AM
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Default Mark's surgery date

Has come and gone! He's out and about with a newer improved cervical spine. Check out his surgery blog
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