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Dosage cut

Good afternoon all,

Just as the title says the day finally came that they cut my dosage. Very little explanation other than “you’re going to need more and more to keep your pain down”. I’ve literally never had a dosage increase, I’ve been on 7.5/325 hydrocodone 6 times a day. They had even given me oxys before for bad days but I refused them.

She said “we will go down to 5/325 6 times a day. I want to get you down to maybe 15 a month if you need them.


Again, I’ve never had a dosage increase. Never missed an appointment, never had a failed UI. What to do now?

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Comments

  • Also I should add ive been on this medication for 17 years. Never missed an appointment, I work a full time job. I don’t drink, don’t smoke, and I am an active father of 2.

  • Sorry for all of the replies to my own message but I want to give as much information as possible. I began going to this pain clinic in 2013, (this was after my PC said pain management would be better for me). PM almost sent me back to my doctor because as they put it “you are On such a low dose from what we are used to seeing, your PC should be able to write your script with no problems”


    But this clinic had been great, my only issue up until roughly 6 months ago (more on that in a minute) was that this has been my 3rd different doctor at this clinic. My first doctor I only saw for roughly 6-7 months before she was gone. I got moved to another doctor who was absolutely great, I had her for 5 years. Then one day I got a random phone stating that she was no longer with the clinic and my appointment had been moved out 2 weeks to another doctor.


    The doctor I currently have had been great as well, but slowly over the last 6 months the clinic started basically doing these depression questionnaires with all of the patients, which I had no problems with but it was different. And it asked if you’ve tried any other therapies such as “PT, yoga, hot/cold, tens unit”

    My last few appointments my doctor had started making comments such as “boy, you are on a high dosage”. Which again I thought was odd being that 6 months prior they had offered me oxys and muscle relaxers. 


    I couldn’t help but to get the feeling that it wasn’t her telling me that my dosage is being cut but maybe a doctor or medical director above her.

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  • Sounds like deja vu to me.  Been with my PM for 9 years and never had an increase, always at my appointments on time and no issues with drug testing or anything else.  Then 6 months ago they called me out of nowhere and said the government was making them fill out Whats called a SOAPP-R questionnare to see if a person is prone to addiction.  The nurse said it was just something else they were required to have in a patient file.  Then just 2 months ago, I saw a completely new doctor at my regular appointment.  He said I was a little over the 90 MME which I already knew.  He asked me about procedures and I had already done all that he mentioned.  Said he had looked at my huge file from my last doctor and saw that I had done procedures and alot of different meds over the 13 years I was with him.

    Said what they are trying to do is make a med cut and offer the patient a procedure hoping to get to the very least amount of meds possible. He wanted to cut my long acting med from 60mg per day to 30mg per day starting the following month.  Did a ton of thinking before my appointment last week and decided to ask for a cut to 45mg instead of 30mg.  The PA agreed but says we may have to cut a little more somewhere else.  I take 3 short acting percocet per day and get a dozen hydromorphone for emergencies.  She cut the hydromorphone to 6.  She says they have to be added into my daily MME(a 4mg pill equals 16mg!) even though I don't take them everyday.  So those are probably gone and I had not had one ER visit since i have been on them. 

    It's sad that they can no longer make the best decision for their own patients.  I know without a doubt that this particular doctor would not be doing this unless he felt like he was being forced to.  I have been on these type of meds for the last 20 years. 

    The only other thing I could come up with is leaving my long acting morphine at 60mg per day and changing percocet to Vicodin.  In the MME world a 10mg percocet equals 15mg while a Vicodin 10mg equals 10mg.  So long acting at 60mg and 3 Vicodin at 30mg would get me to the 90MME.  Anyone who has been thru this think that would be a good idea?

    Sorry I wrote so much on your thread but I wanted you to know that you are not alone.

    Cindy

  • Thank you for the response. It does sound eerily similar. I do understand that some doctors and clinics went nuts and went on a frenzy. But gee-whiz, you have legit pain sufferers who take their meds only as prescribed and we are still being treated this way.

  • I totally understand why it bothers you.  I mean as a patient you follow all rules to the T for years and never ask for an increase, never bother them even with a phone call unless absolutely necessary and it still isn't enough.  In fact they did increase the long acting morphine from 60mg per day to 90mg(I did not ask for it) and I decided there wasn't any real benefit and had the change it back so obviously I am not selling or overusing my medication.  Oh well, I will go with whatever they say but I am so afraid all this might cause me the kind of out of control pain that used to send me to the ER and I am not sure they would even treat me.  You know how that is right now.  Hopefully things will start to swing back the other way soon.  I guess that's the best we can hope for.

    Cindy

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  • Cindy, my dr cut me down to 90 MME the beginning of the year....ms Contin 15mg X 2 and Percocet 10mg X 4 to equal 90 MME...said that TN state law requires that, but I can’t find that particular law anywhere...all the DEA says is that anything over 90 just needs to be medically necessary, documented and be through a pain management doctor

    I’ve gone from 150 to 90 MME within the past year...can surely tell the difference but deal with it and keep my mouth shut...just hope it stays like this for the forseeable future...but I also take a muscle relaxer

    if you don’t figure a way to get down to 90 your office might...I do hate when a new doctor shows up wanting to change things not knowing a thing about the situation

    but we all know they put pressure on and closely breath down their neck if they’re prescribing over...and nobody wants the hassle

    my insurance next year will not allow over 90 MME...just unbelievable 


    good luck getting it sorted out!

  • scinmyheart, Thanks for your post.  It always helps to know you aren't alone.  I have been suffering for two weeks now with the cut to my long acting meds.  I was hoping that losing 15mg per day might not be so bad.  Was thinking about changing percocet to vicodin and getting 4 a day instead of three so that when the long acting doesn't cover me I can always supplement with a short acting.  Guess I will give it a couple of months and just see how it goes. 

    Like I said, I know my doctor would not be doing this if he didn't feel like he had to.  I am going to do my best to get along with less and not add to their problems.  It does bother me that the CDC picked this arbitrary number and set it as a maximum level for everybody.  It's insane to think that would work but common sense is lacking in this country these days.

    Another issue is the way they are adding all these fentanyl deaths to the opiate overdose statistics.  90 percent of those are going to be carfentanyl that comes from China and not prescribed fentanyl patches as used by a patient.  They should be making the distinction between the two.  Even the CDC has admitted that all the limitations to prescription drugs has not made the difference they thought it would but can the train be stopped and turned around?  Who knows. 

    Cindy

  • @n2braves @scinmyheart

    Another distinction that I wish could be made in the guidelines - I do think it makes sense to try harder moving forward not to get patients up above the 90 MME level, as was done so often in the past.  But trying to rush everyone down below it doesn't make too much sense to me either.  I hear people complain about it all the time while waiting in the office... If you've been doing well for years at 120 or 150, does it really make sense to push the level down?

    Best of luck to you!

    Kevin

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