Steve - tell me if I'm really taking too much Norco

[karri]

Hello Steve. I don't know you, but it's been over a year since I've been here. I have a question for you regarding medications. I've been surfing here since 1999 when I had brain surgery for an AVM. I have been an epileptic since. BUT....in 2005 I started having back surgery after back surgery. My lower lumbar down to my S1 (took 2 surgeries, 2005 and 2008) and also my cervical (also took 2 surgeries, 2007 and 2011). And let's not even include my carpal tunnel surgery in 2010 and the frozen shoulder I've been dealing with since August of 2011. Ok, my doctor slowly increased my Norco up to 360 per mo. - at 4 pills 3 times a day. I've been at this dosage for quite a few years, maybe since 2007. He added oxy after my last cervical surgery in 2011 and I recently told him to just cut those out. Now, my doctor is gone for the next 4 months and the doctor I saw freaked out and cut me back to 270, and the plan is to cut, cut and cut. I'm desperately trying to take 9 per day, hoping my body can handle it, but I still find myself hurting, but I'm trying. It's only been 2 weeks, but he told me I was a drug addict and killing myself. I have another appt. one month after my last one with him and I'm worried he's going to try to cut me back more and more until I'm only taking 30 per month. Even with the 12 per day, I can't stand straight, need to hold onto something and (I don't drink so THANK GOODNESS I don't have to worry about taking a dui test! - lol) I can only walk with a cane and I lean forward and to the right, 5 minutes max and very slow. I've had 4 laminectomies with fusion. I even told my surgeon to just slice my back from my head to my butt and put a zipper in.


Now, at 57, I've got the arthritis coming in pretty bad, too. I am in so much pain and the 12 per day was cutting the pain good enough, even to my 5 minutes walking with the cane and not being able to stand still existed, I could deal. These 9 per day are making it a lot more difficult. So, did he have the right to actually call me a drug addict? Am I an addict or just in need of the medication? I don't get high from them, my body is too ammuned for that anymore. It's been years since that's ever happened. I feel so ashamed and left crying not because of him cutting me back, but for him telling me I was addicted to Norco. I don't feel withdrawals, just pain. And it's getting pretty bad. I just realized I am staying in bed much more and not going anywhere and the house isn't getting cleaned as much. Please give my your opinion, thank you, Karri

[Eva 14]

Karri,

I just wanted to say that I'm sorry for what you had to go through with that doctor. It sounds like you have LOTS of genuine pain. If a doctor called me a drug addict, my feelings would be very hurt, too.

If my memory is correct, Norco is a combo of hydrocodone and acetaminaphen. I know that too much acetaminophen is harmful to the liver, so maybe that what the doctor was freaked out about. If that's the doctor's concern, he should have switched you to one of the long-acting pain meds.

This new doctor sounds opiophobic. I hope you can find a way to manage things until your regular doctor returns. You have my sympathy. No one should have to suffer needlessly in pain.

Best Wishes,
Eva

[Lil E]

Hi Karri,
First of all anybody in your position deserves some respect for just getting up in the morning! Don't listen to anyone who belittles you for needing pain meds. The problem is not your Norco use but the fact that you need something stronger so you can cover your pain and be able to take less. You need to find a pain management doctor who knows what to use. There are long acting meds better than Oxycontin (Yeecchh!).

[Burr]

Lil E,
I hope you don't mind if I ask you a question. When you say there are long acting meds better than oxy, what are they ? My neurologist say I am on the strongest pain med by being on oxy. It sure doesn't last the 12 hrs. it is supposed to and you always need a higher dosage. I have not had an increase in a long time, because of all the hype there is from oxy. I'm just happy that I can get that plus other meds. I sure would be interested in something better!

[Lil E]

There are Avinza and Kadian, 24 hour drugs which I believe are morphine based, the Fentanyl patch which is stronger than morphine and there is a new long acting Dilaudid. Dilaudid is five times stronger than morphine and Oxy. Is your neurologist also a pain management doctor? Only PM docs know what is out there for you to try. IMO Oxy is the worst drug for chronic pain. You have to use too much and its highly addictive. Most docs who are not PM's always say " you're taking a very powerful drug" even if its just Darvocet or Vicodin because they don't know much about the opiates.

A lot of the long acting drugs don't last as long as they say. Most people I know who take Oxy use it every eight hours. I've tried many different meds over the years finally got one that is a good fit. A good pain management doctor is hard to find, much luck if you look for one, it will be worth it.

[karri]

Thank you to everyone's repliesl. I told the doc, before he started cutting back my norco to just take the oxy off because it didn't seem to work as well as the norco. I did this before he cut me back. I asked him, well, don't I get any credit? He asked me 'credit for what?" and I said for not needing or wanting the oxy any more and he tells me 'well, youre still on the norco." Nice guy, huh.

But, I will look those two meds up. I don't really want to take any morphine type thing because I don't want to feel the way I did when I first woke up after my surgeries. The Norco was just fine - at 12 per day. I have an appt with a PM doc on 6-11-12 but I thought all this time they were just physical therapy type people and I can't drive all the way down there for that. Remember, I have seizures, but only one since the 1990's.

[karri]

WHY........when I post, it comes out all weird like running sentences together and picking up the first one 1/2 way thru and re-writing it? It looks like I'm repeating myself 1/2 way. WHY?

[Mark N]

Karri, I am furious about that dr and the approach he is taking with you. You should be given credit for cutting out a medication that isn't working for you as others would continue it afraid to tell a dr they don't need it. Situations like yours is the reason many are afraid to reduce their meds. Your dr is mistreating you from my perspective. He has no right to call you a drug addict is wrong unless he has some evidence you haven't given us and I don't believe he has. The good news is you only have to deal with this dr for four months but the bad news is you deal with him for four months too long.

Burr, Oxy and in fact many of the time released meds don't provide 12 hours of relief the company claims they do. Many of us take them at intervals of 8 hours instead of 12 hours so you may see if your dr will move you to 3 times a day instead of changing meds or increasing the dose. I take my MsContin 3 times a day but it feels like it works for about 6 hours at a time instead of 8 hours and far short of the advertised 12 hours.

[Diandra]

Hi Karri,
I take Norco(10mg hydrocodone, 325mg acetaminophen) daily as well and my doc asked me to not exceed 8 pills per day(this is my pain mgmt doc) BUT, and this is a big one, I have not had any surgeries and I take other stuff like oxycodone and lyrica and soma. It is my understanding that the highest dose a person should take of acetaminophen is 4000mg daily(and that gets debated). Norco has 325mg of aceta per pill so if I calculated correctly, you are taking 5100mg of aceta daily, which is supposedly too high. I don't know if you can't take the longer acting meds like Oxycontin or Kadian, etc or they have not been offered to you but they are a better solution OR, as I did for a few years ago , my doctor let me get hydrocodone compounded at a pharmacy without any aceta, so we added that to the Norco. That may be a solution if you are concerned about your liver.
I personally was on Oxycontin for 2.5 yrs but found I had to increase the dose too frequently and got to a dose that nailed me with side effects so I got off it.
(Burr....please ask your doctor for the oxycontin every 8 hrs....any doc worth his/her salt knows oxy only last 8 hrs despite the makers labeling).

Karri dear, you have my sympathy. What a laundry list of surgeries and you don't have an ounce of self pity in your voice...you must be a very strong person. Karri, please, if you do not have a pain mgmt doctor handling your meds, please get yourself to one of them if that is possible. Put in a post here and ask folks who they see in your area and they can PM(personal message)...post title something like NEED PAIN MGMT DOCTOR IN CARMEL, CA or wherever you are from.

Please take milk thistle for your liver. It is wonderful to clear out the toxic effects of the aceto. I take it daily and if I run out for a week or so, I feel poorly. I wish you the best and hope Steve chimes in soon with his advice. I highly recommend a long acting pain med. I know the tough part is, at our age, once you reach the max amount of meds, what do you do then? What are we going to do until we are 80? I have found you need to change up your meds once in awhile for pain coverage.

I wish you the best Karri. Take care, Diandra

[Mike Weins]

WHY........when I post, it comes out all weird like running sentences together and picking up the first one 1/2 way thru and re-writing it? It looks like I'm repeating myself 1/2 way. WHY?

Hi karri :)

I see that you edited the post you made before the questions. If you wouldn't mind not editing the next post that comes out garbled I might be able to figure out why it's not behaving :)

[Mark N]

Karri, Diandra is right about the limit on acet. but with the new lawsuits out due to liver damage or death from taking too much dr are trying to lower the amount. One very good thing about changing to MSContin or Oxy is there is no acet. in them so you aren't putting your liver at risk. The other problem with that much norco is if you ever have to tak cold medication you are often adding more acet. and can really get the numbers way above recommended levels. I hope this dr will work with you on getting a new med with no acet. in it to relieve your pain.

[Pharmacist.steve]

Kari... taking 3900 mg of APAP/tylenol is no longer considered a safe level... the FDA advisory committee wanted it down to 2500mg/day but ended up at 3000mg/day.. IMO.. the longer you take APAP.. I believe that the dose should be < 2000mg.. My drug of choice is Morphine SR.. Morphine and Hydrocodone are equal mg to mg as far as pain relief.. Your doc has been giving you a 4 hr duration medication for a 24 hr pain... doesn't make a lot of sense for chronic pain... Moving someone from 40mg of Hydrocodone (HCD) three times daily .. should get better pain management from 45 mg of Morphine SR every 8 hrs... I agree with your new doc about the amount of APAP that you are taking... it is dangerous level... I do not share his concern about the amount of opiates that you are taking per day... just that the frequency and amount per single dose.. seems to be a bit "off the norm"... IMO.. neither doc really knows what they are doing in regards to properly managing your pain.

[Boxerlover]

An Option?

Would it be an option to have your hydrocodone compounded. This way you can have the amount of Hydro you need yet lower the amount of acetaminophen. My first PM med was a compounded Hydro with 15mg hydro and only 85 of acetaminophen.

[Pharmacist.steve]

Insurance companies are cracking down of paying for compounded meds.. that are very similar to what is commercially available.. There is suppose to be a new long acting Hydrocodone coming out with 40 mg of Hydrocodone and no APAP. It is called Zohydro.. I am not sure that it available yet... I suspect that it won't be cheap.. as any new drug are.

[MacDelta]

How to get the care you need and deserve and remain confident in your treatment plan

Karri, many of us, myself included, blame physicians for their inability to help us overcome that what ails us, or potentially puts us in harm's way. We allow some doctors to intimidate us, or try to convince us we know less about ourselves than they do. As some posters have mentioned, some doctors are opiophobic. Nothing you have to offer vocally or present medically is likely to change their minds. They may be fantastic clinicians and have helped you with other medical situations in the past. When the subject of opioids comes up, they are not going to help you. They may even make you feel insecure and dishonest. I have had the misfortune of seeing such doctors. It was through this forum and Pharmacist Steve's plethora of postings that convinced me that I am responsible for my well-being and therefore it was my responsibility to find a physician who satisfied my medical needs.

Reading posts from Pharmacist Steve, I was able to understand the issues I had with my original long-term doctor were not my fault. Fortunately, I located and became a patient of a no-nonsense pain management physician who gave me the confidence to be straightforward with him as to what does and what does not work. My physician keeps very detailed notes and is a firm believer in the "Trust, but verify," motto made popular by a former President. The particular pain clinic I visit maintains a limited patient load so the doctor can take time to examine affected areas, diagnosis my pain levels and keep track of any changes or new problems and analyze the symptoms and their likely causes. After the examination, the doctor spends time talking with me on matters some might mistakenly think are unrelated to the purpose of the visit. I was fortunate to find this doctor when I chanced on a advertisement for a seminar sponsored by the DEA (I worked in a network of children's hospitals). The doctor that was to speak at the seminar concerning the correct procedures for operating a pain clinic which prescribes controlled substances became my physician of choice. I have no regrets. Within months, though still permanently disabled, I could function better than I had in years.

The doctor you will find will unlikely have any interest in destroying your liver with acetaminophen. Acetaminophen can be much more life-threatening than many opioids prescribed. Your new doctor will have no motivation to over medicate you with controlled (and uncontrolled) medications. Random testing will be part of the doctor-patient relationship, so trust won't become an overriding issue (as long as you are taking your prescribed medications exactly as prescribed). When you find said doctor and establish a professional doctor-client relationship with him or her, you should no longer suffer in pain needlessly and should feel confident and secure with the pharmacological plan and treatments your doctor provides you. If you still have reservations and are bothered by the stigma of opioid medications, don't hesitate to share your concerns. There is a world of difference between being opioid dependent and an opioid addict; just like although all living humans are food dependent; there will always be those that have an unhealthy and dangerous addiction to overeating!

Good luck, Karri! Keep us posted and always try to stay positive — you are among friends!