They added a long acting that did nothing....

Question submitted to DrMikeSays.com : I am currently on Oxycodone 7.5-325 x4 and they just added Oxycontin ER 10MG X2 but I have see no help and its upped my MME to 75. How would I go about asking to move to Oxycodone 10MG X5 and eliminate the Oxycontin. I believe it would be the same MME however I know the pill count would be high.

Let me begin by saying I understand the intent of the question, and it is a great question by the way. My advice will cover two points: 1) Direct answer to your question about asking, and 2) some reasons you may not want to give up on the long acting/short acting regimen just yet.

To begin to address this, let me say that the problem with the plan as it was changed is that the short acting dose and long acting doses are too close in strength. You can note when the short acting begins to take effect, but the long acting, though being additive to your short acting is probably not something you can "feel" and that is the cause of your perception of "absolutely no change".

I have had to learn the hard way that the long acting medication needs to be at least twice as potent as the short acting for the patient to feel a perceptible difference. So in this plan, I would not have started on a short acting dose less than 15mg. But that is what I call "Baskin Robbins" meaning that I am not calling your prescriber wrong - I am only telling you what my individual flavor is.

So, part one of your answer is simply - say "the change didn't make a noticeable difference." If you want to drive him to "your way of thinking" - you need to ask in the form of a curious question, "I want to thank you for adding the long acting, I wonder if we did 5 short acting doses per day if we could keep the same medication amount but find out the plan is actually more helpful?" Be willing to try (5) 7.5's first not insist on bumping to 10 to "keep everything equal" - remember it is very important for the provider to feel like THEY are driving the dosing and form of dosing, so best you can do is ask the curious question. "Can we try (5) 10mg Oxycodone short acting per day?" for example is too pushy.

Now part 2 - because I already intimated that the long acting dose may have simply be too low, you really might be better off saying, "the change didn't make a noticeable difference but I appreciate you trying to increase the efficacy of my plan. I wonder if the long acting dose could be bumped to see if I can see a better difference, since you want me to try to be successful with the long acting/short acting combo?"

Again, note the tone, curious. I cannot stress how much curiosity is less off-putting that suggesting directly. My final words on this - LEAD WITH GRATITUDE - your provider did not increase your total opioid dosing by nearly two thirds to be unhelpful. You must begin this conversation with full acknowledgement of them seeing you and the pain you are in.

As always #loveyou #nobuts