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Is It Safe To Decrease Dosage Of Oxycodone From 60mg To 20mg?

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Posted on Wed, 12 Aug 2015
Question: My spouse has been under the care of a pain management clinic for three years. She had spinal fusion surgery and has been relegated to their whims ever since. They led her to believe that increasing doses of Fentanyl and Oxycodone were the precursors for determining if she would be a candidate for a pain pump. Well, after getting her up to 75 mcg Fentanyl patches/72 hrs. and 60 mg Oxycodone/day, her doctor said, "you are too young to get the pump". At age 47 and wanting more than ever to become productive and enjoy life again, this was contradictory. It begged the questions, "If I am too young, how old do I have to be? Do I have to be so old that I am beyond being able to work, be productive, and have no hope of being a wage-earner again?" This made no sense, since the whole idea of getting the pain pump would be to be able to return to some semblance of a normal life without dependence on oral medications that saturate the bloodstream and turn one into a virtual vegetable. After that revelation, my spouse rightly told the PM doctor "no more". They have started a tapering program over supposedly three months that seems much too rapid in some respects starting out and the process of dosages reduction over time has not been fully disclosed. Although they have related the Fentanyl dose would decline as 75/50/25/12.5/unknown over two-week intervals, they have initially decreased the Oxycodone from 60 mg/day to 20 mg/day in the first two week period, which is causing problems - both pain-wise and mentally withdrawal-wise. There is no doubt my spouse will continue to need adequate medication of some sort to continue to manage her extreme pain, or approval to receive the pain pump at best, but the uncertainty and distrust of this tapering process, given the level of non-disclosure, is leaving my spouse stressed out and enduring emotions and uncertainty that, at least to me, are unwarranted from doctors if they really cared about the patient's well being through the process. What course of action, to mitigate a process of tapering not really tailored for the patient and to get them into a more effective program of treatment for their pain would be recommended?
doctor
Answered by Dr. Dr. Matt Wachsman (51 minutes later)
Brief Answer:
so, the total amount is 20 mg/ day?

Detailed Answer:
wow....
Different doses of narcotic have different risks. Below about 40 mg a day is the minimal amount of risk. It rapidly increases and at up to about 90 mg a day the risk of any significant side effect triples. We are not at the death risk and this includes people starting to do stupid things with their medications. As such it is a bit of a tautology. If someone can tolerate 30 mg a day or less, they are going to be very careful and use a very minimal amount of any drug. Anyway, it is somewhere over 100 mg a day that things get actually dangerous. If there is a 12.5 mg fentanyl patch AND 4-5 a day of 5 mg oxycodone, that is a low, reasonable dose that might not be enough for everyone BUT is likely a bit more effect than, say, suboxone.
If you are just on a total of 20 mg a day of oxycodone, then suboxone might give more pain effect and be quite safe.
These are all low to moderate doses and, might be increased by a pain managment specialist.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Matt Wachsman (19 hours later)
I believe you may have somewhat misunderstood, since my question did not inquire about risk. The patient has begun tapering off the two medications. In the first two-week period, Fentanyl patch went from from 75 mcg to 50 mcg and Oxycodone went from 60 mg/day to 20 mg/day. It is the sudden drastic cut in Oxycodone that is the concern, which brings into question the whole tapering process which should cause as little discomfort for the patient as possible. I know the patient should seek out another physician of some sort to pick up managing the pain in some way as these other hard narcotic medications decline, but just who or where that would be while this tapering regimen is going on is the question. So, what best course of action should the patient take (meaning who and where should the patient seek out) to continue adequate pain management during and following this tapering process?
doctor
Answered by Dr. Dr. Matt Wachsman (7 hours later)
Brief Answer:
Pain management

Detailed Answer:
sorry, best I can do.
But it's really a fraught topic:
1) a large number of pain manangement physicians WILL be inappropriate either because they are good... and want to ONLY do spine problems and are highly specialized or because they are not so good. Some are a bit too interested in narcotics and some are too interested in procedures. Your situation is not at all a common one, so.... they really might not want to be involved.
2) there's an epidemic in narcotics and that distorts the discussion. I mentioned the risk/amount/doses to set up the discussion AWAY from addiction issues because the doses we are discussing are SMALL but, the overall context is going to distort the situation and you might not be able to get anyone involved in your case OR... there will be a LONG wait, so, regardless, you should try to set up appointments immmediately.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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Is It Safe To Decrease Dosage Of Oxycodone From 60mg To 20mg?

Brief Answer: so, the total amount is 20 mg/ day? Detailed Answer: wow.... Different doses of narcotic have different risks. Below about 40 mg a day is the minimal amount of risk. It rapidly increases and at up to about 90 mg a day the risk of any significant side effect triples. We are not at the death risk and this includes people starting to do stupid things with their medications. As such it is a bit of a tautology. If someone can tolerate 30 mg a day or less, they are going to be very careful and use a very minimal amount of any drug. Anyway, it is somewhere over 100 mg a day that things get actually dangerous. If there is a 12.5 mg fentanyl patch AND 4-5 a day of 5 mg oxycodone, that is a low, reasonable dose that might not be enough for everyone BUT is likely a bit more effect than, say, suboxone. If you are just on a total of 20 mg a day of oxycodone, then suboxone might give more pain effect and be quite safe. These are all low to moderate doses and, might be increased by a pain managment specialist.