Opinions - Hydrocodone, Norco, Lortab and Fentynl Patches

[SubD]

AFOM has cancer; found in July this year during a total hysterectomy; colon cancer, it has since metastasized to the liver and the lungs.

My friend has decided NOT to do chemotherapy due to a couple of reasons (so far) but the main is her intolerance to pain and discomfort in general.

Since July she has had a hysterectomy, a colonoscopy, a colostomy and also shattered her left ankle thinking she was 20 something again and could jump a fence as a shortcut so had surgery on her ankle and now has pins and plates in her ankle, it's almost healed.

The problem is she a couple fold; A. She is a wimp when it comes to pain/discomfort. B. She "used" to use illegal substances (T's & Blues, Cocaine (these two injected IV) and smoked crack) she walked away from these in 1986. She did not use drugs other than physician prescribed until last year July when she got involved with a man and did crystal meth with him until stopping in December of 2007. (Smoked it then started injecting it). C. She is bipolar with panic and anxiety attacks. D. She lives with her bestestest friend in the world who does a great many wonderful things for her and has been taking care of her since her hysterectomy in July and will be taking care of her until she goes to hospice.

Now, recently her mind has been wandering to crystal meth, she has actually shot it a couple of times in the past month (bunk, pure bunk might as well have been epsom salts). Well her physicians have prescribed her for her bipolarism and panic/anxiety attacks; Prozac, Abilify, Lamictal and Xanax, none of which she abuses.

Her physicians also prescribed her for her shattered ankle Hydrocodone, Lortab, Norco and once Oxycontin and Oxycodone. These disappear rapidly as her friend/roommate has a number of ailments and over does her own doses and ends up needing more before the next refills. She however does share hers when my friend's pills are gone and she had gotten her refills.

Once she shared a 50mg patch of Fentanyl when the pain of the ankle was at it's worst and it worked very well.

This past Tuesday both my friend and her friend/roommate went to the walk in acute care clinic of my friend's Dr's building. She was given a tramadol shot that did nothing and 30 Norco 10/250(?) and told to see her Dr. ~ Later that day she did see her primary care physician and he gave her a prescription for two boxes of five each 100MCG Fentanyl patches and 90 Lortab 7.5/500's.

Her friend/roommate gave her a 25MCG Fentanyl patch to put on which has had no effect whatsoever and both have been taking the Norco's which are gone and now there are 45 of the Lortab left. (her friend/roommate took the majority of the Norco/Lortab's)

This one has been perusing the forums for a few days now and has learned a lot of valuable information which she thanks all for but her main concern for her friend now is:

The friend is not the one doing the "majority" of the pills and as of yet does not have a big tolerance so she is scared to death of putting on a 100MCG Fentanyl patch and yet wonders is there a way to cut the patch in half, tape up the cut edge of the half of the patch and store it, tape up the cut edge of the other half of the patch and put it on to be used as a 50MCG patch instead of the whole 100?

Also being a big fan of the needle she is starting to wonder about doing bitty bitty shots when she thinks about getting high (usually when the weight of the knowledge of cancer gets to be too much or she can feel herself going into a panic/anxiety attack over such although right now she really has no outward or inward signs/symptoms of the cancer although the colon cancer tumor was taken out but a PET scan did show that it had metastasized to the liver and lungs and different areas between).

Also when should my friend BEGIN to show signs/symptoms that would really and truly warrant the pain medicine she is getting and will research further on (morphine, Demerol, etc?) and what would be the best to ask her primary care physician for once the Fentanyl patches need break through pain help?

Thank you all and I hope I followed the guidelines here in getting my friends questions answered.

[JarvyJarvison]

The friend is not the one doing the "majority" of the pills and as of yet does not have a big tolerance so she is scared to death of putting on a 100MCG Fentanyl patch and yet wonders is there a way to cut the patch in half, tape up the cut edge of the half of the patch and store it, tape up the cut edge of the other half of the patch and put it on to be used as a 50MCG patch instead of the whole 100?

This sounds like this *should* work, but keep in mind that the fentanyl patches aren't meant to be cut in half. This means that the fentanyl isn't necessarily equally distributed across the medium (the gel). Therefore, theoretically, your friend could end up with one half of a patch with 100% of the fentanyl and one half with 0%. Or she could have a 50/50 split, but more than likely it will be somewhere in between the two extremes.

Your friend should talk to her doctor about her concerns. Doctors are very understanding with cancer patients and I really can't see a doctor turning down a request to *lower* your friend's dosage.

Also being a big fan of the needle she is starting to wonder about doing bitty bitty shots when she thinks about getting high (usually when the weight of the knowledge of cancer gets to be too much or she can feel herself going into a panic/anxiety attack over such although right now she really has no outward or inward signs/symptoms of the cancer although the colon cancer tumor was taken out but a PET scan did show that it had metastasized to the liver and lungs and different areas between).

Your friend should carefully consider the potential consequences of abusing the fentanyl in such a way. Her tolerance will rise rapidly and the analgesic effects of the fentanyl will vary inversely to her tolerance. Not only that, but if it is found out that she is abusing her medication in such a way she may lose them. What this means is when she is in real pain she might be shit out of luck. If she insists on abusing her medicine, then she might want to look into less obvious and less-tolerance-building routes of administration such as sublingual and smoking.

Also when should my friend BEGIN to show signs/symptoms that would really and truly warrant the pain medicine she is getting and will research further on (morphine, Demerol, etc?) and what would be the best to ask her primary care physician for once the Fentanyl patches need break through pain help?

It really depends. Some people don't get any pain until the very last stages of cancer. If the cancer is in your friend's lungs than morphine will likely be prescribed to reduce the panic and anxiety that comes with not being able to breathe. *My experience* is that the heavy duty drugs do not come into play until hospice gets involved. Obviously, it could be different with your friend if her quality of life affected enough by the pain. Fentanyl 100mcg is already a pretty heavy duty drug in itself, a much more potent analgesic than both morphine and demerol. When your friend needs more help with breakthrough pain the doctors will probably know because they'll see it on your friend's face.

My friend has decided NOT to do chemotherapy due to a couple of reasons (so far) but the main is her intolerance to pain and discomfort in general.

Your friend might want to reconsider chemotherapy and/or radiation therapy. Make no mistake about it, the procedure *is* painful and it has lots of nasty side effects but, trust me, it is nowhere near as painful as the last stage of metastisized cancer. Someone very close to me died in exactly the same way as your friend might (colon cancer which metastized to the liver and lungs). Since your friend is averse to discomfort she will want to put this off as long as possible. I don't want to scare you but just watching this process was the most painful experience of my life. The chemotherapy and radiation can slow down the progress and even put the cancer into remission. The sooner this is done, the better as the results will only get worse with time.

Anywa, I'm sorry to hear your friend has to go through this. I can't imagine what it would feel like. Best of luck.

[mrsyavez55]

SWIM's mom was in the same predicament. Only she never did rec drugs. Yet the cancer went from lungs to everywhere else and into the bone. SWIM's mom was on the lortab and fentanyl patches. Towards the end she was wearing 150mcg patches as well as morphine pills for breakthrough pain.
You can cut the Mylan patches in half. Not the others though. So if she feels that the 100 is too much then she can cut it. If she expericence breakthrough pain the doc's will definitely prescribe something for her. SWIM's mom's pain issues started about 3 months after diagnoses and it was already metastasized. SWIM's mom had to keep complaining though and SWIM had to get on the doc's ass a few times so that they would prescribe her some heavier narcotics than regular vicodin or lortab. Of course the heavy duty stuff like 150mcg patch plus morphine didn't come until 3 months prior to her death.
I would try and get her to do the chemo. SWIM's mom was so against it too. DIdn't want to be nauseated or in pain. Yet we were surprised cause she didn't have any discomfort and was well taken care of when it came to nausea. The drugs they have now for nausea are great. If she was even slightly nauseous I'd give her more at home.
I really hope the best for you friend.