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Doctors' Answers to "Frequently Asked Questions" - Opiate Painkillers

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/17/1999]
Question: I have kidney stones and one began moving this month. My Dr. prescribed both Lortab and Vicoden ES for the pain. I have yet to pass the stone and use the prescriptions only as needed for pain. However, my employer has a strict substance abuse policy. They often reject prescribed medication as a reason and have suspended people without pay until proper documentation and other innformation is provided by the Dr. They want the neccessity of the medication to be explained by the Dr. This takes time and my HMO is not willing to have their Doctors spend the time to complete the multiple forms, which cost me a Doctor's visit to bring in.
Due to the random drug testing by my employer, I need to know how long Lortab and Vicoden ES remain in the system. I think it would be best for me to remain off sick from work until that time to prevent any potential problems.
Thank you.

Answer: Well, could be, but sounds easier to get the note. Usually, the PA or NP or MD's secretary will do this in about 5 minutes. This would protect you in the future as well. The length of time varies a lot with the sensitivity of the test, that is how much they wish to spend. Usually however, one week for narcotics would be a guess. Some screeing will last longer.

Opiate Use [posted 8/7/98]
Question: My wife suffers from very severe facial pain (above right eye). After 10 years of searching for a cause using the most sophisticated diagnostic techniques no cause or cure can be found. She has, also for the past 7.5 years, been using morphine sulfate by injection (15 mg) 4 to 5 times daily to control the pain. Even this is sometimes not enough. She tapered its use off about 3 years ago and stopped completely because of the sudden and unexplained disappearance of the pain. A year and a half later it started again. After 1.5 months she said it was intolerable and began using morphine at the same rate. She sticks to a daily limit of 5 times a day at 15 mg. She works full-time, exercises 3 times weekly and has an quiet social life, is happily married. She has no sign of swelling or breathing problems. Our new doctor refuses to prescribe morphine as he says it lowers your pain threshold so that even a small pain is magnified out of all proportion. Also he feels she is abusing the drug. He refuses to consider any analgesic because she is a potential addict. She refused to go into a clinic and withdrew its use over a period of 3 weeks. Three months have passed and she is in such pain that she talks of ending it for good. She can't work, go out over, even play with her child because she is in such pain. Does morphine lower your pain threshold (whatever it is) that much and for months on end as he says? Would it really kill her slowly as he also suggests? How? (assuming constant and stable use) Does one become increasingly tolerant so that ever increasing doses are needed? She seemed to stabilize at 5 times a day at 15 mg and remain at that for years. Her doctor says it will increase later on. Can you direct me to information which is practical and correct,

Answer: Patients develop a tolerance for morphine. That is, higher doses are needed to achieve the same analgesic effect. However, it does not work in the manner that your physician is describing. Secondly, it will have addictive side effects - constipation, sleepiness, etc., but will not kill her. I would see another physician, has she been to a pain specialist? Lastly, there are oral morphine products that last 12 hours and would be preferable to injections. The pain relief can be achieved with less addictive potential.

Opiate Painkillers [posted 7/21/98]
Question: How long is it safe for a patient to be taking opiate (Tylenol #4) for a back injury?

Answer: Addiction will begin after 3-4 weeks depending on the dosage (assuming 6-8 per day) and most would have some addiction by 8-10 weeks of steady use if over 4-6 a day. The acetaminophen has some liver toxicity over 8 per day and long term will affect the kidney (10 years or longer depending again on the dosage).

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