Saturday, May 5, 2012


Ahhh, Opana ER, I hardly knew ya!

For many of you chronic pain patients, especially CRPS patients, you know all too well what happens when a drug company changes their formulation on a tried and true pain medication.

1) The chronic pain patients who have been having great success on that medication, and who were NOT abusing it, suddenly find that the new version does not work as well for them;


2) The new version has some type of coating, which was the reason for the new formulation in the first place, that seems to make everyone who takes it sick to their stomach because of the stuff it is made of;


3) Because this new coating is not completely breaking down in your stomach and/or intestines before it passes through and out of your body you do not get 100% use out of the medications pain-relieving properties.

Therefore, you do not get the pain relief you were getting on the old version of the medication, your stomach develops various problems, AND your pain issue (whether it is CRPS or fibro or whatever, starts to spike.  Sometimes people forget that the Digestive System is endowed with its' own local Nervous System and when it gets riled up it can lead to all sorts of pain spikes, especially when you have a disease like CRPS. In fact, some children can get what they call CVS or cyclic vomiting syndrome and it involves migraines and the gut.

Don't think you are alone in this. It happened back in 2010 with Oxycontin when they changed that medication ( Oxycontin Re-formulation - not well received )  and now it has happened again with another very successful medication for treating chronic pain, Opana. You can read many blogs/lists/websites about patients stories on the net, here is just one I have followed 

Unfortunately the purpose behind these re-formulations was supposedly to deter abuse.

Mainly by people who were getting it from the street, they were doing everything from snorting it to breaking it down into smaller sizes, and probably a hundred other things. Some were doing it to get high, some were doing it because they needed the drug for pain relief and couldn't get it legitimately.

The makers of these drugs decided they would come up with ways to coat the medications so no one would be able to "break-down" the drug without destroying it in the process.

Well in both of these cases they severely underestimated the people they were up against and their desire for the drug, and apparently the financial demand for it. In both cases within days the internet was filled with instructions on how to break it down.

I remember going on-line after the new Opana was introduced, I wanted to see what, if any, people had to say about it. I was shocked to see the posts by people who were already sharing ways to break down the coating. Those posts were mixed in with posts from legitimate patients who were really upset because once again, their pain relief was going away, the stomach pains were back, and another short-lived attempt at pain-relief was yanked from their hands by short-sighted people.

I personally had been on Opana since the change to Oxycontin. I was one of the many, many legitimate patients who had done well on Oxycontin only to have to change to something else when the change came to Oxy. I, like many, switched to Opana. I was thrilled because it worked even better than Oxy. There aren't a lot of options when it comes to pain relief for CRPS patients; opiod agonists are one of the best. Oxy was one of the most popular, then most had to switch to Opana.

Then in March of this year Opana switched to a new formulation and bang. It happened again. Within days the abusers had figured out how to beat the system, get around the new tamper-proof and crush-proof coating, and they were back to snorting it, and doing whatever else they do to them once they are in powder form. While those of us who take them legitimately were left holding the bag, and for some people it was a very expensive bag depending on your co-pay.

So .... it is back to searching for a new source of pain relief for many of us, and looks like after spending all that money on re-tooling a successful product, Endo Pharmaceuticals will be losing quite a lot of customers. What is that old expression? If it ain't broke, don't fix it.

Some will go to another opiate, many will try the patch. Some will even try the Opana IR, or instant release version (the re-tooled opana was the ER or extended release).

For me, I went to the Fentanyl patch. I tried the new version of Opana for five weeks. All it did was put me into a very bad CRPS flare, very bad. I have been on the patch for a few weeks now and it has started to calm down my flare and I am doing better. I should be back to "my version of normal" in another week.

The good thing about the patch is that it has three levels, 25 mg, 50 mg, and 75 mg so I can even get more pain relief than I had with the Opana, PLUS I have already noticed the best thing about the patch; since there is no internal opiate being taken, I have no internal side effects that come with it! Meaning no constipation! I know that may sound a little vulgar but for those of you who have had to deal with it for years like me, even with whatever remedies you have used, it is a pain in the you know what, no pun intended.

Nor do you have the other side effects that come with taking an oral opiod, dashes of medication (where suddenly you feel a rush of the medication, it can sometimes get released that way when it is an ER), it is much steadier with the patch, and you don't feel as sleepy or dopey with the patch for some reason, even at the same level or higher of med. In addition, the medication is more effective because it is delivered directly into your bloodstream, nothing is wasted, nor do you have to wait while it is absorbed through your intestinal wall.

So I am hoping and praying that people don't find a way to abuse the patches so they don't feel the need to re-formulate them! Wish me luck.

Praying for all of you as well.

Peace to you all,


American RSDHope

1 comment:

ecanarensis said...

Hi Keith,
My sincere wishes that you didn't have to deal with chronic pain issues. I'm afraid I'm not real familiar with CRPS, but from what little I do know, t'ain't fun (how's that for an understatement?). I've been on OpanaER about 3 months now, have never had terrific success with any opioids, but they work some, & nothing else works at all (& boy, have I tried the gamut!). My issue with OER may have to do with the coating; I acutally find myself at times sliding into withdrawal symptoms (mainly cold sweats), about 5-7 hours after the last dose! Now, no opiates work even 1/2 the claimed time on me, but usually I get "just" (!) increased pain. My digestive system has always been real screwy, & I have to take huge amounts of magnesium to keep it from just halting completely. I'm wondering if at times the dose or doses are, dunno how to say this diplomatically....running thru without dissolving. Have you heard anything about people having very variable effects & duration from the newest (biconcave) OpanaER? I fear my doc is freaking out about my "breakthroughs."
I hope the patch works well for you (tho I confess I found about a 15% early-failure rate for it too...maybe it's just me). Wishing you the best possible, & least possible pain.
ecanarensis in NC
PS I’d vote “pain” as being the vilest & most obscene 4 letter word, myself.