Duragesic

[Ga31419]

I saw my PM yesterday.  I was telling her that effectiveness was failing after 48 hrs.  She had do the urine test and it showed no narcotics in my system.  I was wearing a patch that I had put on the previous morning, replacing the patch I had worn for 72 hrs.  Any ideas or has anyone else had a similar experience?

[Tuckamore]

Thanks for clarifying your concern. Sometimes we miss the true question and I apologize.

The Fentanyl Patch is a very effective pain management medication - however it doesn't work the same in all ppl. I've heard your very complaint from others. I was only on it for a few days before I developed blisters from the tape. We tried everything for a week to treat the blistering - I'd hope it would be an answer - but my body said different. My point is that I didn't note a significant pain reduction while on the Patch. Granted it wasn't a long period of time - but just nothing. My astute PCP/PMP later tried an oral long acting med that provided me almost immediate pain relief.

As long as you have such a good relationship with your PMP I would be sure to share with them the ineffectiveness of the Patch. There are other choices - Fentanyl may simply not be a good drug for you. I've heard that tolerance can build quickly - though I have my own thoughts (as did my astute PCP/PMP) on tolerance that isn't always in line with general consensus. At any rate don't suffer needlessly. You can always return to the Patch if other long acting opiates fail you.

Phil is a wonderful wealth of knowledge - one of our community assets. If you didn't see this thread on Fentanyl and failed drug screens you may want to read it. This is great info to provide your physician - if nothing else for info sake. Here's the link:

http://www.medhelp.org/posts/Pain-Management/How-bad-is-going-off-of-Fentanyl-100mcg-cold-turkey-going-to-be/show/2640578

Again thanks for the clarification.  I do understand you want to try it for another month. You may just need some adjustment to the dosage -  Again don't suffer needlessly.

My Best,
~Tuck

[Ga31419]

I'm not really concerned that my PM Dr. would suspect that I'm not using the meds.  I've know her for a long time (she treated my father).  I'm more concerned that the patches aren't working as they should.  I was curious to see if anyone else had a similar situation using transdermal patches. We discussed some alternatives but I decidedto leave things as they are for 30 days and then reevaluate.  Thank you for replying.

[philnoir]

Remember, there are two kinds of UDT

Immunoassay -- quick, done in the doctor's office, marginal accuracy.
Chromatograph -- requires medical laboratory test, highly accurate.


First, synthetic opioids like fentanyl are not detected by all immunoassay tests.

Second, fentanyl, being 100-times more effective than morphine, is dosed, not in milligrams (1/1000 of a gram) but in micrograms (1/1000000 of a gram), and operates at such a low serum level, it may be difficult to detect even in chromatography.

For your info, fentanyl metabolites are as follows:


Fentanyl (Transdermal, Transbuccal, Transmucosal, Sublingual)

    Norfentanyl
    4-N-(N-propionylanilino) piperidine
    4-N-(Nhydroxypropionylanilino) piperidine
    1-(2-phenethyl)-4-N-(Nhydroxypropionylanilino) piperidine

(Source: Remitigate.com)

As for my experience with transdermal fentanyl, when I used that patch, I found them effective to 2 days only, after only 3-6 months of use.

For me, the problem with transdermal fentanyl was a rapid development of opioid tolerance. Within 18 months of use, my dose had gone from 25 to 100 ug, and I needed another adjustment upward. Instead of doing that, my doc and I chose to use another long-acting opioid medication.

Best wishes.

[Tuckamore]

Hi Ga31419,

Welcome. I'm sorry to hear about the results of your drug screen. I hope this does not effect your pain management.

Do you know which test was preformed? Was this a quick urine test done in her office (immunoassay) or was it a GC-MS?  (Gas chromatography-mass spectrometry [GC-MS])

The less effective drug screen, immunoassay is often performed first. It's actually more of a screening method and has a higher rate of inaccuracy. The GC-MS is considered absolutely accurate - though there are factors that can change results. Sadly if you fail a GC-MS you are often dismissed from Pain Management and labeled an abuser and/or diverter.

Yes, I hear from ppl that have failed a drug screen, even while wearing a patch and claiming they have taken their meds as prescribed fairly regularly. I do believe you can have an inaccurate drug test results - but I can't always or often explain it.

I suggest you have a long discussion regarding the results of the drug screen with your PMP. I assume she is keeping you as a patient.

Please keep in touch and let us know the outcome. Please consider joining our community and becoming an active member. You'll learn a lot, find support and be able to offer the same to others.

Good Luck,
~Tuck