Oxycodone

[luvflyin]

My Mom was in Hospice care for a couple years. They discharged her from it because they no longer estimate she has less than 6 months to live. They had her on Oxycodone (Oxyfast) Concentrated Liguid, .25 ML, by mouth every 6 hours for SOB. That’s shortness of breath. They said when she feels short of breath it keeps her from over reacting to it. I guess it’s kinda realated to why there are Codeine cough medicines. I got a list of her medications from the pharmacy at the Assisted Living Facilty and had them highlight those that were prescribed by Hospice and took it her Primary Care Physician so that he could write prescriptions for them. The response I got from his nurse was they are not as liberal with controlled substances as Hospice was. This tells me he is probably not going to prescribe it. We have an appointment with him in about 10 days. My question now is what happens if he won’t do it. Is she likely to go into cold turkey withdrawal symptoms?

 

[Salty]

Sorry to hear about this.

This reminds me of when I tell my dog he's being good and he immediately stops behaving. She's doing better, so let's stop doing what we were doing that was working. I don't know why anyone thinks this makes sense.

Punish the innocent to prevent the crimes. Who is the a-hole that decided for all of us that it's better to make people that need it suffer than to have someone abuse the drug?

 

[DeltaCharlie172]

Is she a pilot?

 

[luvflyin]

Is she a pilot?

No

 

[TCABM]

Do you have a medical POA?

Have you raised your concern with her PCM yet?

Have you talked to the hospice to see what their thoughts are on tapering off?

Is there another way to control the shortness of breath? Some type of non-pharmacological therapy?

 

[bentmettle]

Sorry you've had to deal with your mother's health issues and recent difficult prognosis.

I don't think I'd worry too much about the nurse and let the doctor do their job. I've had more than one experience of nurses kind of doing a weird flex thing that felt condescending.

Being a layperson, I look at something like this and am left thinking that she's currently getting one of the appropriate medications for her condition as you describe it.

BPJ 47: Managing breathlessness in palliative care

The Best Practice Advocacy Centre delivers educational and continuing professional development programmes to medical practitioners and other health professional groups throughout New Zealand.

bpac.org.nz

I would give the doctor an opportunity to explain how they intend to treat the condition she has. This would seem to suggest that opioids are an acceptable treatment, and that some of the other treatment options aren't as effective. Maybe the doctor has some other effective treatment option. Maybe they realize they don't, and have no intention of trying to alter the medication being used to treat her condition at this point.

good luck

 

[JOhnH]

Is there any chance the docs at the hospice could write her a prescription? At least enough to try to taper her off.

 

[luvflyin]

Do you have a medical POA?

Have you raised your concern with her PCM yet?

Have you talked to the hospice to see what their thoughts are on tapering off?

Is there another way to control the shortness of breath? Some type of non-pharmacological therapy?

Yes
Yes
Not yet
Don’t know

 

[luvflyin]

Sorry you've had to deal with your mother's health issues and recent difficult prognosis.

I don't think I'd worry too much about the nurse and let the doctor do their job. I've had more than one experience of nurses kind of doing a weird flex thing that felt condescending.

Being a layperson, I look at something like this and am left thinking that she's currently getting one of the appropriate medications for her condition as you describe it.

BPJ 47: Managing breathlessness in palliative care

The Best Practice Advocacy Centre delivers educational and continuing professional development programmes to medical practitioners and other health professional groups throughout New Zealand.

bpac.org.nz

I would give the doctor an opportunity to explain how they intend to treat the condition she has. This would seem to suggest that opioids are an acceptable treatment, and that some of the other treatment options aren't as effective. Maybe the doctor has some other effective treatment option. Maybe they realize they don't, and have no intention of trying to alter the medication being used to treat her condition at this point.

good luck

Thanks for the link. We see the doctor in a week.

 

[luvflyin]

Is there any chance the docs at the hospice could write her a prescription? At least enough to try to taper her off.

I don’t know but I doubt they would write for someone not under their care.

 

[robin ardoin]

In my state, hospice physician staff prescribe palliative meds for patients under hospice care. My terminal cancer patients were given appropriate narcotics to ease suffering once all therapeutic options were exhausted or patients elected to not have further treatment. Back when oncology was part of my practice, Fentanyl patches, MS Contin and MSIR were our usual choices.

 

[Bob Noel]

Sorry to hear about your mom.

There used to be a palliative care program for someone that doesn't quite qualify for hospice. Is that no longer an option?

 

[Llewtrah381]

My question now is what happens if he won’t do it. Is she likely to go into cold turkey withdrawal symptoms?

To directly answer your question, if she was indeed taking no more than 0.25ml no more often than every 6 hours, she’s not opioid dependent and wouldn’t go through withdrawal. If you think she’s been on substantially more than that, you need to be candid with her new provider and raise the issue with them.

That’s a peculiar prescription. Opioids have a variety of effects. They suppress the drive to breathe (which is why/how fentanyl kills: it’s an exceptionally potent opioid with an exceptionally potent effect on respiratory drive) and, separately, they suppress the urge to cough (they sort of numb the desire to cough, distinct from the effects on respiratory drive).

As you have probably learned, hospice is functionally a benefits status for people not expected to live more than (semi-arbitrarily) 6 months. In exchange for a focus on patient comfort, specific treatment for the condition (not related to comfort) isn’t covered. Hospice isn’t limited to 6 months (as you’ve seen) and it’s unusual to get off of it. If she’s off, the focus should be on treating the underlying condition. If it can’t be treated, then consider pushing to get her back on hospice. Either way, I’d work to clarify why she was on the oxy - and if it was needed or actually helpful.

Hopefully that helps answer your actual question, if I read your post correctly.

 

[luvflyin]

To directly answer your question, if she was indeed taking no more than 0.25ml no more often than every 6 hours, she’s not opioid dependent and wouldn’t go through withdrawal. If you think she’s been on substantially more than that, you need to be candid with her new provider and raise the issue with them.

That’s a peculiar prescription. Opioids have a variety of effects. They suppress the drive to breathe (which is why/how fentanyl kills: it’s an exceptionally potent opioid with an exceptionally potent effect on respiratory drive) and, separately, they suppress the urge to cough (they sort of numb the desire to cough, distinct from the effects on respiratory drive).

As you have probably learned, hospice is functionally a benefits status for people not expected to live more than (semi-arbitrarily) 6 months. In exchange for a focus on patient comfort, specific treatment for the condition (not related to comfort) isn’t covered. Hospice isn’t limited to 6 months (as you’ve seen) and it’s unusual to get off of it. If she’s off, the focus should be on treating the underlying condition. If it can’t be treated, then consider pushing to get her back on hospice. Either way, I’d work to clarify why she was on the oxy - and if it was needed or actually helpful.

Hopefully that helps answer your actual question, if I read your post correctly.

It does answer the question. Thank you.

 

[455 Bravo Uniform]

Sorry to hear about the protracted issues with your mom.

Good on the POA members and moderators for maintaining such a place where we can come for non-aviation related support. It’s not just SGOTI like other sites.

 

[Chris Mixon]

I am sorry to hear about the change in care for you relative and the MD's here have provided some great feedback. My only suggestion if they are sending them home is to look into a Pallative or Hospice at Home program if one is availible in your area. I used to help create training, protocols and procedures for a EMS based program that supplied non-emergent home health and pallative care in several different states, and the process and procedures were different every time.

 

[PaulS]

In my state, hospice physician staff prescribe palliative meds for patients under hospice care. My terminal cancer patients were given appropriate narcotics to ease suffering once all therapeutic options were exhausted or patients elected to not have further treatment. Back when oncology was part of my practice, Fentanyl patches, MS Contin and MSIR were our usual choices.

To directly answer your question, if she was indeed taking no more than 0.25ml no more often than every 6 hours, she’s not opioid dependent and wouldn’t go through withdrawal. If you think she’s been on substantially more than that, you need to be candid with her new provider and raise the issue with them.

That’s a peculiar prescription. Opioids have a variety of effects. They suppress the drive to breathe (which is why/how fentanyl kills: it’s an exceptionally potent opioid with an exceptionally potent effect on respiratory drive) and, separately, they suppress the urge to cough (they sort of numb the desire to cough, distinct from the effects on respiratory drive).

As you have probably learned, hospice is functionally a benefits status for people not expected to live more than (semi-arbitrarily) 6 months. In exchange for a focus on patient comfort, specific treatment for the condition (not related to comfort) isn’t covered. Hospice isn’t limited to 6 months (as you’ve seen) and it’s unusual to get off of it. If she’s off, the focus should be on treating the underlying condition. If it can’t be treated, then consider pushing to get her back on hospice. Either way, I’d work to clarify why she was on the oxy - and if it was needed or actually helpful.

Hopefully that helps answer your actual question, if I read your post correctly.

There is some excellent advice here. Sorry you are going through this, it is a difficult situation, your mom is lucky to have you. Part of making this process easier is having a good doc, like the ones above, but specializing in geriatric care, on your side. Knowing a good nurse is extremely helpful too, along with an experienced, caring social worker. If you don't have this, work on finding them by asking friends who have been through dealing with aging parents, another great resource is your local senior center. That's all I have for you, best of luck as you deal with this.

 

[mandm]

Gosh I’m sorry that you’re going through this. The system and everyone involved is frankly disgusting. Yes, there’s withdraw symptoms and that’s difficult to watch. We had experienced the reversed situation, the docs addicted my Mom to morphine and others and then said we’re not going to renew any prescriptions unless you agree to hospice. (We doctor shopped and found one who apologized and explained the situation and said he could only write one more script for her). She was a fighter and determined to live. But the system and doctors decided otherwise for her. I’ll never forgive anyone involved, the malice and disrespect. Disgusting.