Relative drug costs--eye opener!

[aimeee, BSN, RN]

Cost of Opioids: Equianalgesic Dose

(using morphine 30 mg q 4 h as the base

based on average wholesale price (AWP), 2001

click here to view table

Isn't this an incredible premium that has to be paid for the formulation of controlled released medication? And I had no idea of how expensive regular oxycodone was in relation to morphine!

I heard at a seminar once again about methadone and what a shame it is that nobody in this country uses it because there are about 20% of the population who cannot effectively metabolize morphine. I'm told it isn't used because of the stigma associated with it being used to treat drug addiction, and because doctors don't know how to use it. No pharmaceutical rep will ever recommend it because there is no profit to be made on it.

If even a few patients on the census were using methadone instead of oxycontin just think of the savings! What extra services could your hospice offer with the money that would be saved?

[NRSKarenRN, BSN, RN]

it's a same that the exteded realse preparations are so costly but they do help to prevent the pesaks and valleys associated with Q 4-6 hr dosing.

As aware of this back in early 1990's when in Hospice. We DID use Methadone with extensive teaching. Had good success with using TRILISATE as adjunctive med due to antinflamitory properties comes as extended tablet and liquid, less costly than other NSAIDs too.

[aimeee, BSN, RN]

Yes, the controlled release preparations are necessary because they do such a good job of bringing that pain roller coaster under control. I would really love to know what the difference in profit margin is for the manufacturer though. Does it really cost anywhere near 6 times more to produce the controlled release Morphine? I know we are also covering the price of development. I would just find it interesting to know to what extent.

[Aerolizing]

We had a young nurse who came to our hospital to request that her spinal cord be severed. (That is how she ended up on the psych unit.) She knew that meant paralysis and life in a wheelchair. She had pain that was not controlled by multiple surgeries, PT, or meds. She had gotten hurt at work, ambulating a patient who fell, jerking her back and she was never able to work again. Forgot what her actual injury was. Anyway, she was brought in unable to get out of bed for a ccouple years on multiple pain meds and left using a walker and on methadone. She never thought she would be able to function upright again. She wrote us a letter from a road trip she was able to take. Still using her walker but at least not bed ridden and her pain was controlled.

I was recently without prescription insurance for a couple months. I had no idea birth control pills were $43.50 a month and my allergy nasal spray was $70.00 for a one month supply. Makes you wonder how our older folks afford all of the newer meds without prescription coverage.

[Lucy RN]

I recently was prescribed Celebrex for abd pain which they thought may be inflammation related- and my insurance wouldn't pay for it because they needed a prior approval.... it was $45.00 for 15 pills......I too wonder how people can do it without insurance.

It makes me sad to think that most people go without simply because they can't afford it.....I consider myself lucky.......