Oxycontin - I didn't know how to answer this for pt.

FLArn · Sep 10, 2010

While all the other posters are PROBABLY correct about the patient's motives; something to be considered / explored especially in today's economy MIGHT be the fact that the patient is falling on hard times and is looking for ways to make his meds last longer. I saw an article in a magazine that suggested that people ask their doctors to order larger doses that patients could cut in half and therefore stretch their money since a script, for example, of 20mg Lasix 30 tabs would be the same as 30 10mg tabs but would last 2 months instead of 1. We know that Oxycontin couldn't be worked that way but the patient might not.

We need to not be so cynical that we automatically think every patient is drug seeking or manipulative, some are just trying to get by the best they can with what resources they have!

MAISY, RN-ER, BSN, RN · Sep 10, 2010

While all the other posters are PROBABLY correct about the patient's motives; something to be considered / explored especially in today's economy MIGHT be the fact that the patient is falling on hard times and is looking for ways to make his meds last longer. I saw an article in a magazine that suggested that people ask their doctors to order larger doses that patients could cut in half and therefore stretch their money since a script, for example, of 20mg Lasix 30 tabs would be the same as 30 10mg tabs but would last 2 months instead of 1. We know that Oxycontin couldn't be worked that way but the patient might not.
We need to not be so cynical that we automatically think every patient is drug seeking or manipulative, some are just trying to get by the best they can with what resources they have!

That is a good point with regards to the economy and medication usage...I am seeing this alot during our triage with patients taking 1/2 tabs daily. However, 20mg Percocet ER makes me think that this is probably long term or chronic pain usage which gives the impression of a "knowing" patient. In any case, everyone has been correct in their responses.

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SnowStar4 · Sep 10, 2010

As a person who used to make drugs, I agree it was correct to not split the pill. Not only because it was a long acting drug, but I assume it was not marked to divide. A pill that is not marked to divide should never be cut.

We assume that a pill divided in two equal parts would give two equal doses- but that is simply not always the case. There are many things in that pill other than the active ingredient, and an equal dose cannot be guaranteed. When it can be safely split, then it will be marked as so.

The fact that it is a long acting drug is a whole other story. There are things in the pill that make it long acting, or slowly dissolving. If you take away the layers of the pill, then then you take away the whole science behind it (and believe me, it is a lot :))

(PS- yes, I realize that hospitals often provide pills that need to be cut without the markings. Just because they do it doesn't make it right!)

Tait, MSN, RN · Sep 10, 2010

We give 5-10mg PO oxycontin Q3, so if he was genuinely concerned about getting to much I would have just called the doc and asked to have the dosing changed.

Tait

grandmawrinkle · Sep 10, 2010

We give 5-10mg PO oxycontin Q3, so if he was genuinely concerned about getting to much I would have just called the doc and asked to have the dosing changed.
Tait

This is an interesting dosage schedule, are you sure you don't mean oxycodone? (They are not one and the same.) If you do mean oxycontin, what type of patient population is that prescribed for?

morte, LPN, LVN · Sep 10, 2010

I wonder how many times this pt presented that particular request to his nurse. Can you get Oxycontin in 5mg and 10mg tabs? If that's possible, just give him a smaller dose tablet. Of course somewhere down the line the MD would have to be notified.
I would not have cut it either.

Oxycontin does not come in 5mg tabs....

Tait, MSN, RN · Sep 10, 2010

My bad. I meant Oxycodone, aka Roxicodone.

I love my cat! · Sep 10, 2010

You are smart not to cut/split the medication.

The first thing that came to mind to me is that his pain is not being adequately managed. If he was really looking for a high-he would have accepted the 20mg and just chewed it!

He is asking for a smaller dose of an opiate that acts more quickly.

What is his number on the pain scale prior to the drug being given and then after the drug is given?

tuttle13 · Sep 10, 2010

Where I work (and I assume everywhere else) we are NEVER allowed to score a narc in half or otherwise. A nurse did this at the facility I work at and got fired on the spot when it was found out. Not only was she changing the prescribed dose, but had no way of showing what happened to the other half. All unused narcs have to be wasted by two RNs, or administration will think you took the med yourself. Most patients think "what's the big deal" since they would be taking less than prescribed and they should be able to do that if they want. They certainly can take a lower dose, however they will have to wait until I can get a hold of the MD to prescribe it and then wait for the pharmacy to deliver it if none is available in our emergency supply. Don't mess with meds, especially narcs - it could mean the end of your job or your nursing license. Document what the patient is requesting an call the doctor. End of story.

tewdles, RN · Sep 10, 2010

I had a patient yesterday, that gets 20mg Oxycontin long acting bid. He asked me to cut it into fours for him b/c he only wanted to take 5mg of oxycodone at a time. I told him that long acting med's should not be cut or crushed due to the medicine being absorbed all at once, and possibly causing an overdose. He then told me that it would only be 5mg of the medicine all at once, ( just a little too educated for my taste on narcotics) and he wanted to see if that would be all he needed to help with the immediate pain, and then would not want anymore if so. I was stuck. It makes sense that it would only be 5mg, but I didn't feel comfortable telling him (or agreeing with him and going against the "laws of long acting"), plus.. honestly... I don't know. I again reinforced that they should not be cut or crushed, and if he felt he doesn't need the entire 20 dose, I could talk to the doctor about cutting the DOSE for him. He said he'd talk to him.. however.. I still don't know. p.s. I didn't cut the dose.

okay...we can all assume that this man is manipulating and abusing and might be a terrorist to boot...

or...we can run with the thought that he wanted some information about his pain control which, of course, he has EVERY right to know. What is missing from this scenario is any pain assessment...what is the nature and location of the pain, how severe is it, how long has he had it, what fast acting or immediate relief agent does he have available, etc.

What is absolutely correct is your refusal to break or cut that oxycontin tablet. What is unfortunate is that you did not follow up on the notion that he apparently feels that he doesn't need that much, that he got no education about the principles of pain management which would include a combination of long and short acting agents and, in chronic pain, also often includes other adjuvant medications and therapies.

Honestly, when I have patients on opiates I WANT the patients AND their families to be extremely conversant with the nature, purpose, dose, side effects, etc of the meds...why should you assume that if your patient knows anything about his opiate that he is under suspicion of abuse? As well, doing the math about dividing a 20mg tablet into quarters = 5mg doses is just math...it is NOT knowledge of "narcotics".

Without knowing any of your comprehensive pain assessment, it is impossible to do more than guess...but I will give it a shot...

maybe his pain is well controlled and so he is wondering about lowering his dose...warrants a review of his prn fast acting use, his pain hx over the past 72hr, his symptom burden, and a call to the doc to collaborate. He may just be well controlled on a dose and is not aware that if he decreases that BID dose it will significantly affect his overall comfort...that he may have to take MORE opiate in total if he removes or significantly reduces the long acting agent...and that he will have periods of discomfort more frequently than he may currently have with an effective regime. These would be educational opportunities for his nurse. He may just be as fearful and uninformed about opiates as too many nurses and doctors are.

other posters have suggested that he may be trying to save money when he is home...true...and so you need to educate him that this is not an efficient or safe way for him to cut costs. Oxycontin costs more than MSContin...could he be transitioned to a less expensive option?

It is a sad fact that many, many (too many) people live with chronic pain which is poorly controlled precisely because they have medical and nursing professionals involved in their care who are not comfortable with or well informed about the use of analgesics...and too many of them are considered "drug seekers" by otherwise well meaning and good hearted professionals, thereby, hampering their ability to achieve adequate relief.

ok...off my soap box now...

you did good to not cut the tablet.

NocturneNrse · Sep 11, 2010

Thanks everyone! I didn't think that is how it would work... and there was NO way I was cutting it or allowing him to cut it. He has since gone, but I will mention it to the MD concerning this for future admits (this fella' is a "frequent flyer") UGH.. it's hard taking care of this kind of pt who is manipulative and trying NOT to be judgemental.

Thanks again everyone!