[mmglobal]

I've been communicating with a client who has such very serious problems that he's on the 75 mcg patch. It was prescribed with little fanfare and no warnings. He did ramp up to 75's or he'd probably be dead now. Not only was his medication prescribed with little fanfare and no warnings, but his insurance requires him to get maintenance medications from sponsored mail-order, so there was no opportunity for a pharmacist to be of assistance here.

He's very severely disabled by pain. Like most of us, he can function around the house on a limited basis and get in his car for doctor appointments and small errands, but he's probably an "18 or 20 hour a day laying down" patient. He's been my client for well over a year. He's somewhat sleep disordered and frequently complains of problems that don't seem spine, but often seem spine syndrome and medication related.... confusion, dizziness, difficulty breathing. Every once in a while I'd hear it first hand over the phone. I know the client very well and I'm not concerned about abuse issues... he's religious about the meds and I've spent a lot of time with him... he's not abusing his meds... intentionally, that is.

It seems that the only thing that gives him relief has to do with hot water. In addition to long, hot showers; he uses his hot tub twice a day.

I cannot stress how dangerous this situation is. Note that his patches did not work very well at the prescribed 3-day interval, so his doctor moved him to 2-day changes. How could it last if he FREQUENTLY accelerated the delivery rate??

At the suggestion of Peter Holzner, the amazingly helpful pharmacist in Bogen, I'm contacting the manufacturer... they should have data on release rates. The client and I reviewed the package insert and it warns of hot tub use. Not only does it not specifically warn about showers, but it says that you can shower with it on. Physical problems with the patches and water can also cause damage the patch (I've seen it), not only making an extra change necessary, but I wonder about the release in a damaged patch?

>> What must it do to all of your systems to get a 'booster' 2-4 times a day?

>> What must it do to the effectiveness of the medication at non-boosted time?

>> What must it do to accelerate tolerance, dependence and addictions issues?

>> What must it do to the risk of confusion related accidents. People who are over medicated not only have accidents and function very poorly because of the confusion and drowsinesses, but they also make mistakes with other medications that can be very dangerous.

I'm sure that this list should be much longer, but I have to go now... I just wanted to get the word out. I'll let you know what I get from the manufacturer.

All the best,

Mark