Zohydro ER: Truth or Dare

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As our blog followers and much of the opioid media and political opioid-vote-seekers know, controversy surrounding Zohydro ER has exploded in the past three weeks. Just today, the American Academy of Pain Management issued a Statement on Extended-Release Hydrocodone (Zohydro ER), also available on their website that mirrors much of the discussion outlined below. This blog will help separate fact from the array of fictions that some lawmakers, governors and state attorneys general are spewing forth. Then we can debate the real issues.

First, let’s start with the sound bites being splattered throughout the media. Please note: none of the responses to the statements below are debatable. The responses are based on science.

TRUTH

Statement: “Zohydro ER will result in overdoses because it contains PURE hydrocodone.”
Duh. All prescription drugs approved by the FDA contain pure drug. Lortab and Vicodin each contain PURE hydrocodone and PURE acetaminophen. The hydrocodone in Zohydro ER is no more or less PURE than any other prescription hydrocodone.

Statement: “Zohydro ER is 5-10x more potent than Lortab or Vicodin.”
No. Hydrocodone is equipotent to morphine and about 20-30% less potent than oxycodone. The hydrocodone in Zohydro ER is still hydrocodone. It is no more or less potent than the hydrocodone in any other prescription drug. Any “experts” who have been quoted in the mainstream media as stating otherwise should be embarrassed and review pharmacology 101.

Statement: “There’s no need for Zohydro ER or an extended release hydrocodone.”
Untrue. Many patients are not able to tolerate certain opioids but can tolerate hydrocodone. There are five general chemical classes of opioids. Hydrocodone belongs to a class known as phenanthrenes, more specifically dehydroxylated phenanthrenes. There are two other oral products available in that chemical (dehydroxylated) class, OxyContin (oxycodone extended release) and Opana (oxymorphone extended release). Both brand named products have abuse deterrent (AD) technology, however the generic form of Opana is not AD, just like Zohydro ER. Some patients cannot tolerate drugs from the other chemical classes, and some cannot tolerate oxycodone; some patients don’t respond to some of the other options; some patients have drug-drug or drug-disease interactions precluding their use of other options.

Statement: “All other extended release opioids on the market have AD technology.”
False. The ones that DO NOT have abuse deterrent technology are all extended release brands and generics of morphine (and there are a lot of them), which as mentioned above is mg for mg equivalent to hydrocodone. Other extended release opioids that DO NOT have AD formulations are generic oxymorphone ER, fentanyl transdermal, and Nucynta ER. Methadone is not an extended release product, but it hangs around for a long time in the blood – no methadone formulations have AD technology. The same is true for levophanol.

Statement: “There’s no need to have a ‘PURE’ hydrocodone.”
Untrue. Patients with elevated liver enzymes or documented significant liver disease should not take acetaminophen chronically. Also, there are several drugs that interact with acetaminophen, and, therefore, for some patients acetaminophen should be avoided.

Statement: “Zohydro ER will cause increased deaths because people will overdose it or snort it.”
Unclear. There are no data to support or dispute this because it hasn’t happened yet, nor do drug companies test patients in advance with a specific endpoint to see who dies.

D.A.R.E.

This last item is the only debatable point. But, in my humble opinion, anybody that overdoses on Zohydro ER most probably died of natural causes, took more than prescribed, and/or combined the drug with other sedative-hypnotics that were not prescribed. Or the prescriber did something wrong or the dispensing pharmacist did something wrong.

I suspect that anybody who chooses to take more than prescribed, and/or combine the drug with other sedative-hypnotics that were not prescribed would have gotten hold of another opioid and overdose on that instead. So will opioid overdoses increase overall? Not likely. Will some people die from abusing this drug? Probably, but they likely would have died from another opioid, and if it was injectable heroin, they may have the pleasure of dying from an infectious disease such and HIV or Hep C or right-sided infectious endocarditis.

On the flip side, tens of thousands of people with legitimate chronic pain stand to benefit from Zohydro ER for the reasons outlined above.

So there you have it. Want to argue? Have at it!

 

42 thoughts on “Zohydro ER: Truth or Dare

  1. Worse. Now our country is enforcing genocide. Tis far better to be a drug addict in the United States today than an innocent victim of genetics suffering the catastrophic effects of an INCURABLE, degenerative, progressive congenital disease that causes excruciating pain in its early stages. As the disease progresses, now that pain management isn’t available, several members of my support group are discussing suicide as a viable alternative solution to the no longer available, legal, medically supported pain management.

    As a drug addict (that is, an adult who repeatedly makes bad decisions, not someone who is suffering from a disease. Those suffering from a disease cannot trace any number of THEIR OWN DECISIONS back to the moment which defined them as an addict forever.)

    However, our Country’s public opinion for the drug addicts has always been one of such reverence and esteem. They (heroin addicts and the lile) are nearly as exalted as The Christ in our culture.

    1. You are so right, I’m a chronic pain sufferer and we go through so much discrimination, regardless whether I’m on disability, which is really hard to get in S. Florida to begin with. If you were approved for SSDI, especially for pain conditions, you should automatically be inducted into the hall of pain club and not be profiled, scrutinized the way we are. I remember the days/years prior to being approved! Prejudice coming from every which way! No help, financially, emotionally, physically, support or otherwise! Lost everything in the two yrs it took for a hearing and still w/ debilitating pain! So how come Manchin is trying to block the drug made by his supporters and where his daughter is CEO of the manufacturer of said drug? Fast forward, since that didn’t work out, he’s now trying, with the help of Senator Braun, to go round the back door and pass a bill called, FDA labeling act.labels on opioids stating not approved for use of long term chronic pain! As you can imagine everyone who believes in folks having or getting adequate pain care, are fighting them on this!So far all I know, to date is that it’s stalled. So another question would be if they have no jurisdiction over FDA to block sales of approved meds, what makes this labeling act any different? Our government seems to be chaising their tails half the time and chaising someone elses the other half!

  2. I have been taking Zohydro to help address issues with severe sciatic back pain, and to me it was absolutely useless. The only way I knew that I was taking an opiod was the effect that it had on my gastrointestinal system. Alleve did a better job at dealing with the pain, so I worked my way off of it. Absolutely worthless to me.

    1. Try stretching just a mm at a time. Over and over and over. Inactivity is the enemy here. Get slowly back to being physically active. Mine went away starting with stretches and then doing yoga poses for back stretches and increasing strength. Takes ten minutes, however stretching was all day at first. Like 20 times a day. I wake up daily to do stretches. I could not take opioids long term and stay sober, but keeping you mind clear is a far far better thing!!

  3. FANTASTIC BLOG!
    I’m an ex-medic but also worked in surgery with anesthesiologist and in the ER as well as on the street
    Due to injuries I can’t work. Took me years to find a good PM Dr.

  4. Zohydro is in my “Opinion” better than Fentanyl. Fentanyl should have NEVER been prescribed outside of the O.R.
    My sister died because a JUNKIE murdered her for her Fentanyl and Oxycodone. Fentanyl is dangerous due to the patch especially, because it still has enough drug interactions it to kill someone not regularly using opiates as well as also people using a chronic pain cocktail of Soma, Fentanyl, and Zanax. Or another cocktail we use to call “Dallas Turnaround” Zanax, Soma, Vicodin. I recently was switched BY CHOICE” to an ER /& breakthrough combo of Zohydro 10mg / 7.57g Oxycodone 3.25mg Acetaminophen. Unfortunately all are addictive. Been taking opiates for 16 years. (Morphine,oxycodone,hydrocodone,
    Oxycontin due to severe injuries as a paramedic/FF, CSI, Sniper. Broken bones, DDD, bullet wounds, explosion injuries, injuries from martial arts/ combat training (CQB), knife wounds as well as surgeries. So for you morons than use these for a buzz only, or decide that stealing someone’s meds is a good idea don’t get caught by me stealing from me. You’ll have a bad day besides possibly going to jail.
    Nmcop@msn.com

    1. I’m only go their website they offer copay assistance got mine filled for free first time and rest fills be $15 can print card and that’s with me having Ins

    2. Go to their website and you can get a coupon for free first time filling then $15 thereafter. My drugstore without insurance, would charge you $572 for 60 -10mg capsules.

  5. First and foremost, I suffer from two herniated discs, two bulging (3 lumbar, 1 thoracic), Spinal stenosis in the Lumbar, Osteophytes (bone spurs) and a lot of arthritis. I have been going to my family doctor for 8 years and he knew I was lying about my pain at first because he could see the spasm in my back. He first starting me on Prednisone, Tramadol and Naproxyn. Prednisone made me sick. The Tramadol worked for a few years, but as my back worsened, nothing worked. I would go 3 or 4 nights without sleep. So I saw him again at that time and he added one vicodin to take a night time. Of course that didn’t help, but with all the drug seekers out there and stigma with painkillers I suffered through it until I started missing tons of work because I couldn’t even put my socks on in the morning. I then demanded an MRI . My insurance company made me get and xray first and physical therapy. PT helped a lot, but only for the time I was there. Then came the MRI and when it came back my doctor called and wanted me to come in the following week. He then told me I needed to talk to a surgeon because my back was a mess (go figure). I then sheepishly asked for stronger pain meds. Surprisingly he agreed and prescribed 7.5mg Percocet every 4 hrs. I have been taking this along with Robaxin (muscle relaxer) steadily for about 8 months. Talked to the surgeon. He said judging by the MRI, I shouldn’t be able to walk as good as I can. I explained that the sciatica wasn’t bothering me much that day, but I’m pretty much always in some sort of pain. If I take two percocets it helps very decent for a few hours, but i do not want to tell my doctor I take two at a time. What I need is a long-term pain med to go with it as Perocet is best for break through pain. So, I found Zohydro on the internet. Now I know Hydrocodone doesn’t work very well with me for pain anymore, but I was never able to take high doses because of the tylenol in it. I’m wondering if I should ask for it or another drug. I’ve had morphine in the hospital and it made me sick. dilaudid works for me.. Had it IV for diverticulitis but it doesn’t have an ER version. What can I ask for? Maybe Zohydro or maybe a low dose Fentenyl patch. I’m trying to hold off on surgery because I’m petrified, but the pain is giving me depression. He once told me he didn’t want to prescribe anything too strong because I will need it when I get old. I’m only 35. But I have a son to raise and my quality of life is more important to me while I’m young. what to do?!

    1. Jeff,
      I’m sorry to hear about your pain. I, too, have been in pain for years which wasn’t verified until the proper MRIs were done.
      Hydrocodone works the best for me, but I don’t like the acetaminophen in it. I think that my doctor is open to prescribing Zohydro for me, so I am going to ask for it next time I go in.
      I’ve tried Fentanyl transdermal and I hated it. It didn’t help with pain, but it made me groggy. Tramadol is ineffective, and I haven’t found the same level of relief with hydromorphone or OxyContin as I have with hydrocodone.
      My advice to you is to have the surgery! Research the surgeons well and choose one who does your type of surgery almost exclusively. I’ve seen people delay surgery out of fear, and it diminishes their quality of life. Don’t put off the inevitable. There are 80 year-old who come out of knee replacement and hip replacement surgeries just fine.
      Best of luck to you.

  6. I took zohydro er 20 mg 2 times a day for 30 days for chronic pain it was not helping so a week ago it was increased to 30mg 2 times a day and developed breathtaking problems I have been off it for 24 hours, how long before it leaves my system. I what to know so if it really is this drug causing the problem.

  7. Dr Jeffery,

    TITLE:
    My struggle with treating chronic pain and the system that has turned doctors into cynical, fearful misanthropes.

    ALT TITLE:
    The smørgasbørd of opiates I’ve tried, but eventually begged my PMDoc for my Norco’s please, sir. (…And how Zohydro ER offers me a unique promise).

    Zohydro ER is a drug I’ve been excitedly anticipating for what very likely is going on 5 years. I tried twice to leave the horrific mood cyclorama that Norco combined with MDD and BP2, constantly subjected me to as a result of short duration of action and miserable half-life. The first time was at one of these branded anesthesiologist groups who do a lot of nerve blocks and manage your meds. The rollercoaster had become tedious, laborious and sometimes rather suicidal (mood disorders ;). So, I needed ER salvation. We started with generic Morphine ER, but it made me sleepy and wasn’t covering pain. We then tried Dilaudid and in 3 days I showed up begging doctor to trade a script for Norcos for my bottle of 10mg Dilauded. I felt that I had embarked on a real “horror-show” downward spiral of depression, and fast. But I also sensed physical strangeness. Stomach, achey, behind eyes… Yawning! Watery eyes! Hey, that’s withdrawal! WTF? Then doctor tried Opana, and everything got worse. I chickened out of this experiment as withdrawal for me, is a real nightmare.

    Dr Kildaire would have none of my anecdotal findings from research, which included cross-tolerance formula innacuracy? Drug withdrawal syndrome (common complication, ~10%)? Poor bioavailability underestimated and the good ole tamper resistant-extended release mechanism inconsistent by manufacturer, and finally, a pharmacokinetics long shot, hydrocodone was basically attaching to my opioid receptors much more effectively than other opioids (doctor was really offended by this one, until I showed him an email response from a Department Head at a Med School in Calif substantiating my theory. Funny thing is, before I showed him the email, he scoffed “what email from what doctor? Turns out the Dept Head was Kildaire’s mentor.

    Basically I was being treated like a drug addict, although given my strategy to return all unused drugs entirely accounted for, he basically just looked and acted like a jerk.

    Then I went to my current PMDoc, recommended by my PCP. We tried his suggestion of Buprenorphine .66mg bid film. He gave me Norco 10/325 4x day PRN for breakthrough. This worked well from an efficacy standpoint, however eventually I ended up sleeping 20hr per day. So I had to try, again. I explained my great fear and past horrors.

    We want directly to Oxycodone IR, but put me to sleep. Tried OxyContin ER, but they didn’t work in pain much. Tried adding some Norco for BT pain, but now back to sleep.

    Thanksgiving was in 3 days, and wouldn’t you know, PMDoc says “I’m always here or can be reached…” I never call after hours. I grew up with father as a doctor. I was taking Dilaudid 15mg and my bad spiral down was so bad I began to throw up violently and terrible horror depression. 15mg BID.

    I go to ER and get Dr Fancypants attending, I show him my bottle of Dilaudid, give him my doctor’s phone number to call service if needed. He sits, I’m sick and in great pain, he starts drilling me about pain pills – typical inquest, but especially rude this time. gives me 2mg IV Dilaudid, qty 15 10/325 Norcos.

    I limp through weekend and on Monday go see my doctor. In the meantime I decided to check on Zohydro ER status. Yay! In the market.

    I suggest Zohydro ER to my doctor, he agrees and calls a small pharmacy adjacent to psych in-patient. Pharmacist says sure, might take a few days to get it in. I go, show him Rx, he gets prior auth req from my ins.

    This takes 10 days total. I check pharm one more time and, oops! ” Not going to get that in for you sir” in a very terse and dis-cordial manner. WTF? I recognize the tone; it’s the drug addict treatment. I’m confused and have no clue. Head over to my CVS, who previously gave me some story about corporate policy to not approve Zohydro ER. I thought I’d try again.

    Beforehand, I called the number for Zogenix and used their pharmacy referral service. Bingo! 1 mile from home, and they have it in stock! Yay!

    Walk in, say hello and introduced myself. Filled out new customer form and just as I handed it over, pharmacist approaches as says “we won’t be able to fill this today, sir” I recognized that tone. How could I forget? I asked what the problem was and they had some paper and asked if I’d seen Doctors One, Two and Three?

    Our policy doesn’t allow multiple doctors. I said, “well, uhh, Doctor One is my Psychiatrist, Doctor Two was at the ER just 2 weeks ago, and Doctor Three is the one who wrote this Rx.

    We won’t be filling this for you today, I’m not going to jeopardize my job, or the business license just so you can have drugs.” In her BEST “You’re a drug addict” voice.

    I was absolutely furious and humiliated. This is what it’s like for some chronic pain patients. Add that complication on to struggling with medication, finding a resource to buy Zohydro ER, my chronic pain and drug side effects.

    This is what our country has become.

    To this day I am waiting for a phone call from CVS pharm who is trying to order Zohydro ER.

    Thanks for reading and wish me luck!

    Mazarine

    1. I had it where 1 Walgreen’s would provide it to me, I had a constant repor with them, and 1 Walgreens didn’t give it to ANYBODY.

      Then my ins said nope, you need to fail on these other ones first, and made me switch off.

      I hope you have been successful in finally getting covered.

      I go through the same as you (same ER story too recently)

  8. Great work, Mark! That was a great breakdown of the situation.I am still not surprised in the ignorance of other doctors when they evaluated my pain patients. I had one guy, who told me he was driving too fast on a wet road, who wrecked his car and broke his leg. When the doctor who saw him after admitting him from the ER took him off of all of his medication because it was “causing liver damage”. I told him to wait a couple of days and the increased enzymes were not from his liver, but from the local muscle and bone trauma, from his fractured leg. As I predicted,, he had a rapid decrease in the enzymes with the normalization in about two days. I guess no one ever told the lady internist that opiates do not damage the kidneys or the liver and are among the safest of all drugs given to patients! (guess they were not trained as general/trauma surgeons. We know the difference!) I have taken medications I the past and currently with my post traumatic cauda equina syndrome. If I had no pain, I could stop them tomorrow. I don’t now why some people don’t have addiction, but it happens! It is sometimes not even beneficial to be a physician with too much training. It lets me know the inadequate care I am receiving from my own doctors! I was also trained and board certified in pain managment by the American Academyof Pain Management. I was also board certified by he American Academy of Surgery. I could be a very helpful advocate!

  9. Another great Fact outline to separate all the Fiction! I think we also need to hear from actual patients where a non-liver-toxic hydrocodone product is beneficial and has medical merit. I’m blessed a successful cervical ADR surgery changed my life after a 3 year battle with chronic pain. I was on Vicodin and other pain meds and constantly was blood tested for liver and kidney levels due to other meds I was taking. I never had a good nights rest because I woke at 3am in pain just to have to wait for the next does to kick in. Zohydro seems like it would be a blessing to many like me. I never became addicted and no longer need pain RXs. As a chronic pain patient I only used opioid painkillers as a last resort when the pain was more than I could bare and to find some way to have a willingness to live. Thank you for standing first for patient access to this medication and even though I don’t need RXs now, I do have other degenerating cervical discs. It genuinely astounds me politicians feel they can play doctor and truly believe this debate is more about votes and competition market share and dollars.

    On another concern, I’ve also heard that some of the abuse deterrent polymers are hard to digest, perhaps more so as we age. I’d like to know more about this if you have any information.

  10. Another great post Dr Fudin. I keep waiting for some politician to “think outside the box” and come to the defense of ZohydroER (and pain patients). It really is a no-brainer. I think someone could make a name for himself or herself by standing up for common sense, as opposed to falling right in line with the rest of the torch carrying mob.

    For a little fun (and to drive home the point) your readers might enjoy my take on Professor Harold Hill: http://jamespmurphymd.com/2014/04/14/ya-got-trouble

  11. Theres a site called bluelight I believe that tells those people how to get stuff out of medication so they can misuse it. I believe there must be chemists or very smart people to know how to do this stuff…I couldn’t imagine…..I wish I didn’t need the stuff…and they WANT it. Go figure! What about constipation??? And organ damage? I wish they’d legalize marijuana, take the high out and let me live without pain!

    1. There is Medical Marijuana without the high. It comes in a tincture you drop under your tounge. They have isolated different chemicals that do different things. Example: a chemical in Marijuana called CBD is good for seizures and pain. THC (Tetrahydrocannibinal) is the main chemical that makes you high. It is better for depression and anxiety. I’m not a pothead, but have researched it and there is more good than bad. It stimulates hunger for Chemo patients, helps certain pain issues, anxiety, depression, etc. No reason it should be a Schedule 1 drug. People die needlessly from tylenol poison, but there have been no known deaths from cannibis.

  12. There will always be ignorant people who believe whatever they hear. The problem is that they (many of which) are law makers and leaders of this country.

  13. We have enough websites that have to do with chronic pain sufferers of all kinds.
    The NationalPainReport,com is for all kinds of stories that have to do with the way pain sufferers are being mistreated etc.,etc.
    Politicians need to stay out of medical field and what medications are made for the chronic suffering. T Politicians think their fixing things when indeed their doing more harm. Of all medications hydrocodone is the least likely that someone would overdose on , careless people do careless things which leads to positive overdoses.
    Zohydro ER is a excellent medication for those that don’t need too strong of a time released opioid.
    Blocking this medication in any state is a mistake and people that suffer from chronic pain need what best works for their chronic pain.

  14. Pharmacists that refuse your legit/on time prescription for little/no reason.. is violating your rights under the ADA.. which is considered a civil rights violation and discrimination.. I have created a DIY instruction sheet to file complaints with the various entities http://www.pharmaciststeve.com/wp-content/uploads/2014/03/How-to-file-complaints-if-patient-is-being-denied-having-a-valid2.pdf.. don’t need an attorney.. most expense may be a the cost of a certified letter. IMO.. the bureaucrats that have put arbitrary daily limits on opiates ( FL, IN, OH, WA) are practicing medicine without a license and is unconstitutional.. unless you consider “life ,, liberty, pursue of happiness”.. that “life” is just breathing and doesn’t consider quality of life

    1. THANK YOU SO MUCH!!!
      Pharmacist Steve, thank you thank you thank you!!! I am getting started on this today! Where I live I was told by THREE different Walgreens stores that they WILL NOT order or carry ZoHydro ER, that the Lead Pharmacist said my doctor should “try something else first” (apparently the back surgery wasn’t good enough, nor the scar tissue buildup). I was told that this is a “HIGHLY DANGEROUS drug” that shouldn’t have been prescribed (guessing my PM doc’s 23 years of experience, school and current board certification doesn’t count for much). THEN I was also told it was a “Corporate Decision”, probably because I shot down all their arguments. Now I finally have recourse for being made to feel like a fool in front of the other people that were standing there, who got to hear all of this. Luckily, the local pharmacy in the little Podunk town I live in not only orders especially for me and one other person, they call me a couple of days before my appointment to see if I think there will be any changes to my prescriptions AND to see how I’m ding with ALL me medications! They do this, apparently so, that if I think everything will stay the same , they can order it and have it in already BEFORE I bring in the new script every month.

  15. Pain patients need news coverage. A website for all people that have chronic pain needs to be made. We need coverage about the truth. The problem is we have lawyers telling doctors how to do there job. There has to be government money in research for patients in pain. In Kentucky, they have created doctors that are afraid. Do no harm. But when the doctors do not band together, to help the patient, they are doing HARM. We are living in a century that this should not happen.
    But it has. More truth, we must unite for the good of all people. Great Job Dr.Fudin. Let’s get on TV and speak the real truth.

    1. And see where it all is now, 3 years later. Us poor bastards have to jump through hoops and pray we find someone with mercy to help us get out of bed due to chronic pain. It’s all in our minds now. Embrace the pain! New pain management class technique, cause, you know, we happy thought it away.

  16. Thank you Dr. Fudin for crystalizing just the facts on this drug. I am still saddened by the media’s vilification of this drug before it is even available; especially Dr. Gupta and Dr. Oz their media reach to the masses is huge and harms those with intractable pain. I would like to add to Michael’s request for groups combining forces. Perhaps an invitation to pain physicians and other clinicians would be in order..

  17. Your usual great job with the blog, Jeff. It’s nice that AAPManage put out their statement. It would be nice if we were able to get together a number of groups that claim to advocate for patients with pain – including the US Pain Foundation, Penney Cowan’s group, the Foundation for Ethics in Pain Care, etc. – and released a consensus statement on Zohydro. Thoughts?

    1. AGREED! If you have thoughts on how best to coordinate this, email me and we’ll get right to it! Thanks for your patient advocacy, continued dedication to patient care and the facts!

    2. Michael,

      Thanks for the compliment! I’ve sent the statement to a number of patient advocacy groups and have alerted them to your call for a consensus statement from them. We’ll see what develops…

  18. Bravo, Dr Fudin, I’ve suffered for what seems like forever.Do to political bickering.So glad your here to put forth the truth and as you said have at it. I’ve been without proper medication for April 2 years and i do therapy at home daily. Now in in so much pain from the cyst in the nerve not able to even do my orthopedic stretches All I ask is a little help so I can help myself ,because without being able to stretch I’m becoming a vegetable.Excellent article, many thanks for all your support.

  19. Let’s not forget about the abusers that use cold extraction to pull the acetaminophen out of the combo products! It’s simple enough to dissolve the combo product in water, put it in the freezer for a couple minutes and the apap drops out of solution. Nice drink mixed with a little koolaid!

    1. I thought about doing this just to save my liver. I don’t abuse my Percecet, but I’m prescribed 7.5/325 six times a day. Whose to say thats not enough to fry my liver. Everyone is different. I should be bumped up to 10mg/325 soon. I’m going to ask for the 10mg oxycodone without the tylenol. And I WON’T abuse it.

      1. Not sure if you ever switched to oxycodone, but that is what I am on and for the first time did not get rebound headaches from taking it often. It’s the Tylenol that does it. If I take Tylenol when I have a headache it will trigger a migraine at times. Weird. I love my oxycodone, it doesn’t make me sleepy or high! I get energy off it when taken at the right dose. Unfortunately, I metabolize it quickly and adapt just as fast. I have a faulty metabolic system. Stinks to be me.

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