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Withdrawal Question - Butrans/Fentanyl Patch Insurance Mix-Up

chrelseycchrelsey Posts: 90
edited 01/16/2015 - 4:01 AM in Pain Medications
I'll try to make a long story short! After six years of multiple procedures, followed by a lumbar laminectomy, a cervical fusion, and three spinal cord stimulator surgeries (the SCS is to buy time on having a three-level lumbar fusion), I told my PM I wanted to try an experiment. Over the years I have tried the full spectrum of meds - Tramadol, Norco, Gabepentin, Lyrica, and Oxycodone. In the end, Norco seemed to work the best, and it is what I have been on pretty consistently for the last several years. So - my experiment - I wanted to take myself totally off of the Norco. My reasons were two-fold. One, I wanted to give my body a break from the meds, and two, I wanted to get a good feel for how the SCS was working on it's own. After two months of not taking Norco, my PM and I came to the conclusion that I really needed some type of medical pain management in conjunction with my SCS. I am very glad that I gave my body a two-month break from meds, but it was a very painful two months (lower back and both legs), with maybe only 2-3 hours of sleep per night. FYI - I had tapered down my dose over a several month timeframe prior to stopping (again, with my PM's blessing), and therefore did not experience horrible withdrawal symptoms. After having been on it for so many years, I was surprised by that - but I think it was because I did it slowly. The worst thing I really felt was restless legs for about a week.

My PM said that it would be best to not go back on the Norco, as long-term, it's not a good solution. He said that what I really needed was a consistent release of meds, and he wanted me to try the Butrans patch. When I called the pharmacy to see if it was ready to be picked up later that day, they told me it needed pre-authorization from my insurance. No problem. Almost one week later, after still not hearing anything, both my PM's nurse and the pharmacy said I should call the insurance to check, as they were also not getting any info. I spoke with a very nice person who apologized profusely and said I would have an answer the next day. The next afternoon (it was getting close to end-of-business), I still hadn't heard back, so I called the pharmacy to see if they had received the authorization. She ran it through my insurance and said it went through and I could come pick it up. Awesome! So I go and pick it up, get home, read through all the instructions three times (I'm very nervous about taking new meds), got up the courage, took a deep breath and put the patch on. Done!

You can imagine my surprise, then, when about 20 minutes later my husband came out of his office and said the phone was for me, and that it was the insurance company calling to explain to me why they had denied the pre-authorization. Huh???

Two hours and three people later they figured out that yes, it had been denied, but somewhere along the line of inputting information in their system, someone hit the wrong key and it ended up approved even though it wasn't. They said that before I could be on the Butrans patch I had to first have already tried Tramadol, and if that wasn't effective, then Duragesic (Fentanyl) patch. I asked what I was supposed to do with the Butrans patch I had already put on. She said to leave it on until I could talk to my doctor the next day (it was quite late by this time). I called my doctor's office that night and left a message, and then spoke to them the next day. My PM's nurse said my PM would likely prescribe the Duragesic, and to just leave the Butrans patch on until then. That was yesterday - and it's currently end-of -business today and I still haven't heard back - but truthfully, that's not unusual for my PM, so I'm not upset, as I'll likely hear from them tomorrow. No worries. I'm assuming it's ok to leave the Butrans patch on, and then take it off and put the Fentanyl on when I get it, since the nurse said to leave it on - at least I'm hoping it is!

Finally - here is my question! When I do try the Fetanyl patch, if after two weeks it's not effective, my PM's nurse said to let them know and my PM would then be able to prescribe the Butrans. What should I expect in terms of withdrawal symptoms if I switch from the Fetanyl to Butrans after only two weeks? I've been reading about the Fentanyl patch, and it seems like withdrawal is TOUGH. but will it be built up enough in my system by that time where I will have awful withdrawal? Will going straight onto Butrans cancel that out?

Thanks so much in advance for any help, info, or insight that anyone can share!




  • Hey,
    I have gone back and forth between the two (70 Butrans and 50 Fentanyl) a couple of times.
    To me, from Fentanyl to Butrans has been more difficult than the other way around, but both have not been too terrible. I sometimes keep a small piece of Fentanyl (perhaps 10) while I change to Butrans. After a few days it is all same-same.
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