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

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.
Long acting medications should never be crushed. If the patient wanted less than 20 mg of the medication, then the same medication should be ordered in a lower dosage for him. Quartering a 20 mg pill that is sustained release won't give the equivalent of 5 mg of the pill..

I would not have cut the pill. Although probably not unsafe, it was not as prescribed and actually gave the patient more medication at once than was ordered (he got 5 mg immediately instead of the 20mg over 12 hours -- I believe oxycontin is dosed q12h.) If patient wants/needs immediate acting narcotics, 5mg of oxyCODONE is not much (the equivalent of 1 percocet.) -- I could see that getting ordered as a sub or in addition to. I would have discussed this with the patient and called the physician if he wanted immediate-release meds. If he didn't want that, I still wouldn't have cut the pill and charted it as refused if he wouldn't take it as prescribed. I am curious as to why a patient would be refusing a long-acting narcotic as prescribed. Those are typically used for people with chronic pain (as you know) ... my suspicion is that if the patient didn't want it as prescribed, perhaps they don't really have chronic pain. Is this patient cutting the pill at home? Is this why he thought it was an ok idea? Is he abusing the drug? Seems fishy to me. I probably wouldn't push the misuse/abuse issue with the patient, but I would not mess around with narcotic dosing. That is one thing that will get your license suspended/revoked in a hurry if there is a paper trail of you not wasting/giving meds as prescribed. What did you do with the other 3/4 of the pill? How did you chart what you gave? Just something to think about....be careful. ---- addition: misread your post, I thought you said you DID cut the pill. Good for you for not doing that.

Sounds to me like he's trying to use Oxycontin incorrectly. If he's having severe pain right now, he should take Oxycodone or whatever fast acting PRN he has available. He should take the Oxycontin everyday at the same time as prescribed to try to prevent the pain from occuring. Oxycontin is not designed to be taken at the sign of acute pain, as it will take longer to kick in than Oxycodone will.

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.

A pain management physician once told me that abusers will "break" the time-release coating on pills by cutting them in order to get the rush of the narcotic all at once. I have no idea if this is what your patient wanted or he just had a different way of doing things.

Manipulative patient put you on the spot IMHO. I'd have given it as ordered and offered to ask the doctor to reduce the dose for him.

Agree with all the others, he should have orders for breakthrough pain for a small dose, but the long acting is to cover pain throughout the time period till the next pill. He won't be getting 20mg immediately....he definitely was yanking your chain as most patients taking these meds are "well aware" of the hows and whys of their meds!We these patients it's simple, you want it or you don't......I will call for an order if you insist on 5mg but YOU WILL WAIT! It's hard when you have to care for manipulators dressed as sick people....M

Agree this makes no sense. if the medication is long acting patient will only be getting a small amount hrly, so why cut it in quarters. Patient needs med for breakthrough pain.

good job on NOT cutting the pill, we have to remember that it is not the nurse's discretion to change the scheduled dose, we have to get an order for that

Only giving him a quarter of the pill is changing the order, essentially, both is dose of medication and in type of medication. If he wanted 5mg of fast acting oxycodone, I would have obtained an order for 5mg of regular release oxycodone. It's not within an RN or LPN's scope of practice to change dose or type of medication. Also, any pill that isn't scored isn't guaranteed to be evenly mixed. While it seems highly unlikely, essentially it is vaguely possible that all of the drug is on one half of the pill and the rest is all filler.

That is what addicts do. When you break the coating, the whole drug is immediatly released, giving the pt a euphoric feeling. Good job not cutting it.

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!