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Karen,   You state that very few doctors would prescribe 80 mg OxyContin for sustained, long-term use.  I must interject here.  I have written, above, about my condition in considerable detail -- but what is relevant to your reply is that I am currently taking 200 mg OxyContin every 12 hours (a total of 400 mg every 24 hours).  This is actually the British National Formulary's recommended maximum daily dose -- but it is essential to mention that there is no upper ceiling associated with opiates and opioids.  Many people -- including doctors -- do not know this.  The fact is that a person on high-dose opioid therapy can take massive doses -- doses that would kill an opioid-naive patient -- without any ill effects whatsoever.  It is not unusual to read about patients taking OxyContin 800 mg daily -- in fact, I think that this is the maximum amount that Medicaid will pay for.   You state that very few doctors would prescribe 80 mg OxyContin for sustained, long-term use. Respectfully, I must interject and strongly disagree here. I have written, above, about my condition (Marfan syndrome) in considerable detail -- but what is relevant to your reply is that I am currently taking 200 mg OxyContin every 12 hours (a total of 400 mg every 24 hours). This is actually the British National Formulary's (BNF's) recommended maximum daily dose -- but it is essential to bear in mind that there is NO UPPER CEILING associated with pure opiates and opioids. Many people -- including doctors -- do not know this. The fact is that a person on high-dose opioid therapy can take massive doses -- doses that would literally kill an opioid-naive patient -- without any ill effects whatsoever. It is not unusual to read about patients taking OxyContin 800 mg daily -- in fact, I think that this is the maximum amount that Medicaid will pay for in some states.  I refer you to http://www.gao.gov/new.items/d04110.pdf, where it is stated (about OxyContin) that "Like all pure opioid agonist analgesics, with increasing doses there is increasing analgesia, unlike with mixed agonist/antagonists or non-opioid analgesics, where there is a limit to the analgesic effect with increasing doses. With pure opioid agonist analgesics, there is no defined maximum dose; the ceiling to analgesic effectiveness is imposed only by side effects, the more serious of which may include somnolence and respiratory depression."   Back in 1995, I started on OxyContin 80 mg twice daily (a total of 160 mg OxyContin every 24 hours), with hydrocodone / APAP 10 / 325 for breakthrough pain. I developed tolerance very slowly (gradually increasing to 200 mg twice daily over a period of 14 years). When I moved from the US to the UK, I started taking OxyNorm for breakthrough pain (hydrocodone is not available in the UK), so in addition to the OxyContin 200 mg twice daily, I also take OxyNorm 10 mg and OxyNorm 20 mg as needed for breakthrough pain.   You state that it will do a person no good to make a scene at a hospital ER, and I completely agree with you. There have been times when I have suffered such excruciating pain that I have gone to the ER -- and by asking for an injection of diclofenac (which is a particularly painful and unpleasant injection), I have obtained more appropriate pain relief with a fentanyl patch or with an injection of meperidine -- by asking for a non-opioid injection, I have established my good faith intentions with the hospital staff, and have obtained more appropriate pain relief.  That is truly perverse.  This was NOT a ploy on my part; I go through utter hell when my back acts up (please see my above message about Marfan syndrome)...   I have written above about the problem with the D.E.A. -- doctors in the UK are much, much more willing to prescribe powerful opiates / opioids than are doctors in the US, precisely because they do not have to worry about a Sword of Damocles hanging over their heads every time they write out prescriptions for drugs such as OxyContin. I have NEVER abused my prescriptions and have NEVER sold them -- this would be such shabby treatment of my doctor here in the UK, who is a kind and decent person who has bent over backwards to help me, and who is a wonderful clinician; I am shocked and upset when I learn of patients who sell their doctors down the river like that...   Thank you, PHILIP