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    Best instant release pain medication? 
    #1
    I mentioned this in my other thread but I figured I would start a new one since the topic in different.

    I am current prescribed Oxycontin 30mg twice day and Oxy IR 5 mgs up to 6 times a day. Since I have started using Lyrica it kills the pain way better than Oxy can. The only problem I have is sometimes when taking my "normal" dose of Lyrica the pain in my back jumps out.

    What I would like to do is dump the Oxycontin and stick with the Lyrica and find a better break through med.

    What is the best med for break through pain that is not Supeudol (what Roxis are called in Canada)?
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    #2
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Oxymorphone IR
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    #3
    Bluelighter OpiYum's Avatar
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    dilaudid - hydromorphone q4-6h for break through pain

    opana has a pathetic oral ba, and the new formulations gel and are kind of a pain to prep
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    #4
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Quote Originally Posted by OpiYum View Post
    dilaudid - hydromorphone q4-6h for break through pain

    opana has a pathetic oral ba, and the new formulations gel and are kind of a pain to prep
    Oxymorphone has a pathetic oral BA? So does hydromorphone, incredibly low. Hydromorphone is a total waste of a drug taken orally. Such a weak opiate orally. At least you can snort Opana for a better high, snorting Dilaudid doesn't get you too much higher. IV'ing Dilaudid...that's a total different story.
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    #5
    Bluelighter Codones's Avatar
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    It all depends. Medical marijuana can be great if opioids aren't working. A lot of people who have a condition that causes chronic pain who use pregablin find marijuana works great for them. I have 2 friends and 4 extended family members with chronic pain. 3 use Lyrica and also use marijuana and they say marijuana works better than their hydrocodone or oxycodone for break through pain.

    Oxymorphone works great, and morphine is supposedly great for break through pain as well in the opioid/opiate department. Hydromorphone as well. If you can get them, ask your doctor to try each and see what works.
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    #6
    Bluelighter TheLostBoys's Avatar
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    Im assuming you will have to snort the oxymorphone/hydromorphone to get the effects needed to keep your pain at bay. Too bad doctors all over arent prescribing med-marijane for their patients.

    Like K'D mentioned above, Dilaudid is the best when ived which I have never done but have heard & read about it that way. I am wondering if you can get liquid Morphine to drink for break through pain?
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    #7
    Bluelighter TheLostBoys's Avatar
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    I dont recommend Fentanyl but have you discussed Fentanyl at all with your doctor?
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    #8
    I tried fent for a week once but I seem to be allergic to the patches. What ever they use to get it to stick to your skin gives me a massive rash. I tried every brand there was and they all did the same thing. My skin is super sensitive to things like that, makes it a pain in the ass. Even getting general cleaning stuff like spray clean for cleaning counter tops will give me a rash if it gets on my skin.

    What I would really like is to stay as far away from opiates as possible. That is why I would like a STRONG instant release med for those times when the pain gets past the Lyrica. It doesn't happen very often, maybe 3 to 4 times a week, but when it starts to hurt it really starts to hurt.

    I don't take my meds to get high, that is side effect which I enjoy of course, but my main goal is to keep the pain at a level I can stand so I can keep working and live my life.

    My doctor was so happy that the Lyric was working and he can't wait to stop prescribing Oxy to me.
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    #9
    Bluelighter TheLostBoys's Avatar
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    Quote Originally Posted by Kindatired View Post
    I tried fent for a week once but I seem to be allergic to the patches. What ever they use to get it to stick to your skin gives me a massive rash. I tried every brand there was and they all did the same thing. My skin is super sensitive to things like that, makes it a pain in the ass. Even getting general cleaning stuff like spray clean for cleaning counter tops will give me a rash if it gets on my skin.

    What I would really like is to stay as far away from opiates as possible. That is why I would like a STRONG instant release med for those times when the pain gets past the Lyrica. It doesn't happen very often, maybe 3 to 4 times a week, but when it starts to hurt it really starts to hurt.

    I don't take my meds to get high, that is side effect which I enjoy of course, but my main goal is to keep the pain at a level I can stand so I can keep working and live my life.

    My doctor was so happy that the Lyric was working and he can't wait to stop prescribing Oxy to me.


    If you're trying to stay away from opiates, I recommend asking your doctor about the Flector Patch that you change every 12 hours. It is used for mild to moderate pain & the medication in the patch is Diclofenac Epolamine which is an anti inflammatory non-steroidal medicine. This patch is obviously not a narcotic. Google the Flector Patch & see if its something you may be interested in.

    But you said that you have severe pain so I dont know if it will help. Ive also heard of a non narcotic pain reliever called Neurocet thats supposed to be like 2 years old & supposed to be very effective. If anyone has more informnation about Neurocet, chime in.
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    #10
    Something IV I would presume.
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    #11
    Bluelighter kokaino's Avatar
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    I'd say roxicodone or methadone are the best IR opioid medication. Both have high BA, that's the only reason why I would pick them. After that, I would say levorphanol and then all the other ones are equally the same (morphine, hydromorphone, oxymorphone), but morphine has the best oral BA of the 3, so I'd say morphine would be next.

    Potency isn't everything - BA and pharmokinetics are a major factor more important than just potency.

    I would rank them like this:

    1. Oxycodone (in the form of Roxicodone) & Methadone
    2. Levorphanol
    3. Morphine
    4. Hydromorphone
    5. Oxymorphone
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    #12
    Bluelighter kokaino's Avatar
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    Quote Originally Posted by K'd-OUT-in-AZ View Post
    Oxymorphone has a pathetic oral BA? So does hydromorphone, incredibly low. Hydromorphone is a total waste of a drug taken orally. Such a weak opiate orally. At least you can snort Opana for a better high, snorting Dilaudid doesn't get you too much higher. IV'ing Dilaudid...that's a total different story.

    Hydromorphone has a higher BA both orally and intranasally than oxymorphone.

    I've IV'd hydrmorphone, but not oxymorphone (I've never done oxymorph, never come across it yet and I live in fucking DETROIT). Hydromorphone has a better rush because it's more lipid soluble, so it crosses the BBB quicker resulting in a more intense rush.

    I think people are over-hyping oxymorphone. It's not all that it's cracked up to be because I'll tell you right now, half of the people that say they've tried it on here - haven't.
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    #13
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Quote Originally Posted by kokaino View Post
    I'd say roxicodone or methadone are the best IR opioid medication. It has high BA, that's the only reason why I would pick that. After that, I would say levorphanol and then all the other ones are equally the same (morphine, hydromorphone, oxymorphone), but morphine has the best oral BA of the 3, so I'd say morphine would be next.

    Potency isn't everything - BA and pharmokinetics are a major factor more important than just potency.

    I would rank them like this:

    1. Oxycodone (in the form of Roxicodone) & Methadone
    2. Levorphanol
    3. Morphine
    4. Hydromorphone
    5. Oxymorphone
    Bioavailability is how much of the drug is absorbed (the degree to which a drug or other substance becomes available to the target tissue after administration...same thing basically) so I like to think that it "is" the potency of the drug. A drug becomes more potent IV'd because the bioavailability is increased.

    I believe hydromorphone has a very slightly higher BA than Morphine, it is around 30-35% while Morphine is 25-35%. Or at least they are roughly the same.
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    #14
    Quote Originally Posted by kokaino View Post

    I think people are over-hyping oxymorphone. It's not all that it's cracked up to be because I'll tell you right now, half of the people that say they've tried it on here - haven't.
    I don't follow your logic. I'm sure many people claiming to have tried oxymorphone on the net haven't, but many have, and the overwhelming majority say it's great. It isn't like it's some new RC being hyped by vendors.
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    #15
    Bluelighter K'd-OUT-in-AZ's Avatar
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    I to have my suspicions that many people on here who claim they have used it really haven't but what does that have to do with hype? I think anyone who tries oxymorphone will like it once they have reached their correct dose. Many people take lower doses because they are afraid it. I know a fair share of people who absolutely love it. Who I've used with. Never heard someone saying they don't like it unless they did too low of a dose. I'm not talking about people on here.
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    #16
    Bluelighter kokaino's Avatar
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    Quote Originally Posted by fryingsquirrel View Post
    I don't follow your logic. I'm sure many people claiming to have tried oxymorphone on the net haven't, but many have, and the overwhelming majority say it's great. It isn't like it's some new RC being hyped by vendors.
    It is a relatively new opioid med on the market. Many pain patients have been on fentanyl patches, morphine, Oxycontin, etc for years and continue to be on them. I see a few patients here and there being switched to Opana, but not as many as people on this forum make it seem like.

    I'm telling you, half of the people that say the've tried oxymorphone on this forum haven't.

    Oxymorphone is an opioid, no different from the others. Just more potent. Like fentanyl.
    Last edited by kokaino; 03-04-2011 at 20:57.
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    #17
    Bluelighter TearItDown's Avatar
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    Marijuana.
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    #18
    Quote Originally Posted by kokaino View Post

    I'm telling you, half of the people that say the've tried oxymorphone on this forum haven't.

    Oxymorphone is an opioid, no different from the others. Just more potent. Like fentanyl.
    I don't doubt the first point.

    The second is obviously true as well, but a more potent opiod is something many people have wet dreams about.
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    #19
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Quote Originally Posted by kokaino View Post
    I'm telling you, half of the people that say the've tried oxymorphone on this forum haven't.

    How do you know that? Why would someone lie and say they've tried something when they haven't? To look cool on the internet? I don't see the point.

    Numorphan is where most of my experience with oxymorphone comes from, not so much Opana. I remember back when I was on this website under my old sn like around 2004 or something like that when Opana wasn't even released yet, I was the only person who seemed to know what oxymorphone was. I talked about it like it was the going to be the next big thing and always wondered why haven't they begun prescribing it in a tablet form so that everybody with severe pain could take it. Nobody really talked about it. Then when I came back to this website after 4 or something years, people are talking about this drug called "Opana". I read up about it and saw it was oxymorphone. I remember the thread "Will Opana be as popular as OxyContin?" My prediction was no. OC's were too big. And Opana sounds weird. I tried it once orally and three times insufflated. That's all the experience I have with Opana but I have gone through vials of Numorphan. Preferred it to heroin. Wound up in rehab because of it, mixed it with ketamine and went crazy.

    I agree Opana may be over hyped, but just a little. Some people make it sound incredible. But don't knock oxymorphone until you've IV'd it. Second best I've ever found to heroin. Doesn't pack as much of a rush like Hydromorphone but the high is very balanced. It lasts longer than hydromorphone and almost as long as heroin.

    Personally I think more people lie about doing heroin than oxymorphone.

    EDIT: You said "you" see patients...are you a doctor or something? You seem to have an awful lot of time to spend on here to be a doctor. Not saying your always on here, what I mean is from what I've heard doctors are so incredibly busy that they have to move people along really quick. My physician gets me in and out in 5-10 minutes to fit in another patient. That is just from what I've heard.
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    #20
    Low bioavailability can always be adjusted for with appropriate dosing. It isn't like we're talking about metabolic rate limiting how much you can get in your blood, like with codeine, or dangerous side effects, like with tramadol. You simply need relatively higher dosing as compared to IV to get comparable effects.

    Hydromorphone has a very short half life so it should only be used for breakthrough pain. Oxymorphone also has a very short half life intravenously. Oxycodone IR is also incredibly effective. Orally, oxymorphone then oxycodone then hydromorphone are your best bets regarding duration. Intravenously (and probably intranasally), oxycodone then oxymorphone then hydromorphone would be your best bets regarding duration. They are all very strong opiates. Potency is sort of irrelevant, it's mostly therapeutic index that counts regarding strength. Of course, time release formulations are much better for long term pain. Does pharmaceutical fentanyl even come IR?
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    #21
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Quote Originally Posted by Anonabyss View Post
    Intravenously (and probably intranasally), oxycodone then oxymorphone then hydromorphone would be your best bets regarding duration. They are all very strong opiates. Potency is sort of irrelevant, it's mostly therapeutic index that counts regarding strength. Of course, time release formulations are much better for long term pain. Does pharmaceutical fentanyl even come IR?
    What? Are you kidding? The bioavailability of oxycodone intranasally is worse than oral and it only increases a little via IV as it already has a high oral bioavailability. Oxymorphone IV is 20 times more potent than oxycodone and while you won't find much information on IV oxycodone, its potency doesn't increase much higher than its oral route because of its already high BA. Oxycodone would by far be last behing IV oxymorphone and hydromorphone. Oxymorphone would be first because it becomes ten times stronger when IV'd than its oral route (1 mg IV=10mg oral), hydromorphone increases 5 times (1mg IV=5mg Oral) and Oxycodone probably 2 or 3 times (1mg IV=2-3mg Oral). Oxycodone is a prediction but it wouldn't become more than 3 times.
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    #22
    Bluelighter 'medicine cabinet''s Avatar
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    #23
    Well thanks for the suggestions. I can't use weed as a medication because there is no way i could do my job stoned. Not to mention i couldnt just say "ok guys, going out back to smoke a fatty because my back hurts" that would be a one way trip to the unemployment line. And its not like I have time to set up a needle and inject the stuff, not that I ever would since I don't want to IV anything.

    I will ask my doctor about Opana, don't know if we even have it in Canada yet. We are slow to get some drugs.

    My doctor dosent seem to be against anything but Oxy, he really hates to give it out for some reason. Maybe one of his patients was selling the stuff and got caught. He was more than happy to give me Morphine, and Fent, maybe the dose of Morphine wasn't high enough.

    Just to make it clear, it has to be some kind of oral medications, I work close to 13 hours a day, 6 days a week, some times 7. I can't be crushing up pills to snort or inject, or go out back to light up a fatty. I need a drug I can take orally, kills my pain fast and doesn't fuck me up so much that I can't run my kitchen. Trust me if I don't focus the muppets that are my cooks will start fucking up and that falls on me. Try managing a kitchen with 7 cooks when you are high as kite. Besides if I was stoned I would probably be eating all the food and the customers would get nothing. Lol
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    #24
    Bluelighter K'd-OUT-in-AZ's Avatar
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    Quote Originally Posted by Kindatired View Post
    Well thanks for the suggestions. I can't use weed as a medication because there is no way i could do my job stoned. Not to mention i couldnt just say "ok guys, going out back to smoke a fatty because my back hurts" that would be a one way trip to the unemployment line. And its not like I have time to set up a needle and inject the stuff, not that I ever would since I don't want to IV anything.

    I will ask my doctor about Opana, don't know if we even have it in Canada yet. We are slow to get some drugs.

    My doctor dosent seem to be against anything but Oxy, he really hates to give it out for some reason. Maybe one of his patients was selling the stuff and got caught. He was more than happy to give me Morphine, and Fent, maybe the dose of Morphine wasn't high enough.

    Just to make it clear, it has to be some kind of oral medications, I work close to 13 hours a day, 6 days a week, some times 7. I can't be crushing up pills to snort or inject, or go out back to light up a fatty. I need a drug I can take orally, kills my pain fast and doesn't fuck me up so much that I can't run my kitchen. Trust me if I don't focus the muppets that are my cooks will start fucking up and that falls on me. Try managing a kitchen with 7 cooks when you are high as kite. Besides if I was stoned I would probably be eating all the food and the customers would get nothing. Lol
    Well it would be nice if you guys had Opana but you may not since its only been around for 5 years or so. I'm well aware that in Canada you guys get drugs late. Have you ever tried MSir before? Instant release Morphine? You said the Morphine kind of worked but that you may have just needed a higher dose, well try the instant release stuff for breakthrough pain. I believe Morphine is much better instant release than sustained release, which I find to be rather weak. Maybe if you could find the right dose it may work.
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    #25
    Bluelighter Supeudol's Avatar
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    Another thing, we don't have Oxymorphone in Canada either, where the OP is from I believe.
    In Canada, we are always the last to get everything.
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