Hi GWB, Percocet is oxycodone and tylenol , not time release, The time release version of Oxycodone is OxyContin.
There are several Time released morphine preps on the market. The first was MSContin. It releases half it's contents at about 1 hour and the rest at about the 6th hour, Most folks take MSC or the generic version 3 times a day. Kadian was the first 24 hour morphine to come out about 3 years ago. It's a smooth steady release over 24 hours. Say your taking 100mgs once a day, You may find it lags a bit the last few hours. The full prescribing info also says you can dose every 12 hours which works much better.
The difference between a 100mg MSContin and a 100 MG Kadian is that the MSC releases all 100 mgs over about 8 hours and the Kadian releases all 100 mgs over 24 hours so it creates a lower serum level than the MSC. But if you were to take 30 mgs of MSContin 3 times a day and took 100 mgs of Kadian once a day you would get roughly the same serum level.
The advantage of taking Kadian twice a day is that it's not all wearing off at the time of the next dose, With twice a day dosing only half is wearing off when it's time for the next dose which maintanes a more steady serum level.
Kadian worked great for me and has the better tamper resistant release system, You just have to have a doc that understands that a 100 mg Kadian only contains 100mgs of morphine. Spread that over 24 hours and it's something like taking 15mgs of MSIR every 4 hours , which isn't a large dose of oral morphine.
Even though Kadian is newer, has a better release it's also cheaper than Purdue's MSContin. The generic versions of MSC are cheaper but there isn't a generic version of a 24 hour morphne product. A newer 24 hour morphine hit the market last year called Avinza.
I really haven't heard much about a comparison between the two. Avinza has an initial burst of morphine that Kadian doesn't but if the goal is to maintain a smooth and constant level and Avinza truly lasted 24 hours why would it need a burst at the onset. kadian is smooth, I never felt it wear off or kick in in the year I took it.
Oxycodone tends to be more stimulating than morphine and a little stronger mg to mg so don't think you have stepped up to the big guns because now you are taking morphine. Morphine is just the gold standard to which other opiates are compared in strength. This will give you an idea of how other meds compare to morphine.
Welcome and good luck with the Kadian. Also it's better to get your dose correct from the get go then to except less than adeqaute relief now and then ask for an increase in 3 months. That looks more like rapid tolerance than improper dosing from the get go.
OxyCodone is actually styronger than morphine, the average conversion is 1:1.5 meaning 20mgs of Oxy is equal to 30mgs of morphine. Morphine is more sedating so don't be shocked if you sleep alot the first few days. It's very common with morphine and not a reason to discontinue morphine if the only negative side effect is sleepyness. That goes away as you get used to the side effects.
What did they start you at and what were you taking before?
Welcome and good luck, Dave
I am new to this site..found it tonight while researching Avinza. I was just to the pain specialist today, and got a prescription for it. Have any idea what the side effects are and how long should you be on it? From what I have read, it can be a very dangerous drug. Any input would be greatly appreciated.
Hi L13, What did you read about Avinza being dangerous. Morphine is morphine. Whether it's Kadian, Avinza, MSContin, Oramorph or any of the generics.
Avinza is the only long acting opiate that has a limit on the amount you can take, 1700mgs per day, due to the Fulmuric acid used as a preservative. Other than this one drug that uses this preservative and only at extrremely high doses does it become dangerous.
Pure opiates due no harm to internal organs, Tylenol does more damage than morphine. Yes you will become dependent on morphine after you have used it around the clock for several weeks.
Dependent just means you can't stop taking it cold turkey, you have to taper. But dependent doesn't mean addicted. There is nothing positive about addiction and if using morphine improves the quality of life and you can't function without some form of pain relief I really see no danger other than the danger of abuse among people that really have no buisness taking these meds.
The real danger is taking these meds if you don't really need them. Can someone not live without taking morphine around the clock and continue to function or do the meds just make them feel better. Pain management is about function more than making a patient feel better. There are plenty of drugs that will make you feel good, but it doesn't mean everyone should take them.
Long acting opiates should be the last resort when you have tried everything else and nothing else worked. Not the first and only therapy a patient is willing to try.The idea that it works so why try anything else is a huge problem now.
Why spend a month learning biofeedback when someone can just keep changing docs untill they find one that gives you what you want because he knows you will be his patient as long as your physically dependent on morphine. If it's the only thing a patient thinks will work, because they haven't tried anything else people can't really complain about being dependent on morphine.
Morphine will work, But If you go directly from my back hurts but my GP is tired of prescribing lortab so he refers you to PM who prescribes long actng morphine because the patient has told the doc they have no quality of life or can't function or work, or whatever. The patient has put themselves into a poition of being dependent n the meds and all the negative crap that goes along with them, Like nasty pharmacists that thnk you shouldn'tneed them, ER docs that will call you a junkie and friends that want a pill everytime they have a back ache or head ache.
It's not all roses even when intractable pain is managed well. In some cases opiates can only do so much for someone. No matter what dose I talke, It doesn't stop my hardware from shifting with every step, But I have so much hardware it would be a 16 hour surgery to revise my fusion for the 4th time, and still no gaurentee, just more invasive procedures and more hardware and a longer fusion
There are so many PM forums it's very easy for an addict to come here and read how to describe their pain and conditon so that their doc will prescribe the drugs they want. It's the nature of addiction.
Someone unwilling to try anythng other than opiates, that has never tried anything else really isn't ready to jump on the dependent for life train. It's a huge trade and if you can function without it, you shouldn't be taking it.
If PM was simply about feeling better everyone over the age of 40 would be on Morphine to feel better and mask the aches and pains of growing older. These meds are designed for long term use when other methods to manage pain have not worked.
Long acting morphine isn't something you keep around for a bad day and take a pill every now and then because you have a back ache from worrking a long day.
These meds are designed to restore quality of life to folks that are disabled by Intractable pain, and when it's not treated they have no quality of life.
There isn't a time limit as to how long you can take any pure opiate. If you pain is so severe that you need Avinza, or kadian, around the clock pain relief 24/7 then you can take it forever or untill a way to fix the pain generator has been found.
It's not a matter of you shouldn't take it longer than a month or a year or a decade. You shouldn't take it unless it's the last resort and every other method to manage your pain has been tried and failed. That's the only way your doc can justify prescribing the most potent pain meds available.
Docs that prescribe these meds to anyone and everyone that complains of some form of pain better have great charts describing every other attempt to manage pain. What surgeries and other modalities to manage a patients pain have been tried before he can safely prescribe these meds without fear of prosecution.
If he's simply doping up the comunity for a price for anyone that complains of pain, he will be shut down at some point which means everyone of his patients will likely experience withdrawal cold turkey when this happens.
What other methods of pain management have you learned or tried before a doc prescribed long acting meds. If you read any of the patient info on any long acting meds they are designed for intractable pain that isn't expected to improve. Intractable means the pain doesn't respond to any other modality, surgery has failed or there is no surgeical solution, other attempts to manage your pain have failed like PT, TENS, TINS, Biofeedback, self hypnosis, guided imagry, epidurals, nerve cblocks, trigger point injections and TP pressure, accupuncture, acupressure, reflexology, counseling and even diet can contribute to pain.
I have tried every method I just wrote and then some, over a 7-8 year perriod where I had 3 failed spine surgeries, the last was a failed fusion from L1-S1 that left me bedridden before any doc prescribed a long acting pain med. Now the screws have crumbled the bone around the screws and just toggle back and forth with every step because the fusions failed and the hardware is only designed to hold things in plavcce while you heal, not support your spine indefinitely.
There is no escaping the pain I'm in, so my decision to use opiates is rather simple, I tried everything else, It didn't work.
Every method I have tried and learned is charted in my PM docs office so that if anyone ever asks why My doc prescribes such high doses of medication to me he can pull out my file and list 3 surgeries and 20 different modalities over 8 years to try to manage the pain and nothing worked and I was bed ridden before any long acting pain med was offered.
I understand things are different now, They didn't have OxyContin or Kadian or Avinza back when I had my first 2 surgeries ion 93 and 96 and Duragesic and morphine was only used on cancer patients when my pain began.
Do you feel like you have tried everything else under the sun before going to a medthat you will become physically dependent on? A med you will likely need for the rest of your life.
Long acting opiates are not meant for short perriods of painful flair ups, that's what short acting meds are for. The LA meds are for patients with intractable pain that have no other options. At least that's the way the meds were intruduced in my case.
I'm sure there are plenty of folks with DDD that have gone straight from their GP who was no longer comfortable prescribing short acting meds so they passed the potato to a PM doctor to deal with the complaining patient There are many more option than opiates to try but if all your PM doc can do is write a script, he's no different than any other doc. Anyone can write a script.
Please cut and paste what you read about morphine being a very dangeropus drug. Honsetly that sounds like the same BS, opiate phobic docs want patients to believe so they tell them this to justify their unwillingness to prescribe these meds.
17,000 people die every year from OTC pain medication. No where near that amount of people die while being treated for pain by a compitent pain management doc. Even the deaths reported about Oxycontin are inacurate. They fail to mention the deaths were poly drug overdoses and there is no way to tell if the patient took OxyContin or any other product that contains oxycodone, could have been a handful of perceocet mixed with some valium chased with jack daniels that killed them, Not the evil drug OxyContin.
In the 400 or so deaths atributed to oxy, 97% had other drugs or alcohol in there system. But these folks were just so smart they knew it was safe to mix whatever drugs they could find and chase it with alcohol. People don't die from using long acting opiates properly. The people that died, either killed themselves because they couldn't deal with the pain any longer or accidently killed themselves by mixing meds and alcohol without knowing the consequences. Or that idea that nothing bad will ever happen to me.
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When you compare 400 people that have died from drug overdoses involving some form of oxycodone it pales in comparison to the 17,000 people that die every year trying to find relief with over the counter meds and poisen their liver with tylenol or shut their kidneys down with non steroidal anti inflamatories like Ibuprofen or Alieve or any other OTC pain med. If 3 advil doesn't help just take 6. That type of thinking is what kills people.
Not pure opiates when properly prescribed to patients that could not function without these meds.
Opiates do no damage to your internal organs. The only real downfall is physical dependence and tolerance to meds that docs are not able to control because they don't have the knowledge to rotate opiates, mix different opiates or use adjunct meds properly. But morphine is not a dangerous drug in the hands of a true chronic pain patient that is compliant with their docs instructions.
If you put that same morphine into the hands of recreational drug user, then yes, they can kill themselves by mixing morphine with other CNS depressants and alcohol.
I would say, If you don't think you will need Avinza for the rest of your life, why would you need long acting meds now? IF you going to get better in a month or two, short acting meds would work just fine. They work for horriable orthopedic post surgical pain, so I imagine they would work for other conditions that flair up and go away.
Take care, Dave
In some ways I feel sorry for you, being on this bored must make you feel like a broken record! But, suffice to say, you change peoples lives every day by sharing that whopping pile-o-knowledge in that noggin of yours!
I learn something new everytime I read your posts, no matter what they're about.
As far as the gent with the SR Morphine, I was on it for a short while, didn't really do very much for me, except make my stomach upset and put me to sleep. A friend of my has fibromyalgia (spelling?.. sorry) and it does wonders for him. LIke Shore said, if you NEED to be on these meds, it's worth the try, but if you can get by with lesser, I'd STRONGLY reccomend staying away from long acting meds, you're taking one step deeper into the spirial of opiates. Not saying they're evil or anything silly like that.. just.. .. good luck.