Discussions that mention morphine

Arachnoiditis board


Lou,

From what I've read about Opana, I think the rotten feeling you're experiencing is withdrawals from Oxy.

And, I think very possibly that your dose of Opana is too low. Only 10% of this drug makes it into your central nervous system. So, even though it's stronger than Oxy or morphine, at only 10% bioavailability, what you are getting is next to nothing. I think this drug is gonna fail miserably in the market if docs don't figure this out.

I really don't know if going off of all LA meds, and going to hydro or something else so low on the potency list is the right idea. I highly recommend trying morphine, like MS Contin or Kadian. These are two forms of LA morphine. Please don't assume it won't work or you'll react badly unless you have already tried it and know for sure.

steve
manders061904,

On the ladder of potency, milligram for milligram, oxymorphone is pretty potent. Look at it this way, starting with codeine, you go to hydrocodone (vicodin), then to morphine (MS Contin, Kadian, Avinza), then oxycodone (OxyContin, Percocet), then hydromorphone (dilaudid), then oxymorphone (Opana), then fentanyl (Duragesic, Actiq). Opana is pretty high up that list. I don't mention methadone because it's a beast unto itself - good material for another time. Ultram falls somewhere between codeine and morphine, and it really depends on the person.

After potency, you have to consider what's called bioavailability. Once you take a med, it goes into your stomach and then the intestines. During this process the medicine is absorbed and goes to the liver where it's metabolized. It's here that the absorbed med is broken down and sent out for use by the brain, spinal column and peripheral tissues. Getting into the brain and spine is where it gets into the central nervous system (CNS), attaches to the opioid receptors and relieves the pain. Which drug it is, how the drug is metabolized and how much gets to the central nervous system is called bioavailability. With morphine only about 30-40% gets into the CNS. Oxycodone ranges from 70-80%. Opana is about 10%. Keep in mind this is when the med is taken orally. All drugs have much higher bioavailability when given IV, as they have no first pass through the GI tract. So, taken orally, very little of the oxymorphone in Opana actually gets used to relieve the pain you have. Granted, milligram for milligram oxymorphone is very potent, so even a little goes a long way. But at 10% that very little that's left doesn't go all that far for someone who's tolerant of opioids. This is why I believe Opana is given in doses too low, and why the majority of users don't get the relief hoped for. And, I think this drug is gonna fail in the market if they don't wise up and figure out how to appropriately dose this med.

I hope this helps to answer your question. Please post again if you have more questions. I'm no doc or pharmacist, this is just from my reading.

steve
Well, I went to my pm doc this morning and am not all that happy with the result. This doctor is a firm believer in strictly prescribing LA narcotics for chronic pain control. So, he was not at all receptive to my suggestion to drop off the LA meds and go down to something like hydrocodone. He said that taking a dose of hydrocodone every 4-6 hours to chase the pain is the fastest way to become an addict.
SO, he has decided that I am going to stay on the Opana for now...but slowly decrease the doseage. I am to take my normal 40 mg tablet in the am, followed by a 20 mg tablet at night. This is a daily drop of 20 mgs. The doc feels that possibly my body cannot tolerate the high doseage that I am currently on.
To the poster that claims that such a low amount of the drug is metabolized from Opana....I don't quite agree with the logic that I am getting much less active narcotic in my system to work on the pain. The 40 mg tablet is the highest dose that Opana comes in, and I could feel that I was getting a very hefty dose. The whole idea of LA meds is that the patient is not supposed to feel the med "kick in" as you would in an IR form. Well, I defintely feel a massive "kick"....nothing euphoric at all...just a dizzying overwhelming sensation that makes me severely nauseated ans experiencing a sort of "out-of-body" sensation. Not at all pleasant. These symptoms definitely feel to me that I am getting too high a dose of the drug.

Anyway, I was hoping to be taken off the Opana by now and started on something else. It looks as if I have a couple more months of slowly titrating down the Opana. The doc is mentioning a couple other LA meds he would like to try once I get down off such a high Opana dose..ie...Kadian and other Morphine derivitives. I have no knowledge of these drugs, and I hope I will not be jumping out of the frying pan into the proverbial fire.

The doc did give me a script for some klonopin to ease me throught the severe anxiety and panic attacks that have developed since I started the Opana. He is also hopeful that, at a lower dose, these symptoms will also begin to dissipate.

One can only hope...Say a prayer for me gans...Thanks for all the replies so far. I value each and every one's insight and personal experience. It helps me a great deal

Take care,
Lou
Sorry you are having such a hard time. I have never taken Opana, because Morphine makes me sick as a dog. I have had very good results with Oxycontin. I've been taking it for about 6 years now and have only had 2 changes. The first was from 10mg to 20mg. The next was a change from 2x/day to 3x/day. This is where it gets sticky. The manufacturer (Perdue) insists that it is a 12 hour med. It is not. My PM doc has heard from several of his patients that it has never lasted 12, including me, and he agrees. He did have to get special authorization from my insurance to dose 3x/day, and has to renew the request every six months.

There are docs who feel that a long acting med should cover a patients pain, entirely. The studant who came in with my doc at my last appointment had this mindset. (My doc works and teaches at a teaching hospital) He thought there should be no need for BT meds. My doctor, however, understands that some BT meds are needed, because even pain patients like to move around and do things that might cause their pain levels to elevate, so I take hydro for BT as well.

I hope you can get this straightened out and find something that works for you across the board. Best of luck and let us know how it's going. CMP/MM
[QUOTE=forginon;3570376]manders061904,

On the ladder of potency, milligram for milligram, oxymorphone is pretty potent. Look at it this way, starting with codeine, you go to hydrocodone (vicodin), then to morphine (MS Contin, Kadian, Avinza), then oxycodone (OxyContin, Percocet), then hydromorphone (dilaudid), then oxymorphone (Opana), then fentanyl (Duragesic, Actiq). Opana is pretty high up that list. I don't mention methadone because it's a beast unto itself - good material for another time. Ultram falls somewhere between codeine and morphine, and it really depends on the person.

After potency, you have to consider what's called bioavailability. Once you take a med, it goes into your stomach and then the intestines. During this process the medicine is absorbed and goes to the liver where it's metabolized. It's here that the absorbed med is broken down and sent out for use by the brain, spinal column and peripheral tissues. Getting into the brain and spine is where it gets into the central nervous system (CNS), attaches to the opioid receptors and relieves the pain. Which drug it is, how the drug is metabolized and how much gets to the central nervous system is called bioavailability. With morphine only about 30-40% gets into the CNS. Oxycodone ranges from 70-80%. Opana is about 10%. Keep in mind this is when the med is taken orally. All drugs have much higher bioavailability when given IV, as they have no first pass through the GI tract. So, taken orally, very little of the oxymorphone in Opana actually gets used to relieve the pain you have. Granted, milligram for milligram oxymorphone is very potent, so even a little goes a long way. But at 10% that very little that's left doesn't go all that far for someone who's tolerant of opioids. This is why I believe Opana is given in doses too low, and why the majority of users don't get the relief hoped for. And, I think this drug is gonna fail in the market if they don't wise up and figure out how to appropriately dose this med.

I hope this helps to answer your question. Please post again if you have more questions. I'm no doc or pharmacist, this is just from my reading.

steve
I was on 30 to 50 mg Methadone for the last 30 years, due to a Dr. stabbing my spinal cord with a large guage needle after a Pantopaque myelogram. Pantopaque is an oil-based contrast dye, and must be removed from the spinal canal after the myelogram. Well this DICK, Dr Basile from Hartford, CT, managed to inject some of the Pantopaque directly into my spinal cord. This is my second experience with a Pain clinic. They had me drop from 20 to 10 to zero methadone while giving me Opans 20. I went thru withdrawals every day. Now I'm on 30 Opana ER 2x/day with 10 mg morphine (Opana, not ER) for breakthru. I take the Opana 7 am/pm. Every morning at about 5:30-6 am, I wake up with withdrawals. So I take a 10 mg breakthru and wait until 7 am to take the 30 ER. It lasts about 10 hrs, even tho I take on an empty stomach. So there goes the other 10 mg Opana non-ER. even so, I am going thru the same thing daily. I haVE Arachnoiditis and RSD. I work 8 hrs a day, 7:30 am to 4 pm every weekday. I'm dying here, I cannot seem to get a Dr appt when I can take the time to go. Any suggestions PLEASE!!! Mark