Discussions that mention morphine

Pain Management board

Hi Eyes Docs usually start on the low side and I would bet there isn't a true CP patient that has ever gotten the dose right on the first visit. I have done cold switches from short acting oxycodone to SA opana and didn't experience withdrawal. On a single dose comparison I replaced 30 mgs of oxycodone with 10 mgs of opana, 15 really felt closer although opana does have a different feel and I felt more impaired by opana so rarely took 15 mgs.

There is no reason two drugs in the same class like oxycodone and oxymorphone, Both keto synthetics can't be easily swappped if the right dose is used. However given this is the first time this doc has prescribed anything to your brother, it's reasonable to expect him to start on the low side,not that 2:1 would be considered low by any doc or equianalgesic table I have seen.

I really don't understand the doctor bashing for not getting a brand new patient comoftable on the first vist if he was given the acurate previous dose. The process of finding the right dose is called titration and nobody gets it on the first go round, to expect more is unreasonabale. It doesn't make him a bad doc, It makes him a safe doc and compasionate enough to squeeze him in to make an adjustmentbefore his next monthly apt if he was given a month supply. If he was given less than a month than the doc never intended to make him waight a month although 2:1 is generous enough to think you could get away with waiting a month to check on a patient.

Anything more than a 2:1 conversion would be excessive/dangerous and leave him liable for anything negative that might happen when you don't bother to follow at least the manufacturer guidelines. They say 3:1 to morphine which equate 2:1 to Oxy and thats where a doc that want to avaoid law suites and over doses is gong to start.

It sounds like he has a good doc that is willing to see him rather quickly to work towards finding the right dose.

When oxymorphone was avaialable as an injectable only the standard conversion for IV use is 10:1 to morphine, Oxymorphone isn't as effective oraly as the injectable version so the conversion is knocked down to 3:1 for oral oxymorphone. Oxy is 1.5 to 2 times stronger than morphine so giving him half his prior dose in opana should leave him in full blown withdrawal. Some discomfort wouldn't be abnormal, but isn't he chronic pain patient, he hasn't had bad days before?

I'm just not as quick to attack any doc that doesn't prescribe anough opiates on the first dose, He's a new patient, he has no trust built with this doc, it would be crazy to start someone any higher than 40 mgs of Opana iven the previous daily dose was 80 mgs of oxy. That's 2:1 and in the ballpark, now heit just needs to be fine tuned. Complete relief on the first visit is a fantasy and when changing meds it's normal to take a step back and hope the patient hasn't developed complete cross tolerance and they can get away with even less of a new drug than the guides suggest. Some guides actually allow the docs to calcualte the suspected degree of cross tolerance based on duration and previous exposurre to other medications.

Empethy is nice, I can empethize, but he's right where the best docs in the country would have started.

Tell him you read about docs that don't return calls and patients whos requests are ignored. Encourage him there is light at the end of the tunnel purely based on the fact this doc is the first to offer opiates and is squeezing him in so quickly. We aren't going to die from chronic pain or some mild withdrawal, so waiting a couple days to be seen after reporting a problem is impressive to me. Espeically when he's seen other PM docs that won't prescribe any pain meds.

There are other methods to manage pain that can be tried prior to concluding you have to spend the rest of your life dependent on opiates. He has a choice as to whether or not he wants to try them. Whether they are appropriate or not comes down to are they helping him more than hindering.

Good luck, Dave