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Can't find ANY opiate comparison charts etc that include both Tramadol and Dihydrocodeine - I have so many questions..

Wilson Wilson said:
DHC itself is a controlled drug, it's just very loosely controlled in practice. Under the Medicines Act DHC itself is schedule 2. However depending on the preparation it is schedule 5. Schedule 5 is the lowest level and basically just means uncontrolled POM. Basically schedule 5 means a controlled drug in a preparation which has a low enough dosage that it is treated like it is uncontrolled. This is why for instance codeine linctus 15mg/5ml can be purchased OTC even though codeine is controlled. It is also why 30mg DHC tablets are effectively uncontrolled. There actually are 120mg DHC tablets, but those are controlled due to the higher dose.

Fun fact: Oramorph 10mg/5ml is falls under schedule 5 so is actually an uncontrolled POM under the Medicines Act. I shit you not. Oramorph Concentrated Solution 20mg/1ml is controlled as schedule 2. But the regular Oramorph 10mg/5ml they hand out is somehow not a controlled drug because that's classed as a low enough dose to be exempt from all CD measures. Madness innit.

In case anyone doesn't believe me here it is from the NHS themselves (PDF link):



The way the pharma laws work in this country is bloody confusing, just goes to show how little sense drug laws really make eh?

But yeah I do think DHC remains somewhat of a "hidden gem." It is treated as if it is just one up from codeine and weaker than tramadol. That's crazy to me. DHC is very euphoric.
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Tramadol is actually the same strength as codeine, and DHC is double the strength of either. On the opioid scale, Tramadol is a 0.1 whereas DHC is double at 0.2, although a lot of people argue DHC is more of a 0.25.
 
Got ya. Better than Codeine for pain defo. Only ever got anything noticeably recreational from rectal DHC. Here to buy 30mg tabs online, it’s significantly cheaper than Codeine too.
 
ChemicallyEnhanced said:
Tramadol is actually the same strength as codeine, and DHC is double the strength of either. On the opioid scale, Tramadol is a 0.1 whereas DHC is double at 0.2, although a lot of people argue DHC is more of a 0.25.
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According to the NICE ranking of opioid potency (which of course I can't find the link to...) tramadol is considered more potent than codeine or DHC and so the NHS treats it as such. Personally I agree with you, in fact it is if anything weaker than codeine in my opinion, but NICE disagrees.
 
I was thinking about that myself WW. They tend to treat it in clinical settings, with some sort of ring fenced notoriety. I remember being admitted to CDU last October and they tried prescribing me 50mg every 4 hours, and said it is for severe pain. ????????????
 
Bahaha exactly mate they act like they're giving you fucking oxy or something. In hospital they put me on IV tramadol it was nasty I was fucking shaking. When I asked for DHC instead they looked at me like I was mad. "But we're giving you tramadol, are you sure you just want dihydrocodeine?" Mate the way they were fucking reacting you'd think I had just rejected oxy for codeine or something ?
 
Hehehe fucking jobsworths ?. I also remember telling them my long term chronic pain is treated (at that time) with Palladone SR 8mg, so 5mg Oramorph isn’t going to help me). I had to plead just to get 5mg IV Morphine. They haven’t a fucking clue half the time!!

To be fair to Tramadol though, when I used to staggered 50mg over 4 hours before the gym, the synegising of 5HT release and endorphins was a uniquely euphoric experience, which had me smiling at everyone and everything even adverts on the tube!! Summer in the ark was amazing that year ????
 
Yeah they have shockingly little knowledge of the meds they hand out honestly... this lot knew full well I was on dex but didn't have any problem loading me up with tramadol. Literally a combination that causes seizures. It's why they made no fuss about switching me to DHC, because I pointed that out to them. Shocking when I know more about the meds I'm being given than the fucking doctors.

When I first did tramadol at uni, back when it was uncontrolled and everywhere, I did quite enjoy it. But that's before I used a real opiate. Like you I staggered my doses throughout the day and got a nice glow. Back then it was pretty decent.

Nowadays though it does fuck all for me except give me brain zaps and the shakes. Weird ain't it?
 
Weird indeed. I used to have to be careful talkmg to them on a pharmacological level, As they would mistake knowledge with drug seeking lol.

Obviously risky this, but Trams is a great potentiator for Molly taken an hour before.
 
Shortec Stublue!! said:
I used to have to be careful talkmg to them on a pharmacological level, As they would mistake knowledge with drug seeking lol.
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Yeeep they absolutely hate it when you actually know something about the medicines you take. I made this mistake in the hospital. I couldn't sleep for like three nights straight because I kept waking up from breakthrough pain. I kept asking for something better than a 10mg morphine pill but they wouldn't give me anything stronger. So eventually one night I snapped and just said to the nurse "oral morphine only has a 20% oral bioavailability, can I have something that actually works?"

Nurse just said "someone's been doing their reading, you're trying to play me aren't you?"

Yes, genius, I had surgery done and stayed in hospital for a week just so I could play you for 10mg oral morphine.

Funny thing though from my room I could hear when the nurses changed shifts. So when a new one was on shift I played dumb instead and said "that blue one you give me for when it hurts at night doesn't work well" and they actually upped my dose.

So yeah the moral of the story is if you want potent opioids just act like you have no idea what you're taking.

Shortec Stublue!! said:
Obviously risky this, but Trams is a great potentiator for Molly taken an hour before.
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Sounds like a perfect recipe for serotonin syndrome tbh.
 
@ChemicallyEnhanced I found the NICE link if you're interested:

BNF is only available in the UK

The NICE British National Formulary (BNF) site is only available to users in the UK (England, Scotland, Wales and Northern Ireland)
bnf.nice.org.uk bnf.nice.org.uk

Scroll down to opioids, there's a ranking of all of them and they're broken down into weak and strong.

DHC is listed as a weak opioid with "an analgesic efficacy similar to that of codeine phosphate." It then just says: "Higher doses may provide some additional pain relief but this may be at the cost of more nausea and vomiting." And that's it. No mention of it being 2.5x stronger than codeine (which I certainly believe to be true, but NICE doesn't think so!)

Tramadol is then listed at the bottom of the strong opioids section along with the claim that: "It has fewer of the typical opioid side-effects (notably, less respiratory depression, less constipation and less addiction potential)" which is likely why the NHS prefers to script it over DHC despite it being less effective and prone to causing seizures.

Curiously it says of oxy: "Oxycodone hydrochloride has an efficacy and side-effect profile similar to that of morphine. It is commonly used as a second-line drug if morphine is not tolerated or does not control the pain." So in theory if NICE guidelines are followed, oxy should be scripted to any patient who does not respond well to morphine. In practice however this is subject to the postcode lottery. Often a CCG will happily script Oramorph but not Longtec. Anyone who has a morphine script but is having trouble getting oxy might be helped out by showing that page to their doctor. They treat NICE guidelines like a bible on the NHS so you never know.
 
I have tried codeine, tramadol, oral morphine and I take dihydrocodeine daily.

DHC is surely stronger than either codeine or tramadol for me. Oral morphine I didn't think it was anything better.

For some reason GPs here in the UK tend to think tramadol is stronger than codeine and DHC.You can get DHC prescribed privately with an online consultation but not tramadol.
 
Wilson Wilson said:
According to the NICE ranking of opioid potency (which of course I can't find the link to...) tramadol is considered more potent than codeine or DHC and so the NHS treats it as such. Personally I agree with you, in fact it is if anything weaker than codeine in my opinion, but NICE disagrees.
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Yes, don't know why they think tramadol is more potent. It's definitely not. I have taken all 3 and tramadol is the worst one.
 
Tramadol is fucking awful, I feel more of the SNRI effects than the opioid effects. I just get brain zaps and shaky. I've also had a seizure on it before even while keeping my use under the 400mg limit and I'm not prone to seizures normally at all.

DHC is lovely, tolerance is the only problem but that's true of any opiate.
 
Wilson Wilson said:
According to the NICE ranking of opioid potency (which of course I can't find the link to...) tramadol is considered more potent than codeine or DHC and so the NHS treats it as such. Personally I agree with you, in fact it is if anything weaker than codeine in my opinion, but NICE disagrees.
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NICE is full of shit. DHC is at least twice as strong as codeine or Tramadol. 200mg of codeine I feel a slight buzz with lots of itching, 200mg tramadol I'm in a nice mood, 200mg DHC I'm high for sure.
 
What is the best ROA for DHC?
I've just been chewing them thoroughly (better rush, more rapid onset). Is this the best way to use it or is it worth insufflation or sublingual? And is it better to take a lot in one go (like Codeine), or to stack them (like Tramadol)?
 
Whatever you find works best. I would think it should work just as well just swallowing the tablets?

I always liked codeine best dissolved in water for whatever reason.
 
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