Opioids Chewing my Oxy. ER or pain control

[CAfurbabyMama]

Hi, I have some serious chronic pain issues that I’m trying to manage. I’m being treated with OxyContin ER 30mg and 15mg OxyCodone ir, I love slicing the ER’s and sucking on’um through out the day, but I’m worried I might be shorting myself on my pain management. I know my pain has gotten worse from my physical issues getting worse, but I’m not sure if chewing on the sliced pieces are contributing to my crazy pain level… am I screwing myself over?

 

[Fire&Water]

Hard to say ...
a lot of people shit the extended release out before they fully
dissolve / push out the oxy

 

[CAfurbabyMama]

I’ve never really been good at hitting the “sweet spot” with pain control and I’ve always felt like I’m not taking enough, then my pain is too much to manage. My doc tells me not to mess around and take meds when I need it. He says I really need more meds, but his “hands are tied” b/c of “opioid crisis”. I just hurt

 

[Fire&Water]

I think at least 80% of pain dr's say the same shit

"in this day and age"

 

[KBL0606]

I’ve never really been good at hitting the “sweet spot” with pain control and I’ve always felt like I’m not taking enough, then my pain is too much to manage. My doc tells me not to mess around and take meds when I need it. He says I really need more meds, but his “hands are tied” b/c of “opioid crisis”. I just hurt

My advice to you would be to look for another pain doctor.

 

[xtcgrrrl]

My advice to you would be to look for another pain doctor.

Not sure that would do any good. As a chronic pain patient myself, I know how difficult it is to even get prescribed the medication that OP stated they currently get. Any other pain doctor might say the same, or, worse, tell you that you can’t have even those anymore and take you off without so much as a taper (yes it’s happened, and other people on this site have posted saying that’s happened to them. This fucking “opioid crisis” has all the doctors spooked. They don’t want to lose their licenses!

 

[KBL0606]

Not sure that would do any good. As a chronic pain patient myself, I know how difficult it is to even get prescribed the medication that OP stated they currently get. Any other pain doctor might say the same, or, worse, tell you that you can’t have even those anymore and take you off without so much as a taper (yes it’s happened, and other people on this site have posted saying that’s happened to them. This fucking “opioid crisis” has all the doctors spooked. They don’t want to lose their licenses!

I am also a chronic pain patient and after my amputation in 2019 my then pain doc wasn’t willing to increase my pain meds to match my increase in pain. So I found a doc who would. I do understand how difficult it can be sometimes to convince someone that your pain is real, trust me. I also consider myself incredibly lucky that I have found a physiatrist who is sympathetic to the fact that people do experience real pain.

 

[Dextro .45]

I also have chronic pain for 20+ years

You don’t need another pain doc….you need a sit down, and truthful be honest with them. If you were on this same dose for long, you’re building a tolerance and dose could be slightly increased. Or you can state that although your current regiment is very effective in managing your pain, sometimes you experience more breakthrough pain and ask if it possible to slightly increase your IR tablets for the times your really hurting

Also, inquire about adding an NSAID anti inflammatory medication to your regime …..so you don’t come across as specifically seeking opioids alone which doc might see as a red flag / warning sign

Sometimes pain levels increase or opioids are too low…….you can tactfully and gently probe into having your dose increased slightly in addition to adding an anti inflammatory

Doc might suggest something else depending on your condition…… Lyrica (Pregabalin) for neuropathic pain syndrome, etc

Talk with your current pain doc….be honest and open to alternative suggestions by your doc. Don’t come across drug seeking, just wanting more Oxycodone (due to its VERY high euphoric relaxation) although a very potent and effective opioid narcotic analgesic.

If your doc suggest trying something…..say, “Sure doc….if you think that will help, I’m willing to try anything” then come back and say, sorry doc but it wasn’t really that helpful…I had stomach discomfort, felt dizzy, headache, etc, whatever (IF it really was useless)

A gradual increase in mg dosage is very common in opioid pain management due to tolerance and chronic pain is constantly changing

Note: if your condition is lifelong and will never go away….enquire about Methadone tablets. It’s a full mu-agonist (just like Morphine, Dilaudid, Oxy, etc) and has a 24h half life lasting all day, although it’s true painkilling properties last 6-8 hours on average. Short acting opioids like Oxycodone although amazing, taking 4-6 pills through out the day, every day (with peaks & valleys) are not ideal. Great for short term pain (broken leg, car accident, 2/3rd degree burns, etc) pain that will resolve itself in months / year max.

Chronic life-long medical condition is best treating with the long acting potent opioid Methadone (100 tablet bottles) you’re not going to some Methadone clinic for your daily observed drink, then 6 “carries” after clean urine samples….pure b.s..

Best of luck

 

[Dextro .45]

I am also a chronic pain patient and after my amputation in 2019 my then pain doc wasn’t willing to increase my pain meds to match my increase in pain. So I found a doc who would. I do understand how difficult it can be sometimes to convince someone that your pain is real, trust me. I also consider myself incredibly lucky that I have found a physiatrist who is sympathetic to the fact that people do experience real pain.

Jesus H Christ man…..you had a freaking amputation and your doc wouldn’t increase your dosage. Woooowwww.

F@ck Purdue Pharma fucked it up for everyone, forever…..setting fire to the Opioid Pandemic with OxyContin. FDA are hyper vigilant to seek out high prescribing doctors, opioid pill mills in Florida, etc

Normal, Legitimate pain patients are F@CKED when in comes to getting the real pain management they require all because of Purdue Pharma (Sackler family) massive kickbacks to docs prescribing OxyContin, aggressive marketing, bonuses, misleading information about the true dependency potential of OxyContin, etc.

3,000 years + mankind have been using “the plant of joy” for pain relief and as a recreational drug, binding to the mu-opioid receptor causing pleasurable euphoric warmth and profound happiness beyond the natural scope of day to day life. Too bad for its tolerance, dependency, and withdrawal symptoms that inevitably follows.

Can’t have our cake and eat it to I guess lol

Oldest drugs know to man kind, dating back thousands of years +, all naturally produced by Mother Nature for us mammals with legitimate medicinal properties with recreational/spiritual/ceremonial uses…

Opium poppy
Coca leaf
Cannabis
Ethanol
Psilocybin & Mescaline (mushrooms & peyote cactus)
Nicotine (Tobacco leaf)
Caffeine (coffee beans)
Khat shrub (beta-ketone-amphetamine)

 

[AlsoTapered]

Oxycodone has a dependence liability far greater than most other opioids of similar analgesic potency. Many people here have noted that it's fun for a while, then it's not fun, then its hell.

So I strongly suggest you just take the pills as prescribed.

Depending on where you are, levorphanol (Levo-Dromoran), ketobemidone (Ketogan) or even plain methadone (Physeptone) might actually be more effecting in controlling pain since they all possess NMDA activity as well as opioid activity. The last one you should have regular EEGs because methadone can cause long QT. One friend died of a heart attack due to methadone (130mg/day - he was trying to quit heroin) and another fiend had a heart attack but survived... BUT generally speaking, it's only over 30mg methadone/day that is a problem unless you have an underlying heart condition.

 

[ColoradoOpiateGirl]

Oxycodone has a dependence liability far greater than most other opioids of similar analgesic potency. Many people here have noted that it's fun for a while, then it's not fun, then its hell.

So I strongly suggest you just take the pills as prescribed.

Depending on where you are, levorphanol (Levo-Dromoran), ketobemidone (Ketogan) or even plain methadone (Physeptone) might actually be more effecting in controlling pain since they all possess NMDA activity as well as opioid activity. The last one you should have regular EEGs because methadone can cause long QT. One friend died of a heart attack due to methadone (130mg/day - he was trying to quit heroin) and another fiend had a heart attack but survived... BUT generally speaking, it's only over 30mg methadone/day that is a problem unless you have an underlying heart condition.

Good HR advice.

 

[AlsoTapered]

BTW people mistakenly believe that the SR formulations offer lower bioavailability. The mean average is ~74% whereas studies on insufflation suggest a mean of ~87% BUT first-pass metabolism by the liver converts around 10% of the oxycodone into oxymorphone, a compound x10 more potent than oxycodone itself. That explains why the plasma level of oxycodone is lower - it's been converted to oxymorphone!

So in this case, parenteral administration will actually make the drug LESS potent. Yes, the fast onset might lead one into thinking that it's the superior ROA but after a lot of research and some self administration, I discovered that 80mg or oral oxycodone equated to around 90mg insufflated.

I SUSPECT this is why oxycodone was initially considered to be a good option for an oral medication. It's most active when taken as prescribed. Of course, they ignored the long, long history that indicated the high level of dependency it can cause.

OT I note that their was considerable work carried out to develop 'biased' ligands that were supposed to produce less tolerance and dependence. But studies showed that they offered no advantages.'

 

[Delmonte421]

Is it true that with ER formulations that sometimes you don't fully absorb all the API an that some does go through you literally

 

[AlsoTapered]

No - or at least not the 12 hour formulations. They have a coating that dissolves at a higher pH than the stomach so they are absorbed as they travel through the small intestine. The entire point of the SR formulation is that more than one tablet is present in the body at one time and so a steady state plasma level is reached. They do entirely dissolve.

It's not perfect and opioids with inherently longer activity (methadone, bezitramide, levorphanol) provide an even smoother plasma level. In all of those cases, BID is the STANDARD dose regime. But each one of them has other issues. With methadone, bioavailability can differ wildly (from 52% to 78%%), with bezitamide it's the abuse potential and with levorphanol it's the side-effect profile. The last one is also costly to produce.

I guess that is why oxycodone SR has become the strong opioid of choice in so many nations. There is no advantage in using it other than prescribed... at least in theory. It's also cheap as long as one has access to thebaine.

 

[Delmonte421]

thebaine

Is that the beginning route for most pharma companies?
I like IR they seem to last me 6 hour and 8 if I push. But the 80mg ER I crush in my mouth and find them to last the same. I just lie the ER's better then the IR's

 

[AlsoTapered]

No - the t1/2 of oxycodone is 2.5 hours so if you crunch IRs yes, you will get a higher plasma level initially, but after 6 hours, that level will be less than 25% of the peak. After 8, less than 12.5%.

With the SR formulation, after 24 hours you reach a steady plasma level. I did find the appropriate studies that give the values.