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  • BDD Moderators: Keif’ Richards | negrogesic

Did my pain doctor lower dosage overall? Morphine SR&Oxy switched to Morphine IR

P

Painfully

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May 25, 2018
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I am a chronic pain patient. I have pelvic trauma and fibromyalgia. I always wonder how much of my pain is fibromyalgia or just plain opiate withdrawal (waiting too long between doses) but I digress.

So this is going to sound like a ridiculously small amount but it?s true?for five years I?ve been on the same dose of morphine sulfate SR, 15mg 3x a day.

I eventually asked for break through pain and I was given 5mg oxycodone 3x top of this for about a year. Then they increased the dosage (without even telling me) to 10mg 3x.

I never abused my pain meds til this year sad to say :/ I think it?s because the sudden jump to ten mg actually made me feel high and I liked it. But I?m no stranger to it, before I became chronically ill I tried everything before. Which is why I tried for years to never abuse my meds.

ANYWAYS MY QUESTION:

Is morphine INSTANT release 15mg 8x a day LESS than morphine SR 15mg + oxycodone 10mg(3x a day)?

I have the option of trying it out for three months and asking how it works, and I could ask for more. Or I can ask for more when I see him in a month and just deal with being drug tested again. (Choosing more pain meds over pot basically because a change in prescription always requires a drug test).

RECENTLY my doctor took me off my Xanax entirely after tapering it down, which is when I first started ?needing? to get high, to curb my anxiety. So that was bad/has been bad. Stg I went years with my pain meds being FORBIDDEN to abuse. Then I went and did it and now I?m worried I won?t even be able to control pain, let alone get buzzed.

Like for real? Instant release morphine 8x a day? That?s so annoying. Will I need to pop a pill every three hours just to keep withdrawals at bay?

Did I ruin my tolerance? By ruined I mean I?ve taken 40-50mg at once at least three times in the last two weeks. And tbh it didn?t really do much.

What should i do? Ask for more? Or leave it? Is the doctor trying to reduce my medication entirely this way? At this rate I?m scared he?s just gonna keep reducing. I am currently in so much pain right now but it?s not quite time to take my meds, and I shutter to think what it would be like to be stuck in pain and not have meds at all.
 
Hey buddy, this is truly a teach a man to fish as opposed to giving a man the fish. It's really important for your own safety both now and in the future for you to be able to produce and deduce your own answers by your own power. For this purpose, I've included my favorite and what I feel to be the the most simple and reliable of the readily available charts.

https://olh.ie/wp-content/uploads/2014/09/Opioid-Conversion-Chart-2016.pdf

From here, you can figure out with the utmost precision available to "civilians" how your Opioid dosage and thus yourself has been affected. We really can't figure out anything further than this, as a lot of this stuff is both completely subjective and is going to vary widely from person to person, making anything beyond a wild guess pretty difficult. I understand that it's difficult to be taken off of Benzodiazepines, but what you are doing regarding the self-medication is not even going to be helpful in the way that you want it to be.

Opioids are great at relieving physical and emotional pain, yes, but they are nothing near an effective antidote for Opioid withdrawal. It's not going to make you feel completely better, but it's going to make you feel a little bit better. What is the catch? You are indeed increasing your Opioid tolerance to a degree that could leave you with a dependence that you cannot effectively medicate and to an extent that will render your painkillers significantly less effective than you have previously known them to be.

We usually don't comment on this stuff, but I would highly recommend against asking your prescriber for an earl refill if you start hurting, which you will, as this could potentially lead you into complete withdrawal of all medications, beyond that, there is nothing we can do in discerning the disposition of your prescriber or how they are planning to proceed with your treatment. I'm going to leave this open for a moment, but it's on the short list for being closed up.
 
Thank you for the response but I didn’t mean asking for an early refill. I’m not in danger of withdrawals. I actually never run out of my meds. I only meant I have an appointment with him on a schedule and I have the option of telling him the meds are not working. In fact he always gives me exactly a month to decide how I like new medication, then we discuss it from an appointment.
 
So...120 mgs of morphine IR per day vs 45 mgs of ER morphine and 30 mgs of oxy.

Only you know how well morphine works for you. It seems that it's only the oxys that you have started to increase/abuse so maybe going completely to morphine as a test wouldn't be a bad idea. If morphine works and you don't abuse it then why not try It? If you can switch back to your old dosage then I would do it.

If you decide to try the all morphine route, instead of 15 mgs 8 times a day you can take 30 mgs 4x a day so that you aren't constantly taking another pill. You can take more at times when you know you'll be in pain, less when you are lounging around the house.

Let us know how it goes. Morphine doesn't work well for me at all but it works amazing well for others.
 
Thank you both for responding. I honestly don’t know anymore because I’ve had the oxy as an option for over a year now. And I was in so much pain before. But I think it is better this way that I don’t have anything to abuse anymore. I guess I’ll find out in a few days when I begin this new script (it’s been sent the pharmacy electronically all I have to do is fill it).

After looking at the conversion chart it seems like my pain pills are really about the same as before, or in paper it seems. But over all I think it is actually less. I do wish there was some sort of chart for morphine SR to IR because I do not feel they are the same. To me a 15mg SR pill probably really only feels like 5mg instant relief. I know even “civilians” as you call them don’t feel anything when taking these 15mg SR pills, but I supposed that is the point of them. To not feel a high, to have pain relief only.

As an experiment I have been trying to only take my morphine SR today and the results aren’t great. I feel a lot of pain in the usual fibromyalgia tender points. I will be worried if this is how I will feel when I switch to the morphine IR as I cannot do anything this way. It hurts just to lie in bed.
 
It's too late to switch if your scripts are being sent to the pharmacy but in my opinion I feel like you'll be fine. If it's not working as well then switch back to your morphine SR with oxy for breakthrough pain.

You might be pleasantly surprised at how well it works for you if you've taken morphine in small doses for years.
Btw, but agree that 15 mgs of morphine SR is like 5 mgs of immediate release.
 
Right, I wouldn’t be switching scripts until I see the doctor. I’ll see him before this new script ends. They set it up like this so that you “try” the meds for a month and are able to tell them if it’s working or not. But god right now my body aches just lifting up my phone and typing. Is there such thing as having withdraws from one opiate while still taking another type of opiate? Or will there be no withdraws because I’ll be taking the morphine IR pills so often?

I think I’ll search for more threads about chronic pain but if anyone could link me to similar issues such as pain relief on this site I’d appreciate it. I don’t know how many other people on here use morphine for chronic pain though. My apologies if I shouldn’t have posted this. I’m new.
 
Yes, you can withdraw from one pain medicine while being on another (happened to me).

Yes, there are many chronic pain patients here.

No, I couldn't imagine the best place on this huge site to search for whatever questions you may have in regards to the best pain relief. We all have different medicines we prefer. The search engine will help.
 
Oh man so I could actually be having pain from oxy withdraws while on morphine? I asked the doctor if this would happen. He said no but he kinda seems to just tell me what I want to hear :/

thanks again everyone.
 
You may possibly feel withdrawal when you change up medicines. I've had it happen on several occasions.

When pain specialists were told to lower the dosages of pain meds for all patients my doctor dropped me from 50 mgs of Methadone to 30mgs...immediately.

I was on 50 mgs for about a year, and 30mgs of Methadone before. Even though I had 15mgs of oxyIR and Norco, I still spent 3 weeks in the bathroom and my mood was horrible. It goes away. I think you'll do fine on 120 mgs of morphine. Just give it a shot.

The truth is that many pain clinic doctors are borderline stupid on how they handle both meds and patients. Try to do as much homework as possible and be open to trying suggestions from your doctor. It will come back to help you in the future.

Feeling 'high' is a side effect that goes away. It's only when people try to chase the high do they find themselves in trouble. If it helps your pain enough that you can function then you're good. Getting high forever is impossible and leads to ruined lives.
 
Thank you for sharing. Besides this thread I found almost no information on this type of withdrawal. That sucks he did that to you. I?ve had pain doctors make me endure fentanyl withdrawals cold turkey. It was horrible. I literally had withdrawals for six solid months. I couldn?t believe it. Something about the long acting medications just fucks you up like that.

I?ve managed to decrease my oxy intake. I went three days with none at all. There was increase in my chronic pain and some chills. I caved yesterday and took ten mg. I havent taken any today. Really trying to not chase a high but I guess this is what they get for taking me off my anxiety meds. Used to I?d take a xanax and the feeling would go away. Now I have been prone to abusing what I have. I will at least be proud of the small victory of decreasing my daily oxy intake from 30-70mg a day to 10 or less. I also have stopped cannabis since I drug test my next visit at the end of the month.

(Also just a couple days dropped my tolerance way more than I expected. A 10mg had me actually feeling slightly high).

I had like 70 10mg oxys laying around for ?emergencies?, and i got rid of half of them to try to control myself. Didn?t like my stash being THAT good. So once they?re gone, it won?t be a problem anymore (wanting to get high off them that is).

This Friday I start the new script of the morphine IR 8x a day. If anyone is curious or if someone in the future gets switched to this kind of medicine, I am gonna update how it goes. My main concern is actually being in pain. If that happens, I?ll just have to tell my doctor how I feel.
 
Congratulations on lowering your oxy intake so that you eliminate any potential problems from withdrawing from it during the switch. Believe me, I never thought I'd go thru withdrawal from lowering the Methadone when I had plenty of breakthrough medicine. It was a shock.

I would definitely like to know how you are doing with the morphine. And While I understand that you might not want temptation around, I would NEVER get rid of any of my pain medicine or my klonopin lol. After a bad lab result got me kicked out of a pain clinic I've decided that even if I have 200 extra methadone laying around I'll put them in a safe hiding place....just in case.

I'm sorry about your Fentanyl withdrawal. In any civilized world we should not suffer because of meds we were scripted, or even meds we weren't scripted. Compassion is all but gone when it comes to pain meds or benzos. I'll never understand. We act like we are becoming a more intelligent race but we mistreat more people now than in the 1960s. Does more intelligence mean less empathy and sympathy? I hope not.
 
Yes I really wish people would not punish us for drug dependency no matter the circumstances. Sorry to hear you?ve had the same stuff happen with doctors. It shouldn?t be legal for doctors to yank you off drugs like that.

So its 6 pills a day, not 8. I was just mistaken. But it is prescribed for every 3 hours. And I?m surprised to say it works pretty good. I have a decent comparison to the worst pain.

Oh btw I JUST got them filled today! I was supposed to get them filled 6 days ago but the pharmacy literally didn?t have 180 pills in stock for me. So they had to order it! You were totallt right about holding on to spare pills. I would have been so fucked.

I have found I am able to function somewhat normally. I did some sweeping around the house. I walked with my dog and played Pokemon GO too. I still feel some pain but lets face it? oxy?s bioavailability is like 95% whereas morphine is 20-40%? It shows. I can tell. But I am happy to have it.
 
I'm glad you are doing okay with the switch. I've been waiting for you to post how you are doing.

As for the pharmacy problem? After dealing with the same problem (We have 96, not 120. Is that Okay? No, no it's not okay!) and waiting days for them to get them in stock I've learned to call about 5 days early and tell them what scripts I'll be bringing in.

I usually get mine from a mail order pharmacy but about every 3 months I have to use CVS. They know me by name now lol.

My mail order pharmacy can be 3 or 4 days late, or 5 days early, so I never take all my medicine every month. It's good to have a week's worth put back because life happens, you know? Snow storms, hurricanes, and all kinds of stuff can mess up deliveries.

I think giving you 6 a day was a mean thing to do but I'm glad it's working. I would never be able to do that unless they weaned me for months first.

Post back in a couple of days. I'd like to hear what your pain level is and if you think 6 a day was an acceptable swap.
 
120mg of morphine is better than 90...

30mg oxycodone = ~45 morphine, sothat and 45mg sr morphine means 90mg morphine chronic equivalent

and morphine classic is better than morphine, personally, would rather have several tablets to control dosing, regardless of route

Opioid calculators vary, however yours truly has been adjusting ours to make it arguably the most, at least thourough/precise Luck
 
Personally, I do use the same pharmacy and they do know me but for one reason or another, they can run short. My doc understands that and tells me to get what they have, bring in the Rx bottle and he'll write another script for the remainder. It doesn't happen often but....
Don't you guy's doctors have a policy like that? Particularly in today's environment, these things will happen.
 
I have recently ran into issues with pharmacies running out due to the fact I now need to take a specific brand of one of my pain meds. I know my doc would of most likely worked with in this type of emergency but multiple pharmacists who were willing to do it had told me that it's not a good idea to. With all the new bs regulations it can cause unnecessary problems for you not to mention even if your doc wants to their hands may be tied.
 
BeachBum, if I had to get a lower amount of my medication my doctor would fix the difference, but I don't allow myself to run low so if the pharmacy takes an extra few days to fill mine I don't worry.

About 6 years ago pharmacies would fill my regular meds but say they were out of my scheduled medicine so I had to go to several pharmacies every month. I finally found one that would have mine in stock if I called ahead of time.

My current insurance requires that I get mine from a mail order pharmacy and while they don't run out of stock I often feel like I'm talking to a brand new employee every time I call to get refills. Fortunately I have a nurse that knows how to deal with them so I call her if I have a problem and it's fixed quickly.

I do fill at CVS about once every 3 or 4 months but I call a few days early and they have everything for me. But they know me by name and I've used them for many years. A good relationship with the pharmacist is essential nowadays, and a doctor who will go to bat for me is priceless.
 
Painfully:

With the CDC guidelines finalized in 2016 in the "CDC Guideline for Prescribing Opioids for Chronic Pain" a Morphine Milligram Equivalent standard was established. The MME is the amount of morphine an opioid does is equivalent to when prescribed.
Morphine is morphine is morphine . . . The only difference between Morphine IR and Morphine SR is the mechanism used to deliver the drug.
SR or sustained-release tablets are designed to deliver (release, liberate) a drug at a predetermined sustained rate over a period of time to achieve and then maintain a constant drug concentration for that time period. So although 15mg of morphine is 15mg of morphine, 15mg of moprhine sr x2/day DOES NOT necessarily equal 15mg of morphine ir x2/day.
As nonsensical as it is 15mg of morphine ir will be delivered as its name suggests, immediately (more on ir to follow). Whereas 15mg of morphine sr will be delivered over a period of 12 hours.
With ir formulations of morphine or any given drug, there will be an immediate peak concentration following ingestion. Such formulations have a short half-life (the elimination of the drug from the bloodstream) vis-a-vis sr formulations. Additionally, with ir tablets there is no deliberate effort to modify the drugs release rate.
Now, Moprhine is not Oxycodone & Oxycodone is not Morphine. Working from the CDC 2016 guildeline, Oxycodone is roughly equivalent to a 1.5 morphine conversion factor.
i.e. - 10mg of oxycodone = 15mg of morphine.
Thus:
15mg of morphine ir 8 x/day = 120mg of morphine daily.
15mg of morphine sr 1 x/day = 15mg of morphine. 30mg of oxycodone (10mg 3 x/day) x 1.5 (oxycodone's mme/day) = 45mg of morphine. 15mg of morphine + 45mg of mme/day = 60mg morphine/day.
120mg morphine/day > 60mg morphine/day.

Quick note:
The 8 x/day for morphine ir doesn't seem to fit with what you described in your post. So assuming the 8 was a typo for 3,
15mg morphine ir x 3/day = 45mg morphine/day.
15mg moprhine sr 1 x/day + 30mg oxycodone/day = 15mg moprhine/day + 45mg mme/day. Which still = 60mg morphine/day.
45mg moprhine/day < 60mg morphine/day.

BUT if by 15mg of morphine sr + 10mg of oxycodone 3 x/day you meant 15mg morphine sr 3 x/day + 10mg oxycodone 3 x/day the following holds true:
The 120mg moprhine/day stays the same for the ir moprhine 8 x/day value.
15mg morphine sr 3 x/day = 45 mg morphine/day. 45mg morphine/day + 45mg mme/day = 90mg morphine/day.
120mg morphine/day > 90mg morphine/day.
 
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GQ, I know all about it. My doctor even showed me the booklet they use that measures the difference between, say, hydrocodone v. Morphine (1:1) up the methadone v. Morphine (8:1). It gave the doctors and nurses more work and requires drug screens, but my doctor does UAs every 3 months and always has so no problem there.

We lowered my medicine for approximately two years now and he said, as of 3 months ago, that he would not be lowering my dosages anymore. I'm still a pretty large amount over the 200 mg of morphine equivalent that I should be prescribed so I feel blessed to have a wonderful doctor who is not scared and is willing to write the proper prescriptions for who he thinks needs them.

In the eight years I've been with him I've never asked for an early refill or said I had my medications stolen or ever gave him any problems. When he said he had to lower my dosages I said fine, let's do what we have to do.

His clientele is now much smaller because people did not like having their medicines cut way back but mine didn't get cut back even close to the 200 morphine milligram equivalents. Plus he didn't take my klonopin when the so-called guidelines said you couldn't take both a benzodiazepine and opioids at the same time lol.

He is a sweetheart who is always in pain from nonstop surgeries so he understands.
 
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