Opioids Hydromorphone or Fentanyl for Pain?

[LoveTractor]

I am pain management patient. I am seeking input / guidance from BLers with similar experiences. I'm finally feeling minor relief with 12-mg every four hours of oral hydromorphone tablets (72-mg/day). I do not abuse my meds, run out early, etc.

I have been offered either an increased hydromorphone dose or a switch to a fentanyl patch for my dose for my increase next week. Let's assume the analgesia will be sufficient with either formula.

Disregarding the hassle of dosing tablets round the clock every four hours, which would you choose for its pain management attributes, 96-mg/day hydromorphone or x-ug/hr transdermal fentanyl. What would you suggest the fentanyl dose/hour would need to be 50, 75 or 100-ug?

I have been offered what I need with no hard limit as long as I am compliant and in severe pain. I don't expect I'll ever have complete relief. There will be a major surgery within a year.

I don't want to fuck my tolerance unnecessarily. Ketamine will be added as an IN solution PRN when my dose is stabilized. Thank you.

 

[Dextro .45]

Perhaps look into oral Methadone tablets (scripted a 100 tablet sealed bottle) ….due to its very long half life, a full mu-agonist and NMDA antagonist properties, it’s very suitable for long term chronic pain.

….not just for Heroin addiction

It’s a prominent long acting, potent opioid narcotic analgesic that any family doctor can prescribe as an analgesic.

I too was on Oxy-IR 5mg x 6 daily and then Dilaudid 2mg x 4 daily /Hydromorphone 9mg XR x 2 daily, but short acting opioids are best suited for short term pain management (like a broken leg, surgery, etc)

Hydromorphone (Dilaudid) although a very potent opioid, taken orally has a piss poor bioavailability. Roughly 70% of the oral dose is destroyed by first pass metabolism (your liver). Dilaudid is most suitable for hospital administration via IV/IM injections, bypassing the liver and rapidly penetrating the BBB with 100% bioavailability

Oral Methadone has excellent bioavailability of approximately 80%, and increases when taken “chronically” as it builds up after 4-7 days due to it 24h half life, becoming more potent after daily usage for weeks+. However, it’s true potent analgesic pain killing properties only last 5-8 hours of duration……but many patients are held just fine with a single daily dosage.

I have been on Methadone 80mg daily for 10+ years, started from 30mg and slowly increased until optimal dose achieved.

For yourself, doctor could start you on 5mg tablet in morning, and another after dinner…..then slowly increased once a week until your pain in under control and you’re not impaired, dizzy, sleepy, etc. research it and be aware of any DDI and not combined with any other CNS depressants such as benzodiazepine which can cause slow breathing and accidental overdose

Your doctor might be impressed with your knowledge of DDI regarding Methadone, and emphasis on safety….while suggesting starting at the lowest dose 5mg tablets and each week or 2 weeks, doc can safely increase

Speak to your doctor if you wanna go that route…..Fent I’ve never tried, now highly stigmatized by massive illicit supply and O.D. numbers. Dilaudid HM is an amazing potent classic opioid very similar to Diamorphine (Heroin) in potency and subjective feelings, but short acting and best used as a pharmaceutical injectable solution.

I suggest oral Methadone for long term chronic pain conditions, requiring a long acting potent opioid with a long 24h half life, suitable for once a day administration for some people.

Best of luck

 

[LoveTractor]

Thank you for the suggestions, unfortunately methadone is not an option provided by this clinic.

Hence my suggestion and the doc's concurrence that ketamine would help both w/ breakthrough pain and to reduce tolerance via NMDA activity.

I agree 100% that short acting opioids are a poor choice for chronic pain. Its mostly for titration afasik, but its also my choice if I want to stay with that vs. moving to patches.

So... I'm leaning towards fentanyl patches but would like some more well informed opinions and experiences like d-0.45's above.
There's a few more reasons for thinking fentanyl would serve me best if my choices are b/w hydromorphone IR and patches. Fentanyl will have a less warm feel to it if my memory from in-patient experiences is a good indicator. That would be ok, better even for me if the analgesia is the same. I don't want things to get too reinforcing. Also I'd have to return each spent patch, yeah that could be manipulated...

I am walking a fine line b/w dependence and addiction, I know this very well. I didn't get to such a high dose w/o learning a lot about how reinforcing semi-synthetic opioids can be. Fentanyl I've only had IV while in-patient. I've avoided abusing my meds thus far. How? idk. Will power? No, I think its fear of getting cut off and / or death. I've been to too many funerals where those grieving, myself included, stood around morbidly mumbling, "Well, this was bound to happen".

I'll think on and maybe ask about ER hydromorphone. Not sure this clinic favors ER tabs over fent patches but open conversation about subjective and objective pros & cons of are welcome and ongoing. That's a big reason I want input - it will add value to my patient/physician relationship, even if its not perfect knowledge it helps move conversations along.

Thank you all so much for caring enough to share experiences and data you feel may be relevant.

 

[LucidSDreamr]

I would go with patches. Make sure you get matrix and not gel patches. Mylan makes matrix patches. The matrix ones are way stronger.

Taking hydromorohone orally youbwaste like 70% of it because it has extremely horrible bioavailability when take. Orally

Fentanyl transdermal patches have 100 percent bioavailability.

You just have to make sure your don’t get cheated during the switch where they effectively lower your opioid dose.

But oral hurdomorphome is basically useless. Sniffing or injecting it you get much more of the drug into your system.

 

[ChemicallyEnhanced]

Perhaps look into oral Methadone tablets (scripted a 100 tablet sealed bottle) ….due to its very long half life, a full mu-agonist and NMDA antagonist properties, it’s very suitable for long term chronic pain.

….not just for Heroin addiction

It’s a prominent long acting, potent opioid narcotic analgesic that any family doctor can prescribe as an analgesic.

I too was on Oxy-IR 5mg x 6 daily and then Dilaudid 2mg x 4 daily /Hydromorphone 9mg XR x 2 daily, but short acting opioids are best suited for short term pain management (like a broken leg, surgery, etc)

Hydromorphone (Dilaudid) although a very potent opioid, taken orally has a piss poor bioavailability. Roughly 70% of the oral dose is destroyed by first pass metabolism (your liver). Dilaudid is most suitable for hospital administration via IV/IM injections, bypassing the liver and rapidly penetrating the BBB with 100% bioavailability

Oral Methadone has excellent bioavailability of approximately 80%, and increases when taken “chronically” as it builds up after 4-7 days due to it 24h half life, becoming more potent after daily usage for weeks+. However, it’s true potent analgesic pain killing properties only last 5-8 hours of duration……but many patients are held just fine with a single daily dosage.

I have been on Methadone 80mg daily for 10+ years, started from 30mg and slowly increased until optimal dose achieved.

For yourself, doctor could start you on 5mg tablet in morning, and another after dinner…..then slowly increased once a week until your pain in under control and you’re not impaired, dizzy, sleepy, etc. research it and be aware of any DDI and not combined with any other CNS depressants such as benzodiazepine which can cause slow breathing and accidental overdose

Your doctor might be impressed with your knowledge of DDI regarding Methadone, and emphasis on safety….while suggesting starting at the lowest dose 5mg tablets and each week or 2 weeks, doc can safely increase

Speak to your doctor if you wanna go that route…..Fent I’ve never tried, now highly stigmatized by massive illicit supply and O.D. numbers. Dilaudid HM is an amazing potent classic opioid very similar to Diamorphine (Heroin) in potency and subjective feelings, but short acting and best used as a pharmaceutical injectable solution.

I suggest oral Methadone for long term chronic pain conditions, requiring a long acting potent opioid with a long 24h half life, suitable for once a day administration for some people.

Best of luck

^I agree with everything BUTTTT it depends where you live with the "any family doctor" thing. Where I live doctors need a special license to prescribe methadone

 

[Keif' Richards]

Everyone is different, but if you ask me Hydromorphone (Dilaudid) is a superior analgesic to Fentanyl. I've used both for pain and have always found the semi-synthetics or organic Opioids to be better all-around relievers of misery.

If I had to put it into words, I would say that Hydromorphone has a superior psychological element to it. It produces more anxiolysis and just feels more comfortable. If you want me to get all psychedelic about it, I'd say Hydromorphone is like a nice bed with soft sheets and a pillow while Fentanyl is like sleeping on your front lawn in a sleeping bag. Both can do the trick, but one is always just going to feel more "right".

I would continue with what's working as a general course of action for anyone. Between these two though, I will always recommend Hydromorphone and I think most people would agree with me. Hell, it's pretty much my favorite drug in the world besides Oxymorphone (Opana).

 

[sekio]

i recommend you investigate as many other synergistic painkillers as possible to take alongside your opioid. Opioids alone are actually not super effective painkillers, which is why they are often combined with acetaminophen (not just to make life hard for abusers),

I suggest you add acetaminophen and a NSAID like naproxen to bolster efficacy.

 

[Delmonte421]

Taking hydromorohone orally youbwaste like 70% of it because it has extremely horrible bioavailability when take
How can they say the bioavailability of hydromorphine is so low... so when I do a conversion chart to match my oxy to my hydromorohine, it doesn't take into account bioavailability with the ROA? I have eaten 24mg of hydromorphine and felt literally nothing, I will try 48 next time but I see it not changing the euphoric part

 

[ColoradoOpiateGirl]

Dilaudiddddd *Homer drool*

 

[Delmonte421]

I got a shit ton but they do nothing to me but hold off withdrawals. I tried snorting and I still don't get it, I wont IV and I hear thats what there best for

 

[MadHatterMike]

I've only done fent once when younger..chewed on a corner of a patch and it sure felt amazing..having said that I wouldn't mess with it now after learning of all the stupid crap I've done..also with methadone popping them like candy like a moron without knowing back then that u could not wake up especially if drinking with em. Rambling but personally I would stick with the hydromorph.

 

[Delmonte421]

Even with the low oral bioavailability? It may give me a SLIGHT and VERY SLIGHT euphoria but NOTHING compared to oxy IR

 

[Dextro .45]

Dilaudid (Hydromorphone) all the way ……f@ck fent

Some individuals who want to significantly increase the bioavailability of HM without crossing the scary line of injecting oral tablets (which can result in relatively hazardous harm, and many health complications can occur) ….they choose the safer route of dissolving pulverized powder from crushed tablets in room temp bottled water, drawing up in oral syringe (without needle) and slowly administer HM solution into rectum while laying on side in privacy of your bedroom or locked washroom if people in house

Just 1/2 to 3/4 the length of your pinki finger inside and slowly push plunger and lay there for a few min to absorb a bit.

I personally have never administered this way, but many have described it, and has Excellent bioavailability, greater absorption, faster onset, and most importantly…..bypassing first pass metabolism so your liver won’t destroy 70% of the oral dose you would’ve taken

I totally would have done this btw ….but current on Methadone 80mg daily, so HM would have zero effect on me. After 40mg of Methadone daily for several weeks/months all the mu-opioid receptors in your CNS are completely saturated with the super long 24h half-life Methadone that inhibits other opioid agonists from binding / taking a noticeable effect

While on Methadone 60mg for months…..I took 3 & 4 tablets of genuine OxyContin 80mg and felt F@CK ALL. Absolutely nothing. I’m on 80mg now.


Oxycodone was the most euphoric & pleasurable in addition to being an amazingly effect & potent opioid analgesic

Hydromorphone was VERY potent and super effective opioid analgesic, but being significantly more sedating, and definitely less euphoric ecstasy compared with oral Oxycodone.

That being said, Dilaudid (Hydromorphone) is a HIGHLY respected, highly desirable, gold standard Heavy Hitter with no ceiling dose and can eliminate even the most extreme pain, given the required mg dosage. Pharmaceutical Dilaudid HP Fort solution for IV/IM/SC injection (100mg/per ml) in a cute tiny little 15ml glass vial with red label Sandoz Pharmaceuticals ….google it to see the pic. It’s so beautiful lol.

 

[LoveTractor]

Ok, here's the deal for now and to recap accurately where I was at:

I split the difference w/ 4-mg hydromorphone (6/day, 180/mo.) and 25-ug/hr Mylan matrix for the patch for now, increase step wise - as desired / tolerance builds.

Patch is to be changed every 48 hours, I get #15 each month.

I thought the 25-ug/hr was a low dose for my tolerance but it is the matrix. I'm coming from 48-mg/day hydromorphone.

I wish everyone in pain management would be treated as well as I have been.

To each of the respondents above - you've been a big help, much appreciated.

@LucidDremer and others - is there good consensus that the matrix patch is preferable? I can switch patch type if I desire after this month.

Other thoughts?

Thank you.

 

[Skeee420]

I am pain management patient. I am seeking input / guidance from BLers with similar experiences. I'm finally feeling minor relief with 12-mg every four hours of oral hydromorphone tablets (72-mg/day). I do not abuse my meds, run out early, etc.

I have been offered either an increased hydromorphone dose or a switch to a fentanyl patch for my dose for my increase next week. Let's assume the analgesia will be sufficient with either formula.

Disregarding the hassle of dosing tablets round the clock every four hours, which would you choose for its pain management attributes, 96-mg/day hydromorphone or x-ug/hr transdermal fentanyl. What would you suggest the fentanyl dose/hour would need to be 50, 75 or 100-ug?

I have been offered what I need with no hard limit as long as I am compliant and in severe pain. I don't expect I'll ever have complete relief. There will be a major surgery within a year.

I don't want to fuck my tolerance unnecessarily. Ketamine will be added as an IN solution PRN when my dose is stabilized. Thank you.

I use M2 been on theme for 3yrs 2mg . Do not I mean do not go on fentanyl. After that your basically. Exchanging 1demon to another. After fentanyl I think there is noting stronger for pain but it lasts 2 secs yes short life means no legs on both hydromorphone or fentanyl

 

[Skeee420]

I use M2 been on theme for 3yrs 2mg . Do not I mean do not go on fentanyl. After that your basically. Exchanging 1demon to another. After fentanyl I think there is noting stronger for pain but it lasts 2 secs yes short life means no legs on both hydromorphone or fentanyl

I would try oxycmorphone opena

 

[Skeee420]

Dilaudid (Hydromorphone) all the way ……f@ck fent

Some individuals who want to significantly increase the bioavailability of HM without crossing the scary line of injecting oral tablets (which can result in relatively hazardous harm, and many health complications can occur) ….they choose the safer route of dissolving pulverized powder from crushed tablets in room temp bottled water, drawing up in oral syringe (without needle) and slowly administer HM solution into rectum while laying on side in privacy of your bedroom or locked washroom if people in house

Just 1/2 to 3/4 the length of your pinki finger inside and slowly push plunger and lay there for a few min to absorb a bit.

I personally have never administered this way, but many have described it, and has Excellent bioavailability, greater absorption, faster onset, and most importantly…..bypassing first pass metabolism so your liver won’t destroy 70% of the oral dose you would’ve taken

I totally would have done this btw ….but current on Methadone 80mg daily, so HM would have zero effect on me. After 40mg of Methadone daily for several weeks/months all the mu-opioid receptors in your CNS are completely saturated with the super long 24h half-life Methadone that inhibits other opioid agonists from binding / taking a noticeable effect

While on Methadone 60mg for months…..I took 3 & 4 tablets of genuine OxyContin 80mg and felt F@CK ALL. Absolutely nothing. I’m on 80mg now.


Oxycodone was the most euphoric & pleasurable in addition to being an amazingly effect & potent opioid analgesic

Hydromorphone was VERY potent and super effective opioid analgesic, but being significantly more sedating, and definitely less euphoric ecstasy compared with oral Oxycodone.

That being said, Dilaudid (Hydromorphone) is a HIGHLY respected, highly desirable, gold standard Heavy Hitter with no ceiling dose and can eliminate even the most extreme pain, given the required mg dosage. Pharmaceutical Dilaudid HP Fort solution for IV/IM/SC injection (100mg/per ml) in a cute tiny little 15ml glass vial with red label Sandoz Pharmaceuticals ….google it to see the pic. It’s so beautiful lol.

My friends ppl once you put that needle in your done. It's like you flushed your life. What I mean you can't go back and say oh iam going to sniff or it's hard I wish I did your rout my friend but is 14yrs to late. Love your care for writing educate everyone. What I mean don't do it . Boot or snort they all kill you but the needle is quicker and it will take everything from you please every1 don't shoot

 

[Skeee420]

Perhaps look into oral Methadone tablets (scripted a 100 tablet sealed bottle) ….due to its very long half life, a full mu-agonist and NMDA antagonist properties, it’s very suitable for long term chronic pain.

….not just for Heroin addiction

It’s a prominent long acting, potent opioid narcotic analgesic that any family doctor can prescribe as an analgesic.

I too was on Oxy-IR 5mg x 6 daily and then Dilaudid 2mg x 4 daily /Hydromorphone 9mg XR x 2 daily, but short acting opioids are best suited for short term pain management (like a broken leg, surgery, etc)

Hydromorphone (Dilaudid) although a very potent opioid, taken orally has a piss poor bioavailability. Roughly 70% of the oral dose is destroyed by first pass metabolism (your liver). Dilaudid is most suitable for hospital administration via IV/IM injections, bypassing the liver and rapidly penetrating the BBB with 100% bioavailability

Oral Methadone has excellent bioavailability of approximately 80%, and increases when taken “chronically” as it builds up after 4-7 days due to it 24h half life, becoming more potent after daily usage for weeks+. However, it’s true potent analgesic pain killing properties only last 5-8 hours of duration……but many patients are held just fine with a single daily dosage.

I have been on Methadone 80mg daily for 10+ years, started from 30mg and slowly increased until optimal dose achieved.

For yourself, doctor could start you on 5mg tablet in morning, and another after dinner…..then slowly increased once a week until your pain in under control and you’re not impaired, dizzy, sleepy, etc. research it and be aware of any DDI and not combined with any other CNS depressants such as benzodiazepine which can cause slow breathing and accidental overdose

Your doctor might be impressed with your knowledge of DDI regarding Methadone, and emphasis on safety….while suggesting starting at the lowest dose 5mg tablets and each week or 2 weeks, doc can safely increase

Speak to your doctor if you wanna go that route…..Fent I’ve never tried, now highly stigmatized by massive illicit supply and O.D. numbers. Dilaudid HM is an amazing potent classic opioid very similar to Diamorphine (Heroin) in potency and subjective

Dilaudid (Hydromorphone) all the way ……f@ck fent

Some individuals who want to significantly increase the bioavailability of HM without crossing the scary line of injecting oral tablets (which can result in relatively hazardous harm, and many health complications can occur) ….they choose the safer route of dissolving pulverized powder from crushed tablets in room temp bottled water, drawing up in oral syringe (without needle) and slowly administer HM solution into rectum while laying on side in privacy of your bedroom or locked washroom if people in house

Just 1/2 to 3/4 the length of your pinki finger inside and slowly push plunger and lay there for a few min to absorb a bit.

I personally have never administered this way, but many have described it, and has Excellent bioavailability, greater absorption, faster onset, and most importantly…..bypassing first pass metabolism so your liver won’t destroy 70% of the oral dose you would’ve taken

I totally would have done this btw ….but current on Methadone 80mg daily, so HM would have zero effect on me. After 40mg of Methadone daily for several weeks/months all the mu-opioid receptors in your CNS are completely saturated with the super long 24h half-life Methadone that inhibits other opioid agonists from binding / taking a noticeable effect

While on Methadone 60mg for months…..I took 3 & 4 tablets of genuine OxyContin 80mg and felt F@CK ALL. Absolutely nothing. I’m on 80mg now.


Oxycodone was the most euphoric & pleasurable in addition to being an amazingly effect & potent opioid analgesic

Hydromorphone was VERY potent and super effective opioid analgesic, but being significantly more sedating, and definitely less euphoric ecstasy compared with oral Oxycodone.

That being said, Dilaudid (Hydromorphone) is a HIGHLY respected, highly desirable, gold standard Heavy Hitter with no ceiling dose and can eliminate even the most extreme pain, given the required mg dosage. Pharmaceutical Dilaudid HP Fort solution for IV/IM/SC injection (100mg/per ml) in a cute tiny little 15ml glass vial with red label Sandoz Pharmaceuticals ….google it to see the pic. It’s so beautiful lol.

feelings, but short acting and best used as a pharmaceutical injectable solution.

I suggest oral Methadone for long term chronic pain conditions, requiring a long acting potent opioid with a long 24h half life, suitable for once a day administration for some people.

Best o

Taking hydromorohone orally youbwaste like 70% of it because it has extremely horrible bioavailability when take
How can they say the bioavailability of hydromorphine is so low... so when I do a conversion chart to match my oxy to my hydromorohine, it doesn't take into account bioavailability with the ROA? I have eaten 24mg of hydromorphine and felt literally nothing, I will try 48 next time but I see it not changing the euphoric part

I would straight 2mg nice . Eat 16mg feel noting . This med is only good iv in hospital

 

[Skeee420]

I got a shit ton but they do nothing to me but hold off withdrawals. I tried snorting and I still don't get it, I wont IV and I hear thats what there best for

You don't want to do that . Change to oxyc hydromorphone only good for iv

 

[SpiralusSancti]

I use M2 been on theme for 3yrs 2mg . Do not I mean do not go on fentanyl. After that your basically. Exchanging 1demon to another. After fentanyl I think there is noting stronger for pain but it lasts 2 secs yes short life means no legs on both hydromorphone or fentanyl

If he’s using patch as instructed 25µ/h fent patch isn’t a big concern. It’s a huge difference between using opiods for pain and for a high, I’ve done both. When I use opiods for pain, even now after I have been addicted, I find it easy to not escalate dose and to skip doses or replace it with another pain-relief drug or to stop. Sometimes I might feel almost none mental effects and still get pain-relief.

@LoveTractor I have no idea from what kind of pain you suffer but in most cases you can get more from adding another medicine instead of upping the dose of opiods. Depending on your case you might benefit from NSAIDs or paracetamol or muscle relaxants or gabaerics. Ofc if you get proper relief from opiods alone adding any of those would be harmful. You have been probably recommended such things already if they are appropriate in your case.