Hydromorphone - SC Injection safe?

[Benzopiates]

Hello.

This post refers to a problem I have with helping my mother. I'm taking pretty much care of my mother 24/7 I will refer to her problems as our problems.

My mother has some big pains that happen mostly randomly but the docs says it's when she is stressed... Thing is pretty much everything stresses her lately. They said she has fibromyalgia and the stress causes her pain. Currently that's the only explanation we have for the fact she randomly gets hit with pains that hit the 9/10 and stays on for hours. Only way to make it go away is hydromorphone. Also, I suggested it could be kidney stones, they looked for it once, and didn't find anything so they wrote it off, but I still think it might be some sort of kidney stone reccurence where her body creates many stones each time and they have to pass and they cause pain... I could totally be wrong tho but the stress that causes pains equal to child birth seems sus to me.

At first they gave her some morphine and then not long after she was upgraded to hydromorphone.

The thing is, even with hydromorphone the pain was still strong and since because the pain was so strong and not only that, when she took the hydro orally it would take up to 45 minutes to take effect and she would describe her pain as sometimes up to 9/10 and it would take more than 30 minutes to even start to drop a little, and even when it did drop, it wouldn't drop much, only back down to like 4 after an hour and a half.

Me, being an ex-hydromorphone injecter, I knew that the medecine would be much more efficient injected but I didnt wanted to ask this to my mother... but at one point the pain was so insufferable that I did... and she said do whatever you want to help me this pain is too much... So I cleaned my hands, and executed the most efficient harm reduction I knew and injected her. I told her that we would only resort to this in times where the pain would be very high but of course, time and time again she would notice the difference in pain reduction, the IV method removed her pain completely and started acting almost immediately, where the oral way would take up to 45 minutes and that's not that much, but 45 minutes under 9/10 pain is a lot longer than a normal 45 minutes so more and more she started asking for IV.

After a while I'm starting to wonder, I know my mother isn't addicted to hydromorphone, because the dose she is taking is 1mg and at max once a day, it happened a few times that she needed one in the morning and one later but very rarely, and on the other side, theres plenty of days where she doesn't take any pills at all. But it's still bugging me, would it be possible that her body creates a pain because it knows it's going to create a situation in which she will receive hydromorphone?

Anyway, I'm not a nurse and even on myself I sometimes couldn't inject correctly, sometimes having to redo multiple times but I realized that even if I dont inject directly in the vein the effect still works, maybe less efficiently but it does... So I tried something.

I used a seringue with a much shorter needle and I injected it in her shoulder. She said that the dryness of the mouth can be felt immediately but the pain reduction takes a little while longer to be felt but still works, and it's much cleaner, in the sense that we don't mess up her arms that way. But is it good tho?

I have no idea if what I'm doing is bad long term so I'd like some advice, currently I'm injecting 0.5mg (half a pill) per time, about once per day, and I try to use as safe methods as I can but I don't have micron filters, I'm using a cotton in a spoon and always a new seringue and 5ml (The normal seringue I used to inject in vein was 10ml and much longer needle, but this smaller ones is 5ml and shorter needle) so if I keep injecting that way instead of in the vein, is there anything bad I should expect, or how can I make it safer for her?

Any advice is welcome, but no criticism about choices, we're pretty much forced to do this as her pain is unbearable and doctors can't understand why so they are reluctant to even give hydromorphone, we would really like to have a real diagnostic and proper treatment but so far that's all we have.

 

[not2quick]

Daily injections of these pills is not safe at all. Especially if not using a micron filter. If intravenously, I'd be worried about talcosis if this pace stays the same. It may not happen overnight, but eventually the binders in the pill will cause issues and I've heard it ain't pretty.

With intramuscular honestly IDK. If talc particles never leave the lungs then I'd say it never leaves the body. I'm sure it could build up especially if injected into the same spot. May lead to painful scar tissue, damage to the muscle or nerves, abscesses, probably other things as well.

I'd recommend plugging it. It will hit fast (not injection fast) but way faster than orally.

 

[Benzopiates]

Hi mom, forget about what we've been doing just stick this up your ass when it hurts.

I don't think this is an option, first of all, the fibromyalgia of my mother prevents her from moving properly, she needs me to pull on her just to stand up from sitting position. Even when it's something like laxatives that you have to put there, she prefers to use laxaday orally with some OJ or even use a supposatory since it's a pill you put there. When I tried it myself 7 years ago, I had a hard time keeping the liquid in long enough for my rectal area to completely absorb it. So for her to not only get into this hard position, put the liquid inside AND hold it long enough for her body to absorb, that's a hard stop.

So my options are either SC or IM...

I could always ask the doc to switch to Oxy too, but I'm not sure she'd want to do that.
With Oxy there'd be no reason to inject, apart from the speed at which it works, and even there I'm not sure if theres that much of a difference.

What you feel quickly with the dilaudid injection is the rush, my mom describes it as "my head detaches from my body and I get dizzy" and she doesn't like it at all. but the actual pain relief happens after 5 to 10 minutes. Still better than the 45 it takes orally but it's not instant.

And when you talk about... it's not safe, you talk about years and years of use? Because I've done IV Hydro for about 2 years daily, and in my case it was like 8mg daily, sometimes 16, and always through cotton filtered IV. I never had an absess or some of the blood clots or talcosis or whatever, the only thing that would happen sometimes is I'd get a bad shot and my arm would hurt a bit for a day, and then it would go away.

We just want to know the safest methods to do it this way, and since doing it subcutaneously is still new to me, (haven't done more than 10 shots to my mother that way) I don't know if theres a bad thing in the future or if that's more safe than IV.

And what about micron filters, if I decide to use them, would it make it perfectly safe ? Let's say 0.1% of the binding agents of the pill make it through the cotton, and after maybe 1000 injections it might be dangerous, would using micron filter make it 100% safe?

 

[not2quick]

You had a hard time keeping .50ml of water in your ass? It's not that complicated and it works well. As far as not being an option for your mom, if you say so, then it's not an option.

Using a syringe is not safe because pills are made to take orally. People shoot pills for years and may be fine. Some won't be fine. It's a gamble. If you walk out in traffic blindfolded enough, eventually you'll get hit.

If you are going to inject SC or IM is most likely "safer" than IV. The safest way would to use sterile needles, alcohol pads to prep the area and a micron filter. Nothing is perfectly safe. Good luck.

 

[RustyCrackleford]

Id wanna bring up the inevitable and rapid tolerance thats gonna develop with IV use. Maybe you could get the doctor to switch her to something more potent that lasts a shorter time, like fentanyl patches when she needs it. I know its not gonna equal that instant iv relief but i imagine fentanyl being more potent and faster acting itll drop her pain quicker and then in the patch form itll last out over the day. Then again maybe not? But like they said above, micro filters and keeping the area clean and rotated is the best you can do. Maybe you could do an extraction on the hydromorphone and use that, but thats got its own issues too. Id say maybe shop around and see if any other opiates or formulations help her more and only stick with the IV/IM/SC route if nothing else works.

Sorry your mom has to live with so much pain.

 

[oldschool@it_again]

You're right though, oral Dilaudid is almost useless. I've only ever had decent effects with IV. If you don't have a micron filter, use a 5ml syringe, pack it with 3 cotton balls and between each cottonball put a piece of clean cloth like from a T-shirt between each cotton ball. Force the solution through it. It's very effective.

 

[paranoid android]

You can't sc dilaudid pills even with a micron filter. SC and IM can cause a abscess unless your using dilaudid made for injection. So this is very unsafe imo. IVing pills is actually alot safer then SC or IM but your mom doesent need to know the horrors of severe dilaudid addiction

You could ask your moms doctor for dilaudid suppositories though that would work far better.

As far as oral dilaudid goes though i fid oral morphine to actually work better. Works far longer to

 

[Keif' Richards]

Any person is capable of becoming addicted to Opioids. I want to open with that. Opioids are happiness/contentment/safety contained within a substance. There is not a person alive who doesn't want to be happy. The difference between "legitimate" and "illegitimate" Opioid usage is often impossible to truly differentiate. People with "legitimate" pain issues can later develop "illegitimate" addictions in the course of their treatment. Anything is possible with this shit. In the course of dealing with your Mother's issues, you may have to ask some seriously difficult questions leading to some seriously difficult conversations before you actually find a solution to the problem.

Fibromyalgia is a real syndrome, as far as I'm aware. It's supposedly very painful, miserable etc. It's also essentially impossible to substantiate the syndrome. It's almost entirely based upon a patient's own reporting of their symptoms. This means there are a lot of folks in sheer misery who need Opioids and another group of people who know that Fibromyalgia is a good racket for getting pharmaceuticals. I don't know your Mom, this is all totally just for information purposes.

The route of administration does little to change the pharmacokinetic profile of an Opioid like Hydromorphone (Dilaudid). If we're looking at oral vs. one of the injection routes, the biggest difference is going to be in the potency of the medication, not in how the medication actually works. It's not surprising that someone would say injection is "better/more effective" than oral, both because they get the quicker onset and a more potent effect.

In case you're unaware, here is the general bioavailability profile for Hydromorphone (Dilaudid). For the record, these same figures apply similarly to other Opioids like Morphine.

Oral = 30%
Intranasal = 60%
Parenteral (Injection) = ~100%

So if you're taking your mother from oral to injection, you're giving her 3x as much medication and that medication is also going to "hit" faster than the oral route. We know that a faster onset of a drug is often directly related to a user's "liking" of the drug and this faster onset is a reinforcing factor in addiction.

If you're really trying to get her pain relief, I would absolutely advise against messing around with this. The key to chronic Opioid usage is to keep the dosage as low as possible. To triple the dosage of a patient's Opioid intake is a major change. To continue this sort of thing could easily see your Mother requiring this triple dosage while being in essentially the same place she is today.

I know the medical community is not entirely trustworthy or supportive. Still, I highly recommend trying to negotiate this issue with your prescriber before trying to do anything yourself.