Opioids Medicinal Opioids -- MST Continus, Codidol Retard, MS Contin & all the rest

[Nicomorphinist]

I was told the other day that scientific opinion, in North America, apparently preceding and independent of the US "opioid cri$i$" is turning against extended-release opioid preparations, whilst I detect a split opinion on them in Continental Europe. The main idea seems to be that the morphine, dihydrocodeine, hydromorphone or whatever is sitting there for 7-36 hours, irrespective of whether it is needed. I have heard other propaganda as well. For example, I dismiss the concerns about decreased lifespan out of hand as I have known several people on morphine for 50-85 years who looked younger than their years and lived to phenomenally old ages, including people on it from before the Harrison Narcotic Act 1914 who lived into the XXI. Century. The one casse with which I am personally familiar is a woman inducted on round the clock morphine in October 1908 with prn diamorphine (smack) before 1924 and Dilaudid afterwards for tubercular spondylitis of the lumbar and sacral spine who died in her sleep of old age in mid-February 2009;

What I can tell people from my experience is that:
1: Unless you are some kind of superhero with a stomach acid pH of 0.1 and a robotic zirconium gut which can be controlled with a smartphone and loaded with instrumentation, there is no way that 100 per cent of that medication can be pulled from modern extended-release preparations -- you will be shitting out valuable Miss Emma, DHC, D, and so on.
2. In my opinion, 70-85 per cent of the analgesia is done by the come-up . . . then it is maintaining for several hours, which is why I have had good results with nicomorphine or hydromorphone SL, IM, or SC taken almost simultaneously with immediate release morphine, which can hold me analgesia-wise for up to 9 hours. There is a case for ranking analgesic preparations by their power to shatter existing pain, and I believe the speed with which therapeutic concentration is achieved is the key to this, which is probably a bit similar to the concept of brisance from another chemical engineering field.

From there, it gets more complicated -- levorphanol as expensive as plutonium because of the satanic Pharmacy Bro, the QT concerns about open-chain opioids, the crazy toxicity of 4-phenylpiperidines, dextromoramide going the way of the passenger pigeon . . .

 

[Wilson Wilson]

I can tell you that in the UK doctors prefer to give out extended release opiates unless the script is only short-term e.g. for post-op pain, then they don't mind throwing instant release about. But for long-term scripts used for chronic pain etc they tend to want patients on extended release formulations. The logic being that XR opiates are harder to abuse and are less psychologically addictive since they work slowly over the day instead of multiple doses of IR opiates giving you "hits."

It does seem like the US has turned away from them however yes, everything I read suggests that IR oxy in lower doses has replaced OxyContin for instance, which I chalk up to the obvious OxyContin previously being handed out like sweets as everyone thought you couldn't get hooked on it because Purdue was flying doctors to fancy resorts and paying other doctors loads of money to tell them that.

But time release opiates have never been treated like that in the UK. Rather it's always been understood that opiates are inherently addictive drugs, but that time release preparations are simply less likely to cause euphoria, cravings, etc that could lead to an addiction.

Even for weak opiates like DHC as you mentioned, my GP would rather have me on DHC Continus than the regular 30mg pills even if the dose is high... I have practically been given the freedom to pick my dose so I could get DHC Continus 120mg if I want, but the concern it seems is not as much the dose of the opiate, but rather ensuring I don't keep getting "hits" from repeat dosing that risk causing psychological addiction. So they want me on one or two slow release pills a day instead.

To be honest this seems perfectly sensible to me and I'm not pushing back on it, just so long as the time release mechanism does work as it should and doesn't hinder absorption or efficacy of the opiate, and I get a dose high enough to control my pain, I'm fine. I would prefer MST Continus if given a choice but I also can't complain about a nice high dose of DHC either. Both fine opiates.

Never had time release DHC before though so will have to see how my body reacts to it.