Opioids Offsetting hallucinations in pain control

[Foreigner]

I'm currently in hospice care, on my death bed for the 5th time in 5 years. Yes I am technically dying... organ failure, etc. Am I going to actually die this time? I don't know. I didn't last time. But there's nothing they can do for me other than "make me comfortable" which means lots of opiates. Modern medicine is really full of idiots. I keep telling them I have a cyclical bowel infection marked by waxing and waning periods, that it's likely a virus, a virus that they have already confirmed is in my blood. Are they willing to try anti-viral therapy on me though? Nope. And why... because I won't allow them to go into my bowel and take 10-15 biopsies of tissue that is already extremely inflamed, just so they can look for the virus in those samples. It's all about their liability, their procedures, their convenience. So, here I am, dying uselessly again.

Anyway, that's my little update. The real reason I'm writing is that I'm on a lot of hydromorphone right now. I don't know why people love opiates so much. They are such a mashy high and the things you hallucinate are disturbing. Last night when I woke up in the middle of the night to have a painful, bloody bowel movement, I hallucinated that demons were coming out of my ass and swirling around the room, cackling wildly with slanted glowing red eyes. Earlier today, I woke up from a dead sleep with the urgent need to go to the bathroom, and as I ran to the bathroom I was only aware that my legs existed. The rest of my body was gone. So I just perceived myself as a pair of legs running to the bathroom. It took about 10 minutes of sitting on the toilet to realize who I was again, and where I was.

Is there anyway to offset this shit? I need the pain relief, but I am tired of this mental fuckery. I am already so exhausted from slowly bleeding to death and cachexia. The worst trips seem to be when I am transitioning from sleep to being awake. But it happens at other times too. Is there something else I can take to keep my brain alert, while the opiates do their job and suppress pain?

If I'm going to die, I don't want my final moments to be surrounded by cartoon entities laughing at my pain, or other fuckery.

 

[Larimar]

I have heard stories of dying cancer patients really enjoying ecstasy ; having a wonderful body feeling and just feeling full of love .
Sorry you are going thru all this, have you told the doctors about the scary hallucinations?

 

[Phobos]

Amphetamines are a powerful painkiller for me, but I have no clue if it would be feasible for you to take them.
Good luck either way.

 

[negrogesic]

The psychotomimetic properties of opioids are strongly mediated by their activity at the kappa opioid receptor (KOR). I would strongly recommend switching to oxymorphone or fentanyl, with oxymorphone probably being the best option in this case (which would logistically be easier to switch over to and is over three times less selective for the KOR than the oxycodone, with a MOR:KOR ratio of about 1:180 as opposed to hydromorphone at around 1:50). If you still are having problems, then fentanyl patches might be the best route (along with oral breakthrough pain medication as needed). Explain this to your physician.

What sort of organ failure? What was behind the organ failure?

 

[Foreigner]

Thank you for the fentanyl suggestion. The only problem is that opiates are making me somewhat constipated, which isn't a bad thing considering I have 30 bloody BMs a day right now. Opiates give me a break, but the break can't be permanent. I need to let them wear off so that all the necrotic tissue and blood can properly exit. I wonder if a fentanyl patch would make the constipation factor permanent? In which case I would be straining in screaming agony on the toilet for hours getting nothing out.

Though... my condition is so recalcitrant that even dilaudid doesn't seem to completely stop BMs, and I took as much as 8mg the other night.

Which organs... liver and kidneys. Left kidney at 10%, right kidney at 60%. Liver at 50% or so. On intermittent dialysis now.

Best guess for why, is devastating cachexia combined with toxic sepsis due to necrotic inflammation. Doctors aren't too clear as I don't have a fever, and they don't bother guessing when someone is this far gone because all they care about is lawsuits. My case is a mystery.

I believe I have an active cytomegalovirus (CMV) destroying my colon, as evidenced by immune suppression not making my condition better. Unfortunately they are not willing to administer Valcyte because of the black box warnings, and because of the single criterion that they need to find viral RNA inside of biopsies taken from bowel ulcers... and there's no fucking way on god's green earth are they putting a scope up my ass right now to slice off 10-15 tissue samples from my ulcers that are already painfully deep.

So rather than take a chance on a blind treatment they're just content to let me die. Idiots. I hope they all burn in hell.

 

[KS78]

So rather than take a chance on a blind treatment they're just content to let me die. Idiots. I hope they all burn in hell.

I totally agree with what you are feeling Foreigner. Basicly, they aren't fully doing their job because of a potential trouble that they may face. They are assholes who are pretending to be doctors. I need to also add that it's not only the doctors who are a joke but also the whole system.
I wish you as painless days as possible Foreigner and your luck to change.
Finally, as Phobos stated, amphetamines help a lot with pain especially in combination with opiates/ opioids. So if it's ok for you to use them, they may be a great help for potentiating the analgesia that you get from narcotic pain killers.

Here's a study on this subject if you are interested:
"Recently, using the formalin test, Dalal and Melzack confirmed that d-amphetamine (0.5 and 1.0 mg/kg sc) potentiates morphine (1.0 and 2.5 mg/kg sc) analgesia in the rat.19 D-amphetamine on its own was subanalgesic at both doses. Morphine on its own was subanalgesic at 1.0 mg/kg, but had some analgesic effects at 2.5 mg/kg. In a parallel experiment, Dalal and Melzack found that methylphenidate (2.5 and 5.0 mg/kg) potentiates morphine (1.0 and 2.5 mg/kg).19 Both doses of methylphenidate were mildly analgesic on their own, but when combined with morphine, they strongly potentiated its analgesic effects."
Source: Attached

 

[Foreigner]

There's no way my doc will RX amphetamines. Besides, I don't know how they would impact my health.

 

[KS78]

You are right, this is a very important decision that must be weighed by the doctor. I just wanted you to see this study thinking that any extra analgesia, as long as it's not detrimental to your health, would be welcome.

 

[d1nach]

Negrogesic brings up what i believe may be your best option to ask your doctor about.

They may be unaware of the K opioid receptor.

If your current opiate has a high affinity for the KOR switching to one with less could possibly greatly reduce hallucinating.

Im unsure if they will give you fentanyl due to the bad press lately. But, the key is a opiate with lower KOR affinity.

 

[negrogesic]

I believe I have an active cytomegalovirus (CMV) destroying my colon, as evidenced by immune suppression not making my condition better. Unfortunately they are not willing to administer Valcyte because of the black box warnings, and because of the single criterion that they need to find viral RNA inside of biopsies taken from bowel ulcers... and there's no fucking way on god's green earth are they putting a scope up my ass right now to slice off 10-15 tissue samples from my ulcers that are already painfully deep.

So rather than take a chance on a blind treatment they're just content to let me die. Idiots. I hope they all burn in hell.

To be frank it sounds like you might want to consider the biopsies...

 

[Painful One]

Sending some love your way.
hugs and comfort to you.

 

[Zonxx]

Oxycodone is less constipating and has less of atleast for me a peripheral impact, along with being less sedating than most opiates, mostly just pain relief and a mood lift, so the oxycodone / oxymorphone is a good option

 

[Foreigner]

Oxycodone is less constipating and has less of atleast for me a peripheral impact, along with being less sedating than most opiates, mostly just pain relief and a mood lift, so the oxycodone / oxymorphone is a good option

Thank you, I'm going to ask!

 

[Foreigner]

To be frank it sounds like you might want to consider the biopsies...

Because it's a fulminant bowel flare, the risk of perforation during biopsy would be very high, and they would have to take 10-15 of them. Also, I don't trust my GI doc not to do something psychopathic while he's in there in order to force my bowel to be removed. I don't trust him and I don't want him touching me. I could just see him saying, "Oops, we perforated your bowel, looks like we have to do emergency surgery now!"

 

[negrogesic]

Because it's a fulminant bowel flare, the risk of perforation during biopsy would be very high, and they would have to take 10-15 of them. Also, I don't trust my GI doc not to do something psychopathic while he's in there in order to force my bowel to be removed. I don't trust him and I don't want him touching me. I could just see him saying, "Oops, we perforated your bowel, looks like we have to do emergency surgery now!"

Yikes, thats seems like an unfortunate situation.

 

[Akane]

Opiates are known to cause sleep paralysis (especially at high dosages), which is basically when your body is still asleep and in REM mode (so like paralysed in order to prevent you from hurting yourself while sleeping) but your brain is awake. You are awake but you can't move or do anything and feel like you're gonna die. This causes hallucinations, auditory and visual, and intense fear and so on. I think this is what you were talking about when you mentioned hallucinations whilst transitioning from sleep to being awake.

Just had sleep paralysis tonight when I nodded off after taking some DHC, which is way weaker than what you take so I can imagine what those high dosages of hydromorphone do to you. It happens to me sometimes and I hate it but I learned to not get too scared whilst it's happening. I know it will pass and go away. I have hallucinations whilst experiencing sleep paralysis. I also always feel like I am gonna choke because I can't breathe right.
Tonight I thought my bf was touching me and speaking behind me but he was at work so it wasn't real. I see spiders on the wall at times or a big green insect. Once I saw a hooded figure. That was terrifying to me.

I don't have a solution as it's a side effect. You have all my sympathy and I am sorry about everything you're going through.

 

[checktest]

Sometimes they do low-dose olanzapine or haldol in hospice, especially at night, but I don't think I'd sign up for haldol too readily. NG is definitely accurate with fentanyl and a breakthrough / PRN oxymorphone/dil in people with hallucinations, rather than morphine and the like in end-stage COPD and other cases.

Some GIs do nitazoxanide with non-specific cases, but coverage may be lacking. Broad spectrum. I mean it covers parasites, viruses, has some antibacterial activity. No black box. Off-label

Sounds like a very tough situation. Scary. Hope you can get some relief.

 

[Foreigner]

Sometimes they do low-dose olanzapine or haldol in hospice, especially at night, but I don't think I'd sign up for haldol too readily. NG is definitely accurate with fentanyl and a breakthrough / PRN oxymorphone/dil in people with hallucinations, rather than morphine and the like in end-stage COPD and other cases.

Some GIs do nitazoxanide with non-specific cases, but coverage may be lacking. Broad spectrum. I mean it covers parasites, viruses, has some antibacterial activity. No black box. Off-label

Sounds like a very tough situation. Scary. Hope you can get some relief.

I actually have a full course of nitazoxanide in my cupboard that I haven't used. I was saving it for a rainy day, so interesting that you mentioned it. It's broad spectrum and if there's a bug happening, it could nuke it. I know it has anti-viral capability, but I'm not sure if it covers the herpesviridae family which is more what I need. Still, it could be worth a shot. I was just afraid of nuking everything in case it causes more problems. Also, I don't know if I'm strong enough to handle major die off right now. My body's systems are already so overwhelmed.

 

[checktest]

Yeah, I would be wary unless you were in a more reliable situation with your doctor and health. They have been not prescribing some of those antivirals without clear indication lately, reviews and all. Foscarnet in hospital. Adding unknown factors/treatments acutely when you aren't well is tricky. Hopefully you can get a better handle with your GI and everyone.

 

[LucidSDreamr]

hydromorphone was the most hallucinogenic opiate ive used. when i used to IV it and nod out after the shot i would see psychedelic visions similar to cannabis or acid. this didn't happen with oxy or H

sorry to hear what you are going through. I wish you the strength to handle it.