Question Regarding Hydromorphone and Interactions

[PainQuestion]

I had surgery about 4 weeks ago, and barely used the HM drip (3-5 presses a day, at a medium or low strength and didn't notice it do much of anything) while in the hospital (despite being in plenty of pain).

Basically, I don't really take pain killers, including NSAIDs. The most I've ever taken at once was four vicodin when I had two broken ribs, and I only took that a couple times. The rest went in the trash. It didn't really do much for the pain directly anyways, and considering the APAP in them I didn't want to go any higher or bother CWE. It did however seem to reduce the muscle contractions in the area a bit, which allowed for a nice relaxing nap (not really like nodding out, just a bit of an extra push to relax).

Fast forward to now.

I currently take .5-1.5mg of klonopin per day, and have been on it, as prescribed, for at least six years.

I also take 60mg of propranolol ER per day, and have been on it, as prescribed, for at least six years.

I drink 2-10 ounces of vodka per day (for about 20 years), in the evening only, and hydrate heavily with gatorade for a mix (usually 20 oz of gatorade per 2 ounces of vodka).

I'm 5'10", and 120 lbs (I lost some weight pre-surgery and am slowly gaining it back - the surgery was diverticulitis related so I had some GI issues prior).

The hospital prescribed me 40 x 2mg hydromorphone pills (orange, small, "P" on one side, "2" on the other), even though I stated I didn't want or need them, but I filled it like I was told to anyways. So far I have taken 0.

I've gone 4 weeks and am making a good recovery, but sometimes I bump into days where while I can tolerate the pain pretty well (I suppose I have a high tolerance to it), but some days just doing basic exercise (not heavy lifting) like a reasonable amount of walking can take a toll on me, so I was considering possibly using some of the HM to get through this rough patch and be able to get a bit more light exercise to assist my recovery time, as I will need to be in reasonable shape to do substantial walking in a couple months.

The doctor's were aware of the klonopin and alcohol use, and allowed me to take a higher than usual klonopin dose (1.5-2mg a day), as well as my propranolol dose, while connected to the HM drip. All three can slow the CNS, which I thought odd, but as I rarely used the drip and made sure to space the medications, it was mostly not a problem aside from some dizziness.

My question is, how risky is taking HM with everything else mixed in? Is a 2mg pill a risk factor, considering my long term tolerance to everything else? I'm not talking about plugging 8mg while taking klonopin, propranolol, and drinking a six pack, but if I toss in a 2mg HM in the afternoon (when I'm not drinking and the klonopin is no longer at its peak (I tend to take it upon waking and before sleep, or skip the sleep med if I've had more than two drinks) would that help take the edge off safely and allow me to get some light exercise without risk of respiratory failure?

Second question. If I forgo the klonopin for one whole day (only taking the propranolol ER), could I safely get a rush by snorting a 2mg, or so, assuming I will need to have two drinks 4-6 hours after? I'm just curious about the rush, and would only take it in that manner one time (I have an addictive personality, but not for opiates, as I have tried H in the past, via snorting, felt the effects rather strongly, and never got hooked, however I was not on any of the meds or alcohol that I listed back then).

EDIT: Also, if I were to take some sporadically for the pain, should I prepare with a regular routine of stool softeners or the like, ahead of time? I recall the vicodin got me to the point of having to use a suppository to finally go, which was not a fun evening at all. Clearly I'm very sensitive to that side effect.

EDIT 2: Why the heck do they hand this stuff out like candy? My last four days in the hospital I didn't take a single pain med, drip, orally, tylenol nothing, and even told them I didn't want the script. It's no wonder there's such an opioid epidemic in this country. /sigh

EDIT 3: I just wanted to note that I hope Edit 2 didn't come across as pompous or condescending. I realize a lot of people get hooked because of what started as pain management, and I have a good friend that is doing prison time because he abused H while neglecting his mental disorder, so I fully understand that these issues can escalate faster than many people expect, which is why I'm trying to be as careful as possible (as well as on a plan to wean myself off of my prescribed klonopin, and alcohol, because even though I don't abuse benzo's I have most certainly felt the w/d when I've tried to stop it before and it's not pretty).

Thank you.

 

[HeadHigh]

It shouldnt be a problem just make sure that you REALLY pay attention to whats in your body at one time. Because if, lets say, your pain comes back late at night and you had just taken your klonopin and maybe a beer, dont take the hydromorphone.

Also, yes, if youre sensitive to gastrointestinal constipation, then yes, go ahead and take preventative measures because hydromorphone is definitely prone to causing constipation.

 

[PainQuestion]

It shouldnt be a problem just make sure that you REALLY pay attention to whats in your body at one time. Because if, lets say, your pain comes back late at night and you had just taken your klonopin and maybe a beer, dont take the hydromorphone.

Also, yes, if youre sensitive to gastrointestinal constipation, then yes, go ahead and take preventative measures because hydromorphone is definitely prone to causing constipation.

Gotcha.

If the pain hits me and I've had even one drink, or recently (within 6 hours) had klonopin, I will definitely skip the HM.

 

[Raysu]

Ok so you have a lot of questions in here and I have a lot of experience with hydromorphone and clonazepam both clinically and recreationally (not propranolol personally but I know a little about beta blockers) so here are my two cents...

My question is, how risky is taking HM with everything else mixed in?

At your doses it is not that risky, and as you don't get strong side effects from the HM as is I see no issue.

Is a 2mg pill a risk factor, considering my long term tolerance to everything else?

No. It is the smallest dose and with oral bioavailability being so low (30-35%) you wouldn't be getting much out of it with that ROA.

I'm not talking about plugging 8mg while taking klonopin, propranolol, and drinking a six pack, but if I toss in a 2mg HM in the afternoon (when I'm not drinking and the klonopin is no longer at its peak (I tend to take it upon waking and before sleep, or skip the sleep med if I've had more than two drinks) would that help take the edge off safely and allow me to get some light exercise without risk of respiratory failure?
Yes. As you had IV hydromorphone in the hospital and rectal BA is less than the 100% IV BA I don't see it having much impact on you. Though as you didn't get much IV from the hospital (typical admin is 1-2mg dose) don't expect much at 2mg rectal. I applaud you for starting low though.

Second question. If I forgo the klonopin for one whole day (only taking the propranolol ER), could I safely get a rush by snorting a 2mg, or so, assuming I will need to have two drinks 4-6 hours after?

Some people get high from insufflation and a good warm fuzzy high from plugging but I've only ever gotten a rush from IV use. Not that it's impossible as everyone is different but while I've been good and high from alternate ROAs (even oral) the rush was absent in those methods. As you have an addictive personality I don't recommend it. That rush is THE rush I go for that cost me everything.

Also, if I were to take some sporadically for the pain, should I prepare with a regular routine of stool softeners or the like, ahead of time?

EDIT 1: Only because of your diverticulitis history and how the hydrocodone was for you I say yes. I find HM to not be as bad as say fentanyl but it is an opioid nonetheless. Staying hydrated helps.

EDIT 2: Why the heck do they hand this stuff out like candy?

You are the exception with post operative pain. Just as one expects to be sedated on good drugs and not go under the knife under say hypnosis, most people expect to experience discomfort/pain due to the procedure for a few days afterwards. It's encouraged to fill the script whether you need it or not because if you find you need it, driving to and waiting at a pharmacy while doubled over is no fun. People having varying degrees of pain thresholds. Media hype is not reflective of the truth IMO. Yes addiction is a problem and yes some doctors err on the side of caution and want to meet expectations of patients but everyone makes up their mind before misusing to misuse/abuse medication. No one is holding a gun to their head. If a person feels like when their meds, that they followed to a T, run out and they feel compelled to use more when it's not necessary and they choose to not address the issue with their doctor, or if they feel like they need or want more than prescribed and don't mention it to their doctor, then that is just one more bad decision. At the root of all addiction is dishonesty, deceit, and manipulation. Blaming the doctors I feel is a cop out from recognizing the issues within oneself.

Hope this all helps!

 

[PainQuestion]

Ok so you have a lot of questions in here and I have a lot of experience with hydromorphone and clonazepam both clinically and recreationally (not propranolol personally but I know a little about beta blockers) so here are my two cents...
Hope this all helps!

It did. Thank you for your thorough response.

 

[withlove]

youre going to accidentally go into CNS depression and not wake up.

im not saying this to be shitty but booze, opiates and benzos are the trifecta of death. tolerance only goes so far in preventing this, it is NOT AN EXACT SCIENCE.

stay safe.