Opioids Need opinions on which opiate I should go with.

[taylor_105]

Hi all,

I am in chronic pain management and have been for many years. My tolerance is rediculous and I have to switch meds frequently because of it. I am currently on Oxycontin 60 mg 2 times a day and 8 mg. Dilaudid 4 times a day for breakthrough. I am happy with the Dilaudid but the question I have is if you had a choice between either Oxycontin or Opana ER for the long-acting narcotic.....which one works better? If it is Opana what dose would be equal to 60 of Oxycontin? Thanks for answers in advance.

 

[Roush]

I'd go with the Opana ER honestly for ER. And I'm not really sure the conversion I'm sure with a little research you could get the exact mg to mg comparission. My number would be Round-A-Bout.

 

[BeachBum4u]

I just did that exact switch myself but I'm on a much higher dose (Oxycontin - 80mg 2 twice a day, 320mg) and I was switched to Opana ER (40mg 2 twice a day, 160mg). I was told these are very high doses and I explained I've been on Oxy for the past 10-15 years and I have a whacked tolerance. They're looking at moving me down in the near future. So, back to the conversion, I was told the Opana ER is twice as strong as the Oxy. My doc explained that Oxy is broken down by the body to Oxymorphone and that Opana ER "IS" Oxymorphone, so less is needed to make an equivalent dosage. One less step. So, just divide your current Oxy dosage in half and there you go. It does work and feel a little different but it does work pretty well for pain mangagement. At least, that's been my experience. Good Luck with the change!

 

[WeThePeople90]

Hey Taylor, I would say Opana over Oxy any day. With a conversion ratio of about 2:1 in potency(Opana/oxy), I'd say 30mg Opana = 60mg oxy(explains why price is nearly doubled most times $1/1mg(oxy) $2/mg(opana).

I'm prescribed 20mgER & 10mgIR, I wouldn't change these med's for anything else

 

[taylor_105]

I just did that exact switch myself but I'm on a much higher dose (Oxycontin - 80mg 2 twice a day, 320mg) and I was switched to Opana ER (40mg 2 twice a day, 160mg). I was told these are very high doses and I explained I've been on Oxy for the past 10-15 years and I have a whacked tolerance. They're looking at moving me down in the near future. So, back to the conversion, I was told the Opana ER is twice as strong as the Oxy. My doc explained that Oxy is broken down by the body to Oxymorphone and that Opana ER "IS" Oxymorphone, so less is needed to make an equivalent dosage. One less step. So, just divide your current Oxy dosage in half and there you go. It does work and feel a little different but it does work pretty well for pain mangagement. At least, that's been my experience. Good Luck with the change!

Basically, say that I would like to switch to Opana ER 40 mg. one twice a day? The only reason I ask is that the new Oxycontin pills that they are making give me stomachaches and don't seem to cover the pain as well as they used to. I will talk to the doc at my next appointment about the Opana and let y'all know. Thanks!

 

[taylor_105]

Hey Taylor, I would say Opana over Oxy any day. With a conversion ratio of about 2:1 in potency(Opana/oxy), I'd say 30mg Opana = 60mg oxy(explains why price is nearly doubled most times $1/1mg(oxy) $2/mg(opana).

I'm prescribed 20mgER & 10mgIR, I wouldn't change these med's for anything else

Thankfully, with medicare I only pay $3.20 for name brands and $1.10 for generics. As for benzos...those aren't covered at all! I have taken the IR Opana before and those worked well but I like Dilaudid better for breakthrough. I have not tried the Opana ER but I think I am going to ask for it next time. Luckily, I have a good strong trust with my doc and he pretty much lets me try new things when the old things stop working.

 

[WeThePeople90]

A strong patient/doc relationship is always good. Fair warning (I know no one asked but for the sake of your well being) Opana can be a mother fucker. Very potent & addictive with some of the worst withdrawals possible(I've herd it's worse than heroin, fentynol, etc). When things are good, boy aren't they great but when there bad it's hell to pay. Lost a friends life to it and ruined a few good friendships due to people always trying to take the shit to the next level (friends bangin IR's, I don't condone that method)

If used properly, it can be a game changer when it comes to your chronic pain. Let me know how your doc reacts

 

[Opiates4lyfe]

I would suggest Opana for you, if it were me i would probably go with the oxys though!

 

[Hobble]

For legitimate pain relief I would suggest the oxycodone because Opana(oxymorphone) is a more complicated drug. Opana has only a 10% bioavailability when taken orally but eating fatty foods can increase the bioavailability(the amount of drug that reaches your brain) significantly and drinking alcohol can cause dose dumping, ie more of the drug being released at once. Drinking alcohol while on any opiate is never reccommended but lots of people figure just one or two drinks will be ok and they do it anyway. With Opana this can be extra dangerous, imagine eating a fatty meal, now the bioavailability has been increased, add a few drinks and you could have dose dumping on top of the increased bioavailability and that could be very dangerous.

 

[flyonth3wall]

Right, you need something explained because no-one else has bothered to cover it:

Yes, Oxymorphone is nearly double the potency of Oxycodone, but that's only when it is 'dose for dose' - 1mg absorbed vs 1mg absorbed..

The Oral Bio-Availability ( BA ) of Oxycodone is near on 90%, which means when you take that 60mg pill, ~90% of it will be absorbed over the next 12hrs, so you will absorb +-54mg of that Oxycontin pill.

The Oral BA of Oxymorphone is ~10% ( plus/minus, this can be increased slightly as said with fatty foods/grapefruit juice and a couple of other things ) which means when you take that 40mg pill, only ~10% will be absorbed, so this time you will only absorb around ~4mg of that Opana pill, which if converted to Oxycodone ratio's, will be about ~8mg of Oxycontin.. ( 54mg vs 8mg, which sounds better? )

The reason a lot of people prefer Oxymorphone over Oxycontin is for a number of reasons, the main one being that they like to abuse it, and use other methods of administration to get a higher BA ( IV, Insuffulated, Plugged.. ). When you use this medication as you are supposed to, the BA is low, and most of the pill does not get absorbed. I take it that you are not abusing your meds, which is great, so you will only be taking your meds by mouth.

For someone in your position, I would keep on taking the Oxycontin, as switching to Opana will only end up decreasing the actual amount of opiates going into your bloodstream, hence reducing the painkilling ability of your meds. Dr's will not usually take into account the lower BA of this med when converting from Oxycodone to Oxymorphone, for a number of reasons, incl protecting themselves, and the risk of you not using the medication as prescribed.

So, as said, unless ( not usually gonna happen I'm afraid ) your Dr will take into account the Oral BA when switching you, I would just stay on the Oxycodone, or look into converting to another med with a higher Oral BA.

 

[taylor_105]

Right, you need something explained because no-one else has bothered to cover it:

Yes, Oxymorphone is nearly double the potency of Oxycodone, but that's only when it is 'dose for dose' - 1mg absorbed vs 1mg absorbed..

The Oral Bio-Availability ( BA ) of Oxycodone is near on 90%, which means when you take that 60mg pill, ~90% of it will be absorbed over the next 12hrs, so you will absorb +-54mg of that Oxycontin pill.

The Oral BA of Oxymorphone is ~10% ( plus/minus, this can be increased slightly as said with fatty foods/grapefruit juice and a couple of other things ) which means when you take that 40mg pill, only ~10% will be absorbed, so this time you will only absorb around ~4mg of that Opana pill, which if converted to Oxycodone ratio's, will be about ~8mg of Oxycontin.. ( 54mg vs 8mg, which sounds better? )

The reason a lot of people prefer Oxymorphone over Oxycontin is for a number of reasons, the main one being that they like to abuse it, and use other methods of administration to get a higher BA ( IV, Insuffulated, Plugged.. ). When you use this medication as you are supposed to, the BA is low, and most of the pill does not get absorbed. I take it that you are not abusing your meds, which is great, so you will only be taking your meds by mouth.

For someone in your position, I would keep on taking the Oxycontin, as switching to Opana will only end up decreasing the actual amount of opiates going into your bloodstream, hence reducing the painkilling ability of your meds. Dr's will not usually take into account the lower BA of this med when converting from Oxycodone to Oxymorphone, for a number of reasons, incl protecting themselves, and the risk of you not using the medication as prescribed.

So, as said, unless ( not usually gonna happen I'm afraid ) your Dr will take into account the Oral BA when switching you, I would just stay on the Oxycodone, or look into converting to another med with a higher Oral BA.

Thank you. I do swallow them as they are intended to be taken. I was wondering something else then? What else is a little more strong in pill form than Oxycontin for long-term? As I said I am fine with Dilaudid for break-through but Oxycontin, which I am on now, is the new Purdues and since they chnaged the formula I get a stomach-ache and not as much pain relief as I did with the old ones. Someone told me they put plastic into these pills. Is that true? I don't want to be eating plastic!! That does not sound healthy at all.

 

[MrNaptown]

15 years and that much stuff Lol systems fucked dieing family r a for 20 years etc nothing that much dope. Funny I laugh because pretend it's not abuse admit it. I AM

 

[lptrax]

you are very wrong fly.



mg for mg (assuming 100% bio availability) oxymorphone is 10x stronger than oxycodone

 

[crashg]

I think you should definitely give the Oxymorphone ER a try, and either keep your IR hydromorphone or give the IR oxymorphone a try. I think it would be best to keep the IR hydromorphone, just because in my experience as a chronic pain patient, is that relying only on one chemical is less effective than having a different BT med.

for example, when I was on Morphine ER, with the MS IR for BT, it wasn't NEARLY as effective as using roxicodone as a BT med.
and when I take Oxycodone ER, the Oxycodone IR doesn't do nearly as much as the MS IR. Sorry if this is a little wordy but it should make sense

Really the MSIR work better for the bt pain then the oxy? I was just switched from oxy to MSIR and it seems the opposite for me...Maybe also since I'm not on a er or maybe just everyone is different...

Good luck bud I hope you get your meds dialed in for you! Pain is no joke.

 

[flyonth3wall]

Hi again

I only have personal experience with Oxycodone, Oxymorphone, Morphine and Fentanyl. I always found Oxycodone Instant Relief to be great for breakthrough pain ( something like Roxicodone, I use Oxynorm IR Liquid here in the UK, 5mg per 5ml liquid, and it always worked brilliantly until my tolerance was through the roof and I was taking 400-600mg per day... But that's another story LOL ). But seeing as you are taking Dilaudid for BT pain, and it works great, then stay with it. Don't try fix something that isn't broken

As for your ER meds... As I described above, I would avoid Opana purely for the reason of the low Oral BA, as stated, in reality its only people who use other methods of administration that get the full benefit out of it, and no, you don't want to start abusing your meds and trying different ways for it to work better, I promise you this when I say it, that it will only come back and bite you in the ass.

As of now I am no longer on Oxycodone, I am on Fentanyl Duragesic Patches, the 100mcg/hr ones. When used transdermally as intended, these patches have a 100% BA, so you get all the medication that is going into your bloodstream. I have been on opiates for over 3 years following severe medical problems, and if I'm honest with myself, I find the patches to be great for 'round the clock' pain maintenance, as it is a controlled amount of opiate being absorbed every hour, continuously ( say 100mcg/hr, so 2.4mg per 24hr period ). If you were to speak with your Pain Management Dr and have the Fentanyl vs Oxycontin conversation, and see if he would be willing to let you 'test it out', you may find that it will work brilliantly for your pain, and along with your Dilaudid for BT pain, I honestly think you will have all bases covered. Fentanyl works great for my pain ( abdominal, lower back ) and along with an IR med it covers all angles and lets me live as near a normal life as possible.

From previous calculations I have made ( please see my Fentanyl Withdrawal Thread for proof of this if you wish ):

100mcg of Fentanyl IV = 100mcg of Fentanyl Transdermal = 15mg of Oxycodone Oral.

So, you take 120mg of Oxycontin per day, which would mean you would need to have approx 800mcg of Fentanyl per day for it to be on a 'dose for dose' ratio.

800mcg/24hrs in a day = ~34mcg/hr of Transdermal Fentanyl needed for equivalent dosage of 120mg Oxycontin per day.

They make 12.5mcg, 25mcg, 50 mcg, 75mcg and 100mcg/hr patches. I would suggest a 25mcg/hr patch and a 12.5mcg/hr patch to try it out, so 37.5mcg/hr, if you wish to try Fentanyl ofcourse - This is slightly more than the 60mg of Oxycontin twice per day, but you have to take approximations into account, so it would be nearly equal opiate-wise to what you are currently receiving. I'm sure if you did in fact try this great med out, it would do a great deal for your pain combined with your Dilaudid IR.

Sorry for the long post, but I like to try explain these things in terms everyone can understand who are not experienced in opiates and conversions etc, so I hope this helped.

As for your question on plastic in Oxycontin and the health aspects of it, yes they contain polymers in them which they have put into the formula to try stop people from abusing them. You are not the first person to complain about stomach problems as a result of ingestion I'm afraid Sorry, can't help you with that, though it might just give you more of a reason to want to switch meds.

**** Disclaimer - I am not a Doctor nor do I claim to be one, nor am I any sort of Healthcare Professional, nor is anything written here intended as advice - it is purely my own personal experience, and research. Please discuss anything you wish to do/change with your Healthcare Professional first ****

 

[flyonth3wall]

you are very wrong fly.



mg for mg (assuming 100% bio availability) oxymorphone is 10x stronger than oxycodone

I will accept being wrong if I am, and am happy to stand corrected - But please provide proof.

 

[TheLostBoys]

I would say, it depends on whether you like the stimulation of Oxycodone or the laid back feeling of Opana.......Opana is defintely stronger, like 2.5 or 3-1. Also, Opana is lousy taken orally while Oxycodone has a high BA orally. Snorted, both are great but Opana is better, at least for pain.

 

[taylor_105]

15 years and that much stuff Lol systems fucked dieing family r a for 20 years etc nothing that much dope. Funny I laugh because pretend it's not abuse admit it. I AM

I am sorry but I am having a hard time understanding what you are trying to say.

 

[taylor_105]

Hi again

I only have personal experience with Oxycodone, Oxymorphone, Morphine and Fentanyl. I always found Oxycodone Instant Relief to be great for breakthrough pain ( something like Roxicodone, I use Oxynorm IR Liquid here in the UK, 5mg per 5ml liquid, and it always worked brilliantly until my tolerance was through the roof and I was taking 400-600mg per day... But that's another story LOL ). But seeing as you are taking Dilaudid for BT pain, and it works great, then stay with it. Don't try fix something that isn't broken

As for your ER meds... As I described above, I would avoid Opana purely for the reason of the low Oral BA, as stated, in reality its only people who use other methods of administration that get the full benefit out of it, and no, you don't want to start abusing your meds and trying different ways for it to work better, I promise you this when I say it, that it will only come back and bite you in the ass.

As of now I am no longer on Oxycodone, I am on Fentanyl Duragesic Patches, the 100mcg/hr ones. When used transdermally as intended, these patches have a 100% BA, so you get all the medication that is going into your bloodstream. I have been on opiates for over 3 years following severe medical problems, and if I'm honest with myself, I find the patches to be great for 'round the clock' pain maintenance, as it is a controlled amount of opiate being absorbed every hour, continuously ( say 100mcg/hr, so 2.4mg per 24hr period ). If you were to speak with your Pain Management Dr and have the Fentanyl vs Oxycontin conversation, and see if he would be willing to let you 'test it out', you may find that it will work brilliantly for your pain, and along with your Dilaudid for BT pain, I honestly think you will have all bases covered. Fentanyl works great for my pain ( abdominal, lower back ) and along with an IR med it covers all angles and lets me live as near a normal life as possible.

From previous calculations I have made ( please see my Fentanyl Withdrawal Thread for proof of this if you wish ):

100mcg of Fentanyl IV = 100mcg of Fentanyl Transdermal = 15mg of Oxycodone Oral.

So, you take 120mg of Oxycontin per day, which would mean you would need to have approx 800mcg of Fentanyl per day for it to be on a 'dose for dose' ratio.

800mcg/24hrs in a day = ~34mcg/hr of Transdermal Fentanyl needed for equivalent dosage of 120mg Oxycontin per day.

They make 12.5mcg, 25mcg, 50 mcg, 75mcg and 100mcg/hr patches. I would suggest a 25mcg/hr patch and a 12.5mcg/hr patch to try it out, so 37.5mcg/hr, if you wish to try Fentanyl ofcourse - This is slightly more than the 60mg of Oxycontin twice per day, but you have to take approximations into account, so it would be nearly equal opiate-wise to what you are currently receiving. I'm sure if you did in fact try this great med out, it would do a great deal for your pain combined with your Dilaudid IR.

Sorry for the long post, but I like to try explain these things in terms everyone can understand who are not experienced in opiates and conversions etc, so I hope this helped.

As for your question on plastic in Oxycontin and the health aspects of it, yes they contain polymers in them which they have put into the formula to try stop people from abusing them. You are not the first person to complain about stomach problems as a result of ingestion I'm afraid Sorry, can't help you with that, though it might just give you more of a reason to want to switch meds.

**** Disclaimer - I am not a Doctor nor do I claim to be one, nor am I any sort of Healthcare Professional, nor is anything written here intended as advice - it is purely my own personal experience, and research. Please discuss anything you wish to do/change with your Healthcare Professional first ****

I have been on the patch before and I couldn't stand it. So that one is a no go for me. It made me lethargic and feel overall crappy. I need to function for college so I need my wits. Is there a pill stronger than Oxycontin for long term? It seems people say Opana but you disagree. If it is stronger only when abused I do not want it.

 

[taylor_105]

I would say, it depends on whether you like the stimulation of Oxycodone or the laid back feeling of Opana.......Opana is defintely stronger, like 2.5 or 3-1. Also, Opana is lousy taken orally while Oxycodone has a high BA orally. Snorted, both are great but Opana is better, at least for pain.

I do not snort my pills. I only take them as prescribed. I wonder if there is a way to get Oxycontin without the plastic in them. Maybe that is why they hurt my stomach. I have a strong tolerance to opiods since I have been on them in CP management since 2008 so I am just looking for a pill that taken orally would be a but stronger than Oxycontin.