Opioids Keep trying Oxy or go back to Norco?

[Lichking83]

I have been taking Hydrocodone for about 6 or 7 years now. I was taking 8 10mg tablets every 24 hours until my doctor decided to send me to another pain managment doctor because I do not need injections and the doctor I was seeing specializes in injections. He put me on a few different time released drugs in combination with the Norco, but only a max of 4 a day. I went a few months like this but unless I was having a really low pain day I would take the max of 4 in my first 8-12 hours. I was told I could take two at once, but try to take 1 or 1.5 if I can. I told him about this problem and he put me on 4X 15mg oxycodone every 24 hours, a long with my 2X 20mg Opana. Everything I read says that is the 60mg of oxycodone is actually stronger and more effective then 80mg of Norco, but I feel I got more pain relief from the Norco. The other thing I liked about the Norco was that I could take 1.5 if I wanted and not use them all or even take 5 doses if I did not take 2 in all of my 4 doses. Is this all in my head? I am thinking about asking him to go back to the Norco but afraid he is going to think I am trying to double my medicine to sell or something, which I do not do. Also, I was told from a pain managment doctor a few years back that 8 10/325 norcos is a eventually lethal or close to lethal dose of apap, so that might mean he wont change me back. Is this all in my head and should I just ask to maybe go to 20mgs and give it more of a chance or go back to the norco? My primary care doctor said it could be that since I have taken the Hydrocodone so long and it has been my sole pain relief for so long that it just in my head. Anyhow, I thought some of you might have some ideas, opinions, and helpful knowledge. One last thing, I am physically dependant on the opiates for pain and probably more, I also enjoy the euphoria, but I always make sure not to exceed my dose.

 

[BiggDirty01]

I am also a chronic pain patient and also started at norco. Trust me, you don't want to go any longer taking opiates with tylenol in them...jesus 6 or 7 years of it already can do some damage to your liver.

The oxycodone is definitely stronger than hydrocodone, about 1.5x the analgesic potency. Plus oxycodone has a very high oral bioavailability, meaning you absorb a high percentage of the active opioid compared to other opiates (like say hydromorphone).

You might want to check out the "opiate potentiation" mega thread here on BL, just search for it. There are some proven OTC medications that you can take (I take several of them daily) that will increase both how much you absorb and how long the effects last for.

Other than that, I'd suggest maybe seeing if your doctor would be willing to try you on a low dose (2mg) of hydromorphone/dilaudid. It is a very effective pain killer and quite potent.

PM me if you have further questions, good luck!

 

[Paulington]

Hey there.

If you really have been taking hydrocodone for 6-7 years, your tolerance should be WAY up past 80mg per day of hydrocodone.

If I were you, I would speak to your doctor about changing to 2x 40mg+20mg (60mg) OxyContin a day and 2x 15mg OxyNorm/Oxycodone IR for breakthrough pain, but IR opiates should be avoided AT ALL COSTS. Opiates that are IR (Instant Release) should be seen as a 'parachute', something to be used only if your pain is absolutely, unequivocally and completely intolerable for some reason, for example you did something that caused a huge spike in your pain level, otherwise DO NOT USE THEM!

Controlling your pain with ER (Extended Release) medication is much preferred as it gives you a constant, consistent and predictable serum level of the medication in your blood, which means consistent and predicable pain relief and also has a much lower capacity for addiction than IR versions of the same medication.

The dosage I've given above is just a tiny bit more than your current dosage, so it will account for the fact that you shouldn't be using your IR medication, but honestly, talk to your Doctor about this, it would likely be much better for you to stick to ER opiate pain relief and no IR opiate pain relief unless 100% absolutely necessary.

It's not in your head, it's tolerance. Also, do not worry about medications with Paracetamol/Acetaminophen/APAP in them, if you take a dose of 4g (4000mg) or less per day, your liver can cope with it, so can your kidneys and as far as I know they are no studies linking long term paracetamol use and liver damage. Most studies done on this were done in the 60s/70s when protocol wasn't as good and patients could have had underlying conditions. Paracetamol can cause elevated ALT/AST but since you're in chronic pain and you will be seeing a Doctor a lot, with regular blood tests and monitoring even if in some way the paracetamol magically did cause what could be seen as the beginning of liver damage, it would be caught in time for it to be no issue most likely, so just don't worry about it. Paracetamol can damage your liver if you overdose, but taken as prescribed, it will be fine.

Cheers!

 

[tricomb]

Hey there.

If you really have been taking hydrocodone for 6-7 years, your tolerance should be WAY up past 80mg per day of hydrocodone.

If I were you, I would speak to your doctor about changing to 2x 40mg+20mg (60mg) OxyContin a day and 2x 15mg OxyNorm/Oxycodone IR for breakthrough pain, but IR opiates should be avoided AT ALL COSTS. Opiates that are IR (Instant Release) should be seen as a 'parachute', something to be used only if your pain is absolutely, unequivocally and completely intolerable for some reason, for example you did something that caused a huge spike in your pain level, otherwise DO NOT USE THEM!

Cheers!

1) Why 2x40mg and 1x20mg? They make OxyContin in 60mg form.

2) I'm pretty sure they've linked liver damage to as-prescribed 4000mg APAP or less, which is why they've changed the standard to 3000mg per 24 hours (source1) (source2)
IN MY OPINION, the only reason they've lowered it from 4g to 3g and not less is so that the pharmaceutical companies don't lose too much money since over 500 OTC and RX medications contain APAP.

3) ER medications are not significantly less addictive than IR medications.

 

[Paulington]

1) Why 2x40mg and 1x20mg? They make OxyContin in 60mg form.

2) I'm pretty sure they've linked liver damage to as-prescribed 4000mg APAP or less, which is why they've changed the standard to 3000mg per 24 hours (source1) (source2)
IN MY OPINION, the only reason they've lowered it from 4g to 3g and not less is so that the pharmaceutical companies don't lose too much money since over 500 OTC and RX medications contain APAP.

3) ER medications are not significantly less addictive than IR medications.

Hey there.

1) I couldn't remember if they made OxyContin in a 60mg pill, which is why I put 2x40mg+20mg (60mg), just in case they did, I take 120mg OxyContins and I can't remember ever taking a 60mg, so.

2) Right, I'm fairly sure they haven't. The only studies that showed a minor link, as I said, were done in the 60s/70s when protocol wasn't as good and the participants could very well have had existing liver damage which would negatively influence the results. As far as I know no studies have been done recently with modern protocol. Also, read this paragraph from source 2:

"Acetaminophen is safe when used as directed. But, when too much is taken (overdose), it can cause liver damage. Some people accidentally exceed the recommended dose when taking multiple products at the same time, often without realizing they contain acetaminophen or by not reading and following the dosing instructions. McNeil is revising its labels for products containing acetaminophen in an attempt to decrease the likelihood of accidental overdosing in those instances."

This is the point with paracetamol, the dosage of 4000mg per day is totally safe and has been proven so, they are reducing the recommended dosage to 3000mg to prevent accidental overdoses. Paracetamol toxicity can result from doses as little as 5-6g per day for a couple of days. People see the 4g recommendation and go "Well, a few more tablets should be okay, right?" and end up causing liver toxicity, they are hoping that reducing the recommended dosage to 3g a day will make people think a bit more and take a bit less.

As I said, the 4g per day dosage is safe and has been proven so for a long time, there will only be a definite link between hepatic failure and paracetamol when a long-running double-blind study is done, and that won't get done, but millions of people around the globe take 4g of paracetamol daily which equates to millions of maximum paracetamol dosage-years and if there was a significant link to that and liver damage, we'd have heard about it by now.

3) I never said that ER formulations are significantly less addictive than IR formulations of the same medication, why attack a straw man? I said, and I quote:

"and also has a much lower capacity for addiction than IR versions of the same medication."

having a "much lower capacity for addiction" is in absolutely no way the same as "significantly less addictive". Addiction is caused by, ignoring the psychological component, "peaks and troughs" in the serum level of drugs and IR medications result in HUGE variations of serum drug levels, this means users get "ups and downs" due to the way IR medications work, about half an hour after taking them the serum drug level skyrockets and reaches a peak and then drops off rapidly, so the user needs another dose, another dose, another dose and this leads very, very quickly to addiction.

However! The same medication but in ER formulation gives you a constant and predictable serum drug level in the blood, so instead of having huge peaks and troughs resulting in highs and lows, you get a constant level of pain relief with no need to crave another dose another dose. This method of treatment results in a much better analgesic effect and psychologically means the user don't have to experience ups and downs that get "fixed" by the drugs, they take their meds every 12 hours regularly and the pain is controlled. I've spoken to many doctors about this including heads of the British Pain Society and they have concluded (and this is seen in UK prescribing practices for chronic pain patients) that ER formulations are much more efficient for controlling pain whilst minimising the capacity for addiction and dependence when compared to IR formulations of the same drug.

Hope that clears things up.

Cheers!

 

[tricomb]

The two sources I gave were not professionally cited sources, they were just to address the 4g --> 3g safe limit issue.

How can you say something is totally safe when you yourself admit there are no long-term studies on it?

My main dislike for APAP is how toxic it is to your liver, since there is a lot more information on it's acute toxicity. APAP overdose is absolutely horrible, so I have a hard time believing that it is benign taken at 3g or less, since there are no studies on long-term usage, even though it is probably one of the most widely used pain relievers on the planet.

I didn't say you claimed ER medications were significantly less addictive than IR medications, I said that for everyone else who reads this.

I know all about the differences between ER/IR medications, I'm a chronic pain patient. I'm currently on a purely IR dosing schedule
I totally agree with you that IR medications carry higher risk of dependency, I was just saying that the difference is not that significant. I don't want someone to read this and think "Oh, I'll be fine if I stick to ER medications, they're less addictive."

You said ER medications carry "a much lower capacity for addiction than IR versions", which people could interpret to mean they are less addictive. I'm not attacking a straw or whatever that means, my response had to be said.

 

[BiggDirty01]

I think the only way the argument about ER medications carrying less risk of dependency is completely tied to the abuse-proof mechanisms in the newer versions of ER medications. Until Oxycontin OP and the new formulation of Opana, I would've ventured that ER medications were actually causing more dependency than their IR siblings simply because the ER medications would have had so much more medication in them for which to abuse.

And I don't think an ER's medication to provide a constant serum level of medication, even to chronic pain patients like myself and Tricomb, would matter much in the issue of addiction or pursuing a buzz/euphoria. Having a constant serum level would just make it easier to use one's IR medication to catch a buzz, but that is neither here nor there in terms of relevance to the OP.

 

[Paulington]

Hey there.

If something has a reduced capacity for addiction, that means if someone was taking it is less likely to become addicted to it than something with a higher capacity for addiction.

Someone taking ER formulation oxycodone for pain is less likely to become addicted/dependant on the medication than someone taking the same medication in IR formulation. As I've explained, the reason for this is the consistent painkilling effect gained by a constant drug serum level. If you take IR meds every four hours and notice your pain creeping back after three hours, what will most people do? "Oh it's only an hour" and they'll take a pill. This builds a psychological link between taking the medicine early and the pain going away (and likely a 'buzz' due to slight overdose). Over time this means the 4 pills per day prescription has become an 8 pill per day habit.

Whereas ER medication, you take your pill at 9pm when you go to bed, you are asleep all night, you wake up with a bit of pain then at 9am on your way to work, you take your pill, constant pain relief for all that time, then when you get home and go to bed at 9pm, you take your pill, repeat ad nauseum. This means, due to the constant pain relief and non-fluctuating levels of pain, you are more likely to only take your pills as prescribed. Put it this way, I know a lot of pain management Doctors, some heads of the British Pain Society and they are all proponents of this method for both opioid-naive patients and opioid-dependant patients. It works. The medication is the same, but the method of taking it and the pain relief gained from it in both methods of taking it are what makes the addiction potential different.

I am also a chronic pain patient, I take 240-300mg of oxycodone per day. This is in the form of:

2x OxyContin 120mg. (Still OCs, we don't get the new OPs in the UK).
2-3x OxyNorm 20mg.

I rarely, if ever, take the 20mg, maybe one or two a week if I am in stupendous pain due to falling over that just isn't going away or something, but I always take my OxyContin when I am supposed to and I get fantastic pain relief all day from it.

My point is this, if you take two people, both opioid-naive, in similar pain (on the pain chart and in the same place) that gain the same type of relief from 10mg of oxycodone and gave one 2x OxyContin 20mg per day and one 4x OxyNorm 10mg per day, the one taking the OxyNorm is more likely to become addicted/dependant on the medication. This was the case for me and many other patients of the Doctors I know. It's not just the medication, it's the method of administration, the consistency of pain relief and a whole host of psychological factors, but this is the reason why, especially in the UK, you may get prescribed MS Contin or something for pain relief, but the chances of you being prescribed IR opiates (besides codeine) are much, much slimmer and this has worked for us.

This is only when the medication is taken as prescribed, not factoring in abuse such as crushing the pills etc etc.

Tricomb:

I can say paracetamol is safe without any definitive studies on whether or not it is safe for one reason:

If 4g of paracetamol per day was causing noticeable liver damage, we would have seen it by now..

If you say that 0.000001% of the population of the Earth is in enough pain to take 4g of paracetamol all day, every day, that's 7000 people. That means every day, 7000 max paracetamol/days are passing. Given that they may have been taking it for 50 years, that is 126 million max paracetamol/days. Given a sample size like that (and I am sure it is actually much bigger), we would have seen trends appearing if that dosage of paracetamol was causing liver toxicity.

Of course, I can not be 100% certain, but given the information we have, it seems to be safe when taken as prescribed, which is a max 4g per day given a normal day for a healthy person.

It's been shown that your liver can handle 4g of paracetamol per day, and I'm certain I read a study that after 50 days/100 days or similar, they tested patients AST levels and they were unchanged and their liver was unchanged from the first week they started taking the paracetamol. Like I said above, given the amount of paracetamol days seen worldwide, statistically, we'd have seen something by now.

My statement is totally true, ER medication has a much lower capacity for addiction/dependence than the same IR medication, this is for the reasons I've explained above and many more. If you stay on either long enough, you will become addicted/dependant, but, if you are only taking it for a month or so, i.e. for post-surgical pain, then the person on it for a month on an ER regimen will be much less likely to suffer withdrawal and dependence issues when they stop the medication when compared to the person on the IR regimen.

Finally, go see your Doctor, and ask about an ER schedule with IR for 'breakthrough pain', but with a good ER schedule, you really shouldn't need IR medication.

Disclaimer: The number of paracetamol users above was just picked out of the air, but I think it's a lot more than that and the principle is sound. !

 

[BiggDirty01]

I still don't see the relevance in your argument about addiction. Oxycodone is oxycodone, whether it is in IR formulation or ER. In fact, the patient taking the oxycontin is likely to have a much lower, albeit stable, level of medication in their system and thus not having an opportunity for the necessary oxycodone levels to reduce pain more effictively.

This is why BT meds are so necessary; Yes you may have more stable serum levels but that is neither here nor there if that serum level is not addressing the pain as much as it could be. The extra force of the IR oxycodone is what is actually lowering the pain, the ER just making the amount of IR meds needed less than would be on its own.

Oxycodone addiction occurs no matter what the formulation. To say that Oxycontin produces less risk than Oxy IR is nonsense because you may not be addicted to quite as high a dosage versus Oxy IR but you are nevertheless addicted. Having Oxy in your system around the clock via ER is just as addictive as the ups and downs of a purely IR regimen.

I hope you are getting the necessary pain relief from your regimen and I am not condemning you. Rather I just want you to understand that a as-prescribed Oxycontin addiction is really not different from a Roxycodone or Oxynorm (must be a UK thing) addiction.

Best of luck to you in treating your pain, as a fellow pain sufferer I wish nothing but the best for you,

 

[shanim]

Just ask around until you find a doctor that gives you what you wants!