Opioids Conversion from morphine xr to fentanyl patch

[Stephy]

What I've read is that 25 microgram fentanyl patch is equivalent to 60 mg of morphine. I brought this up with my doctor when he switched me to the morphine patch recently and he said that was IR morphine not XR meaning instant release morphine versus extended release morphine. I'm trying to figure out the conversion online but I don't see any conversion tables that explicitly label it as XR instead of ir. Can anybody please tell me what the conversion of 120 mg of XR morphine a day plus 45 mg of morphine IR a day would be equivalent in a fentanyl patch. Probably just do the conversion for 120 mg of morphine since he will probably still give me the instant release IR morphine as my breakthrough pain. I'm so done with this pain my life is terrible and I don't get to see my son and I'm so f****** miserable. I stopped smoking pot a decade ago and I'm seriously thinking about picking it up again but then I know I'd lose my pain management doctor and I'm not even for sure that would help my pain. The couple times I tried it it didn't help my pain. I'm such a lazy person I don't want to do anything and my pain makes it worse and my laziness makes my pain worse. I'm only 46 they tell me I'm not supposed to hurt like this.

 

[Fire&Water]

Theyre trained to convince people at least in their 70's that they are
"too young to be on pain medication"

 

[coffeeshroom2.0]

Your calculations seems to be right 25mcg fentanyl = 60mg morphine. But then there is the bioavailability of both. Guessing the fentanyl being superior.

If you can get away with getting the fent patch and still a few IR morphine tabs. Then you should be set and then you can Guage on your next script full just how the 2 will work together to killing the pain from the get go and the fent kicking in later and slowly working as it needs to do

 

[Keif' Richards]

Hey @Stephy

Sorry to hear you're dealing with pain. You've gotta not only deal with that, but also the aspect of getting the medication, feeling judged, condescended to... all of that. I know it's difficult. The good thing is that it seems you're able to get some relief and you have a doctor willing to prescribe.

When you do the conversion from Morphine Milligram Equivalents to Transdermal Fentanyl specifically, forget about whether the Morphine is instant or extended-release. Instead, you're going to take the stated equivalent per 24 hours. This takes the ambiguity out of the situation that you're struggling with. From there, you can say that 60mg Morphine is taken 3x/day in 20mg increments, perhaps 2x/day with something like MSContin and so on.

It's important to note that the absorption of Fentanyl and other transdermal systems is subject to a high level of variability based upon all kinds of environmental factors, for instance, heat often causes the patch to release more medication, faster. For this reason, there are some pretty wide estimates regarding conversion. It seems that even experts in the field concede that there is guesswork involved in making switches like this. Likewise, you're probably gonna have to fine-tune things as well.

If you're total Morphine intake is as you stated, 165mg Morphine per day, then most literature states you will likely require a 50mcg/hr patch. This is something you will have to figure out with your doctor though.

A lot of people feel the same way you do. They feel like their pain is preventing them from living life the way they want to live it. That is tragic for anyone. Just keep jumping through the hoops for now, as that's the only choice people have if they want pain management. Play the game and see if you can get where you need to be. Regarding the Cannabis, is it not possible where you live to get a medical card? There are plenty of pain specialists these days who are coming around to the potential benefit of Cannabis. Many studies indicate it is effective in reducing patients' Opioid intake.

We will help you out however we can, so stay strong! If you have any questions, you know where to find us.

 

[Stephy]

I do have access to medical marijuana. Just got a card but afraid to use it because of my ex or pain doc

 

[Jnowhere]

Your ex, really? Medical Marijuana works for somethings, but it is not a panacea for all issues.
A pot card, just ask, they might be cool with it. Pain doctors, tend to be quacks or dicks. But ask about it, don't say you have one, just ask his/her thoughts.
Your ex; what the fuck do they have to do with your life?
Are you( not here to judge) codependent on your ex?

 

[Jnowhere]

The bioavailibility( mis?) Can be horrible for morphine. I used it for many years. My doctor, actually knew what drugs to give me to get off it. Clonidine and gabapentin. Oxycodone is the best, next to IV Dilaudid.( legal, and not from a street pharmacist, in America)

 

[Keif' Richards]

I do have access to medical marijuana. Just got a card but afraid to use it because of my ex or pain doc

A good pain management provider in our current age should be fine with the concurrent use of Cannabis with Opioids. In fact, the knowledgeable ones will be glad to, ad it often leads to a reduction in total Opioid intake. This allows them to keep a happy patient, while also keeping their prescribing levels low.

I imagine with a medical card, there shouldn't be any kind of problem. This is common sense stuff, though we know doctors are capable of stupidity like all other humans.

If you need any advice or pointers, I'm also a long-term Cannabis user. I've successfully gotten a couple family members to start using it in favor of stuff like sleeping pills, Benzo's and such. Let us know!

 

[Stephy]

A good pain management provider in our current age should be fine with the concurrent use of Cannabis with Opioids. In fact, the knowledgeable ones will be glad to, ad it often leads to a reduction in total Opioid intake. This allows them to keep a happy patient, while also keeping their prescribing levels low.

I imagine with a medical card, there shouldn't be any kind of problem. This is common sense stuff, though we know doctors are capable of stupidity like all other humans.

If you need any advice or pointers, I'm also a long-term Cannabis user. I've successfully gotten a couple family members to start using it in favor of stuff like sleeping pills, Benzo's and such. Let us know!

I'm in texas and it's still pretty frowned upon here and the dosing levels are incredibly low on that note as well.

 

[Keif' Richards]

I'm in texas and it's still pretty frowned upon here and the dosing levels are incredibly low on that note as well.

I should've known. As someone who has dedicated a lot of time, love and energy to Harm Reduction, it's the physicians who often give me the biggest letdown of all.

I don't think this is a situation that should be accepted. I am sure that there is an avenue in which you can get the appropriate treatment. It sucks that sometimes you have to think creatively just to access necessary medical treatment.

For instance, for a long time in New England, the basic statute was that Opioid addiction did not warrant in-patient medical treatment/detox as it was not potentially fatal. This was circumvented by stating you were a severe Alcoholic/Benzodiazepine addict during intake. Most doctors here in Vermont, I will say, were pretty willing to check the box for people even in dubious cases. The problem is, you're trying to start a new life of honesty. How is a person supposed to get better if the very first step in the process is just more lies?

Still, my main point is that there is hope. There are good doctors and bad doctors. There are doctors willing to put parts of themselves and their reputations on the line in the name of doing what they believe is right. Look at Jack Kervorkian. He sacrificed everything he had in this world so people would not have to suffer. He was labeled a monster, a murderer and a psychopath.

There are other doctors out there like him. The narrative is changing every day regarding Cannabis, with more acceptance and more application. I understand Texas is one of the major "holdout" states in this process, though I'm sure; positive in fact that there is a doctor out there somewhere who will do right for you.

I'm no saying you haven't invested time and energy into this process. I'm sure you have. Still, there are sometimes stones left unturned. I don't know what help I could offer, but if you wanted a little help, it wouldn't be the first time I've made phone calls for people. It wouldn't be a big deal at all, so let me know if you want help.

 

[Stephy]

I should've known. As someone who has dedicated a lot of time, love and energy to Harm Reduction, it's the physicians who often give me the biggest letdown of all.

I don't think this is a situation that should be accepted. I am sure that there is an avenue in which you can get the appropriate treatment. It sucks that sometimes you have to think creatively just to access necessary medical treatment.

For instance, for a long time in New England, the basic statute was that Opioid addiction did not warrant in-patient medical treatment/detox as it was not potentially fatal. This was circumvented by stating you were a severe Alcoholic/Benzodiazepine addict during intake. Most doctors here in Vermont, I will say, were pretty willing to check the box for people even in dubious cases. The problem is, you're trying to start a new life of honesty. How is a person supposed to get better if the very first step in the process is just more lies?

Still, my main point is that there is hope. There are good doctors and bad doctors. There are doctors willing to put parts of themselves and their reputations on the line in the name of doing what they believe is right. Look at Jack Kervorkian. He sacrificed everything he had in this world so people would not have to suffer. He was labeled a monster, a murderer and a psychopath.

There are other doctors out there like him. The narrative is changing every day regarding Cannabis, with more acceptance and more application. I understand Texas is one of the major "holdout" states in this process, though I'm sure; positive in fact that there is a doctor out there somewhere who will do right for you.

I'm no saying you haven't invested time and energy into this process. I'm sure you have. Still, there are sometimes stones left unturned. I don't know what help I could offer, but if you wanted a little help, it wouldn't be the first time I've made phone calls for people. It wouldn't be a big deal at all, so let me know if you want help.

I would love help. I've been in SO much pain. I'm sure from being sedentary, but being active is so painful. I stopped smoking pot about 2008-9 but I'm willing to give it a shot if it would help. An anonymous call to my doctor asking if he would approve medical marijuana...I got a card but I have not used any yet. I'm scared. Dr agarwald...Dr. ajay.... Thomas is the real person to talk to. Let him know his anynonmony is well preserved. He does not advertise. I was just LUCKY to find him. He gives me 120 ir morphine that really doesn't seem to work. And now 25 mcg of fentanyl patch. I was on 120 xr morphine plus 15 x3ir morphine. I can pass any drug test