Opioids DHC to OXY, why do i feel less from more potent opioid ?

[WellTram]

Hello everybody

I was tapering a lot and i stayed on 400mg tramadol plus 240mg dihydrocodeine.
It was ok but now i do not have 60mg DHC tabs, instead i have 20mg Oxycodone long-acting Targin tablets...

I take 2 of these oxy every once in a while but i can't get rid of impression that tramadol + dhc was superior to tramadol plus Oxycodone....

20mg oxy (PO) = 30-35mg morphine (PO)

Morphine is 10x stronger than codeine.
If i ingest 5mg morphine, it should be close to 60mg codeine. But according to the low BA of morphine, 5mg eaten is 1,5mg active. If i eat 60mg codeine, isn't it converted to 10-15% morphine, so 6-9mg active morphine ?

DHC is twice as strong as codeine but it has 25% BA. So from 60mg prolonged release tablet only 15mg dhc is active ? Then how i can't feel 20mg oxy prolonged release with almost 90% BA and much higher opioid binding than dhc, even if i eat more of them at once ? I take maybe 100mg tramadol daily less, and oxy is proper from pharmacy. Do i have to just...let my body adjust to different opioid ? Or why i do not feel much stronger effects ?

 

[Opana313]

My opinion is because it is extended release..these to me always felt weak unless it was 80mg and even that on its second day wasn't smacking as hard.

I used to be hella addicted to Tramadol and these things are fantastic when you are up there nodding itching staring off into space.. mixed with codeine I bet it did feel great. For me I had to take my tram dose 200-400mg wait for that get damn near to its peak then I would snort oxy whether it was 10mg or 30mg either felt fantastic

 

[Opana313]

But I think maybe a slight tolerance break may fix things better to your liking

 

[Keif' Richards]

Something important to consider here are the differing pharmacokinetic/pharmacological profiles of these two.

Oxycodone has pretty straightforward characteristics in regard to the two above-stated variables. It's pretty much the same potency between different ROA's. It does not require metabolism to become active. It is known that a certain amount of Oxycodone is often metabolized into Oxymorphone, but it's not super significant, so I'm not going to get into it here. As there is little metabolism involved in this drug's active effects, it's going to present a relatively more stable pharmcokinetic profile from person to person.

Dihydrocodeine (DHC) requires enzymes from the CYP450 family to metabolize the Dihydrocodeine to Dihydromorphine, the drug which will actually produce the desired effects. This is 100% analogous to the process for Codeine's transition to Morphine in the body.

CYP2D6 is the specific enzyme responsible for this process. Different people are going to have different levels of this enzyme in their bodies. Someone with let's say "a lot" of this CYP2D6 activity, is going to produce a higher quantity of Dihydromorphine from the DHC than the person with "less" of this CYP2D6 activity.

This potential for variability is not typically accounted for by the physician prescribing, though some will be aware. Essentially, you have Oxycodone, which is highly predictable in in pharmacology and DHC which is going to vary in its potency significantly from person to person. My main point would be, perhaps the prescribing doctor needs to account for these potential changes and titrate your dosage accordingly.