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  • BDD Moderators: Keif’ Richards

Dilaudid vs Fentanyl for terminally ill

Immediate release oxycodone is likely your best bet. If the dose is right, it should have you feeling better. Oxycodone is a good analgesic (painkiller) even compared against other opioids, and also one of the opioids that many report produces superior euphoria. It is one of the more "stimulating" opioids, if not the most. It sounds like a more "stimulating" opiate would be a good choice for you because of the reported exhaustion, and your pain tied into that. Just my thoughts.
 
So sorry to hear about your situation :(

I would just opt for fentanyl, since it will be excellent at controlling pain. Tolerance is a problem, but since that is long term it should not be an issue for you. As your condition progresses, your doctor can increase the fentanyl dosage as needed.

This is more Basic Drug Discussion material, so I'm going to move it over there.

-->bdd
 
Just recently released from a long trip in the hospital from a bad accident. I went in opiate dependant as a daily heroin user. When I was picked up in the ambulance from accident site the people in the ambulance were hitting me with 100mcg fentynal shots which did absolutely nothing. Once I got to the hospital and they were informed of my usage, they then started hitting me every 30min with IV dilaudid. It did the trick on holding me over till I could be fit into the ER.

. WHEN I came out of surgery I was on a IV pump of hydromorphone AKA dilaudid. It was .5 mg every 8 mins, it did the trick to a certain degree. No euphoria but it did a good job at maintaining the pain on a tolerable level of about a consistent 4 out of 10 on the pain scale. While also taking oral meds 10mgdilly and 75morph sulf(every 3hrs on dil and6-8 on mor). Anyways where I am going with this is that the pump was taken away after 18hrs after surgery.
I came o

Then after I came out of my 4th surgery which was a reconstructive surgery, came to in the post op room in an INSANE amount of pain, they hit me with 1000mcg of fentynal which was given in about 6-8 shots, and 10mg of hydromorphone iv(in 1-2mg shots every 10 or so min). The pain was still not bearable then someone recommended a 15mg shot of morphine. Now I'm not sure if it was a different kind of morphine( dia, hydro, oxy, etc not sure of all the kinds) anyways they hit me with that and BOOM it kicked my ass, I continually kept nodding out and when I did nod out I would stop breathing immediately, so they put me on oxygen etc (meanwhile I am still trying to come out of anesthesia) they kept yelling at me when I would go out and my deeper go off sayin I'm not breathing.

Anyways what I'm sayin' is each drug may not be as powerful as the next depending on the ROA. Example, dilaudid oral = weak compared to fentynal oral ( lollies) strong. Femt iv = weak, where as iv dilly = strong.

Good luck in your search hopefully you have a good doc. No good person deserves to live in pain like that.
 
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DO NOT GO THROUGH THE FENTANYL ROUTE! Tolerance builds quick and plus it's not the best painkiller around, even though it's the most potent.

My suggestion is to go ask your doctor for morphine.
Morphine because there is nothing out there that has been proven to be superior to it as a painkiller (check every study up on pubmed - no opioid is as good of a pain killer as morphine is). But it also has more side effects (both the positive and the negative).

It's the closest thing you can get to heroin, heck it's essentially the same drug as heroin.

Ask for it and see how it goes. Morphine is a grand opiate - the original, the gold standard, all opioids new and old have to measure up to morphine and if they can't measure up then they aren't good enough.

It's the best, go for it man!

Do morphine sustained release and ask for Percocet 7.5 or 10 mg for breakthrough, or you can ask for Norco (10 mg hydrocodone/325 APAP). Vicoprofen (7.5 mg hydrocodone/400 mg ibuprofen) is also an excellent breakthrough pain med.

Personally, if I were you I'd start on the morphine sustained release and keep the 8 mg dilaudid's for breakthrough pain - they work better if you crush them and snort them. Or if you are into shooting, they are very easy to shoot.
 
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Hi everyone,
So I have been on fentanyl for a while. I'm on 100mcg patches, also given roxycodone 30mg tablets, I had to switch to Opana since for some reason the new brands of roxy are really like taking water to me.
I hate Fentanyl though because sometimes when my pain is worse I can't take my usual dosage of opana or anything, I have to take even more I HATE how Fentantyl is rasiing my tolerance but I do like that it doesn't make me feel high and I can feel like a normal person and do regular day to day things on it.
Any advice on how to prevent the need for higher dosage of other meds? I did a steop down to come off of fentanyl but now I need it again since I'm getting the pain I had forgotten about back in full force again. I went against my doctors advice, I just hated how being on it made me have to take more of other meds I was starting to feel like a damn junkie!
 
Sorry to hear about your situation, ive had several relatives with cancer & its hard to watch them in pain. Ask your doctor about Levorphanol, its a great pain reliver with legs. 4mg pill should last about 8 hours. They are very euphoric & the oral route is very high. I dont understand why doctors dont prescribe it more often.
 
For me i found the fentanyl patches worked wonders and i had other meds such as morphine and baclofen but after a year the pain i had was coming back through making my back jar.
As others have said methadone works well and as of a couple of months my pain has been better than ever, with that i take diclafenac, baclofen and paracetamol.
One thing i found is you may be right about tolerance but they just increase it. So from personal experience methadone is the best, one other thing as well is even if i miss a days meth the pain can be controllable.
 
I have very limited experience with the two named compounds, but for what its worth I got far less nausea from fentanyl than dilaudid. Both were given in a clinical setting with zofran to prevent incipient nausea, so that may be a significant factor.
 
Opana and Roxi 30s are your best bet. You can get high as fuck and you will receive proper analgesia. I was on fentanyl before I was put on opana and opana has made a world of difference in my pain and in my life. You won't be disappointed in the combo.

I'm sorry to hear about your condition. I hope you get what you need. Keep fighting!
 
negrogesic said:
For those who are dying or near death I often prescribe duragesic patches, which admittedly, is not the "best", but it is effective and is easy for gravely-ill patients to use (no pills, etc). I also generally write a fast acting oral like oxycodone or morphine sulfate oral suspension, PRN (as needed), which is something physicians dislike writing because they are C-II's (opioids in particular).

On occasion I will prescribe methadone in rather high doses, which often works well at treating severe pain that is resistant to other opioids. Plus, given the state of the patient, methadone generally doesn't cause the same degree of cognitive impairment seen with equianalgesic doses of morphine, hydromorphone, fentanyl etc equianalgesic. If there is a 24-hr nurse involved or inpatient hospice, I sometimes try more exotic opioids if the patient has been catheterized and is wired and plugged in (aka life-support/monitors).

Obviously, the goal is to both effectively treat the pain and keep the patient conscious enough to speak and have some final time with their family/loved ones. And no, the Brompton cocktail would not go over well here in the US, my methods are already rather unorthodox. I have, however, prescribed d-amphetamine to younger terminally ill patients (particularly for some of the painfully slow AID's-related complications--->death).
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Damn, I didn't know you were an MD... and MD on Bluelight. whaddya know... do u mind If I ask what state you Practice in..... if I get lucky it'll be North Carolina..
To the OP, Sounds like A very sad situation that you've found yourself in, I agree that you should ENJOY the Time you have left, Enjoy it to the Fullest and that's hard to do being Sick and suffering all the Time, the Doctor should be ashamed of himself and have more Compassion for You.
At this point they should be willing to Script you Whatever it is you want.. see if you can switch to Opana(Oxymorphone) Nasally it works Wonders and Runs Circles around Dilaudid(Hydromorphone) it will Kill the Pain more effectively and provide a Much needed Euphoric Buzz that can help you be more at ease with your situation which I think you need right about now. If for some reason Your stuck with the Dilaudid for a little while I'd say in your particular situation that You should Learn to IV for Maximum Effectiveness, I normally would never suggest that to somebody but Obviously in This case I feel it's warranted.. Also If your Doctor Is Not willing to Make you Comfortable and Help you Enjoy the Time you Have Left, Do not waste Time Arguing with him.. GO to another Doctor.. and Keep looking and Going Till you get what you want., They have NO right to Deny You ANYTHING at this point.. .so you are Perfectly Justified to go to as many Doctors as you NEED to , To receive the care and Medications that You not only Need but Want as well.. Also if the Nausea persists get them to prescribe additionally Odensatron it works Wonders for Nausea and sour stomach, Vomiting, ect.... and there is NO sleepy side effect like there is with Promethazine(Phenergan)..... I hope you get this Worked out and hopefully You keep plugging right along. I've heard Many, many Cases where the Doctors gave people a certain amount of time to live and they are Still doing just fine and some are Even Cured... so Never Give up hope....
Sending Positive Energy Your way, If you Ever Need TO Talk I'm Available Anytime...
Brandon Payne
 
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