Opioids Hydromorphone or Fentanyl for Pain?

[Skeee420]

Same here but breakthrough pain 800mg nasid/motirne/alive. Killing My stomach I am sorry to say but anyone that takes any type opioids it takes 3days. Your an addic you just don't know it yet. I would tell you been there done that . To much info but thank for your input

 

[LucidSDreamr]

^I agree with everything BUTTTT it depends where you live with the "any family doctor" thing. Where I live doctors need a special license to prescribe methadone

What authoritarian hell hole is that? So a cancer doctor needs a special license to prescribe methadone?

So the same doctor can script oxy 80s, 200 mcg fent patches, 8 mg dilauded and so on without a "special license.” These are all far more addictive than methadone from a psychological standpoint

Please tell me the isn’t in America (I know this isn’t the case in my state which is a pro personal freedom state with the exception of untrained 18 year olds having personal freedom to own military arsenals…but everything else you can think of a person could do personally is basically legal by now here….including full trained doctor’s to prescribe an ancient medication known about forever (methadone)

 

[LucidSDreamr]

Same here but breakthrough pain 800mg nasid/motirne/alive. Killing My stomach I am sorry to say but anyone that takes any type opioids it takes 3days. You’re an addic you just don't know it yet. I would tell you been there done that . To much info but thank for your input

A drug addict and a drug dependent person have completely different meanings per the DSM 5. Standard of practice guidelines used in psychiatry.

You’re conflating the two.

 

[LucidSDreamr]

My friends ppl once you put that needle in your done. It's like you flushed your life. What I mean you can't go back and say oh iam going to sniff or it's hard I wish I did your rout my friend but is 14yrs to late. Love your care for writing educate everyone. What I mean don't do it . Boot or snort they all kill you but the needle is quicker and it will take everything from you please every1 don't shoot

I quit IV usage 7 years ago after being a heavy IV user of opioids and everything else too.

Have not touched a needle in seven years. Continued to abuse opioids and other drugs over those 7 years. Now I don’t even abuse them I take them as prescribed and no illicit drugs.

It’s absolutely possible to change she you see the deaths from blood infections in your good friends, hepC and hiv diagnoses…and a foot amputation from IV absence in a friend …and you get married and find a life partner you do not wish to risk hepC exposure to.

So I was able to get off the needle without getting off drugsz

Some ppl in recovery groups are shocked when I’ve told them.

It’s not usual but it’s my experience. I would probably make an exception for IV dilauded if I ever had it again…but I haven’t really sought it out and glad I left the needle behind

 

[PaulAxe]

I do not suggest Fentanyl for anything at all. When I was 20 I overdosed on Fentanyl and it was pretty horrible. I didn't even know where I was, got left in the middle of the woods by a fake friend and rescued and taken home by real ones. They saved my life. Fentanyl is harder than Heroin my friend, I've done both. What I suggest for you is Tramadol. It's base of opioids, works wonders for pain but just don't smoke while under the effect of it or you risk having a seizure. Been there, done that. Hydrocodone is also pretty good for pain. And it's not as strong as Fentanyl. Fentanyl can get you killed if you mess with the wrong dose and attempt to get high on it. If you're a Heroin addict, try to get a Methadone prescription or Subutex. Subutex is the best one. I have a friend who used to be an Heroin addict and he takes Subutex everyday. It's also what cured the Heroin addiction of a relative of mine. Now she drives buses, has a legit boyfriend and lives outside of her original city. She has her life settled but suffered a lot from withdrawals during the healing process with Subutex. You have plenty of choices, decide which one is best for you. I just don't recommend Fentanyl.

 

[ChemicallyEnhanced]

What authoritarian hell hole is that? So a cancer doctor needs a special license to prescribe methadone?

So the same doctor can script oxy 80s, 200 mcg fent patches, 8 mg dilauded and so on without a "special license.” These are all far more addictive than methadone from a psychological standpoint

Please tell me the isn’t in America (I know this isn’t the case in my state which is a pro personal freedom state with the exception of untrained 18 year olds having personal freedom to own military arsenals…but everything else you can think of a person could do personally is basically legal by now here….including full trained doctor’s to prescribe an ancient medication known about forever (methadone)

No, not America.
It's nothing to do with the addictiveness of methadone, more because it's so very easy to OD on I think. But yeah, doctors can prescribe arguably worse things without it. Like Fentanyl, Oxy...even 200mg Morphine's which is WAY worse in terms of OD risk IMO [obviously, the 200mg morphine pills are slow release and only prescribed in extremis, like cancer, palliative care etc.]
Methadone is just almost never prescribed for pain anyway as there is no need.
There's also a stupid lack of opioid options here and they decreased them FURTHER last year be removing dihydrocodeine. You can literally only get: Codeine, Tramadol, Morphine, Oxy or Fentanyl [also methadone and buprenorphine, but for addiction].

Doctors MAY be able to prescribe methadone tablets for pain, I'm not sure. But for addiction, they have to have a license for it and you have to get it from an addictions service (equivalent of a methadone clinic).

On the plus side, all these meds are free.

 

[Dextro .45]

UK was a pioneering country for legally licensed Diamorphine treatment for severe treatment resistant opioid addiction. Methadone is maintaining for addiction treatment, BUT may be prescribed by certain physicians (90% sure)

Some individuals who are long term patients of Diamorphine get several boxes (5 vials/box) at a time, some even 5 boxes apparently. I’ve seen pics online Reddit a guy had 13-15 sealed/full Diamorphine 100mg vials lined up on wooden dressed with glass mirror behind it.

100mg of pure Heroin for IV/IM/SC injection per vial ….oh my lol.

They even manufacture 500mg vials (5/10/30/100/500mg) of Diacetylmorphine HCL

….a half gram shot of 100% pure H ….what kinda sick maniac built up a tolerance that insane lol

 

[LoveTractor]

Thank you to all who replied here.

Just to be clear the fentanyl is prescribed not street sourced. The newer patches are much less subject to abuse but probably could be used to get a much higher dose than labeled. I wouldn’t know, don’t abuse my meds - a few IN Dilaudid aside but tolerance, which is already kind high, is something I must keep as low as possible, surgery is near.

Pharmacies are a fucking bitch to work with - my suggestion - use an independent pharmacy and cultivate a relationship with the pharmacist(s) if you’re in the United States and needing any dose of opioid.

I asked outright and was graciously upped to a 50-mcg patch every 48 hours along with 4-mg Dilaudid every four hours. Finally my pain is well controlled. Maybe staying with 72 or 96mg of Dilaudid / day would have been better, hard to say. I’m good so that’s what counts.

Again, thanks to all who responded, I appreciate the feedback. I wish all pain patients had as good care I do. I think its kinda rare in the States.

 

[Spo2138]

I am pain management patient. I am seeking input / guidance from BLers with similar experiences. I'm finally feeling minor relief with 12-mg every four hours of oral hydromorphone tablets (72-mg/day). I do not abuse my meds, run out early, etc.

I have been offered either an increased hydromorphone dose or a switch to a fentanyl patch for my dose for my increase next week. Let's assume the analgesia will be sufficient with either formula.

Disregarding the hassle of dosing tablets round the clock every four hours, which would you choose for its pain management attributes, 96-mg/day hydromorphone or x-ug/hr transdermal fentanyl. What would you suggest the fentanyl dose/hour would need to be 50, 75 or 100-ug?

I have been offered what I need with no hard limit as long as I am compliant and in severe pain. I don't expect I'll ever have complete relief. There will be a major surgery within a year.

I don't want to fuck my tolerance unnecessarily. Ketamine will be added as an IN solution PRN when my dose is stabilized. Thank you.

What country are you in that they give prn ketamine. I want to get on that so bad for my pain. Sorry if u cannot ask about what countries do what I’m new. Thanks

 

[swimmingbird421]

Try opana and diluadid.. fentanyl patches are soo hit or miss...now if they'd do the lollipops
You can snort opanas very successfully w.o shooting. I used to sniff the kvk tech k71 10mg pills GOD what a RUSH.
It's like iv 1mg in hospital but just snorted 10mg oxymorphone
If diluadid is the queen
Opanas the king. Period

 

[SpiralusSancti]

Try opana and diluadid.. fentanyl patches are soo hit or miss...now if they'd do the lollipops
You can snort opanas very successfully w.o shooting. I used to sniff the kvk tech k71 10mg pills GOD what a RUSH.
It's like iv 1mg in hospital but just snorted 10mg oxymorphone
If diluadid is the queen
Opanas the king. Period

I assume you're talking about recreational potential as strong fent patches work great for many even with sever pain. Are they overall good idea or better kept as back up in case of cancer or whatever idk.

 

[swimmingbird421]

Hey spiralusSancti
Oh I've wore like 2-3 100ug patches
And got a glorious time
I still think dilly's and pan's have that punch moat pain patients want. But fent patches for the incredible legs. They used to give me a fent patch on top of 1mg diluadid and I liked that combo not as much as the opana diluadid combo though

 

[VAPain]

I have had no issues with fentanyl patches and the prefer because I don’t get a drugged feel. I am sure it is there, but for me I can function and not feel dilaudid drugged feel.
However, I am at the last known doctor in my state that prescribes narcotics. He will retire soon. I will likely have to be put under anesthesia to avoid withdrawals. In VA pain clinic means injections of cortisone and acupuncture. You go to a pain clinic amd they explain they never give narcotics. Ever.
It will surely put me in a wheelchair, maybe bedridden. We try to be proactive with letters and visits to lawmakers and fda. FDA was oblivious that pharmacies can refuse to fill and doctors are afraid of DEA so don’t give med anymore. I hope for better days , but surgery is not an option.
Many doctors have left the clinics and practices won’t prescribe. They get flagged.
Maybe someday an ‘important person’ will have severe pain, but my doctor said the influential patients and CEO’s don’t want to go public. They can afford to fly out of state or country.

 

[4DQSAR]

Just for any UK based BLers. Hydromorphone is now in the BNF and a GP can prescribe. But I note when methadone is discussed, it states that it should only be prescribed by specialists. I suggest that's because the bioavailability or oral methadone and it's duration of action can vary by huge amounts depending on the patients metabolism. It has to be titrated up to the appropriate dose and when I asked a specialist, they suggested that titration can be a lengthy process.

On another note, at least in the UK there have been several occassions when the pills were simply out-of-stock. Now you might think 'well, a doctor could substitute methadone linctus' but that isn't the case. Pills are almost ezxclusively used for chronic pain, linctus almost exclusively in substitution therapy. Possibly because those variables differ depending on the format of the drug.

Crazy but I thought about asking and then uncovered all of these odd proscriptions on it's usage.

 

[xyz69]

First of all, we should ask ourselves what we expect from pain management.
As a former addict and a current pain patient, I have to say this: opioids don’t eliminate pain completely. That’s a fact. In severe cases, they can sedate you to the point of unconsciousness — but that’s not real pain relief. That’s just sedation. Real pain management means taking the pain away.
So, a good drug is hydromorphone, because it works on both physical pain (it creates distance from it) and — more importantly — emotional pain, which is often even worse than the physical one. And when they come together, it’s completely debilitating. So, between the two, there’s just no comparison.
Fentanyl is a cold molecule — no euphoria, no lift, just a momentary dulling of the pain. At the right dose it can make you sleep, but it gives you no emotional benefit, no anxiolytic effect.
Hydromorphone is the exact opposite. It covers both physical and emotional pain. It gives you energy, and yes, even a bit of euphoria.
The flip side of the coin is that, in my opinion, hydromorphone is much more seductive and addictive than fentanyl — precisely for those reasons.
That’s why, in pain management, there’s no contest: hydromorphone and morphine are the gold standard. I’m not including heroin, because it’s been banned in most countries.
Today, to feel good around my relatives, I skipped my usual buccal fentanyl and took 32 mg of hydromorphone instead — and I felt great.