Opioids Is it possible to take Oxycodone and/or Morphine ER (both meant for oral administration) via sublingual ROA instead for a faster onset?

[ivorymoon]

Try cutting the 15 mg ER morphine in half and have her put the half under her tongue and letting it melt.
then do the same with the other half.
(push the half down on that big vein under the tongue with your tongue and hold It there, keep it moist so it melts.
rub It against that vein)

I have found stronger pain relief when done this way and they still last almost 12 hours.
overlap the halves a bit so that the pain control is continuing without a break.
When a break in pain controls happen it is much harder to get it back under control.
Keeping the pain “managed “ is key.

Use 800 mg ibuprofen every 4-5 hours on bad pain days.
It really helps in conjunction with the morphine.

Caffeine also seems to give the morphine an extra push.

I also use the extended relief morphine and when I use them cut in half and under the tongue it makes me fall asleep.
It really seems to relax the muscles and body quickly and stronger.
Heat pad also helps and breathing exercises and meditation.
meditation really is useful once you get the hang of it.

I hope this helps.
I send my love to you both and hope she can find some comfort.
You are a good kid!

❤

You are lovely. Thank you SO much for your help.

 

[Painful One]

Oh fuck, thank you so much. I wish I would've read your post before typing out that longass reply reiterating everything and losing my shit lmao.
Do you know if she can take her oxycodone under her tongue, as well? They're small pink round pills with K 56 on them

I would think she could.
have her give it a try.
There is a huge vein under the tongue and on the underside of the tongue.
so holding it there and kinda rubbing it around on that area really hits me hard.
It really helps me.

Let me know if it helps her.

 

[Painful One]

I mean, she says that they both help a little bit but only to the extent of like "it's better than nothing", you know? She was on a high dose of methadone for pain for well over 20 years and even the methadone didn't completely control her pain, but it helped enough that she could get out of bed each day and do very light cleaning, like dishes, wiping down counters, things like that so the shit she's on now hardly touches her pain and her pain management doctor isn't keen on raising her dose. I don't think she has an appointment anytime soon. Not soon enough, anyways.

She's been super sick the past half a week to a week and whatever she's sick with is causing horrible joint pain and she's been throwing up. Last time she was at the hospital, they gave her a covid test and it came back negative so idk wtf is going on. I've been up literally all night taking care of her and I feel so fucking helpless. She's hardly been able to sleep and when she does fall asleep, she wakes up crying because the pain is more than she can bare.

I finally convinced her (after several hours of fuckin begging her) to call 911 to get a ride in an ambulance back to the hospital and the EMTs who came were the same ones who picked her up a few days ago and they swayed her into "staying home and seeing if she feels better after a while and if not, to drive to urgent care" even though she's way too fuckin sick to drive herself and I don't have my license. My mom has always been "too nice" and she didn't wanna burden them so she told them she would stay and idk wtf to do.


I just need to know if her oxycodone can be taken sublingually so that it'll have a little stronger of an effect and so that maybe she can actually fall asleep for longer than 10 min without waking up sobbing.


Please can someone just tell me if she can do this? I'm seriously at my wits end, frazzled as fuck after being up all night and feel helpless beyond words that there's not a goddamn thing I can do to help her.
Please, someone.

yeah, sweetheart- when I get a bad pain flare up or overdo it- I go into this cycle of symptoms.
it starts with throwing up and flu like symptoms, migraine headache, and then gradually eases from deathly ill into major back pain, skeletal pain.
It is like a chronic pain flare up cycle.
It has taken me years to figure out what happens.

Just have her take it easy.
Bring her drinks. Try to keep her hydrated and you just have to wait it out.

I am so sorry.
I really hope she feels better soon.
I know it makes you feel so helpless.
It is horrible. I know.

 

[Lorne???]

DO NOT put oxycodone or Morphine under your tongue; studies shpw it's terrible. If I'm not mistaken, the lipophillic Opioids likr Methadone and buprenorphine are
Good canditates for under the tongue, and
Maybe Fent?

Anyway, sublingual administration a actually results in a slower onset, because of the depot effect , I
Presume

2-3 hours Tmax instead of 1-2hrs, and lower cmax as well. Just like rectal administration (except with Morphine and select otherS)

Also they would need to be in liquid form.
Just don't do it bro. Parachute them, or, if you have the right formulation you can snort the oxycodone, which, bye oxy OP's
Would
Gel up under your tongue

Good Luck

 

[Deru]

K56 can definitely be taken sublingual. Hope that helps - although I don't know if you'll see much benefit.

No matter what you do, you're going to wind up getting less because of how it's bioavailability works.

I'd honestly just take the K56 normally if getting the maximum analgesic effect is what's important.

You could mix it into a saline solution and spray it into her nose or just crush it and insufflate it, that would get you more rapid relief at the expense of losing some - it's just not worth the loss in the circumstances you describe.

 

[Keif' Richards]

She should not be in pain like that. This is utter bullshit. Morphine Tincture is the gold standard for the the mouth is not viable. I dont understand why she doesn't have that.

I think a trip to the hospital is in order. Having a 9/10 scale for pain, cannot walk etc You might find a new ans better doctor in the first place.

They work for you, not the other way around. Display the pain triage. Any doctor who truly respects the Hippocratic Oath cannot let an innocent person suffer.

Our healthcare here just sucka. Like a lot of you guys, I find myself educating Pharm and my doctor about Pregabalin. His response?

"I know you're hurting but like I told you before I will not prescribe Benzodiazepines."

Ivory, you now have some people behind you. We will do everything we can to help.

For starters: Liquid Morphine. Tell the doctor she cant swallow.

Gabapentinoids: Phenibut, Gabapentin, Pregabalin. Pregabalin has been used mostly for Analgesia. PGB has been shown to augment pain positively aynd some even lowermany peoples*

Here is an article. It's not exactly what we were talking about, but it definitely, but I feel it demonstrates the drug's utility.

https://www.google.com/url?sa=t&sou...Vaw0_OTqGvaREIK9CAnBeUc2W&cshid=1590037279397

[/URL]

 

[Lorne???]

If you can't swallow you need to go to the hospital, that is literally a medical emergency. How are they eating?

This is suspicious to me. If they truly couldn't swallow they would DIE without IV nutrients, which would barely keep her alive barely

I just don't buy they can't swallow liquid; male the pills into liquid, and let it slide down the throat. It will work just fine

 

[Painful One]

@ivorymoon
How is your mom doing today?
Was she able to get some sleep?
Is she hydrated?

I hope things are better today.
Chronic pain is very severe at times and other people who have no experience with it just do not get it.
I am injured in my lower back and when I overdo it, my entire nervous system goes into some kind of horrible “flare up” and it has a lot of bad symptoms just as you described.
It can take days, weeks, or even a month to get calmed back down and under pain management again for me.
From the information I have read, your mom is living with chronic pain also.
Gabapentin and or clonazepam are very helpful to me.
That could be something you could bring up to the pain management doctor at her next appointment.
Her Doctor is not willing to raise the dosage of pain medication so suggest those medications as an addition.
Those two medications help me with sleep disorder, joint pain, mood stability, energy level is improved along with functioning.
Getting adequate and solid sleep is so important.
Chronic pain tends to make sleep very broken up and not refreshing.
The Gabapentin has been a huge help for me!
Sending my love.
❤

 

[Deru]

Chronic pain is very severe at times and other people who have no experience with it just do not get it.

I have chronic pain, and I do realize exactly what you're saying.

The problem is, in the OP case, her mom doesn't have much to work with to begin with, and taking them orally is the most efficient and effective way for pain relief with her two specific medications - the recommendation wasn't because I don't understand, it's because I fully understand - and short of going back to the ER or finding a different pain management doctor as others have mentioned if this one refuses.

It took me almost 7 doctors to finally find one that I could develop a relationship with and would treat my pain appropriately.

I truly understand the struggle - and it's a miserable process until you can find the right doctor.

 

[Painful One]

I have chronic pain, and I do realize exactly what you're saying.

The problem is, in the OP case, her mom doesn't have much to work with to begin with, and taking them orally is the most efficient and effective way for pain relief with her two specific medications - the recommendation wasn't because I don't understand, it's because I fully understand - and short of going back to the ER or finding a different pain management doctor as others have mentioned if this one refuses.

It took me almost 7 doctors to finally find one that I could develop a relationship with and would treat my pain appropriately.

I truly understand the struggle - and it's a miserable process until you can find the right doctor.

I am sorry that you also live with chronic pain and do understand this struggle.
I agree with all you have said.

It is just that the OP’s mom does not have a lot to work with and I have found that breaking the extended Release MS Contin (extended release morphine) in halves and letting them melt under the tongue has produced stronger pain relief at times of major pain flare up.

For me, that has worked.
I was just giving my experience.
The OP’s mom sounds like she is really hurting right now and desperately needs some relief and some sleep.
Needs to be able to eat.

I think it is worth a try.
She only has the 15 mg Extended release morphine.

It is best to just swallow them. I do agree.
but in a major flare up situation, the sublingual method does help me.
I think it would be worth a try.

It took me a LONG time to find a doctor who would treat me with what I needed also.
It really sucks for the people who are desperate and living with a chronic pain condition.

I am so sorry and sad for us chronic pain patients!

 

[Lorne???]

Exactly, except Pregabalin is far better than gabapentin. Lyrica (pregabalin) and Clonazepam is one heck of a combo

Problem with Morphine SL, it doesn't have very high solubility, water or lipid - which is why Diamorphine (Heroin) is just so much better, despite literally being a prodrug for Morphine

Oxy has better solubility so would, in theory be more effective, though the onset may still be delayed

Finding the right Medical Doctor is key

 

[JoEhJoEh]

I never did it by myself but saw it with friends - they put the capsule on a big spoon and hold a lighter under the capsule until it turns to a fluid. The wax that is swimming then on top of the liquid they remove carefully away with whatever - then they took the liquid without the wax into a glass of something that is very smelly because the smell of the morphine seems to be quite bad. Guess it was Orange juice. But they were high like hell.

JJ

EDIT: Of course it depends whether you have pills or capsules or whatever - these were capsules, Substitol as far as I know. With Tablets it's easier - crush them with a morter and drink it with whatever you want.

 

[Lorne???]

Sublingual morphine: efficacy reviewed - PubMed

Current guidelines on the treatment of moderate to severe cancer pain recommend the use of scheduled doses of opioids for persistent pain combined with "as needed" doses of similar agents for breakthrough pain. Oral drugs given on an "as needed" basis can be problematic for patients with...

pubmed.ncbi.nlm.nih.gov

"Current guidelines on the treatment of moderate to severe cancer pain recommend the use of scheduled doses of opioids for persistent pain combined with "as needed" doses of similar agents for breakthrough pain. Oral drugs given on an "as needed" basis can be problematic for patients with difficulty in swallowing or for those who suffer from nausea and vomiting. Further, breakthrough pain can become excruciating in a relatively short time, a drawback for analgesics that require gastrointestinal (GI) absorption before pain relief can begin. Hence, there is considerable interest in the development of novel drug administration routes to provide rapid relief of breakthrough pain, particularly through a route that bypasses the GI system. Sublingually administered morphine has sometimes been used in the treatment of breakthrough pain because some believe it provides effective analgesia via an appropriate alternate route. Available pharmacological data, however, do not consistently support the rapid absorption of morphine through the sublingual mucosa, and clinical data concerning the efficacy of sublingual morphine for the treatment of cancer pain are limited, not well-controlled, and inconclusive. While there seems to be a need for provision of rapid, effective analgesia to cancer patients by an alternative route, sublingual morphine may not satisfy this requirement. Newer formulations of analgesics should be tested in t"

Also:

Cite
Abstract
Previous literature reports have suggested that sublingually administered morphine sulfate results in an improved bioavailability of the drug when compared to orally administered morphine. To investigate this possibility further, we studied six cancer patients all of whom received 10 mg doses of morphine sulfate by intramuscular, oral and sublingual routes. Pharmacokinetic analyses failed to suggest an advantage of sublingual administration when compared with oral dosing. Bioavailability of morphine following intramuscular administration appeared superior to both oral and sublingual routes.

Reference: https://pubmed.ncbi.nlm.nih.gov/8406404/

 

[Lorne???]

Show details
Full-text linksCite
Abstract
Background: The optimal route for immediate-release morphine administration is controversial. The known physical characteristics of morphine that allow absorption are counter to the unproven belief that sublingual morphine is absorbed more quickly.
Objective: The aim of this study was to compare swallowed and sublingual morphine for effects on plasma morphine concentrations (PMCs), pain relief, and taste.
Methods: Ten participants with cancer (mean age, 50 ± 12 years) received a 10-mg morphine tablet in a randomized crossover design with repeated premeasure and postmeasure for 60 minutes. Measures included PMC and visual analog scale (100 mm) scores for pain relief and taste.
Results: Interindividual variability in maximum PMC was 25-fold (2.2-55 ng/mL). At 60 minutes, sublingual and swallowed routes were not significantly different for mean area under the curve for PMC (swallowed, 329 ± 314 ng/mL; sublingual, 314 ± 299 ng/mL) or for mean pain relief scores (swallowed, 81 ± 32; sublingual, 78 ± 31). Taste scores at 5 (P < .05), 10 (P < .04), 15 (P < .02), and 20 (P < .04) minutes after swallowed doses were significantly less unpleasant than after sublingual doses.
Conclusion: In this crossover design, between-group PMCs were similar for sublingual and swallowed morphine and resulted in a similar level of pain relief. Given the 25-fold across-participant differences in PMC after the same dose, additional research is warranted to identify the sources of this tremendous variability in PMC.
Implications for practice: Because of unpleasant taste, which could influence adherence and subsequent analgesia, clinicians should encourage patients to swallow their morphine doses and restrict use of sublingual morphine to individuals who are unable to swallow.

 

[JoEhJoEh]

Hi Lorne,

thanks for that abstract. I just posted the way I know how my friends do that, it was not about bioavailability. but thanks for the info.

JJ

 

[Lorne???]

Except when you're taking drugs it's always about BA%, and Tmax, and to a lesser extent Cmax(the reason IV buprenorphine is nearly 10X as potent as sublingual suboxone, despite BA% being just 3-5x higher)

Anyway, there is other information in those abstract s, like Morphine not being any faster sublingual thanPO. And Morphine lacking the physical properties for effective SL, although apparently it can be equal to PO, whether this is acute or Chronic I do not know

And your very Welcome

 

[scooterjonz]

Pain management as applied in the United States sucks!
The knee jerk reaction of government to the opioid crisis is ridiculous. They went after the makers of OXY and now fentanyl is King.
I have fibromyalgia and myofascial pain. It can be a BITCH.
I went to a pain management specialist who was very liberal. I was getting morphine, Dilaudid, and Percocet by the bucket. But my tolerance just kept increasing with every adjustment.
Nobody where I live prescribes methadone for pain. Something to do with State policies.
I was taking so many fucking pills I finally had enough. I decided to try to manage my own pain through alternative means (spoiler: this never actually happened).
But when I told my PM doc what that i wanted of the opioids, i got a rx for klonopin and a walk to the door.
I went to the methadone clinic to try to detox that way, thinking that would give me a way off that didn't kill me.
I was lucky the clinic doctor was so understanding. I told him what I was going through. He told me, "no promises, but sometimes methadone can help with pain."
But, he said, the party line was that I was there for addiction treatment as that is the ONLY approved use for the drug here. So all our clinical notes and visits should reflect that.
What happened though is years of pain management that actually freaking WORKED.
Will it work for your mom? Each case is different. I had to go daily and go to counseling with them, etc. for a year until I got up to two-week take homes. I go in twice a month and my life has achieved some normalcy.
I hope this helps in some way.

 

[3DQSAR]

Morphine has low oral bioavailability (20% or less), Oral oxycodone is supposed to have oral bioactivity of around 70%. Thus the increased activity of morphine will be much greater if the user chooses a parenteral ROA for the stuff.

Years ago I had the chance to obtain a few hundred 10mg morphine sulphate tablets. Now IV users don't like them, too much bulk. But the capsules did contain small spheres of active. It was easy to open up the capsules, crush the spheres and snort the powder.

But it wasn't that impressive. It was fine at the price but a lot of hassle.

Uncertain that IVing oxycodone is better than just swallowing the pills whole.

 

[Stephy]

@ivorymoon There could be a couple reasons for this. With the opioid epidemic they changed the way they treat pain and really forced doctors to change some of their prescribing habits, at least here in the US.

I had a huge problem with this after my third open heart surgery. Right after I got out of the ICU they wanted all patients off of opioids and on Tylenol within 5 days. My family used to get into huge arguments with the pain management doctors.

Has your mother expressed how poorly her pain is controlled to the doctor and allowed the doctor a chance to compensate? There are plenty of other great pain medications besides opioids that work great in conjunction with the two medications you mom is on - some manage the pain even better.

If so, maybe a second opinion is in order here?

like what because I've tried ALL THE OPIOIDS