Nicomorphinist
Bluelighter
I was told the other day that scientific opinion, in North America, apparently preceding and independent of the US "opioid cri$i$" is turning against extended-release opioid preparations, whilst I detect a split opinion on them in Continental Europe. The main idea seems to be that the morphine, dihydrocodeine, hydromorphone or whatever is sitting there for 7-36 hours, irrespective of whether it is needed. I have heard other propaganda as well. For example, I dismiss the concerns about decreased lifespan out of hand as I have known several people on morphine for 50-85 years who looked younger than their years and lived to phenomenally old ages, including people on it from before the Harrison Narcotic Act 1914 who lived into the XXI. Century. The one casse with which I am personally familiar is a woman inducted on round the clock morphine in October 1908 with prn diamorphine (smack) before 1924 and Dilaudid afterwards for tubercular spondylitis of the lumbar and sacral spine who died in her sleep of old age in mid-February 2009;
What I can tell people from my experience is that:
1: Unless you are some kind of superhero with a stomach acid pH of 0.1 and a robotic zirconium gut which can be controlled with a smartphone and loaded with instrumentation, there is no way that 100 per cent of that medication can be pulled from modern extended-release preparations -- you will be shitting out valuable Miss Emma, DHC, D, and so on.
2. In my opinion, 70-85 per cent of the analgesia is done by the come-up . . . then it is maintaining for several hours, which is why I have had good results with nicomorphine or hydromorphone SL, IM, or SC taken almost simultaneously with immediate release morphine, which can hold me analgesia-wise for up to 9 hours. There is a case for ranking analgesic preparations by their power to shatter existing pain, and I believe the speed with which therapeutic concentration is achieved is the key to this, which is probably a bit similar to the concept of brisance from another chemical engineering field.
From there, it gets more complicated -- levorphanol as expensive as plutonium because of the satanic Pharmacy Bro, the QT concerns about open-chain opioids, the crazy toxicity of 4-phenylpiperidines, dextromoramide going the way of the passenger pigeon . . .
What I can tell people from my experience is that:
1: Unless you are some kind of superhero with a stomach acid pH of 0.1 and a robotic zirconium gut which can be controlled with a smartphone and loaded with instrumentation, there is no way that 100 per cent of that medication can be pulled from modern extended-release preparations -- you will be shitting out valuable Miss Emma, DHC, D, and so on.
2. In my opinion, 70-85 per cent of the analgesia is done by the come-up . . . then it is maintaining for several hours, which is why I have had good results with nicomorphine or hydromorphone SL, IM, or SC taken almost simultaneously with immediate release morphine, which can hold me analgesia-wise for up to 9 hours. There is a case for ranking analgesic preparations by their power to shatter existing pain, and I believe the speed with which therapeutic concentration is achieved is the key to this, which is probably a bit similar to the concept of brisance from another chemical engineering field.
From there, it gets more complicated -- levorphanol as expensive as plutonium because of the satanic Pharmacy Bro, the QT concerns about open-chain opioids, the crazy toxicity of 4-phenylpiperidines, dextromoramide going the way of the passenger pigeon . . .
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