Opioids Morphine and Dilaudid

[Foreigner]

I'm sorry if this falls under the category of UTFSE. Normally I would but I am so weak right now that after I write this post I'm signing off. Yes I'm still alive, but I'm in palliative care. So things are still fucked up. I'm a really tall guy but I'm down to 120lbs (54kg), I'm too emaciated for surgery, and the last chemo drug has failed. They keep giving me blood transfusions and various electrolyte IVs because my heart and kidneys are starting to show wear and tear, but it's all just fighting the tide at this point. Anyway, I came here to ask about the pain program I'm on. Since euthanasia is not available in my province for another 4-5 months pending a supreme court ruling, I am determined to be as comfortable as possible.

I've been taking 5mg morphine sulfate with 1mg dilaudid orally up to 3x daily. I combine this with CBD. My pain is so severe that it barely touches it so now the doctors are discussing an upgrade in dosage of both, or switching me to another drug entirely. They discussed a fentanyl patch with me the other day but because the lowest dose patch would still be way stronger than what I'm currently on, they may just opt to give me more dilauded or another opiate. They were giving me IM dosages of morphine and dilauded with a subcutaneous butterfly but I started to have an irritating reaction to the needle so they switched to oral. I miss the IM though, it was stronger. When the pain was nutto they were giving me 0.5mg dilauded by IM every 20 minutes. I was out in orbit.

I'm already noticing some unpleasant cognitive effects, like bad dreams and somewhat disjointed thinking. I have visual disturbances like an intermittent snow, and nystagmus. I'm also starting to look forward to my morphine a bit too much. It takes my shitty pain and exhaustion and turns me into a talkative, somewhat friendly person again. I don't have an addictive personality, but the pain of my condition is totally trashing my psyche and at this point I will do anything to stop it. Anything. It also helps me eat because when the pain gets my body just voids everything.

My in-person community includes some HR people and they say my morphine dose is really quite low, but what they don't realize is how sensitive I am. My dosages of any drug are low across the board. The first time they gave me dilaudid I was drooling and nodding off mid-sentence, and that was 0.2mg IM. The other reason why they aren't going a lot higher with the pain killers is because it slows the bowels. Because I have insane bowel inflammation and dysentery, they are afraid that if they slow my bowels too much it could cause something called toxic megacolon, or even cause the bowel to rupture.

So I'm wondering if even this quantity of morphine is causing me long-term harm. I read somewhere that if there's genuine severe pain, then the deleterious effects are not going to be the same as if it's just recreational use. But I don't understand how that matters since you're still displacing endogenous endorphins? I'm also wondering if I should just say fuck it and take the fentanyl patch. Sometimes I wonder if my doctors even know what they're doing. They tried to switch me to tramadol w/acetomenophen but because my body can't process the latter, I had a spike in liver enzymes and they took me off it.

Yeah, things are a fuck show. I'm a opiate virgin mostly and that's why I have these questions. Thanks for reading... I'll try to post more updates when I'm lucid and able to keep more food down.

 

[Foreigner]

Sorry for the double post. Let me just clarify... I'm asking if a person can be at risk of becoming an addict from the dosages I'm on. Is the amount and risk relative to each person, or is general quantity important to consider? Like if any given person is taking 50mg morphine, are they going to be at higher risk than someone taking 10mg?

I really don't care that much given how much pain I'm in right now, but if by some miracle I come out of this I don't want to be messed up. I know opiates modify your pain perception over the long term and that would really suck. But... yeah... no alternative right now. It's either that or screaming my head off all night.

 

[SS373dOH]

You run the risk of getting addicted with any amount of opiates, and yes, obviously the more you take, the more likelihood of addiction is.


- Hopeless Soul

 

[tacodude]

While I'd usually recommend against self administered IV you're in a unique situation that might benefit to have immediate release.... The only issue is of 0.2 hydromorphone hit you hard with the skin irritation reaction that could possibly be countered by using benadryl or another anti histamine an hour before dosing. Still measuring out lower than 1.25 mg (1/4 of a five mg morphine pill) of morphine might be hard and you're definitely more likely to get a skin reaction from that where the dilaudid can only break in half into 1 mg pills. You can mix it in water and use liquid measurement method (dissolve 1 mg hydromorphone into 1 ml water, filter with cotton drawing into a 1 ml 27 or higher gauge 1/2"-1" needle syringe where I use 29 guage, and once you have the 1 ml solution each 10 units [0.1 ml] will be 0.1 mg dilaudid that you can backload into another syringe or squirt into a container that you dilute and refilter pulling through cotton or micron filter if you can [my local needle exchange carries sterilfilt micron filters designed to filter pills through an insulin rig] into another syringe). This filtered liquid can also be used nasally if you get a syringe with a leur lock atomizer nasal spray syringe attachment although that requires a leur lock removable tip syringe that the atomizer (and wheel filter micron filters) can attach to.

You do seem to be on a super low dose and a set of compound that have extreme cross tolerant vs h/o codone vs codeine or morphine based compounds. I honestly suggest trying to get 5-10 mg oxycotin (12 hour release OC) 2x daily with oxymorphone IR 5 mg or even 1.25-2.5 4x a day if you can get a pill large enough to break, which the endo brand and generic are definitely large enough while the roxxane labs are tiny that can't even be halved unless done carefully with a razor blade forcing the liquid measuring method I mentioned above. I say this combo as both are selective to different opiate regions preventing cross tolerance issues while the oxycodone is used as matinance as it isn't as sleep inducing and I find harder to nod on even meant to prevent it somewhat while nodding can happen on it for sure while the oxymorphone is used for breakthrough and more resting with pain vs activity with pain as it can easily lead to nodding that will last as it has a 6-8 hour half life leading to long lasting pain relief vs dilaudids 2-3 hour relief. Both can easily raise your tolerance though. Oxymorphone is great IV too as it's immediate relief yet I've rarely gotten anything like a rush that dilaudid gives or the pins and needles morphine gives in the slightest. I find those two compounds lack a lot of the rashing and other negative physical side effects yet develop a dependancy and tolerance fast.

Fentanyl could be a good choice as it lasts for 3 days in a patch. The only issue with that is the compound itself only last 30-60 minutes, which is why they put it in the three day patch. It was also made to fit in the receptor best as possible and create the strongest effect so it will lead to a huge tolerance increase for any opiate you use.... Plus it lacks the "euphoria" or in other words "warm fuzzies" that opiates are known for and just create sleep inducing sedation, pain relief, and respritory depression that you will either hate lot appreciate trying to find non intoxicating pain relief.

Really it's a touch spot your in... I wish you the best with everything. Keep us updated for sure, feel free to PM me, and I hope my recommendation and info helps.

 

[cjh1221]

I really think that tacodude has some great suggestions. One thing I wanted to bring up though....at the point you are at, addiction should be your last concern. You can always taper off your meds later, should it (hopefully) come to that. Right now, the most important thing is your pain level and reducing your discomfort. Pain is very powerful. It can have a lot of negative effects on your body and mind. At this time, being as healthy as possible is in your best interest. Pain can raise your blood pressure, increase your heart rate, cause depression and anxiety, and even cause more pain via tense muscles. Keeping your pain under control will make it easier for your body to focus on the task at hand, getting healthier and beating whatever illness youre facing.

Addiction and dependence are two terms that are often confused and while they can, and usually do occur together, one is not necessarily exclusive to the other. Addiction is a mental symptom. An addict craves the drug, the high, and the numbness but doesn't NEED it to feel well. Someone who is dependent NEEDS the drug in order for their body to be comfortable. Once the body is hooked, they will face withdrawals without it.

I know this is an uncomfortable subject but which would you rather, to live what could possibly be your last days in pain, uncomfortable and depressed, or have to take a few extra steps to wean off the pain meds if things should turn around? I know, not a fair choice to have to make. I watched my father suffer through colon cancer. He wasn't in a lot of pain until his body became so withered and fragile from malnourishment that simply walking was enough to break the small bones in his feet. Every twitch was excruciating. He opted for pain management and was immeasurably glad he did. He didn't survive, unfortunately, but if he had, I'm positive he would have made the same decision.

I hope things turn out for the best and I hope that possibly getting hooked on narcotics is the worst thing that comes from your situation. I know it's hard to stay positive. Your quality of life now is more important than worrying about addiction or dependence. If you're strong enough to get through whatever it is your going through, you are strong enough to face the challenges of addiction later.

Best wishes and I hope that you find comfort in whatever lies ahead.

 

[withlove]

Quickly just want to say I was taking morphine 5-10gm 3-4x a day for a few years and it got the point where my gut slowed down and almost stopped and it became ineffective for pain. i switched to 5mg oxy ( starting at 2.5 and working up over 2 weeks) and have better pain relief and the constipation is not a serious issue anymore.
My point is if what you are on is not working for you try and switch it up, different people are going to have better pain relief and different side effects depending on.

You may become dependant but dependancy and addiction arent one in the same.
Its ok to look forward to pain relief and even the feeling the meds give you esp given the situation you describe yourself in.

 

[Foreigner]

Thank you.