Opioids PM for 5+ years

[Ativanage2mg]

Ok,
long story short..
I have 3 torn discs in my lower back, and 3 of them were dislocated.
It took 5 surgeries to somewhat putting them back in place.
The pain was EVILISH, 10/10 pain.. I was on a wheelchair for a year and a half.
My torn discs wouldnt allow me to get up.. When I did it felt like a dagger was stabbing me non stop.
So after 5 surgeries.. I can finally get up and walk.
I was a 22 year old on a wheelchair.. very bad. I'm now 29.

Anyways, I'm obviously in pain management..
Here's what I've been RX'd throughout my 6 years in PM... Completely naive to Opioids at the start.

My very first script - (1st surgery)
Hydrocodone/APAP 7.5/500.. 4 tabs daily
Promethazine 12.5mg.. 3 tabs daily
Was on these meds for 12 months.

Second script - (2nd and 3rd surgery)
Hydrocodone/APAP 10/325.. 4 tabs daily
Promethazine 25mg.. 3 tabs daily
Was on these meds for 15 months

Third script - (4th surgery)
Oxycodone/APAP 10/325.. 4 tabs daily
Promethazine 25mg.. 4 tabs daily
Was on these meds for 12 months

4th script - (5th and final surgery)
Oxycodone 15mg.. 4 tabs daily
Promethazine 50mg.. 3 tabs daily
Currently still on these meds

So yeah, my problem here is, I've gained a bunch of tolerance on these Narcotics.
I've been on 15mg Oxy IR 4x daily for nearly 5 years now..
My PM doctor is super surprised that I havn't asked for a dose raise or switch to a stronger narcotic.

This is where I need your guys help.

What Narcotic is best for Chronic pain?
Oxycodone has helped me TREMENDOUSLY. Downfall? Its very addicting, and of course being on Narcotics for as long as I have, I'm already dependant/addicted to them.

Here's what my PM DOC has talked to me about,

Double up on Oxycodone dose (30mg 4x daily)
Methadone 5mg 3x daily + current Oxy dose for breakthrough
Oxycontin 40mg 2x daily + current Oxy dose for breakthrough
Morphine 60mg ER 2x daily + current oxy dose for breakthrough

I'm leaning more towards just staying on Oxycodone and doubling my dose because it has been working good for me.

What would you guys go with?
adding a long acting narcotic and use current dose of Oxy for Breakthrough? If so which long acting narcotic do you recommend?

Or just double up on my Oxy (Roxicodone) dose?

 

[HeadHigh]

If oxy works for you, i would say that the Morphine 60mg ER 2x daily and current oxy for breakthrough would be good, if not, then my second choice would be the methadone. Ive heard many people raving about how methadone has worked for their chronic pain.

 

[tacodude]

Morphine with the oxy. Methadone is garbage and adding more oxy to the oxy will likely raise tolerance, but it could also work better. Morphine and OC work in different areas and really the best plan would be morphine at night and oxy in the day, which you can do if you want and save the extra morphines from the morning dose. Then again you'll be adding a dependancy to a secondary opiate region oxycodone barely touches.

So either the morphine and oxy or just the oxy.... Honestly if he's willing I think the best option would be oxycotin and replacing the oxycodone IR with oxymorphone IR as OM is a metabolite of oxycodone and works in the area oxycodone doesn't while not activating the area oxycodone does.

Honestly I say try the oxycotin er with the IR OC for breakthrough and if that doesn't work switch the oc IR to morphine with the oc IR and if that doesn't work the oxycotin while changing the oc IR to oxymorphone.

 

[Ativanage2mg]

Thanks guys.

Ive done tons of re search on opioids, and Oxycodone hands down is everyone's favorite... Most likely because it has LOTS of recreational value. But for me, it's both.. It helps A LOT with the pain, AND makes me feel good.

Those were just a couple examples I gave out...
I've noticed that Methadone has a great reputation/reviews for Chronic pain.. It's also VERY strong.
They say oral wise, nothing compares to the strength of Methadone.. Correct me if I'm wrong?

But IV route.. Both Hydromorphone and Oxymorphone are more potent than Methadone.
IV Morphine is equivalent to Oral Methadone MG FOR MG.. According to the opiate equivalent dose chart on Wikipedia.

My top options, from reading and re search, there's tons of different opiates.. But here's what I think are my best 3 options.

Oxycodone 30mg 4x daily

Methadone 5mg 4x daily + Oxycodone 15mg 4x daily

Oxymorphone 10mg ER 4x daily + Oxycodone 15mg 4x daily

Morphine 60mg ER 3x daily + Oxycodone 15mg 4x daily

if you guys were in my situation,with those 4 choices, what would you choose?

 

[tacodude]

If you plan to IV get the oxymorphone IR. I find it lacks the rush, but just lasts vs short acting hydromorphone. Hydromorphone has that amazing rush feeling, but I'd still choose oxymorphone any day as it has serious legs and lasts a good 4-6 hours IV.

Seriously from my experience oxymorphone and oxycodone is the best route for pain although for recreation oxymorphone is only useful IV or nasally.

5 mg oxymorphone 4-6x a day & oxycotin 30 mg 2x is how I began although the oxycotin should've been 3x a day. After tolerance developed I stabilized at 10 mg oxymorphone 6x & oxycotin 60 mg in the morning and 30 mg at lunch and nighttime. That is the only time on opiates I felt I had stable pain relief. Don't get the ER oxymorphone as orally it isn't worth shit and they are seriously made abuse proof. Oxycodone works best orally so it doesn't matter if you have the abuse proof ones as I did and it worked fine. Even though the pain broke through I felt I was able to go 6-8 hours in between dosing vs 4-6.

I'm not going to lie my doses are high as I was using it more for recreation and pain.... Both meds can raise your tolerance fast so find the lowest dose that works and stick with it because as soon as you go above it then you won't have nearly the same relief with your regular dosage.

PM me if you have more questions. I'll add for pain 60 mg morphine ER 3x with the Roxi should do you find just don't try to inject the morphine unless you get an IR formula.

 

[Ativanage2mg]

I have an appt with my PM doctor tomorrow.
we were talking on the phone earlier and he recommended me to get a long acting opiate and keep the 4 15mg Oxys for breakthrough.

Also, he talked to me about the 10mg Methadone tablets.. I got surprised because I thought that would be too much..
But he's the doctor.. So he knows more.
I rated my pain a 8/10 last week to him, because being on the same dose of Oxy for nearly 5 years has sky rocketed my tolerance to opiates. The Promethazine goes amazing with Oxy.. Actually it goes amazing with all opiates.
When I don't dose my Promethazine with my Oxy it feels like I'm only taking half my dose.. Literally.
Well it's scripted to me for that exact reason. As an opiate adjunct, to make my Oxy stronger, and take away the negative side effects e.g Nausea, dizziness, etc.

Btw I don't IV drugs.

The only time I had IVd anything was at the hospital.
Ive had Morphine and Ativan injections countless times at the Hospital.. One time I stayed at the hospital for 3 weeks.. After I finished my 5th and final surgery.
I had Morphine, Ativan, and Promethazine IV every 6 hours. I was in extreme pain of course.. But the Meds took away most the pain and gave me tons of Euphoria.
The combination of Morphine, Ativan, and Promethazine is one hell of a combo.. Felt like I was in heaven.
After every release comes a 10-20 minute rush.. A rush that I wish that lasted forever haha.

Anyways.. I'm actually leaning more towards Methadone.. I'm really interested in it.
it has the best oral BA of all my choices for long acting opiates.. Same with Oxy.. Oral BA of Oxy is just as good.

I think I'll be golden with,

10mg Methadone 3x daily
15mg Oxycodone 4x daily
50mg Promethazine 3x daily

 

[tacodude]

I'd still recommend the 60 mg morphine or even just the sustained released oxy as if you're ok without them they might manage it better and allow you to save roxis. Morphine definitely is a much heavier stronger pain reliever in the terms it can make you sleepy, but I find oxycodone has an effect that counters it a bit. Methadone I hated as it made my mind racey.... I didn't get affected as much mentally/emotionally with things that only worked in the opiate receptors.

I'd recommend avoiding the methadone and taking I've of the ER formulas.

 

[roxi2873]

I would ask for Oc 80s and Roxi 30s for breakthrough, but then again... I fucking love oxy. Better than heroin.

 

[roxi2873]

The only person I know that is legitimate in that much pain from a horiffic car accident that tore him to shreds is RxD fentanyl patches and 240 Roxi 30s a month.

 

[tacodude]

Some people handle pain better and don't need as much. If you notice the oxy both forms are doses half for them.

 

[cjh1221]

I would also say morphine, it's not very good for euphoria but your goal here is pain management. Please don't IV anything, especially pills and ESPECIALLY if your not already an IV user. You'll never turn back to another ROA and it will seriously fuck you up.

 

[Tinker55]

If there's anyway to manage with a sustain release oral, that may be your best bet. I'm not a doctor, but the fewer the pills, the better. I'd also avoid methadone and morphine if you can. If you need another surgery being this opiod tolerant can give you issues with anesthesia and post-op pain control.

 

[Ativanage2mg]

I just got back from my appt.. (anyone else have doctor appts on the weekends? Only my PM doctors office is open Sat and Sunday. My psych and primary Dr's offices never opens on weekends. Maybe because my PM Dr's office is inside a major name hospital? idk)

I got a script for Oxymorphone 30mg ER 3x daily and Roxy 30mg 3x daily.

I'm actually happy with what I got. I got a dose raise on my Roxys and got generic Opana 30s.

 

[Rachella666]

I'm on oxycodone 10mg ER x 4 a day and 180 codeine for fibromyalgia, along with 600 mg lyrica. I know it's very mild for pain but have you tried pregablin?

 

[tacodude]

The global pharmacicuticals generics? If they are (and it should say on your bottle) they can be broken down into powder and used nasally, which increases bioavailability by 30% to 40% total. Start very slow if you do this. The old formula won't crush and needs to be used orally.

Hope it works out the best for you.... I would've gotten the oxymorphone IR and oxycodone ER. I'm really interested to hear how well it controls your pain especially in comparison to what you used to use. I also wish I had your pm doctor...

 

[Felonious Monk]

Where do you live? If you have access, medical cannabis might be something to consider. It would allow you to stay on your current dose of oxy most likely (by increasing the subjective effect of the medication). Many patients find they can even reduce their opioid use.

 

[tacodude]

It seems like the OP is fine with their dose it was the doctor that wanted to change it

 

[Ativanage2mg]

I'm actually quite disppointed with the Opana..
I expected A LOT more from it.
I double checked the opiate equivelent dose chart on Wiki, and they state that,

10mg Morphine PO =
10mg Hydrocodone PO
10mg Oxymorphone PO
6.67mg Oxycodone PO
3.33mg Methadone PO

I called my PM Dr. about that, and he told me 'remember I recommended you to go on Methadone, it's my personal favorite for Chronic pain due to the EXCELLENT Oral BA and its highly potent'

He told me to bring in my Oxymorphone bottle, We'll put it back on the medicine shelf in the hospital, and I'll swap it out for 10mg Methadone tablets.

So I did exactly that this morning and got,

Methadone 10mg 3x daily 90/month
+
Oxycodone 30mg 4x daily 120/month

That's awesome. I got what I wanted (Methadone) and an extra 30mg Oxy.

I dosed 10mg of Methadone 3 hours ago, and has fully peaked, and WOW.. Methadone kicks Opanas ass.
I also took a 30mg Oxy after the 'done kicked in... I havnt felt this good in YEARS.

Methadone is fucking awesome

 

[tacodude]

Some like it... Like I said it made me racey on thought and emotionally unstable. I was expecting opana oral use to suck.... If only you tried nasal if they were the right generics. That's why I thought oak morphine would've been better as it's more reliable for oral dosing

 

[DixiChik]

So sorry you're dealing with chronic pain Ativanage...

I wish I had access to CBD:THC oil because opiates further choke my bowel. My pain has gotten worse, not better, with the introduction/trial of pain meds. It remains "un-managed".

I'm told the Cannabis product could alleviate some inflammation and the small amount of THC would help depression. It would be a miracle (for me) if I could just get some relief without sedation and worsened constipation.

Hugs~DixiChik