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Opioids Switching from the NEW Opana to what?

N

nonug

Greenlighter
Joined
Jul 30, 2010
Messages
33
I am a chronic pain patient & because our insurance/health care systems are sooooo messed up I have had to start insufflating opana. I need about 4-6 40mg pills during a 24 hour period to stay well. I am also prescribed oxycodone 30mg 8 X per day for breakthrough pain which I take when I need to orally as prescribed. These new concave Opanas are an absolute joke and even taking them orally gives me a HORRIFIC stomach ache and I am in WD's instantly. What options do I have in terms of switching from the 5-6 insufflated Opana to? My doctor is pretty friendly and actually cares about this patients so I don't think he would have any problems switching me to a different ER medication + the oxycodone for BT pain.

What are my options for replacing the amount of Opana I need just to function and go to school, work, etc? I have done some research on hydromorphone and morphine and fentanyl but what kind of doses would I need? I am also open to switching my breakthrough med if necessary. Any suggestions/info would be GREATLY appreciated. Thank you all....
 
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Oxymorphone and Hydromorphone are pretty similar when it comes to strength..meaning if you were taking 200mg a day of oral oxymorphone, which is about what you said you needed..roughly 150mg's of oral hydromorphone would give you the same relief. I think that would be a good bet.
 
If the oxycodone works for breakthrough, keep it, don't fix what ain't broke. If I were you I would switch out the Opana ER for hydromorphone (which to me, is only available in IR form so consider the effects of a purely instant release medication regimen) and if that doesn't work, switch to morphine ER w/ oxycodone for breakthrough.

I'm in the same boat as you, fucked me over when they did this with oxycontin too, the new formulation is unbearable for my stomach and pre-existing GI issues. I'm on a completely instant release pain medication treatment right now, which has it's benefits but also major drawbacks like peaks and valleys. I've been slowly switching off the old octagonal opana to HM, and also, like you, I take oxycodone for breakthrough.

I would avoid the patch if at all possible. If all the pill opiates fail, then it's time consider it, but this is all issues you should be discussing with your doctor. I presume you're seeing a pain management clinic?
 
tricomb said:
If the oxycodone works for breakthrough, keep it, don't fix what ain't broke. If I were you I would switch out the Opana ER for hydromorphone (which to me, is only available in IR form so consider the effects of a purely instant release medication regimen) and if that doesn't work, switch to morphine ER w/ oxycodone for breakthrough.

I'm in the same boat as you, fucked me over when they did this with oxycontin too, the new formulation is unbearable for my stomach and pre-existing GI issues. I'm on a completely instant release pain medication treatment right now, which has it's benefits but also major drawbacks like peaks and valleys. I've been slowly switching off the old octagonal opana to HM, and also, like you, I take oxycodone for breakthrough.

I would avoid the patch if at all possible. If all the pill opiates fail, then it's time consider it, but this is all issues you should be discussing with your doctor. I presume you're seeing a pain management clinic?
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If you don't mind would you share the strengths/dosages you were/and now are on just so I can get a clearer picture. I don't know if you caught this in my original post but I have been insufflating my opana recently (about 180-280mg) daily. Obviously that is quite a lot....is there any amount of hydromorphone/morphine/etc. that would roughly amount to that?

I am so furious with Endo. I tried calling to complain today but it's passed their business hours. They can be expecting a call from me on Monday morning bright and early! We should all be expressing our frustrations towards them and MAYBE they might actually listen...
 
Only problem with that is that I had been insufflating my opana recently cause it just wasn't keeping me well orally any longer....
 
Checkout the opiate conversion link in my signature. I went from like 40mg sniffed opana with 100mg morphine to 64mg hydromorphone w/ oxycodone for breakthrough.

I still am snorting opana though....as I have quite a few of the octagons but I really want to stop and put them in the safe with the legit OxyContin.
I'm down to like 5mg opana snorted a day now, but I'm taking hydromorphone now and methadone sometimes.
 
Although I don't have any experience with Opana (oxymorphone) I have however experience with pretty much all the other potent opioid ER formulations and in my opinion I have had great success with Duragesic (fentanyl) patches. Based on the conversion ratio it looks like it would be somewhere in the 200 mc/ug, The patches can be worn for up to 72 hrs although they take, in my experience, at least 8 hours to kick in.

Another medication, although not listed specifically as an ER formulation, is methadone. With a very long half life, methadone can sometimes work for longer than your typical ER formulation. I've been using it since my last back surgery and I think it is a terrific analgesic. It looks like based on your Opana dosage, somewhere around 60 mg a day would be ideal.

Hope this helps OP
 
I'd say ER morphine sulfate is your best bet; probably around 800mg per day with your current dose of IR oxycodone remaining the same. Or as you mentioned, fentanyl could be a viable option. Discuss it with your doctor and forulate a strategy that will adequately manage your pain while not causing you any added discomfort.
 
Things to consider with fentanyl:

1) It's much more dangerous, due to it being incredibly potent.
2) The patches suck, they are flimsy and certain factors like heat can cause dangerous amounts of fentanyl to be released.
3) Many users experience a moderate to pretty severe withdrawal while waiting for the new patch to kick in.

I vote fentanyl as very last line treatment, use morphine instead, much better. It's the gold standard for a reason.

Your doctor can tell you about all of this, I suggest you raise your concerns with him.
 
Thanks a bunch for all the suggestions guys. I just want to make sure you are all aware that I have been insufflating the Opana, not taking it orally. I generally dose 80mg in the morning and 120mg in the evening, with the oxycodone orally as needed for breakthrough pain. As far as I am concerned, I have QUITE the opiate tolerance...especially to oxymorphone. So when you suggest switching to hydromorphone and/or morphine are you guys referring to using that much nasally or orally? Also, what kind of hydromorphone/morphine is available in such large doses? Is Jurnista available in the US (I believe that goes up to 64mg but it is impossible to break the time release, correct?)

Sorry, I'm not naive when it comes to opiates at all, I have just been on the same regimen for a while now. I didn't think I would have to worry about making a switch from opana cause honestly it WAS the only thing that allowed me to live a normal life (I am a pre-law student about to graduate...so you can imagine all of the stress in my life at this time). Chronic pain sucks; to say the least. If you ask me, it's absolutely rediculous what Endo is doing with these reformulations, they are complicating SO many peoples lives and for what? Sorry for the rant....

Any further suggestions would be GREATLY appreciated. Thanks a lot guys....
 
A friend of mine just told me all you need to crush the new opanas is a dremel. If there is another way other than dremel ? Let me know, thanks^^
 
As I said, I would definitely consider looking at methadone. Until I had my spine fused in 2011 I thought it was strictly a maintenance drug; However post operatively it worked somewhat better both as an IV medication (with hydromorphone and morphine) and as 10mg pills for 6 months afterwards. After my latest fusion I am currently taking 60mg of methadone a day with either oxycodone 30mg or dilaudid 4mg and the combination has been very effective,

And this is after having titanium implanted into my vertebrae after a bonesaw cut through my spine!
 
(http://1.usa.gov/Hx0dU8)
Above link lists all your options available in the US for ER meds.

I also recommend ER morphine. Its crushable , potent, cheap, & readily available in high doses.

Also consider Activis makes a generic Opana ER that is still crushable but only up to 15mg, your doc has to specificity RX that dose and not many pharmacies will have it. Or you could switch to the generic 10mg IR.
 
BiggDirty01 said:
As I said, I would definitely consider looking at methadone. Until I had my spine fused in 2011 I thought it was strictly a maintenance drug; However post operatively it worked somewhat better both as an IV medication (with hydromorphone and morphine) and as 10mg pills for 6 months afterwards. After my latest fusion I am currently taking 60mg of methadone a day with either oxycodone 30mg or dilaudid 4mg and the combination has been very effective,

And this is after having titanium implanted into my vertebrae after a bonesaw cut through my spine!
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I doubt methadone would work effectively for me. And I wasn't aware that you could take methadone AND a full agonist together on a daily basis. Doesnt the methadone and oxymorphone/oxycodone/hydromorphone/etc counteract one another, at least to a certain extent?

I haven't had much of a past experience with methadone but when I have, I remember feeling somewhat nauseous and queesy.

I think that switching to hydromorphone would be my best bet, but I don't think there is a dosage high enough available in the US that would work for me. Converting nasal oxymorphone of ~240mg daily to hydromorphone is an extremely high daily allotment, right? And if the highest dosage per pill is 16mg of hydromorphone then I would need too many pills per day and per month. Am I right?

This is so frustrating!
 
In terms of analgesic quality, methadone w/ hydromorphone or oxycodone (for me) does not counter act the effects; it absolutely magnifies them. It may somewhat dilute the 'buzz' with methadone's highly sedating sensation compared to for instance oxycodone which is generally regarded as a somewhat stimulating opioid.

I would not discount the potential of methadone as a potent extended release analgesic. Also, the notion of getting prescribed hundred or more mg of hydromorphone seems somewhat illusory and unreasonable. I have been through many pain doctors (6) and a few less than reputable clinics and I've never heard of anyone getting rx'd anywhere near that high a dosage of hydromorphone. Even the dose of Oxymorphone seems somewhat ridiculous frankly -- not in that you might not need it and be in pain-- but in prescribed that amount of a top-tier opiate leaves you almost nowhere to turn in terms of alternative medication management. Your physician has done you a disservice in prescribing such copious amounts IMO, and any alternative will seem 'less than' per se because of it.

Good luck bro!
 
I would recommend morphine. It is the best pain medication there is, nothing has been proven better than morphine whether IV/IM or oral. Any clinical study you read putting morphine up against any opioid, morphine is always either superior or equal to the other in effectiveness. It's never ever less effective than any of the other opioids they put up against it.
 
Tell your doc you're snorting the opana. You won't be able to go to school or work snorting those without dozing off and you should never drive on all of those meds under any circumstance. Besides they're concave and you need a chemist to help you snort them now, but I'd tell your doc you're abusing drugs and want to try suboxone or something different. I'm not saying you have to stay in pain, but you don't have to be an addict either. Try pain management and tell them you're an addict. They will dtill manage your pain and the methadone clinic is free as a last resort. Why let opana and oxycodone control your life?
 
kokaino said:
I would recommend morphine. It is the best pain medication there is, nothing has been proven better than morphine whether IV/IM or oral. Any clinical study you read putting morphine up against any opioid, morphine is always either superior or equal to the other in effectiveness. It's never ever less effective than any of the other opioids they put up against it.
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yea, he needs oral morphine CR. he could easily overdose being an addict with IV/IM. what were you thinking lol?! and pain management so they can give him a few pills at a time, suboxone, or methadone. I heard they're taking Opana off the market. My doctor mentioned it, but my pharmacist says no. Is this true or false?
 
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