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Opioids Oxycodone for Coronavirus, will Oxy ease any of the symptoms?

sekio

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I'm not suggesting anyone starts shooting heroin pr doing other opioids if they come down with COVID19. I'm just pointing out that contrary to what people believe, morphine does have some use in relieving the effort of breathing in patients who are pained from it (lung infecions, cancer, ventilator use, palliative care etc).
 

copium7777

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I'm not suggesting anyone starts shooting heroin pr doing other opioids if they come down with COVID19. I'm just pointing out that contrary to what people believe, morphine does have some use in relieving the effort of breathing in patients who are pained from it (lung infecions, cancer, ventilator use, palliative care etc).
A lot of people fail to realize that palliative care is more than just relieving "pain", there are all sorts of niche symptoms of discomfort that can be very bothersome. and palliative care docs have discovered the treatments for some of these, like dyspnea. You are correct and it shouldn't be controversial to say

Although with people that have actual low spo2 /pneumonia I'm guessing the opioids are being used a lot more Judiciously... however I don't think they put people on ventilators without pain meds and sedation, ever , even if they're in respiratory distress.
 

sekio

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however I don't think they put people on ventilators without pain meds and sedation, ever , even if they're in respiratory distress.

I would hope not. I can imagine that being very uncomfortable.

Conveniently, being on a ventilator removes the one major risk of opioid use at high doses, as well. I would argue they have an obligation to pump me full of narcotics if they're going to abuse my windpipe. I am not suited to audition for Deep Throat after all...

A lot of people fail to realize that palliative care is more than just relieving "pain", there are all sorts of niche symptoms of discomfort that can be very bothersome.

Palliative care is arguably one of the few medical practices where I see shades of "heroic medicine" still persisting. For instance, "Brompton's cocktail" was once given to the dying. It was effectively a mixture of every euphoriant drug the physician could manage to supply. The classical recipe calls for morphine or heroin, cocaine, chlorpromazine, strong ethyl alcohol, and chloroform as active ingredients (with some simple sugar syrup and flavoring added, for all the good that would do), but often substitutions or additions were made. Wiki: Some specifications for variants of Brompton cocktail call for methadone, hydromorphone, diamorphine (heroin), or other strong opioids in the place of morphine; diphenhydramine or tincture of cannabis in place of the chlorpromazine; and methamphetamine, amphetamine, dextroamphetamine, co-phenylcaine (lidocaine and phenylephrine hydrochloride), methylphenidate, or other stimulants in the place of cocaine.

Now, in any other context, someone trying to fill such a prescription would be laughed out of the pharmacy. Most people wouldn't even believe such a thing could ever have a use outside of a really wild party (those sorts of parties, you know, the kind you don't get invited to), but yet it works to give those in their final days as a mortal a more comfortable time.

It seems like a more benevolent cocktail of pharmaceuticals than some of the medications used today. I would rather be speedballed to death than have my soul smothered slowly by benzodiazepines and antipsychotics, living my last days in a fog of amnesia with no recollection of the present.
 
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copium7777

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I would hope not. I can imagine that being very uncomfortable.
I don't think it's even just confined to putting people under for the initial period they're on the vent. It seems like they like to keep people somewhat sedated the whole time they're intubated as it's uncomfortable to be sick and feverish with a tub down your throat and some patients RIP it out.

Unsure how they determine the safe amount of morphine or propofol or midazolam when a patient has severe covid pneumonia but evidently they do use them.

There is a possible shortage of these bc of "just in time" fragile supply chains being hit by the pandemic: https://www.thebureauinvestigates.c...tages-put-worst-hit-covid-19-patients-at-risk

Intubation. Sounds very unpleasant, I personally made a living will specifying I wouldn't get intubated
 

sekio

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There is a possible shortage of these bc of "just in time" fragile supply chains being hit by the pandemic

A lot of opioid medications are produced in several locations globally. I know for instance there's opium produced commercially to some extent on every continent, save for Antarctica. Then there's also synthetics, which could be produced basically anywhere. On top of that the US has a strategic stockpile of many medications needed to keep the population healthy. Narcotics are part of this stockpile, even if they don't announce it.

Another possible stopgap could be an extension on the shelf life/"use by" dates on stocks of existing medicines. It is known that most pharmaceuticals are very stable when stored in typical conditions (away from the elements, in sealed packages) even over extended periods of time. Even assuming exposure to light/heat/air, breakdown would be slow and gradual, and the predicted breakdown products of medications are often inactive, even identical to the metabolism products made by your body, so you'd have a marginally less effective drug. If you're treating a bruised arm with ibuprofen, it's not a concern. If it's really, really important that the dose be known then analysis can be done to check. The end goal would be a reduction in the amount of medications that are destroyed after going unused, despite still having utility.

If critical medications like methadone, naproxen, amoxicillin etc start to become scarce then it will not happen in the blink of an eye. There will be fair warning, and at least some opportunity for manufacturers to adapt. Maybe substitutions will need to be made, either in terms of dose form (liquids instead of pills, multiple smaller dose tablets rather than larger single doses, etc) or outright choosing more readily available medications. That might mean XR morphine uers being moved to IR morphine or oral methadone/transdermal fentanyl, as supplies dictate. But I don't think it's something to lose sleep over right now.

I personally made a living will specifying I wouldn't get intubated

It's a hard choice, but I'd rather suffer through intubation than asphyxiate.
 
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G_Chem

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sorry if i missed something; but he did say opiates will help manage symptoms. Opiates are not part of the doctors protocol in treatment of covid in any hospital..not even if patient is dying. i checked.

Yea they also won’t give people dying of cancer opioids nowadays either... I checked.

-GC
 

CfZrx

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copium7777

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interesting!
Yes, the effect is well known. My grandfather had heart failure caused by years of chemo and cancer stress on his heart i guess, and sepsis , he was discjarged to hospice , they gave him morphine and oxygen for his air hunger. Even though he was dying they still let him have his oxygen for palliative purposes.

I wish i couldve been there and i still regret not being with him and getting to talk to him before he died so much. It was very sudden and i was very ill on other side of country
 

Wilson Wilson

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Thanks @debored13 and @sekio for all that knowledge, some very interesting info on the medical use of opioids in hospitals here.

It is also true that opioids can paradoxically open the airways and help breathing - they used to use opium for asthma.

Before someone else gets down my throat I never once said "anyone who gets Covid should take opiates" I am simply guessing, as even the doctors are right now, at what the effects could be, and I threw in my experience since I had symptoms and codeine helped to ease them. If someone has breathing difficulties I would say definitely don't take opiates outside of a medical setting.
 

MsDiz

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Just to state, they will not intubate a conscious patient in a hospital setting. You’re being sedated for the duration of time needed for intubation.
 

sekio

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Aren't paralytic agents sometimes employed to intubate people as well, to make tube placement easier and reduce laryngospasm? (As if you could make the process any more stressful!)
 

G_Chem

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All people with cancer? That sounds like an overgeneralization

wtf!? really? Who was it you knew of or heard about?

yes, it does appear that way.

I just went through a cancer diagnosis that involved some fairly painful surgery this past winter. The most they gave me was Gabapentin (which is a joke, ibuprofen works better.) It took me 4+ months of healing, I couldn’t leave my room for a month.

To be fair, I had an opioid problem over 10yrs ago but I’m about as stable as they come. This is why I had to source my own opioids and manage my own pain. (Which I did so successfully followed by a taper and cessation.)

My friend is battling leukemia, it’s not looking great at times for him, he uses kratom.

I know 3 other people in my life with nasty cancer diagnosis they have been given a pat on the back and “good luck.”

I’m guessing we might see them if we’re ever 3-5 days from death, then and ONLY then will they be acceptable because in their eyes we’re dead anyways.

-GC
 

Wilson Wilson

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I just went through a cancer diagnosis that involved some fairly painful surgery this past winter. The most they gave me was Gabapentin. It took me 4+ months of healing, I couldn’t leave my room for a month.

To be fair, I had an opioid problem over 10yrs ago but I’m about as stable as they come. This is why I had to source my own opioids and manage my own pain. (Which I did so successfully followed by a taper and cessation.)

My friend is battling leukemia, it’s not looking great at times for him, he uses kratom.

I know 3 other people in my life with nasty cancer diagnosis they have been given a pat on the back and “good luck.”

I’m guessing we might see them if we’re ever 3-5 days from death, then and ONLY then will they be acceptable because in their eyes we’re dead anyways.

-GC

What country? I can imagine the NHS going this route these days sadly. Despite not having any widespread prescription opioid problems in the UK they seem to have looked at the US, got themselves all scared of lawsuits, and started getting real strict on opiates recently. It is very recent too like in the past year or two. I used to be able to get opiates easily. But I had surgery with painful recovery not too long ago and had to fight to get anything that wasn't OTC. Last time I was in such a position, a good few years ago, they pretty much threw opiates at me without any fuss. Things seem to have changed.

Same thing with both NHS and private health too, so it seems like it's the actual docs turning against opioids rather than order from the top (i.e. stricter NICE guidelines) forcing a change.
 

evo4ever

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What country? I can imagine the NHS going this route these days sadly. Despite not having any widespread prescription opioid problems in the UK they seem to have looked at the US, got themselves all scared of lawsuits, and started getting real strict on opiates recently. It is very recent too like in the past year or two. I used to be able to get opiates easily. But I had surgery with painful recovery not too long ago and had to fight to get anything that wasn't OTC. Last time I was in such a position, a good few years ago, they pretty much threw opiates at me without any fuss. Things seem to have changed.

Same thing with both NHS and private health too, so it seems like it's the actual docs turning against opioids rather than order from the top (i.e. stricter NICE guidelines) forcing a change.

Funny that cos my GP still has my 120mg Oxy script on repeat and he always fills it when it's due. He doesn't know I'm quitting tho lol.
 

G_Chem

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What country? I can imagine the NHS going this route these days sadly. Despite not having any widespread prescription opioid problems in the UK they seem to have looked at the US, got themselves all scared of lawsuits, and started getting real strict on opiates recently. It is very recent too like in the past year or two. I used to be able to get opiates easily. But I had surgery with painful recovery not too long ago and had to fight to get anything that wasn't OTC. Last time I was in such a position, a good few years ago, they pretty much threw opiates at me without any fuss. Things seem to have changed.

Same thing with both NHS and private health too, so it seems like it's the actual docs turning against opioids rather than order from the top (i.e. stricter NICE guidelines) forcing a change.

I’m US, but I have heard things are beginning to change over there for ya’ll too.

I have a doctor as a fiancée and a few doctors in the family too. Their mindset is that opiates should only be used in low doses for 1-2 weeks in the most extreme cases. Doctors over here are beginning become kind of cold to people because it only takes one addict trying to get pills to sour them completely.

In fact she was none too happy that I decided to take pain management into my own hands, using a heroin analog due to its high oral BA compared to morphine. She’s still mad at me if I bring it up even though I used them for a month and quit just as I said I was going to do.

-GC
 

MsDiz

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Aren't paralytic agents sometimes employed to intubate people as well, to make tube placement easier and reduce laryngospasm? (As if you could make the process any more stressful!)
Paralytic agents are pretty much essential to for intubation along with sedation. Rapid sequence intubation is the standard now for emergency departments. Something like ketamine is given and then a paralytic like succinylcholine.
Sedation is mandatory when intubating I’m nearly sure. Will have to double check that again.
 

G_Chem

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Paralytic agents are pretty much essential to for intubation along with sedation. Rapid sequence intubation is the standard now for emergency departments. Something like ketamine is given and then a paralytic like succinylcholine.
Sedation is mandatory when intubating I’m nearly sure. Will have to double check that again.

Pretty sure this is what they did to me for surgery over winter. Ketamine for sure. I wasn’t a fan of the K legs lasting an hour after I woke up..

-GC
 
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