Opioids Why KNOLL (and only Knoll) Dilaudid is safer to inject

[honeywhite]

A few days ago, I went to a garden party. I was fortunate enough to become acquainted with a very nice and very knowledgeable physician of German extraction. This gentleman was into retirement age but still in practice as it is his passion. As the hours ticked by, the conversation naturally flowed to one specific opiate, and I learned some interesting history. I'll put it out for you here, plus fill in some gaps that I researched out of pure boredom.

Dihydromorphinone, or hydromorphone, was discovered by a company called Knoll. It was, until relatively recently, a subsidiary of BASF, which is itself a quasi-subsidiary of Interessen-Gemeinschaft Farbenindustrie, aka IG Farben (which technically isn't a corporation in the English sense of the word---closer to a price-coordinating cartel). IG Farben, at last count, had well over half a million employees. Anyway, Knoll was sold to Abbott, which is a drug manufacturer (IG makes mostly dyes, photographic film, magnetic tape, the teflon that shopping bags are made of---which is why teflon is called Igelit in German---Zyklon B and Uragan D2 HCN fumigants---it's the German equivalent to DuPont). What's this got to do with anything? Fuck all---I'm just including it here for completeness.

EDIT: The rights to make Dilaudid were recently sold to Purdue Pharma, the kind folks who brought you OxyContin, CodeineContin, HydromorphContin, and MSContin. The new imprint is a capital P; the formulation is the same as ever.

Anyway, before 1970-ish (right around the time medicine started being sold in metric units), wet Dilaudid ampoules for injection were rare. As in hen's teeth rare; they were perishable and mostly sold to hospitals and the like. For field-expedient use, in first-aid kits and the like, you'd usually find a glass tube of Dilaudid Hypodermic Tablets. You would use them as follows: you'd empty a 1/2 dram ampoule of Water for Injection BP into a clean container. You'd then drop in as many Dilaudid Hypodermic Tablets as needed (1/32 grain, 1/16 grain, and 1/8 grain strengths) into the container, and stir with a glass stirring rod. You'd then inject the medicine as usual.

When the production of wet ampoules became more common, hypodermic tablets went out of production. Except not really. The packaging was changed to remove the word "hypodermic", but the ingredients and production method remained the same. If you get Knoll Dilaudid on prescription, identifiable either by the letter K, P, or lowercase letter a on one side, you are getting LITERALLY the same tablets as used to be used BY DOCTORS for injection. Therefore, minimal harm is engendered by using the tablets for their original intended use.

One more opiate is sold in this fashion. In the UK, it's sold under a plethora of brand names. Here are just a few: Diacephin, Diagesil, Diaphin, Diaphorm, and Morphacetin. Bayer also produces it as Heroin; there are 10 and 30 mg dry ampoules (to be mixed with Water for Injection as detailed above), and 10 mg no-longer-advertised-as-hypodermic tablets (ditto). Morphacetin et al. have largely displaced the other salts of morphine (sulphate, tartrate, phosphate, hydrochloride) in clinical use, especially in paediatric and oncological use.

 

[honeywhite]

I hear you that tablets with minimal excipients designed for dissolution and injection are the bees knees but I seriously doubt that any pharmacy in the States at least, is going to stock it. Being in the midst of the opioid crisis has seriously messed up the doctor patient relationship as pharmacists now play the role of drug police. I can't even get generic Roxicodone that doesn't have 400mg of extra fillers to make it abuse resistant. If I were able to find a pharm that would order these Knoll brand dillies my insurance would never cover it anyways making it more costly that gold, weight for weight.

Interesting story though. Is that pic 80-90 years old?...as measuring things in grains (60 mg-ish IIRC) has gone out of style some time ago.

Hint: ask for Purdue Pharma dillies instead. Same company, same formulation. It's aka brand name Dilaudid with a capital D.

As far as I know the Knoll brand Dillies are THE MOST common in the USA. They definitely are in Canada; the pharmacist straight out asked me if I wanted Knoll or Apotex hydromorphone and I asked for Knoll.

The picture is from any time before the early 70's. Hypodermic pills were out of use by 1969.

They look like this (left hand side):

Still sold.

1 gr = 64mg. That is why dilaudid is still sold as 1, 2, 4, and 8 (i.e 1/64, 1/32, 1/16, 1/8).

Note that the imprint changes; at one point, original Dilaudid was marked with a cursive K, then a lowercase a (for Abbott), and now (apparently) a P (for Purdue Pharma?) What matters is the COLOUR of the pills. 2mg ones are yellow and 8mg ones look like a Reuleaux triangle (i.e. the rotor in a Wankel engine).

 

[Jekyl Anhydride]

Looks like they only have anhydrous Lactose and Magnesium Stearate with a dash of Sodium Metabisulfite. Not bad as far as pills go as some have 2 dozen inactives in them. I am going to change the title of this thread to "Diluadid is safER to inject" as no pill is truly safe to IV, not anymore at least.

 

[honeywhite]

Looks like they only have anhydrous Lactose and Magnesium Stearate with a dash of Sodium Metabisulfite. Not bad as far as pills go as some have 2 dozen inactives in them. I am going to change the title of this thread to "Diluadid is safER to inject" as no pill is truly safe to IV, not anymore at least.

These were sold as pills FOR INJECTION, so I'd call that "truly safe to IV". The packaging was changed to get rid of the words "for injection" but the pills are still made of the exact same chemicals in the same proportions. You may disagree and I won't hold it against you.

 

[Ejizme]

i see the two here in the states a lot. the most recent to hit now have two d's on them and are the same shape(we call them triangles around here).
there are also a few others that are round.
everyone here has always said the yellow 4mg are THE BEST and you can 'cold shake' them(put them right into the back of your rig with water and shake).
i personally do not believe in 'cold shaking' anything. ive seen it done with the P's and one of the round brands too.
none of my friends are scientifically knowledgeable at all, so ive never reallly trusted them about the whole 'cold shake' thing but there must be something to it.

 

[LucidSDreamr]

I've banged all those types of dillies except the peach 2mg and cursive Ks

 

[EP158207]

This is actually really interesting even though we dont have Dilaudid here in the UK.

 

[Atreus]

Swim gets his script of dillies tomorrow and needs to know if they have these good ones you speak of in the states and which ones swim should ask for. Swim gets 115 8mg dillies every 2 weeks and would like to make the most of these while swim is still getting them

 

[Jekyl Anhydride]

I get his script of dillies tomorrow and needs to know if they have these good ones you speak of in the states and which ones I should ask for. I gets 115 8mg dillies every 2 weeks and would like to make the most of these while I still get them

This is the pill the OP is discussing, that is available in the US.

Pill with imprint P d 8 is White, Three-sided and has been identified as Dilaudid 8 mg. It is supplied by Purdue Pharma LP. (Inactive ingredients) Lactose anhydrous, Magnesium sterate, Sodium Metabisulfite.

While IMO no pill is safe to inject, these seem to be safer than other brands. Micron Filtration is always recommended along with safe injection practices, IF that was your intention.

---

Please don't use SWIM on BL and edit it out of the above post , Thanks. Why-we-don-t-use-SWIM-MEGATHREAD

 

[fairnymph]

I wouldn't want to inject magnesium stearate. I don't even like using it topically or consuming it in supps.

 

[NewJerseyChill]

So hard to get in jersey. The most delicious opiate.

 

[Nicomorphinist]

I spoke to a chemist shop owner in the United States who said she is not aware of any formulation changes to hydromorphone tablets in the last 10 years with the exception of Roxane making a very short-lived and poorly-received change in 2009 and now their hydromorphone tablets are once again almost zero-residue, as in almost like the old hypodermic tablets. Hydromorphone tablets seem to either dissolve totally, dissolve totally with a bit of a plastic scum forming on the surface as the solution cools, or dissolve leaving behind a simple powder which can be filtered out if need be. One could decant the solution, but why do that when one can filter it?

Folks who work in a hospital dispensary in Chicago and in a compounding pharmacy in Montréal tell me that at least at wholesale the morphine cubes like in the old days (why they call it Cube Juice) are said to still be available. The cylindrical tablets of 5, 10, 15, and 30 mg (but just in plastic bottles, not the glass tubes) are actually more common both for compounding, and at least in the past, given to patients so they can, usually, take them sublingually or dissolve them in lemonade and drink them.

That, the cubes, is how I got my morphine in Austria and elsewhere in Europe for a while and in the USA in the 1980s in some cases. Then the cylindrical tablets for a while into the XXI. Century, then ampoules of M after the solu-tabs and hypodermic tablets disappeared after some problem with the monsoon in India screwing with the poppy crop long about 2005, which also meant I couldn't get laudanum for a few months because the same company made it. When all they had for me were oral tablets with all sorts of sugars and fillers and coatings and colours and all that, the doctor just told me to eat 8 times as much until they could solve the problem, and it worked. The morphine lasted longer PO too. The next week she wrote for Numorphan ampoules and that did the trick nicely.

The cubes used to come in a box of ten foil squares of one hundred 10 mg morphine hydrochloride (in Europe, or sulphate or tartrate in the States), so a small square box of a thousand cubes of morphine adding up to 10 grammes of the stuff. I have a photo some place of a script the head of the hospital dispensary once gave me of three of these boxes with the stamps sealing the boxes still intact and everything, and ten glass tubes of hydromorphone hypodermic tablets and a big box of Vilan (nicomorphine) ampoules. Seeing that much M in one place made me feel very warm and fuzzy.

Only one time did I see a bundle of 20 glass tubes of 20 hypodermic tablets of 20 mg of dihydromorphine HCl. . . that was a looooong time ago too . . .

When doctors prescribe injectable hydromorphone, it is usually in the form of boxes of ampoules, which come in 1, 2, 4, 5, and 10 mg/ml, and compounding chemists and hospital dispensaries can use pure hydromorphone powder to come up with alternatives as well as aqueous solutions up to 333 mg/ml if there were any reason to do so. When I was in the States and had a script for Dilaudid HP, I would go pick it up at the hospital dispensary and the bottle had 50 ml; in Canada I was able on a couple of occasions to get multiple bottles of it, but in the US I would finish my bottle, take it back for a $3 deposit, then get my new one, generally every 5 to 12 days when I was on the highest dose. If I had not had a bunch of those nerves down-regulate or croak, I am not sure what I would have to do these days -- maybe get the pure hydromorphone powder and put it in my soup like pepper or something? Get them to do an off-licence script for a manufacturer to make a special batch of 14-methoxymetopon? I was very interested in that osmotic engine they can implant with 90 days of hydromorphone, but back then in my case, the one they would have to build for me would have to be the size of a large screwdriver, and where could they implant it?

The case I mentioned of the doctor who gave the finger to the insurance company by switching his patient to one Rx a month for 480 4mg hydromorphone tablets which can also be injected is also in the USA. I probably oughtn't to mention the manufacturer. They called these multi-purpose tablets and are used for PO, SL, SC, IM, IV administration and can be used in the nose and up the arse too, but as they are not the old hypodermic tablets in the glass tubes, I did say that to make sure, she should do the mixing in one syringe, then pull it into the one she will use with a wheel filter.

Back in the day, Dilaudid came also in tablets of up to a grain which were used both for people and animals, so there were 16, 24, 32, 48, and 64 mg Dillies way back when, possibly 12, 30, 36, 45, 56, and 60, and 0.5 mg hydromorphone tablets were around until recently too. I heard once about 72, 96 and 128 mg Dilaudid tablets but never was able to find any information.

The ne plus ultra human prescription I have heard about was a cancer patient who has survived for 20 years and now things are actually getting noticeably better quite rapidly -- the oncologist typed up the script for an entire 5 gramme bottle of pure lipophilysed hydromorphone powder with the instructions to encapsulate the most of the powder in a few different doses for ad libitum use for pain and dissolve the rest of it in distilled water 1:1000 with lime-flavoured syrup for PO administration for same and delivered it to the compounding pharmacy and then gave the patient a script for Dilaudid HP with 3 cc syringes with 25 gauge needles for nighttime to take with Xanax.

A pharmacy professor also tells me that Brompton Mixture is still used in many places including the USA for outpatient cancer pain management, home and hospice pain management, and some extreme cases of permanent neuropathic pain from injuries and some infections. Usually the ingredients are morphine (hydromorphone is also common and methadone is used too; diamorphine where available and sometimes phenadoxone or morphine plus pethidine), cocaine, prochlorperazine (though cannabis tincture is expected to once again become common as it was before 1942 in the United States for this use), anhydrous ethanol (gin or vodka too) and one flavour or another of syrup and the distilled water to bring up the volume so very precise dosing can be done. Old school doctors and chemists do call for the chloroform water too, and it is not uncommon for methylphenidate or dextroamphetamine plus caffeine plus a mixture of lignocaine, bupivacaine, and tetracaine to be used instead of cocaine if it cannot be obtained and used.