Sorry this is so long, but I tire of all the replies from people that know not their facts but rather state what THEY feel is right. It don't matter what we think but rather it is what it is.
Hope this can help clear up at least some misconceptions.
Morphine vs Hydromorphone vs Oxycodone vs the Fentanyl Patch
w/side notes of others
The spectrum of available opioids has increased. Why do we need alternative opioids?
o
Concept of individual variability in opioid response
- relative intensity of analgesic and toxic effects
- spectrum of toxicities experienced
varies with different opioids within the same individual and between different individuals on the same opioid
May be due to:
•Genetically - determined expression of opiate receptor subtypes
•Incomplete cross-tolerance 2nd to differential receptor subtype affinity or efficacy
• Opioid metabolite accumulation
•Pain mechanism - specific opioid response
Recent proliferation of reports -->improvement in analgesia-toxicity balance with opioid switch.
Morphine: (immediate release -
Morphine HP, Statex, MOS, MS-IR, Morphitec; slow release -
MS Contin, M-Eslon, MOS-SR, Oramorph SR,
Kadian)
• preferred routes: oral, subcutaneous, rectal
•the standard/benchmark opioid, usual first choice
•
10x more potent mg for mg than codeine
•parenteral maximum concentration: 50 mg/ml
Hydromorphone: (immediate release - Dilaudid, PMS-Hydromorphone; slow release - Hydromorph Contin)
• preferred routes: oral subcutaneous, rectal
•
approx. 5x more potent mg for mg than morphine
•parenteral maximum concentration: 100 mg/ml
•the usual alternative to morphine
Oxycodone: (immediate release - Supeudol; slow release -
OxyContin)
•preferred routes: oral subcutaneous, rectal
•originally introduced in combination with ASA (Percodan, Oxycodan, Endodan) or
Acetaminophen (Percocet, Oxycocet,
Endocet,
Roxicet) for moderate pain.
•hallucinations reported in studies.
*
approx. 1.5x more potent mg for mg than morphine (controversial/due to multitudes of factors including, but not limited to:
morphine introduced to a healthy 25 year old male with no/miniscule experience with opioids loses 45-75% potency factors during liver metabolism.
Morphine also acts as a "depressant" on the system whereas Oxycodone and Hydrocodone act as "stimulants", both situations being main categories for misunderstandings and false pre-tenses when giving information to patients or colleagues as to which opiate is "better".
Ultimately, the facts remain that Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine.
Thebaine (paramorphine) is an opiate alkaloid. A minor constituent of opium, thebaine is chemically similar to both morphine and codeine, but has stimulatory rather than depressant effects, causing convulsions similar to strychnine poisoning at higher doses.[3] Thebaine is not used therapeutically, but can be converted industrially into a variety of compounds including oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, buprenorphine and etorphine.)
•parenteral maximum concentration: 50-60 mg/ml
Fentanyl: (transdermal -
Duragesic; parenteral - Sublimaze)
•high lipid solubility
•
50-100x as potent as morphine
•transdermal patch convenient in patients with stable pain control. Caution advised in uncontrolled pain syndromes (not suitable for rapid titration)
• possible in constipation and sedation
•GI withdrawal syndrome described with switch to patch
•conversion ratio uncertain (use published conversion table)
•no convenient form for rescue doses
•subcutaneous infusions pump needed for continuous infusion high cost of drug
Consider switching drug when opioid toxicity develops (ESPECIALLY IF ONE IS USING
DEMEROL AS DEMEROLS METABOLITE. Pethidine (Demerol) may be more likely to be abused than other prescription opioids, perhaps because of its rapid onset of action. When compared with oxycodone, hydromorphone, and placebo, pethidine was consistently associated with more euphoria, difficulty concentrating, confusion, and impaired psychomotor and cognitive performance when administered to healthy volunteers. The especially severe side effects unique to pethidine among opioids — serotonin syndrome, seizures, delirium, dysphoria, tremor — are primarily or entirely due to the action of its metabolite, norpethidine.); accumulating with regular administration, or in renal failure. Norpethidine is toxic and has convulsant and hallucinogenic effects. The toxic effects mediated by the metabolites cannot be countered with opioid receptor antagonists such as naloxone or naltrexone and are probably primarily due to norpethidine's anticholinergic activity probably due to its structural similarity to atropine though its pharmacology has not been thoroughly explored. The neurotoxicity of pethidine's metabolites is a unique feature of pethidine compared to other opioids.)
eg: sedation, delirium, hallucinations, myoclonus. calculate an equianalgesic daily dose of the new opioid, reduce this by 20-30% to account for incomplete cross tolerance between opioids, divide into multiple daily doses at regular intervals (q4h for immediate release opioids). Provide approx. 10% of the total daily dose available as a rescue dose.
-Personally I have been taking LEGAL prescribed Pain medication daily since 2004. I've been prescribed every dose of just about every available pain reliever sold in the US. For pure unadulterated and legitimate PAIN RELIEF, Fentanyl Patches and/or some
Actiq lozenges are the undisputed top dog for continuous relief but every couple of days breakthrough pain can kick in and something strong, fast acting, and relatively short lived is mandatory. I personally find 2x
Norco 10/325 (10mg hydrocodone) with 100mg
Tramadol to be optimal in effectiveness. Oxycodone may be stronger, but for me the Euphoric effect is long time coming, short lasting, and the withdrawals of Oxy are FAR worse than hydro. Occasionally I pick up a gram or so of herion just to shock my system because when you continuously take these short duration opiod and opiod-like pain meds tolerance is inevitable so you must get into the groove of switching out on occasion because none of the meds on earth last forever.
And a note on drug Scheduling: which really has nothing to do with potency but rather the legitimacy of its construants:
2. Drug schedules
The Misuse of Drugs Regulations 1985, made under the Act, divide the controlled drugs up in a different way to take account of the needs of medical practice. They define the classes of persons who are authorised to supply and possess controlled drugs while acting in their professional capacities and lay down the conditions under which these activities may be carried out. In the Regulations drugs are divided into 5 schedules each governing such activities as import, export, production, supply, possession, prescribing, and record keeping which apply to them. Details of the schedules are as follows:
Schedule 1, the most restricted drugs, (eg, LSD and cannabis), can only be supplied or possessed for research or other special purposes by people licensed by the Home Office; these drugs are not available for normal medical uses and cannot be prescribed by doctors who do not have a licence.
All the other drugs are available for medicinal use. Most are Prescription Only, so they can only be obtained if prescribed by a doctor and supplied by a pharmacy (eg, strong analgesics like morphine, stimulants like
amphetamines or
cocaine, tranquillisers and most sedatives). Some very dilute, non-injectable preparations of controlled drugs - because they are so unlikely to be misused - can be bought over the counter without a prescription, but only from a pharmacy (eg, some cough medicines and anti-diarrhoea mixtures containing opiates). Medicines available in this way can also legally be possessed by anyone. The same also applies to benzodiazepine tranquillisers and hypnotics (except
temazepam and flunitrazepam) even though these drugs can only be legally obtained on prescription.
Schedule 2 includes such drugs as diamorphine (heroin), morphine, pethidine, cocaine. These are subject to the full controlled drug requirements relating to prescriptions, safe custody, the need to keep records, etc.
Schedule 3 includes the barbitrates (except secobarbital, now in schedule 2), buprenorphine, pentazocine, the tranquillisers nitrazepam and flunitrazepam. These are subject to the special prescription requirements, but not, for the most part, to the safe custody requirements, nor to the need to keep registers.
Schedule 4 includes benzodiazepines (other than flunitrazepam and tamazepam which are now in schedule 3) and anabolic steroids. Controlled drug prescription requirements do not apply and Schedule 4 Controlled Drugs are not subject to the safe custody requirements.
Schedule 5 includes those preparations which because of their strength, are exempt from virtually all Controlled Drug requirements other than retention of invoices for 2 years.
Additional regulations (the Misuse of Drugs (Supply to Addicts) Regulations 1997) effectively restrict the ability to prescribe heroin, dipipanone and cocaine for the treatment of addiction to a few specially licensed doctors. Solvents are not classified under the Act.
6Likes
Oxycodone Vs. Hydrocodone 
reply 
patch idea 
which should be permanent.
Morphine vs Hydromorphone vs Oxycodone vs the Fentanyl Patch 
Linear Mode
