Wanting to make the switch to hydromorphone

[Synack]

Currently I'm rx'd 15mg oxy QID PRN(4 times per day as needed for pain[duh]) and 10mg oc's BID(twice a day), That's 80mg a day, but I usually use about 95 - 110 (up to 200mg on a real bad day) and I'd like to switch to hydromorphone. I've tried IV'ing but I have a family on the way so I won't get into that.

Tomorrow I'll be seeing my girl's regular doctor with all my pain records until I can get into a clinic which will be months.

I think 8mg tablets ad lib would be perfect :D or ad lib injections...but that's not going to happen.

What dosing do you opio's feel would be equal to what I'm at now? This is for nerve damage and sadly, no amount of oxy I can take w/o falling out/asleep takes all the pain away..

Honestly, I'd be willing to do injections at home but I don't even know if that's legal..
I think 4mg pills, 6 times per day would be a good start or 8mg pills 4 times per day

This doc is not a pain doc, but I do have all of my records - how do I go about switching? In the hospital, when I go - I tell them morphine makes me itch so they give me hydromorphone instead..

I fully intend on breaking down at this visit, and telling this doc how horrible my quality of life is - water works, mentioning my extreme depression, ER visits, crisis workers, etc, etc.

PLUS hydromorphone is cheaper than oxycodone

So I need advice from the experts...

[pharmboy]

Here is a good narcotic converter

www.globalrph.com/narcoticonv.htm (http://www.globalrph.com/narcoticonv.htm)

Methadone is cheapest of all but I
prefer the buzz from hydromorphone
or oxymorphone.

[Synack]

Yeah, I did it off the top of my head using similar figures...

How's the levorphanol working out for you? I'm going to also ask about that as I did mention it to my old pain doc but its not in my records..

edit: AT THIS POINT, I DON'T CARE AT ALL ABOUT "GETTING HIGH", "RECREATIONAL VALUE" or ANYTHING OTHER THAN PAIN RELIEF

[CSiiSEQ]

~3 - 6 mg depending on how much cross-tolerance is factored in (that's converting 15 mg oxycodone po to hydromorph po)


[quote] Honestly, I'd be willing to do injections at home but I don't even know if that's legal..It's not illegal, but it's not likely either.


I think 4mg pills, 6 times per day would be a good start or 8mg pills 4 times per day 99% of the time it's written as q. 6 h, not 4.

[youwonhundred]

Just my two cents here, but even if your doc would switch to dilaudid, accepted pain management practice would not allow the doc to start with that much. I would bet that if you were lucky enough to get the dillies, you'd probably get 2mg's q 4-6 h. Based on the dosage converter, and the initial reduction of dosage for incomplete cross tolerance, 60 mg's of oxy works out to basically 12 mgs of hydromorphone per day. Your doc should titrate that upward based on any pain you still have, and any symptoms you are experiencing. Since this doc isn't a pain doc, I don't see him going through all that until you get in to the pain clinic, so as I said, 12 mg's a day is about the best I would expect (were I in your shoes) on the initial visit.

Also, keep in mind, many docs are a little gunshy (thanks to the fucking DEA) when it comes to Rx'ing CII meds, so my last bit of advice, you could tell the doc that you'd done some research on several drugs, and ask about them, but going in and straight out asking for dilaudid is a BAD idea. Even though you are just looking for pain control, asking for a drug by name is a red flag for docs. Doctors may be cruel sometimes, but they did go to school for a lot of years to learn their business, so they aren't stupid. You can suggest, or mention stuff you "researched," but going in with one drug on your mind is a mistake, and could just as likely get you tossed on your ass.

I would suggest printing out a bunch of info on several stronger opiates, as well as adjunct meds (muscle relaxers or those lidocaine patches or whatever) to make the opiates you do get go farther toward controlling your pain. Put simply, don't dwell on the opiates, just tell him what you have doesn't work as well as it used to, feel the doc out, mention the stuff you read about, but ultimately, let the doctor think he is in control. Docs are control freaks of the highest order, and you get farther letting them think they thought of everything. After all, they are the ones who went to med school for umpteen years.

I apologize for rambling on so much, but I kept thinking of stuff to add, so I suppose I should apologize for the possible incoherence of the post. Good luck, I hope you score the mother load, but tread softly all the same. Oh, for Gods sake, please don't use slang terms (dillies, oxy, percs, that sort of thing) Use the trade name or the chemical name when you make your "suggestions." Using street terms is a dead giveaway. I would think that is obvious, but some folks would surprise you.

Cheers.

[Synack]

That's really what I was thinking, I'm actually going in there main asking for anti-depressants with a suggestion from the hospital that I be place on dilaudid.. I was told this doc is compassionate, but who knowsl...

[Inspektahdek]

yea listen to youonehundred's advice and def come in and talk about NSAID relief as well like some motrin ibuprofen 800s or lidocaine patches so you look legitimate about pain relief and not just looking for narcotic increasements

[flipside]

That's really what I was thinking, I'm actually going in there main asking for anti-depressants with a suggestion from the hospital that I be place on dilaudid.. I was told this doc is compassionate, but who knowsl...


U-100 gave you the best advice you are likely to recieve. One more thing..if you are going to say the the reccomendation for Dilaudid came from a hospital..you better have the records to back it up.

Be sure to stress that the depression comes from you decreased quality of life..otherwise they could very well balme it on the narcotics..and could backfire.

I'm confused..who is writing your scripts now? And your reason for seeing this PCP ( we know it's for meds) but why does he think you are coming in? You said anti-depressants. If that's the case you may want to re-think your approach.

[Duckfeet]

One little side-note. Most docs I've run across--usually Veteran's Admin.--have totally froze up when they found out I had *any* history of mental health problems. Since they know most junkies eventually, inevitably end up under some kind of mental health pills/program, they are just gun-shy. If I told them I had depression they wouldn't give me shit. You can be in pain, but u better not have any other problems or they don't wanna fuck with u...IMHO....just gotta stick with the tried and true: "I'm in a lot of pain. What you are giving me does not work. I need something stronger." And all it's variations...After that it's just luck of the draw IMO.

[Synack]

this doc kicks ass.... and she basically asked me what I wanted and what she could offer..

I got 20 - 40mg OC's and 10mg opana.. TID

I also got resteril or something and wellbutrin.

no one was writing my meds... that's why I'm seeing this pcp...

[Markov]

Wow, that's excellent! Congratulations. If this doc is willing to keep you on that pm regimen, I wouldn't even bother switching to a pm clinic, unless she wants/expects you to. More hassle, more likely of an adverse change in your meds, etc.

Regarding what works for nerve pain, I have both nerve pain (L5, I've had a fusion and a billion injections, etc), and chronic kidney stones. I've taken oxy, fentanyl, morphine, opana, muscle relaxers, lidoderm... I could go on, but basically everything for nerve pain. I take dilaudid for the kidney stones. So I'm basically an n=1 clinical trial for what works for both conditions. Simply put, the dilaudid is excellent for the kidney stones, and doesn't do a thing for the nerve pain. (recreational/IV use aside). I find that Opana (my lover and friend), oxy & fentanyl (patches & or lollipops :) ) are the best for the nerve pain. All in all, I'd have to say that oxycontin at the right dose, or opana are the bestest best best for nerve pain, in my experience. Or a mix & match of the above for controlled-release & breakthrough pain, which is the best scenario, which appears to be exactly what you've received. I'd do everything you can to keep this snowball rollin' down the hill. Just make sure not to 'lose' any prescriptions, refill early, get narcs from other docs, or anything else that will spoil the stew.

[Synack]

Exactly, once I can afford it - the goal is opana ER 20 - 40 mg BID, and oxy 15's for BT and then switching monthly to the other Oxycontin 20 - 40mg BID and opana 10's TID for BT

[9177]

That's great, I get Oxycontin and Dilaudid for chronic pain, along with a few other things.
Been trying to get the medications right for years and finally just did.

[roxi*stardust]

Man keep the oxys, hydromorphone sucks orally. You will be disappointed with them if you just swallow or snort them. I am in no way advocating IV use but that is the only way I have ever felt hydromorphone, from a shot at the hospital. I do not IV but I have taken them orally and compared to the shot I got at the hospital, it was like taking a T3.

[oc80tn]

What a lot of people don't realize about Dilaudid (hydromorphone) is that is a very fast-acting opioid, but with the rapid onset of angalgesia comes the downside of not having a long half-life. The only two times I have received this in an IM or IV delivery are at the emergency room when I was having a flareup in my pain (both times for this, they gave it to me in the ass) and I got it in an IV formulation following my back surgery in a PCA pump. It was almost instantaneous this way, but even with a round-the-clock setting on the PCA, along with a .1 mg dose available to me every 10 minutes, it seemed the Dilaudid would wear off pretty quickly. Fortunately, the surgeon wrote 20 milligrams of OxyContin in the morning at breakfast and around dinner.
Dilaudid is a great pain reliever for a bad bout of breakthrough pain, but just keep in mind that it's designed to knock your pain back down to where your continous action narcotic can take back over.