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Thread: Oral opioid dose equivalency chart for you all

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    Default Oral opioid dose equivalency chart for you all

    I made my own opioid dose equivalence chart a while back but never posted it here. I know there are programs, websites, and even a chart or two already out there, but the values differ a bit .... and some of the common ROAs for common opioids that we use are ignored. I made my own chart from a combination of other credible dose converter multipliers AND from consensus drug potency when compared to morphine.

    ALL DOSES are ORAL dosing --UNLESS-- OTHERWISE STATED IN ()

    Opioid --- Half Life Range --- Dose Equivalent

    morphine --- short acting -- 10 mg
    diamorphine -- short acting -- 7 mg
    hydrocodone -- short acting -- 10 mg
    oxycodone -- short acting -- 5 mg
    oxymorphone -- short acting -- 2.5 mg
    levorphanol -- intermediate acting -- 1.3 mg
    levomethorphan -- intermediate acting -- 5 mg
    fentanyl (BUCCAL) -- short acting -- 0.03 mg
    **buprenorphine (SUBLINGUAL) -- long acting -- 0.34 mg
    nicomorphine -- short acting -- 5 mg
    methadone -- long acting -- 5 mg
    sufentanil (BUCCAL) -- very short acting -- 0.004 mg
    *codeine -- short acting -- 120 mg
    dihydrocodeine -- short acting -- 60 mg

    *codeine has a dosage ceiling imposed by metabolic limitations that is said by many to lie between 300 mg and 500 mg

    **buprenorphine has a dosage ceiling and feels a bit different from the others due to being a mu receptor partial agonist instead of a full agonist like the others


    ------------------------------------------------------------------

    If anyone sees any glaring errors, let me know. I make typos AND mistakes at times! I wanted to try to give you all a quick reference right here on the board by posting my personal handwritten reference chart. These values are from what I gathered to be consensus on potency from crawling academic info on these drugs and looking at the conversion factors used in other reputable calculator scripts when the opioid in question was in a credible calculator.

    If anyone thinks they have info that would warrant tweaking a value, let me know. Also, again, point out a mistake if you see one. I want this to be pretty accurate.
    Last edited by resorcinol; 08-05-2009 at 06:40 PM. Reason: fixed a probable error
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    Default Re: Oral opioid dose equivalency chart for you all

    thanks res, these values generally match my intuition (except for hydrocodone being equivalent to morphine by weight, i find HC slightly more potent by weight, but that's probably from differing individuals metabolism of morphine and HC) , theirs only a couple up there i haven't indulged in.

    antinociceptive

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    Default Re: Oral opioid dose equivalency chart for you all

    Right on resorcinol, I've always found this one to be pretty accurate, although I like the idea of having our own chart, we indeed are the experts when it comes to opiates.... at least some of us haha.

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    Default Re: Oral opioid dose equivalency chart for you all

    nice ,i was just looking through equivalence charts.. then i come here and see your post. interesting.

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    Default Re: Oral opioid dose equivalency chart for you all

    maybe you should post this on the Bioavailability/Half-life thread or maybe merge it with that? http://forum.opiophile.org/showthread.php?t=23643
    I think it would be a pretty cool idea to have the bioavailabilities, half-lives, and equivalency in one chart on one sticky thread.
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    Default Re: Oral opioid dose equivalency chart for you all

    I always thought oxy was 50% stronger than morphine, not 100%

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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by duck View Post
    I always thought oxy was 50% stronger than morphine, not 100%
    I'm going to take a lot of convincing that 60mgs of codeine equals 10mgs of morphine.
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    Default Re: Oral opioid dose equivalency chart for you all

    another thing I wanted to add was that it is really hard to have an accurate equivalency chart because some opioids have incomplete cross-tolerance.
    here is a quote from an article on equivalency tables/calculators:
    However, many equi-analgesic tables provide different information, depending on the source and the manner in which equivalency was calculated. There are drawbacks to these equivalency tables, in part because many do not consider a recommended 15% dose reduction for opioid cross-tolerance.[1,2,7] Some resources actually recommend that a dose reduction of up to 50% is appropriate when switching from one opioid to an alternative.[7] Another common problem with conversion tables is that many are based on single doses rather than steady-state concentrations, so certain data will not apply to chronic opioid users.
    Most opioid conversion tables fail to elucidate the potential problems when converting a patient to methadone from another opioid, or from another opioid to methadone. Methadone conversion requires careful consideration because of its long half-life and unusual pharmacokinetic profile compared with most other opioids. In addition, converting methadone to morphine, for example, is not bidirectional.[8,9] Consider that the half-life of methadone is 15-30 hours. When switching from an established dose of methadone to another opioid, we must consider that measurable methadone serum levels will be around for days. Therefore, when placing a patient on a new opioid, even with the discontinuation of methadone, both drugs are now readily available to the mu receptors, increasing the overall risk for opioid toxicity.[10] When newly converting a patient on methadone from another opioid, the equivalent dose conversion changes in a triphasic pattern[10]: For example, the ratio of morphine (or a morphine equivalent) < 90 mg/day to methadone is 4:1; the ratio for morphine 90 mg/day - 300 mg/day is 8:1; and for morphine > 300 mg/day, the ratio is 12:1.[8,10]
    Dosing opioids requires the clinician to account for a patient's opioid history, physical tolerance, consideration of agents in mixed preparations, cross-tolerance, and conversion irregularities. It is always best to use caution when initiating and increasing opioid regimens.
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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by Paregoric Kid View Post
    maybe you should post this on the Bioavailability/Half-life thread or maybe merge it with that? http://forum.opiophile.org/showthread.php?t=23643
    I think it would be a pretty cool idea to have the bioavailabilities, half-lives, and equivalency in one chart on one sticky thread.
    Good idea.

    Quote Originally Posted by nick View Post
    I'm going to take a lot of convincing that 60mgs of codeine equals 10mgs of morphine.
    I was a bit skeptical of that value myself. It's in theory I guess. I suspect codeine equivalences feel "weaker" despite supposed equality to non-prodrugs no matter what. 150 mg might be a more real life value for codeine in this chart. It actually doesn't sound right at all now that I think about it. I can't remember why I put 60 now. Maybe I was thinking of DIHYDROcodeine ... that would make sense.

    Edit: I changed it, as I probably was thinking dihydrocodeine and not codeine. Switched codeine to 120 mg and DHC got 60 mg.

    As for the oxycodone vs morphine thing ... this is a tricky one as morphine has shitty oral bioavailability and may be absorbed more differently from person to person than oxycodone due to first pass metabolism rates depending on individual enzyme activity. Some people may feel that oral oxycodone is only 1.5x stronger than oral morphine while others may feel it is 2x stronger as shown in this chart.
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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by duck View Post
    I always thought oxy was 50% stronger than morphine, not 100%
    Yea definitely not twice as strong... but of course this stuff varies from person to person and how similar the drugs are (for cross-tolerance) and what not.

    I think it would be interesting to have a thread where we each speculate based on our own experience how the drugs relate and then compile the data using statistics... I never agreed much with these charts.

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    Default Re: Oral opioid dose equivalency chart for you all

    When I was in hospital I found that both 60 mg codeine or 10 mg morphine gave pain relief for about 3 hours. This was with dosing every 4 hours provided the nurses weren't too busy. It was fucking agony much of the time. But for a pain prospective, I'd say 60 mg codeine and 10 mg morphine were equivalent.

    Although one of the doctors in the hospital I was transfered to told me that the latest research showed that 10 mg morphine was equivalent to 30 mg codeine. Now that is certainly not the case with me.

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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by resorcinol View Post
    Good idea.



    I was a bit skeptical of that value myself. It's in theory I guess. I suspect codeine equivalences feel "weaker" despite supposed equality to non-prodrugs no matter what. 150 mg might be a more real life value for codeine in this chart. It actually doesn't sound right at all now that I think about it. I can't remember why I put 60 now. Maybe I was thinking of DIHYDROcodeine ... that would make sense.

    Edit: I changed it, as I probably was thinking dihydrocodeine and not codeine. Switched codeine to 120 mg and DHC got 60 mg.

    As for the oxycodone vs morphine thing ... this is a tricky one as morphine has shitty oral bioavailability and may be absorbed more differently from person to person than oxycodone due to first pass metabolism rates depending on individual enzyme activity. Some people may feel that oral oxycodone is only 1.5x stronger than oral morphine while others may feel it is 2x stronger as shown in this chart.
    Yeah 60 mg of dihydocodeine is about right and I use 100mg of codeine to 10mg of morphine-that's just what works personally though,
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    Default Re: Oral opioid dose equivalency chart for you all

    here is a pretty easy to read and understand chart:



    http://www.pharmer.org/forum/discuss...oid-comparison

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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by Woody Bear View Post
    When I was in hospital I found that both 60 mg codeine or 10 mg morphine gave pain relief for about 3 hours. This was with dosing every 4 hours provided the nurses weren't too busy. It was fucking agony much of the time. But for a pain prospective, I'd say 60 mg codeine and 10 mg morphine were equivalent.

    Although one of the doctors in the hospital I was transfered to told me that the latest research showed that 10 mg morphine was equivalent to 30 mg codeine. Now that is certainly not the case with me.
    10mg of M equals 30mg of codeine? Are you sure he was a doctor and not a porter? Hell,even a porter would know that's absolute crap and as I said above,I really doubt 60 mg of codeine equates to 10mg of M.

    I think it's closer to 100mgs of codeine to 10mg of M.

    30mg to 10mg......that's funny.

    50-60mg of DHC to 10mgs M is about right though.
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    Default Re: Oral opioid dose equivalency chart for you all

    80mg codeine = 10mg morphine sounds more reasonable to me

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    Default Re: Oral opioid dose equivalency chart for you all

    I think we can all agree that codeine's potency is more variable from person to person than other opioids due to the required oxidative metabolism into morphine and glucuronidation into codeine-6-glucuronide before activity is realized (it's an inefficient prodrug). Other drugs that are substrates, inducers, or inhibitors or cyp2d6 and genetic variability in the gene coding for cyp2d6 protein both effect how much codeine gets converted into morphine. It's just probably fair to say that somewhere between 80 mg to 140 mg of codeine is about equipotent to 10 mg oral morphine.

    Okie dokie, that's not a bad chart overall, but the inclusion of nsaid pain relievers makes it clear that they're talking equianalgesic dose as those won't even have opioid effects. On some level I object to that regardless as NSAIDS and opioids vary in the type of pain they more effectively target. I was trying to find more of a happy medium between equianalgesic and equi-intoxicating with my chart: essentially general opioid equipotency and not just equianalgesic values.

    I included sufentanil because it will soon be coming to the market as TransdurSufentanil; it is a Duragesic-like patch with sufentanil freebase as the opioid instead of fentanyl. It will be a matrix patch like Mylan generic fentanyl transdermal system (cool ... I like mylan patches) and will be a 7 day patch (fucking stupid idea). Multi day patches are already dumb as they make falling off a bigger issue than a once a day patch would have. Instead of improving and making it once a day vs duragesic's once every 3 days, they were stupid and made it worse with once every full week! The second issue is --- since it's meant to be worn for a full week, and they'll look deceptively small due to the extreme potency of sufentanil and the small size of matrix patches when compared to resivoir patches -- there's practically guaranteed to be a rash of overdoses when these first come out. People "cheeking" these like mylan fentanyl patches will have to be VERY careful with the amount they cheek. Now, I'm not sticking up for people who are too lazy to do the research so they don't die at all ... it infuriates me as well when a teen just pops something not knowing if it's safe, but nevertheless every time shit like this happens opioids are demonized again by the media. The last thing we need is more vitriol from the general public towards opioid pain relievers.

    Levomethorphan is the only one on the chart that I really can't see anybody getting their hands on unless they're a chemist and synthesize it themselves. I do however believe that it being eventually marketed in some form for CP is more likely an occurance than for a lot of other currently unused opioids. One reason for this is that levorphanol, which is an active metabolite of levomethorphan that is more potent than levomethorphan itself is, has an established record of efficacy against CP and lasts longer than many other IR meds (but not like methadone, which lasts TOO long IMO, it just has like a 10 hr half life instead of 4 hrs like oxycodone or morphine).

    Levorphanol is an available CII rx in the U.S. at least, but it's not often prescribed. Nonetheless, several opios have tried it. Pharmboy I think was even prescribed it for a long while. It's been described as slightly less mind blowingly euphoric than the likes of morphine, heroin, and oxycodone and a noticeably longer come up period ... but still quite euphoric and with the benefit of a longer duration than the former opioids. Levorphanol is definitely an opioid I'd like to try someday (its brand name is LevoDromoran). I'd also love to try levomethorphan, which is not a prodrug (it's a quite active mu agonist itself), but sees significant contribution to its overall potency by its much stronger active metabolite levorphanol. Basically as hydrocodone is to hydromorphone, levomethorphan is to levorphanol; levomethorphan is just much more potent than hydrocodone as a mu agonist (the metabolites are closer in potency I think).
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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by nick View Post
    10mg of M equals 30mg of codeine? Are you sure he was a doctor and not a porter? Hell,even a porter would know that's absolute crap and as I said above,I really doubt 60 mg of codeine equates to 10mg of M.

    I think it's closer to 100mgs of codeine to 10mg of M.

    30mg to 10mg......that's funny.

    50-60mg of DHC to 10mgs M is about right though.
    Yeah no way 30 mg codeine is as potent as 10 mg M. Even my non drug using family members could tell ya that a tylenol 3 sometimes can't even be felt working while 10 mg M puts a nice dent in the pain and has 'em buzzing. Of course we all know there's no way a T3 is as strong as 10 mg oral M.

    I'm glad Tylenol w/ codeine has been made largely obsolete by Vicodin. Codeine is just no good for any serious pain even post op. It's OTC in many countries because codeine is honestly more suitable for rougher than average everyday pain, like a killer headache or toothache; its dependency potential is low enough to be no biggie compared to non-prodrug full agonists (codeine can produce a w/d syndrome if stopped after long term use, but it's nothing compared to the w/d syndrome from stronger opioids). It should be OTC in the U.S. also -- bring us Nurofen Plus, goddamnit! Vicodin and other hydrocodone preparations are more suitable as first line Rx only opioid pain relievers; hydrocodone is a much more potent, non prodrug, opioid analgesic that has far, far less side effects for equivalent or stronger pain relief.

    As for d-propoxyphene, the other "codeine-level" super weak opioid that is a controlled but shouldn't be .... it should either be OTC also but not mixed with any other drugs (it basically has even less recreational potential than codeine, by a big margin), or it should be removed from the market totally. The latter is not a bad option considering it can cause a long QT interval (causing heart problems in susceptible people) and can easily cause OD when mixed with other downers before euphoria is even felt due to having stronger affinity for the mu2 subtype than mu1 (mu1 is behind pain relief and euphoria, mu2 is behind heavy sedation and respiratory depression -- physical dependence is caused by both receptors and their activation). Also due to this very non-ideal affinity profile comes the fact that d-propoxyphene is a shitty painkiller; it's been shown in studies (somebody link to 'em if you've got 'em bookmarked) that d-propoxyphene is no more effective than NSAIDS like aspirin for analgesia. Is the potential heart issues or OD risk worth aspirin grade pain relief from an opioid that can hardly be called recreational even to a new user? Codeine > d-propoxyphene bigtime. The latter barely deserves to be called an opioid while codeine, while it may not be potent, is certainly a lovely opioid in the opioid family.

    So yeah, I'd like to see ibuprofen w/ codeine, say 300 mg ibuprofen / 20 mg codeine per pill or capsule, be made available OTC. Pure codeine can be Rx only in CIV. Hydrocodone w/ another drug can remain CIII as now as the "introductory" prescription grade opioid painkiller.

    Even better would be having dihydrocodeine also available OTC also when mixed with ibuprofen / APAP / guiafenesin / whatever, just in CV so a pharmacist would have to dispense it. DHC only preparations could be prescription only CIII. The scheduling for DHC would be slightly more strict than for codeine because DHC is decidedly less of a prodrug than codeine (it's sorta a half-prodrug, which makes it less prone to a powerful dose ceiling). The key is that pharmacists would have to honor the OTC availability of CV DHC preparations without being asses about it. Prescription DHC ONLY preparations would be great for folks who need a CIII level introductory Rx only opioid analgesic but cannot tolerate hydrocodone for one reason or another, or have liver damage that makes APAP contraindicated.

    To ice the cake, I'd make a pure hydrocodone only product (hopefully Purdue would make it under the name HydroContin). It would have to be CII since lets face it, tablets with high doses of only hydrocodone would have tremendous recreational potential ... much more than low dose mixed preparations that require tons of pills and CWEs to get enough out of. Just a 160 mg HydroContin (which would be marketed as equipotent to the 80 mg OxyContin) crushed up and railed would have somebody who gets off hard on an 80 mg OC flying pretty much just as high. HydroContin would also be a fantastic pain reliever to try first IMO after the low dose mixed stuff fails.

    I of course despise the CSA in general but I'm trying to have a realistic fantasy here for the future of opioid availability
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    Default Re: Oral opioid dose equivalency chart for you all

    10mg of M equals 30mg of codeine? Are you sure he was a doctor and not a porter? Hell,even a porter would know that's absolute crap and as I said above,I really doubt 60 mg of codeine equates to 10mg of M.

    I think it's closer to 100mgs of codeine to 10mg of M.
    She was the leader of the pain management team, and she was the one who prescribed me my 10 mg morphine tablets to take home, when I requested them. I did speak to her for a while on this, and she seemed really well informed on the lastest research. I was quite surprised at the 30 mg codeine = 10 mg morphine figure, but she also said that only 2/3rds the population respond to codeine, the rest don't get much or any pain killing effect from it at all. So she wasn't saying that 30 mg codeine = 10 mg morphine for everyone, but for the ones who get the very best response from it.

    Anyways the doseage converter: http://www.globalrph.com/narcotic.cgi gives the figure:
    10 mg oral morphine = 66.67 mg oral codeine.

    So if you're one of the type who gets a good effect from codeine, then the amount that equals 10 mg morphine is going to be quite small. And also the people who don't get much pain killing effect from codeine will need a huge amount of codeine to equal 10 mg morphine. So even the 66.67 mg figure isn't fixed for everyone, but more of an average depending on which studies they include.

    After hearing that 30 mg codeine = 10 mg morphine, I thought that I must be a poor responder to it, seeing as for me 60 mg codeine lasted the same amount of time as 10 mg morphine. But now, after hearing that it takes other people 100 mg codeine to equal 10 mg morphine, it makes me feel like I must be average on the curve.

    I also had 20 mg oral morphine for a day or so, and it gave me pain relief for over 5 hours, but 60 mg codeine or 10 mg morphine only gave me pain relief for 3 hours. So for me at least 60 mg codeine = 10 morphine, not 20 mg morphine. But I can believe that other people would respond better to codeine then I do.

  19. #19
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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by Woody Bear View Post
    She was the leader of the pain management team, and she was the one who prescribed me my 10 mg morphine tablets to take home, when I requested them. I did speak to her for a while on this, and she seemed really well informed on the lastest research. I was quite surprised at the 30 mg codeine = 10 mg morphine figure, but she also said that only 2/3rds the population respond to codeine, the rest don't get much or any pain killing effect from it at all. So she wasn't saying that 30 mg codeine = 10 mg morphine for everyone, but for the ones who get the very best response from it.

    Anyways the doseage converter: http://www.globalrph.com/narcotic.cgi gives the figure:
    10 mg oral morphine = 66.67 mg oral codeine.

    So if you're one of the type who gets a good effect from codeine, then the amount that equals 10 mg morphine is going to be quite small. And also the people who don't get much pain killing effect from codeine will need a huge amount of codeine to equal 10 mg morphine. So even the 66.67 mg figure isn't fixed for everyone, but more of an average depending on which studies they include.

    After hearing that 30 mg codeine = 10 mg morphine, I thought that I must be a poor responder to it, seeing as for me 60 mg codeine lasted the same amount of time as 10 mg morphine. But now, after hearing that it takes other people 100 mg codeine to equal 10 mg morphine, it makes me feel like I must be average on the curve.

    I also had 20 mg oral morphine for a day or so, and it gave me pain relief for over 5 hours, but 60 mg codeine or 10 mg morphine only gave me pain relief for 3 hours. So for me at least 60 mg codeine = 10 morphine, not 20 mg morphine. But I can believe that other people would respond better to codeine then I do.
    Leader of the pain management team,huh..............She's wrong.
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  20. #20
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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by nick View Post
    Leader of the pain management team,huh..............She's wrong.
    I wouldn't go that far. We have not defined what we mean by "=" here. It certainly is some kind of equivalence, but it's clearly not to say that codeine is ever the SAME as morphine (well except I guess in the sense that it is metabolized that way -- I don't know too much about this)...

    in any case there may be many legit reasons why the effects on the average human of 30mg codeine is comparable to 10mg morphine (not even involving the "high" felt at all).

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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by Morfiend View Post
    I wouldn't go that far. We have not defined what we mean by "=" here. It certainly is some kind of equivalence, but it's clearly not to say that codeine is ever the SAME as morphine (well except I guess in the sense that it is metabolized that way -- I don't know too much about this)...

    in any case there may be many legit reasons why the effects on the average human of 30mg codeine is comparable to 10mg morphine (not even involving the "high" felt at all).
    Yeah 10mg of m or 30mgs of codeine are equally useless to me,but apart from that I'd really like to hear,in any sense,how 10mg of M equals 30mgs of codeine.

    That equation is not a little bit off-it's a lot off.
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    Default Re: Oral opioid dose equivalency chart for you all

    I'd really like to hear,in any sense,how 10mg of M equals 30mgs of codeine
    You do a study to find out average length of pain relief for patients given either 10 mg morphine, 30 mg codeine, or 60 mg codeine.
    Then you calculate the range of the length of pain relief, and the average length.

    Every single person on the study will give different lengths of time for each of the 3 drugs. The people who respond best to codeine, will give roughly the same length of pain relief for 10 mg morphine and 30 mg morphine.
    E.g pain relief duration for 10 mg morphine = 3 hours 40 minutes
    pain relief duration for 30 mg codeine = 3 hours 30 minutes
    pain relief duration for 60 mg codeine = 5 hours 50 minutes

    The people who respond less well to codeine will give give a shorter time for pain control for the 30 mg codeine, then 10 mg morphine or 60 mg codeine.
    E.g pain relief duration for 10 mg morphine = 3 hours 40 minutes
    pain relief duration for 30 mg codeine = 1 hours 40 minutes
    pain relief duration for 60 mg codeine = 3 hours 30 minutes

    The people who respond the least well to codeine will give way less shorter time for pain control for the 30 mg codeine or or 60 mg codeine, then the 10 mg morphine.

    E.g pain relief duration for 10 mg morphine = 3 hours 40 minutes
    pain relief duration for 30 mg codeine = 0 hours 50 minutes
    pain relief duration for 60 mg codeine = 1 hours 20 minutes

    Then you'd conduct statistical analysis on the data, and use the average of the length of time of pain relief to be able to compair. So if the average showed that for most people in the study, the length of pain relief between from 10 morphine was closer to the same amount of time as 30 mg codeine, then the study would show that 30 mg codeine is equivalent to 10 mg morphine.

    But even if that was what was shown in the abstract, what the study wouldn't show is that every single person responded identically, and that 30 mg codeine gave comparable pain relief as 10 mg morphine for every single person.

    So the figure on the narcotic converter page gave 66 mg codeine = 10 mg morphine. Now that figure came from the statistical analysis from a whole bunch of studies. Now every one of the people on those studies would have shown different responses, some better some worse.

    But when I was speaking to the doctor, she told me that on the lastest studies she read, it showed that for most people, 30 mg codeine was equipotent as 10 mg morphine. That doesn't mean that that is the same for everyone, because she said that 2/3rd of the people in Britain respond to codeine, and the other 1/3rd have such a poor responce, that codeine is just not effective for their pain.

    So it's equally wrong to say 30 mg codeine is equal to 10 mg morphine for everyone, as to say 30 mg codeine is never equal to 10 mg morphine for anyone.

    It would be more accurate to say something like, response to codeine varies with the best responders getting equal pain relief from 30 mg codeine and 10 mg morphine, the worst responders getting no pain relief from codeine. 2/3rds the population do get pain relief from codeine, and of all of those who do get pain relief from it, the duration of pain relieve varies, but the latest studies show that the average duration of pain relief from 10 mg morphine is closer to 30 mg codeine, than it is to 60 mg codeine.

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    Default Re: Oral opioid dose equivalency chart for you all

    Obviously there's a degree of subjectivity in folks response to codeine,but I'm telling you now that anyone that gets the same response from 30mgs of codeine as 10mgs of M is a freak of nature and for the vast majority of folks it ranges from 80-120 mgs codeine to 10mgs of M and around 100mgs to 10mgs is an accurate dosage conversion.

    30mgs to 10mgs is absolutely nuts-unless you're a freak of nature.
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    Default Re: Oral opioid dose equivalency chart for you all

    Now I've not read the study that my doctor refered to showing 30 mg codeine was equal to 10 mg morphine. Nor have I read any study Nick is talking about which showed the range being as 80 -120 mg codeine is equal to 10 mg morphine with the average being 100 mg.

    But for me, I get roughly equal duration of pain relief from 60 mg codeine and 10 mg morphine. And this is very close to the figure that http://www.globalrph.com/narcotic.cgi gave as 10 mg morphine = 66.67 mg codeine. That dosage converter, didn't pull the 66.67 mg figure out of a hat, they did have to do statistical analysis on pharmaceutical studies. And as that is likely to be a data composite of many multiple studies, so I'd be more inclined to believe that most peoples response is going to be closer to the 66.67 mg figure, then a single smaller study showing a radically larger or smaller number.

    However, it's not surprising that there is such a large variation, because codeine itself isn't a painkiller, it's a prodrug and only it's metabolites give the pain killing effect. So the range of the average duration of pain relief is likely to be much larger for codeine, then for another opiate which isn't a prodrug, and is a painkiller in it's own right, like morphine, hydromorphone or fentanyl.

    But still, it would be quite interesting to see how much the pain relief duration for those drugs vary as well. Different converters give different figures, because they analyse different studies. So I wish the narcotics dose converters would list the studies, and give the sample variation as well as the averages as well, because just giving one figure is misleading, because people responses vary so much.

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    Default Re: Oral opioid dose equivalency chart for you all

    Quote Originally Posted by nick View Post
    Obviously there's a degree of subjectivity in folks response to codeine,but I'm telling you now that anyone that gets the same response from 30mgs of codeine as 10mgs of M is a freak of nature and for the vast majority of folks it ranges from 80-120 mgs codeine to 10mgs of M and around 100mgs to 10mgs is an accurate dosage conversion.

    30mgs to 10mgs is absolutely nuts-unless you're a freak of nature.

    I know there is overlap, but maybe are you considering the high/euphoria of morphine and not just the analgesia? Maybe codeine isn't as euphoric, but it may be ok in analgesia.

  26. #26
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    Default Re: Oral opioid dose equivalency chart for you all

    I agree that the 10mg ORAL morphine = 30mg ORAL codeine thing seems a bit (actually a lot) off. I've always used the 60mg to 10mg thing. But, then again, I don't deal with codeine much anymore. Actually, I've not for several years. It's just useless now because of tolerance, and also if you're on certain meds.

    The person who said that a segment of the population is "immune" to codeine (so-to-speak) is correct. Codeine is metabolized by the CYP2D6 enzyme into norcodeine (which is useless and basically inactive) and morphine. Some people naturally lack that enzyme, so if they're prescribed codeine, it's basically useless to them. I think codeine does have some action on it's own, but it's minimal. The majority of it's analgesic effects come from it's conversion to morphine.

    Also, people can temporarily be "made" into these codeine-immune people. Certain medications inhibit the CYP2D6 enzyme, thereby making codeine ineffective for pain-control. I know Prozac and Paxil are two, and when I just looked it up on Wiki, it also said that Wellbutrin and even Benadryl (diphenhydramine) are also CYP2D6 inhibitors. I knew that Prozac was one, because once when I was taking Prozac I had gotten a sprained ankle, and was scripted T-3's, and basically took the whole bottle of 24 and felt absolutely nothing, and that was even before I had a tolerance really. So, I called back, and said listen, this isn't working, and reminded them that I was taking Prozac (even though the doctor knew that, because it was in my chart), and begrudgingly they called in a script for 12 measly Vic 5's.

    I also tend to agree that codeine should be made OTC in America. I mean, it's a pretty weak opiate, and it's practically useless for severe pain even if you're non-tolerant. There's no reason why you couldn't have a combination product containing a moderate amount of codeine and APAP or ibuprofen like they do in Europe or Canada. I honestly feel like the only reasons there isn't such a product like that in the US is because of the perceived amorality of drug-use (heaven forbid they make drugs available), and because of the money factor: it's more capitalistic to make people go to a doctor and then to a pharmacist than to allow them to go directly to the drug store and get the meds themselves.

    I mean, if you have a migraine, and don't have insurance, and can't afford prescriptions like Imitrex or Zomig, and also the pain is too much for the migraine formulations of ibuprofen or APAP (which really are the same dosages as the regular ibuprofen and APAP, just with caffeine and / or other ingredients), what are you supposed to do? It would be nice to have the option of getting a T-10 over the counter. But, no, can't have that. The world would fall apart, and society would run amuck. And people really think that way. I mean, if that were the case, Canada and Europe (where codeine is OTC in many places) would be in shambles. Come on America, think. Use your minds. PLEASE!

    And don't get me started on the whole "you can get codeine cough syrup at pharmacies if the pharmacist dispenses it and you sign for it" shit. First of all, try going to Walgreens or CVS or Krogers and doing that. No chain pharmacy is going to do that for you, even though it's completely legal and within your right. The pharmacists their would look at you like a lunatic. They're just being asses about it. And it's even rare to find smaller, independently owned, mom-and-pop pharmacies that do that now. So, your only option is shitty syrups containing DXM which (at least to me) aren't that effective for coughs and also have more interactions with medicines, and now they're even bitching about DXM because the kiddies are getting high on it. So, pretty soon, you'll either have to sign for DXM and have it behind the counter (which is already happening in some places), or it will be removed from the market altogether, and you'll be stuck having to go to the actual doctor for a simple cough, and be screwed in the process by either paying a copay if you have insurance, or a hefty doctor's fee if you don't, for a simple cough that could have been helped by being able to get a (legal mind you) bottle of Robitussin with codeine at the pharmacy.

    And another thing that pisses me off is when you're stuck going to the doctor for a bad cough, and they prescribe a prescription-strength cough syrup containing DXM. I mean, the OTC stuff contains what, 10 or 15mg of DXM per 5ml. The prescription stuff contains 30mg. Like you couldn't just take two teaspoons (10ml) at home. And why in the hell would they give that to you anyway? I mean, especially if you've told them you've already taken Robitussin and it didn't work. I mean, most people don't go to the doctor for the common cold or flu anyway. They usually use OTC meds to cope with it. If you're going to the doctor, chances are you're pretty bad off. And they can't even give you a good cough syrup like Histussin-HC or Robitussin with codeine or something that would actually work better than a prescription version of the OTC stuff? It's like they're giving you no help at all. And to top it off, you have to pay for it by paying a copay if you're lucky and have insurance, or a huge-ass doctor's fee if you don't. And heaven forbid they prescribe 4oz of Vicotussin or Histussin-HC or Tussionex or something that would actually work. They think that one bottle of cough syrup is going to get everyone addicted. I'm so sick and tired of the opiophobia in the medical community nowadays, especially when you're in true need of something like that. Because, let me tell you, if you're a true junkie / addict / opioid fiend, chances are you're not wasting your time with narcotic cough syrups unless you're really desperate. So, yes, give the sick people the meds they need and quit taking their money and giving shitty prescription versions of OTC meds. They can just double-up on those at home.

    .......

    On another topic (and I know this is about oral opiates), I get sort of peeved when people say oxy is so much stronger than morphine. Yes, oral oxycodone is MUCH stronger than oral morphine, because oxy has a much better oral bioavailability than oral morphine. If you take 10mg oral oxycodone, probably 85-90% is reaching your CNS, whereas if you take 10mg oral morphine, you're lucky if you get 30%.

    Concerning the IV ROA, however, oxycodone and morphine are *equal.* Actually, and I don't remember the exact studies so I can't cite them to prove this, but I think IV morphine is actually slightly (and I do mean slightly) stronger than IV oxycodone. For instance. If you were to compare them. 10mg IV oxycodone would be like 9 or 9.5mg IV morphine. It's negligible really, and most people say they're equal in terms of IV strengths, and I guess for all intensive purposes they are, but technically, IV morphine is a BIT stronger than IV oxycodone. Just something that bothers me and I wanted to point out.

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    Default Re: Oral opioid dose equivalency chart for you all

    If I could +rep you again I would Woody Bear

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    Default Re: Oral opioid dose equivalency chart for you all

    I agree Nark, there's no way in hell 30 mg codeine is as potent as 10 mg M. Whoever said that to that poster doesn't know what they're talking about or is confused.

    My initial 60 mg figure, I think, I was thinking of DHC and not codeine. For DHC 60 mg being equipotent to 10 mg M makes sense. I'd say 120 mg codeine is equipotent to 10 mg M, but that codeine stops getting stronger past 350 to 400 mg due to the metabolic saturation of the enzyme needed to demethylate it to M. DHC does NOT need to be demethylated to produce effects (although dihydromorphine contributes significantly to its analgesic ... maybe 50 percent). Thus, DHC probably increases in strength more rapidly up to about 400 mg at which point the conversion path to DHM is saturated, and at that point the potency increases more slowly with rising dose. There does come a point with DHC though where side effects would begin to overwhelm gains, limiting its usefulness in opioid tolerant folks.

    Hydrocodone is really the first in the "codeine" series that one can go up and up in dose with and get increasing effects consistently (this is just hard to do because there's no high dose prep free of additives like "HydroContin"). I know that while on fentanyl 50 mcg/h even, if I didn't have a patch for some reason, 180 mg hydrocodone (yes CWE was done on the 18 norcos) would still get me pretty damn high without any unpleasant side effects.

    Oxycodone is obviously the current king of the codeine series and will always be my DOC. I love the codeine series for its high oral bioavailability despite its relative weakness compared to other opioid groups. Oxycodone is the strongest of the codeine series; it's probably the only one of the series strong enough to be considered a "heavy duty" opioid. MUCH stronger codeine series opioids derived by modifying the 14 position on hydrocodone with groups other than just an -OH (oxycodone) could be made and marketed, but currently are not.

    You're right about it being possible to be made artificially immune to codeine too. Just try getting off on codeine (with no tolerance) if you're on paroxetine or many SSRIs really. Not gonna happen. GFJ is the only potentiator that is benificial to codeine (it inhibits CYP3A4 which produces inactive norcodeine, but leaves CYP2D6 which produces morphine pretty much untouched). Cimetidine is no good for codeine, it inhibits CYP2D6, which will dramatically cut the potency of the codeine dose.
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    Default Re: Oral opioid dose equivalency chart for you all

    i love it..
    resorcinol make a thread and some of you..
    put in links not even to the effect as in to compare.
    so you wanna be a junkie ehh

  30. #30
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    Default Re: Oral opioid dose equivalency chart for you all

    The most comprehensive and accurate IMO is thatspopycock.org It has fife different kinds of charts based on the medications, if you want to equal a dose of a different drug, type of administration, or if its coverting from oral 24hour morphine dose to another drug, dosage, type of anministration. the 2nd best site is the globalrph.com. I hope these help. They both include converting the fentanyl patch to other meds and types of administration.
    Fieldgoal

    ---------- Post added at 04:46 AM ---------- Previous post was at 04:29 AM ----------

    Quote Originally Posted by resorcinol View Post
    I made my own opioid dose equivalence chart a while back but never posted it here. I know there are programs, websites, and even a chart or two already out there, but the values differ a bit .... and some of the common ROAs for common opioids that we use are ignored. I made my own chart from a combination of other credible dose converter multipliers AND from consensus drug potency when compared to morphine.

    ALL DOSES are ORAL dosing --UNLESS-- OTHERWISE STATED IN ()

    Opioid --- Half Life Range --- Dose Equivalent

    morphine --- short acting -- 10 mg
    diamorphine -- short acting -- 7 mg
    hydrocodone -- short acting -- 10 mg
    oxycodone -- short acting -- 5 mg
    oxymorphone -- short acting -- 2.5 mg
    levorphanol -- intermediate acting -- 1.3 mg
    levomethorphan -- intermediate acting -- 5 mg
    fentanyl (BUCCAL) -- short acting -- 0.03 mg
    **buprenorphine (SUBLINGUAL) -- long acting -- 0.34 mg
    nicomorphine -- short acting -- 5 mg
    methadone -- long acting -- 5 mg
    sufentanil (BUCCAL) -- very short acting -- 0.004 mg
    *codeine -- short acting -- 120 mg
    dihydrocodeine -- short acting -- 60 mg

    *codeine has a dosage ceiling imposed by metabolic limitations that is said by many to lie between 300 mg and 500 mg

    **buprenorphine has a dosage ceiling and feels a bit different from the others due to being a mu receptor partial agonist instead of a full agonist like the others


    ------------------------------------------------------------------

    If anyone sees any glaring errors, let me know. I make typos AND mistakes at times! I wanted to try to give you all a quick reference right here on the board by posting my personal handwritten reference chart. These values are from what I gathered to be consensus on potency from crawling academic info on these drugs and looking at the conversion factors used in other reputable calculator scripts when the opioid in question was in a credible calculator.

    If anyone thinks they have info that would warrant tweaking a value, let me know. Also, again, point out a mistake if you see one. I want this to be pretty accurate.
    One thing I would add to the drugs name and length of usage is dosages example. Oxycontin (brand name for extended relief) doses,(oxycodone is the generic name).(Extended relief doses 10mg, 20mg, 40mg, 60mg, 80mg). There is also an imedieate release dosage. List names of Brand and generic for both.(w/o tylonel 15mg, 30mg) and (with Tylonel 2.5/325mg, 5.0/325, 7.5/325, and 10.0/3.25.List the Oxyfast liquid with generic name and dose info for both. I know this is far more time consuming, but it lets a person know everything about the medication. From the names, to method of administration, to different dosages, etc.. I think your work was great. I in know way meant to be rude or criticial.

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