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Thread: Opiate/opioid equivalency doses/charts

  1. #1

    Default Opiate/opioid equivalency doses/charts

    Personally, I have very little experience with opiates except for a one-time experience with codeine. It just didn't work, btw.
    But you never know what will happen...

    Recently I've been reading a bit about the various opiates and the supposed equivalencies.
    To keep it simple, I disregarded the strongest opioids.

    What would you say about the supposed equivalencies from the various sources ? Are they correct ?
    For example: http://www.wales.nhs.uk/sites3/Docum...%5DNov2010.pdf

    Lists dihydrocodeine as three times as strong as codeine. Elsewhere on this forum someone suggested a ratio of 1.5.
    10 mg oxycodone would be equivalent to 20 mg morphine.

    Are these charts accurate ? Or is it like comparing apples and oranges ?
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    I haven't found much personal accuracy in the numbers, but the relative magnitudes appear plausible.
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    I agree with both @Brax and @MRNUTTY. This chart seems to lack in accuracy.

    I was having a discussion with @GreenThumb (vendor thread name removed) about a medication called Tussipax.

    A tablet contains 10 mg of codeine and 10 mg of ethylmorphine, also known as codethyline. Tussipax is an antitussive which also contains an expectorant. This cough medication is mainly manufactured and prescribed in France. Finding the equivalent potency of ethylmorphine is not as easy as comparing, lets says, codeine and morphine, for example.

    French Wikipedia : ttps://fr.wikipedia.org/wiki/Éthylmorphine
    L'éthylmorphine, ou codéthyline2, est un analgésique opiacé utilisé notamment comme antitussif3.

    Chimiquement, la molécule est proche de la codéine. Sa puissance narcotique serait équivalente à cette dernière, ou jusqu'à 1,25 fois plus puissante chez certains sujets.

    On dispose de très peu de documentation sur la pharmacodynamique et la pharmacocinétique de l'éthylmorphine.


    Translated (free of charge ) : Ethylmorphine, or codethyline, is an analgesic opiate used especially as a cough medication.
    Chemically, the molecule is kin to codeine. Its narcotic potency would be equivalent to that of codeine or, for some patients, up to 1.25 stronger.

    There is little documentation available on the pharmacodynamics and pharmacokinetics of ethylmorphine.

    Tableau équivalences.jpg

    I also found a few research articles published on NCBI, but unless one is working on their own PhD, they would be a bit long to digest.

    Soooo, what's my point ? I don't think it's a good idea to use a cough medication as a pain killer, even if one uses the ice water wash method. Who knows how much expectorant one would end up ingesting to obtain a satisfying dose of pain killer. Besides, is it cost effective?

    Used to ease coughing, the dosage is 1 tablet. If each Tussipax tablet contains the equivalent of 20 to 22.5 mg of codeine, it would take 3 tablets to get the effective dosage of pain relief for moderate to moderately intense pain, which, for most people, is 60 mg of codeine.

    I remember a PR member once writing to me that we were so lucky in Canada, because we could get 222's or another mixture containing 4 mg of codeine and acetaminophen, over the counter. We still can, but really, is it worth torturing my liver with 3.75 g (yes, g, not mg !) of Tylenol to get my 60 mg's worth of codeine?

    An other point : potency equivalence charts are a tool for approximation, just that. If managing pain with drugs was that simple, there wouldn't be so many different drugs on the prescription market. Some people with react comfortably to morphine while they can't tolerate tramadol, etc. etc.

    I remember having been injected with Demerol after a major surgery; 20 years later, it was oxycodone. My! These drugs put me in such a state of panic that their analgesic effect was null. The medical staff had to give me a hefty dose of anxiolytic before I literally crawled out of my skin.

    So, all my PR friends, I wish you as little pain as possible and "One flew over the coughing nest" this already ongoing winter.

    Take care,

    ST
    Last edited by Kerry; 11-18-2019 at 07:49 AM. Reason: Remove vendor name
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    I find that all the various opiates affect my brain differently. When I switch from one to another, it seems to take a few doses for it to have the same effect. Of course the really strong ones don't have that unless taken in very small doses. I have never felt DHC to be that much stronger than codeine either, but it seems to vary again from individual to individual. And tramadol has never done anything for me except give me a headache.

    I guess that's why I think our brains have a lot to do with the effectiveness. Everyone seems a bit different.
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    So far I agree with most of what's been said. I can tell you that from my own experience, the morphine/oxycodone ratings are right on. I have been prescribed both in the past and oxycodone is the better pain killer. I guess the ratio could be up for debate, but it's basically right on. As @jaders mentioned, the codeine and DHC are the same to me also. I"ve never felt a difference between them, but everything I read supports the DHC as being stronger.
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  6. #6
    Keep in mind, if you switch opioids, there are cross tolerance issues, which renders the charts inaccurate. I believe cross tolerance occurs when there are some overlapping receptors. You really have to be careful when switching from an opioid antagonist, to an opioid anti-antagonist. I don’t remember specific examples, but some switches can cause you to go into withdrawals. If switching opioids, search for cross tolerance, and you will get guidance on how to switch safely.
    Last edited by M77; 11-18-2019 at 04:19 PM.
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  7. #7
    Quote Originally Posted by jakemoe View Post
    So far I agree with most of what's been said. I can tell you that from my own experience, the morphine/oxycodone ratings are right on. I have been prescribed both in the past and oxycodone is the better pain killer. I guess the ratio could be up for debate, but it's basically right on. As @jaders mentioned, the codeine and DHC are the same to me also. I"ve never felt a difference between them, but everything I read supports the DHC as being stronger.
    @jakemoe
    Codiene has a low ceiling, as in something around 150-200mg will be the limit you can take, with additional dosing doing nothing. I agree that codeine, and DHC, have very similar effects, but DHC does not have the low ceiling of codeine. I have found DHC to cause major slowdown to your gastric system, and I have found it worse than oral M0rphine in that regard.
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    Thanks for the extra info on that @M77. It's good to know that about the low ceiling being around 150-200 mg. I had no idea. I have to say that back when I was less experienced and having awful back problems, I took extra doses of the codeine I had (probably over 200mg.) and I had a horrific experience with itching all over my body. It wasn't the regular itching many can get when taking any sort of opioid, but this was so severe that I couldn't let myself scratch because I would keep scratching as the act just intensified it. Don't know if my description makes sense, but just a warning to anyone out there. Sometimes taking too much of some drugs not only can knock you out, it can make you horribly uncomfortable.
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  9. #9
    @jakemoe
    That extreme itching is common with many opioids, and opiates. It is caused by your body releasing antihistamines. I never had a problem with it, but now I get it from Alleve, and sometimes Advil too. Those are NSAID’s (Non Steroidal Anti Inflammatories) but can cause the same reaction.
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    @M77 I'm in awe, as I am every time I read you.

    @jakemoe, @jaders, thank you so much for sharing your experiences.

    As I'm lucky enough not to suffer from chronic pain requiring more than Advil or other, maybe stronger, anti-inflammatory medication, I use very little opiates. I know I've mentioned that in other posts.

    However, I have had plenty of surgeries where I was given opiates, some times intravenously before leaving the OR and then getting the oral prescription. I have a hard time tolerating opiates because if the effect goes beyond the level needed to manage the acuteness of my pain, I feel stoned and I start panicking because I hate losing control.

    This is why I reacted so badly to the oxycodone I received after one of those surgeries. This was one operation after which I expected to be in a lot of pain. It didn't happen. I went home to lie on a comfy couch as my daughter went to the pharmacy to fill up the resident's prescription. You know what? I did not feel enough pain to even need to take a Tylenol. It's no wonder I overreacted to the oxycodone!

    About the itching, I remember that a member, probably 10 years ago, had developed a horrible allergic reaction when she took codeine that she got from an IOP. She sincerely thought she had been poisoned and wanted to warn us. It must have happened on the other board, DB, the one that closed about that, 10 years ago, because some members became very nasty towards her. PR has much better moderators! She felt so hurt by this lack of sympathy that she even posted pictures of her legs. They were so raw that I could almost feel the depth of her pain through the screen!! She wouldn't admit to an allergic reaction as she had taken codeine before and this had never happened to her. She went to an ER, but she didn't get any help as she did not want to show them what she took.

    It could be that she just had taken too much of it. Thanks again for that M77! Drugs sold by some vendors are some times not as strong as advertised. You take one, you get little or no effect; you take two, it doesn't kick in as soon as you would like; and then you take two more and you've gone over the safe limit.

    I'll share an other story. Those who have read me a bit over the years know I have an inexhaustible collection of "little stories". Feel free to skip .

    Not so long ago, I spent nearly a week in one of those horrendous 4 beds hospital rooms. Even if one had insurance, that's the only type of room that was offered, because the hospital could cut on staff that way. The lady in the bed beside me was suffering a lot. She tried to keep up appearances when her children were there, during the day, but at night, she would whimper as quietly as she could. She was on tramadol, because her body couldn't tolerate anything else any more.

    I asked her children why they didn't just increase the dosage. All her organs were shutting down anyway. But there was this problem of the itching, precisely because her liver couldn't metabolize the drugs properly any more. She would scratch herself to the bone and bleed all over. One night, as I was feeling a bit better than when I came in, I got up - I had tubes, but I was mobile - and dabbed some cream her daughter had left for her very gently over those wounds. I took this 80 something lady in my arms and sung her a lullaby. My voice actually soothed her more than the cream, which was not a pharmaceutical preparation. Why the hospital did not supply her with something that might have given her some relief just beats me.

    A nurse came in as I was sitting on this lady's bed. She gave me hell! "Are you crazy? What if she had C-difficile or another resistant bacteria?!!" If I had answered that if patients got proper care, the less sick wouldn't have to cater to the sickest, it would just have aggravated her. So, I told her, with a smile, that the microbes for which I was being treated myself were willing to challenge any competitors she could find around the hospital. She laughed. I also assured her that the next time, I would put on gloves and mask before I jumped into bed with other patients.

    I didn't have to. The next day, the lady went to the OR and never came back to her bed.
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  11. #11
    @SoTired
    Thanks for your kind words. I enjoyed your story, and I frequently add little stories to my posts too. As far as the nurse, the only problem with her warning was, if your roommate had an infectious disease, she wouldn’t be in your room. I worked at a hospital, a long time ago, and they mostly worry about liability. Healthcare is secondary to profit. If they put an infectious person in a room with three non-infectious patients, they would be worried about getting sued. That said, what you did says a lot about your character. What a great world this would be if everyone was like you!!!
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    Quote Originally Posted by M77 View Post
    @SoTired
    Thanks for your kind words. I enjoyed your story, and I frequently add little stories to my posts too. As far as the nurse, the only problem with her warning was, if your roommate had an infectious disease, she wouldn’t be in your room. I worked at a hospital, a long time ago, and they mostly worry about liability. Healthcare is secondary to profit. If they put an infectious person in a room with three non-infectious patients, they would be worried about getting sued. That said, what you did says a lot about your character. What a great world this would be if everyone was like you!!!
    Ah ! Mais mon ami, this is Canada, where healthcare is free and liability a foreign word in our medical world! In fact, this is Québec, where you can sue a doctor till you're in the poor house; the "Collège des médecins" will protect them against a tsunami of complaints.

    In fact, I was admitted because of a very ugly infection. I was put on the strongest variety of antibiotics. I should never have been in a room with anyone, at least until they could identify what bacteria was causing all this disgusting purulence. It could very well have been the flesh-eating bacteria. Find me sexy?

    I'm no scientist, but I'm pretty familiar with hospital management around here. I can affirm that, more specifically in the case of that hospital, the only concern of administrators was about cutting costs.

    OK. This was one bad experience. But I want to add that I've had the best of care in that same hospital on other occasions. Besides, now, in our new teaching mega-hospitals, these multiple patients rooms do not even exist any more.

    "What a great world this would be if everyone was like you!!!" Well, that's very kind of you . You know, while I still had the energy for it, I was quite the activist on the political scenes and I did win a few debates. I wonder how my opponents would have received that statement.

    Take car now, y'a hear?

    ST
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  13. #13
    @SoTired
    Yes, my thoughts were based on our lovely Health Care system in the U.S. I missed the Canada part of your posts. And with your nationalized health care, my post would not make sense. When you go to the hospital here, they charge you about $20 for a Tylenol. None of that changes how nice it was to care for your roommate.

    I had surgery 3 times. I don’t remember what a private room would have cost, but I do know a relative asked, while I was still in the recovery room. It was so absurd that we all just laughed. I had a roommate, in the 4 bed room, that had a very serious procedure, and he was miserable. He was up all night crying and I felt so bad for him, it kept my mind off of my own pain. Of course the m0rphine drip helped. When he was coherent, I talked to him, to try and get his mind off of things. I can’t say for sure that it worked, but at least I tried.

    When I worked at the hospital, it was when HIV/Aids was just starting. Nobody knew how it was transmitted, and everyone, including the doctors, were scared. They put those patients in isolation rooms, and I guess they had no choice. Nobody was sure that it wasn’t transmitted from a cough or sneeze. It was heartbreaking how they spent what little time they had left in isolation. Whatever you might have heard, it was worse.

    There were a few large cases of MARSA at hospitals near me. Patients were coming out from routine surgery, and ending up with MARSA. They have some ways to treat it, but none are quaranteed to work. Scary stuff.

    By the way, I’m glad John Tavares went to Toronto. This way I don’t have to hate the Habs.
    Last edited by M77; 11-18-2019 at 08:12 PM.
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