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Pain Management/Don't Want Addiction- Choice of Oxycodone or Morphine

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Question
Dear Ms.Patricia M,

   Thank you for taking the time to read/answer my question!
Very unfortunately, I am a chronic pain patient of 36 years and my pain has *worsened significantly* after fusion surgery indicated by a vertebral fracture. Because my question is about pain treatment options, I shall not elaborate further on my history unless it would help you to know more specifics.
    Unlike before the surgery (when I took Vicodin 5/500, I am now in such pain that my prescribing physician is not comfortable with the amount of acetaminophen required to treat my ongoing pain with Percocet and, knowing I am afraid of addiction having a family history of it, he has offered to start me on either Oxycodone HCl 15mg (TID) or Morphine Sulfate 30mg (TID), and I have a few weeks to decide based on which one I'm most comfortable with based on which my research indicates is less addictive, as all my physician told me was that it "depends on the person".
     I realize there may be no absolute answer you can give me, but my readings have yielded some contradictory pieces of evidence, and I was hoping you might help me make sense of them, as well as provide your personal experience/opinion.  
      When he first mentioned "morphine", I thought immediately that it must be the more addictive, as I've rarely heard of it used outside a hospital setting #i.e. in an instant release tablet#, whereas members of the codeine family are common.  Also, I found a primary study that found a preference among previous Heroin addicts for intravenously-administered morphine over any other opiate analgesic. I don't know how relevant this is, however, as I have no drug abuse history, and would be taking one tablet three times daily, not through a needle in a hospital setting.
      However, there is clearly an epidemic right now centered around Oxycodone.  On forum-type websites for chronic pain patients #with many comments made by apparent addicts looking for euphoria who have no concern for pain relief#, oxycodone seems to be glorified as "stimulating, addictive, and heroin-like" where comments by these people label morphine as "dull", "useless", and/or "not very potent".  These descriptions #if they can be trusted# have made me lean toward Morphine Sulfate, as it seems to be less "pleasurable" to those looking to abuse it and/or use it for reasons other than relieving agonizing discomfort.  I've also seen several pieces on the news about pharmacy robberies becoming more common due to people seeking Oxycodone, and #finally# have read that more of Oxycodone is absorbed by the body #and more quickly# than Morphine, apparently making it more addictive.
       I suppose I am leaning strongly toward morphine based on the descriptions and facts about Oxycodone I've uncovered above, but I am hesitating because as a layperson, I don't understand why Morphine is considered the "gold standard" of opiates, is prescribed very rarely, and is basically a household name representing the pinnacle of powerful pain relief if, in fact, Oxycodone is much more addictive, euphoric, potent, and common.  Is some of my information wrong, or am I missing something?  What is your experience with respect to which one has the lesser potential for euphoria/addiction, etc?  And does this change for people who are using it ONLY to relieve pain, and in the lowest possible dose?

Thank you so much for considering this question, I am confused and feel nervous as this is a potentially life-altering choice if I don't know what I am getting into!

Sincerely,
Charles G.

Answer
Charles,
I can tell that you have certainly done your research on these drugs. Due to your own knowledge in this area I found that I had to do some further research myself. Here are my thoughts:

Basically, morphine and oxycodone are  both Class II narcotics, meaning they require a written Rx each time; they cannot be called in to the pharmacy. Class II drugs also have a higher potential for addiction and dependency, which you already know. Morphine is a much older drug, having been around since before WWII. Oxycodone  is much newer, but is still used very widely in hospitals, particularly for moderate to severe pain, usually after surgery.

In my research, and also in my experience treating patients with both of these drugs I have found that they are fairly equivalent. UNLESS the morphine is given by injection, as you have already noted, then the morphine would, of course, enter into the circulatory system much quicker and more thoroughly than an ORAL dosage. Much potency is lost when a medication is ingested through the stomach; not only does it take 30 to 40 minutes for the drug to cross over to the blood-brain barrier (and thus entering the central nervous system where it will do its pain-killing work), but also you have to keep in mind that the hydrochloric acid as well as other enzymes in the stomach and digestive tract render approximately 30-40 percent of the drug inactive or inert. This is just the nature of our stomachs and digestive tracts. That is why doctors prefer to use injections either muscularly or IV immediately after surgery when pain is more acute. This way it works much faster and since it is injected directly into the bloodstream, either via muscles or veins, you know that most of the active drug is going to enter the central nervous system and provide pain relief for the patient.

With all this being said, I realize you will not be treated with injections. However, let me make something clear to you. Morphine is very effective when used orally, as is oxycodone. I want to point out that since it appears you may need this pain-relief on a long term basis, then it is important that if your doctor prescribes oxycodone  that it is the type which is acetaminophen free type, namely Oxycontin. You may have heard of it, and it is a very highly abused narcotic. However, when used for true pain control it is found that patients develop dependency and tolerance at a much slower rate. The exact reason for this is not truly known but thought to be because the patient in pain is receiving regular, even doses instead of abusing the drugs, thus no "ups and downs" which very often contribute to dependency. There is also a long-acting  form of morphine, called MS Contin which is a 12-hour dose. I hope you understand my reason for alerting you against taking a strong painkiller which contains acetaminophen. One  can always use Tylenol for headaches and other mild pains if necessary, but I'm sure you are aware of the potential for liver toxicity.

I wish I could give you a more direct answer, but pain management physicians use both of these drugs, MS Contin and Oxycontin pretty much the same. They are considered to be about the same potency, but there is always some "wriggle room" if a patient does not tolerate the drug, or if their pain is poorly controlled. With the little science lesson above, I was just warning you about dangers of Tylenol. So, if the doctor offers you a choice of morphine or oxycodone, make sure neither contains acetaminophen. Other than that, you will probably find excellent pain control with either. It wasn't clear if you are seeing a pain control doctor or not, but if you require pain control for more than six months, it is very likely that your primary physician will refer you to a pain clinic. They are the ones who are licensed to prescribe these strong Class II narcotics long-term, as laws have changed in the last 5 years, necessitating physicians who specialize in long-term pain management.

I do hope I've been clear. You seem very knowledgeable and well-read in this area. That is always helpful when going on a new medication. An informed patient is easier to treat, and leaves less guesswork to the doctor.

It will be ultimately up to your doctor, but in my personal experience with treating patients after surgery, both morphine and oxycodone seem equally effective.

I hope I have helped you some. If you have further questions please feel free to write back in. It is my pleasure to help.

Pain Management

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Patricia M

Expertise

I welcome questions from people who may want a "nurse's perspective" on the subject of chronic pain and pain management. I am a nurse, NOT a physician (MD).I can answer questions on medications, alternative approaches, and the various organs and body systems. There are many avenues to explore with chronic pain. I am against seeing patients suffer simply because healthcare professionals might suspect they are "drug seekers". There are methods of identifying true pain, and this makes patients feel as if they are taken seriously, which they should be.

Experience

Over 25 years working experience in Internal Medicine, Adult Cardiology, Post-Surgery care, Cancer, psychiatry and some experience as a lay-counselor in addictive medicine (dependence to alcohol and/or drugs, both legal and illegal drugs).

Organizations
I am an Expert with AllExperts in several areas: Pharmacy, Internal Medicine, Medical Errors. Feel free to check my Q&A history as well as my ratings, which are very high.

Education/Credentials
Diploma from hospital-based nursing school. Additional courses in pharmacology. I keep current in continuing education. Am currently working as lay-counselor which can lead to my certification as Substance Abuse Counselor.

Awards and Honors
Dean's List while in college.

Past/Present Clients
Internal medicine patients, cardiology patients recovering from heart disease and/or open-heart surgery, cancer, as well as recently working as a lay-counselor to individuals dealing with addiction to drugs and/or alcohol. NOTE: Just because I attempt to help patients with addictive diseases, I have over 25 years in Internal Medicine, have nursed patients with great deal of pain, and I am compassionate. I never label anyone as a "drug seeker". I have seen that done for years, and am against it. All patients should be evaluated for pain in a fair and comprehensive manner. Am an Expert with AllExperts in three other medical categories; feel free to check my ratings, which are high.

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