Talk:Opioid comparison

IMPORTANT- PLEASE NOTE- Poor to the point of being dangerous!! +++++This topic is of great clinical relevance. Its subject matter is highly complex. The entry has started, however, at present the 'article' needs completely rewriting... Now! If this article grows from this, hotch-potch, guessmiquick, anecdotal tripe, we shall at best, do both the subject matter, & encyclopedia a great injustice. 1}. Opiate Comparison chart which uses NSAIDS as precedents. 2}. OC chart written without any knowledge of clinical significance, 3}. A distinct lack of opiates in regular clinical use. 4}, A basic outline of agonism & antagonism in relation to receptor sites 5}, Do you need help on this one??????

PS To the chap asking about DIM & Methadone. It doesn't. Why? Heroin (DAM) has very different pharmacodynamics, pharmacokinetics, favoured routes of administration, dosages (chronic & acute). However, I will try to answer what I must presume you are asking. Methadone, a long-acting (half-life>24 hrs) opiate usually administered orally in the so-called 'detox programmes'. A synthetic invented by the Germans during WWII, due to the shortage of morphine. Morphine is the standard drug by which all other opiates are measured by (not codeine). Morphine, like diamorphine (diacetylated morphine i.e heroin), both have a high first-pass metabolism), i.e they are absorbed by the stomach but the liver's microbial enzymes attack ~80%(F.P).Thus their use medically & non-medical, are injected. This is not the case with methadone. Hence, one reason stated for its preffereded use as a detox agent. Listen! Check out the drugs on Wiki independently, they are well-written, & read around. Begin with Heroin is not like methadone because.....?

Respectfully,

Prof Mad ++++++++--Profmad (talk) 20:39, 13 April 2010 (UTC)

==

The table seems to be a straight copy from the reference, which itself references wikipedia, and also states that it is not a reliable source of information! --Greg

Diacetylmorphine

where does diacetylmorphine (heroin) fit on this chart also methadone? —Preceding unsigned comment added by 71.182.109.139 (talk) 04:30, 9 March 2010 (UTC)

Opioid

This page should be called opioid comparison as this is the correct usage of the term. "Opiate" only refers to substances obtained directly from the poppy - codeine and morphine

--Axxaer (talk) 13:11, 30 December 2010 (UTC)

And diacetylmorphine and methadone can easily fit on this chart in regards to relative potencies.

--Axxaer (talk) 13:15, 30 December 2010 (UTC)

Moved. If you have any problems with it let me know

--Axxaer (talk) 13:45, 30 December 2010 (UTC)

Aspirin dosage

I don't think it is responsible to show what would be getting close to an overdose of aspirin (3600 mg) for the comparative dose to 10mg morphine, as some eager fool may try and take that much aspirin in the hopes that it would feel like morphine. Besides, aspirin would have long inhibited all the COX enzymes in a person's body before that dose so the pain relief would not be equivalent to 10mg of morphine. It is purely a mathematical calculation. For these reasons I think it better to say "nil". Comments?

--Axxaer (talk) 13:43, 30 December 2010 (UTC)

Codeine columns

It is my opinion that the codeine columns should be deleted, as it is just duplicate information, and as Prof Mad said, all opioids are compared to morphine as standard, not codeine. Thoughts and comments please. If no one disagrees I will delete it within a month. Respectfully --Axxaer (talk) 10:29, 2 January 2011 (UTC)

11:34, 4 March 2011 (UTC)~PROFMAD11:34, 4 March 2011 (UTC)Thank you for acknowledging this point. The chart does need re-editing. I will do another table, which may then be further edited by fellow 'Wiki's', followed by replacement of the main article chart. I think it necessary to remove NSAID's, since these are not opiates. The chart is regarding relative pain-control effectiveness, (which differs to opiate transfer change, particularly in/for dependency). Ketamine, hyoscine, alcohol & nitrous oxide, all have analgesic effects, but have no place in such a chart, it being an OPIATE COMPARISON CHART (For Pain)11:34, 4 March 2011 (UTC)PROFMAD11:34, 4 March 2011 (UTC) — Preceding unsigned comment added by Profmad (talk • contribs)

I went ahead and deleted the codine comparison columns. AreThree (talk) 09:00, 27 July 2011 (UTC)AreThree

Tramadol

Perhaps tramadol should have a footnote clarifying that it is a prodrug. Tramadol itself is very weak. It's metabolite, O-desmethyltramadol, is the more potent μ opioid agonist. 100 mg of tramadol hcl is metabolized into O-desmethyltramadol which precipitates analgesia similar in strength to 100 mg of codeine or 10 mg of morphine. --Rotellam1 (talk) 20:04, 30 May 2011 (UTC)

changed the reference to prodrug in the chart AreThree (talk) 09:00, 27 July 2011 (UTC)AreThree

Math wrong in chart? Poor source? Math is hard!

I am a bit confused and concerned. I don't think that the math is correct in the comparison chart.

For instance, if Oxycodone is 1.5–2 times the strength of Morphine, the equivalent dose for 10mg of Morphine isn't 4.5-6mg ... it would be 5-6.66mg wouldn't it? And if Levorphanol is 8 times the strength of Morphine, the equivalent dose for 10mg of Morphine isn't 0.8 mg ... it would be 1.25mg? Or am I not understanding the conversion correctly?

Additionally, the reference that is quoted says ITSELF that it is single-sourced and NOT to be quoted! Opioid Comparison at http://www.pharmer.org/forum/discussion-prescription-and-otc-meds/opioid-comparison AreThree (talk) 03:36, 21 July 2011 (UTC)AreThree

Fixed the math. I agree that the article is in desperate need of reliable sources. – Acdx (talk) 20:46, 25 July 2011 (UTC)

Methadone Potency

It says Oxycodone is 1.5-2x the strength of morphine, yet says Methadone is only half the strength of morphine.This is the most ridiculous thing I've ever read, and honeslty the entire chart is off. Methadone is at least the same potency as oxycodone, and in chronic users, is atually more potent.and to say it takes 20mg of Methadone to equal 10mg of ORAL morphine is laughable.Now, if it was IV morphine it would be different, but oral is only around 20% the strentgh of IV.As such, most people would literally not even get any analgesia off of a 10mg ORAL morphine dose, but would possibly be nodding and sick from being high on 20mg Methadone.Someone fix this, otherwise there is NO REASON WHATSOEVER to have a chart like this up, if it's data is completely and inexplicably wrong... — Preceding unsigned comment added by 24.98.250.155 (talk) 01:21, 12 August 2011 (UTC)

Fixing this article.

I changed methadone to 3-4x the strength.Note that this is speaking exclusively of ORAL dosing.You see, Methadone has a great oral bioavailability, averaging around 80% and sometimes being 90%.Conversely, Morphines extremely heigh first pass metabolism yields an obnoxiously low bio-A, around 20%, though it varies.As an educated person on this subject, Methadone is definitely more potent than morphine mg-per-mg, and since it also has 3 or 4 times the bio-a of when taken orally, you ultimately get MUCH more effect.Though again, if this chart we're speaking of IV/IM, it would be closer, MD probably isn't more than 2x as strong injected, but as long as it's oral, this is how it stays.I honestly suggest the chart be expanded though to include IV, because when you're talking 15-20% of a drug by mouth vs 100% IV, it's a HUGE difference, particularly when IV is the gold standard for Morphine, and morphine is the gold standard for pain relief.I might do it myself but it's all about time... — Preceding unsigned comment added by 24.98.250.155 (talk) 01:40, 12 August 2011 (UTC)

Couldn't agree more, it is ridiculous to put Methadone between Pethidine and Hydrocodone, it needs to moved above morphine(oral) for starters and just off hand i believe it is stronger than oxycodone and possibly stronger than morphine IV. — Preceding unsigned comment added by 86.7.13.168 (talk) 18:33, 15 August 2011 (UTC)

Bupe

The article says "all BA's are listed oral unless otherwise specified" well that is incorrect, the buprenorphine figure is obvioulsy not oral, because it has a BA of less than 10% via the oral route. Thus, the MOA being used for the comparison should be listed. I am honestly not sure what the MOA used is; I know IV is AT LEAST 40x the strength of oral morphine, but I am not sure if it is any more than 40x. Conversely, I doubt the sublingual administration(which is the intended route) is quite that strong. So I guess I shall try to figure out which MOA the figure refers too, and then alter the article appropriately. I may also add a footnote explaining Buprenorphine has an even lower BA orally then either morphine or diamorphine(AKA: Heroin)