How Strong are Different Painkillers: Equianalgesia Introduction
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- Опубліковано 31 тра 2024
- Intro to how strong/potent different painkillers are
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Disclaimer: the information in this video only represents the knowledge and property of the video’s authors- no one else. - Наука та технологія
I've had a few back surgeries over the years and live with spondylosis. As of this writing, I have 2 steel rods 6 screws in the lumbar from a failed fusion and 2 more herniated disc in the cervical neck. Pain is unbearable especially in the middle of the night and especially when I wake up in the morning. I have been on 30 mg. 12 hr time delayed Oxycontin twice a day and twice a day 15 mg Oxycodone for quite a few years. No more or no less on the doseage. I have always taken them as prescribed by the Surgeon and my Primary Care Doctor. Always! I submit to random drug tests and pill counts at the hospital on a regular basis. I have always passed these drug and pill count tests. Every single one! It is the only medication that relieves about 80% of the pain which helps me lead a so called life during the day. I've faithfully been in physical therapy since 1987 and do my back stretches twice a day. You only hear about the bad stories of taking Oxy's. Never hear any good stories about them such as mine in helping with pain management. Again, i have always taken as prescribed and have always past the many drug tests and pill counts.
Before covid, there was endless talk about the opioid epidemic, with its 89,000 deaths from people who abuse them, lots of the deaths from street Fentanyl. Barely a word about just a few deaths shy of 500,000..year after year, directly linked to cigarettes - and you can buy them in grocery stores. Wo do THEY help (Besides Big Tobacco)?
I have been on Hydrocodone since 2008. Without it, I would be miserable all the time. I take it as prescribed and submit to random urine tests. Never a problem.
@@lisapitts9518 If you legally have them, why do they randomly test you? is it an American thing?.. I've been on 30mg oxy for close to 2 years and haven't heard of any one being tested..
@@familyfalc8109 Oh yes, it is an American thing. So sad, but true.
@@lisapitts9518 Why do they test tho? To make sure they're being used properly and not sold?
Best and most easily understood explanation I have ever seen and heard! Thank you! By both explanation and a visual description, you have made this easy to understand! Thank you again!
So glad you enjoyed the video. Thanks for watching! If you have any other video suggestions please let us know!
Actually I do? Any information about the difference in pain medication and the location of the pain? Can you please discuss pain medication and the difference in the way it responds to different locations? So skeletal issues vs let's say internal pain from internal organs? And what happens when an individual presents completely different than the textbook version? Thank you for asking!
Another thing I am learning and wish I had known about years ago is palative care? When I was working there was only hospice care. This required 5 Drs to agree to 6 months or less and anything preventive was put aside. Now it's just a wonderful thing to learn about palative care and know that it more accepted and offered to individuals at an early and sometimes initial diagnosis time. This will help someone who may not think about the details after a terminal diagnosis. I am really enjoying this channel! Thank you for your service to others!
Correction to my above statement. I meant to say 2 drs not 5? 🤦♀️
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I'm not even in med school, I just wanna write a hospital scene that makes sense lol
I'm just a person trying to figure out what drugs to buy lol
@@nikkimarie2115 NONE OF THEM BRO !! DONT BE STOPID !! i was in a car accident and had pain all the time but just lived with it bc i was younger then i got older and started waiting tables while in school so the shit was weighing on my body and my friend gave me a 10 and boom instant superman mode but then i wanted to feel like super man all the time and it hasnt stopped luckily im now trying stop but i wish id never started i dont mess with any of the hard shit but still this is hard enough .. just smoke some quality bud man and call it a day .. take these words and really believe them
Legal to go by some Tussen. Meds are under lock and key by the g o v.
What kind of scene are you writing?
@@thomascoatesjr175 It's technically a morphinian compound. It's a isomer of some opioid, I wanna say levorphanol (actually it's an enatimoner of a modified ether of levorphanol) it just loses nearly all of its mu receptor activity which is where nearly all the analgesia and euphoria is mediated. Kappa receptor agonism is usually where dissociative opioids happen. That's why if you've ever heard of Demerol (pethidine/meperidine) has psychiatric side effects that most narcotics don't. It has both a toxic metabolite and a disproportionately high degree of kappa agonism.
Thanks for this info - very informative.
I dislocated my arm and broke my elbow. Once I got out of the emergency department, doctor prescribed me 100mg of tramadol to take twice a day. First time I had it, the first pill was fine, but the second pill made me extremely drowsy and I had trouble urinating despite having a full bladder. The next day, I couldn't do anything except sleep and my speech was slurred. After sticking to just the one tablet of tramadol once a day, it's been fine.That seems like to right dose for me while I'm healing from my injury. Only slightly drowsy and a bit relaxed. But most of all, my broken arm isn't causing me so much pain.
hey doc i was uh..taking 500mg of ibuprofen and it hasn't really worked well for me, so i was wondering uh... if you could bump me up a notch say uhh... like 500mg of etorphine?
popos22..go to Cambodia, you can get everything OTC
Lol yes sir no problem, n ur name is again DEXTER!.
I wonder how you got the 500mg ibuprofen pills? Do you mean Tylenol because ibuprofen normally come in 200mg pills available over the counter or 400, 600 and 800mg pills that are prescribed-only. I could write you a Vicodin HP every six hours for a month (it's now scheduled II) how does and some valium 5mg in the morning, 5mg in the evening and 10mg at bedtime.
Remco van Vliet.. don't matter,, dead is dead..it's better to live a short time happy rather than live a long time and be miserable and unhappy..just sayin
Sure here ya go!!! aaaaaand dead.
Amazing information. Our Law in Texas for prescribing these pain meds just changed. I was having it out with my pharmacist but I really needed to know what he meant after watching your video. Lol...I feel horrible now and will go apologize eventually. 🙃 Thank you much.
Great job with this video. Thanks for sharing
I'm a Pharmacy Technician and this video helped me a lot. Thanks!
How did you start your career? Looking to become a pharmacy tech as well
@@nlnprtr requirements vary from state to state. You would have to research how to become one in your state.
@@RM-ke3zm did you start off by doing an apprenticeship?
I was hired as a pharmacy technician for a drugstore and completed on the job training to be licensed
Thank you, very informative.
thank you! helped explain to my Mom who is on tramadol why post-op oxycodone is a different ball game.
alamoman444 Bbnb u
@Tim that's none of your business. Why are you even asking? You're acting as if this random person's mom is an addict or something for no reason at all
Tim, most pain management patients take their medication appropriately.
Tramadol is very difficult to abuse.
@@HM-ec5vi Extended Tramadol use is a negative factor. The withdrawals from Tramadol are not like those from a standard opiate agonist med. They are akin to a combo of benzo and opiate withdrawal...the current popular ideology/business policy of replacing Darvon and Darvocet with Tramadol will come home to roost...already is...
I had oxycoden last week for 2 days and I've never felt so sick in my life I have 2 herniated discs and waiting for op but those things 5 days of then I still feel the effect I was having crazy dreams
Good info man thanks I take IP 109 5/325 for pain 3 surgerys on my Ankle/Tibia
This is interesting as with pain management I usually start on the low end and work my way up this is an interesting take on medications hadn't thought about this way of thinking
One thing that you didn’t have on the list is Dolophine; after a workplace accident I’ve been through the Tramadol, hydrocodone, Duragesic; they all had both benefits/problems. The patches had a big problem that even with an overlay they wouldn’t stick or placement made absorption quicker; thankfully my GP was licensed for Dolophine Rx and for almost 20yrs. The only problem is the stigmatization, they only hear “ drug problem “…just wanted to pass that along…thx for your time and info
I do not see buprenorphine which works well on my pain and yes I have been on methadone, morphine, oxy's etc but maybe it's my nature but I always required more and more and was on 270mg oral morphine and it stopped working. I went into a clinical trial of the bupe for us pain patients and it was a godsend.
@@glenbearh9109 could you explain how it works for you in comparison to Oxycodone? Thank you so much!
Could you speak about first pass metabolism (GI, liver etc) in some detail as it relates to percentage and quality of absorption? Thank you.
I would love an answer to your question as well. Unfortunately for me, I had an legitimate back injury from when I trained MMA. I lived in south Florida and was pushed into the south Florida pain mill trap from the advice my personal doctor . For over 10 years I battled with my addiction. Clean now and have been but have been fighting with liver disease for the past 3 years. Currently on the transplant list for a new liver . Not a drinker but admittedly been was quickly hooked and stayed on opioids for years. Please let me know if you found some information on this. Thank you for your post.
@@tommulchy1 what were you taking and how many a day ? It had to be acetaminophen because that's the only thing that messes with the liver .
Very insightful,thank you.
Most, if not all of these meds are metabolized by the P450 cytochromes and no one will metabolize all of these perfectly. I think an individuals rate of metabolism by these enzymes should be something that pain doctors should test for. I am a ultra-rapid metabolizer for several enzymes and a ultra-slow metabolizer for a couple (that I know of myself). This makes my reaction to a particular dose of pain meds much different than another with more typical metabolism. I hope the future of pain medication will include more personalization by pharmacists and doctors given a patient’s P450 enzyme’s behaviour. Right now, a lit of people look like drug seekers when in reality they rapidly metabolize common pain medications and they need higher and more frequent dosing. Not everyone who needs more analgesia are faking or looking to get high. Everyone’s bodies are different.
it's called tolerance and yes, eventually everyone will need a higher dose to get the same effect.
DlchMcV Yes! I metabolize quickly and am asking my Dr for a blood test to check to adjust my pain meds accordingly. I am a chonic pain patient and my er meds last only 4hrs instead of the normal 8. It's killing me. Sick of this "war on opioids" and government sticking their nose in where it doesn't belong. They are attacking the wrong demographic. Kolodny and PROP should be put out for public stoning! There has been such an increase in suicide and illicit drug use due to chronic pain patients losing their meds and drs being too scared to prescribe opioids due to false info and threats from the DEA,FDA and ATF.
End rant.
So sorry for the long reply
Very true. I also metabolise at higher rates. So much so that after 4 hrs a Urine Drug Screen (UDS) will not be sensitive enough to find metabolites. This has caused issues and the need for unnecessary cost for blood tests.
It has also left me with in tractable pain. DEA/FDA, thanks for nothing.
All these knee jerk reactions have caused the opioid epidemic.
I am not medically trained but CBD which can in itself help with pain and inflammation also competes for p450 which should extend the action of any other p450 metabolized drugs in high enough doses, which with CBD is easy as it is a very benign chemical
@@slgogo594 AGREE
D Rock 75 I have the same situation as yourself and am currently going thru acute withdrawal which is absolute hell ! It has been over 1 week now and I am still in pure agony although I do feel that there is very slight improvement at this time. You may want to reconsider what you are doing unless you never plan on getting off of the opioids. I want to live life again, the sooner the better. These drugs were ruining my life more than you ever could imagine, both mentally and physically. Good luck to you.
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How are you now?
Hydromorphine, isnt necessary post op. I was given dilaudid ( hydromorphone ) at the hospital after an acute severe pancreatitis episode. I was in excruciating pain and after I believe it was 15 mls of dilaudid, the pain went away almost in seconds, serious powerful stuff.
I had the same thing after kidney cancer removal of the kidney and dilaudid was my savior.
Yeah I was prescribed it for two years. 2mg instant release pills and I ended up snorting them. 8 a day so 16mg Dilaudid up my nose daily for a couple years. Stopping that cold Turkey nearly killed me
I had/have Acute Pancreatitis and Dilaudid (Hydromorphone) set me straight. Wonderful drug we can’t shy away from given the correct circumstances.
I had a heart transplant and got the same thing (dilaudid) but 2mg pills every six hours. When the pain of having my sternum wired shut didn’t really go away, my doctor gave me the go ahead to up the dose at home at a time. Now that I’ve upped my dose, the pain is almost non existent when I’m breathing or walking around.
@@babybearburns4759 seriously have a plan to eventually ween off or get on suboxone if and when you don’t need it anymore. Those little peach coloured tiny pills nearly killed me.
A lovely post thank you. I knew something like this had to exist and when I asked my pharmacist for something along these lines she was at a loss. I had moved up to hydromorphone from Percocet and the pain increased. I think I'll go back to the Percocet but I'm wondering if too much opioids gives you an over sensitivity to pain. Was wondering if anyone else was similarly situated.
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They definately cause over sensitivity. Take lots of b vitamins and ashwaganda to clean out neurons. Good luck
@@patduffyforever thanks. I just tried, I think it is called TMSr... cranial magnets... the results were extraordinary...really good but lasted a few weeks.
@@jamesharris184 sounds good! 🙏
I moved up from partial pain control with Percocet, to 30 mg oxycontin about 4 years ago. The improvement was amazing. Have had no addiction issues or any desire to increase the dosage. This was all closely monitored by my family doctor and my pharmacist.
Really good explanation.
Thanks for explaining my mom was in a bad reck and she cracked 90% of her ribs they were giving her morphine but the pain would be back within the hour. Dilaudid is the only thing that let her actually get some relief while she waits for surgery
@Stephanie west she’s already home and doing well, she’s doing just fine with Tylenol 3 or oxy if the pain is intense and she doesn’t take them daily
@@stephaniewest8226 that’s crazy
It’s great to show the order of strength as a guiding principle. It’s surprising how few people interested in medicine have experience with these common drugs, so it’s helpful. The numbers aren’t accurate and should be seen as a guideline at best. Tolerance is built up as one example and humans have individual body chemistry. Then there is the administration of the drug and bioavailability. It’s more complicated than this suggests.
Rick Fletcher this is more a general guideline
Well said!
It shouldn't be a "guiding principle" at all. It's not the same for everyone. Some people are fast metabolizers. Others can't process some of these meds. People are individuals, not clones. Pain is individual. Fentanyl would knock my mother out, but it did nothing for me - I couldn't process it. You can't say Fentanyl is X times stronger than Morphine if it has no effect whatsoever.
So where does kratom fall under, since it affects the opiod receptors and relieves pain like these drugs do?
This is something its took me years to learn while under pain management and its came in handy lately due to the cut backs by doctors who are no longer in actual pain management but puppets lead by the DEA. Been under pain management for 14 years taking Percocet now i have been cut back to point it does little good. Not sure what i am going to end up doing only thing that works outside of Percocet is ibuprofen at high dosage but very dangerous. To get the relief it take 1600mg ibuprofen per dose or just 2 Percocet 5/325 per dose during my flare ups. Otherwise about half of that dose works for my everyday pain. But my doctor won't no longer address my flare up pain which leaves me short about 15 doses per month so now i am back almost as if pain isnt managed.
Ken Jett Kratom
It works
Try going to a methadone clinic. Shit is amazing for chronic pain. It's duration is incredibly long acting also.
Learn about WILD LETTUCE
Try herion. If u can get it. Or bump up to roxy,s first. Theres always methadone as well. Or try subutex
@William Loudermilk wow couldn't have put it better...this war on chronic pain is inhumane...trumps ignorance has a major role in this he has put us in the same category as junkies because we have an injury or disease. So wrong..
I had Hydromorphone through an IV after my surgery . My god never felt so go in my life . But it only lasted around an hour and I had to wait 6 hours to get another dose . But it really helped me get up and walk . I had a ilesotomy reversal surgery so it was painful as hell .
@@gds6381 Thanks 🙏 .
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@@melvisachama3444 LOL
Sounds like you're a fast metabolizer. I'm the same way with oxycodone - lucky if it lasts 4 hours, let alone the 6 it's prescribed for me to take. Surgeon said every 4 hours. GP said 6. I had to wait 6 because of the idiotic pain contract. Wishing the GP would have discussed treatment with the surgeon. Some day my GP will have to experience real pain and change their mind about how frequent it should be prescribed.
@@4TIMESAYEAR They can write their own prescriptions. They don't giva damn about your pain.
Fentanyl is the strongest opioid analgesic you can get by prescription. You also have 2 other kinds of fentanyl used during general anesthesia. (Remi and Su). Hydrocodone and Oxycodone are just about the exact same in efficiency. Methadone is a form of the same drug but not as potent as Fentanyl. (1) Fentanyl, (2) Oxymorphone, (3) Hydromorphone, (4) Methadone, (5) Oxycodone....(2) Used to be Levo Dromoran, but it's hardly used anymore. *Fentanyl is dosed in Micrograms...not Milligrams...because of it's potency
And in addition you can also use "Alfentanil" or RAPIFEN for short operations that last shorter than the use of Fentanyl or Sufentanil allows. All are really cheap.
I agree completely . Everthing is right.
Great vide! Thank you for it!
Very informative, thanks!!!
I'm a big fan of Sidafinal. Things are looking up!
😂
Just give us what we need as life is short!!!
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Thanks. That was very helpful!
A little bit off topic, but for those of you that have cancer you might want to ask your doctor for Subsys. It works incredibly fast. It's fentanyl that you spray under your tongue. Expensive, but for me it was highly effective for break through pain. ..
I had two separate surgeries on my feet and woke up from anesthesia with a horrible headache both times. The first time they gave me IV morphine and the second time, dilaudid. The dilaudid definitely felt much stronger to me, for whatever reason.
But the dilaudid was orally right, like a pill? Cuz I assume hydromophine IV like the mophine would have a 3x as strong effect too, found it weird the guy here didn't mention that, Hydromorphine IV would than be 15x simple hydrocone orally.
Sounds like they need to change your anesthetic and try one that won't give you a migraine.
I’ve had both of my legs below the knee and both times they gave me diluadid. It was the only pain medicine that has ever worked for me. That was given to me through a IV. Once the nurse messed up and gave me twice the amount that I was supposed to get and it didn’t have a different effect on me.
There seems to be little rhyme or reason as to why some pain killers work better for some than others. I suffer from Type 2 CRPS, unbelievably painful, but I get enough relief from 100mg of Tramadol a day to allow me to work part time. Strange that it works for me but rarely for others. Worth a try though if you haven't already fellow sufferers.
Very informative..well said
Fascinating. Thanks mate.
After seeing Equianalgesia... I thought “oh here we go, this advice is gonna be specific to horses...”
I have tried codeine, tramadol, Norco, percocet, iv Morphin, Fantanyl. For my broken body.
I am currently on Norco. Yup. Damm Cdc guide line killing me.
Same + hydromorphone
All I can get is Tramadol. It's not working anymore because I'm 38, but I have the arthritis of someone in their 50's. I'm fucking miserable.
@@KLMosely I have the same arthritis knee pain
@@KLMosely I have it in my spine n foot n I’m 26
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Thanks that was hugely helpful!
Ur welcome
I am currently on hydromorphone for my bad pancreas. I just got Belbuca to try and reduce the other medicaton. Where does Belcuca rate in terms of this chart in helping with pain?
It is strange how different medications affect different patients differently. For example, I was given morphine and fentanyl post surgeries and during kidney stones and other blockages inpatient, but the one that was most effective (I even asked the doctor to cut the dose in half) for me was Meperidine. Everyone’s body reacts differently…
No kidding!
Meperidine was the first migraine med I was on, injection.
Been on it all.
Methadone being the strongest the longest- dilauded 2 or 4 MG is strong- but short acting.
Now, I am on Subutex. VERY VERY strong, but in a more functioning way.
Everyone's brains are wired a bit different,
And we respond differently based on many variables such as weight, age, tolerance, drug history and brain 🧠 receptors.
These chemicals all work by acting like keys 🔑 to our receptors sites.
I didn't know fentanyl was so strong. I was given Hydromorphone in the ED once due to a complication following surgery (colostomy) and I swear you could have beaten me with a baseball bat and I wouldn't have felt a thing. It also made me have color flashes. I can't imagine what Fent does let alone Etor. Downside with hydromorphone was the effect only lasted about a half hour and they couldn't give me anything else for about 4 hours.
I was given fentanyl once. Needed a biopsy done to check a tumor on ovaries before transplants. I went home same day and I didn't feel right. Hated it. Signed it off as a no no drug with drs and my power of attorney. Tramadol puts me in a coma regardless of dosage. Post double transplants i was on morphine but never felt "high". It eased my pain like Tylenol does a headache. Nothing more. No funny effects or feelings
@@kathrynhill6452 Funny how pain killers affect people so differently. I like Tramadol and morphine fucks my world up big time. I get pain meds for pinched nerves in my neck in between RFA's
I had the same surgery. Hydropmorphone would send me into a dizzy trance for several minutes. Those few minutes of total pain relief were bliss. Crazy stuff...
Fentanyl killed my dad.
@@MissMariQueen Sorry to hear. It's killed quite a few.
too bad the show ended so soon, really enjoyed this lecture
Nice job !
codeine is as old as my grandmother..i could take 10 and barely feel anything.
Codeine is much harder to assign a number to than you're making it look like, because it's inactive until a liver enzyme turns it into morphine and different people have different versions of that enzyme. In some people, the enzyme works rapidly and extensively, so codeine is effectively the same as morphine for those people. In most people, the enzyme kinda works and mostly doesn't, so they get a bit of opioid effect; this might be where your 1/10 number comes from. And then there's people who don't metabolize codeine into morphine at all, so it doesn't do anything.
It’s just wonderful.
Very interesting Dr.
I've been dealing with chronic pain for almost twenty years now and I've been on pretty much every type of pain killer you can try. By far, and I mean by a LARGE margin, Methadone has been the most effective. I use Oxy IR's for breakthrough pain.
I get no withdrawal effects as the time for my next dose comes up, as I did with pretty much everything else, and I stay at a pretty even pain level except for the breakthrough pain, which has been there no matter what I've been taking, but it's usually overcome by the IR's. I can miss the occasional dosages and my pain levels don't immediately spike. It's also pretty damn cheap. Methadone has been a God-send for me.
I know it's tearing up my insides, but we're all going to die and I choose to do it with as little pain as possible.
If you haven't tried Methadone for long-term chronic pain, maybe talk to your doctor about it and see what they say. It was actually a last-ditch effort for me but it ended up helping more than anything else I had tried.
FUCK METHADONE. Unless your dying and are never going to have a life anyways by all means methadone will dope you up for the rest of your life. I was on methadone for 17 years. In that time all I became was a bigger junkie then when I was on heroin. Methadone is nearly impossible to get off of. I got back on heroin for over a year and then I got off heroin in 3 days of withdrawal and now I'm stuck on suboxone. Methadone is like slow acting fentanyl and twice as physically addictive. I wouldn't wish methadone withdrawal on my worst enemy and I can be a real bastard. It's great for people who will never stop using heroin because you can just use your methadone to get you to your next hit without ever going into withdrawal. Maybe if you just take it for pain then this may not apply to you. I used methadone for 17 years and heroin. I will say it kept me out of prison because I was never stupid desperate enough too fuck up my FREEDOM plus I was so scared of being in prison while withdrawing from mdone. Suboxone should be the only choice for people who want a life after heroin and not tied down to a clinic and the hours of the clinics dont have hours that you could ever have a real full time job unless you work from home. There is life after heroin. Just dont think you'll ever have one on methadone. Sorry this doesn't apply to people who just use it for pain.
Dig it man. We row the same boat
@@theogsmoka9624 , Yeah chronic pain is a totally different thing. In the twenty years I've been on heavy pain meds, not once have I gotten high or took my medications for any reason other than to deal with the pain. In the past I've had to take handfuls of pills to get the pain under control and I didn't get high in the slightest way.
I knew the day I first got on Methadone that there was no going back, I even had to sign a contract, but the pain isn't going away either so I gotta take something, and I'll take what gives me the best results with the least side effects every time.
I appreciate the concern though, it's just a totally different boat.
@@BrassStacks I was on Methadone for about 25 years for chronic pain and it was a Godsend! I tried so many other drugs and nothing targeted my nerve pain like Methadone. Sadly my pain doctor died 3 years ago and absolutely NO doctor in this hell hole of a state I live in would take me! I keep hoping one day the government will stop with all this hysteria and allow those of us who really need these drugs to have them back. Sadly I don't think I will live to see that day, we are out gunned and do not have the finances nor the media hype to fight the anti drug zealots! For some reason the government just wants to ignore us while catering to the addicts!! I knew the deck was stacked against us but I never imagined it would be this bad!! There seem to be many of you out here who Are still able to get your meds, you are very lucky!!
@@sarabryce9348 Yep there are a lot of us being a pissed on by the govt. ...Methadone for chronic pain works great but getting them for chronic pain is impossible anymore.
I have been off opiates for 5 years( was an addict) and after kidney stone surgery the Dilaudid and Morphine was not working they gave me 5mg of Dilaudid..is this common? I was still in Pain. Is there something the Doctor could have sone to help the pain? Or a diffrent drug?
SmithN' Wesson experiencing kidney stone issues as well. Just had lithotripsy 2 days ago, and dilaudid IV (1mg) worked for about an hour and a half. I'm home with hydromorphone/dilaudid pills and it's OK. I just take 8mgs to get any relief.
Lady Love Yea im only 31 and i just had surgery yesterday to break up my two large stones and put a new stent in. Unfortunately once you go the extremes I have with pain killers nothing works anymore and its too risky.rIf I go off the rails Ill nwver come back and I have three little kids to think of. I hope your pain gets better.
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@@williamsbrown8700 your site can't be reached.help me plz I need zannys big time man.
couple questions:
is darvocet in the same category/strength as demarol?
and
can you please add in methadone, buprenophrine and/or suboxone.
and, can you explain the receptors briefly and why morphine affects one different then a like dosage of hydro or oxi codone?
They stopped making darvocet.I used to take it
So for folks that have Sickle Cell is it better to get Morphine or Hydromorphone ?
After a few surgeries this year, I'm surprised to discover that fentanyl is commonly used for anesthesia. The culture is so caught up with opiate overdose deaths and the failed war on drugs, that the proper uses of these things are mostly overlooked. Companies don't manufacture these drugs to kill you, or even get you addicted (although companies have been famous for hiding the addictive aspects). They manufacture them because they are still by far the best solution to pain, particularly acute and chronic pain. If they didn't work, they wouldn't make them. Of course they get misused, but so does alcohol, the elephant in the middle of the room, as they say.
I was in the hospital and they had me on fenty and I didn't die
You sound like a Sackler
Fentanyl doesn't work for everyone. Has no effect whatsoever for me.
@@4TIMESAYEAR bet
@@trippplecup1563 Bet what? I was wide awake and in total agony. Bet what? If you're missing what it needs to process it, it has absolutely NO effect.
I'm so glad you showed Etorphine. I'd love to get some of that stuff!
Your all di dicks
Ur going to get addicted 😂
It's for elephants not jackasses, fool
Shouldn't joke about any of this!! I bet you have never felt, what it's like to exit these!! Or you wouldn't be joking about it!!
Tramadol never worked for me
I broke 6 ribs and got a spleen laceration in a car accident last week. My doctor prescribed me Ketorolac and Hydromorphone. They told me to only use the Hydromorphone when i am in serious pain but the Ketorolac relieves most of the pain all day long on its own. I guess i will have some Hydromorphone handy if i ever get hurt in the future.
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Update over 3 years later. I was in the hospital for 6 days before I was discharged and prescribed these pills and the nurses injected me in the arm multiple times a day with the regular old morphine I'm guessing but maybe it was low doses of Fentanyl or some other powerful opioid, I have no idea what they had in those needles, I didn't care to ask because I was high as a kite on that stuff and telling the nurses how pretty they were before passing out from the drug. When they discharged me I had 5 days of Ketorolac pills and they really got me through the worst of the pain, I don't remember how many milligrams each pill was but I know they worked well and didn't make me feel high or under the influence at all because they are not a opioid. I switched to the regular off the shelf Tylenol extra strength after that and never once took a Dilaudid for my pain. Here is the part of the story where I feel like a bad person. Over a year later I was telling this guy I had just met minutes earlier about my accident and I brought up how I have 30 Dilaudid pills in my car and they are small and pink and they are 2mg each. He went on to explain that people call them Dillys on the street and they are worth big money to a junky. Long story short we crushed one of them and snorted 1mg of hydromorphone each and got really high, it felt very much like the opioid injections I got in the hospital but not powerful enough to make me fall asleep like the hospital dose did. This was the only time I ever sold drugs in my life but that dude gave me 500 in cash for those 29 pills and I only paid 60 bucks at the pharmacy. I know it was wrong and illegal to sell those pills but it taught me a lesson and that lesson is never take opioids unless you are in so much pain that you need them.
Is there a significant difference between hydrocodone and hydrocodone-acetaminophen?
What about Oxymorphone aka Opana
I was thinking the same thing
you need to keep in mind the oral bioavailability of morphine which is only 20%. so for every 10mg consumed this way you are only metabolizing 2mg. hyrdrocodone is about 80% for oral BA, and 87% for oxycodone. So 10mg of oral oxycodone is equal to around 45mg of oral morphine.
I was a patient in a trial of buprenorphine (subutex) for pain patients who did not do well on regular Mu Agonist opiates. I tried them all short of heroin. I have suffered withdrawals upon detoxing from oxy's and morphine so I know they hell it puts one through. In the trial I was coming off a large amount of oxycodone and had to endure WD's but not for long. Once the buprenorphine entered my bloodstream, the WD's went away (heebie geebies, runs, sweats and massive leg kicking) I stayed on for a year or so then went off to see where my pain level was truly at. I stayed off a year but knew I'd most likely have to go back on due to pain. I tried the tylenol and tramadol but they only worked for a while. I did go back to bupe but have no regrets because it does work well on pain and the concern about major surgery and not being able to use regular opiates is NOT true. After hip replacement I was on a PCA of diludid and it worked in fact when the hospital finally got bupe in the pharmacy and I took it with the hydromorphone, I required less and was not whacking the PCA button ever two minutes. My hope is more pain doctors wake up to the benefits of buprenorphine
I just had surgery and was given a hydromorphone iv and I felt like I wasn't on earth. After visiting hours my friends and gf left and that night I caught myself talking to them and they went there lol... powerful shit
Everytime I hear on the news about how sad it is for people "suffering" from opioids I can really associate. About twenty minutes after I take some percocets I lay down and "suffer" frequently. My wife also suffers from strong orgasms. Pity us.
Most of the opioid ODs you hear about are people trying to commit suicide (and often succeeding). Take away the opioid and they will just use something else. It's the same mentality that imagines making guns illegal will end murders.
After breaking my back in 3 places, I was put on pain meds. It started out with 60 loratabs a month for 3yrs. Then it got to the point it wasn't doing anything anymore. So they bumped me up to 180 a month. Then I went to Pecks at 180 a month till they quit working. Then went to 30mg Roxy's 6 times a day. So just say that my tolerance is not even on a scale. I had a kidney stone and matter or fact, it was 2 coming down at the same time and out my same kidney. The ER gave me 1mg Dilaudid through an IV and I'm not lying. As soon as that crap hit the vein it was instant. The nurse tels me not to try to get up. I looked at her and said I'm fine and I was. 2 years later I had another stone and this s at 1am in the morning. I was getting dressed in the bathroom and my wife walks in and says umm, where in the hell are you going. I turned around and she new I was crying. I said the hospital right now. She said it's going to take me a few minutes to get dressed. I simply said I'll meet you there. I'm laying on the bed and the catscan showed I had a 7 and a 1\2 mm stone. They asked me if I had a ride home. I said I sure do, my wife. They not me with 2mgs of Dilaudid in the iV. Now this time they did NOT tell me they stepped itupfrom the last time. Look people, I've been messed up before and I've been taking pain killers for 19yrs now. I was grabbing the table so hard to make sure I didn't fall off the face of the Earth. Till this day I truly believe that she overdosed me. Now I'm on 100mg fentnal patches. People these patches are nuts!!!! Thee 100mg patch only contains about 10mgs of fentnal and it will last for 72 hours. Fentnal is the strongest pain killers I have ever used. It was so bad that I told my doctor that I needed to switch back to something less. The withdrawals from that crap is ever lasting. It has messed up my tolerance and my doctor and I were talking about me getting admitted in the ER to detox. If anyone knows how bad tht is, I didn't like the idea but said ok. After 12hrs I had a heart attach. So there went my chance. I also had a minor stokedue to my blood pressure spiking. Just becareful everyone and God bless you all
Bro holy fuck
@RPG 808 thank you so much. 3 Joint replacements, man I am so sorry. That has gotta suck pretty bad. I had a friend that had to have his right hip replaced and it was probably the est thing he could have ever done. He couldn't walk and when he did try, he looked worse than a drunk penguin. I hope you get everything that you need. Living in pain is not for the weak hearted. God bless man and take care of yourself.
I crushed a disc in my back spent four months in bed crying went to hostpital my husband helped ne walk the doctor left me crying for seven hours and I told her that dilaudid dissent work for me she told me to go home and exercise I couldn’t walk she was awful I was in my sixties later I had back surgery I can never forget how cruel some doctors plus I had cancer at the time but didn’t know it yet .
@@francesgillotti1378 oh my. Yeah that's what good lawyers are for. I thought about it for awhile and no matter how bad it is and was. I dont think I would want to sit in a courtroom. Plus I wouldn't want someone sueing me either. But sometimes it's the only way. I am scared but I still have a wife and kids to be here for. So that makes me fight.
@Robert Biondo
Breaking a back isn't fun. Don't do like me and over do it. It's hard and I mean hard to move around anymore. I force myself because I know if I don't move, I'll lock up and there's nothing that will help. Perks worked good for awhile. So stay there as long as you possibly can.
quick and easy guide helps deffo cos most ppl take stuff iff the streets ..but i went through the docters i was on oral morthine and codeirn aint on it all anymore though...what is m99 that can not be a painkiller ppl get painkillers mixed up with nockout drugs
Kind of simplistic. In addition to potency; there is efficacy, and duration of action, and metabolism. Opiates primarily act on the opiate receptors, but aspirin does not. The lethal toxicity of opiates is usually respiratory depression but this is not the major problem with ASA or ibuprofen.
Opiates can differ in duration of action and metabolism. This would affect how often you take the med (an important factor in getting relief and avoiding overdose toxicity) and what drugs might interfere with the metabolism. For instance morphine is metabolized by different mechanisms than fentanyl or codeine so just knowing its potency is not enough to predict how long analgesia will last.
Meperidine and fentanyl are short duration agents and both have drug interactions with grapefruit juice. Morphine is considered a prototype but many other opiates are not metabolized in the body the same way so not great for predicting duration of effect for many opiates. As noted in the video it is more potent when injected directly into the blood. Not mentioned in the video; methadone, and opiate drugs like it, have longer durations of action than morphine. Methadone also interactounds s with grapefruit juice. Codeine and Tramadol are not really fully potent until the patient's metabolism converts them to more active comp. A mistake is to dose codeine and tramadol at the same frequency. Tramadol actually has a significantly longer duration of action than codeine. So when I was being treated in a fancy hospital with a famous name I was unconscious for 12 hours after surgery because they switched tramadol (in response to the fuss about using opiates, which doctors had been using with good results for many years) is a longer acting drug. However, you can't totally blame the the doctors for this one because the FDA in their desire to help industry market tramadol quickly, didn't require new time course studies. Oops.
The discussion of NSAIDs (=Nonsteroidal Anti-Inflammatory Drug) was incomplete. Aspirin and Ibuprofen are not opiates and act by entirely separate mechanisms which effects such things as maximum efficacy from single administration. For instance NSAIDs agents demonstrate "ceiling effects", that is to say that the analgesia may not increase when larger doses are administered, while opiate analgesia is more dose related. (Acetaminophen is a bunny, not really like anything else, but at high doses shares some toxicity with the NSAIDs.)
Many pain medications are combinations of these analgesics and if miss used can show toxicity associated with either. During the same period that there was a concern that too much opiates were being used, there was also a concern of increased toxicity due to NSAID's and acetaminophen. This could relate to not understanding the pharmacology of these different types of agents. Since tolerance develops to opiate analgesia with repeated use but not to NSAID analgesia, there is a temptation to increase the number of tablets being given, which eventually leads to NSAID toxicity.
My point is: even if you know equipotencies, you could be a long way from being able to manage someones pain control.
I had three heart transplants. I've been on just about everything on this list but the last one. I hated the Fentanyl so much. It made me sicc every time I hit the button but it did help with the pain. No more narcotics for me. If Tylenol or Motrin don't help I'll just deal with the pain
Faceof Extinction If you don't mind me asking... How did you get lucky enough to receive three different hearts.
@@heavyhitter8972 Well I got my first transplant in and April 2011 at Mount Sinai hospital in Manhattan. That heart only lasted for a year so in August 2012 I was put on a total artificial Heart while I waited for another donor. In April 2014 I got the heart I have now. You can check out the Mount Sinai website and look up my name. It was all in the news about the total Artificial Heart. My name is Daquain Jenkins. When you have time go check it out. Its been a hell of a ride to say the least
@Crazy Sven I'm not allowed to take UNSAid cause I take aspirin once a day.
@Crazy Sven I was taking Motrin at one point but was told to stop by my transplant team. For any pain I have now I take Tylenol extra strength or a lol bit of the medical marijuana. I got my card about 6 months ago and its don't wonders for my pain and my seizures
Yeah, at this point, it seems Cannabis May potentially be the most effective and still safest option
Having chronic pain for over 9 years, I found hydromorphone to be the most effective. Though, I have never had fentanyl.
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I had fentanyl in the hospital it works very well but it is short acting
I love pharmacology and the potencies aren't always appreciated by people are they. Carfentanil is of course extremely potent but there are others too. There's a drug called Diprenorphine which is an extremely potent reversal agent and is used to reverse Etorphine's effects, since as you'd expect, Naloxone does not work.
I suffered 4 days from Pulmonary Embolism pain. 10! Worst pain I ever felt and I also felt like I was going to suffocate. It was lodged behind my liver. One thing I noticed with the pain difference was temperature and using heat pads. My pain reduced in the heat. You might want to factor heat in to the mix.
Or cold.
"Extra painkiller kick from ACAP" Haha! good one!
.
Technically yes, but also agree as a chronic pain patient lol. It does technically boost pain killing of sum of either one on their own.
@@iKazed I think all it does is thin the blood a bit, so more of the oxy is available
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Should have talked more about RoA's, bioavailability, half life and blood brain barrier, metabolism and body chem types. There's nothing cool about this, but I am able to take approximately 4 times the amount of some very heavy opiates without having the same physical affects that most people get when taking one fourth the amount I've taken. Again, this is not cool and it took over a decade before I found a doctor that understood what was happening. Some people (approx. One tenth of one percent of the pop) have an overproduction of certain enzymes that break down certain meds in your liver. There are so many things that need to be taken into account because the strength of a med is relative
i found out a few years ago that meperidine is another name for pethidine are the same drug and that Demerol is just a brand name of them, like Dilaudid is a brand name for Hydromorphone
Great explanation! Very informative. Thank you
I use medical marijuana orally, because hydrocodone had no effect on me. I did not want to take addictive pain killers. I had a splintered spine complicated with back spasms. The pain was intense. The medical marijuana I make is very potent. I have had IV morphine before for a kidney stone. My medical marijuana is similar in strength but is not addictive. My last batch of marijuana brownies is so strong. One tablespoon of brownie is one dose. I have a high resistance to the effects of marijuana. The only drawback to medical marijuana is consistency of dosages. The edible medical marijuana you can buy had no effect on me. So I made my own after doing a lot of research. The first time I tried it. I could not walk or crawl. I simply could not feel my body. They could have operated on me. Since then I am more cautious about dosage.
Mojo Stone: Marijuana has little to no effect on neuropathic pain.
Do you get high ? I've never liked the THC high.
@@nerblebun many people with neuropathy would disagree grandpa
@@BigGreezyJake : Disagree with my Doctor. Dr. William Akerman III. He's been a board certified pain specialists for over 40 years & authored 14 books on the subject. Perhaps you know something he doesn't.
@@nerblebun again... the people paying a lot of money would be to differ. One man's opinion does not outweigh facts, facts which can only be established through double blind studies, no matter what fancy title or letters they have before or after their name
what about oxymorphone/opana?
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what abut non-opiates/opioids? stuff like ketamine and other hexocycloamines, or tropanes like cocaine. are these also based upon user information or how they receptor efficacy?
I’m curious about where methadone would sit on this list. Thank you for this info!!✌️❤️
Beutiful man
I’m surprised no one mentions Gabapentin to augment pain when on opiates. I’ve prescribed to patients when we were prevented from prescribing what we thought appropriate Part of the reason I retired a little early are the constraints put on NP, PA,MDs. First insurance companies then the DEA.
My GP just started me on that about a year or so and it has allowed me to reduce my Dolophine from 60mg a day to 40mg with 600mg twice daily.
@@SneekyRafiki I’m so sorry to hear that you are in so much pain. I would prescribe ketamine for you. Ask your health care provider.
I've been wondering about this since Grey's Anatomy season 1 ep 5 where the patient was probably "allergic" to various drugs and wanted 10 of dilaudid. I didn't know what most of them really were but mostly wondered how they compared. (So I've been wondering for about 13 years.if I asked, people just said they were strong. Not kidding)
It is a mistake to use this method. It's not scientific. You should read how they got it. It wasn't objective science. It was subjective.
Anyone have experience with tinnitus and pain killers I've been prescribed tramadol and wonder if there's one more favorable for avoiding worsening tinnitus. I noticed kratom fucked up my tinnitus.
Do higher potency opioids increase tolerance exponentially faster or just linearly according to the equivalent dose to a lower potency opioid? Or can this not be said in general terms because other properties of the opioid such as half-life, variability in receptor affinities, etc. have a greater influence than the pure potency?
I wish codeine, dihydrocodeine, tramadol, and tapentadol up to 60 mg a pill could be bought OTC.
Too many junkies for that to ever happen. If everyone could be responsible that would be fine and probably beneficial but our society is not at all responsible lol
@Steven lol
@Stopthewar Taylor yeah lol stop it, I bet it's just like walking into a shop haha.
@Stopthewar Taylor btw where I work I just take the DHC120mgs n sometimes I'm a little high little low will you let me go, bismela, no , i will not let you go ! Now. I love my dihydrocodeine tartrate 120/napp pharmaceuticals. Bla bla fucking bla.
Tylenol #1, Tylenol #2, and tramadol with acetaminophen (Ultracet) should be OTC in my opinion. However, with the opioid crisis here in the U.S. that will never happen at the moment or ever really. Before dextromethorphan codeine was widely available for cough OTC. Even before that in the 1930s-1960s amphetamines were available over the counter. L-methamphetamine is available over the counter today, but it's not as psychoactive as D-methamphetamine and its availability seems to go unnoticed. Either way in Central and South America and certain other parts of the world including Mexico for example, tramadol is available over the counter in alone formulations in 50mg and 100mg tablets, concentrated drops, liquids, as a combination with naproxen, aspirin, paracetamol/APAP/acetaminophen (commonly known as Tylenol in the US), and even injectables (I.M./I.V.) of tramadol known as Tramal in 50mg/ml formulations. My friend got hooked on this and buprenorphine after undergoing a surgery in Mexico.
How about they simply give something for pain? All the sudden (since 2015) they've decided Pain isn't as important as it was? Something to do with Accountability I think.
I'm taking Palexia sr for back pain, with tapentadol being the active ingredient. Where does that fit in, please ?
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I have a question I’m sober from heavy use it’s been years five in October why is it that now whenever I take something like when I have to I get a bad reaction when I used to get a good one
Tiffany Early You’re tolerance is not what it is as a heavy user, maybe your dose is too high. Or it’s a blessing, your body says it’s done with that stuff lol. Five years, that’s great / Take care.
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I was on high doses of hydromorhone (Dialudid) for post herpetic Pain from a severe case of Shingles. I decided one day that I couldn’t stand the addiction. I went “Cold Turkey”. It was not fun. It took 4-6 weeks. At the risk of grossing out, but, every pore of my body secreted. I ended up wearing Depends. BUT, I made it to the otherside against my doctor’s wishes. I went down from 155 lbs to 129 lbs. I was totally alone. Still, I realized that Opiate Addiction is REAL. Once off of it, my doctor prescribed Lyrica and guess what 90% of my pain has dissipated. So were the pain killers masking truth. I tend to believe so. I don’t preach because I own that I have an addictive personality. My friend asked me if I would ever do it again. I said NO. However, I know there’s probably a few pills that fell on my closet floor. And I said I would probably take them for one more ride. Thankfully, the universe has not allowed me to find them. Just BE Aware.
Hey bro im hooked to dilaudids takin 40 mg a day. What was ur dosage?
@@charlesleger6787 bout tree fiddy
Tell us more about the pores and what you saw come out please was it strange color or just not sweat?
I’m on fentanyl I wish dilly’s worked
The ONLY thing that works for me is Demerol. Unfortunately, most of the hospitals won't give it to you any more. I had a very bad car accident and was on morphine at first. It did absolutely NOTHING!!!! One shot of 75 mg of Demerol and pain was instantly gone. It's short-acting though, so not so great. I really don't care. Need surgery, but last time, I laid there in pain for weeks. I know you won't be pain-free, but there is NO reason to lay there and suffer, which I did. Refused badly needed surgery because of this.
reason we stopped giving Demerol is that it killed the kidneys...…...primarily used only for gall bladder pain......before surgery
@@nathanielcohen9890 Was given 100 mg of Demerol every three hours for 3 months! Was hit by a train in 1977. Did no damage at all to my kidneys. I remember having to wean off of it, but it wasn't a problem for me. Worked SO SO much better than morphine or fentanyl. There are some doctors that will still give it to you on a limited basis (as it should be) but God, it's the only thing that worked for me. Thank God my accident happened back then and not now. I'd be in real trouble. PS You can buy Tramadol online very easily.
@@ElizabethF2222same. I’ve had many major surgeries and Demerol was the most effective, and I only needed half of the dosage my doctor had initially given me. It was short term (as in days) but I would prefer it 100x over to anything else should I go through another surgery
Thanks. Is it possible for you to show the buprenorphine comparison? Plain old 8 mg tab bupe without naloxone. Thanks.
Buprenorphine isn’t an opiate/opioid but it does affect similar parts of the brain
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I react very strongly to medication and hate taking hydrocodone (I was given this for muscle pain and it just hits me like a truck.) I wonder if I could request one of these lesser medications next time.
I'm curious where methadone and suboxone fall in this list.
Methadone is about 4x more powerful than Morphine so 1mg of Methadone is the same as 4mg of Morphine, however Methadone is a slow release drug (when taken properly) meaning it doesn't give (or doesn't give as much of) a euphoric high as a drug such as Hydrocodone or Oxycodone would. however although it is most commonly used to treat addiction, it is also used to treat chronic pain and it does so quite effectively.
Those don't really convert like that. Especially Suboxone. Suboxone has a ceiling effect so it's only so effective up to a certain dosage and beyond that it has no greater effect. Also, they are partial agonists so they effect you differently. That's why they're mainly used to treat addiction and not pain. Sorry, if i got anything wrong but I'm trying to explain as best as I know.
opiods
@@budzbudzbudz that was a good explanation and answer to my question thanks
@@ghostpuppolter3207 thank you for explaining that 👍
'I was on 400mg of ibuprofen, can you not just give me 400mg of oxycodone?' 🤣🤣
Imagine man. If only lol.
Sameeee im on 800mg if ibuprofen
Hello Med School! On that list, what size oxycodone was it one and a half times stronger than the 1/1 examples?
Yea so 7.5mg oxycodone is equal to 10mg of hydrocodone
In the UK we use the estimate that oxycodone is twice the strength of morphine. Also the fentanyl conversion are you saying 100-200mcg subsys or Actiq is equivalent to 10mg oral morphine ?? We say 10mg IV morphine is equivalent to 100mcg IV fentanyl but no official conversion for oral morphine to buccal /sublingual/ oral mucosal fentanyl.
This is brilliant. I got a double dose of Fentanyl after being brought into a trauma unit after my motorcycle accident. After that I was basically on Hydro and then PO Morphine at home. That fentanyl is NO JOKE.
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My father died in the space of two days after he was given fentanyl.
I wonder where kratom lies on this scale it be interesting to really study and find out since the plant has so many unknown properties
I'm new to kratom and was here wondering why morephine Drs gave me made me hallucinate but diladed didn't yet still made me very woozy and groggy. The three gram dose of kratom I take is half as strong be as a 2 my diladed but no fuzzy head no nausea and no sedated feeling. I have spinal injuries and I really hope kratom can be used like this drugs as it's be a better life quality for me
You can’t really compare plant matter to pure molecules, but one of the two major psychoactive alkaloids in kratom, 7-hydroxymitragynine, is about 17 times as potent as oral morphine.
It's properties are not unknown. The plant has two basic chemical 'branches' one, and the strongest is as a member of the coffee family, thus a stimulant; the other half has opiate agonist properties, with around 10 grams equaling about 5-15 mgs of hydro, IN AN OPIATE-INTOLERATE individual
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a little confused? So Tramadol is 1/10 the strength of hydrocodone but you didn't mention the milligrams of either. So my doctor prescribed 50mg Tramadol. m in the middle column is that hydrocodone 1000 mg 500 or 7:50?
I been on it all I'm on fentanyl and oxi atm , I used to be on opana( oxymporphone ) as well, my dr. doesn't consider tramadol a pain med, the bioavailability for hydromorphone is only 40% orally cause I was on the 8's and they did nothing for me bioavailability is very important as well
Yeah tramadol sucks, it has a side effect of making me very angry and agitated
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You forgot vidicon roxycotin and Kratom
Oral morphine is a low bioavailability, only 21%. Rectal dose of morphine is 71%.
Anomaly88man what’s up with people and shoving things up their ass?
Oral morphine bioavailability is low but 21% is exaggerated,its around 30-35%
Wikipedia data said 71% anal bioavailability.
Thanks so much for this explanation - helpful to understand my doctor's prescription.
Suppose I have an abscess or something that makes my jaw hurt bad. What can I expect a dentist to proscribe or recommend? Back before the overdose scandals, they’d give maybe a dozen hydrocodone pills. Well, usually some multiple of four because the pills are six hour pain relief.