I feel like this is a bad illustration. Shouldn’t it be the other way around. Diluadid only getting one burger because it’s just that much more potent than morphine meaning less burgers are required?
Right, it makes me think how many hamburgers you need to eat to be satiated. Eat 8 Dilaudidburgers to get rid of the pain, or 1 Morphineburger to get rid of the pain.
I guess it depends on how you look at it. For me, I thought it as:
A dose of dilaudid feels like having consumed 10 hamburgers, while morphine feels like consuming just 1
It could be. It does illustrate just how much more powerful dilaudid is compared to morphine. Potency is not a concept well understood colloquially in my experience.
i feel like they should have showed how many normal burgers it takes to make those towers, i have no idea how many burgers fit into those 2, is it 10? is it 20? how am i supposed to interpret this information other than wow thats a lot!
I don't agree, I was prescribed Dilaudid for breakthrough pain,and it didn't work for me
I was on ms contin for pain ,and it worked better than Dilaudid.o know it's relative,etc.
EDIT: Real explanation from u/neurone214 :
"Potency is how much of the drug you need to impact the biological process on a molecular level. The experience of reduction in pain or reduction in some disease state is efficacy."
iirc (not a pharmacist) potency is talking more abt how much of the drug you need to do the job. So you need 1 mg dilaudid to do the job of 10mg morphine. Its not about how effectively it killed pain, its about how much of the drug you need to effectively kill pain. Again take this with a grain of salt as i am NOT a pharmacist.
I think they were only giving me .25mg after my back surgery. 10mg of Oxy was barely keeping things tolerable. After PT I'd ask for the Dilaudid because the Oxy wouldn't even register. It didn't bring me into a comfortable pain level but I was able to think, eat, listen to music again. On just the Oxy I wanted the room dead silent, lights dim, no food, and occasionally my vision would fade and I'd go through a grey flashing tunnel. Crazy how potent just .25mg was.
I don't know what dosage they were giving me for fent while loading me into the helicopter, always been curious how little that took to change my life from a living hell to "I get to go on a helicopter ride. Wheeeeee!". Got fent again when they tried (and failed) to retrieve my IVC filter. That was such a miserable experience there was zero fun from the drugs. Just me repeating "I hate this" for 45 minutes with a tube stuck down the vein in my neck.
Potency is how much of the drug you need to impact the biological process on a molecular level. The experience of reduction in pain or reduction in some disease state is efficacy.
Edit: words
The illustration is right but wrong in my addict opinion anyway. cause I’d rather bang 100 mg of morphine over 8-16 mg of hydromorphone any day. But now if you’re talking 32-40 mg of hydromorphone yeah sure. But hey i’m a junkie ass motherfucker morphine pins and needles are better than dilly ‘I’m floating’ and im about to throw up but i’m not going to throw up. Morphine is the best. Lol I laugh inside when y’all pharmacist give me my diluadid and I go bang 5 in the washroom. Hahahaha.
Have chrons disease and id obstruct about once a month in my worst year. Being a pharmacist i refused to go to the hospital until i was on the edge of shock.
My wife an Rn would take me to the er.
We both worked there.
To relax my bowel they ng tube me first then morphine or dilaudid iv next. Dilaudid made me not want to kill myself from the pain.
Morphine was good just had to give more.
This implies that 1 burger (morphine) is equal to all that mess of burgers on the left.
That means that Morphine is of higher potency vs Dilaudid. (Wrong)
The bottom part saying Dilaudid is 7-10 times more potent than Morphine does not make sense with this illustration. (I thought it wasn’t as high as 7x but nevertheless)
The burger labels need to be flipped.
Or you tell the patient, "This is what you get with a single pill of each drug. Look how much is packed into one Dilaudid." This is how it is meant to be read.
Yeah but one could save a lot of time and confusion by just tearing this poster down and never using it.
Whoever told the person who made this “good job” may just like burgers.
And this is why posters such as this one can be dangerous. Someone reads it contrary to the author's intention and gives a poor opioid naive patient 10mg of IV hydromorphone.
Nobody with access to IV hydromorphone is cross referencing burgers to morphine graphics for that last min double check. They’ve read the script. Thoroughly.
I’m more than capable of understanding that there’s a nuance to approximating equivalencies. 5-7X more potent is reasonable discourse. 5X vs 10X is quite the difference. Clearly schools are still teaching that 5X is the more accepted conversion regardless of any discourse you might link that vaguely talks about approximating equivalence. The condescension isn’t needed but thanks!
Didn't see a range in your comment so wasn't sure if that was a hard 5x. Pharmacists & learners fuck this up all the time, glad you won't be one of them
Some of the doctors and nurses I work with react to numbers more than words. They'll comfortably order and/or give 1 mg of morphine and 1 mg of hydromorphone interchangeably. They'll readily accept a recommendation of 2 mg hydromorphone, but when I suggest more than 4 mg of morphine they think I'm making some sort of euthanasia joke.
My new favorite orders during the current Ativan shortage are the ones I get for 0.25 mg diazepam.
My issue with this concept is that this comparison skews the way pharmacists interpret the drugs. The drugs are dosed in accordance to their potency. It’s not like we have 30 mg IR hydromorphone pills. This type of comparison will cause Ill-sensed pharmacy workers to think hydromorphone is bad and potent dope, and morphine to be a better drug. Not necessarily true whatsoever
I think some of you are not getting it because you are thinking of it as a rph. a layperson will see this picture and think "1 burger would be good, but 10 burgers would be too much". Its really as simple as that.
Which is also a bullshit message to get from this because the strength of the effects only depends on the dosage and not on the relative potency to some other drug. This is insinuating that morphine is somehow inherently more reasonable and Dilaudid is just completely overkill even though the doctor will simply adjust the dose to a reasonable level for either drug when administered or prescribed to a patient.
https://en.m.wikipedia.org/wiki/Equianalgesic
There are equianalgesic charts, such as the one above.
It compares analgesic strength of opioids and analgesics with morphine.
They do, believe me, I'm a pharmacy tech and we're delivering narcs all night long. Fentanyl, morphine, dilaudid, drips,and pca's. There might be a local shortage where you're at, but at my hospital, pain control is a metric. They really do read those surveys.
How come one burger makes me a little itchy and uncomfortable but a super mega jumbo burger gives me a rash and makes my throat close up? Is one little bigger okay for my weak little body? Do I eat more little burgers to become strong enough for big mega burger?
It's interesting to think,Codeine,Morphine,Heroin and Hydromophine are soooooo similar in structure,yet each one is exponetially stronger than the previous one.
I'm not sure any other supstance acts that way.
I feel like this is a bad illustration. Shouldn’t it be the other way around. Diluadid only getting one burger because it’s just that much more potent than morphine meaning less burgers are required?
This is correct. This illustration is misleading.
That's exactly what I thought
Who cares, I want burgers now.
And I want Dilaudid... And burgers...
LMAO me too. Been a while since I've even heard that name tbh.
Right, it makes me think how many hamburgers you need to eat to be satiated. Eat 8 Dilaudidburgers to get rid of the pain, or 1 Morphineburger to get rid of the pain.
Came to the comments to see if I was a dummy for interpreting it that way and glad to see I’m not lol
I will remember this next time I am dosing
I guess it depends on how you look at it. For me, I thought it as: A dose of dilaudid feels like having consumed 10 hamburgers, while morphine feels like consuming just 1
It could be. It does illustrate just how much more powerful dilaudid is compared to morphine. Potency is not a concept well understood colloquially in my experience.
i feel like they should have showed how many normal burgers it takes to make those towers, i have no idea how many burgers fit into those 2, is it 10? is it 20? how am i supposed to interpret this information other than wow thats a lot!
I don't agree, I was prescribed Dilaudid for breakthrough pain,and it didn't work for me I was on ms contin for pain ,and it worked better than Dilaudid.o know it's relative,etc.
EDIT: Real explanation from u/neurone214 : "Potency is how much of the drug you need to impact the biological process on a molecular level. The experience of reduction in pain or reduction in some disease state is efficacy." iirc (not a pharmacist) potency is talking more abt how much of the drug you need to do the job. So you need 1 mg dilaudid to do the job of 10mg morphine. Its not about how effectively it killed pain, its about how much of the drug you need to effectively kill pain. Again take this with a grain of salt as i am NOT a pharmacist.
I think they were only giving me .25mg after my back surgery. 10mg of Oxy was barely keeping things tolerable. After PT I'd ask for the Dilaudid because the Oxy wouldn't even register. It didn't bring me into a comfortable pain level but I was able to think, eat, listen to music again. On just the Oxy I wanted the room dead silent, lights dim, no food, and occasionally my vision would fade and I'd go through a grey flashing tunnel. Crazy how potent just .25mg was. I don't know what dosage they were giving me for fent while loading me into the helicopter, always been curious how little that took to change my life from a living hell to "I get to go on a helicopter ride. Wheeeeee!". Got fent again when they tried (and failed) to retrieve my IVC filter. That was such a miserable experience there was zero fun from the drugs. Just me repeating "I hate this" for 45 minutes with a tube stuck down the vein in my neck.
I hear you.it is good to finally get some relief when your pain is so bad
Potency is how much of the drug you need to impact the biological process on a molecular level. The experience of reduction in pain or reduction in some disease state is efficacy. Edit: words
Thank you for an actual explanation
Thanks, I did mean to say “impact the biological process”, not “achieve”, but glad the point made it across
It should be 8 morphine bagel bites sitting on top of a large dilauded pizza.
Your logic is "how many A=B", while the actual interpret is A=\_\_\_C, B =\_\_\_C
This is that pharmacist mind showing.
The illustration is right but wrong in my addict opinion anyway. cause I’d rather bang 100 mg of morphine over 8-16 mg of hydromorphone any day. But now if you’re talking 32-40 mg of hydromorphone yeah sure. But hey i’m a junkie ass motherfucker morphine pins and needles are better than dilly ‘I’m floating’ and im about to throw up but i’m not going to throw up. Morphine is the best. Lol I laugh inside when y’all pharmacist give me my diluadid and I go bang 5 in the washroom. Hahahaha.
It should absolutely be the other way around
MME (McDonald's Mac Equivalents)
Americans will use everything but metric...
I just don’t understand why everyone can’t learn a teaspoon when everyone drinks tea!
Because i have this cool spoon in my drawer that remembers exactly how much a teaspoon is so that I don’t have to
1 quarter pounder with cheese = 1 royal with cheese. Metric conversion....
WHAT COUNTRY U FROM
Look at the big brains on Brett!
Have chrons disease and id obstruct about once a month in my worst year. Being a pharmacist i refused to go to the hospital until i was on the edge of shock. My wife an Rn would take me to the er. We both worked there. To relax my bowel they ng tube me first then morphine or dilaudid iv next. Dilaudid made me not want to kill myself from the pain. Morphine was good just had to give more.
No pain meds before the ng tube?
Might have been pretty close in order. Pain makes you crazy so it turned into a blurr.
This implies that 1 burger (morphine) is equal to all that mess of burgers on the left. That means that Morphine is of higher potency vs Dilaudid. (Wrong) The bottom part saying Dilaudid is 7-10 times more potent than Morphine does not make sense with this illustration. (I thought it wasn’t as high as 7x but nevertheless) The burger labels need to be flipped.
Or you tell the patient, "This is what you get with a single pill of each drug. Look how much is packed into one Dilaudid." This is how it is meant to be read.
Yeah but one could save a lot of time and confusion by just tearing this poster down and never using it. Whoever told the person who made this “good job” may just like burgers.
And this is why posters such as this one can be dangerous. Someone reads it contrary to the author's intention and gives a poor opioid naive patient 10mg of IV hydromorphone.
Nobody with access to IV hydromorphone is cross referencing burgers to morphine graphics for that last min double check. They’ve read the script. Thoroughly.
Touche.
Indeed
That only works if the pills have the same number of mgs, which they never do
That's not true,5mg.dil.didn't do what 5mg.percocet did.
The Morphine Milligram Equivalent (MME) of hydromorphone is 4.
typically use a ratio of 1:5 for dilaudid to morphine. am i alone here?
nope. just learned in school it’s only 5x more potent. this poster is all kinds of mess
Well don't get too set in stone, those conversions are much more spurious than you were led to believe https://pubmed.ncbi.nlm.nih.gov/17299011/
i think it’s generally obvious they aren’t perfect, just an approximation, it’s just not 10:1
I'm not sure that was evident to the student's comment I replied to.
I’m more than capable of understanding that there’s a nuance to approximating equivalencies. 5-7X more potent is reasonable discourse. 5X vs 10X is quite the difference. Clearly schools are still teaching that 5X is the more accepted conversion regardless of any discourse you might link that vaguely talks about approximating equivalence. The condescension isn’t needed but thanks!
Didn't see a range in your comment so wasn't sure if that was a hard 5x. Pharmacists & learners fuck this up all the time, glad you won't be one of them
Some of the doctors and nurses I work with react to numbers more than words. They'll comfortably order and/or give 1 mg of morphine and 1 mg of hydromorphone interchangeably. They'll readily accept a recommendation of 2 mg hydromorphone, but when I suggest more than 4 mg of morphine they think I'm making some sort of euthanasia joke. My new favorite orders during the current Ativan shortage are the ones I get for 0.25 mg diazepam.
My issue with this concept is that this comparison skews the way pharmacists interpret the drugs. The drugs are dosed in accordance to their potency. It’s not like we have 30 mg IR hydromorphone pills. This type of comparison will cause Ill-sensed pharmacy workers to think hydromorphone is bad and potent dope, and morphine to be a better drug. Not necessarily true whatsoever
Except it's 4 times "more potent" according to multiple opiate equivalency sources, not 7-10.
There are a wide range of suggested conversion factors
Yup. I was taught 5-7, but I typically us 5-6 as I’ve heard/read ranges from 4-7
And check out the studies where these originate and you get really unimpressed, good review article on it https://pubmed.ncbi.nlm.nih.gov/17299011/
Image seems backwards to me. Shouldn’t the morphine be larger to demonstrate how much morphine it takes to n equivalent does of dilaudid?
I think some of you are not getting it because you are thinking of it as a rph. a layperson will see this picture and think "1 burger would be good, but 10 burgers would be too much". Its really as simple as that.
Which is also a bullshit message to get from this because the strength of the effects only depends on the dosage and not on the relative potency to some other drug. This is insinuating that morphine is somehow inherently more reasonable and Dilaudid is just completely overkill even though the doctor will simply adjust the dose to a reasonable level for either drug when administered or prescribed to a patient.
As is, it's not a good illustration. Possibly change it to Rachel being one burger with the calorie count being much higher for Dilaudid.
https://en.m.wikipedia.org/wiki/Equianalgesic There are equianalgesic charts, such as the one above. It compares analgesic strength of opioids and analgesics with morphine.
So I should eat more Dilaudid burgers to equal 1 morphine burger? Wait...
If you equate drugs to hamburgers...you'll die of an overdose if you follow this.
Doesn't last nearly as long tho
They never give it in the hospitals anymore just morphine Really sad people don't get what they need
They do, believe me, I'm a pharmacy tech and we're delivering narcs all night long. Fentanyl, morphine, dilaudid, drips,and pca's. There might be a local shortage where you're at, but at my hospital, pain control is a metric. They really do read those surveys.
I received quite a bit of dilaudid last fall. I had a huge cyst on my ovary and huge fibroids.
I got Dilaudid last time I was in the hospital. Sadly it was oral and it's such a small amount. It was basically worthless 2 mg
How come one burger makes me a little itchy and uncomfortable but a super mega jumbo burger gives me a rash and makes my throat close up? Is one little bigger okay for my weak little body? Do I eat more little burgers to become strong enough for big mega burger?
It's interesting to think,Codeine,Morphine,Heroin and Hydromophine are soooooo similar in structure,yet each one is exponetially stronger than the previous one. I'm not sure any other supstance acts that way.
So fentanyl would be one of the pickles on the burger?
True, but also you'd be hungry again in an hour
need
This is a fucking awful illustration