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Originally Posted by Buehler445
As always, you provide good information.
Can you tell me the difference between immediate release opioids and whatever are unsafe?
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Immediate release opioids are generally simply designed tablets that dissolve and release the entirety of their dose right away. The total dose is lower, so the risk of overdose is also low. Most opioid prescriptions should be IR formulations, because most people don't need round-the-clock dosing.
Examples: hydrocodone/acetaminophen (Vicodin, Lortab, Norco), oxycodone/acetaminophen (Percocet), morphine sulfate.
Extended/Controlled/Sustained release opioids are designed to deliver a higher dose over a longer period of time. There is a correlation between use of these formulations and an increased risk of overdose--sometimes intentional, sometimes not. The most infamous of these is oxycontin, which is an extended release version of oxycodone, and can be up to 80mg in a single pill, compared to 5 or 10mg of an IR formulation.
There are also abuse-deterrent formulations that are designed to be hard to crush, or that contain additives that make it difficult/unsavory to crush up and use all at once, but there isn't a ton of good literature demonstrating that they actually reduce overdose.
Finally, there are patch formulations, like fentanyl (Duragesic). These are usually safe, but require a period of time for absorption, so they are usually issued with an immediate release opioid for breakthrough pain, and must be used properly. For example, if you put a heating pad over an area where the patch is you can cause dose dumping and actually unintentionally overdose yourself.
Another thing to recognize is that there is incomplete cross-tolerance between opioids. Although you may be able to take a large dose of one opioid, if you are switching to another, practitioners may decrease your dose (in what we call morphine equivalents) by 30-50%.