Substituting Oral Morphine for Oxycodone

[turnupthevapor]

After reviewing a meta analysis, "Likeability and Abuse Liability of Commonly Prescribed Opioids" by Rachel Wightman et al with 9 studies, all double-blinded RCTs that concluded that oxycodone has a substantially elevated abuse liability vs morphine and hydrocodone. We had the idea to eliminate oxycodone use from our facility and use upon discharge by substituting oral immediate release morphine.

Curious if anyone else on the thread made this move and how it went? Are the patients tolerating the morphine? Any issues that have come up? We were thinking of substituting the 5 mg oxycodone with 7.5-10 mg of morphine.

Thank you in advance for any input

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[NICMAN]

I always thought a one-size-fits-all policy is usually not great for patient-centered care.

 

[hiyaman]

If you are administering the oxycodone as part of pain regimen for recovery, why would abuse potential be an issue? Unless you are prescribing the medication for discharge? but then that should be the realm of the surgeon/proceduralist in my opinion.

 

[nimbus]

If oxy is more likeable and has more addictive potential than hydrocodone, it’s probably best to avoid it because hydrocodone is VERY GOOD.

 

[woopedazz]

I worked at a hospital that did this. It was the dumbest thing I've ever seen.

1. Patients in pain, vomiting everywhere, with pruritus, failing discharge.
2. Patients not in pain prescribed opioids they didn't need because "it's okay to prescribe, it's less abusable."

Not a single member of staff outside the 2 anaesthetists that championed the idea supported it after 1 year. That hospital is currently in the process of transitioning back to Oxycodone.

It might work for you, but it didn't work for my Australian hospital

 

[DocVapor]

Why is morphine even still used outside of hospice?

 

[Aether2000]

It doesn't matter which opioid is prescribed as long as PACU nurses are encouraging drug abuse by telling patients to take opioids before they have pain, that they need to stay on top of pain, and never mention ice or NSAIDs that in several studies have been shown to be equally efficacious as oxycodone.