What is your (average) daily opioid dose?

[QyX]

I looked it up and there are no real guidelines and information how opiods should be dosed when a patient is suffering from RLS.

There are lot's of recommendations and guidelines for cancer and non cancer pain but RLS isnt't included in these papers. Opioids have been used to treat RLS quite a while but only since last year finally an opioid (Oxycodone in a fix combination with Naloxone) was approved to treat RLS so that here no problems with insurance. (This information applies for Germany).

Because there is a wide number of Opioids available and every opioid has it own strength/potency I suggest to use morphine equivalent doses:

I take 16 mg of Hydromophone daily which would be 120 mg of Morphine.

100 mg of Tramadol = 10 mg Morphine
100 mg of Codein = 10 mg Morphine
100 mg of Dihydrocodein = 20 mg Morphine
10 mg of Hydrocodone = 10 mg Morphine
10 mg of Oxycodone = 20 mg Morphine
10 mg of Methadone (short term use) = 20 mg Morphine
10 mg Methadone (long term use) = 60 to 80 mg Morphine (!)
8 mg of Hydromorphone = 60 mg of Morphine
10 mg of Oxymorphone = 85 mg of Morphine (Oxymorphone only available in the U.S.)
1 mg of Buprenorphine (*) = 30-60 mg of Morphine (Buprenorphine is not a classic full mu-Agonists, reduces risk of overdose, respiratory depression and addiction, mostly used to treat heroine addiction)
1 mg of Fentanyl = 100 mg of Morphine
10 mg of Morhpine (i.V. i.m. or s.c. injection) = 30 mg of Morhpine p.o.

In Europe, Hydrocodone is only used in Switzerland and here in Germany (I think that applies for most other countries in the EU and Europe) almost no patient with chronic pain or RLS is treated with Methadone and it's very unlikely that any patient would ask for it because of its use to treat heroine addiction it has a very bad image. It is approved to treat chronic pain and I think insurance companies would love if doctors would start using Methadone more often because it is a lot cheaper then classic opioids such as Morhpine, Oxycodone and Hydromorphone but because of the image it is only used on addicts.

I read a lot in a discussion board for heroine addicts because I'm simply interested in opioids and the topic addiction in general and patients treated with Methadone often complain about sleeping problems, weight gain, swollowed legs, low testosterone (male), low libido (male and women) and impotence (male).

So methadone really has a horror image. I know that it is not as bad as some say and Methadone has this unique receptor profile (it also acts on the NDMA-Receptor) which could Methadone give some advantages over the classic opioids in managing RLS symptoms but unfortunately nobody has investigated this further.

I don't see any evidence (except for Buprenorphine) that any of the potent opioids is more or less addictive. This huge problem with Oxycodone (Oxycontine) was caused by excessive marketing, the liberal narcotics law in Florida (I know that this has changed) and most important that these Oxycontine pills were so easy to crack for smoking and injecting. Doing this with Morphine or Hydromorphone is much more complicated.

When I would start someone new on opiodids for RLS, I would use Codeine because it has this sedative, hypnotic potential. Codeine instantly gets transformed into Morphine. So when someone exceeds the maximum recommended dose for Codeine he can just take Morphine and wont feel any different. The sad thing is that these hypnotic effects will get lost after some time.

Methadone might be something for patient suffering from additional neuropathic pain or were an extra antiepileptic drug is needed to fully treat all the RLS symptoms. Maybe here Methadone can help avoiding taking an additional drug but again, nobody seems to have investigated this issue.

We had this big study with Oxycodone/Nalxone in Germany because the manufacturer has a patent on this special combination which prohibits that other companies can produce a fix combination of Oxycodone/Naloxone. It is such a joke: regular Oxycodone is produced by around 10-15 companies but is not approved for RLS. Although it is around 200 $ cheaper (100 pills, 40 mg) Doctors normally must use the original Oxycodone/Naloxone combination.

This study helped us but it also turned Oxycodone into a money making machine for the company producing Oxycodone.

I think most Doctors thinking about using an opioid for RLS will still start with a low potent opioid like Codeine. Here in Germany they can still prescribe it and insurance companies wont care since the original Oxycodone is much more expensive. Pharmacie always will fill the prescription as long as you have a valid script but insurance companies who control the scripts can hold the Doctor responsible if he wrote a script for an unapproved drug. We have some rules and laws when it is allowed to use a drug for a disorder even when the drug is not approved for it. This is why my insurance pays for my Hydromorphone. If I would take the same amount in Oxycodone, my insurance company would have to pay more then they are paying now.

[Polar Bear]

This is a great post - very informative and explained perfectly .