# Are there any opiates on the market or coming to market for pain that don't get you high **URL:** \ **Category:** Factual Questions\ **Created:** [December 7, 2018, 5:11am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733 "2018-12-07T05:11:31Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 8, 2018, 6:41pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/41 "2018-12-08T18:41:30Z")
> [@DrDeth](#): > > For \*long term \*pain relief they are MORE effective. Meh. I take all such comparative studies with a huuuuuge shaker of salt. Pain is so damn subjective, difficult to characterize, quantify, assess for its intensity much less its relief. While some studies looking at very narrow parameters for pain assessment proclaim tylenol more effective than codeine, studies of severe post-trauma pain and post-operative pain still show opioids are the gold standard for relieving suffering, if not pain. I do hope we find better pain relief. We are not there yet ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 8, 2018, 7:45pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/42 "2018-12-08T19:45:44Z")
> [@nearwildheaven](#): > > Dextromethorphan is also an opiate derivative, and people have definitely been known to abuse it. > > Pharmacologists have been searching for a non-addicting, non-euphoric opiate for as long as we’ve known that such a thing might possibly exist. DXM is an NMDA antagonist, which is different than an opiate. NMDA antagonists are used as analgesics and anaesthetics though. > [@SigMan](#): > > I’ve read that druggies extract the stuff from the pills. It’s insane to get high by taking a bunch of pills though some do. What they do is they take a different drug that blocks the pump that kicks imodium out of the brain, so it can cross the blood brain barrier. Still doesn’t sound too appealing, supposedly even when you do that you need 20+ pills just to equal the feeling of one vicodin. Sounds like a lot of side effects just for that. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 8, 2018, 7:57pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/43 "2018-12-08T19:57:17Z")
> [@Wesley\_Clark](#): > > DXM is an NMDA antagonist, which is different than an opiate. NMDA antagonists are used as analgesics and anaesthetics though. in high doses, DXM is also weakly active at the opioid receptors. Its mirror image, Levomethorphan, is a very potent opioid analgesic. DXM abusers take it in large amounts to get both the opioid and dissociative effect, which is pretty harsh actually. But for an addict, dysphoria is better than no phoria at all. I speak from experience, tho clean now after 28+ years of abstinence from opioids. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [December 8, 2018, 8:53pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/44 "2018-12-08T20:53:08Z")
Might one also expect to find levomethorphan as an impurity in dextromethorphan? I understand that’s not uncommon, with mirror isomers. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 8, 2018, 9:49pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/45 "2018-12-08T21:49:19Z")
> [@Chronos](#): > > Might one also expect to find levomethorphan as an impurity in dextromethorphan? I understand that’s not uncommon, with mirror isomers. I honestly don’t know. I believe current processes for synthesizing drugs now can yield fewer such impurities, if the manufacturer decides to do so. But I’ve no idea what’s actually being done in the industry. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 8, 2018, 10:30pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/46 "2018-12-08T22:30:57Z")
> [@Ambivalid](#): > > Have I consulted my physician about what? How many diarrhea pills it takes to get high? Um, no. I haven’t thought to pose that question. That you are taking " _very large doses of Imodium on a regular basis, at times upwards of 15-20 pills,_" ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 8, 2018, 10:34pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/47 "2018-12-08T22:34:32Z")
> [@Qadgop\_the\_Mercotan](#): > > Meh. I take all such comparative studies with a huuuuuge shaker of salt. Pain is so damn subjective, difficult to characterize, quantify, assess for its intensity much less its relief. While some studies looking at very narrow parameters for pain assessment proclaim tylenol more effective than codeine, studies of severe post-trauma pain and post-operative pain still show opioids are the gold standard for relieving suffering, if not pain. > > I do hope we find better pain relief. We are not there yet Sure, but I am talking about long term chronic pain over years and years. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [December 9, 2018, 12:17am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/48 "2018-12-09T00:17:11Z")
> [@Chronos](#): > > **beckdawreck** , better pain medicines are exactly the sort of thing that the pharmaceutical companies like to pursue, as they’re used by a lot of people over an extended period of time. Now, certainly no drug company would just suppress a cure for cancer or a new antibiotic or whatever if they happened to stumble across one, but they won’t put as many resources towards finding one. Actually, they do, and there are some drugs that might as well be a cancer cure because they really do work that well, although only for specific types of cancer. I’m thinking specifically of Herceptin for certain types of breast and stomach cancer, or methotrexate and 6-mercaptopurine for ALL, and there are some others, used in combination therapy. Too many laypeople don’t realize that cancer is not a single disease; diabetes, another disease I would personally love to see cured, or better yet prevented, isn’t either. As for antibiotics, some infectious disease specialists are going back to older drugs that have fallen out of widespread use, because newer drugs don’t work any more but these do. We do periodically hear about some new “Godzillacillin” but those are almost always used for people with multiple risk factors, and usually in an ICU. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [December 9, 2018, 12:18am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/49 "2018-12-09T00:18:48Z")
> [@Chronos](#): > > Might one also expect to find levomethorphan as an impurity in dextromethorphan? I understand that’s not uncommon, with mirror isomers. I suppose it would be possible, but after all these years, chemists have almost certainly figured out how to make dextromethorphan, and the dextro isomer only. ---
**Author:** ![SigMan](https://avatars.discourse-cdn.com/v4/letter/s/13edae/32.png) [@SigMan](https://boards.straightdope.com/u/SigMan)\ **Post date:** [December 9, 2018, 12:22am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/50 "2018-12-09T00:22:55Z")
> [@DrDeth](#): > > It also may be that studies have shown the Vicodin is not that useful for LT pain relief. You are quite possibly getting no pain relief from the drug, not due to the change but due to the nature of the drug. > > Perhaps you shoudl consult your MD and try something else? > > [https://www.sciencedirect.com/science/article/pii/S0885392407006720](https://www.sciencedirect.com/science/article/pii/S0885392407006720) I’ve been taking hydrocodone since 91 starting at 5/500 then 5/325 now 7.5/325. I always got relief but a few months ago I’m not. That was when I noticed the change as I kept the empty bottles in a bag. They used to be Watson and Actavis. Now a few months ago I was getting Mallinkrodt and by changing pharmacy I got Lupin this month and it was worse. I will find out soon because I just ordered some opiate test strips. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 9, 2018, 12:33am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/51 "2018-12-09T00:33:30Z")
> [@DrDeth](#): > > Sure, but I am talking about long term chronic pain over years and years. Yeah, opioids are not good for chronic pain. You end up with a person who’s habituated to huuuuuuge doses of opioids who’s also in just as much pain as he was before starting to take them for the chronic pain. Of course NSAIDs and APAP aren’t much better in this situation either. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 9, 2018, 12:40am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/52 "2018-12-09T00:40:31Z")
> [@Qadgop\_the\_Mercotan](#): > > Yeah, opioids are not good for chronic pain. You end up with a person who’s habituated to huuuuuuge doses of opioids who’s also in just as much pain as he was before starting to take them for the chronic pain. > > Of course NSAIDs and APAP aren’t much better in this situation either. Thanks Doc. ---
**Author:** ![SigMan](https://avatars.discourse-cdn.com/v4/letter/s/13edae/32.png) [@SigMan](https://boards.straightdope.com/u/SigMan)\ **Post date:** [December 9, 2018, 1:52am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/53 "2018-12-09T01:52:53Z")
In order to have long term relief you’d have to have dry days. I take IBUs on those days. ---
**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\ **Post date:** [December 9, 2018, 10:39am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/54 "2018-12-09T10:39:00Z")
> [@Chronos](#): > > Might one also expect to find levomethorphan as an impurity in dextromethorphan? I understand that’s not uncommon, with mirror isomers. The answer appears to be yes. The following are: an explanatory note relating to a change in the USP monograph for Dextromethorphan; and the revised monograph. [https://www.uspnf.com/notices/dextromethorphan](https://www.uspnf.com/notices/dextromethorphan) _…This is a major safety concern, because recently, levomethorphan was found at toxic levels in the drug formulation and resulted in deaths globally. The purpose of this revision is to introduce a procedure to quantitatively monitor levomethorphan in Dextromethorphan._ > **[dextromethorphan\_hbr\_rb\_notice.pdf](https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/dextromethorphan_hbr_rb_notice.pdf)** > > 619.34 KB _Acceptance criteria: NMT 0.10%_ You would not introduce a limit if the impurity was not produced in the synthesis. The level set is pretty standard for an impurity, which suggests it isn’t astonishingly toxic (or, _I guess_, particularly abusable at that level). j ---
**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\ **Post date:** [December 9, 2018, 10:44am UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/55 "2018-12-09T10:44:50Z")
> [@dorvann](#): > > What would be safer on your liver to take long term though? acetaminophen/paracetamol or morphine? IANAD but I was not aware that liver\* toxicity\* was a particular problem with morphine. The issues with opiates lie elsewhere. > **[Morphine 10mg/5ml Oral Solution - Summary of Product Characteristics (SmPC) -...](https://www.medicines.org.uk/emc/product/3427/smpc#UNDESIRABLE_EFFECTS)** > > Morphine 10mg/5ml Oral Solution - Summary of Product Characteristics (SmPC) by Martindale Pharma, an Ethypharm Group Company Note that in section 4.3, morphine is contraindicated in acute hepatic disease; but that’s another issue. j ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 9, 2018, 6:23pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/56 "2018-12-09T18:23:15Z")
> [@Treppenwitz](#): > > IANAD but I was not aware that liver\* toxicity\* was a particular problem with morphine. … However, acetaminophen \*is \*hard on the liver. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 9, 2018, 7:07pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/57 "2018-12-09T19:07:54Z")
> [@DrDeth](#): > > However, acetaminophen \*is \*hard on the liver. a healthy liver can stand up to 4 grams of acetaminophen a day without problems. Just avoid alcohol while taking such doses. Even a liver that’s cirrhotic, but not yet in liver failure can tolerate generally 2 grams a day, again if alcohol is avoided. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [December 9, 2018, 7:14pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/58 "2018-12-09T19:14:14Z")
> [@Treppenwitz](#): > > morphine is contraindicated in acute hepatic disease; but that’s another issue. That’s a relative contra-indication, since morphine is metabolized more thru the liver. For most folks, doses can just be adjusted down to avoid problems. Or use oxycodone, which is more metabolized by the kidneys, IIRC. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 9, 2018, 7:24pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/59 "2018-12-09T19:24:52Z")
> [@Qadgop\_the\_Mercotan](#): > > Yeah, opioids are not good for chronic pain. You end up with a person who’s habituated to huuuuuuge doses of opioids who’s also in just as much pain as he was before starting to take them for the chronic pain. > > Of course NSAIDs and APAP aren’t much better in this situation either. What about taking off days, or combining opiates with low doses of DXM or micro doses of naltrexone to slow tolerance? Some people do handle opiates over the long term w/o needing ever increasing doses, but I’m not sure what is different about them. ---
**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\ **Post date:** [December 9, 2018, 8:25pm UTC](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733/60 "2018-12-09T20:25:08Z")
> [@Qadgop\_the\_Mercotan](#): > > That’s a relative contra-indication, since morphine is metabolized more thru the liver. For most folks, doses can just be adjusted down to avoid problems. Or use oxycodone, which is more metabolized by the kidneys, IIRC. The contraindication is in acute disease. Is it viable to adjust dose for acute disease? j [Previous page](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733.md?page=2) [Next page](https://boards.straightdope.com/t/are-there-any-opiates-on-the-market-or-coming-to-market-for-pain-that-dont-get-you-high/825733.md?page=4)