If it were schedule I, it would not be able to be prescribed by anyone. Heroin, LSD, etc, those are Schedule I. Schedule IIs are drugs with great potential for abuse but some medical use. Even cocaine is Schedule II, because it has use as a local anesthetic, particularly for eye surgery. (The placement of cannabis as Schedule I is concerning to many people because of this -- some feel it has a legitimate medical use and should therefore be Schedule II.)
I've taken both Percocet (which is schedule II) and Loracet (which is schedule III), and a 10 mg Loracet gives me the same relief as a 10 mg Percocet. For some people oxycodone (Percocet) is stronger, perhaps I'm not one of them. My father, too, gets better relief from a Vicodin than a Percocet of the same dosage. Then again, we're weirdos. :) (He has DDD and really ought to get a fusion in his lower back according to his doctor, but he wants to avoid it as long as possible -- he takes methadone as his mainstay of pain relief, and asked his doctor to switch him from Perocet for breakthrough over to Loracet/Vicodin because it works better for him.)
I was referring to dosage equivalence, not necessarily strength of relief, however. Morphine is considered a very strong drug and is not given to someone with a just toothache. But orally, it takes 60 mg of morphine to be equivalent to 30 mg of hydrocodone or 20 mg of oxycodone according to this chart. It takes 200 mg of Demerol orally to equal 60 mg of morphine or 30 mg of hydrocodone or 20 mg of oxycodone. (Both morphine and demerol are poorly absorbed orally. IV or IM take much less drug to be more effective.)
http://www.musc.edu/pharmacyservices/medusepol/OpioidAnalgesicConversionChart.pdfFentanyl is dosed in the micrograms -- while hydromorphone (Dilaudid) is dosed in the milligrams. A 0.1 mg IV dose of fentanyl is equal to 1.5 mg of hydromorphone IV, or 7.5 mg of hydromorphone orally.
But no, I was not suggesting that hydrocodone and Fentanyl were the same. Most people who are started on Fentanyl, however, were previously using an oral pain regimen. The Fentanyl patch's prescribing instructions specifically say that no one should be started on the patch who was not opiate-tolerant, and gives a conservative equivalence table for conversion over to Fentanyl patches. They recommend people who were on 30-67 mg of an oxycodone-containing drug to start out at the 25mcg level because each person will absorb the medication transdermally a bit differently than others, and because of Fentanyl's potency, it's a really bad thing to OD on.
And with different body chemistries, the conversion charts are not always accurate. Some people get absolutely no relief with one particular opiate even at high levels (although they may experience cognitive effects), but get very good pain relief with a different medication, even at the low end of that particular medicine's recommended dosing. One medicine even at a very low dose for it may cause too many cognitive side effects to continue, while another will relieve the pain without making them drowsy or dizzy. That's why pain management doctors really have to listen to their patients and work with their patients to find the best medication *for that patient*.
I'm sorry you had a bad reaction to morphine. When my grandmother broke her hip, they gave her a morphine shot and she started having a bad allergic reaction. So when we had to take her into the ER when she developed shingles, they had to give her Demerol. (They actually almost gave her two shots of it -- she was in awful pain, and one nurse had ran off to get the medication but had to take care of another patient. The doctor actually administered the first shot. Then that nurse came back in with another needle, and she was VERY happy we told her that Granny'd already gotten one shot! An overdose is not something to play with for an 85 year old lady!)
As for myself, the only pain medicines I've had allergies to have been NSAIDS. I broke out when I was given Etodolac once (when I fell down the stairs and sprained my ankle), and when I dislocated my kneecap they gave me an injection of Toradol, and the itching very quickly turned into anaphalyaxis. (Really sucks, too, because I've talked to many people who swear by Toradol, especially with Zofran for migraines.) I also broke out when I attempted to take Aleve. So now my doctor says I shouldn't even take Advil (even though I've never had problems with it). I instead pay the huge copay for Celebrex -- but at least it works, and works well. I'm really thankful that I don't need narcotic pain medication on a daily basis. Celebrex, Zanaflex, and massage therapy are the best things I've found for my pain. (I've only got fibromyalgia and arthritis in the joints that I have injured, nothing serious like kidney stones or back issues, thank God!)
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