The Many Different Levels of Narcotics

Managing pain is obviously an important part of a podiatrist’s job. Just ask Lebron James who recently sprained his ankle in a playoff game. Last week we began a discussion on narcotics, specifically how tricky it can be to find the right drug and dose to control one’s pain without causing addiction. The general rule of thumb is to treat pain with the lowest possible dose to keep pain at a manageable level. Now I will break down the different levels of narcotics from weakest to strongest.

Morphine is used as the gold standard to compare the strength of all other narcotics. Hydrocodone is considered about 1/10 the strength of morphine. Vicodin is the combination of hydrocodone and Tylenol. Oxycodone, or oxycodone with Tylenol (Percocet) is stronger. Controlled-release oxycodone is called Oxycontin.

Vicodin and Percocet are the most commonly used for post-operative pain control. Again, treatment differs depending on the physician, hospital, and patient, but one rule of thumb many podiatrists start with is that patients undergoing a soft tissue procedure get sent home with Vicodin while those require a bone procedure get sent home on Percocet. It is important to keep in mind that both of these medications contain Tylenol. Therefore, do not take additional Tylenol as liver damage can result in doses over 4,000 mg per day.

Now we will get into the heavy duty narcotics. Hydromorphone (Dilaudid) is 10 times as powerful as morphine and given through an IV. Therefore, taking Dilaudid at home is usually only considered in very extreme cases of pain. Sublimaze (Fentanyl) is 100 times as strong as morphine. It is the only narcotic given in the form of a patch. However, the patch form takes about 12 hours to take effect. If Fentanyl is needed in a hurry, then it can be given in a transmucosal form (absorbed through mucous membranes) for a quick onset of action.

Narcotics work beautifully for managing post-op pain. Although addiction is an issue, many surgeons think it is greatly overblown in the acute setting. Chronic pain patients, however, should be monitored closely for addiction.

If you are in need of foot or ankle surgery, make an appointment with Cast A Foot Podiatry in Hempstead, NY for your evaluation.


Nicole M. Castillo, DPM 

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