Lindsay's Prescription Drug -- Stronger than Morphine

You may want to skip to the last 3 paragraphs if you hate long posts and/or do not have a good understanding of opiate pharmacology or don't care about it. If you choose to read my whole post then you are so very awesome, really! I promise never to post this much in one shot, ever again. :-) There is one plausible reason for her to be prescribed something of that level. Here goes...

Exactly commenter #3 (and probably many others), my relatives that died from cancer and suffered severe chronic pain before death weren't given Dilauded to take home from the get go. You had to work up to that. Some Dilauded injections are given in the ER for trauma pain, surgical pain and withdrawal. For many late stage painful cancers, a patch that slowly releases the same chemical that is in Dilauded can be given. I believe Dilauded's generic is Hydromorphone, the same as is in Fentanyl which is the very strong patch I just mentioned. I am too lazy to look it all up and I am searching the dusty corners of my mind for the pharmacology of all these opiates. If any medical professionals out there know for a fact that I am mistaken, please, please, please correct me as I hate giving out wrong info and am happy to be informed by an expert. Anyway, Dilauded and/or its generic is actually stronger than heroin although street heroin varies so much in potency and purity making it so hard to compare and I would only be talking of pharmaceutical heroin, theoretically. Heroin has a stigma and rep as being the "worst" of the opiates but that actually isn't always a fact. It is the most accessible on the street and cheapest, in most cases, to opiate addicts and that is why it's presence as an addictive substance is so well known. In many places, Oxycontin has overtaken heroin because it is more readily available and cheaper, which I do not understand because I know Oxy's can go for a dollar a milligram which gets expensive no matter how you slice it. Any heroin addict worth his or her salt would need anywhere from 80 - 500 mgs of Oxycontin a day so, if Oxy is cheaper than Heroin where a particular junkie lives, then they don't belong in that neighborhood! Anyway, I know an RN who works in a busy ER and that nurse says the withdrawing junkies come in for Dilauded when they are out of their usual favorite opiate, such as Heroin. They tend to like Dilauded more than their opiate of usual choice. It's a real tasty treat to them.

Why any M.D., Surgeon or Dentist would prescribe that level of pain control for a dental procedure is beyond me and I can't help but feel that reporting is inaccurate. It just seems as if, if TMZ knows about this then law enforcement and the medical board must know and it would never fly the way we are hearing it. People have complicated re-sectioning surgery (in other words...removing various parts or organs surgically) for various cancers of the mouth and throat, as well as the rest of the body but they don't get that strong a narcotic straight off. It is used a lot in the ER because it is fast acting, easy to administer and effective at stopping acute pain. It is not something anyone wants to take long term, IMO. I would believe it if I heard she was prescribed time released Oxycontin, it's immediate release cousin Percocet (both of which include the active generic ingredient of oxycodone but Percocet also has acetaminophen, aka tylenol), Vicodin or MSContin (a morphine timed release formula). I would believe any of them but still, there would be no reason to prescribe any of them to a known addict, alcoholic and/or substance abuser for a relatively minor procedure that likely does not produce acute or chronic pain of that level. It is medically unethical which we know means nothing in Hollyweird and all over actually. Money rules all and if you have enough of it, you can get a greedy, star struck M.D. to prescribe just about anything.
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Woa Nelly! Hold on! Wait a sec! You know, I am tempted to wipe out all that I just wrote because something occurred to me that may make this scenario plausible. I will leave it all there though because there is some useful random pharmacology info to tuck away if you like that sort of thing.

Here is what I realized...Many opiate (heroin and prescription) addicts, and those not addicted but with physical dependencies because of long term legitimate use of pharmaceuticals, opt for a medical detox and maintenance program that includes the prescribed partial opiate called Suboxone or Subutex. Usally it is Suboxone that is prescribed for take home use. Subutex is usually given in a facility and not out of the pharmacy. It's active ingrediant is Buprenorphine which has long been used in veterinary medicine for medium to severe pain control but has little value as a long term painkiller for humans. I will refer to Buprenorphine as Bup for the rest of this post and Suboxone I will call Subs. Bup is a far superior Replacement Therapy opiate to Methadone. Methadone is a regular opiate that will get the user high if they increase their dose but Bup acts differently and has a ceiling dose meaning any more than the ceiling dosage will not produce any intoxicating effects. Bup is a weird opiate in that it strongly binds to the opiate receptors itself and also is efficient in kicking anything less potent off those receptors in order to situate itself. It is called an agonist-antagonist or a partial agonist because of its dual nature. For comparison, Dilauded and the other opiates I wrote about above, including heroin and Methadone, are all full agonists, meaning they only stick to the receptors instead of kicking things off the receptors and the level of efficiency and binding to those receptors is what determines an opiate drug's relative "strength".

When a Bup user needs high level pain control by a doctor, dentist, etc. they have to be given the only opiate med strong enough to immediately knock Bup off the opiate receptors. Hydromorphone, in any of its brand names including Dilauded, is the only opiate that binds strongly enough to not be knocked back off by the Bup (which has a very long half-life and lingers in the body for many days). Just waiting for the Bup to leave the system so that the patient can get something more normal and in line with what the non-addict would get (like Vicodin, Codeine or Percocet) for dental work or trauma pain is not feasible. It would take too long to exit the body enough. So, my guess is that she was given Dilauded because that is the only option because she probably takes Subs as a maintenance drug to stay off the Oxycontin she is/was reported to be dependent on/addicted to a few years ago. I've always thought Lilo has various opiate addict traits and clues. I am sorry for the long and winding path to get to my theory but that's what I think about her taking Dilauded.

If she is a Sub/Bup patient she will receive Dilauded or something with the same ingredient for severe pain but only short term. She won't be given Dilauded for long and will have to switch back to Subs (if she chooses to, which she probably would) as soon as the pain is controllable with OTC stuff.

Any Sub doctors or patients out there that think I am correct with this? I am sure of the pharmacology in that Hydromorphone (Dilauded generic) is a stronger agonist than Bup but not sure if there are any opiates of weaker binding that would be tried without first resorting to Dilauded. I've seen the cards Sub users carry in their wallets and it warns medical personnel that the user is on Subs and therefore needs high level pain meds in the case of emergency.

she needs to get a grip - she is on dilaudid because she is a drug addict! plan and simple. that is how she isn't drinking she is high all the time - look at her eyes - her dr. needs to go to jail and she just needs to od already!

Mixing painkillers, sleep aids, and speed(adderall), will eventually kill this girl. If the combination's don't kill her, then they will leave her with major psych. problems. One's heart can only take so much.

Dilaudid is for cancer patients. She is wacky she really needs to go to jail and rehab.

You may want to skip to the last 3 paragraphs if you hate long posts and/or do not have a good understanding of opiate pharmacology or don't care about it. If you choose to read my whole post then you are so very awesome, really! I promise never to post this much in one shot, ever again. :-) Here goes...

Exactly commenter #3 (and probably many others), my relatives that died from cancer and suffered severe chronic pain before death weren't given Dilauded to take home from the get go. You had to work up to that. Some Dilauded injections are given in the ER for trauma pain, surgical pain and withdrawal. For many late stage painful cancers, a patch that slowly releases the same chemical that is in Dilauded can be given. I believe Dilauded's generic is Hydromorphone, the same as is in Fentanyl which is the very strong patch I just mentioned. I am too lazy to look it all up and I am searching the dusty corners of my mind for the pharmacology of all these opiates. If any medical professionals out there know for a fact that I am mistaken, please, please, please correct me as I hate giving out wrong info and am happy to be informed by an expert. Anyway, Dilauded and/or its generic is actually stronger than heroin although street heroin varies so much in potency and purity making it so hard to compare and I would only be talking of pharmaceutical heroin, theoretically. Heroin has a stigma and rep as being the "worst" of the opiates but that actually isn't always a fact. It is the most accessible on the street and cheapest, in most cases, to opiate addicts and that is why it's presence as an addictive substance is so well known. In many places, Oxycontin has overtaken heroin because it is more readily available and cheaper, which I do not understand because I know Oxy's can go for a dollar a milligram which gets expensive no matter how you slice it. Any heroin addict worth his or her salt would need anywhere from 80 - 500 mgs of Oxycontin a day so, if Oxy is cheaper than Heroin where a particular junkie lives, then they don't belong in that neighborhood! Anyway, I know an RN who works in a busy ER and that nurse says the withdrawing junkies come in for Dilauded when they are out of their usual favorite opiate, such as Heroin. They tend to like Dilauded more than their opiate of usual choice. It's a real tasty treat to them.

Why any M.D., Surgeon or Dentist would prescribe that level of pain control for a dental procedure is beyond me and I can't help but feel that reporting is inaccurate. It just seems as if, if TMZ knows about this then law enforcement and the medical board must know and it would never fly the way we are hearing it. People have complicated re-sectioning surgery (in other words...removing various parts or organs surgically) for various cancers of the mouth and throat, as well as the rest of the body but they don't get that strong a narcotic straight off. It is used a lot in the ER because it is fast acting, easy to administer and effective at stopping acute pain. It is not something anyone wants to take long term, IMO. I would believe it if I heard she was prescribed time released Oxycontin, it's immediate release cousin Percocet (both of which include the active generic ingredient of oxycodone but Percocet also has acetaminophen, aka tylenol), Vicodin or MSContin (a morphine timed release formula). I would believe any of them but still, there would be no reason to prescribe any of them to a known addict, alcoholic and/or substance abuser for a relatively minor procedure that likely does not produce acute or chronic pain of that level. It is medically unethical which we know means nothing in Hollyweird and all over actually. Money rules all and if you have enough of it, you can get a greedy, star struck M.D. to prescribe just about anything.
++++++++++++++++++++++++++++++++++++++++++++++++++
Woa Nelly! Hold on! Wait a sec! You know, I am tempted to wipe out all that I just wrote because something occurred to me that may make this scenario plausible. I will leave it all there though because there is some useful random pharmacology info to tuck away if you like that sort of thing.

Here is what I realized...Many opiate (heroin and prescription) addicts, and those not addicted but with physical dependencies because of long term legitimate use of pharmaceuticals, opt for a medical detox and maintenance program that includes the prescribed partial opiate called Suboxone or Subutex. Usally it is Suboxone that is prescribed for take home use. Subutex is usually given in a facility and not out of the pharmacy. It's active ingrediant is Buprenorphine which has long been used in veterinary medicine for medium to severe pain control but has little value as a long term painkiller for humans. I will refer to Buprenorphine as Bup for the rest of this post and Suboxone I will call Subs. Bup is a far superior Replacement Therapy opiate to Methadone. Methadone is a regular opiate that will get the user high if they increase their dose but Bup acts differently and has a ceiling dose meaning any more than the ceiling dosage will not produce any intoxicating effects. Bup is a weird opiate in that it strongly binds to the opiate receptors itself and also is efficient in kicking anything less potent off those receptors in order to situate itself. It is called an agonist-antagonist or a partial agonist because of its dual nature. For comparison, Dilauded and the other opiates I wrote about above, including heroin and Methadone, are all full agonists, meaning they only stick to the receptors instead of kicking things off the receptors and the level of efficiency and binding to those receptors is what determines an opiate drug's relative "strength".

When a Bup user needs high level pain control by a doctor, dentist, etc. they have to be given the only opiate med strong enough to immediately knock Bup off the opiate receptors. Hydromorphone, in any of its brand names including Dilauded, is the only opiate that binds strongly enough to not be knocked back off by the Bup (which has a very long half-life and lingers in the body for many days). Just waiting for the Bup to leave the system so that the patient can get something more normal and in line with what the non-addict would get (like Vicodin, Codeine or Percocet) for dental work or trauma pain is not feasible. It would take too long to exit the body enough. So, my guess is that she was given Dilauded because that is the only option because she probably takes Subs as a maintenance drug to stay off the Oxycontin she is/was reported to be dependent on/addicted to a few years ago. I've always thought Lilo has various opiate addict traits and clues. I am sorry for the long and winding path to get to my theory but that's what I think about her taking Dilauded.

If she is a Sub/Bup patient she will receive Dilauded or something with the same ingredient for severe pain but only short term. She won't be given Dilauded for long and will have to switch back to Subs (if she chooses to, which she probably would) as soon as the pain is controllable with OTC stuff.

Any Sub doctors or patients out there that think I am correct with this? I am sure of the pharmacology in that Hydromorphone (Dilauded generic) is a stronger agonist than Bup but not sure if there are any opiates of weaker binding that would be tried without first resorting to Dilauded. I've seen the cards Sub users carry in their wallets and it warns medical personnel that the user is on Subs and therefore needs high level pain meds in the case of emergency.

WTF sort of doctor or dental surgeon would prescribe Dilaudid for pain? People with end stage cancer are prescribed this, people with sore teeth are prescribed Tylenol # 3 at best. I'd say this physician needs to be investigated as well.

Dilaudid for a friggin' tooth ache? What is wrong with these Doctors in California? They'll prescribe ANYTHING to these people. Never in my life have I heard of a dentist perscribing dilaudid. Somebody better check these (cough) doctors out in LA. One thing this wacko chick does NOT need is dilaudid.
Unbelieveable.
And to the guy who wrote the 10 page e-mail about BP - what is your problem? This is not the place for your opinions and suggestions you jerk. Get a life and contact the government or BP if you have something to say.

#93: "Uhh, I am an RN, and dilaudid is not stronger than morphine. Morphine is the gold standard for narcotics. The only way dilaudid would be stronger, is if someone took a higher dose."

I have a pharmacy tech license. Dilaudid is stronger than morphine. Dilaudid is hydromorphone; it is a tweaked version of morphine created to be absorbed more readily and therefore to increase its painkiller properties.

Yes, morphine is the gold standard...because that is what most doctors like to prescribe. But that does not make it the strongest. By that analogy, morphine should be stronger than fentanyl, and we know that's not true. Fentanyl is 100 times stronger than morphine.

Holy S*** Balls. I had all of my wisdom teeth removed in one visit; so did both of my boys. No one needed medication for more than oh...3-4 days. Enough with excuses, entitlements, special dispensation. Get her to a jail/rehab/nunnery in that order and let's all move on.

Man...Dilaudid is insane. I was in so much pain when the hospital gave me Dilaudid and as soon as they administered it, I smelled and tasted cheap vodka or rubbing alcohol and my veins felt like they were about to explode. It kicked in instantly and the pain was gone, but holy sh**! I never wanted to even try hard drugs, but even now I sometimes want Dilaudid.

Even if LiLo is taking it in pill form, most drug addicts like her will either chew it like candy to get the quickest effect or they'll snort it. Seeing that she had a coke problem, I would imagine she's doing the latter. She's still allowed to do it even though she's taking it in a way not approved by a doctor, simply because she's got a valid scrip for it. The dumb girl is going to die soon, and it's kinda sad because she was actually a good actress when she was still a kid.

There is so much misinformation in these comments it's crazy! First, Dilaudid is NOT only for cancer or those who are dying. In the PDR (physician's desk reference) it states that it is given for "moderate to severe" pain. Thus, any doc can prescribe it for that (not that it's always a good idea!). Second, no matter what any of you think you know of Lindsay, you are NOT privy to her medical records, and can NOT say that she does not have pain. Third, Adderall is used for many more things than ADHD! Often if a patient is in pain, and must have strong pain meds, it does make them drowsy, so they are ordered Adderall to relieve the side effects of the pain meds.Fourth, a person who rarely/never takes this type of med may be "unable to function" on them, but if you're on them long term, you adjust to them, and they have little effect, and will NOT knock you out. Personally, I have Fibromyalgia, I don't LOOK sick, but am in constant pain and am on this type of med round the clock. People have made ignorant comments about there's NO way I'm sick...until you live in another's body, you can't possibly know how they feel, so stop judging and leave people alone! BTW, Adderall and Ambien are not narcotics, they ARE controlled substances, but not narcotics.

This is unbelievable...their doctors can't give them prescription motrin like the rest of us...this is what is wrong with the world

I am a Registered Nurse and the docs only prescribe Diluadid for hospice pts who are actively dying and for extreme and I mean exteme chronic disease cases. On another note I had 4 wisdom teeth pulled and all I received was about 8 Loratab with 0 refills! This doc needs to be arrested and have his/her license revoked ASAP!!!!

#13. you wrote...
So, she's on painkillers and anti-anxiety drugs? What was so bad in this idiot's life that she had to anesthetize herself to the world? She was young, she had millions of dollars, she had a growing career, she had millions of fans who loved & adored her. Why did she need to take drugs when she had all these things going for her?
All I can think of is, either she thought it would be "cool" to do drugs & drink like a fish, or she's got some serious mental problems. I think she's pretty much another sh*tney spears; she's lost her career, she's burning through her money, she picked the wrong type of hanger-on friends, etc. Time to toss her stupid arrogant retarded ass into the loony bin & throw away the key...

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The answer to your question is that Lindsay is an addict. Being an addict is a disease and not a choice. Even if Lindsay had never consumed any drug or a drop of alcohol up to this point, she would still be an addict. If the signs and symptoms aren't obvious now, they will be at some point. Addiction is not just for drug abusers and boozers. There are food addicts, eating disorders such as anorexia and bulimia which are in the spectrum of addiction and are treated much in the same way. Being an addict is a genetically coded predisposition and is not relegated to just the stupid and lower class. There are active and recovering addicts in every walk of life, every religion, every gender, every salary level, etc. Please open your mind up and let go of your self-created definitions of who is susceptible and how they will act as addicts. Something about your tone and bitterness hints that you may be projecting feelings about yourself onto Lilo. Are you displaying addict behavior? Yes, addiction is a mental illness but why word it as "some serious mental problems", with all that stigma and judgment you attach to it. When an obese individual is diagnosed with Diabetes II, which is avoidable but usually forms because of the obese one's continued food addiction and lack of desire to recover, do you say they have some serious mental problems? Their disease is a manifestation of their addiction in many cases. Most Diabetes II can be reversed with weight loss and exercise but usually the patient cannot be bothered to change their behavior with their drug of choice which is food. My point is that an illness in the organ known as the brain is no better nor worse than an illness in any other part of the body. Why must you refer to mental illness, of which addiction is, as a dirtly, low-class choice?

#175 Nurse Amy - what would you give a Suboxone or Methadone patient if they came in to the ER with severe accident injuries and as a result severely acute pain? Would you think a tylenol 3 or vicodin is appropriate? If you are feeling generous, maybe a useless (to them) percocet? No, nurse Amy you would be ordered to administer Dilaudid. Maybe you would have to be convinced first by the guy or gal with the M.D. that this is the correct drug to give if the pain is to be treated. Even addicts deserve proper pain control.