Slow release vs immediate release opioid pain medication. Why can’t I choose what works best for me?

oxycodone opioid pain medications

Yesterday my GP and I discussed my opioid pain medication use.  He is concerned that my usage is too high.  Of course that crosses my mind as well.  In the chronic pain world, opioids (or narcotics) are a normal part of life.  Sometimes I have to remind myself that most people don’t need oxycodone to get out of bed.

Even just writing that sentence down makes it sound like I am an addict. I am not. I am in a great deal of pain. And after lying still for six or eight or however many hours I have been in bed, I am in bad pain.  Nothing is worse for inflammatory arthritis than staying still.  And that’s the paradox. You have to move to reduce the pain. But you’re often in too much pain to move.

oxycodone opioid pain medicationsThat’s where opioids come in.  Takes the pain down a notch or two, so that you can move.  Moving then lubricates your joints and reduces stiffness and inflammation, and therefore some of the pain.

This is what my routine looks like.  Or used to look like.


Get up. Take 10mg Targin (slow release oxycodone) and 10mg Oxynorm (immediate release oxycodone). I need the immediate release to get moving quickly, to get my kids off to school.  Obviously immediate release works faster.  Slow release provides a baseline pain relief throughout the day.

After the kids have gone to school, I might have an hour of feeling ok and I’ll clean something. Or write something.  Or go get some groceries.  Whatever is essential.  I can really only choose one thing and then I will be spent.  Then I lie down and rest.

Around 2pm the pain has ramped up because the immediate release has worn off.  The kids come home in around an hour and a half, so I take a dose of oxynorm (10mg) to get up and moving so that I’m functioning for them.    We hang out for a bit, and chat about their day, homework, stuff.  Then they wander off and do their thing.  So I lie down again.  On a good day I’ll go do a light workout at the gym.  I only manage that two or three times a week these days.  I should go more.  I really need it. But sometimes I can’t see well enough to drive. Sometimes the pain is too much, and I know the gym will hurt, and I’m just not up for it.  But I try to push myself, because once I get there, and warmed up, the pain improves.  And my mood improves.

Around 6pm I take another dose of oxynorm (10mg) because I need to prepare dinner.   I also take 20mg of Targin (slow release) because the pain is worse at night, and the higher dose will hopefully allow me to sleep.  After dinner I clean up if I have the energy. Usually I don’t.  I lie down again and watch TV with the kids.

By 9pm the pain has ramped up again, and I take my last dose of oxynorm for the day, to get to sleep.

This works for me.  Oxynorm is effective and ‘clean’.  It doesn’t give me bad side effects.  It is short acting, so I can use it to get through the task at hand, and then I rest.

But doctors believe immediate release drugs are a problem. They believe they are addictive.  Because of the fluctuating doses in the blood, they believe patients get addicted to the high.

Maybe some people do.

I don’t.

I’m not addicted. I don’t get a ‘high’. I do love that feeling of the drug kicking in. That’s not addiction. That’s pleasure in that my pain levels are going down.  Different thing.

Totally. Different. Thing.

With my routine as it is, I am mostly clear headed and lucid. I don’t get dizzy or dopey from oxynorm.  I don’t feel impaired. I just feel pain relief.

But my doctor is forcing me to increase my slow release medication – Targin. Let me tell you what Targin does. I makes me feel ‘doped’. I feel drugged. My reactions are slower. My brain is full of cotton wool. I can’t think clearly. I am sedated.  I feel dizziness.  I feel nausea, lots of nausea.  I have no appetite as it is, but Targin suppresses it further.  My balance issues seem to be worse. And , best of all, I have a headache.  I also feel lethargic.  It lowers my pain, but it also makes me not give a toss.  Totally apathetic.  So I still just lie on the couch.  I am drugged.

That’s where I am now. I took 20mg of Targin this morning, and 10mg of Oxynorm.  I still need the immediate release hit to get going in the morning. I tried to go without it, but an hour after the Targin, I took the Oxynorm.

So now my pain is controlled. But I’m lying on the couch, sick to the stomach, with a cracker headache and I feel doped out and I’m fighting to stay awake.

Why bother staying awake, right?  Why not just spend my life in a stupor?  Or asleep?  Seems that what doctors want.

Docile.  Easy to manage.  Sleeping patients don’t argue.

I assume, over time, I’ll get used to the higher dose, and my body will adapt.  The sedation effect, the headache, the nausea will probably pass. Or I’ll get used to them.

But for now, my pain is controlled, but I can’t function. I can’t drive anywhere. I can’t think. I can’t DO anything.

And that’s the other thing.  Targin causes depression.  Apathy.  I’m writing all of this, and when I started I was angry, and now I’m thinking ‘so what?’.  Why bother fighting so hard?  Maybe it’s time I just gave in.

Instead of trying to clean the kitchen or pay the bills I’ll just lie here.  I wasn’t keeping up with things before. My house is filthy.  There is crap everywhere. Little piles of papers and bills and kid’s stuff that just keep growing.  In every corner. I’m not getting around to dealing with them.  And I won’t today.  I’ve been lying here for three hours.

If I’d taken 10mg and 10mg I would be up and moving and attacking some of this stuff.

But instead I’m lying here.  And I don’t care.



  1. You should also print this page out and take it with the pain diary. I don’t take slow release pain meds, but I do take my di-hydrocodeine pretty much just as you do. With coffee after my shower while sitting getting ready, while they kick in. Another dose around 2-3 pm, I try and leave it till I really have to take it. Then another around 8-9pm to help me sleep with less pain. On a really bad day I’ll take them 4 hourly instead of 6, and I’ll take 4 doses. And if needed I’ll take an Amitriptyline during the day and or at night, that’s a really bad day.
    I also don’t get a high, I used to feel that when I first went on them but now it does nothing but help my pain. I hate feeling doped up too and I certainly wouldn’t take ‘anything’ to get a buzz. I don’t even like feeling drunk.

  2. Brilliant article. I take Targinact 10mg about 12 hours apart and will occasionally top that up with two Oxynorm 10mg at night. Helps too with what seems to be a little lymphedema developing (after radiation) in my ankles/ feet. Oyxynorm seems to take away that uncomfortable feeling in the ankles. Not really pain but just uncomfortable.


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