In a SHTF scenario, lack of medical help will be a significant problem. I believe lack of medical supplies and medications will become to a point of crisis sooner than later. It is important to stock medical supplies and medications as part of your survival plan.

Pain management is a basic part of medical care. Pain can range from mild to severe. Pain medication for mild to slightly moderate pain can be bought over the counter (without a prescription). Pain medication for moderate to severe pain needs a prescription from a doctor. Let’s look at a pain medication comparison chart.

Pain Medication           Strength compared to Morphine
Aspirin                           1/360
Acetaminophen               1/180
Ibuprofen                       1/150
Naproxen                       1/120
Codeine                         1/20
Tramadol                       1/10
Anileridine                     1/4
Pethidine                       0.36
Hydrocodone                 0.6
Morphine (oral)             1
Oxycodone                    1.5–2.0
Methadone – Acute        3-4
Morphine (IV/IM)           4
Hydromorphone             5
Oxymorphone                7
Methadone Chronic        7.5
Levorphanol                  8
Buprenorphine              40
Fentanyl                       50–100

The chart compares strength of each pain medication to Morphine (Oral). Morphine’s strength number is 1. Codeine’s strength is 1/20 of Morphine. In other words, you would need 20 mg of Codeine to equal 1 mg of Morphine. A word of warning. The chart is for comparison purposes. Different drugs are utilized differently in the body. You should not take 300 mg of Codeine to make up the pain relief of 1 7.5 mg Oxycodone. This could cause liver damage and because of the speed at which the liver uses Codeine, you could never get the same pain relief.

In theory you should be able to take three 5 mg Hydrocodone pills to roughly equate to one 5mg Oxycodone pill but all Hydrocodone pills (Vicoden, Lorcet, Lortab, etc) are combined with Acetaminophen, ibuprofen and other analgesics and too much of these medications can cause liver or kidney damage. Short-term you are probably okay. Long-term could be a problem.

The first 4 pain relievers are available in the US OTC (Over the Counter). They are good for mild pain. The rest of the pain relievers need a prescription with one small exception. The exception is Codeine. Codeine can be purchased in cold and cough formulas and in Canada can be purchased in pills.

If you travel to Canada you can buy A, C & C over the counter. A, C & C is Basically Tylenol 1. It has Acetaminophen, Caffeine, and 8 mg of Codeine. As I understand US Customs law, you can bring 50 pills through Customs with you without a prescription. A, C & C also is available with Aspirin instead of Acetaminophen. I prefer this formulation because Codeine is turned into Morphine in your liver. Acetaminophen is also handled by your liver so it puts double stress on your liver. Aspirin is handled by your kidneys so it doesn’t stress a single organ too much.

I have to talk about addiction here. The pain meds from Codeine on down are opiates or opioids and are all extremely addictive. This is why you need a prescription to get them. Let’s all be big boys and girls and realize that while having a stock severe pain meds for survival emergencies is wise, other less mature people who either live in or come in to your house might look at your stock differently. KEEP YOUR PAIN MEDS UNDER CONTROL.

Unless you have a sympathetic doctor who you have a relationship with and is willing to write a prescription for you for preparedness storage, you are pretty well left to storing left over prescriptions you may get after a surgery or accident. Let’s talk about shelf life of pain killers.

Pharmaceutical manufacturers use very conservative expiration dates for several reasons, some good and some greedy. The good include safety reasons for drugs like Nitroglycerin. Nitroglycerin has a very short shelf –life and when you need it, it is a matter of life and death. Hoping it is still good is not an option. Greedy includes a host of other drugs that are know to last for years after their expiration dates but the drug companies want you to think they are bad so you’ll buy more.

The military conducted a series of drug shelf life tests in conjunction with the FDA and drug companies. The drug companies participated on condition that the results would be know only to the military to aid them in stock piling drugs but the results should not be made known to the public for fear of lost revenue.

Here is a DOD news article about the tests. DOD News Article
Here is another article by Laurie P. Cohen, staff reporter for the Wall Street Journal. WSJ Article

The results of the testing was they found out that more than 90% of medications were still effective up to 15 years after their expiration date.

Shelf-Life of drugs has a lot to do with storage conditions just like it does with food. Cool, Dry, and Dark are the optimum conditions. I use a resealable paint cans from Home Depot to store my drugs. I have a gallon size for antibiotics and a quart size for pain medication. I put an oxygen absorber in with the prescription bottles and seal the lid tight. If I need to open the can to add or use some pills, I add a new oxygen absorber and reseal it.

From everything I have read, opiates (Codeine, Morphine, etc) and opioids (Hydrocodone, Oxycodone, etc) have shelf lives way beyond their expiration dates. If stored properly, they can still be at full strength 5 years after their expiration date. After that, they only begin to slowly lose their full potency and can still be at 80%-90% potency after 10 years.

The big question is: In an emergency what would you rather have, an out of date drug that still has some potency or no drug at all?


Ed Rogers

Copyright “Keep It Simple” 2012.  All Rights Reserved.

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