Because they are administered as wax-cellulose matrices, the tablets cannot be chewed, ground, or halved. A second prescription of a short-acting opiate should accompany controlled release morphine to relieve breakthrough pain. According to Dr. Levy, hydromorphone's main advantage is that it is potent and soluble. The patch is like the equivalent of receiving three days' worth of drugs, Dr. Levy explained. It is akin to a subcutaneous infusion that does not require a pump or needle.
Disadvantages are that it has a twelve-hour lag time to be effective.
The patch may be removed to reduce the dosage but there will still remain a day's worth of drug in the subcutaneous space. Dr. Levy stated that in general he and his colleagues utilize morphine and oxycodone. The routes of choice are first oral, then transdermal, and then subcutaneous or intravenous. The spinal route is reserved for a small number of patients who have too much systemic toxicity from parental or systemic routes.