Opioids High tolerance - can I just keep increasing?

[JoeDobbin]

Hello.

I have an extremely high tolerance for Opioids, due to taking a lot of them for pain from my terminal illness. I currently take 200 mcg Fentenyl ER patches, 120 mg of Oxycontin ER, and 16mg three times daily of Hydromorphone. It has been about two months, and I no longer can feel any "rush" feelings from the Oxy (before the pill version of delaudid) and I feel nothing from the 16 mg of delaudid pill form. When I was last in the hospital, via IV, I was on 3mg per hour of Delaudid (highest my doctor would go), and it seemed to do hardly anything, but it take the edge off.

In the past, getting Delaudid would feel like someone hit me in the chest with a sledgehammer, but in a weird good sort of way. The last time I was in the hospital, none of that.

I take the 16 MG of hydromorphone, and it does nothing. No sleepyness, no high feeling, etc.

I have never really wanted to feel "High", but it was a good distraction from the pain. I no longer get any of that now. I guess I am wanting it now, or at least a distraction, from the pain.

Questions: Is that feeling lost forever? Can I take more Hydromorphone and get pain relief? Is there an OD amount that I should be weary of? I can't really ask my doctor these questions, and was hoping I could rely on other peoples experiences who do this on a more recreational level and have ACTUAL experience with this.

Not sure what to do at this point?

Thanks

 

[LilikoiMoon]

I've never liked Dillies, at all. Of course I've never IV'd drugs for a high and never will. One of my close friends IV's Dillies at 4mgs 4 x per day. She doesn't feel a rush anymore after 6 months because of chronic use and she has ruined her veins.

In a hospital setting, Dillies, when IV'd, make my heart rate drop and my spine burn. It makes me feel icky, and I just don't like them.

Snorting them takes away opiate withdrawal, but that's at 8mgs, and the feeling is gone within an hour.

So to answer your question, yes, it's your tolerance. This is why after 20 years of using opiates, I have to take breaks from time to time to lower my tolerance a bit and to be able to get the meds to provide full pain relief again...not to get high.

You're on Fent, Dilly and oxy at high levels, so I imagine your dopamine receptors are exhausted. I'm a firm believer in dopamine receptor damage. You may want to speak to your Dr. and try a new combo, or take a break for a while, starting back with caution for risk of OD when your tolerance drops.

 

[mankind]

An old junkie once told me your tolerance will only be restrained by your financial ability. I think this is true for most drugs.

 

[Toknowmore]

I've had 20 surgeries and have neuropathy and permanent nerve damage. I'm looking at number 21 later this year to cut a sensory nerve in my leg. I'd love to find another way to buy 10/325 Norco. It's the only pain reliever that I can take and still be productive at work. I won't take Oxy's period. I was addicted to them years ago and am not going back down that road. Any thoughts?
Thanks,

 

[JoeDobbin]

Thank you for the responses and thoughts; albiet two different forms.

- LilikoiMoon: I am quite worried about the receptors being exhausted. Yet, I am even more worried about stopping. Prior to my current regiment, I was under a much more severe pain scale. Life was nearly unlivable. I would say that I have dropped the pain scale down from the 10 it was, to maybe a 7?

The difference being that when I first started taking some of these meds, I would get that additional sensation of sleepiness, or the light-headed sensation. It was a distraction, not a pain-eliminator. I would like that distraction back. It helped time pass in the evening when I needed to go to sleep. Now, it will lower my pain levels some, but still not enough to allow me to easily go to sleep or relax wen I need it.

Hence, asking if I can just increase the only INSTANT form of pain relief I have available, the 8mg Hydromorphone pills (which I take the prescribed two pills, equaling 16mg per dose). From my RX instructions, I take the total of 16mg three times, daily.

The other two meds (fentenyl and oxycontin) are timed / prolonged released medicines. I am not sure how it breaks down exactly (is it a simple math equation: 200mcg / 72 hrs = 2.77 mcg per hour of Fentenyl | 60 mg / 10 hrs = 6 mg Oxycontin per hour day/night coverage {since I take 60mg in the morning/60mg at night}??)

Ultimately, taking a break isn't a viable option. Since this is not a recreational usage; if I don't reduce the pain I am in I literally cannot survive. Nor would I wan't to either! I have tried many combinations that we (doctors and I) can think of. This has been the best combination thus far. My doctor knows I am not an abuser, and is very willingly to write a combination that works. I know of nothing else!?

- mankind Thanks for the quote and wisdom of an old junkie. This was ultimately what my question was aiming towards; can I increase my Hydromorphone intake? It is currently prescribed as the following:

- Hydromorphone 8 MG
--- Take two tablets by mouth, three times daily as directed

I have tons of these 8mg pills. So to the wisdom of the old junkie, financially affording them isn't a problem. Yet, is it safe? Can I go up to 4 tabs every dosage (equating to 32mg per dose), three times daily? Every time I mention I take 16mg per dose of Hydromorphone, people react as that is a "high" dosage. Which, scares me from taking anymore.

Is this one of those drugs that fits the old junkie quote?

Toknowmore

I would consider NORCO's to be a light strength medicine. It is basically a 10mg Oxy combined with a 325mg of Tylenol. I have taken a lot stronger stuff, that isn't tied to a Tylenol drug that limits the total consumption per day (you are limited due to your liver on those kinds).

I would suggest talking to your doctor to take any of the following:
- Oxycodine for a breakthrough/instant pain relief (like you are now)
- Oxycontin for an extended pain relief base.
- nucynta IR for a breakthrough/instant pain relief
- nucynta ER for an extended pain relief base.
- Tramadol ER (extended / base)
- Tramadol IR (instant/breakthrough)
- Morphine
- Fentenyl - comes in multiple forms (patches for base/extended release | lollypops or spray for instant relief), would say this is pretty strong - if not the strongest
- Hydromorphone (strongest of the bunch) - delaudid in a pill form

Ultimately, you would want to combine a base with an instant. The base, or extended relief, will slowly distribute out the pain medicine all day long. Then, you use the IR or instant breakthrough to help cope when the base isn't covering the pain needs. There are multiple different medicines that can do both forms. I only listed SOME. You and your doctor should have a lot to talk about, as there are many different kinds to work with.

Thanks eveyrone..
- Joe

 

[Quexxxt]

You're on Fent, Dilly and oxy at high levels, so I imagine your dopamine receptors are exhausted. I'm a firm believer in dopamine receptor damage. You may want to speak to your Dr. and try a new combo, or take a break for a while, starting back with caution for risk of OD when your tolerance drops.

This is the technical reason your no longer feeling a "rush" or high, hydromorphone doesn't antagonize the receptors that cause endorphins to be released as effectively as say, diamorphine. The rush delivered from this drug would where off quickly, especially considering your dopamine levels would be thoroughly diminished from such a high daily intake of oxycodone. Not to mention fentanyl. You must be in allot of pain my friend.

 

[Quexxxt]

You can continue to increase your dose, which will drain your dopamine receptors like a guy going to a job interview, desperately trying to strain the last bit of toothpaste from the already squished tube. This will deliver the desired high for a short while, but the matter of the fact is, the longer you persist to use such high doses of opiates, the more damage/alternations it's going to do the chemical balances/functions in your brain. Eventually causing some degree of brain damage. Not to mention the incredible damage you'd be doing do your liver.

 

[Mad Dash]

I've had 20 surgeries and have neuropathy and permanent nerve damage. I'm looking at number 21 later this year to cut a sensory nerve in my leg. I'd love to find another way to buy 10/325 Norco. It's the only pain reliever that I can take and still be productive at work. I won't take Oxy's period. I was addicted to them years ago and am not going back down that road. Any thoughts?
Thanks,

yes, opiates are opiates. So hydro or oxy are going to give you the same exact addictive problems. You are exhibiting classic addictive tendencies. Like an alcoholic switching from liquor to wine. Still has alcohol.

And Joe, the problem with the dilaudid, is they have a terrible oral BA. If you really want to get the most out of them you need to be snorting them. I know people would say shooting, but it isnt about the rush for him it is about duration and strength. So nasal, and plugging would be way to go. And you said this is terminal pain? dont let your morals get in the way.

 

[JoeDobbin]

Quexxxt

Thank you for your feedback. I have a routine blood work to examine my liver functions, to which the levels are still showing normal results. It is interesting though, long term usage and liver and brain damage hasn't been discussed with my level of opiate intake. This is possibly due to the doctor's belief of my other terminal ailments that I have been diagnosed with. Yet, it still worries me as I have not given up hope to survive. I guess there isn't anything that could be more depressing to survive a terminal illness, only to be hit in the face with a failing liver or some sort of brain damage?!

I guess it just seems like a no-win situation here. I cannot stop the intake of opiates, and I have switched multiple times, trying to find a good regiment that stabilizes me for a long period of time. Through the conversations with the doctors, this wasn't a temporary treatment plan; I would be taking this dosage of narcotics the rest of my life 24/7. With that being said, how would one go to not destroy the dopamine levels?

Mad Dash

Thank you for your comments as well.

You bring up an interesting point, one in which I was kind of beating around the gray area with. I am terminal, although I plan to survive. I have a wonderful wife who is my best friend, and two awesome kids; a six year old princess who acts like she is going on 30 with her loving and motherly based instincts, along with my eight year old son who is a typical video-game obsessed nerd. A nerd, but a cool nerd that is. One that he realizes he is happy and does what he wants and impresses me on a regular basis with his knowledge into random subjects. I must survive. I cannot leave behind this family!

Yet, I am inquiring about ways to improve the experience, allowing me to better survive. You bring up a great point about morals, to which I agree with your stance. Yet, this is a difficult subject to approach. I am not one to do an IV, nor am I comfortable to do any rectal abortions either. I am not educated with the snorting aspect of it. What are the PROs and CONs of snorting? Is there a FAQ in how to do it? Will it be noticeable to others that I am doing it (i,e, my Doctor)?

Thanks
-Joe

 

[Mad Dash]

Quexxxt

Thank you for your feedback. I have a routine blood work to examine my liver functions, to which the levels are still showing normal results. It is interesting though, long term usage and liver and brain damage hasn't been discussed with my level of opiate intake. This is possibly due to the doctor's belief of my other terminal ailments that I have been diagnosed with. Yet, it still worries me as I have not given up hope to survive. I guess there isn't anything that could be more depressing to survive a terminal illness, only to be hit in the face with a failing liver or some sort of brain damage?!

I guess it just seems like a no-win situation here. I cannot stop the intake of opiates, and I have switched multiple times, trying to find a good regiment that stabilizes me for a long period of time. Through the conversations with the doctors, this wasn't a temporary treatment plan; I would be taking this dosage of narcotics the rest of my life 24/7. With that being said, how would one go to not destroy the dopamine levels?

Mad Dash

Thank you for your comments as well.

You bring up an interesting point, one in which I was kind of beating around the gray area with. I am terminal, although I plan to survive. I have a wonderful wife who is my best friend, and two awesome kids; a six year old princess who acts like she is going on 30 with her loving and motherly based instincts, along with my eight year old son who is a typical video-game obsessed nerd. A nerd, but a cool nerd that is. One that he realizes he is happy and does what he wants and impresses me on a regular basis with his knowledge into random subjects. I must survive. I cannot leave behind this family!

Yet, I am inquiring about ways to improve the experience, allowing me to better survive. You bring up a great point about morals, to which I agree with your stance. Yet, this is a difficult subject to approach. I am not one to do an IV, nor am I comfortable to do any rectal abortions either. I am not educated with the snorting aspect of it. What are the PROs and CONs of snorting? Is there a FAQ in how to do it? Will it be noticeable to others that I am doing it (i,e, my Doctor)?

Thanks
-Joe

Pros:
- Higher BA meaning more of the drug gets into your body. For some reason the morphones have terrible oral BA.
- Still has a relatively long duration as compared to oral. Maybe a little less time, but as you would be getting more out of it, the 20 minute or so difference would not matter.
- If you are in serious pain the drug is absorbed in minutes providing a 'rush' of relief and euphoria.

Cons:
- It can after years and years of use damage the inside of your nose causing a deviated septum, but there are ways to reduce the risks (make as fine a powder as possible/make a nasal spray)
- Some people develop a snorting fetish, trying to snort everything in sight. This never happened to me but it is possible.

Those are the ones that come of the top of my head. And no, there is no real way your doc is going to know you are snorting. I am praying for you man, sounds like you have a great family, something I lost (military ruined my life). If you want more out of what you currently have snorting your hydromorphone pills is a good way to do it. Also you may want to look in to different Fent preparations, there is a nasal spray I can not remember the name of. And fentora which is buccal. But with what you have avilable to you I would try snorting the HM for now and see what that does for you. Other members if you think of more pro/con list please add them.