Opiate Tolerance - How long for it to lower, how permanent is it?

[vortex30]

Hi all,

About 1 year ago I hit the 80mg dose marker for oxycodone (had never taken that high of a dose before, ingesting a full 80 felt wasteful, but boy was I unaware how bad it could get...). By Spring I was dosing 160mg most of the time and 200mg was the highest I went until more recently, now I've done up to 280mg (was really noddy off that), this is mostly orally. I've injected hydromorphone several times since September and usually take 16mg IV. Also worth mentioning is during the summer I used methadone about 5 times over a month or two in the 25-55mg range. I don't use opiates every day as I could never afford that, my use over the past year probably averages out to 2-3 times a week. I've been through withdrawals several times but only mild-moderate, nothing severe. All that is just to give you an idea of my usage.

I'm now 5 days off opiates and plan to keep it that way for good except a cheeky dose some time during the holidays for fun. My main worry is long-term high tolerance, not so much relapsing and long-term addiction as I feel I'm done now. My natural tolerance was fairly high, I never did less than 20mg oxycodone and found that to be rather underwhelming even, I was up to 30-40mg quite fast even when using very occasionally. How low can I expect my tolerance to drop, and how long will this take? My worry is suffering some severe trauma in the future and not getting the pain relief I need (I've read they make IV hydromorphone in 4mg or lower doses...If I was in severe pain at this point I would want at least 8mg I reckon, but the docs would never know that I even need the big 4mg dose most likely, and just give me what makes non-tolerant people feel good, do they have any way of knowing that you're still in severe pain if you're unable to speak?). Or if I'm getting some surgery done, that I should inform them of the fact that my tolerance was/is very high, etc. and it will be so hard to predict how much I need during the surgery and after it...My doctor doesn't know, neither does my family and only a handful of my friends.

It certainly complicates things like this, something you never really think about when you're using but once you get a clean mind it's a bit of an, "oh shit..." sort of moment. Like you've really screwed yourself over for life if you ever get put in an unlucky circumstance. And for Pain Management, certainly my tolerance will shoot up very fast having been so high in the past.

It all really sucks, but makes me more adamant to quit, as obviously I should get it as low as I can as soon as I can if this is a concern of mine. Better to go in and need 40s of OC at a time or the 4mg IV hydromorphone rather than Fentanyl or be in severe pain with even IV hydromorphone not making the cut...

 

[vortex30]

your way of using, in particular is very dangerous.

Why's that exactly? My tolerance never seems to drop enough between each use to scare me, though whenever I do take over a week off I will generally start with just 120mg Oxycodone orally and snort the rest 30-40 minutes later when it hits to be safe. I'd only IV when I was particularly bored of oral oxycodone, so would always be with a tolerance to back me up. I've been noddy only a handful of times since May of this year. Back then I was generally mixing Xanax and even Midazolam with oxycodone, that I will admit was very, very dangerous and I found myself way more out of it than I like several times, but since then I've rarely mixed other depressants in except for diphenhydramine and sometimes small amounts of alcohol.

Maybe you meant something else entirely so I'd like to know as I value all the input I can receive! For what it's worth I feel I'm done with opiates except for 1-2 uses over the holidays, when I'll definitely be employing my possible lowered tolerance technique and maybe even start with 80mg oral as it will be the longest break I have had since April of this year. But based on previous breaks I don't expect it to drop substantially in 3-4 weeks.

I have always felt like I'm in this stupid limbo state where I've gained a massive tolerance yet don't have the comfort of using daily, so have constantly either been on opiates (or the 24 hour tail-end where I still feel good and have no pain) or in some annoying achey pain. Getting clean here finally feels really good, even though it has only been 5 full days from my last dose I already feel fairly pain free and my mood isn't too bad. In a sense I've dodged a major dependency bullet in my pattern of use, as I have a friend who has been using daily for about a year now and he's gonna have it rough, even though a lot of the time he only does 40-80mg/day to stay straight whereas I always aim to get fairly high, there's no sense spending the money to feel 'normal' or a bit better than that, I feel.

 

[Oxide]

Your tolerance will never go back to zero, but it can be reduced quite a bit by abstaining like you plan to do. I wouldn't expect 10mg of oxycodone to make you nod or anything, but you will most certainly notice quite the reduction in your tolerance. Your tolerance will also build back up much more quickly than before, so anytime you can avoid using consecutive days the better.

Stick with oral oxycodone when you go back, the bioavailability is much higher than intranasal and let's not forget the binders and fillers in pills can do some serious harm to your finely tuned, extremely sensitive nasal passages.

When you do go back to taking opiates again, start much lower than you usually would. You can always work your way up if need be.

 

[vortex30]

Thanks for the reply! I've never done as low as 10mg oxycodone, lol. First time I bought it I was instructed to snort 20mg so I did, and I was underwhelmed by that even, wish I started with just 1-2 percs orally like a lot of people do, oh well...The plan is to stick to oral OC as you said, I prefer it over intranasal due to the BA and duration increases. I like how it's assumed one will be going back to opiates eventually, lol! But indeed if they're available next summer I would enjoy the one off, especially if my tolerance drops down to sane levels.

 

[Raysu]

To qualm your fear if you were in some event that landed you in the hospital then bloodwork is pretty standard so if you've been using regularly the levels can be determined and your doctor will adjust doses accordingly. This was my fear when I went in for surgery and I knew they knew when they asked "uhh so exactly how much are you taking?" Then I saw the report myself and was way outside normal range. Oops but they proceeded at least and had me well managed during and in post-op. If you use off and on there are still indicators for pain (i.e.:elevated BP). A good doctor will address your pain accordingly. An insensitive doctor should be reported. Ask to speak to the hospital administrator if you have to.

 

[IMtrying]

one thing ill say; even if it does become a bit lower, it SHOOTS back up awful quickly. not sure if it was already said or what but I had no time to read other posts. but I do remember being "clean" for 9 months and coming back thinking things would be that much easier. within 2 weeks I was back to shooting 1-2G's a day w/o a problem. yes, it had to do w/ me and how I use but I've seen it, heard it, done it many times.

 

[SS373dOH]

It depends on how much and how often you have used, your body makeup, metabolism, ect, ect. With that being said, you can expect your tolerance to start to lower as soon as a few days, and it can be back to "normal" within a month or two. However, as stated before by others, once your brain is "wired" for opiates, tolerance builds up faster and faster with each tolerance break. As far as your worry about not getting the correct analgesic effects in a hospital setting, your vitals normally will indicate how much pain a patient is in, and you can always communicate and tell the staff what your pain levels are at, unless you're under anesthesia, in which case youre knocked out cold and wouldnt feel pain anyways.


- Hopeless Soul

 

[Cotcha Yankinov]

There are also pain medications that work by different means, I.e Gabapentin. Most chronic pain issues have a big inflammatory component and in that case there are plenty of anti inflammatory meds to try.