Opioids Opioid tolerance

[FutureReference]

Hey all,

Been in chronic pain for years and although with new laws my dosage is lower I'm trying to make the best of it. 10mg Oxycodone 4x a day is minimal at maintaining pain but recently I have been taking 20mg in the morning and then 10mg once 2x a day. It seems to work better this way and I have had no issues with the 10mg not being helpful, just need more help getting out of bed. I have been on the same dosage of Clonazepam for 12 years so I am pretty stable with everything and am just wondering if this will alter the painkilling properties by having the stronger dose daily

 

[Nicholai]

I'd worry about the larger dose increasing your tolerance, making the 10mg pills less effective.

 

[negrogesic]

Hey all,

Been in chronic pain for years and although with new laws my dosage is lower I'm trying to make the best of it. 10mg Oxycodone 4x a day is minimal at maintaining pain but recently I have been taking 20mg in the morning and then 10mg once 2x a day. It seems to work better this way and I have had no issues with the 10mg not being helpful, just need more help getting out of bed. I have been on the same dosage of Clonazepam for 12 years so I am pretty stable with everything and am just wondering if this will alter the painkilling properties by having the stronger dose daily

Hey how is the black seed oil working for you? I remember you said it had significant tolerance reducing properties at first...did this go away? You still take it? I take it daily cause I just like the stuff, it vaguely feels like an opioid itself (in terms of the effect it has on the body and bowels)...

 

[FutureReference]

Hey how is the black seed oil working for you? I remember you said it had significant tolerance reducing properties at first...did this go away? You still take it? I take it daily cause I just like the stuff...

Hey man! That black seed oil truly helps more than anything else I have ever tried. It extends each dose at least an hour and I get 2x the relief I did before you told me about it. Thanks again, seriously! It still has the same effect as Day 1 and I take 1G once a day so thankfully there is no tolerance either!

 

[negrogesic]

Hey man! That black seed oil truly helps more than anything else I have ever tried. It extends each dose at least an hour and I get 2x the relief I did before you told me about it. Thanks again, seriously! It still has the same effect as Day 1 and I take 1G once a day so thankfully there is no tolerance either!

Nice thats good news. I never take more than one capsule at a time (500mg) but depending on the day ill take 3-6 capsules (1.5 to 3 grams). Im not addicted to opioids, but ill occasionally take them for a long enough stretch where ill feel a touch of withdrawal (which is how i found black seed oil). Regardless i pop them all the time (my girlfriend says i smell like an indian if take enough -- eventually it seeps out of your pores). If it works for you, don't be afraid to bump it up. Very glad its working for you.

That said...if you need opioids indefinitely (and you're not going to like this idea) i think methadone beats the pants off of oxycodone, and you won't face the same dose restrictions. Just an idea. Its hard for me to understand the plight of the chronic pain patient (i just enjoy opioids and have no pain other than soul crushing existential dread). Still, methadone is a better painkiller particularly given its NMDA antagonist properties and long duration of action. What it really depends on is how long you intend on being on opioids. If that is a long time, methadone could be a better choice. Would also depend on the nature of the injury and how it manifests (in waves versus constant -- methadone would be more effective in the later versus the former). Its an unpopular proposition but potentially a real solution (albiet a serious one).

 

[axe battler]

Whilst I do agree with the above statement to an extent, if it is for more than a year, you'll be in the same boat.
Ive been on 85ml for 2 years slowly going from 60 and I dont notice a reduction in pain (not a pain paitient though).
And why wouldn't methadone be under the same restrictions? Because he'd have to go to an addiction clinic? It's not something I'd recommend having to do, as you will get propositions from addicts wanting to sell him shit like heroin.
Plus there's the daily dosing but I'm not sure how it works in OPs country.

 

[axe battler]

Plus some staff treat you like scum. There's piss tests and you have to pass if you're going to keep your take homea if you build them up.

I would rethink it and try and manage your pain with other methods and only uses your oxy when you really need it (unless of course you do need it constantly!)

What is the source of the pain?

 

[negrogesic]

Whilst I do agree with the above statement to an extent, if it is for more than a year, you'll be in the same boat.
Ive been on 85ml for 2 years slowly going from 60 and I dont notice a reduction in pain (not a pain paitient though).
And why wouldn't methadone be under the same restrictions? Because he'd have to go to an addiction clinic? It's not something I'd recommend having to do, as you will get propositions from addicts wanting to sell him shit like heroin.
Plus there's the daily dosing but I'm not sure how it works in OPs country.

Perhaps you are right. Maybe my recommendation is ill advised. My perspective is skewed as I never needed it for chronic pain. My recommendation derived from the fact that methadone gives you great coverage, as I can't imagine how horrific it must be to be in chronic pain and being on the cusp of withdrawal at all times from a lowish dose of something short acting like oxycodone. Methadone can be prescribed by pain doctors but i am not sure how many actually feel comfortable doing so.

 

[axe battler]

You are right that methadone seems like a better drug than oxy, it's just if he has to go through the whole addiction clinic route to get it.
If his pain doctor prescribed it, wouldn't it be under the same stupid 60mg morphine equivalent rule as the rest? Such a silly rule!!

The methadone would give him longer lasting relief though, definitely, but probably less noticeable, especially if he can only be prescribed that small amount!

 

[FutureReference]

I truly appreciate the replies and advice guys! I have seriously been debating Methadone but after 5 years on Suboxone I have a very hard time bringing myself to the decision. I metabolize very rapidly which is what makes my pain issue so frustrating. My buddy who served with me said Oxy gives him 6 hours of pain relief. That is mindblowing to me. I was getting 2 hours at best before @negrogesic recommended the Black Seed Oil which seems to extend it to nearly 4.

If I could make them work longer I'd be fine. 30MG is ideal for IR but then I am stuck with just 10MG for the rest of the day. I know I cannot get 120MG daily anymore but at that dose I would be properly managed all day long. I am scared to even ask for dose adjustment but may ask for the max (60MG daily) on my next appointment. I am worried the 20MG might make the 10MG less useful but 10MG doesn't help me get out of bed and it is frustrating.

My doctor did say he would give me take home Methadone but I am just weary. The long half-life scares the shit out of me and for some reason certain opioids never helped with my pain. Fentanyl for example. Even though it is so strong it could get me higher than I wanted to ever be without touching my pain. I am worried Methadone might not help my pain and I know if I agree to it I will never be put back on Oxycodone which truly has helped me more than anything. I hate being in a position like this, I really do. They don't understand I could just get street drugs or Heroin to get high, I just want my life back and to not have to want to die everyday. The pain makes me feel weak enough without the judgement and restrictions that are in place that make it that much harder. Just losing hope idk. Idk what to do really anymore

 

[Nicomorphinist]

Hey all,

Been in chronic pain for years and although with new laws my dosage is lower I'm trying to make the best of it. 10mg Oxycodone 4x a day is minimal at maintaining pain but recently I have been taking 20mg in the morning and then 10mg once 2x a day. It seems to work better this way and I have had no issues with the 10mg not being helpful, just need more help getting out of bed. I have been on the same dosage of Clonazepam for 12 years so I am pretty stable with everything and am just wondering if this will alter the painkilling properties by having the stronger dose daily

How awful -- any possibility of synchronising the oxycodone and clonazepam doses? If you are able to get hydroxyzine that would potentiate both of those drugs, and another antihistamine used for muscle spasms and Parkinson's symptoms, orphenadrine, has similar effects and some analgesia of its own

 

[negrogesic]

My doctor did say he would give me take home Methadone but I am just weary. The long half-life scares the shit out of me and for some reason certain opioids never helped with my pain. Fentanyl for example. Even though it is so strong it could get me higher than I wanted to ever be without touching my pain. I am worried Methadone might not help my pain and I know if I agree to it I will never be put back on Oxycodone which truly has helped me more than anything. I hate being in a position like this, I really do. They don't understand I could just get street drugs or Heroin to get high, I just want my life back and to not have to want to die everyday. The pain makes me feel weak enough without the judgement and restrictions that are in place that make it that much harder. Just losing hope idk. Idk what to do really anymore

The main issue with methadone for your use is that while the half-life is very long and will keep withdrawal at bay for a long time, its analgesic properties wear off after 4-6 hours. Thus you'd have to dose a few times a day. Yet, the full analgesic effect would take weeks to materialize since the metabolites slowly begin to accumulate in the system. Still, you'd be more likely to get prescribed an adequate dose (60mg is equivalent to perhaps 200mg of oxycodone, which is a dose many physicians would have little reservations prescribing -- physicians are increasingly afraid to prescribe oxycodone in effective doses given the bad press associated and hyperbole surrounding oxycodone). Still, it would be a big gamble, but if it worked well it would help give you life back. Worse case would be it doesn't work, and you'd have to switch back to something like oxycodone, in which case the best case seems like a better payoff than the worst case (actually the worst case may be that they refuse to switch you back to a short acting, or that methadone raises your tolerance so much so that they're unwilling to prescribe you an equianalgesic dose of oxycodone/morphine etc.).

Hydroxyzine might help a bit (and from what i recall can purchased from indian pharmacies online cheaply and without concern of legal problems, in the event you can't find a willing physician to prescribe), but the real answer here is that it sounds like you need more medicine. You have a right to ask for more, and 60mg doesnt sound like an unreasonable request.

Interestingly long term opioid use results in neuroplastic changes that can paradoxically cause hyperalgesia in those that use them. They did a study on pain sensitivity in those on methadone compared to non-addicts, and found that those on methadone were more sensitive to pain stimuli than those not on narcotics.

 

[DeathIndustrial88]

This post is about a year old now, but I thought I'd might add some non-opioid (in combination with your opioid) ways to help with pain, but it could very well depend on the type of pain OP had or whoever comes across this and reads it has. Good info from the above commenters though too.

I have found in my experience, low doses of DXM with or not long before your dose of opioid enhances both the pain relieving aspect and the mental aspect of the opioid. You also have the benefit of helping lower/stop tolerance building with DXM.

Cannabis is fantastic for pain, especially in combination with opioids. I can remember a time having an abscess and being in such pain that I couldn't walk without screaming vulgarities at the top of my lungs ever step I took. The only thing that gave me enough pain relief that time was when some one came over and smoked a bowl of good bud with me. It was like the pain completely evaporated. Combined with opioids, this net-effect is excellent.


I think some stimulants have pain relieving properties. I'm not sure how biologically this effect comes about but it's most likely the neurotransmitters being released. I don't recommend getting a stimulant addiction to treat pain but it's just an additional effect I have noticed over the course of 20 years.

And then of course there are always regular NSAIDS in addition to the opioid. They may not get you any more of a 'buzz', but they do provide additional pain relief, especially naproxen and acetaminophen.

Could also try taking something that stops Oxycodones metabolism break down. Although I'd have to look up what needs to be taken for enzyme inhibition for Oxycodone.


Clonidine can be effective for chronic pain (especially neuropathy). I had very tense neck pain yesterday and took everything I could from buprenorphine, naproxen, kava kava, a few kratom, nothing seemed to help. So then I took a clonidine and suddenly an hour later my body (and neck) were much more relaxed and I felt more like a useful productive human being, although unfortunately it was also time for bed. There's more about clonidine and chronic pain here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950462/


Some of these can be applied to your dose later on in the day if you find they are not working as good as the dose you took in the morning.