Opioids Seemingly Natural Resistance, Looking to Increase Bioavailability

[vintage]

Going to do this in "other drugs" since it states for intermediate threads. Am new here, so if it's classified wrong, please feel free to move it.

Earlier in life, I was pretty big into recreational drug use, and had done just about everything across the board: pills, smoke, IV ... type didn't really matter ... opiates, ecstasy, heroin, coke, mj ... just whatever made me feel good. That was about 20 years ago, and although I was doing huge amounts then, it always seemed to require me to do those huge amounts, much more than others, to get to a decent place.

Fast forward to the present, and I've got a number of conditions that cause me chronic, severe pain, including psoriaritic arthritis and some bone degeneration. Used to live down south and had a great doctor that would prescribe me anything, and moved north and found the same thing here. Only problem is, my current doctor (even though both were standard General Doctors) can't prescribe methadone, which out of all prescription painkillers, seemed to have the best effect, even though I still had to take 60mg-100mg at a time to get relief from a "dry state" where I should have no resistance. Good thing about the methadone for me at least was I didn't see to build a resistance to it, even after a year, like I do with other opiates.

To make a long story short, the last of my methadone ran out (I tapered off, but still, I was getting 500 x 10mg per month, so my bottle lasted a while), and I've been experimenting with prescriptions to find something that works as good. And, I do like to get a nice buzz every once in a while, too. Great thing: I have a doctor that will work with me and prescribe me anything I want ... bad thing ... I can't seem to hit on a good combo. Right now, I have oxycontin 15mg (x180), oxycodone 15mg (x180), a couple of fentanyl patches (100mcg/h) and some oxymorphone lci 1335 8mg (x120). Although that may sound like a jackpot, I'm having to take some pretty large doses to get right, and am wondering about increasing the bioavailability.

The Fentanyl worked the best for general relief, although it takes a while to come on, and I know it's wickedly addictive, so I'm trying to stay away. Plus, I'm not sure of the effect of popping large amounts of stuff along with the patch. Current doses I need to correctly kill the pain (this isn't recreational levels) are 120mg of the oxycontin or oxycodone (oral), and 64mg of the hydrocodone at once. Yesterday, I did close to 200mg of the oxycodone and 80mg of the hydrocodone. I'vr always been like this, so I'm assuming I have a natural resistance to opiates. I do not want to IV use again (its been 20 years, no reason to head down that path) and I did try plugging some hydromorphone earlier today ... 24mg ... and although I felt it a bit, I didn't seem to boost the bioavailability much.

Anyway, anyone got any ideas, even outside of what I don't have? As I said, I do have a real need to address, and I can do that, but I'd also like the occasional recreational use, and I am getting tired of taking handfuls of pills to do the job.

 

[sekio]

If you're used to taking 60-100mg of methadone, you're going to need some insane doses of opioids to get the same level of relief. Methadone is one of the strongest painkilling opioids out there (its also a NMDA antagonist as well as an opioid) - and it lasts quite a while too. Anyone who's on it for extended periods of time at a high dose like that is going to drive their opioid tolerance through the roof. It's less likely that you have a "natural resistance" and more likely that years of opioid therapy have put you there.

The BA for orally administered oxycodone is pretty high. Even if you do your best to up the BA of hydromorphone and fentanyl, it's probably not going to do too much for you, because they're both rather short acing and weak compared to transdermal fentanyl taken as directed, or methadone.

The best option is to stick with the medication you feel works best and cut it down to one chronic and one breakthrough opioid. If that means getting back on methadone then that's probably what you should do. The fentanyl patches are probably going to be the closest in terms of strength.

 

[TheGrasshopper]

Tagamet (Cimetidine)
Quinine
Diphenhydramine (makes me too drowsey)

These all increase effect and durration with opiates.

 

[vintage]

Thanks for the detailed answer; I do appreciate it. The only reason I had wondered about a natural tolerance is that it was the same 25 years ago when I was doing everything for recreational use. When I did finally circle back around a couple of decades later and needed it, I was still having to do 50mg starting out to get anywhere. But I definitely know that after a few years of regular methadone use (although I cycle off of it every couple of months to try to keep out of deep physical dependence), I've driven my tolerance up. I was hoping against hope that I hadn't, of course.

Methadone does work fantastically well for me, and the length of the relief, as you pointed out, is quite long. Another great plus often overlooked is price: methadone is fairly cheap, even off a medical co-pay. The only problem I've run into here is that my new doctor isn't licensed to prescribe methadone (although he's written me scrips for almost every single other opioid you can think of). Guess it's time to get a referral to pain management and go from there.

Hydromorphone I was majorly disappointed in because of the seemingly fleeting length of it's action. Even as a breakthrough, it seems the best I can expect out of it is an hour to an hour and half, which is insane to me. Any suggestions for a good breakthrough to go with the methadone, assuming I can find someone to prescribe them to me?

 

[TheGrasshopper]

From what I have noticed, methadone is more often prescribed for opiate addiction, rather then pain management.
Maybe if you have your heart set on methadone, an addiction clinic might be able to help you there.

 

[Kid Amine]

500x10mg methadone a month is 160mg/day, which is very high. All the other stuff aint gonna do shit with that much methadone in your system. The only thing I know that potentiatets methadone is benzos, but that is a VERY BAD IDEA. You DO have a jackpot of opiates at hand, and if they dont work, I dont know what to tell ya. Try dietary changes, better sleep, surgery to fix what's wrong, exercize, maybe even a implantable pump is an option.

 

[vintage]

The only reason I ended up on Methadone in the first place was that at the time, I didn't have insurance, and my PCP knew that Methadone tablets were dirt cheap for the 10mgs. So that's what I started out on. Even then, with no other opiate use before that, I was taking 3x10mg three times daily.

Anyway, not sure why this doctor needs a special license to prescribe the Methadone and my old PCP didn't, but ... it is what it is. Have a referral to a pain specialist, so we'll see where it goes from here.

Have experimented the last few days, and it's taking around 80mg of Hydromorphone to put me at a decent level, but it's so short acting, it's almost not even worth taking them when I get up. I will probably end up ditching them since they aren't doing anything.

This morning, I tried 120mg (8x15mg) of the Oxycontin and I'm OK. Nothing spectacular. Will probably try the same amount tomorrow of Oxycodone and see where it takes me.

The last thing I'll try is the 100mg Fentanyl patches. Due to them being the strongest dose they make, I'd prefer to do those by themselves just to feel the effect, although I do know that it will take 6-12 hours before I feel the first of it.

Have an appointment with my regular PCP tomorrow and will try some morphine; I belive that's about the last thing he's mentioned at high strength that he can prescribe.

I do want to make a comment concerning the lifestyle changes: this is something I realized last year was needed. In the last 12 months, I've lost 70 lbs, and get some physical activity every day, even if it's just walking around the block. Can't change too much on the mobility side, as I work as a systems administrator (and remote at that, so I don't even get the exercise of getting out each day), but I am moving forward. Sleep is a problem, as I've always my whole life only gotten 4 hours of sleep a night unless I worked night shift, and I'm forced into days now.

Thanks for all the responses!

 

[SRLMJ23]

Any MD can prescribe Methadone, however, they have to write it for chronic pain and put that on the script. If they just write Methadone 10mg T.I.D. Quantity 90 the pharmacy will not fill it. So tell your doctor to write for chronic pain on the script. I live in New York state, so maybe it is different where you live? Good luck to you, oh and Fentanyl would be your best bet...I take 100 mcg/h for severe chronic low back pain and it works the best and I have been on just about every pain medication possible, excluding Methadone. Have a good one, and good luck again!

 

[vintage]

Well, since someone was nice enough to resurrect this after a while, I wanted to give an update as to how this worked out for me. Although I knew any doctor could write the 10mg Methadones for chronic pain, my doctor had protested so much about writing them, I thought that perhaps there was something specific in Delaware. Turns out there wasn't: he was just unreasonably prejudiced against Methadone, and refused to write it. Even after I explained that Methadone helped with not just regular pain, but also nerve pain, which was what made it so effective for me.


However, although he bristled at the mention of that horrible drug Methadone, he would write copious, *ridiculous* quantities of everything else. So, for about eight months, I ended up on 320mg of Oxycontin, plus 120mg of Oxycodone, and 64mg of Hydromorphone. Daily. Yeah ... I can function on that. And he would rather write this than the Methadone. One day, I walked in (and I'm assuming his clinic dropped the hammer on him) and he told me he couldn't write me even a single scrip more (not even a taper), referred me to pain management (3 months for an appointment with a requirement that you sign a form acknowledging that you will be prescribed nothing on your first visit), and was about to leave it at that.


Having literally 2 pills left, and knowing what the withdrawals were going to be like, I shamed him into writing me 2 weeks worth of Valium and Clonidine for the inevitible week or two of hell I was about to go through. My wife took care of me and I made it through with not too much damage. The Valium kept me asleep while the Clonidine let me sleep. When everything was over, of course, I was completely off everything, and could barely walk due to the pain.


So, realizing something had to change, I talked to my local pharmacist (a small shop), and flew back down to Texas to see my regular doctor who had been my PCP *and* Pain Management doc for years. So what I do now is go back down every 90 days, and I get three scripts for 30 days each of 10 x 10mg Methadone per day. One of them I fill immediately, while two of the scripts have "Do not fill until ____" with dates 30 and 60 days out, respectively. Those go back to my local pharmacist, who puts them on file and fills them for me on the appropriate dates. Not ideal, but it works.


Am trying to decide now on a breakthrough that will work with Methadone, but at least I've got the big part done.