Opioids Why does opiate tolerance never completely disappear?

[ATLL765]

Searched a bit to see if this was covered anywhere and didn't see it. This has always been something that I've been curious about. Why is it that tolerance, specifically to opiates, never return to the point where it was when you were opiate naive?

When I first started using, I could use for a few days, stop and it was no problem, but now if I use for even 2 days, I'll feel like crap for a few days following my use. Obviously it's not as intense as it is when using every day for weeks or months, but it's enough to make me quite uncomfortable. I've heard very similar stories from other people as well.

So I'm really interested in why this occurs. How could using a substance for only a day or two cause the body to have such issues returning to normal?

 

[XANAX XR]

Searched a bit to see if this was covered anywhere and didn't see it. This has always been something that I've been curious about. Why is it that tolerance, specifically to opiates, never return to the point where it was when you were opiate naive?

When I first started using, I could use for a few days, stop and it was no problem, but now if I use for even 2 days, I'll feel like crap for a few days following my use. Obviously it's not as intense as it is when using every day for weeks or months, but it's enough to make me quite uncomfortable. I've heard very similar stories from other people as well.

So I'm really interested in why this occurs. How could using a substance for only a day or two cause the body to have such issues returning to normal?

I am not sure but benzos are the same way (receptors are permanently 'used to it' rather than damaged?)... Whenever some trick scientist finds a chemical that truly reverses this without adverse effects, it'll be a dream.

 

[FEDOR85]

Same thing happens with me on the rare occasions I use heroin these days. I always get the runny nose, sneezing, yawning, lethargy after using only a small bag. Its sucks cos I cant even chip anymore without paying a price. I think the answer to op question is that after years of using our opiate receptors are fucked

 

[NoComply]

So, I am not a doctor and have no sources to back this up, but I do have a theory.

When we relapse to using opiates, even if its only a day or two, our tolerances' are down, but never all the way down, because we have possibly created more opiate receptor sites in our brain (I don't know how that process works), therefore we use a more, and we get higher than we did when we started; maybe we don't "feel" higher but there is more respiratory depression etc...

I think that we use more H in our relapse than we used when we started because we do have a higher tolerance, it doesn't last as long as it did when we started, and we try and maintain that high by using as soon as, or before, the high wears off. I will use a little to see how strong it is, then I will use the maximum I think I can and continue to use this does until I am out. I am sure not everyone is like me, but I would amagine that most do use much more.

That first shot where I am seeing how strong it is, well, back when I started, I would have been fine with only using that amount and not used more until that had worn off.

I think that if we actually used the exact same way we used when we started, when we could go week of using without withdrawal, then a two day binge wouldn't bring on withdrawal. I do think that it would come on sooner than when we started but not after one short binge. It just is very hard for an opiate addict to use the way he or she did. We tend to use in a similar fashion as to our last run.

I also imagine a lot does have to do with changes in brain chemistry and our opiate receptors, but that is something I don't know enough about to speculate. These brain changes affect the way we relapse and affect the way we use when we do relapse.

Again I would like to make it clear that all I have stated is speculation and just a theory. I have gatered this information based on my own habbits of using and observing those using around me.

One more example is the morning shot. When I started I never saved any for the morning, but now if I relapse I do. I know how good it fees to shoot up first thing in the morning so I make sure I save some for that. The changes in our brain plus our using behavior patterns being that of an addict, not a first time user, I believe to be the reason we get withdrawal so much sooner than when we started. If we used like when we started but still had the changed in brain chemistry, maybe it wouldn't be the "3 days of dope and you're sick", it might be more like one week of dope then you're sick. I do believe the constant using around the clock gets us addicted much quicker, but I can't imagine only using a little bit at random times in the evening and skipping a day, that is if I do relapse, I am always right back where I started, even if it is only one day.

I do wonder that if someone where to start using Heroin, but only did it once a day in the evening after work, how long would it be until they got sick?

 

[ATLL765]

Usually 2 weeks is the amount of time that the medical community would say you'd need to use opiates at therapeutic doses in order to become dependent.

Obviously users of heroin like us don't stop at therapeutic doses. That being said, I usually try to stretch my supply out as long as possible, because for me it's more about the stability it gives me mentally rather than just chasing the high. What I'm saying is that when I use, I don't go balls to the wall shooting up 10 times a day. At most I'll do 4, MAYBE 5 shots in a day, but I have managed to do just 2 or 3 in a day. No matter which it is, after 2 days, I'll be sick. It's a guarantee. Even if I only use a bun over 24 hours. I'm gonna feel some sort of withdrawal symptoms.

I just don't get how that's possible. I went two years without using then used for a couple days and bam, felt like crap. How is it that my body was fine before that, then I used heroin for a very brief period of time and it would then be so out of whack once I cease using? It's baffling to me, but it's definitely something that occurs in those who have been previously exposed to high doses of opiates or were exposed for long periods of time.

 

[Non Nobis Solum]

Everyone is different but for me, it does disintegrate over months and months.

 

[buttershots21]

My best educated guess is twofold: that from the very first dose a person takes, we make new opiate receptors, so that each time you take a dose, there will always be a few more receptors to fill than the last time and you will never be at that "Ground Zero" receptor wise. Have to take more to fill the new as well as all of the old. If you quit taking opiates, all of those receptors don't die off, they are there to stay forever. The second part of this is that our bodies are great at getting rid of "toxins" and our bodies see opiates as a sort of toxin. The more and longer you take opiates, the more efficient your body and liver in particular gets in breaking it down and getting rid of it. I think this is the key to the brief "drop" in tolerance you get when you take a break. The first dose or two, your body has to "relearn" it's elimination process, but like with muscle memory, it doesn't take nearly as long for it to get back into the swing of things and jump back up to that super efficient elimination process. Just my theory!

 

[《Plasticity》]

I have no idea, but mine went pretty close (if not) to square one after a 2-3 year break. Benzos and dissociatives are notoriously bad for semi-permafucking tolerance though... far worse than opies.

 

[ATLL765]

I'm a bit surprised that there isn't anyone bringing up actual scientific research on this. I've always been fascinated by this process and wondered what the science behind it is.

Like was mentioned, tolerance definitely does dissipate over time. After having had two years clean, I didn't need to use 3 bags at a time to get high, but it was an extremely short period of time before I did need to use doses that were identical to what I used at the height of my addiction.

Maybe it is like the last poster said in that you never forget how to ride a bike, just gotta shake off the rust.

 

[《Plasticity》]

What I'm more interested in, which is probably related, is why dependence will still come on very fast in a heavy ex user who has been clean from opioids for years. It's like your receptors are a rape victim who never forget what you did to them, and reminding them sets them off with a vengeance lol.

 

[Bliss26]

AFAIK it's the same with drinking and smoking. Once you quit, and restart it's no time before you're back to a quart of vodka and 2 pack a day habit.
The short answer is, I don't know. Lol

 

[《Plasticity》]

No, for example, it took me almost a month of daily use for my first dependence....layed off opies for a long ass time and what do you know, 3 days use with the same dose and I'm back in withdrawal! It gets worse though, nowadays I can quit for months and two uses puts me back in withdrawal. It's not fair .

 

[shoo-bop]

Tolerance is partly governed by contextual conditioning, and other aspects of Pavlovian conditioning: When you use a drug, your mind and body learn the association between that drug and the things around (e.g. location, people, drug paraphernalia, feelings you have, etc.), so that next time you're exposed to that context (or at least something similar enough to activate the memory) your body can say "oh, I'm in this situation again, so I might be getting that drug again, better prepare myself by making myself more tolerant (e.g. downregulating receptors, etc.)".

The other part of tolerance is just a short-term adaptation of your body to the drug itself: when the drug is out of your body, that "short-term" component of tolerance dissipates rapidly. But the contextual conditioned component of the tolerance remains, and can be to be reinstated when you're re-exposed to something resembling a previous drug-using context. That conditioning may never be fully forgotten.

This is why people are more likely to overdose when using in an unfamiliar context (where their body didn't think to prepare itself for the drug), and also why mild withdrawal symptoms can be triggered in some people by exposure to drug-related cues even when there's no reason they should be in withdrawal at that point. This may also be at least part of the reason why tolerance is regained so quickly: The drug use, and feelings associated with it, are part of that context that your body has learned to respond to with tolerance in the past, so when you start using the drug again, it re-awakens that learned tolerance that may have lain dormant for a long time, even only after a brief period of use.

 

[ATLL765]

Tolerance is partly governed by contextual conditioning, and other aspects of Pavlovian conditioning: When you use a drug, your mind and body learn the association between that drug and the things around (e.g. location, people, drug paraphernalia, feelings you have, etc.), so that next time you're exposed to that context (or at least something similar enough to activate the memory) your body can say "oh, I'm in this situation again, so I might be getting that drug again, better prepare myself by making myself more tolerant (e.g. downregulating receptors, etc.)".

The other part of tolerance is just a short-term adaptation of your body to the drug itself: when the drug is out of your body, that "short-term" component of tolerance dissipates rapidly. But the contextual conditioned component of the tolerance remains, and can be to be reinstated when you're re-exposed to something resembling a previous drug-using context. That conditioning may never be fully forgotten.

This is why people are more likely to overdose when using in an unfamiliar context (where their body didn't think to prepare itself for the drug), and also why mild withdrawal symptoms can be triggered in some people by exposure to drug-related cues even when there's no reason they should be in withdrawal at that point. This may also be at least part of the reason why tolerance is regained so quickly: The drug use, and feelings associated with it, are part of that context that your body has learned to respond to with tolerance in the past, so when you start using the drug again, it re-awakens that learned tolerance that may have lain dormant for a long time, even only after a brief period of use.

I've read that you will have lower tolerance when using a drug in an unfamiliar context/environment, but I don't think that alone covers what I'm describing.

I abstained from all use of opiates for 25 months. I used at that point and by day two I'm already back at my normal dose from 2 years ago. How does that happen? It's literally like my tolerance never went away at all.

 

[shoo-bop]

What I'm suggesting is that when you resume using, you partially "recreate" the context which you've previously learned to associate with drug use, e.g. the presence of drug paraphernalia, the feelings associated with drug use, certian ways you act or things you tend to do when using drugs, etc. Your mind and body recognise that your back in something conceptually resembling a "drug-using context", and this re-awakens the learned tolerance you may have established years beforehand.

Classical conditioning can create memories and associations that last a lifetime, and even though they may lie dormant when there aren't cues activating them, that doesn't mean they can't be fully re-activated a long time down the track. Your body's tolerance response is partly a learned memory about how to function with drugs in the system.

 

[ATLL765]

Right, but it can't account for all of one's tolerance, so how is it that in such a short time that tolerance previous gained and lost, is regained? It can't just be the contextual cues that your mind picks up on that would explain all of the tolerance being regained almost immediately.

 

[Kid Amine]

Usually 2 weeks is the amount of time that the medical community would say you'd need to use opiates at therapeutic doses in order to become dependent.

Obviously users of heroin like us don't stop at therapeutic doses. That being said, I usually try to stretch my supply out as long as possible, because for me it's more about the stability it gives me mentally rather than just chasing the high. What I'm saying is that when I use, I don't go balls to the wall shooting up 10 times a day. At most I'll do 4, MAYBE 5 shots in a day, but I have managed to do just 2 or 3 in a day. No matter which it is, after 2 days, I'll be sick. It's a guarantee. Even if I only use a bun over 24 hours. I'm gonna feel some sort of withdrawal symptoms.

I just don't get how that's possible. I went two years without using then used for a couple days and bam, felt like crap. How is it that my body was fine before that, then I used heroin for a very brief period of time and it would then be so out of whack once I cease using? It's baffling to me, but it's definitely something that occurs in those who have been previously exposed to high doses of opiates or were exposed for long periods of time.

Bolded part is why. That's a lot of H.

I know with myself that WD symptoms are mentally magnified just because I know what's coming, and I sometimes psyche myself up and out about it. The times I just accept Im gonna go into WD seem to be a hell of a lot milder

Dependence and addiction are two different things. Once I broke my addiction and physical dependence, when I went back and did 3 bags some 8 months later, I ODd. 8 months prior, 3 bags would have been a high-ish but normal shot.

and no, you never get a true zero reset... iow, once you go to something like H, hydrocodone will not work for you. Then again, when I started some 20+ years ago, 2 Vicodin HP (10mg hydro) and a few beers gave me a mild buzz. Maybe if I didnt use for 20 years I could feel that again...

 

[ATLL765]

Bolded part is why. That's a lot of H.

I know with myself that WD symptoms are mentally magnified just because I know what's coming, and I sometimes psyche myself up and out about it. The times I just accept Im gonna go into WD seem to be a hell of a lot milder

Dependence and addiction are two different things. Once I broke my addiction and physical dependence, when I went back and did 3 bags some 8 months later, I ODd. 8 months prior, 3 bags would have been a high-ish but normal shot.

and no, you never get a true zero reset... iow, once you go to something like H, hydrocodone will not work for you. Then again, when I started some 20+ years ago, 2 Vicodin HP (10mg hydro) and a few beers gave me a mild buzz. Maybe if I didnt use for 20 years I could feel that again...

If that's a lot, you must know some weak ass junkies, lol. No offense, but I need a minimum of 2 shots per day to avoid withdrawal symptoms and even at 2 per day, I'll be sick before I get high. 3 is what is needed to avoid any feelings of withdrawal. 4-5 is what I do if I have enough dope to not care about saving any. Even at 4-5 shots per day, I'm at most talking about 2 buns of ECP from good 'ol Brick city, but the average day is more like 12-14 bags. That's nothing to sneeze at, but it isn't what I'd call "a lot".

 

[shoo-bop]

Right, but it can't account for all of one's tolerance, so how is it that in such a short time that tolerance previous gained and lost, is regained? It can't just be the contextual cues that your mind picks up on that would explain all of the tolerance being regained almost immediately.

Why not?

OK, I suspect conditioning wouldn't account for all of one's tolerance, but it could account for quite a considerable proportion. It's quite reasonable to assume that a very strong association between "drug use" and "more drug use" could be built up if one has had a pattern of use that involves a lot of redosing (i.e. using multiple times per day for many many days in a row). In that situation, it seems quite probable that your body could learn a strong association that "It's often the case that drugs are followed by more drugs several hours later", so that when you next use drugs (even years later), your body goes "oh, I just got drugs! I remember what that means: that must mean that more drugs are on their way! Better prepare myself!"

Conditioned reactions are typically rapid, and can be quite strong. There wouldn't be an evolutionary purpose for them otherwise. For example, the conditioned reactions that help you find food or avoid danger have to be able to be switched on within seconds. Imagine you're a hunter-gatherer in the stone age, and your looking for food to survive. You smell something that has been associated with food in the past. That cue should almost immediately make you to feel hungry and motivated to look more carefully for food in that location. It's pretty useless if your mind and body take several days to tell you "that smell meant there was probably food nearby!". Similarly, if you saw a friend killed by a sabre-tooth tiger years before, and you suddenly encounter another one, you don't have to sit there looking at it for days or weeks before you feel afraid. You'd feel a very intense fear very quickly.

Tolerance is also a reaction designed to improve your chances of survival and reproduction. To have the best chances of being able to live and reproduce, you need to breathe, be sufficiently sensitive to pain to avoid harmful things, and be sensitive enough to pleasure to distinguish between different levels of pleasure so you choose the "best" food, sex, etc. Opioids push the settings of these systems outside their normal range of functioning, by reducing your ability to breathe and feel pain, and maxing out your pleasure system. Tolerance is your body trying to reset these systems so they can still function normally while the opioids are in you. So there's no reason why conditioned tolerance shouldn't be able to be reactivated quickly when your body senses that you're likely to use more drugs soon, nor any reason why that conditioned tolerance shouldn't be quite substantial if there has been a need in the past for your tolerance to have been very high in similar situations.

Several times, I have seen people suddenly show mild withdrawal symptoms simply from looking at pictures of needles, even though there was no other physiological reason for them to be in withdrawal (i.e. they had enough opioids in their system).

 

[black kat]

Posters saying tolerance never goes back to reset are absolutely right.

After months without H(and opiates in general),i do codeine with a non-addicted/recreational user friend.Codeine never did much for me(despite having them in pure-codeine pill form) but after so much time i figure ill get a buzz or something lol.
Well,friend starts getting all fuzzy and warm,we pop a benzo(flunitrazepam) and he starts nodding and stuff,i literally felt nothing except some anxiety relief maybe(so zero effects on my body,minimal effects on mood).

Then i proceed to do some H and what do you know,after second day of using i wake up sweating,chills all over,runny nose etc and craving like a mofo.

Thats opiates-easier to get addicted each time,and harder to quit.