Opioids Alternating Opiates to Keep Tolerance at Bay

[sola]

I have a question in regards to both tolerance build-up and the nature of tolerance.

When dealing with pain, could someone take one type of opiate, say, oxycodone, once a week, and also take another opiate, say, hydrocodone, a different time in the week and avoid building up a tolerance? Or would this be the exact same as taking oxycodone (or hydrocodone) twice in a week?

In other words, if one was going to take opiates for pain management twice a week, would there be any point in switching up which opiate was used?

All in all, I want to know if a person could use two different opiates, once a week each, and still keep tolerance almost completely at bay -- as in, one could take, say, 20mg (arbitrary dose) of each of these drugs once per week for years on end without ever having to increase the dose.

From my research, it seems that someone could theoretically take an opiate once per week indefinitely without ever gaining a tolerance -- I want to know if this is possible to do twice per week by alternating opiates.

If anyone has any knowledge about opiates acting on the different opiate receptors, that would be much appreciated as well. Does it matter if one acts on the mu receptors, and another acts on the kappa receptors?

 

[Spackeradder]

Cross tolerance would get ya -- you'd build up an opi tolerance just fine and dandy, no matter how little or how often you switched meds.

 

[Sprout]

As long as you're still hitting the opiate receptors, desensitisation and therefore tolerance will still occur.

 

[midnight11]

The majority of opiates are going to hit the same receptors, as others have said, which will just create a cross-tolerance to any drug within the same class. One thing I'd say that could help is to take a small dose of a short-acting benzodiazepine every other time you use an opiate. Reduce the opiate dose slightly if you decide to do this, and don't use too much of a benzo, but I've done this before to not just potentiate an opiate, but rather to get the same result without having to take as much of an opiate as usual.

Good luck, take care, & be safe!

 

[sola]

I was afraid of this, but what I've read agrees with the advice given. It seems that any positive effects are due to mu receptors, and not to the other receptors. All of the main opiates seem to affect the mu receptors...

So, would taking a dose two times a week really increase tolerance? Like, if someone used on Wednesday and Sunday, would they actually see an increase in tolerance? I've searched on this before, but it's tough to find anything conclusive.

Basically, I'm curious if a two-times-per-week chipping habit is sustainable without increasing tolerance.

 

[midnight11]

I was afraid of this, but what I've read agrees with the advice given. It seems that any positive effects are due to mu receptors, and not to the other receptors. All of the main opiates seem to affect the mu receptors...

So, would taking a dose two times a week really increase tolerance? Like, if someone used on Wednesday and Sunday, would they actually see an increase in tolerance? I've searched on this before, but it's tough to find anything conclusive.

Basically, I'm curious if a two-times-per-week chipping habit is sustainable without increasing tolerance.

If you can KEEP it at a two-times-per-week habit, I'd say it's sustainable. Your tolerance will go up a bit, but it shouldn't grow as if you were doing it every day. I'd be more worried about whether or not keeping it down to twice a week is sustainable, personally...

 

[Mr.Scagnattie]

An opiate tolerance is an opiate tolerance.

 

[Coolwhip]

I don't completely agree with most people in this thread, and I'm not going to go scouring for data but I imagine the literature would back me up.

Cross tolerance between opiates is not complete, even the cross tolerance between say hydrocodone and oxycodone is not 100%, and the further away you get in structure the more incomplete the cross tolerance will be.

That being said, it's not going to work anything like you hope it would. When switching between opiates the first few doses of a new opiate will probably get you more(or the same) effects, with an equipotent(or lower) dose, but your tolerance to that new opiate is going to rise VERY quickly, especially if you abuse it at all, it wouldn't be like the slow creep that people naive to opiates experience. And you wouldn't be starting anywhere near 0 with the new opiate, it would be as if your tolerance to your DOC is 100%, your tolerance to a different opiate similar in structure is going to be 85%, and after the first couple times of using it it will be more like 95% and then on to 100%.

 

[Anthrogirl]

Cross tolerance will be an issue but with only two days a week and two different drugs your tolerance will raise more slowly. There are other things you can do to keep your tolerance down also. Taking a normal dosage of DXM with your opiates (you can google it, there are a lot of studies and threads about how it can prevent tolerance), other NMDA antagonists like ketamine and memantine, ultra low dose naloxone taken with your opiates (make sure not to screw the dose up though!!), zofran with opiates has shown some promise at preventing tolerance also and there is always the option of taking a two week break from using to lower your tolerance (I know it sucks but it does help). Good luck! As a chronic pain patient, tolerance is the bane of my existence and I'm always trying to figure out a way around it.

 

[sola]

Thank you all for your help. I suppose the consensus is that a different opiate would help an individual, albeit mildly...

So what's the consensus? If someone could theoretically keep his or her dosage to twice per week, spread out by 3 days, would the tolerance be kept at bay?

I'm basically wondering what a sustainable chipping schedule would be for opiates. I know some people say "a schedule is a schedule; tolerance will grow," but this just isn't true -- if you used once a year, you would never grow a tolerance at all. So I'm wondering where that line comes in... Once a month? Twice a month? Once a week? Twice a week? etc. etc. There has to be a point at which a chipping habit is no longer sustainable due to tolerance issues.

Thanks for the info concerning drugs to keep tolerance from rising. Will definitely look into that, although I'm still curious as to if 2 times per week is doable.

And of course, maintaining twice per week is a whole 'nother animal... But I'm mainly coming at this one from a physiological perspective.

 

[Anthrogirl]

Thank you all for your help. I suppose the consensus is that a different opiate would help an individual, albeit mildly...

So what's the consensus? If someone could theoretically keep his or her dosage to twice per week, spread out by 3 days, would the tolerance be kept at bay?

I'm basically wondering what a sustainable chipping schedule would be for opiates. I know some people say "a schedule is a schedule; tolerance will grow," but this just isn't true -- if you used once a year, you would never grow a tolerance at all. So I'm wondering where that line comes in... Once a month? Twice a month? Once a week? Twice a week? etc. etc. There has to be a point at which a chipping habit is no longer sustainable due to tolerance issues.

Thanks for the info concerning drugs to keep tolerance from rising. Will definitely look into that, although I'm still curious as to if 2 times per week is doable.

And of course, maintaining twice per week is a whole 'nother animal... But I'm mainly coming at this one from a physiological perspective.

Well, I'll tell you about my recent experience. I use my prescribed opiates only on my worst pain days to try to prevent tolerance and dependence (I might be having surgery to correct my pain issue later this year so I don't want to be dependent on opiates if I don't have to be). I also always try to allow two days in between but sometimes I can only go one day in between if my pain is really bad. On the days I don't take opiates I use a prescription NSAID, lidocaine patches, Tylenol, muscle relaxers, TENS unit, ice, etc. I almost never use opiates more than three times a week. Even with this strict schedule my tolerance has risen, albeit much much more slowly than my doctor's other patients. This is why I've recently taken a two week break from all opiates to lower my tolerance as much as possible. Now that I've resumed taking my pain meds I've started taking DXM with them but I will be switching to ultra low dose naloxone soon. This will help keep my tolerance down much better than dosing only three times a week. I definitely urge you to look into the meds I mentioned in my last post. Some studies even indicate that the NMDA receptor antagonists can not only prevent tolerance but can reverse it also! I think doing some research into these might be your best bet. Obviously it's best to keep your drug usage as low as possible too though

 

[Mr.Scagnattie]

Thank you all for your help. I suppose the consensus is that a different opiate would help an individual, albeit mildly...

So what's the consensus? If someone could theoretically keep his or her dosage to twice per week, spread out by 3 days, would the tolerance be kept at bay?

I'm basically wondering what a sustainable chipping schedule would be for opiates. I know some people say "a schedule is a schedule; tolerance will grow," but this just isn't true -- if you used once a year, you would never grow a tolerance at all. So I'm wondering where that line comes in... Once a month? Twice a month? Once a week? Twice a week? etc. etc. There has to be a point at which a chipping habit is no longer sustainable due to tolerance issues.

Thanks for the info concerning drugs to keep tolerance from rising. Will definitely look into that, although I'm still curious as to if 2 times per week is doable.

And of course, maintaining twice per week is a whole 'nother animal... But I'm mainly coming at this one from a physiological perspective.

If you can keep your dosage to only a couple times a week, your tolerance won't go up much anyway..

 

[RobotRipping]

I don't completely agree with most people in this thread, and I'm not going to go scouring for data but I imagine the literature would back me up.

Cross tolerance between opiates is not complete, even the cross tolerance between say hydrocodone and oxycodone is not 100%, and the further away you get in structure the more incomplete the cross tolerance will be.

That being said, it's not going to work anything like you hope it would. When switching between opiates the first few doses of a new opiate will probably get you more(or the same) effects, with an equipotent(or lower) dose, but your tolerance to that new opiate is going to rise VERY quickly, especially if you abuse it at all, it wouldn't be like the slow creep that people naive to opiates experience. And you wouldn't be starting anywhere near 0 with the new opiate, it would be as if your tolerance to your DOC is 100%, your tolerance to a different opiate similar in structure is going to be 85%, and after the first couple times of using it it will be more like 95% and then on to 100%.

you're right in a sense but since they all hit the mu opiate receptor, it doesn't really matter. That's the one we're concerned with when getting the good effects, though they may bind differently, tolerance will still accrue no matter how you go about it. Perhaps more slowly if you were switching between oxycodone and codeine but i have no source on that, just a guess. So if you're a hydromorphone addict, you may switch to an equiv dosage of oxycodone and appreciate its different effects but regardless, you'll still have a big tolerance from the hydromorphone.

 

[Anthrogirl]

Yeah, cross tolerance exists with opiates. However, I can assure you though that cross tolerance is not complete. Switching opiates around is something that pain management doctors do frequently when a patient's tolerance to their original medication has risen to a certain amount (whatever amount is judged "high" by the doctor usually in my experience). It's usually pretty effective to switch to a different med for awhile.