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Opioids Is this safe..................???

^^^ Good post Mr. Happy! Good explanation and advice!

Are you safe? .... Don't take more than you 'need'. No reason to get too crazy with it. (advice I personally need to adhere to currently)

Good advice however! =D

Sounds like the recommended 4,000mg maximum per day to avoid liver damage is a lie

I personally think its bullshit.... Who came up with the 4000mg sweet number? Maybe it really is 4g to hurt your liver but I honestly think your body builds a tolerance to apap.... Why wouldn't it? Hit your thumb with a hammer then do it again and again! After a while you can take more and more pain sooo in my thinking since I started at 4 pills 5/500's and worked my way up to 8 5/500s and then started taking them more frequently and beating on my liver witch is strengthening my shit so maybe my personal number is 15g of apap is safe?? Huh think of that one??!!!

This logic is terribly (possibly dangerously) flawed! As Mr. Happy has said, the way you've tried to quantify pain (which is extremely difficult regardless, even in clinical, controlled settings) doesn't work unfortunately. Also comparing it with internal damage (or organs) - the body/pain reflex don't work like that! The body has multiple sensory (afferent) pathways and types of pain (eg, nociceptive of the "normal" pain people think of, neuropathic, phantom, idiopathic, etc), not all are of the same kind and not all are located everywhere!

A simple example; the only "pain sensors" the intestines have are to sense/communicate over/hyper (dys)tension - no sharp pain, nor for heat/burning!

The 4,000mg dose as an upper, maximum daily limit wouldn't have been pull out of thin air! Clinical trials (predominately on rats one would think! lol), LFTs (Liver Function Tests) and the like would have been used to find this dose. Having said this, this amount is not in any sense a strict dosing! There is still bio-variability between one another which might reduce/raise this level, any liver impairment one might have greater affects metabolism/absorption of drugs, and limits such as LD/TD/ED50%'s are extremely non-specific (and often take with a pinch of salt by health professionals - much like BMI in fact! It's an ok measurement to roughly consider when dosing but I wouldn't place my health on it imo! -_- )

Also, tolerance does not build with paracetamol/APAP! If you were to look at it's basic MOA, the metabolic pathway isn't really conducive to the body building a tolerance! (that's not to say it's not unhealthy to take it every day!) I have heard this argument before and my thoughts are I believe the "reduction" in efficacy is in fact psychological - one becomes accustomed to the effects and convinces themselves that - they've been having chronic pain for quite a while, it's not letting up, so I must have to increase my dose! When in reality it's more than likely said pain is not only chronic but server enough that stronger analgesics may possible in need of use?!
 
....Now 70mg of Hydrocodone for a intolerant user (if the doses were gonna overlap) would probably be quite a bit too much, although I don't know if it is OD territory at all, it would probably make an intolerant user feel quite uncomfortable and nauseous....

An OD dose (for an individual) is quite difficult to even suggest at (hence why drugs can be dangerous :) ) - bio-variability and all! (I generally stay clear of suggesting a dose, don't particularly want to be responsible for someone's OD/bad experience, even if it's from an anonymous person off a forum :! =D)

....And back to the debate about how much apap is "safe" at once, it's really one of those things that will never be able to be precisely defined. I mean, I'm sure an LD50 has been established, but those really don't tell you anything about a drugs safety with concern to repetitive low doses....One is that even highly skilled, knowledgeable and highly trained doctors can only estimate, there is no definitive answer to these type of questions and a big part of that is thing two.....That being said, I think the 3-4g a day number is probably pretty conservative on the part of the CDC or whoever the fuck set the standard....

A good phrase to remember (often one of the first things I say when educating friends and that) is that all drugs are poisons, what matters is the dose!. Regardless on it's schedule, if it's OTC, from the supermarket or from a garden, all medications/drugs (chemicals) will have negative side effects (read: a side-effect profile)! If you're putting something in one's body, I think you should have (at least) a basic level of knowledge (possibly MOA, the general [contra/]indications, side effects and/or other drug interactions) of the drug! I think many "accidental" OD/events could be prevented doing this.

Albeit an extremely, lengthy, thorough educated guess, the dx/tx provided by health care professionals (GPs, mental health professionals [physiologist, -chiatrists, councillors], chemists) are just that, a guess! An important consequence of this being that human - by nature - make mistakes! Which obviously can cause issues being a main reason there are so many procedures/protocols (a health care professional can't be persecuted if the defined protocols are strictly followed, and something goes bad [eg, death or disability, etc]!), insurance, review boards, safety-net and such! Science still only gets us so far! :)

Finally, LD/TD/ED50%'s aren't standardised by any body! Research, clinical trails, and tests are used to produce general dosages for each indication (of that drug) however there doesn't exist a specific "dosing organisation" (of such) =D
 
An OD dose (for an individual) is quite difficult to even suggest at (hence why drugs can be dangerous :) ) - bio-variability and all! (I generally stay clear of suggesting a dose, don't particularly want to be responsible for someone's OD/bad experience, even if it's from an anonymous person off a forum :! =D)

I wasn't intending to imply that 70mg is what I think of as an OD dose, he just said it was his second 35mg dose of the day, so I added those together for 70mg and that is where I got that number. Not my suggestion, it's what he took. And obviously 70mg for a opioid naive person is, well, let's just say "not a beginner" dose.
 
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