Opiate & Narcotic Tolerance Progression

[LostCheshireCat]

Hey all!

As a chronic pain patient, I was wondering--to those of you whose drugs of choice are opiates, do you remember when your usage started & compare it to where it is now? I was thinking about it the other day, and about 4 5/500 percocets (or 6-7 lortab/vics) would keep me smiling through the worst of days. That was almost 4 years ago. When I knew my treatment would be long term, I wanted the acetomenophin cut out to prolong my liver. So 30mg oxycontin would get me through the day after about 1.5 years. Then, about 9 months ago, I found a doctor that would give me what I wanted: 6 10mg Opana/Oxymorphone per day (insufflated for bioavailability increase, but he didn't know.) That worked for a few months till I found myself running out early. Then we added another 60mg Opana ER/day. Those were still snort-able, but still ran out early.

Recently, I've changed it to 40mg Opana IR, and 190mg Oxycodone/day. It seems that the WD's aren't as horrid with Oxy as with Opana, but I still run out early because my pain is still highly, physically active, so I run out.. Of everything! Is it just me, or is this approaching levels of ridiculousness since I'm not even 30? I hate to think of my doses in 10 years. Any ideas to lower tolerance or anything like that? Also, anyone else's tolerance seem to rocket out of control all of a sudden, without warning like that?

Thanks!

 

[qwe]

it's hard to lower tolerance, it's a very long term process. it will probably involve a lot of pain.

ways of reducing the accumulation of tolerance over time (but these do not lower it, only slow the rate of increase)
* ultra low naltrexone dose (eg a microgram)
* dextromethorphan, or another NMDA antagonist if you can get one (eg ketamine) in low doses

ways of potentiating opiates, they will be stronger wherever your tolerance is
* antihistamines (particularly hydroxyzine iirc? )
* possibly cannabis, depending on your state of mind and the source of pain
* possibly muscle relaxants like soma/carisprodol
* possibly gabapentin (prescribed for neuropathic pain, often added onto pain management stacks)

very strong potentiation method: note, this will increase the amount of the drug in your bloodstream, effectively making it so you double your doctor's dose without him knowing... not advised. cimetidine/tagamet, an OTC acid reducer, can potentiate opiates.

note that potentiating opiates by using tagamet (which blocks the metabolism of opiates into smaller products in the liver) does nothing to tolerance... tolerance is actually worse because more of the drug is in the brain... tagamet is basically equivalent to increasing the dose, and is only necessary if your doctor refuses adequate pain treatment and there are no other options.

 

[tokenname]

it's hard to lower tolerance, it's a very long term process. it will probably involve a lot of pain.

ways of reducing the accumulation of tolerance over time (but these do not lower it, only slow the rate of increase)
* ultra low naltrexone dose (eg a microgram)
* dextromethorphan, or another NMDA antagonist if you can get one (eg ketamine) in low doses

ways of potentiating opiates, they will be stronger wherever your tolerance is
* antihistamines (particularly hydroxyzine iirc? )
* possibly cannabis, depending on your state of mind and the source of pain
* possibly muscle relaxants like soma/carisprodol
* possibly gabapentin (prescribed for neuropathic pain, often added onto pain management stacks)

very strong potentiation method: note, this will increase the amount of the drug in your bloodstream, effectively making it so you double your doctor's dose without him knowing... not advised. cimetidine/tagamet, an OTC acid reducer, can potentiate opiates.

note that potentiating opiates by using tagamet (which blocks the metabolism of opiates into smaller products in the liver) does nothing to tolerance... tolerance is actually worse because more of the drug is in the brain... tagamet is basically equivalent to increasing the dose, and is only necessary if your doctor refuses adequate pain treatment and there are no other options.

+1..great post..

my story is the opposite..
i started out dumb as a rock..crazy doses when i was a teenager..
before i even knew what w/d was..but holy hell did i find out.

now..a little of this ... a little of that..once in awhile..
and i'm good.

i'm happy that monkey's not on my back..
but know he's still around following me.

~token

 

[LostCheshireCat]

it's hard to lower tolerance, it's a very long term process. it will probably involve a lot of pain.

ways of reducing the accumulation of tolerance over time (but these do not lower it, only slow the rate of increase)
* ultra low naltrexone dose (eg a microgram)
* dextromethorphan, or another NMDA antagonist if you can get one (eg ketamine) in low doses

ways of potentiating opiates, they will be stronger wherever your tolerance is
* antihistamines (particularly hydroxyzine iirc? )
* possibly cannabis, depending on your state of mind and the source of pain
* possibly muscle relaxants like soma/carisprodol
* possibly gabapentin (prescribed for neuropathic pain, often added onto pain management stacks)

very strong potentiation method: note, this will increase the amount of the drug in your bloodstream, effectively making it so you double your doctor's dose without him knowing... not advised. cimetidine/tagamet, an OTC acid reducer, can potentiate opiates.

note that potentiating opiates by using tagamet (which blocks the metabolism of opiates into smaller products in the liver) does nothing to tolerance... tolerance is actually worse because more of the drug is in the brain... tagamet is basically equivalent to increasing the dose, and is only necessary if your doctor refuses adequate pain treatment and there are no other options.

Wow, great post, QWE. Sounds complicated a bit--and a high time-requirement, but sounds very viable. I usually take a swig of Delsym, which has like 30mg DXM per 5ml--which is higher than I could find in anything else. I'd usually estimate taking about 60mg of DXM pre narcotic dosing, but I never knew how long to wait. Usually about the time it would take to drink & prep a few Opana for IV. At this point, before weaning off, I would IV 4-5 10mg Opanas at once without getting much more than a buzz like 20mg Percocet would give me 3 years ago. From what I understand about Opana, oral bioavailability=10%, insufflated=40-50% and IV=100%. 5 Opanas at once would kill any opioid-naive person, most frequent users of intermediate narcotics like oxy & MS Contin or Morphine sulfate, and even some folks that use harder stuff like Opana or Hydromorphone. Does that sound like a bit of a ridiculous tolerance for someone who's only been usinsg narcotics for less than 4 years?

I'm thinking about taking a total break from all narcotics for a while & seeing how well & how long I can tolerate the pain. I figure I'll still get the scripts filled & keep them, just gonna try not to use at all. I feel like my body & opioid receptors just need to cleanse out & do a "reset," more or less. I'm shooting for staying clean for at least a month, and I'd imagine that should give it time for my body/receptors to go back down to a "normal" level lol

+1..great post..

my story is the opposite..
i started out dumb as a rock..crazy doses when i was a teenager..
before i even knew what w/d was..but holy hell did i find out.

now..a little of this ... a little of that..once in awhile..
and i'm good.

i'm happy that monkey's not on my back..
but know he's still around following me.

~token

Tokenname--

I'm thinking that's how I'm gonna go about things after I complete my "receptor reset," I think that's how I'm gonna do things...not trying to stay high every waking moment, just a good dose every other day or so. Man, the Opana monkey is a bitch when you run out & he's done riding until the next refill lol. I was supposed to get 2,520mg of Oxycodone HCL 30mg's yesterday, and another 560mg of the 10's, but my doc was "too busy" or some shit to fill them. So fortunately I weaned pretty well in anticipation of something like that happening. Normally my WD's last 3 days exactly, the 1st 2 days are hellish aches, chills & exhaustion, the 3rd is pretty much just feeling drained. This time, I had a major back flare-up episode, so I hurt like hell, but no feverish/chills..Think it's been about 3 days since I've eaten anything significant though I'm feeling alright lol.

Anyways, how does my "receptor reset" plan sound? Sensible? Stupid? Any suggestions? Thanks for the input!

--LostCheshireCat

 

[Swimmingdancer]

Anyways, how does my "receptor reset" plan sound?

Anything to try to lower your intake is a good idea, but sadly there is no such thing as resetting your receptors. Even going without opioids completely for a significant period of time will not reset them to where they were before you ever began taking opioids. When a person develops a tolerance to opioids, they opioid receptors decrease in number and become less sensitive, and changes occur in certain hormones in the body (like CCK). There is some evidence that some level of all these changes can be long lasting, or possibly even irreversible in some people. And once you have developed a tolerance, you will develop a tolerance much more rapidly when you use opioids in the future. Studies have shown that someone resuming opioid use (both intermittent and constant) after a period without will rapidly develop a tolerance after just 2 days of using them (it's not entirely clear if this is because the receptors retain some kind of memory or the metabolism has changed, or both).

But this doesn't mean it is hopeless, just that a complete "reset" is not possible. There are definitely things you can do to help with tolerance, such as switching to a different drug or rotating between drugs, using things that slow the build-up of tolerance, and using things that increase the metabolism, effects or absorption of the drug. I find even taking magnesium supplements is noticeably helpful.

I wish you the best of luck, I know how much this sucks.

 

[Brian242]

I am kind of in the same boat. I just turned 18 not a month ago and I take 180 Norco 10-325's and 90 Carisoprodol. The Hydrocodone is normally gone in the first week by <snip>. I take the other 80 so quickly and the soma, I fucking love. My last script only lasted about 9 days.

 

[Beachcat]

OP, I found my self very much in the same boat as you. For years, I got Percocet 10/325 quantity 45. It seems so long ago. Then, I hurt my back pretty badly and my doctor said, let's try this new drug opana. Ha! That was it for me. My opana use was large, soon I was snorting them because it worked better than orally, soon I would wake up in the morning in withdrawal, and would have to rush to get a large amount of opana in me and shake and sweat until it kicked in.

I blew through a large script in a matter of days, went to my doc and said that I could no longer take this medication, that I flushed it down the toilet and needed something else. So then I started with the Roxis. 30 mg oxy will always be my DOC. I got 180 of them, but was running out early. One month I went into severe withdraw and had to go to the ER. My doc (who was a family practice PA btw) said this was a sign that they were not controlling my pain and added ms Contin 30 mg. next month I went up to ms Contin 60 mg twice a day. I found that the ms Contin did help my baseline pain and when I ran out of oxy, they kept me well until my next script.

Now, I am transitioning off things because I am relatively young and my new doc who cut actually knows what he is doing made me see that my "habit" was not sustainable. With much pain and suffering, I am down to 15 mgs ms Contin twice a day and 10 mg oxy quantity 60. Soon, I will jump off the morphine completely and just retain my small script for low dose oxy.

In my opinion, opana is a terrible drug. I only took it in its original easily abuse able form. So many people got messed up by this drug. It ratchets your tolerance into the strtosphere, and as swimmingdancer said, it will never be the same again.

Good luck to you in your journey. I don't know what your exact situation is, but many of us have been through it and are here if you need us!

 

[Missybee]

Hello LostCheshureCat,,, Man do i feel you and everything your going through. I'm an ex police officer and was inured on duty by another idiot officer who tackled me from behind during an arrest. Long story short it ended my career , I blew out my back, both knees, both hands , and right shoulder. I was literally bed ridden and had to walk with a cane at 28 years old!! I lost everything. Being that it was a work comp case I had to fight the city for 7 years !!!! During that time I was put on what started out as Norco , and worked up to Morphine, Soma, and Percocet !!! I noticed that my tolerance quickly got more and more tolerable. Meaning I needed more and more. I did the whole "pill count"" running out too soon. And the whole 9 yards. I finally got my private insurance to do my back surgery in 2015. It took a year for me to feel a difference. I ended up being on all this crap for 13 years !!!! And I didn't even realize it was that long. Recently in had another surgery , long story short the doctors were fighting over who would refill my meds. I had not gone tbrough them to v soon, it was just that no-one wanted to take responsibility for the refill. Long story short it put me into withdraw at home... yes it v was AWFUL. ,,, BUT IT WAS A BLESSING IN disguise!!! During the withdrawal I realized my pain was manageable.. yes I felt like I was going crazy,, throwing up,, chills,, anxiety,,, everything !!! But I said I'm just going to do this.! I'm 23 days clean now., I will not lie at day 10 for some reason my anxiety got so bad I had to go to the doctor. He gave me Clonidine, and valuim.. just a five day dose.. I'm still experiencing the withdrawal symptoms every day but it's getting better. In don't know what your situation is but you should really consider looking into maybe natural alternatives, or other options.. if I knew what the medication was going to do to me in the long run I would have ran like Hello! It ruined my life,, I settled my case and won the city.. I'm stable now and teying to fight this every day. Realize the longer your on these meds the mire your tolerance will build, and the more damage it will do to your body. I'm sorry this was so long. Hope I didn't bore you to bad... DONT GIVE UP,, I wish you the best !

 

[Chronicpain54]

I wonder what the percentage of people who actually take their medicine correctly every month would be? You would have to interview tens of thousands of chronic pain patients to get an idea of what is going on. I've been in pain management for many many years and the only time I ever struggled was when my doctor put me on15mg MS Contin and 10 mg morphine IR for the Breakthrough pain. They did not work at all, caused me massive anxiety and I went through my entire month's script in two weeks. I've been on Norcos, Percocet, oxy IRS, methadone, fentanyl, Opana, and morphine. Oh, and dilaudid.

I currently take 30 mg of methadone a day for my long-acting medicine and I'm prescribed 15 mg Oxy IR and Norcos for breakthrough pain. I get 100 of each of my breakthrough meds a month, plus I'm on 2 mg of Klonopin a day and I take 600 mg of gralise at night after I eat dinner.

I have pretty much been on the same routine for almost 8 years. The only change is that my doctor lowered my methadone from 50 mgs a day to 30 mgs a day and he lowered my oxy IRs and Norcos from 150 a month to 100 a month of each script. I have no problem with my prescriptions and I never run out early and I always have a good bit to put back.

My doctor is old and I expect him to retire soon so I'm currently trying to put back as much as I can because I know that no other doctor, at least in this area, will prescribe anything near to what I'm currently getting.

After I moved to the Deep South and had to go to a doctor for something and I had to list out the medicines I'm currently on he was horrified. In the last two years I've had to go to three different doctors for minor things and I've given up even telling them exactly what I take because they all freak out. I don't discuss my medicines unless they are trying to prescribe something. If I'm there for an x-ray or an MRI I just tell them I'm on 30 mg of methadone a day and leave it at that. They still have this look of horror when I say 30 mg of methadone, which always makes me laugh. They obviously have no idea how methadone works and how you don't actually feel it. They look at me like I must be crazy high at the moment lol.

So to the OP, it's purely my opinion when I say that you are accelerating extremely quickly and possibly finding a long acting opiate medicine that truly works is the first step. Then you can rotate your breakthrough medicine to try to slow down tolerance.

Good luck, and definitely get that tolerance down if you'll need these meds forever. Don't chase a high, it doesn't happen anymore.

 

[Chronicpain54]

LostCheshireCat, you can get 30 mgs of DXM in Robitussin maximum strength nighttime cough DM. I stopped taking Delsym because it's time released so it helps a cough but that's about it unless you drink The bottle.

The Robitussin has 650 mgs of Tylenol but I'm fine with that because I take very little Tylenol and I don't take 3 or 4 doses of Robitussin at once. I take it morning, noon and night because I'm sick but I'll keep some around when I feel better to help potentiate my pain meds.

My Gralise is time released gabapentin so it helps potentiate my pain medicine also.

 

[TheProfessor2112]

Speaking from personal experience, my tolerance rose quite rapidly at quite a rate..

I?ll never forget the first opiate experience I ever had, about a half bag of china white H injected directly into my left arm vein. It was the most intense rush from H I?ve even experienced. It seems that first shot jacked up my tolerance right off the bat. H has always been great but never to that level. I didn?t get heavy into it for a few months. The only rush that surpassed the first one I had on H was the first time I injected an opana 10mg pill.. those things are scary strong.. but my tolerance has risen steadily ever since.

Being on only 2-4mg/day of suboxone for the past 3 years has done the most to raise my tolerance though. As during my last binge, it took me 8 bags of east coast China to get a little high and it was definitely really good.. color, taste, it was all perfect. Not to mention that my friend damn near fell out off a half bag with no tolerance. Basically I am to the point where I could probably out do an elephant when it comes to handling opiates. Pills won?t even touch me anymore.

It comes to a point where it?s just not worth it anymore. For recreation anyway. Hope this gives you something to gauge yourself off of.

- TheProfessor-