Opioids WARNING: Kindling Phenomenon

[Psychopharma]

Hey guys, I'm new to BL and want to start by thanking all of you for invaluable information in harm reduction over the years. My education is in psychopharmacology (less like school, more like fun at the time). I know you all probably are aware of this phenomenon but I just want o bring it up because it technically took my life. I am very opioid experienced due to multiple spinal injuries and to say that I'm familiar with opioids is like saying I'm experienced in the art of breathing or walking. As with everything in life, after years of being prescribed narcotic analgesics, I became flippant and somewhat unconcerned about time between doses or taking an extra dose here and there. About a year ago, I decided I needed to reduce my tolerance and, though nearly torturous at times, went through the process of opioid rotation and sharp reduction. I even managed to go a month without any opioids despite my physicians saying that I must enjoy pain to want to do something like that. Well during this time I was slicing a lemon for a cocktail which I was looking forward to like Christmas since I hadn't been able to drink on my combinations of gabapentin, hydromorphone, nabilone, and extended release morphine. Now many of you know how when you are in withdrawal everything hurts ten times more than normal. Well in my giddiness I made the mistake of cutting the little bastard lemon towards my hand (My Boy Scout leader would have been so pissed) and one glance up at some rerun of Love Boat later I found that the sharp knife I purchased during my "I'm going to learn how to cook phase" was now an inch deep in my hand. Ouch. I was determined it was "only a flesh wound" but after losing about a unit of blood in my kitchen, I deemed an ER necessary. My girlfriend drove me to the ER where, despite losing so much blood they had burgundy carpet in their waiting room, I was finally seen. They were busy so its understandable that they give me substandard care right? After fainting on the walk back to a bed, I was given NO replacement fluids and some stitches. They gave me a script for Keflex (antibiotic-broad spectrum) and Percocet. I told the attending I didn't need anything stonger than maybe Tylenol #3 but he insisted that "That's going to hurt like a bitch" (so. professional.) Well after i got to the 24hr CVS - SUCH a classy joint at 3:15am - i realized he Rx'ed the 10/325 Percocet. Now, normally that would do nothing to me but ehh it actually was starting to "Hurt like a bitch" so i said what the hell, filled the two meds and went home.

Cut to me finally arriving home as the birds were beginning to chirp. I went upstairs, and had that disgusting feeling of having just been in an ER. You know, when you look down and can practically see your skin wallpapered with MRSA, C.Diff, and an assortment of all the other treatment-resistant infection that breed in hospitals like its spring break in Daytona Beach. So i took a shower. As i turned the water on I took the Keflex and thought what the hell I'll take the Percocet at least I'll sleep. I remember getting into the shower. Then nothing.....


Cut to two hours later....

I wake up staring a bright lights with some nurse SCREAMING in my ear - "SWEET HEEEARTTT WUT DID YOUU TAKE BABAYDOLL?" Maybe it pissed her off I answered by saying, " I'll be better able to answer your questions without a perforation to my eardrum". I explained that, prior to answering anymore questions, I'd like to know what the hell happened. This was met by "YOU OVERDOSED - THATS WHAT YOU GET WHEN YOU ABUSE YOUR MEDS". Excuse me? I calmly explained that I took the recommended dose and took a shower. This was met by more sighs and frowns. I had it after about 20 minutes.

Before I go any further, I work in emergency medicine and, while I'm certainly no doctor, I know how healthcare is meant to run after being and EMT, ER Tech, and Practice manager for a large Oncology department.

At his point I yelled, " The NEXT PERSON THAT TOUCHES ME I"LL FILE CHARGES FOR BATTERY. I AM LUCID< COMPETENT, AND FULLY ABLE TO PARTICIPATE IN MY OWN HEALTHCARE. I HATE TO BE 'THAT' PATIENT BUT GET ME SOMEONE FROM ANESTHESIOLOGY OR THE PALLIATIVE CARE DEPARTMENT." I think at this point they realized I had some medical experience.

15 minutes go by and someone from Pain Management came. I explained that I took the recommended dose of both medications and couldn't understand how I ended up gracing his presence. This guy was awesome. We looked at my blood work which revealed only trace amount of oxycodone. He then explained what really happened and it scares me still today...a rare but potentially fatal condition that I want to make as many people aware of as possible.....


When my brain was exposed to so many opioids for an extended period of time, the density of opioid receptors change. Receptors up regulate and become more dense in the brain. Well, during my hiatus from narcotics, these receptors sat empty and hungry. When I took a modest dose of 10mg of oxycodone, the empty receptors were hyper-sensitized and responded as if I had take an exponentially larger dose. I went into respiratory arrest and circulatory shock. By the grace of God a family member found me and I was saved just in time.


PLEASE PLEASE PLEASE be careful if you have withdrawn or go without opioids for an extended period. The sudden exposure can lead to fatal consequences. Start slow even if you are intimately familiar with your usual dose and drug. This probably will never happen to you but I just felt like I should try to tell this story to all you awesome Bluelighters out there that have provided me with invaluable information all these years...


Be well.

 

[HdoubleODeezy]

glad to hear you're alright man.. i've never heard of that happening before.

 

[Venrak]

Wow, I've never heard of this happening either. It's like some sort of reverse tolerance or something. Good to know you pulled through, man.

 

[iconoclast56]

Wait a minute, are you saying that abrupt abstinence results in abnormal upregulation of opioid receptors? I thought upregulating stopped once homeostasis was regained. Some day I'd like to get that treatment where they put you under anasthesia and pump you full of opioid antagonists to force rapid upregulation. I'll tell them I'm addicted to heroin but in reality I'm not. I just want to see what it would be like to have an abnormally large number of mu opioid receptors.

 

[HdoubleODeezy]

Wait a minute, are you saying that abrupt abstinence results in abnormal upregulation of opioid receptors? I thought upregulating stopped once homeostasis was regained. Some day I'd like to get that treatment where they put you under anasthesia and pump you full of opioid antagonists to force rapid upregulation. I'll tell them I'm addicted to heroin but in reality I'm not. I just want to see what it would be like to have an abnormally large number of mu opioid receptors.

you would probably end up in a constant "withdrawal" type feeling since you would have more mu receptors that your body can't produce enough endorphins to fill.
(just guessing, i have nothing to back that claim up, i just thought of it lol)

 

[Swain]

Damn bro crazy story. Glad you are OK. Very interesting read .

 

[Hobble]

Could the fact that you had lost alot of blood had anything to do with it? If so, could it be possible you just fainted, as opposed to truly overdosing? Did they give you narcan?

I've heard when you donate blood you can get drunk off one or two beers.

 

[Psychopharma]

Could the fact that you had lost alot of blood had anything to do with it? If so, could it be possible you just fainted, as opposed to truly overdosing? Did they give you narcan?

I've heard when you donate blood you can get drunk off one or two beers.

Yes it did have a contributing factor but not the cause in its entirety. Initially, I thought that was the ONLY cause but the anesthesiologist and pain specialists were insistent that they had seen it in patients across all clinical presentations - rarely, but still possible. He likened it to in a cartoon when a room full of mousetraps all go off - it has to do with a protein cascade in the central nervous system that initiates an irreversible chain reaction. PLEASE understand I'm not trying to say that if you take a break from opioid exposure for a few days or go through withdrawal then this might just spontaneously happen. Its rare. Very rare. But it does happen. I believe its likely in cases where you have prolonged abstinence, complete the withdrawal process, and then have an abrupt exposure to the SAME or SIMILAR opioid. It's like your brain is overjoyed to see an old friend again and all the receptors release Dopamine into the synaptic clefts in anticipation of a mu agonist circulating in the blood. The MDs explained that they believe it to be related to Situational/Place Tolerance - like when an IV drug used injects the normal amount of his or her drug in unfamiliar surroundings only to overdose on a dose they have used or exceeded many times. Not the exact same mechanism but something along those lines.

i should have added that the first time.

 

[obscure]

I had a similar experience once. I had been off heroin for a little while and then got a scrip for hydrocodone, due to a back injury. I thought, I'm a pro with opiates, I have a high tolerance, and shouldn't expect much here. I took 15mg of hydrocodone then drove to the store to pickup some groceries. I was at the checkout and I almost collapsed. I stared shaking, everything went white, it was similar to an OD I went through once. I couldn't believe that a dose that low could knock me out like that. I spent the rest of the day in bed.

I don't have the science to back it all up, but I do believe in what the OP is saying here; there needs to be a lot of consideration when you jump back into opiates after getting off a habit.

 

[Jabberwocky]

Very interesting OP! Welcome to BL... heh, that first paragraph was kind of a bitch to get through, but what do I have to really complain about next to what you've suffered through

 

[sarcophagus.heels]

Wow, that's insane. I know that with some pharmaceuticals, the effects actually increase the longer you've been on them because rather than develop a tolerance, your receptors become over-sensitized...but I would not have imagined that the same could possibly happen in the situation you described. Even if rare, it's sort of terrifying. Anyway, thanks for sharing, and I'm glad you made it out okay!

 

[Wesley_pipes_27]

Glad you're ok OP, thanks for sharing that with us.

WP

 

[jazz hands]

What was your dose before you started cutting back? For how long were you at a high dose?

 

[Tripman]

Welcome to BL.

This is a fantastic first post, however it is not suitable for OD and I would recommend you repost it in the Blogs area of BL.

I'm closing this, please read the OD guidelines which will teach you what is appropriate material for a thread in OD.

Closed.