Opioids What is the reason my medication is not working like it used to?

[milagro]

It is frustrating when you are in pain after coming home from work or whatever and you take your medication to relieve it but it simply doesn't work anymore. WTF is going on here? I thought it was the manufacturer of oxy hcl and I still believe that has something to do with it but can someone please help me figure out what is going on here?

I use oxy IR and ER combo and have for years. I am a cpp that can barely work 6 hours a week. Diagnosis is not really important.

I am constantly running out early because the dose I have been at is not adequate anymore. I have to believe it is tolerance but this lack of efficacy seemed to happen overnight.

Here is the deal. I pick up my scripts monthly and for the first couple of days after the fill I am great, just like old times on 160mgs total of 80oxycontin and 90oxy hcl. This is after having squat for several days due to running out early. I usually just endure the WD's and have some very old methadone from a couple years ago that has expired but will work if I cannot handle the wd's. On the third or fourth day after the fill the same damn thing keeps happening; the meds do close to nothing. It takes 50% of the pain away and there is no rush of energy like I used to have. I have tried taking larger and larger doses and still nothing. If I take too much I get all the bad effects like wheezing, constipation, headaches, and horrible dreams but the pain relief is only adequate and I don't feel like doing a damn thing. Then I have to take small doses to catch up. One would think that this would help bring my tolerance down but it doesn't. I know this doesn't make sense which is why I am asking BL. I am stumped and I cannot tell my doc or pharmacist that I am taking large doses and running out early.

Please give me some suggestions on how to lower my tolerance without going CT. How long would I have to stay at low doses? Like I said, I go without for several days prior to refill and it seems to work but it is hell and only gives me a few days of adequate relief. I have tried nearly every prescription opioid(ate) and oxy has always worked best for me.

Does this sound like tolerance or is there something going on with my body's chemistry? Are manufacturers screwing with the formulas?

Just an additional thought. If I were to stop using oxy and use methadone, how long and how much MD would be required? Would this just increase my tolerance more? The MD needs to be used or tossed soon due to how old it is.

 

[elz]

Could be that your getting new op oxy , I get them and they don't work as well for me

 

[TheLostBoys]

Tolerance could be the issue & if you're getting the plastic OP's, well.....they are nothing like the old OC's or the generic oxy's out there now a days.

I'm wondering what the long term effect those plastic pills will have on people.......

As for Methadone, it will definitely increase your tolerance.

 

[sekio]

Methadone won't go bad. Unless it's a sugar based syrup.

Welcome to the wonderful world of when opioids don't cut it any more. You basically have to bolster your opioid with some sort of other non-opioid painkiller, tolerance has finally caught up to you. This is typical with opioids, you get into the diminishing returns as the dosage goes up. It would behoove you to let your pain therapist know that your current narcotics are not cutting it so you can get treated properly. Lying and saying everything is OK will only lead to you switching onto street opioids.

I have tried taking larger and larger doses and still nothing. If I take too much I get all the bad effects like wheezing, constipation, headaches, and horrible dreams but the pain relief is only adequate and I don't feel like doing a damn thing.

More indication that it's tolerance to the painkilling/euphoric effects. If you get nauseous etc that's a sign that the drug is making it into your body. Your brain just isn't responding to it like it used to. I doubt very much that the issue is with the formulation of the pills, it's not like it gets changed between prescriptions. OP oxycontins have been around for a while now so I don't think you can blame them. (Lots of people whine and moan about them but the fact of the matter is they still deliver oxycodone, or they wouldn't be sold any more.)

It is unlikely that dose reduction will help on its own. Once opioids start losing their edge then you are in the downwards spiral and you basically need to call it quits entirely for a few years to get back to baseline tolerance. Even then you will be very susceptible to the tolerance returning after a few doses.

Look into getting switched over to something like tapentadol, methadone, the like. See about adding a NSAID or local anesthetic too. Basically you want to go all guns blazing with the non opioid painkillers and hope they provide enough relief for you.

 

[milagro]

Yeah, the OP thing concerned me at first. I took the old OC version years ago and I have NEVER had anything kill the pain as quickly and effectively. It was too good and I became irritable and began sweating profusely at which point I stopped. I was reluctant to try the OP but went ahead with it and while it is nowhere near as good as the original version it DOES work pretty well for me and I have used it for several years.

This is what I am faced with: I am not going to use specific dates.

I fill a prescription on a Monday and the pain is pretty severe. I take 30mg of oxy hcl and 20mg of Oxycontin. An hour later the pain is almost 100% gone and I feel pretty good. I immediately get busy doing things like cleaning. I stay within the parameters of the prescribed doses for the next couple of days.

I wake up Friday morning and the pain is pretty bad as usual. I take the same dose I have been taking every morning since I filled. An hour later I feel a tiny bit better but nowhere near what I felt just 4 days prior. I take more even though I know I am not supposed to because I have too many things to do. I feel no different an hour later. This continues all day and by the end of the day I can't keep my eyes open because I am so sedated. The pain is still there.

I figure I will wait around 20 hours for next dose. The pain is now really interfering and I have none of the surge to "get things done" like I did earlier in the week. I am finally so sick of lack of relief that I take twice the prescribed dose. I may as well have chewed a baby aspirin for relief. This dance continues on and on until I run out having experienced 3 good days out of the entire month's fill.

There is something I didn't mention that has me wondering.

About !@ ago I decided to try and use something long lasting so I wouldn't have to worry about dosing as often. So I started suboxone. I was miserable but stuck with it for a while. Good pain relief, unbearable side effects. I then eased back into the oxy regimen last year and it has never worked the same since. I don't have the horrific side effects of the Sub but I wonder if taking it altered my system to a point that full agonists no longer work like they used to.

It just doesn't make sense that the oxy would work well for 3-4 days and then, overnight, become about 20% as effective.

Maybe I am looking for an impossible answer. I just want my old, smooth, and effective oxy back.

I was typing while the previous post came in and I have to answer it because I found it irritating that someone would be so presumptuous. He indicated I would get into street opioids? Also, I did the Nsaid therapy for a while and now have a recurring ulcer to show for it. Opioids never caused me to vomit blood.