@letsparty -- Respectively, Illicit fentanyl works both ways for tolerant patients & users. I know plenty that get a "speed" type effect and a ceiling effect without catching a nod, this includes intravenously and insufflation. For pre & post surgery I request other opioids instead of Sublimaze because I never feel sedated and the duration is too short.
High doses every 4hrs of IV Oxymorphone and IV Diluadid for pre/post OP pain are right up my alley. Include IV Inapsine (Droperidol) and/or IV Duracion (Clonidine) turns the surgery experience into a "vacation cruise."
I am not saying that Fentanyl is not an effective pain killer by any means. It does not produce the same "euphoric" feeling as high purity Heroin #4. Fentanyl feels "cold & mechanical" and Heroin # 4 feels "warm, loving & therapeutic."
My opioid tolerance is defined as "acute tolerance" and also defined as "tachyphylaxis" from 38 years of Rx opiates & opioids including illicit Heroin #4 IV use and Fentanyl. I have exhausted my opioid rotations because of "rapid tolerance" which created "acute tolerance" to about every type of narcotic. The only PO (oral) Rx's I will take are Roxicodone and Methadone because of the high oral bioavailability of Roxicodone and the fulll-life of Methadone. Oxymorphone, Hydromorphone, and Morphine do not hit the mark PO (oral) for me. I take Roxicodone 30mg every 4hrs and Methadone every 6hrs. The Methadone keeps the Roxi from dropping below a certain point and allows me get get decent sleep without waking at 4am sneezing like crazy and hot flashes.
I want an opioid rotation going to Levorphanol "the forgotten opioid" and keeping Roxicodone 30mg every 4hrs, ultimately removing Methadone. It is difficult to get an Rx for Levorphanol in the US for chronic non-cancer pain. However, studies are starting to open up again about the benefits of it for Chronic pain syndrome which I have a diagnosis of. Mallinckrodt makes a Levorphanol Tartrate 2mg tablet but most pharmacies do not stock it.
Levorphanol acts predominantly as an
agonist of the
μ-opioid receptor (MOR), but is also an agonist of the
δ-opioid receptor (DOR),
κ-opioid receptor (KOR), and the
nociceptin receptor (NOP), as well as an
NMDA receptor antagonist and a
serotonin-norepinephrine reuptake inhibitor (SNRI). Levorphanol, similarly to certain other opioids, also acts as a
glycine receptor antagonist and
GABA receptor antagonist at very high concentrations. As per the World Health Organization, levorphanol is a step 3 opioid and is considered eight times more potent than morphine at the MOR (2 mg levorphanol is equivalent to 15 mg morphine).
Relative to morphine, levorphanol lacks complete
cross-tolerance and possesses greater
intrinsic activity. The
duration of action is generally long compared to other comparable analgesics and varies from 4 hours to as much as 15 hours. For this reason levorphanol is useful in palliation of chronic pain and similar conditions. Levorphanol has an oral to parenteral effectiveness ratio of 2:1, one of the most favorable of the strong narcotics. Its antagonism of the NMDA receptor, similar to those of the
phenylheptylamine open-chain opioids such as
methadone or the
phenylpiperidine ketobemidone, make levorphanol useful for types of pain that other analgesics may not be as effective against, such as
neuropathic pain. Levorphanol's exceptionally high analgesic efficacy in the treatment of neuropathic pain is also conferred by its action on
serotonin and
norepinephrine transporters, similar to the opioids
tramadol and
tapentadol, and mutually complements the analgesic effect of its NMDA receptor antagonism.
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@letsparty -- Brother be careful out there with illicit Fentanyl, tranq-dope, Nitazines, and Hep-C. I wish you the best in and for your life and if you get tired of the dope game follow that instinct man. I had Hep-C from 2000 to 2007. I cured it myself using "standardized" Milk Thistle Extract, Green Tea Extract, and Grape Seed Extract every morning with a bowl of non-instant oatmeal. The oatmeal helps those active ingredients in the small intestine longer for increased & max absorption. I have been tested 5 times since then and the RNA test always comes back negative (the antibodies still shows that I was previously infected). I still remember my mother's tears the day she found out I was infected with Hep-C.