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Author Topic: How rapidly is tolerance established to opioids?  (Read 3653 times)

Offline Pmb

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How rapidly is tolerance established to opioids?
« on: 25/05/2013 03:55:20 »
I tried asking this in the chat forum but didn't get a response. Since this is extremely important to me I thought it best to post it here.

Can anybody tell me where I can find information about how quickly people on opioid therapy become tolerant to opioids? I saw a pain specialist the other day and he claimed that I'd become tolerant in a few days. He's an idiot for saying that. I want to know what really happens. I know as a fact that it simply can't happen that fast due to personal experience. But I need to know where to find this information.

Anybody?
« Last Edit: 25/05/2013 14:23:08 by chris »


 

Offline Lmnre

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Re: How rapidly is tolerance established to opioids?
« Reply #1 on: 28/05/2013 05:52:00 »
Less than a few days — more like 24 hours. Plenty of heroin addicts have told me this (think of it as empirical data):
  • Sniff 1 bag of heroin to get high. Wake up the next morning feeling under the weather.
  • Sniff 1 bag to feel normal, sniff another bag to get high. Wake up the next morning feeling lousy.
  • Sniff 2 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have the flu.
  • Sniff 3 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have a bad case of the flu.
  • Sniff 4 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have a really bad case of the flu.
  • Sniff 5 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like death warmed over.
  • Etc, etc.
Your brain can't tell the difference between you wanting to chase a high or wanting to relieve pain. It's only interested in the chemistry.

Attend any NA meeting, and I'm confident you'll find people there who will tell you the same.
 

Offline evan_au

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Re: How rapidly is tolerance established to opioids?
« Reply #2 on: 28/05/2013 12:41:52 »
Opioid receptors are part of a closed-loop system, where your body responds to an increase in opioid levels by reducing its own production of opioids/endorphins, and reduces the quantity and sensitivity of receptors. This helps maintain homeostasis, but requires progressively increasing doses to achieve the same effect.
Opioid receptors are scattered throughout the body, so increasing dosage causes a series of increasing side-effects throughout the body.

It's hardly a peer-reviewed journal, but for a quick overview, see the sections on Addiction, Tolerance & Withdrawal at: http://en.wikipedia.org/wiki/Morphine#Tolerance
and http://en.wikipedia.org/wiki/Opioid#Tolerance

It suggests that withdrawal symptoms start 6-12 hours after the last dose - this sounds like the elapsed time it takes your body to clear out the previous dose.

Because your body has turned off its own production of opioids, it sounds like this period of withdrawal is quite miserable.

To minimise/avoid these negative effects, and maximise the painkilling benefits it is necessary to work around your body's homeostasis, which could be done by:
  • Avoiding high peak levels of opioids, as these will rapidly downregulate internal production. This means avoiding periodic needle injections.
  • Don't seek a feeling of euphoria - this requires high peak levels (see adverse effects above)
  • Seek only to dull the pain.
  • Avoid extremely low levels of opioids, as this provokes withdrawal symptoms, which just add to the original pain. This suggests a steady, slow infusion like transdermal patches which last a day or more.
  • Try putting on a fresh patch before going to bed. The day is much easier to handle if you've had some sleep the night before.
  • Consciously try to minimise dosage, as this minimises increase in tolerance. This means consciously accepting some discomfort as the patches run out, to keep the dosage at the same level.
  • Good results have been reported with self-regulated infusions, where a button is available to provide pain relief only when needed (up to some preset limit defined by the doctor).
    • Because the pain control is available at hand, patients felt that the pain was under their control, even without pressing the button.
    • With sparing use like this, tolerance may even decrease, over time.
    • In one study in dentistry, they eventually disconnected the button, because people almost never used it! (But chronic pain is a different story...)
    • This requires a computer-regulated pump, and carries some risk of infection due to long-term use of a canula.
  • I have heard that therapies like CBT (Cognitive Behavioural Therapy) may provide some help - to supplement and minimise use of the opiates. At least CBT doesn't have the same level of side-effects.
Conclusion: Opioids are very effective for pain control, provided tolerance is avoided, and doses are kept low and steady.
« Last Edit: 28/05/2013 13:54:10 by evan_au »
 

Offline Pmb

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Re: How rapidly is tolerance established to opioids?
« Reply #3 on: 30/05/2013 09:45:49 »
Less than a few days — more like 24 hours. Plenty of heroin addicts have told me this (think of it as empirical data):
  • Sniff 1 bag of heroin to get high. Wake up the next morning feeling under the weather.
  • Sniff 1 bag to feel normal, sniff another bag to get high. Wake up the next morning feeling lousy.
  • Sniff 2 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have the flu.
  • Sniff 3 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have a bad case of the flu.
  • Sniff 4 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like you have a really bad case of the flu.
  • Sniff 5 bags to feel normal, sniff another bag to get high. Wake up the next morning feeling like death warmed over.
  • Etc, etc.
Your brain can't tell the difference between you wanting to chase a high or wanting to relieve pain. It's only interested in the chemistry.

Attend any NA meeting, and I'm confident you'll find people there who will tell you the same.
That's opioid abuse, not opioid use. The NA literature states the following; from In Times of Illness page 35
Quote
Our experience shows us that many NA members have been successful in taking medication as prescribed for chronic pain and keeping their recovery intact.
People who take opioids for chronic pain typically don't get addicted to it.
 

Offline Lmnre

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Re: How rapidly is tolerance established to opioids?
« Reply #4 on: 31/05/2013 15:30:55 »
People who take opioids for chronic pain typically don't get addicted to it.
How does the brain know the difference? I knew an old lady who took OCs for pain from an abdominal operation. When her prescription ran out, she went cold turkey and felt like she had the flu. I'm not talking addiction as in a granny robbing a pharmacy of its OCs, or turning tricks to pay for OCs on the street.

As I said, the brain doesn't know and doesn't care why the person takes them, the brain will still suffer withdrawal symptoms because the brain has become acclimated to them. Whether the withdrawal symptoms leads to addiction is another story.
 

Offline yor_on

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Re: How rapidly is tolerance established to opioids?
« Reply #5 on: 01/06/2013 18:14:03 »
I think you are correct Pete, but I also think the withdrawal from using it will be there, depending on dosage. But it is true that medically described, and used for minimizing pain, it does not work in the same manner as it does to someone out for a 'kick'. Why that is I'm not sure, but the mind and ones expectations of it must be a part of it. Got morphine to help me some months ago, and I found it just nauseating :) . Stopped it as fast as I could, but it did work very well for eliminating pain. And I found no problems with stopping either.

Everything can be a abuse I think :) If done to excess. And it is related to yourself how fast you gain a tolerance needing to increase a dosage. If there is some other medicine he thinks might have a similar pain lessening effect on your condition you might want to test that, to see if it works better. What about cannabis for example? Seen it used as pain killers with good results in medicine?
 

Offline yor_on

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Re: How rapidly is tolerance established to opioids?
« Reply #6 on: 01/06/2013 18:34:36 »
And Evan has a really good point writing "I have heard that therapies like CBT (Cognitive Behavioural Therapy) may provide some help - to supplement and minimize use of the opiates. At least CBT doesn't have the same level of side-effects."

You need to get out and meet friends my friend.

The more the better, nothing that helps one more than having a laugh with some friends. Had a recent example of it here in Sweden, considering a young girl with chronic pain, unable to walk. In the end she forced herself out anyway and to her surprise found the pain to become manageable, as she once more gained a 'social life'. Pain is a strange thing, that's also why doctors want us to define it on a scale ourselves, instead of them telling us what we feel, related to some experimental evidence. And laughing and having fun will make the world lighter, and that pain less.
 

Offline cheryl j

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Re: How rapidly is tolerance established to opioids?
« Reply #7 on: 02/06/2013 17:18:48 »


That's opioid abuse, not opioid use. The NA literature states the following; from In Times of Illness page 35
Quote
Our experience shows us that many NA members have been successful in taking medication as prescribed for chronic pain and keeping their recovery intact.
People who take opioids for chronic pain typically don't get addicted to it.

People use words like addiction to mean different things, but dependency is a side effect of the drug, the same way weight gain or immune suppression or high blood pressure are side effects of other drugs. Dependency doesn't imply the person was misusing it. It is just the result of the nervous system adapting to or balancing to the effect of the drug, since the drug affects the entire nervous system, not just the few nerves sending pain signals.  I think evan-au's advice about avoiding high peak levels is good as far as preventing or slowing the progression of tolerance.
 

Offline PmbPhy

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Re: How rapidly is tolerance established to opioids?
« Reply #8 on: 04/06/2014 10:38:18 »
Quote from: Lmnre
How does the brain know the difference? I knew an old lady who took OCs for pain from an abdominal operation. When her prescription ran out, she went cold turkey and felt like she had the flu. I'm not talking addiction as in a granny robbing a pharmacy of its OCs, or turning tricks to pay for OCs on the street.
I decided to come back to this subject now that I've been on opiods for a long time. What I realize from your response is when I said People who take opioids for chronic pain typically don't get addicted to it. you misunderstood what I meant. As Cheryl pointed out, people use the term addicted to mean different things. When I use that term I mean nothing more and nothing less than a psychological craving of the substance where as you thought I was referring to physiological dependence which can lead to abuse very easily. This confusion over meaning causes a lot of problems.

However what you meant when you wrote
Quote from: Lmnre
Whether the withdrawal symptoms leads to addiction is another story.
Is beyond me. Can you please explain what you were talking about here and how it differs from the old lady story above? Thanks.

For the curious out there; now that I'm on opiods for my chronic pain I'm doing very well. I'm no longer suffering at the level I used to. The pain is now down to tolerant levels. There's no temptation for me to abuse them because my body has become acclimated which means I don’t experience euphoria yet the opioids yet they still control the pain nicely. I now live a comfortable existence. And all those idiot doctors who claimed I wouldn’t work or that I’d abuse it were all wrong.
 

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Re: How rapidly is tolerance established to opioids?
« Reply #8 on: 04/06/2014 10:38:18 »

 

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