Drug tolerance: perception vs. bio-reality, downers vs. uppers

I can’t get a clear answer from any doctor I’ve asked.

We all know that one can build a tolerance to drugs. In the case of opiates, someone who has built a tolerance not only experiences the effects differently in terms of their “high”, but their bodies can manage much higher doses without dying. The dose that would kill someone 3 times over if they have no tolerance can be safely taken by a junkie no sweat.

I’m asking on my own behalf because I have ADD and I’ve been taking stimulants for eight years. Not only do they not work on my issues the way they used to, but I also don’t feel the heart racing and other intense physical effects I felt when I started using them.

I’ve upped my dose recently and they work a little better but I’m not happy about taking such high doses of stimulants, tolerance aside. BUT, i’d still like to know if, along with my PERCEPTION of a much higher tolerance, if there’s a REALITY of higher tolerance behind it: are my body systems able to cope with the stimulation more effectively now in the same way a junkie’s body can manage opiates?

Since downers and uppers do different things, I can see how it wouldn’t be exactly the same with stimulants vs. depressants.

The short answer: your body used to produce x amount of some neurotransmitter (probably dopamine?). Maybe that level was too low, hence the meds. Taking the drug increases the NT in one of many different ways. Eventually your body “decides” the levels are too high, and thus lowers its own production of the NT. If you were to quit cold turkey, the lowered levels might have a negative effect on your body and psyche, so you’d need to wean off and let the levels adjust slowly back to normal.

The difference between uppers in downers is usually in the neurotransmitter(s) they target. Many uppers are dopamine; many downers affect endogenous opioid systems. Also, some drugs decrease levels of NT released. I think a lot of these are dissociatives like ketamine or PCP. Or in the non-recreational world, many other drugs may also work this way.

Well, that’s the brain effects…I’m concerned about the effects on the rest of my organs and systems.

It depends on the specific stimulant you’re talking about as they work in different ways. For example amphetamine salts work differently than something like methylphenidate or methamphetamine. There are even differences between isomers such as dexmethylphenidate and the levo-rotary enantiomer.

Aside from that, opiates have an endogenous equivalent - endorphins - whereas, AFAIK, amphetamines don’t. Rather they mimic the effects of various catecholamines in addition to acting as reuptake inhibitors, releasing agents, etc.

Ask your psych. If he doesn’t answer right, get a new doctor.

I don’t know about stimulants, but I have read DXM can reverse/prevent opioid tolerance. I don’t know the mechanism though.

Substance like ibogaine have some info about reversing addiction.

There has been info about taking amino acid supplements that help replenish dopamine levels (phenylalanine or tyrosine) by increasing the raw material for synthesis of those NT, but I don’t know enough about it to comment. That would be something to work with with a competent integrative doctor.

I don’t know a ton about it, but I would assume your receptors are downregulating, the fact that you aren’t getting physiological effects from the ADHD drugs implies you aren’t getting as much dopamine in the past.

Wish i could. My situation requires local and cheap, so im stuck with the neighborhood scrip pusher. I came to him ready to have an in depth conversation and he shocked me by just writing up super generous scrips for anything i mentioned! Like my form psych, I had initially met while I was covered by insurance, and who costs $350 per hour, would only write xanax .2 count 10 for 60 days. This guy wrote me a script of 60 for 30 days! I didnt even ask for that!

Interestingly I asked this question of both doctors and neither one gave me much of an answer. They both just said you build up a tolerance… They didn’t seem to get the distinction I was drawing between perception and biological, physiological tolerance.

FTR I switch back-and-forth between amphetamine salts generic and Vyvanse, which Shire pays for.

I would suggest dexmethylphenidate. It is generic Focalin and should be covered. It’s only the extended release version that would be under patent. This seems to have the best therapeutic effects with the fewest side effects such as those you described. However it is much stronger than regular Ritalin from which it is derived so if you have a Dr who is going to write you a script for whatever you want, YOU are the one who needs to exercise caution. 10mg of DMPH is roughly equivalent to 30mg of MPH and I don’t think even a long history of amphetamine use will prepare you for the change.

I would suggest looking at the pharmacology section of rxlist for the drugs you are taking now and DMPH so you can get a feel for the differences. Wikipedia is also an excellent source of pharmacology information.

I do however question the wisdom of taking both stimulants and tranquilizers. It may be worth investigating mood stabilizers as your primary diagnosis is perhaps not completely accurate.

I have been prescribed Adderal (amphetamine) to try and overcome lethargy created by long term use of opioids for chronic pain. When I first took the amphetamine, my dose was 5mg daily. It woke me up and in the beginning would sometimes keep me up for days. However, tolerance quickly built and within a year I was prescribed 30mg a day. Recently the effects have become almost undetectable. My doctor says we have reached basically the traffic limit in that foresee above 40mg have down little or no increased effect.

This is a heartbreaker for me as I thought I finally had my life back, but the only thing that is back is my lethargy. There really doesn’t seem to be a whole lot our there to replace the amphetamine, so I might have to resign myself to never having energy or being truly awake again.

I am assuming you are taking Aderall for your ADD. Tolerance to stimulants builds quickly and from my experience and what I have read There is no easy substitute. Good Luck to you.