For purposes of this thread, assume YANMMD and that all the substances I’m talking about have been prescribed/administered in proper legal fashion (which they have).
I have a lifelong dread of becoming dependent/resistant/tolerant to opiate painkillers. If nothing else, I want to save my opiate sensitivity for end-of-life times if say I get some horrible bone cancer (cheerful sort, huh?).
Within the past week, though, I’ve been forced to cave on my previous no-prescription-painkiller stance by a particularly painful neuromuscular problem (hopefully, relatively acute and short term).
From having had a dozen Tylenol 3 or hydrocodone in my life for dental surgery, I’ve gone to a couple of intramuscular morphine/Dilaudid injections to a prescription for 5mg Percocet/Vicodin, 4x daily over the past week. I’m trying very hard not to cheat on that schedule or double down, and really haven’t but for one or two times. I’d like to wean myself ASAP (someone told me that Alleve + Benadryl was a good approximation of Percocet for antiinflammatory/anti-pain/sedative effect, which I’d love to believe, but am not ready to try as yet given the severity of some of the recent pain).
So – while I’m sure the answer is “it varies” or “it’s all a matter of degree” – If I stick to 4x 5mg oxy/hydrocodone as prescribed over the next two weeks (assuming no increase in dosage and that the pain is under control enough for OTC to do the trick by then) – how much of a tolerance/dependence will I have built up? Or, when does someone become “seriously dependent,” vs. an amount/duration that upon cessation (and assuming no future backsliding or temptation to use leftover supplies recreationally – which I hope I won’t have) I can be basically “back to normal,” which is to say, largely an opiate virgin who will respond well to modest quantities in the event of future medical necessity?
Final Q. – if someone builds up tolerance level X (even a small one), does cessation over a long period reset the clock, or is increased tolerance/habituation permanent?
TIA and I’ll ask for a pass if some of this should have been easily googleable – not at the top of my Google or any other game at the moment.
Answering as an opiate prescriber (only for significant acute pain or malignant pain 99+% of the cases
Q 1: How much tolerance/dependence from 20 mg a day for two weeks? Not much.
Q 2: What about tolerance? Abstinence will return tolerance to baseline levels. Generally in short order. Though if a person’s been on methadone for months, it may take months to return to baseline levels after stopping the methadone.
I was going to relate my six-month use of morphine for severe chronic nerve and back pain, and eventual surgery. I went cold turkey to get off, BUT…
How can anybody top Dr. Qadgop’s concise and accurate reply?
Yeah, my feeling too. Never having circled above 4.5 on one of those rate-your-pain scales (including for broken bones), I did what I’d never thought I’d do and jumped to 8.5 and was about to call the nurse back in to see if I could amend to 9 . . . other scary part on that worst day was when I got the Dilaudid injection (which in itself burns like a mofo when your spasming muscles are already inflamed) and reported back – “It’s a <little> better.”
So at the margin, I guess I will feel a little less bad about not trying to halve my dose right away, or about cheating and taking my 6:00 a.m. dose at 4:00 when I wake up with flaming referred pain rather than sweating through the sheets for the next two hours.
It’s also good to have an actual doctor’s perspective (not individual advice, I know). The rough Googling on how much opiates is too much or whether you can back down with no consequences is a dispiriting mix of message boards where the comments break down into (a) people telling tales of woe where one pill went to two went to 20 and they could never get back; (b) falsely optimistic recreational users strategizing for how they could escalate to the brink of junkiedom and then readily hit reset and have no lingering effects. My underlying fear/respect of this stuff remains, but I’ll try to balance my paranoia with my need not to be bed-bound and writhing around even there.
Look, I don’t know what’s up with you, but pain relief is a good thing. It’s a completely legitimate use of the drug. The less pain the better you rest and the better you heal/recover as a general rule. You’re not using it to get high, just to dim the pain, right? So use it, that’s what it is for, and don’t rush to get off it out of exaggerated fear. It sounds like you’re already motivated not to abuse.
MY experience with opiates is quite limited, however, I found as I got better I just took less and less, would sometimes forget a dose, and had zero problem returning to baseline, never had any cravings, etc. In fact, I didn’t even finish the last prescription, I simply felt no more pain and no need to take the dose.
Of course, your mileage may vary. Some people take opiates for pain and have no problem discontinuing it. Some people do have problems. But above all, listen to Qadgop, as he has substantial experience in these matters.
Treat your acute pain adequately, or you could end up with chronic pain, which is a lot harder to treat. Heck, I got IV morphine and fentanyl during my heart attack and subsequent heart procedures, and I didn’t try to avoid it, even with my history of opiate addiction. Treating real, acute pain with opiates is a lot different than having a jones for opiate narcotics.
Of course I got off the stuff as soon as reasonably possible (didn’t take it after I left Mr. Hospital), but I knew it was foolish to refuse it for legitimate pain. I had some mild cravings for a bit, but they passed, and I got on with life.
Agreed, and I concede I might be being a bit irrational. If you’re being more than rhetorical with “what’s up with you,” I’d single out personal circumstances such as:
(1) having spent most of my life healthy as a horse, I don’t have much experience with seeking/accepting medical intervention in any form, let alone a “serious” one. Not machismo, just not a very educated/sophisticated consumer for what’s a popgun, what’s a .22, and what’s an elephant gun that’s going to get me in over my head. Flip side of never needing help is not being very good at asking for/availing of it or gauging what’s an appropriate amount of help/self-help.
(2) My only analogous experience (again just IME) is with drinking, where without being a rock bottom skid row drunk, or close to it, I figured out early in my career that I could drink, I could drive, but never both. My handful of experiences with “well, I’ll have two drinks, maybe three, but certainly I’ll still be okay to drive” just didn’t work out, so I ended up with the black and white “I’m drinking and taking a cab” or “I’m drinking club soda and driving” mentality. Again, perhaps oversimplistic, but it’s what’s worked for me in that arena and I’ve obviously transferred it over here.
(3) personal experience of acquaintances with bad pill problems. And especially as I get older and get more dings and dents than in my earlier days (see (1)), I have the (perhaps cowardly) fear that what I’d previously seen as, I don’t know, strength of character that separated me from those train wreck friends was really just there-but-for-the-grace-of-God good luck that I’d best not tempt.
All that said, thanks for the helpful input from all.