Does tolerance to opioids occur even at low doses?
February 5, 2009 9:15 PM   Subscribe

Does tolerance to opioids occur even at low doses?

My doctor prescribed me oxycodone (10mg pills, to be taken on an as-needed basis) for my chronic pain. I've found that even very small doses of the medication (1 mg, obtained by splitting the pills) significantly reduce my pain for around 12 hours. It would be great if I could control my pain by using small doses on a regular basis. However, I want to avoid developing a tolerance, and above all, I want to avoid a situation where my baseline levels of pain increase because I am downregulating my opioid receptors through chronic use of oxycontin. A couple of questions:

- Does tolerance to opioids occur even when the drug is taken at very low doses? In other words, will someone who starts at 1 mg eventually need 2 mg, and then 3 mg, etc.?

- Is there some way I might be able to further leverage this discovery that oxycodone works very well for me? (e.g. by exploring related drugs that might work even better with fewer side effects)

(I asked my doctor the first question, but he didn't seem to be an expert on the pharmacodynamics of oxycontin.)
posted by wireless to Health & Fitness (11 answers total)
I can't address your tolerance inquiry, but all literature and the monograph here strongly advises that you should not modify, crush or split controlled-release oxycodone due to issues with rapid release. I understand you are trying to reduce your dosage by doing this, however it would likely be best to speak with your provider and address your concerns regarding tolerance and your comfort level regarding taking this med and alternatives that may be available to you.
posted by Asherah at 9:35 PM on February 5, 2009

I can't answer your stated question but can tell you that tolerance stabilizes and doesn't shoot up incessantly. You may also want to look into this.
posted by daksya at 9:39 PM on February 5, 2009

When I was experiencing chronic pain due to a bone disease not too many years ago, I found it helpful that my doctor prescribed a few different types of (compatible) pain relievers so that I could sort of bounce between them to keep from building up too high a tolerance to the individual drugs. I could also regulate the amount and type of pain relief I needed at any given time. I can't stress enough that my doctor and I spoke at length about this because it's tricky shit mixing chemicals with chemicals, and you know... it's your body.

It can get scary, I know. You want pain relief, but you don't want to end up on Intervention. It is really important to find someone you can discuss your pharmacological needs with in a frank way. Ideally, I'd say this should be your doctor. If he says he doesn't know, ask him to learn everything he can about your pain relief so that you can be safe and comfortable. If he's unwilling to do this, shop for a better doctor. Seriously.

As a result of this method I was using to control my pain, I had frequent blood tests to ensure that no harm was done to my liver or kidneys, which is key if you're eating pills like tic tacs, as I'm sure you know. If you don't know that, you might want to read up and ask your doc.

I'd definitely also advise you to phone your pharmacist to find out whether splitting them is actually okay. When I was prescribed oxycodone I was told that the ones I were given were not to be split because of their composition. Couldn't hurt to ask.
posted by heyho at 10:18 PM on February 5, 2009

Actually, it’s likely you are hastening your tolerance by chopping-up controlled release oxycodone (as the dosage suggests). Talk to your doctor about a different medication or dosing alternatives. Of course (as you have found), pharmacists are the experts. Most physicians have far too much on their plate to be experts in pharmacology.
posted by rotifer at 10:47 PM on February 5, 2009

Does tolerance to opioids occur even when the drug is taken at very low doses? In other words, will someone who starts at 1 mg eventually need 2 mg, and then 3 mg, etc.?


Also, don't cut these. It is a primitive time release technology that is based upon the whole pill dissolving slowly. If you cut them it can screw up how it dissolves. They really should be scheduled until a better version comes along that can not be defeated by mere crushing. The technology exists. Anyway, this is very, very potent stuff and you should try not to take it for more than a week or two unless your pain is from something like incurable cancer.
posted by caddis at 11:32 PM on February 5, 2009

You might want to try tramadol, as most people will not build a tolerance to it. I've been on the same dose for over a year.
posted by ryanissuper at 12:39 AM on February 6, 2009

They really should be scheduled until a better version comes along that can not be defeated by mere crushing.

Oxycodone is already a schedule II drug in the U.S. The only higher schedule is reserved for awful death chemicals like marijuana.
posted by Justinian at 2:41 AM on February 6, 2009 [1 favorite]

Yes, you will develop a tolerance.

Tramadol is a decent alternative and you shouldn't form a tolerance- BUT you will form a dependence over the long term- even on a small dose. Stopping is very uncomfortable. And FYI if you are taking any anti-depressants, Tramadol may not be an option for you.

If you are going to be coping with long term chronic pain I highly HIGHLY suggest you see a pain specialist. It is shocking how little most doctors understand about tolerance and dependance when it comes to opiate pain medications. Most assume that if you are not abusing the meds, you won't have any problems. This is definitely not always the case.
posted by hellboundforcheddar at 3:35 AM on February 6, 2009

I would also suggest that you very carefully approach the subject of specific drugs with your doctor. Some doctors will listen intently when you tell them your research tells you that drugs A and B might work well for you, then nod understandingly and jot down in your chart that they "strongly suspect narcotic seeking." Not all doctors are bad, but most people are really strange, and doctors are people. Just sayin. (In my case, there was even a bone scan clearly showing that something was very, very wrong with my skeleton -- this apparently will not stop some "well-meaning" doctors if they've already got it in their heads that it's a warning sign.) It really pays to tread lightly to be sure that you don't accidentally set off that alarm.
posted by heyho at 10:25 AM on February 6, 2009

Re: the cutting-pills issue, it's unclear exactly what you're taking. If it's nothing but oxycodone 10mg, you should be ok. Likewise if it's an oxycodone/acetaminophen combination (the acetaminophen might be listed as "apap" on your prescription label). If, however, what you're getting is "Oxycodone ER 10mg" (that is, generic Oxycontin), the warnings above to not cut them up do apply. (In any case, IANAD etc., and I'd double-check with your doctor or pharmacist.)
posted by neckro23 at 12:21 PM on February 6, 2009

Find a pain management doctor. If your doctor seriously couldn't answer that question, find a new one. I'm also thirding Tramadol if your pain is not too severe. I was recently prescribed it for my back and I've found I like it a lot more than opiods. However, at very severe levels of pain (from first-hand experience) it may not be enough. If your pain is chronic but not excruciating I would recommend that.
posted by threeturtles at 12:57 PM on February 6, 2009

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