How high can tolerance go?

[The Paregoric Man]

Theoretically if a person had a lifetime to work at it could they never stop raising their tolerance?
Assuming no pressure on use or supply, financial or otherwise.

Highest I ever heard of was an article about Iranian heroin addicts where one claimed his tolerance to be at 7 grams a day.

Is there any science to show a end point or plateau beyond which no one goes?

[losangeleslifer]

There was that story of that Utah man who was synthesizing and using some uber potent opiod and his tolerance was so far off the charts that he couldnt be maitained even on the most rediculous amount of methadone. I remember Robojunkie talking about it. He used amounts that would drop many men dead to the ground.

I think the dude killed himself cuz he couldnt take the WD.

Sobody feel free to clear this story up for me, but I do remember the meat of the story went something like that.

[digby]

It seems to vary by individual on how high they can go before toxic side effects make going further impossible. Many pain patients have taken doses well into the stratosphere however. As far as euphoria goes, I have read that around 1200 to 2000 mg per day of oxycodone was the ceiling beyond which any further increases yielded no additional euphoria, at least for this small group of people, and on that one single chemical.

Pretty much hear-say though, as it is pretty difficult to get any reliable information on something like this concerning the euphoria effects.

[lilred0005]

This is an interesting if not scary question. I know my tolerance has been rapidly increasing, especially in the last yr. I figure it's due to being on the same substance, Oxycodone, for so long coupled w/ the short-acting nature of that drug. The whole tolerance thing scares me as I have gone from around 180mg a day to upwards of 300 a day plus I'm in w/d by 8 hrs. I really need to get on a different opioid for the CP cause this is getting out of control. Are opiods/opiates dangerous after prolonged use at high levels?

[Chipper]

Are opiods/opiates dangerous after prolonged use at high levels?

Not if you slowly build up your tolerance and can then maintain. It's the method of administration and legal issues that can bring us undone.

[mart1n]

While SWIM was still down in San Francisco dealing OC, before moving back to Seattle to attempt to get clean, SWIM was using 1200mg-1600mg of Oxycodone daily via IV. SWIM was at this tolerance level for 1.5-2 years and was still able to get high and catch a nod. SWIM's wife on the other hand, who was using at the same rate hadn't gotten much of a high at all for over a year. So... I think it's different for everyone, just like anything else with opiates.

[Uncle Wiggly]

I once had a doc tell me that every one has a magic number. In other words no matter how high one's tolerance becomes there will come a time when when said person will ingest enough to send them into respiratory shut-down.

I have thought about this "breaking point" often. Many of us on this board are able to consume quantities of opiates that would kill those who are opiate-naive or with a relatively low tolerance. I can see how, by slowly increasing dosage over time, one could easily raise the OD point very high but no one is immune.

It only seems logical that there would have to be a point where "X" (drugs consumed) would outweigh even the most hardened addict's tolerance level. I'm having difficulty putting this into words but hopefully some of you understand what I'm getting at.

It would be great to see what our health professionals think about this.

[lilred0005]

Not if you slowly build up your tolerance and can then maintain. It's the method of administration and legal issues that can bring us undone.

Thanks Chipper, I was asking because I saw a YouTube vid. yest in which this kid is saying how large doses of Oxycodone can cause a myriad of health problems. I was under the impression that Oxy & all other opiate/opiod full agonists were perfectly safe alone except for the chance of OD. Uncle Wiggly, that's kinda scary. So it doesn't matter how long you've been on opiates that despite tolerance anyone can OD at anytime(after taking a dose)? Did the Dr. say if there are any warning signs? Say, I take my 300mg dose & maybe add 15 extra mg & I then OD? I am very afraid of ODing & thought I was somewhat immune as long as I stay around the same amt. & only take it orally. I ODed once off IV heroin & it was a terrible experience. There is no hell to compare w/ being shot up w/ Narcan, ouch!!!!! Don't get me wrong, it's better than dying but it was very very painfull to say the least. Any heath pros want to comment on the possiblility of OD despite a tolerance?!

[Duckfeet]

This is often brought up as a reason heroin-maintenance wouldn't work, as people presume they always want more and more, etc...but on the contrary, studies show that at a point, they seem to stabilize...sometimes myths get started, and we repeat them, since it's all we personally know...I can't remember having enough drugs to where my tolerance quit increasing, and my tolerance is beyond belief...even if I haven't done anything in months, and get a bottle of pills, I'll start out small enough, "feel" that, then double it, then double it, then look for heroin...but I don't learn from the past real well, either...

There are other factors at work, tho, kind of, like, we just automatically keep wanting to go up on methadone, even tho it doesn't change shit, or why I'll waste a perfectly good shot of heroin--that I'd actually "feel" in the morning--by doing it while I'm still loaded, and feel nothing, and come much closer to o.d.ing...common sense has never been our strong suite

[Uncle Wiggly]

Uncle Wiggly, that's kinda scary. So it doesn't matter how long you've been on opiates that despite tolerance anyone can OD at anytime(after taking a dose)? Did the Dr. say if there are any warning signs? Say, I take my 300mg dose & maybe add 15 extra mg & I then OD? I am very afraid of ODing & thought I was somewhat immune as long as I stay around the same amt. & only take it orally. I ODed once off IV heroin & it was a terrible experience. There is no hell to compare w/ being shot up w/ Narcan, ouch!!!!! Don't get me wrong, it's better than dying but it was very very painfull to say the least. Any heath pros want to comment on the possiblility of OD despite a tolerance?!

To be honest I'm not really sure. That's why I'd be interested in what some of our health pros have to say. The way I understand it is that, no matter what your tolerance level is, there comes a point when you ingest so much at once that's it's going to zap you.

I may be totally misunderstanding the concept. It seems logical. ie - Ones tolerance is to the point where you can ingest XXXmg of whatever. But, when you get to the point that your serum level is high enough you will stop breathing because you've went over your personal line. Please don't take what I'm saying as fact. This is my interpretation of what my PM doc told me. It makes sense to me but I've been wrong many times before so why should I stop now. ;)

I'm having a hard time putting my thoughts into words today. Lack of sleep and kidney stones usually does that to me.:rolleyes:

[ryan]

There was that story of that Utah man who was synthesizing and using some uber potent opiod and his tolerance was so far off the charts that he couldnt be maitained even on the most rediculous amount of methadone. I remember Robojunkie talking about it. He used amounts that would drop many men dead to the ground.

I think the dude killed himself cuz he couldnt take the WD.

Sobody feel free to clear this story up for me, but I do remember the meat of the story went something like that.

His name was Thomas K Highsmith...when talking about ubertolerance people usually refer to "Highsmith" levels -- as he most likely set the bar for the highest possible opioid tollerance known to mankind.
The drug he synthe'd was etonitazene, and he used it with a nasal inhaler...he used it for so long that his equivilant morphine tollerance was about 50 grams of morphine per day (IIRC, not sure about this to be exact).

I'm not sure if the rest is true, but what I've heard is that he got popp'd, and no amount of methadone would fix his wd's so he became an hero. Not sure if that's true but still scary as fuck.

How high your tollerance can go depends on which opioid you are using.

Most heroin maintenance users report that it has a cieling effect at about 500mg...
So this guy talking about 7 grams of dope per day was either full of it or using stuff that was extremely cut.
Anyways -- After 500mg -- they level out, and they don't even want any more (I believe Nick talked about this in another thread).

But with more potent opioids, like fentanyl, etorphine, or etonitazene, I would think the possibilities are limitless...although there are only so many receptors...once they're all full can't really go any further..

[libertine]

Erowid has this to say, supporting the theories above,

As usage increases, however, the doses get much higher. Dr Lotsof wrote "In close to twenty years of research and involvement with the treatment of opioid dependence with ibogaine the highest dose I personally saw used of heroin in Europe was 2 grams [per day], that is 2,000 mgs." 2 grams per day, however, is extremely high, much higher than most heroin addicts achieve. Heroin is very expensive and this dosage level would be fatal in most people who had not worked up their dosages slowly.

and a little more interesting

When the Swiss government began allowing maintanence of heroin users, they were able to collect reliable data about exactly how much heroin was being used. The Swiss found that users offered unlimited quantities would, on average, max out at between 300 and 500 mg. of diacetylmorphine per day. One author writes "I've known people prescribed a full gram per day, but they were quite unusual, and such habits on the street are impossible except for relatively high level dealers. Remember, I'm talking about pure pharmaceutical or number 4 if on the street. There are certainly cases of pain patients receiving larger equivalent dosages of opioids, but I've never heard of one of these beating a 1000/1 ratio."

The Swiss data was published in 1999:

Prescription of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort Study

Page 20 states that the mean daily dose of heroin IV ( when used alone, without methadone on the side) was 491.7mg.

Page 22 states "A stable dose was achieved after 6 months at most; beyond this point, almost no further increases in dose were required."

Later in the volume, the authors state that most users tend to gradually reduce their dosages after achieving a peak.

This Swiss data is the best currently available about maximum daily heroin dosages when humans are given nearly unlimited access to the chemical. Using their data, it appears the actual ratio between initial doses of heroin, a low of 5mg per dose, and highly-tolerant maximum daily doses of heroin of about 500mg, this is a 1 to 100 ratio. But it also ignores the difference between single-dose use and repeated dose use. In the same way that its easy to finish off several bottles of wine over the course of several hours, while few ever drink several bottles of wine in just a few minutes, heroin users who are using throughout the day will go through a lot more heroin. So its inappropriate to compare single-dose initial values to daily-ingestion amounts. The increase between no-tolerance dosages and high-tolerance dosages is thus much less than 1 to 100.

[ryan]

Yay I was right. Thanks for that lib.

[Papa Verine]

Robojunkie posted about this experience when he was using high doses of Fentanyl. According to him, there is a point at which you can no longer get any higher. I don't think the risk of OD can ever be below the dose needed to achieve a high. So, I wouldn't worry about that.

For me, I've noticed that I would reach a very high tolerance, then gradually bring it down, always. I never tried to keep going up, up, up even when I could afford it. At one point I was using about 10 bags of dope a day and chewing 100ug Fent patches at the rate of 1 a day. That's the highest my tolerance ever got. I was only maintaining at that dose in the end, and didn't see any use in increasing my dose. It just seemed like to much work to get high that much every day. The same thing happened with my last tea run. It got to be too much work and I had to bring it down, without even thinking about it.

I can't sit at home all day making tea, or fixing, or whatever... It HAS to level off at some point.

[ryan]

Robojunkie posted about this experience when he was using high doses of Fentanyl. According to him, there is a point at which you can no longer get any higher. I don't think the risk of OD can ever be below the dose needed to achieve a high. So, I wouldn't worry about that.


Yup, sounds right. Depending on the opioid you are using, there are only so many opiate receptors -- eventually all of them will fill up. If you have steadily increased your tollerance (like most addicts do) then ODing is actually very hard to achieve. Now I am talking about STEADILY increasing tollerance, not huge jumps here. It's been my experience that most people who overdose:

(a.) have some kind of polydrug interactions [benzos, alchy, barbs, or any other CNS depressant + opiates]
(b.) get clean then relapse and use too much by accident
(c.) dealer gets new dope that isn't cut properly (properly meaning compared to his older stuff) or is actually fent or something else other than heroin
(d.) take relatively large jumps in their dosing to achieve a better high

Most addicts like me steadily increase their tollerance by using more and more gradually.
I've also found that when my tollerance gets really high the amount of dope it would take for me to OD is actually not even obtainable (if you want to look at this another way, basically I stop getting high because the amount of dope it takes to get high just costs way too much). There's certainly a supply factor in here as well.

Uncle Wiggly, that's kinda scary. So it doesn't matter how long you've been on opiates that despite tolerance anyone can OD at anytime(after taking a dose)?

I'm sure anything is possible, I've heard of people ODing just because they used somewhere unfamiliar -- but highly unlikely. PapaV's idea sounds much more logical, and pretty much along the lines of my experience as well. Also the risk of overdose gets alot greater when using ultra-potent opioids like fentanyl when compared to morphine or heroin.
It's alot easier to OD on something that inceases in potency by the microgram rather than milligram.
However, everyone is different. Perhaps there is something to wiggly's doc's "Magic number" theory...

I don't think there are controlled studies of overdose in humans with opioids so we could actually come up with a mean number...but I could be wrong? After all, all it would take is a shot of narcan to bring someone back...althought I highly doubt anyone would approve such a study because of the risk of death being too great. I guess autopsy results could provide a mean number if you took the drug concentration...but you would have to account for tollerance also...ugh there's just so many freaking factors here, some of them unknown (like addicts overdosing simply from using some place they are unfamiliar with even with their normal dose)

[Duckfeet]

My two serious overdoses weren't as a result of tolerance so much as "miscalculation" on my part...first time, I just was young and didn't *really* think "that little bit of heroin" would send me out...I was used to more cut, brown powder, and this was white dope from Chicago (before fent hit the streets), and I went out within seconds...

Second overdose, was on methadone, and even tho I was daily user and had a tolerance of course, I really wanted to "feel" it, and so I did a second shot, and again, out I went...

Most junkies, I think, are pretty aware in general terms of tolerance...but we just can't accept that we have lots of dope in our bodies and won't feel that warm, life-giving happy euphoria we once got...

The other overdoses mentioned--alcohol, benzos, etc., are true, and often happen to people who just don't realize what's going on, or, w/methadone particularly, that it takes some time to feel the effects, so they do more...

It's such a *subjective* thing, and hard to quantify...

[The Paregoric Man]

Thats funny about all receptors being full and you can't get any higher, I always thought when that happened the body started growing more and the one you have currently become less sensitive. In lay terms obviously, maybe there is a point where no more can be produced.