Aa
Aa
A
A
A
Close
Avatar universal

Opioid cross tolerence?

Joe
Dr.Steve,

I was wondering if tolerence to opioid pain meds translates to tolerence to other pain meds specificially fentyl.  The reason for my question, I'm having a medical out patient procedure done next week and I will be given I.V fentyl as an anestetic.  But since I am tolerant to my (presrcibed)oxycodone pain meds, I didn't know if the doctor should be giving me a higher dose of fentyl to handle the pain of the procedure or is this a mute point when it comes to fentyl?
19 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Hello Joe!


Yes, it can make a difference since they are both opiods.  Even though fentanyl is a morphine derivative and oxycodone is a codeine derivative, my experience shows that fact will not change anything.  Depending on how high of a dose of oxycodone you are on however, you may not have a high enough tolerence to warrant an increase in the fentanyl dose.

I would make sure that the physician ordering the fentanyl (whether it be an anesthesiologist, radiologist, etc.) knows the amount of oxycodone you take by telling that person YOURSELF.  Don't rely on the information being relayed to them via the form you fill out when you check-in or the nurse who swares they will tell them - do it yourself.  Voice your concern about pain BEFORE and DURING (if you will be conscious) the procedure.

If you have any more questions, please ask.


Good luck!
Jim
Helpful - 0
Avatar universal
Joe, I agree with Jim,  Make sure you are the one to tell the Dr/anesthesiologist.  Being a nurse myself I do know how some important facts do get "lost" in the schuffle.  After i got out of treatment for opiate addiction i was taken immediately to surgery and made sure everyone knew about my high tolerance to opiates.  Good luck.
Helpful - 0
Avatar universal
I don't know what your specific daily intake of oxy is, but unless you're addicted and taking handfuls of the oxy's instead of the 2 you're supposed to be on per day, I doubt if it wil be much of a factor in your fentenyl dose. Fentenyl is, by weight, the most powerful narcotic on earth. I doubt if the anethesioligist will increase your initial dose. He may monitor your vital signs a little more closely to see if you're coming out of it early. But I betcha he doesn't increase the intitial dose of that stuff. I've had it for back surgery while I had a 30 Vicodin per day habit. I didn't tell them anything about my habit and it certainly didn't interfere with the fentenyl knocking me out. I'd say it will be more of a factor for your post-op pain medication. That's when your tolerance will affect the relief you get. Of course, you've got the Oxy to use, anyway, I assume, and that stuff should take care of whatever hurts. Good luck.
Helpful - 0
Avatar universal
Thanks to all of you for your responce, I am taking 8 roxicodone (40 mg of oxycodone a day).  Unfortunatley, its wearing off so fast(2 last about 3 hrs) that it doesn't cover me the entire day.  I'm kind of worried, I just had it increased from 6 to 8 /day and if I go back and say its still not enough he will start to think  otherwise, but I am taking them for real pain, no abuse here.  I read on this forum that people who don't abuse oxy are as rare as a 3 dollar bill, that kind of thinking makes me nervous when asking my doc to increase my pain meds for ligitimate reasons
Helpful - 0
Avatar universal
Hey, where are you?  I'm having surgery (female stuff) next week, probably.  I'm terrified of the pain.  I came clean with my Ob/Gyn...hopefully they can keep me comfy.  Last surgery really sucked.  I am wondering how you are.  Things are OK here.  Not clean, but not binging or the like.  Still love the high...funny thing...I actually have real pain and now I can't take opiates.  Can't wait til the Verced and Demerol in the hospital.  Gotta run, my back is killing me.  Take Care, Neena
Helpful - 0
Avatar universal
I notice you're taking the short acting version of oxy. There is no time-release effect with roxicodone. It is not unusual at all for you body to process straight oxycodone in four hours. Pretty standard for narcotics. Ask him for OxyContin. They are 12-hour time release. Used properly in the right amount (meaning don't chew them up, but swallow them whole), they will provide pain relieve superior to almost anything short of methadone. This could solve your problem without alarming your doc. Just ask him about the twelve-hour time release OxyContin. They work like gangbusters and won't be abused nearly as often if patients take them whole, as opposed to chewing them up for an instant, highly addicting rush. Check em out. The key to good pain management is steady, continual small inductions of opiates, as opposed to waiting 4 hours and then taking a dose that hits you like a truck, then runs out in two hours. Good luck.
Helpful - 0
Avatar universal
I am having surgery next week and have told my doctor of my addiction to Vicoden ES.  What are my options for pain relief?  Will the hospital know exactly what to do?  Should I ask my therapist/MD?  The pain after the procedure last time required 3 Vics ES at a time and even that was still extremely painful.  I am terrified and almost willing to cancel surgery if they cannot promise to relieve my pain.  Any help will be useful.  Thanks, Neena
Helpful - 0
Avatar universal
ask for PCA, Patient Controlled anesthesia. It's a little machine with a container of morphine in it. I was on one aftr back surgery. It attaches to you through your IV tube on your hand. You get a button that you can push whenever you need pain relief. It's great! You can give yourself very small, controlled doses of pain medicine when you need it. I used it and it kept me pain free but absolutely not "drugged up," that is, I was perfectly lucid and awake, could visit with my family or watch TV, completely pain free. Ask for it, Neena. It's called PCA.
Helpful - 0
Avatar universal
They will give a codiene addict Morphine at home?  This is something that I can utilize for 5 days?  Neena
Helpful - 0
Avatar universal
I apologize for misunderstanding your post. I assumed you were going to be in a hospital where they use PCA. I would certainly discuss your post-op pain treatment with your doctor before going into surgery. Sometimes, an opiate addict still needs to take advantage of their relief.

However, as long as your use is supervised, I imagine you will come through fine. Since your drug of choice was codiene, your doc will probably try to avoid codeine. MY guess is, he'll give you Ultram, which is not opioid in structure but affects the brain in the same way. If he offers Ultram take it. It's slow acting, that is, it takes about an hour before it takes effect  and works better after your second dose. But it's a very potent pain reliever and may be considered less likely to "awaken the monster" of addiction in you.

Beware of any bold promises by your doctor if all he gives you is an antiimflamatory like Voltarin or daypro. they might be good for arthritus pain, but post-surgical pain? I doubt if that would give you much relief. But you might mention the Ultram. A lot of doctors feel more comfortable prescribing it because it is not a scheduled narcotic, even though it provides pain relief the same way that an opiate does.
Helpful - 0
Avatar universal
I am so soory to hear you are having such problems. I just am so ashamed and disapionted with myself. I can't stop this crazy cycle. I still take percodan. I know it made me loose my job a very good one. Then I went to work for my wife at 1/8 the pay. Now I have jumped back into the work force with a great job to try again.The day after I started I went to the doctors and you know what happens there (another script)I am a bad example and can't be of any help to anyone trying to get off this crazy ride. I feel I will fail with this new opertunity. This drug does cloud your jugment and I need to be sharp all the time or many people could get hurt. All my atemps to quit have failed. I have been tying for 17 years. I know I have what I need to be a great success but this drug keeps knocking me right back down. The purpose of this site is to strengthin one another and I just can't do that. I feel I just don't have what it takes.


I will check back though. Hope you are doing well now,  JOHN B.
Helpful - 0
Avatar universal
C:\WINDOWS\Desktop\SARAH.bmp
Helpful - 0
Avatar universal
Hi: I had back surgery in about the year 1981-2.I was so afraid of taking a chance with surgery that I went through about 20 months of H***ish PAIN from the sciatica until my left leg started to gimp and I COULD ONLY walk with a heavy limp.I finally had the surgery,which turned out to be about 80% sucessuful,(where I could endure the pain with only taking about 2 pills a day of percodan every few days.I re-injured my back in a volley ball incident about 3 years later(and AFTER BEING TOLD THAT I WOULD NEED MORE SURGERY AND THAT I WOULD NEED EVENTUALLY RODS IN MY BACK IF THE OTHER VERTIBRAE WOULD START TO GO DOWN WITH GRAVITY AND TOUCH MORE OF MY NERVES,WHICH WOULD BASICALLY CANCEL OUT THE CHANCE OF ME WALKING AND EVER BEING ABLE TO USE MY BACK EFFECTIVELY AGAIN(I at once FIRST,took a lot of Pain Therapy Management Classes,MEDIUM STRENGTH PILLS and excersise.etc..etc..etc...But in didn`t do any(long term good) So I was literally forced(because of my CHEAP insurance carrier(I didn`t have cancer)???!!! and the restrictions on the types of drugs my doctor could legally OR WANT TO GIVE ME to seek a responsible way to treat this problem.I was forced to look for a outside source to relieve the pain.Here I am,a 36 year old Responsible white collar working adult(working all my life since 8 years old (with 6 years of higher education(in the early 1980`s and with never having abused anything(except concentual sex forced to look in the illict market for relief.I found it in my 2 year girlfriend and her job(a highly-placed nurse)with access to a drug called Fentyl.For the next 4-to 5  years,I would,under her supervision and guidence let me take Fentyl in a manner consistant with medical codes and especially cleanliness(I had to actually use less of the drug,because it`s availbilty to her was limited to a certain degree.(The good thing that came out of it (Was that since I DIDN`T TAKE IT EVERYDAY AND HAD SOMEONE THAT WAS PROFESSIONAL ADMINISTERING IT.I NEVER FEALT THAT I NEEDED IT FOR OTHER THAN MY PAIN.BUT,ALL GOOD/and perfect THINGS MUST COME TO A END,AFTER OUR BREAKUP,I ENDED UP getting(BECAUSE I HAD ALSO DEVELOPED A REALLY SEVERE ASTHMA AFTER SUFFERING FROM PNEUMONIA) A YEAR EARLIER)I HAD TO START TAKING SYSTEMIC(STERIODS)SUPPOSEDLY FOR A SHORT TERM,BUT MY DOCTOR(BECAUSE I WOULD CONSTANTLY CALL OR COME IN FOR ASTHMA ATTACKS(WHICH COULD HAVE BEEN TAKEN CARE OF WITHOUT STERIODS WOULD JUST KEEP SUBSCRIBING THEM TO ME(AND I DIDN`T HAVE THE BENEFIT OF A GOOD INTERNET YET ,SO AFTER A NUMBER OF YEARS,I ALSO DEVELOPED DIABETES FROM THE STERIODS, WHICH THEY FOUND STARTED TO GIVE ME NOT ONLY PAIN IN THE JOINTS(OSTEOPOROSIS)BUT,NEUROPATHY IN THE FEET AND LOWER LEGS.NOW THAT(WITH THE SCIATICA WAS JUST TO MUCH TO BEAR AND MY DOCTOR COULDN`T RELIEVE THE PAIN WITH ONLY 2-3 PERCODANS A DAY(HIS LIMIT TO PAIN RELIEF)(UNLESS I WOULD HAVE HAD TERMINAL CANCER(THAT WAY HE COULD BACK HIMSELF UP TO THE FEDERAL GOVT AND THE D.E.A.-SO AFTER SERIOUS THOUGHT,I WENT INTO WHAT`S CALLED A METHODONE CLINIC(THEY ARE USUALLY FOR PEOPLE THAT HAVE ADDICTION PROBLEMS(BUT I FOUND OUT THAT ABOUT 40%(APPROX.)OF THE PEOPLE THERE, WERE THERE BECAUSE OF SOMETYPE OF SEVERE PAIN THAT THEY COULDN`T GET RESOLVED THROUGH THE NORMAL DOCTOR METHOD. DR`S(at least in the early 80`s to the 90`s were SO AFRAID TO GIVE YOU ANYTHING POWERFUL THAT CAN KILL THE PAIN,UNLESS YOU HAVE CANCER AND ARE TERMINAL,SO THE MEDICAL COMMUNITY IS PARANOID TO GIVE PEOPLE THESE TYPE OF DRUGS,I THINK ONLY BECAUSE THE PATIENT IS NOT GOING TO DIE AND THE FEAR OF HAVING THE FEDERAL GOVERMENT COME DOWN ON THEM AND RUIN THEIR CAREERS,NOW I GO TO A METHODONE CLINIC(A DRUG WHICH I CAN`T STAND TO TAKE,BECAUSE OF IT`S MENTAL EFFECTS AND PHYSICAL EFFECTS))THAT MAKES ME LISTLESS ON OCCASION WITH BOUTS OF SERIOUS CONSTIPATION(EVEN IF I EAT A TON OF FIBER A DAY) AND MAKES ME LOOK IN THE EYES OF MY CLOSE FRIENDS THAT I AM SOMETYPE OF DRUG FIEND,which makes me want to hid the fact that I go TO A CLINIC and have the pain all the more and WHICH IS SO FAR FROM THE TRUTH.I PERSONALLY HAVE TO ADMIT THAT I LIVE A 90% FREE PAIN LIFE NOW,BUT AT THE COST OF NO KNOWING THAT I AM PHYSICALLY ADDICTED TO THIS DRUG AND IS SOMETHING I NO FEEL LIKE I HAVE TO HIDE.What would someone else do in my place???PLEASE don`t insult me by saying (go to another doctor ,they are much more liberal about pain now and that they don`t have to worry about the federal govt,etc..etc..etc..) because it`s JUST NOT TRUE.(The best doctors in these fields were taking there residency requirements to become doctors before 1980 and during my intial problems(1985-1993)and they haven`t changed there additude one bit.They are still extremely afraid to get rid of your pain(don`t believe you when you tell them the truth to why you are going to a Methodone clinic AND HOW MUCH PAIN YOU HAVE(INSPITE OF A 1000 PAGES OF DOCUMENTATION FROM 20 HOSPITALS AND 30 OTHER DOCTORS.When I go to a new doctor,I still hear things like "I wasn`t born yesterday" or "I`m sorry I don`t perscribe that to anyone" or ONE TIME even I was asked FLAT OUT)"Where do you inject yourself",I don`t see anything on your arms)or legs SAYS THE DOCTOR TO ME(THE NEW DOCTOR THAT REPLACED MY OLD ONE BECAUSE HE WANTED TO GO INTO TEACHING MEDICINE IN A OTHER STATE?? WHAT A INSULT THAT WAS!!!!!.Even when they(ANY DOCTOR)DOES trust and believe you,they look at you with a degree of suspision(the way,I would look at someone that said yes I have shared needles for 30 years WITH 1000 PEOPLE and I don`t have HIV or Hepitatis with a absolute certainty(WITHOUT BEING CHECKED,even though they can`t keep there eyes open at 3 PM in the afternoon and are so thin and barely cohertent enough to talk to me???. but ,I feel like I have been forced into this by societies attitude toward drugs(one`s that I have the same narrow view of also??get that?? But mostly by Doctors(which shouldn`t have that view) liberal use of the drugs with steriods,I don`t no how they can sleep at night,knowing that they are destroying futures,because they are giving steriods out,even for the slightest cough or wheeze.I now have about 10 problems,that were origially 2..I now have to decide for myself, how to best take care of my problems and my health,because all the Doctors who started me off on steriods are now moved or changed locations(or even professions(for example: My girlfriend(after seeing all the abuse and suffering of so many people because of SO MANY doctors attitudes to pain management has given up a profession and the money that took her 6 + and plus years of higher,continious education and 13 years on the job to get.Someone tell me.What do you do in a situation like mine?? and while your at it.I have heard a million times that Methodone has absolutly no ill effects on your body or liver etc..IS THAT TRUE>>>I will be looking for a honest reply.......ronnie
Helpful - 0
Avatar universal
Ron
I just wrote a fairly semi-long letter to people telling them about doctors not taking care pain properly and giving you steriods like there candy until you get osteoporsis,diabetes,edema and nothing but joint pain where you have to take harder drugs and I get told that my letter was rejected because it was a old stream.this site is not worth my time
Helpful - 0
Avatar universal
Ron
I just wrote a fairly semi-long letter to people telling them about doctors not taking care pain properly and giving you steriods like there candy until you get osteoporsis,diabetes,edema and nothing but joint pain where you have to take harder drugs and I get told that my letter was rejected because it was a old stream.this site is not worth my time..now this one is being rejected because of a long stream(i just got on..........
Helpful - 0
Avatar universal
.......If you have the time, read some of my postings.  I have gone through similar problems trying to get releif.  Now I have a phobic husband.   I have been left to suffer for years.  I was undermedicated after a recent surgury, and would gag/vomit and nearly pass out due to the levels of pain.  I have been made to feel likie a "drug-seeker, junkie....you name it.  Even my own husband makes me feel like this.  All because we are not going to die from cancer......we should be able to accept the levels of pain we experience???  And the media, pharmacies, dea, doctors, and legal system are no help.  
I am trying to write an essay about my experience in the US as a intractable, non-cancer, chronic pain sufferer.  Tom/Pat has aggreed to edit it for me.  He's terrific at this.  Why don't you consider doing the same.  I want to get this message out.  SAY NO TO SUFFERING!!!....The new "War against Pain!"  lol
I have to be honest though.  I am scared to become addicted, untill I have an educated, doctor to treat my pain.  Someone who will do exactly what your girlfriend was doing.  Well give me some feed back.  Look forward to hearing from you.

Annie
Helpful - 0
Avatar universal
Ronnie, I am in total sympathy with your situation. Methadone is about the best you're going to be able to do, from what I understand, unless you can find a pain specialist who will prescribe Fentanyl patches, about the only thing I know of as powerful as Methadone. What about the new MS-Contin -- time release morphine? There's also Levo-Dromoran, although it's probably hard to get outside of the hospital? Perhaps you need to find a younger pain specialist who might be more open-minded about the options out there. Sub-lingual buprenorphine might just work. The point is, there are a number of new drugs out there, if you can find an open-minded doctor willing to try them. Good luck.
Helpful - 0
Avatar universal
....I guess we lost Ronnie, also.  Oh well.
Helpful - 0
Avatar universal
When you write this book let me know I could write a few chapters for you!!!! They could be titled another chronic pain sufferer losses her mind..more on the 11 oclock news. Or 'where oh where have the good Docs gone, Oh where oh where could they be?' This could be the lead song on the CD that you can sell with the books LOL
Helpful - 0
Have an Answer?

You are reading content posted in the Addiction: Substance Abuse Community

Top Addiction Answerers
495284 tn?1333894042
City of Dominatrix, MN
Avatar universal
phoenix, AZ
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Is treating glaucoma with marijuana all hype, or can hemp actually help?
If you think marijuana has no ill effects on your health, this article from Missouri Medicine may make you think again.
Julia Aharonov, DO, reveals the quickest way to beat drug withdrawal.
Tricks to help you quit for good.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.