safety of opiate painkillers?

[zero222]

I am opiate tolerant and have been using painkillers almost daily for the last 3 years.  mainly hydrocodone and oxycodone.

I have tolerated doses up to 300mg/day but my tolerance is not quite that high as of late.

My question relates to the safe use of opiates when they are taken on their own without mixing with other drugs or alcohol and not injected.

In an opiate tolerant person such as myself using doses of said drugs orally, what are the chances of accidental overdose?  I have read that it is difficult for an opiate tolerant person to have a dangerous overdose unless they take extremely high doses.  I know everyone is different, but what would it really take for someone with a tolerance (let's say a single dose of 50mg hydrocodone or 40mg oxycodone simply makes them comfortable) who doesn't IV to have a dangerous overdose when taking only a full opiate agonist?  Thank you.

[zero222]

it seems as if you are putting words into my mouth.

i asked you to elaborate on the theraputic tolerance vs tolerance to overdose since i have never heard of it being explained like that and i gave the example of a methadone patient.  

can you elaborate on the difference since you are the expert?

thanks

[Julia M Aharonov, DO]

What you really want to hear from me is that it is safe for you to take as much opiates as you want because you have developed a high tolerance. I will not reinforce that assumption. Not only would it be cavalier of me, it would be highly unethical.
In my practice, during administration of anesthesia I occasionally find that some patient do have much higher tolerance and require much higher doses of medications. However that is done under strict monitoring of multiple vital signs and one-on-one supervision by highly trained medical personnel to make sure that there is a patent airway and oxygenation,etc.
When you are taking a bunch of pills by mouth at home and going to sleep, none of the above is available, so one might just wake up dead. You will not get approval from me. I like my friends alive and well.
Take care.

[zero222]

HI Julia, can you follow up on this please

thank you

[zero222]

I've never heard of the td/ed you speak of where tolerance to a toxic dose does not develop along the same lines as a therapeutic dose.

If this were the case, wouldn't patients who have had to step their dosages up be od'ing all the time?  What about patients who are on daily doses of 100+mg methadone for maintenance?

Please explain how something like this could be possible. Thanks.

[Julia M Aharonov, DO]

It is rather difficult for me to answer this question without going into technicalities. So allow me. With chronic opiate consumption tolerance does develop, you are completely correct. That actually causes the Therapeutic index also known as Therapeutic ratio TD/ED to decrease, which means that whereas the effective dose did in fact increase, the toxic dose may not have to the same degree. Thus, a patient may need a much higher dose for pain control, yet still overdose none the less.
So, I would recommend you to be very cautious, no matter how tolerant you may think you are.  Please let me know if you would like to get clean one day.  Resetting you system allows you to evaluate how much opiates you actually need and how much pain is cause by the development of hyperalgesia. We often work closely with pain physician who want to get their patients off of the opiates to reevaluate their situation before they resume treatment.
Good luck.