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Opioid-Induced Tolerance

Table of Contents

Aside from many other dangers associated with long-term opioid use, opioid-induced tolerance, which is marked by the loss of desired pain-relieving (analgesic) effects, can be one of the most dangerous. Opioid tolerance essentially means that over time, an increasingly higher dose of the drug is required to achieve the same pain-numbing results. Depending on the advancement of each individual’s disease, increased doses of opiates may also be prescribed.
Tolerance to opioids including OxyContin, Methadone, Suboxone, Vicodin and Hydrocodone, is believed to be caused by physical changes to the opioid receptors on cell surfaces. One explanation is that over prolonged use these receptors experience “desensitization,” which causes the user to feel more pain, triggering the need for an elevated narcotic dosage. Another source of opioid tolerance is caused by a phenomenon where the opioid receptors are internalized by the cell itself. This process, called endocytosis, results in fewer opioid binding sites on the cell surface that are openly available to provide pain relief.

Chronic Pain Management

Opioid tolerance is well-documented around the world. In a study by Bhamb et al. 2006, approximately 61 percent of all physicians noted a concern about tolerance developing in chronic pain management patients. The condition is so prevalent that the FDA also applies its strongest caution, known as “Black Box” warnings to certain opioids. “Black Box” warnings are only used for those prescription drugs that cause serious negative effects, which have been thoroughly documented and studied.
As patients build increasing tolerance to their opioid prescriptions, a related consequence known as hyperalgesia also becomes common. The features of opioid-induced hyperalgesia include an increased sensitivity to pain, and the worsening of pain regardless of increasing doses of opioids.  Pain may also become more widespread and develop beyond the sites of pre-existing pain. Hyperalgesia can transpire with any opioid dose, but it is often associated with high doses of morphine or hydromorphone administered via injection, infusion or implantation.
If you or anyone you know is experiencing increased tolerance to opioid medications, we urge you to consult your health professional. The Waismann Method is a pioneering medical opiate detoxification procedure that provides an alternative option for treatment to prescription painkiller dependency. Performed in a hospital intensive care unit, the Waismann Method utilizes careful administration of medications to reverse the physiological dependence on opiates while the symptoms of withdrawal are addressed. During the procedure patients experience minimal conscious withdrawal. Following treatment, patients are opiate-free and stay at the Domus Retreat where they are supervised by a team of professionals as part of the recovery and transition process.

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