What is the highest dose of meds you have heard of anyone being on? With all this talk of tolerance, I'm wondering, how high could a person go? My doctor once said that there is no ceiling for narcotics in this situation (incurable pain), but how high HAS anyone gone? Are we the guinea pigs? Or the canaries in the mines? Is there really no limit, or can these meds harm us at very high doses? (I am not talking about a sudden change, but the slow increase after a person develops tolerance.)
Last edited by pain research; 01-04-2007 at 10:08 AM.
Interesting question and it made me think. I have a friend with a husband that died of pancreatic cancer--I do not know what they gave him while he was in the hospital, but before that while at home he had a 100Mcg Duragesic patch, 160Mg Oxycontin--2x per day. Percocet (5mg) every 4 hours. I am sure other people have heard of or seen higher, but that seems like quite a bit to me.
There are people who are on extremely high doses. I know Dave (Shoreline) has posted about some people he knows who are really on high doses. When I was on Oxycontin, I was at 160 mg TID (480 mg per day) and 30 mg of Oxy IR QID. I was switched to Duragesic from there.
I've read about folks wearing as many as 12 100 ugh patches, another used 1800 mgs of morphine a day plus BT meds, another used 600 mgs of methadone a day, anyone using more than a couple 1200 or 1600 mic Aqtiqs pops a day is prety phenominal tolerance compared to these daily doses spread over 24 hours.
I got up to 600 mgs of Kadian a day. It's how you tolerate the side efects and how functional you want to remain that truly limits the dose. Some people will spend 20 hours in bed from just a couple hundred mgs of morphne a day, some take that much in a single dose and it doesn't phase.
I guess the next logical question is how long does it take? There is no absolute answer, I've seen it takes a couple years and I've seen it take less than a year to increase too thousands of micrograms of fentanyl per pay using Aqtiq. I've also seen folks stay at the same dose for sevral years although it may apear high to some.
There is no right dose somone should be on for failed back surgery or Fibro or Migraine or any problem. It has to do whith what you have been exposed to in the past and how well you tolerate the meds and side efects. The dose has to be suited to the patient and controlled by a doc that is aware of what that dose is truly doing to the patient.
I've read about folks wearing as many as 12 100 ugh patches, another used 1800 mgs of morphine a day plus BT meds, another used 600 mgs of methadone a day, anyone using more than a couple 1200 or 1600 mic Aqtiqs pops a day is prety phenominal tolerance compared to these daily doses spread over 24 hours...
Good luck, Dave
12 100µg patches at a time.
At one time I was prescribed 250µg (2 75µg patches and 1 100µg patch) Duragesic patches every 48 hours, and up to 8 1,600µg Actiq lozenges per day. I reached this point over a 3 month period with three consecutive bad lots of patches that were dumping their contents in a matter of about 7-10 hours or so. I would complain that the patches seemed to be going flat really quick and was told to replace one if it was bad. I could tell they didn't believe me, and it took months for the problem to come to light publicly. Problem was my blood level of Fentanyl was going through the roof. What a horrible experience. It's hard to believe that now I'm using 80mg of Methadone per day and am enjoying much better pain management than ever before.
Hi PR, I hope SC answers, But I've done a lot of reading about meth and one of the most unusual properties is that when using it to prevent withdrawal, the higher the dose of other opiates, The greater the conversion factor. The chart I remeber best looked something like 100-200mgs of morphine and you used 3:1, 3oo--500mgs of morphine and you use 4:1, 500 -600 and you use 5:1 as the factor. The chart went uo to 1000 mgs of daily morphine and at that level of dependency 10:1 or 100 mgs of meth per day is enough methadone to prevent withdrawal.
The theory suggests the higher the level of dependency and prior use of opiates the lower the degree of cross tolerance. I've also read that 80 to 120 mgs of meth is enough to prevent most withdrawal from any dose of injectable heroin or morphine.
That is a huge dose of fentanyl SC, and it went up amazingly quick, but it does support the info in the article. I've jumped back and forth between 600 mgs of morphine and 120 mgs of meth several times. The switch to meth was always easy, but the switch to morphine was pretty unpleaseant every time for about 3 weeks.
Dave - this question isn't exactly related to the topic, but I wanted to see if you can answer it for me. I was in a position this month where I didn't have ANY break through meds (30 mg. oxycontin 1 tab every 4 hours if needed for break thru pain) for the last two weeks of the month. I was taking my usual dose of Methadone (40mg., 3 times a day) but the pharmacy only had half the amount of the oxy on hand. I decided to see how I could manage without the oxy. It was not fun, but what I want to know is why I didn't have ANY withdrawal symptoms from stopping the oxy cold turkey? Can the methadone really have prevented my body from going into withdrawal from that much oxy? I've been taking the oxy regularly for more than 1 year now. Can you explain?? Thanks. BTW, I'm going to go back to the oxy for bt pain...but now I know I can get through without the amounts I was taking before. KathyMac
Hey Kathy, I do think the meth had a role in preventing you from experiencing withdrawal. Also if your not taking the max dose every day on a sheduled basis the way docs fear BT meds will become part of the daily routine, BT meds shouldn't be a big enough portion of your daily dose to cause withdrawal if you skip days or even weeks.
It's great the meth is working so well, and between the meth and using BT meds the way their intended is why you didn't feel bad. The month my neighbor broke in and stole 3/4 of my BT meds, I didn't have a problem as far as withdrawal, they just aren't a big enough part of my daily opiate intake and I don't use them on any sort of regular shedule or set daily dose to make that kind of difference.
Sorry it took so long to get back. I worked fri and sat and I'm just now feeling human again.
As mentioned, I really was on an incredibly high dose of fentanyl. Shoreline mentioned conversion ratios, and I believe for my final dosing of fentanyl, the conversion ratio to methadone would have been between 10:1 and 12:1 I believe, if one were directly converting.
However, I did not directly convert. As a matter of fact I had to endure detox first, where my opioid level was zeroed out, then started on Methadone from scratch. So I can't really answer how it went going right to Methadone.
This is still hard to write about, emotionally, but it does explain how I got into such a situation and how things turned out. I had begun with Duragesic patches using the 50µg units, rather than the 25s, as I was already on another opioid and the patch was judged to be better. I was also started with the Actiq lozenges at the 400µg level, up to 4 units per day. This worked well for awhile but it wasn't long before tolerance kicked-in and the dose had to be raised. So, over a two year period my dose was increased until I reached the level described in my other post (275µg/hour patches and up to 8 or more 1,600µg Actiq lozenges). It was discovered that the final three prescriptions of the patches I received (the 75µg/hr units) were from bad batches (this was announced by the mfgr a couple of weeks after my detox experience). I had always had difficulty with the patches and sweating. I had to use Tegaderm to keep them for the 48 hours. So my dr already knew I was a bit patch-challenged, but it was by far the best option for my situation. Then, all of a sudden, the patches began acting strangely, and not long after that so did I. I knew the patches well enough to know that the reservior was being depleted way too soon, sometimes within 6 hours. The first incidence was "written off" by my dr and I, so it was just replaced. Actually, this went on for a bit as neither of us knew how to react to this. For all we knew, it was just something to do with me being patch-challenged. Of course, during this time my blood level was rising. I had no knowledge of any prior similar incidences with leaking patches, and apparently neither did my dr. So we had nothing to work from. As this situation continued I began to struggle with my body reacting to the ever-increasing levels of fentanyl, and my pain level was actually rising! Then I received a CT Scan for an abdominal problem and it showed lung spots on both lungs, all lobes. Scared the you know what out of me. I was also running a constant high fever. I was beginning to break down. (I didn't realize it at the time, but my abdominal problem was actually Celiac disease, gluten intolerance, and I was under dr orders to eat as much wheat fiber as possible because of an earlier bowel obstruction - wheat is loaded with gluten so I was killing myself and not knowing it - during this 6 month period I lost 80 lbs). This was all happening at the same time. As my fentanyl blood level continued to rise I was essentially walking around anesthesized. My best friends coworkers told me I was zoning out after each lozenge. It didn't seem that way to me, but I trusted their input.
Ultimately I was hospitalized - this was after 3 months of the as yet unknown bad patches and also from the as yet unknown celiac disease. No one knew what was happening to me. I was switched to IV fentanyl and as high as they kept raising the dose they couldn't find a level at which I wasn't withdrawing. And the pain was unbelieveable (both from chronic pain and abdominal pain from celiac). By this time I had pretty much lost it. I was no longer thinking clearly. I recall my pain dr saying "I wish we could zero you out and switch you to methadone." I was also visited by a psychiatrist who was also an addictionologist who mentioned that with pain meds one can suffer from rebound, where the meds can actually begin to contribute to a pain state. I believe he referred to it as hyperalgesia, where one becomes supersentisized to painful stimulus and existing meds are worse than useless. His recommendation was a full detox, which I chose. No one even offered being tapered off of the fentanyl or a direct conversion to methadone or any other opioid. I can't go into the withdrawal experience because it's really bad memories. They shot me up with buprenex and I suffered terribly.
Six months later we began with methadone. At first the dose was 2.5mg every 6 hours. I finally reached 20mg every six hours quite some time ago and have remained there ever since. I was also allowed three 200µg Actiq lozenges per day, but recently stopped that as I couldn't really feel the benefit and I refused to go to a higher dose. In reality, the methadone is quite good and the need for breakthrough meds really isn't that urgent.
As it turns out, a few weeks after the detox I received a call from my pharmacy, and that's when I learned that I'd been getting bad 75µg patches for over three months. This was the first alert received. You can't imagine all the emotions I went through trying to make sense out of the whole experience. At the worst point I was facing the loss of my job, my family and also my life. Had they not discovered the celiac disease, it wouldn't have been long before I suffered heart failure, and I'm sure the ongoing overdose of fentanyl would have made things that much worse.