Opiate Tolerance – FACT OR FICTION

Opiate Tolerance – FACT OR FICTION – National Pain Report – Aug 2016 – By Steve Ariens, Ph.D.

Finally, someone of authority is stating the obvious:

  1. An increase in pain is like an increase in any other symptom of a disease and it requires more palliative treatment.
  2. For everyone, pain increases with age
  3. Pain increases with activity

We often hear about chronic pain patients need to increase their dosage because of tolerance to their medication(s).

Many of the people that put out all these “facts” tend to blend various facts about pain medications – opiates in particular – and apply it to all those who use opiates both legally and illegally  

Factually, those people who use opiates illegally – to get high – to silence the demons in their head and/or monkeys on their backs… will rather quickly develop a tolerance to getting “high” off of the same amount of opiates … so they tend to increase the amount of opiates that they take to seek that “high” that they were able to reach when they initially started abusing some substance.  

This is actually the usual tolerance issue: the dose that gave a person the high they were seeking requires constant increases as the body adjusts to the previous dose.

Now the chronic pain patient, many of whom are under treated in the first place. Their pain is caused by a disease state and all too often disease states tend to deteriorate over time and will cause additional pain.

This is the most logical reason for increased dosages, but it’s hardly ever mentioned in the literature.

It is normally assumed that if a disease’s symptoms increase, it means that the disease worsened. But not if the disease or condition causes pain.

If pain increases, it is always seen as tolerance to opioids and a reason to blame opioids for being “ineffective”.

Additionally, many chronic pain patients start down their pain path while they are in their younger years.. And aging itself will cause more aches and pain on top of the aches and pains they are experiencing from their disease state.

This is so obvious it shouldn’t require mention, but the anti-opioid folks ignore the aging factor completely.

Then there is activity induced pain. Most chronic pain patients only wish to be able to act/function like other people… to be “normal”.

Most of us can prevent a good amount of our pain by simply lying around all day. This is what we call “existing with pain”.

Call us greedy, but we want more than that. We want to “have a life despite pain”.

A patient’s need for increased dosing, doesn’t need a PhD in Pharmacodynamics, just a little common sense will explain a lot.

Common sense is exactly what’s lacking in all the alarmist reporting on opioids.


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