You’ve heard about the dangers of fentanyl, but you thought it would be safe to try it just a few times, in small doses. But after a couple of uses, it stopped working and you felt nothing. Now it’s 2 a.m. again and you can’t relax enough to fall asleep. What happened? How could something that worked so well suddenly stop working after only a week?
Opioid tolerance is a common response to using opioid drugs, especially the kind you get on the street. Fentanyl-related deaths in the state of Tennessee increased by 446% between 2017 and 2021. If you know someone who is managing an opioid use disorder, the caring staff at ReVIDA Recovery® can help. We specialize in opioid use disorders and can help you reclaim your life from addiction.
Table of Contents
What Is Opioid Tolerance?
Tolerance is a common response to any type of medication. It means that your current dosage isn’t working anymore and you need to take a higher or more potent dose to achieve the same results. Anyone can develop a tolerance, even if they have only taken opioids via prescription.
Opioid tolerance, dependence, and addiction are not the same.
Opioid tolerance does not imply that the person has developed a dependence or opioid use disorder (OUD). It simply means that their body has adapted to the drug and the current dosage is no longer effective.
The opioid class of drugs includes natural opiates derived from poppy plants such as opium, morphine, and heroin, as well as synthetic man-made drugs like fentanyl, methadone, and buprenorphine. Pharmaceutical opioids administered by a doctor to manage pain can result in opioid tolerance but rarely result in addiction.
When opioids are taken illegally, tolerance can quickly turn into dependence or an opioid use disorder, and the risk of overdose becomes high. Illicit synthetic opioids such as fentanyl are especially risky because they may contain higher doses than what the body can handle.
Although opioid tolerance isn’t the same as dependence or OUD, it can be a warning sign that your relationship to opioids is no longer healthy.
How Do the Mechanisms of Drug Tolerance Work?
For more than one hundred years, researchers have been trying to find ways to eliminate or reduce the adverse effects of opioids, but not much progress has been made. We do not know exactly how long it takes a person to develop a tolerance to opioids since it’s different for everyone. Anyone taking opioid-class drugs can quickly develop tolerance in as few as 2-3 doses.
Here’s how opioid tolerance happens:
- As a person repeatedly uses an opioid, the liver adapts and begins to process it more quickly. This happens because the specific enzymes that the liver uses to process the drug become more active. In turn, this speeds up the metabolism, or the rate at which the liver processes the drug.
- Also with repeated use, the number of cell receptors that the opioid attaches to, or the strength of that attachment, lessens. This causes the cell receptors to become less responsive to the drug.
As the brain and liver adapt and become less responsive to the drug, its physical and psychological effects diminish and the person needs to take larger doses to achieve the results they’ve become used to.
Does Drug Tolerance Change Over Time?
Developing a tolerance is common with many substances. You can develop a tolerance to over-the-counter medication, prescription medication, or illicit drugs.
When your usual dosage stops delivering the same effects, there’s a temptation to take a larger dose to achieve the same benefits. And while that may work for a while, it ends up accelerating the tolerance so that, over time, you have to keep increasing the dosage. Continuing to use illicit opioids after developing a tolerance is dangerous because it puts you at risk for dependence, OUD, and overdose. Fortunately, most drug tolerance, including opioid tolerance, can be reversed with a period of abstinence.
Knowing the difference between tolerance, dependence, and addiction is important to understanding how opioid use disorders can evolve.
- Opioid tolerance naturally occurs when you take an opioid drug consistently over time. You need to take higher doses to achieve the same results. This is not as severe as developing a dependence or OUD, but if you ignore it and take larger doses to compensate for it, then tolerance can lead to dependence, OUD, or overdose.
- Opioid dependence is a purely physical condition that does not imply the person has an OUD. Dependence means that there may be withdrawal symptoms when the person stops taking the drug. Dependence is a normal biological result of taking an opioid medication or drug regularly. It shouldn’t be ignored, though, because dependence can lead to OUD.
- Opioid use disorder (OUD) implies a misuse of opioid drugs, ranging from very mild to severe. There is no one-size-fits-all treatment for OUD because different levels of the disorder are addressed with different types of guidance or treatment. Without guidance or treatment, milder forms of OUD can progress into more serious forms.
- Opioid addiction is the most severe form of OUD. It’s usually recognized by the person’s determination to continue using the drug despite negative consequences. At this stage, opioids affect the reward center in your brain and you experience a strong compulsive desire (craving) to use it again. Addiction is typically accompanied by higher levels of tolerance and dependence and is both physical and psychological.
Tolerance, dependence, and OUD are often confused with each other and sometimes misdiagnosed by healthcare professionals. If you experience any of the above, consider reaching out to an OUD specialist for confidential guidance. They can properly assess your situation and recommend the best course of action for your individual needs.
Managing Opioid Tolerance Concerns Within Medical Applications
In a clinical setting supervised by a doctor, healthcare professionals take great care to monitor opioid tolerance in a way that avoids dependence and OUD.
If you develop an opioid tolerance from illegal opioids, it’s important to let your doctor know, even if you have stopped using it and reversed the tolerance. Should you ever need opioids for severe pain related to issues such as cancer or surgery, your doctors may need to adjust their approach to pain treatment to avoid over or under-medicating you.
Identifying Opioid Tolerance and Its Genetic Regulators: Hope for the Future
Some questions about how opioid tolerance works have escaped scientists for more than a century. There is still not much known about how tolerance, dependence, and OUD can be prevented, but one researcher’s recent discoveries may offer some insight and hope for the future.
Dr. Brock Grill, principal investigator in the Center for Integrative Brain Research at Seattle Children’s Research Institute and a professor in the departments of Pediatrics and Pharmacology at the University of Washington School of Medicine, has been chasing answers to the opioid tolerance question for more than a decade. His 2022 findings on molecular genetic mechanisms hint that finding new ways to understand, treat, and potentially prevent OUD may be within reach.
What Are the Signs and Symptoms of Drug Tolerance?
When a person’s regular dosage of a drug stops working for them, and they need more of that drug to achieve the same benefits, they have developed a drug tolerance.There is no way to know in advance when a tolerance will develop or how much usage it will take to get to that point. Some of its most common signs include withdrawal (tremors, headaches, anxiety, depression, vomiting, and more), prioritizing your substance of choice over your family/friends, and a decline in work or school performance.
Is There Treatment for Opioid Tolerance?
If you or someone you know has developed a tolerance to opioids, talking with a recovery specialist can help you determine the best way to move forward. Whether you simply need guidance to address milder forms of tolerance, or treatment for opioid use that has progressed to a more advanced stage, an OUD specialist can provide a confidential recommendation tailored to your situation.
At ReVIDA Recovery®, our compassionate and caring staff can answer all your questions about opioid tolerance, dependence, and OUD, and recommend a path forward. We specialize in opioid treatment and can advise you on the best plan to address your individual needs. Feel free to reach out to us at (844) 972-4673 to find out more.
FAQs
How do I know if I am opioid tolerant?
You’ll know if you are opioid-tolerant if the dosage you normally take isn’t working anymore, and you need to take higher doses to achieve the same benefits
What is the tolerance threshold for opioids?
The opioid tolerance threshold is different for everyone, and there is no way to predict when an individual will progress to tolerance.
Do people with opioid use disorder have a lower pain tolerance?
Some clinical studies have found that people with long-term opioid use disorders may have a lower pain tolerance, which is one of the reasons why it’s important to let your primary care physician know if you’ve ever developed an opioid tolerance.
