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The more you use opioids, the more your body adjusts to them. Over time, you’ll need to take higher doses to get the same effect. These are the basic principles of opioid tolerance.
Your opioid tolerance can change based on multiple factors, so it’s important to have a basic understanding of what opioid tolerance is and how it can fluctuate.
In this article, we’ll explain how tolerance develops, how it diminishes, and what your tolerance means for your opioid use disorder (OUD) treatment.
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Developing an opioid tolerance means your brain and body get used to taking opioids and start to need higher doses to experience the same degree of pain relief or euphoric effects.
To understand how this happens, you must first understand how opioids take action inside your brain.
Inside your brain and throughout your body, opioids bind to specific receptors called mu-opioid receptors. This is true of all opioids, including prescribed opioids such as hydrocodone and nonprescription opioids such as heroin.
Once they activate opioid receptors, your body releases chemicals including the neurotransmitter dopamine. Dopamine influences your pain levels, mood, and reward response.
Activated opioid receptors also affect physical factors like your breathing rate and gastrointestinal function.
When you take opioids repeatedly, your brain produces fewer natural opioids called endorphins, meaning your body relies more on opioid drugs. Yet, the more you take, the more your opioid receptors become less responsive to them.
In some cases, after just two to three opioid doses, the brain demands more opioids to feel the same effects as it did the first time.
Eventually, these changes can make your nervous system less responsive to opioids. Although your tolerance can decrease when you stop taking opioids, you may still have a psychological or physical dependence for some time.
While opioid tolerance and dependence can develop alongside each other, they aren’t the same thing.
Tolerance means that you feel less of an effect from the same opioid dose over time. Physical dependence means that your body has adapted to regular opioid use, which can cause withdrawal symptoms when you stop taking opioids.
Finally, opioid use disorder (OUD) is different from both. It is a medical condition involving a pattern of opioid use that has negative effects on your daily life.
Your opioid tolerance can change or be influenced by multiple factors beyond simply taking or not taking opioids, including your dose, the frequency of use, and more.
Higher doses of opioids may cause you to build a tolerance to opioids faster. When prescribing opioids for pain relief purposes, doctors tend to prescribe the lowest effective dose to reduce the risk of developing a tolerance.
The frequency with which you take opioids can also affect your tolerance. Taking more frequent doses of opioids can cause you to build a tolerance. If you notice yourself using opioids more often to experience a euphoric effect, it may be a sign that your tolerance is getting higher.
Long-term opioid use can cause you to develop a tolerance, even at low doses. Doctors tend to prescribe opioids for pain for the shortest possible duration to reduce the risk of building a tolerance.
Although opioids affect your brain and body in similar ways, some types of opioids stay active in your system for longer and may be more likely to lead to a tolerance. Extended-release and long-acting opioids usually carry a higher risk of opioid dependence and overdose.
If you take one type of opioid for a long time and develop a tolerance, your healthcare provider may switch you to another type of opioid to help manage the risk of an increasing tolerance.
Multiple individual factors related to your health and genetics can also affect your risk of developing a tolerance. You might be prone to building a tolerance more easily based on:
If you have OUD or take prescribed opioids, it’s important to recognize signs that your opioid tolerance is getting higher. You may be developing a tolerance to opioids if:
Fluctuations in your opioid tolerance can put you at an increased risk of an opioid overdose. If your tolerance fluctuates, you might overestimate or underestimate your tolerance at a given time.
Taking larger doses or using opioids more frequently to experience their euphoric or pain-relieving effects are signs that your tolerance to their pleasurable effects is building quickly. However, it can take a longer time for your body to build a tolerance to the more physical effects of opioids on your body.
You may start taking more opioids or using them more frequently before your body can fully handle such large amounts. When you take more opioids, your breathing slows down considerably. If you take more than your body can handle, your breathing may stop entirely.
Slowed or stopped breathing can cause you to lose consciousness because your brain doesn’t get the oxygen it needs to function. Eventually, this can lead to brain damage or death. In fact, this is the main cause of death in opioid overdoses.
Having access to naloxone can be a critical safety measure when you’re in detox. Naloxone is a medication that blocks the effects of opioids, which can reverse an overdose if it occurs.
Naloxone is available without a prescription. Ask your doctor about training for safe naloxone use. It may also help to encourage friends, family, or anyone close to you to learn how to administer naloxone, too.
An overdose is a medical emergency, so you should seek emergency care if someone has signs of an overdose like shallow breathing or loss of consciousness. Call for help even if you or someone else has administered naloxone.
Starting OUD treatment is an important step in recovery for many people with OUD. Contrary to what you might expect, your risk of overdose can be especially high during the detoxification period when you first stop using opioids.
As you go through opioid withdrawal, your opioid tolerance decreases. Cravings and withdrawal symptoms can be so strong that you may want to start using opioids again to alleviate them. However, because of reduced tolerance, you may be at risk of an overdose when taking a much smaller dose than you used to take.
Your care team will carefully plan your OUD treatment to minimize cravings and withdrawal symptoms, thus lowering the risk of relapse and overdose. They will consider your opioid tolerance along with your medical history, symptoms, and preferences when recommending medications. There are three U.S. Food and Drug Administration (FDA)-approved medications for OUD: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine can reduce withdrawal symptoms and cravings, while naltrexone blocks opioid effects but does not treat active withdrawal. For this reason naltrexone must be started after an appropriate opioid-free period to avoid triggering sudden, severe withdrawal.
If you have any concerns about your opioid tolerance and how it may affect treatment for opioid use disorder, don’t hesitate to reach out to a trusted medical provider.
Your OUD healthcare providers can help guide you through medication-assisted treatment (MAT) safely while considering your tolerance and other important health factors.
Physician-guided treatment can help you get through the withdrawal period and maintain your recovery for years after detox. Talk to an addiction specialist about options like outpatient counseling, inpatient treatment, and MAT for opioid use disorder.
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