Methadone is a full opioid agonist that is used to treat opioid use disorders, known as methadone maintenance treatment (MMT). It has a long half-life, meaning its effects may last longer than those of other medications.
In addition to being used in medication-assisted treatment, it has analgesic effects, so it can help you manage pain.
The pharmacology of methadone shows that it works by binding to the same receptors in your brain that opioids do.
As a result, methadone can help with detoxification from opioid dependence and reduce opioid withdrawal symptoms.
Due to the fact that methadone reacts with your brain similarly to the way opioids do, opioid-dependent patients will often already have a higher tolerance to methadone.
In other words, they may need more of the medication to feel its effects.
Factors That Contribute To Methadone Tolerance
In addition to a pre-existing opioid tolerance, there are a few other factors that can contribute to developing a tolerance to methadone.
First, if you’re using methadone for analgesia, you may be at higher risk for developing a tolerance, especially if treatment retention is long-lasting.
This is because prolonged use, such as daily doses, can allow your body to adjust to methadone over time, leading you to need a higher dose of it to manage your pain.
Higher Doses Of Methadone
Additionally, methadone tolerance can be more likely if you’re taking higher doses of the medication.
If you start at a high dose, your body will be more likely to need larger doses more quickly as it has adjusted to an already high concentration.
Lastly, previous heroin use or opiate dependence can contribute to methadone tolerance. This is because the effects of methadone and heroin on the brain and body are similar.
In other words, if you have a tolerance to heroin, you will likely already have a methadone tolerance, known as a cross-tolerance.
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Health Risks Of Methadone Tolerance
Even in clinical practice, there are some health risks that come along with methadone use, especially if you develop a tolerance. They can be minor, such as constipation, or more severe.
One concerning risk that can occur with continuous methadone use is the development of physical dependence.
Physical dependence is an issue that occurs when your body starts to rely on a substance and a specific dosage of that substance.
If you stop taking methadone, or take it in smaller amounts, you may start to experience withdrawal symptoms.
Though it’s not quite as risky as using opioids or other illegal substances, developing a dependence on methadone can come with risks.
Another health risk associated with methadone is toxicity or overdose, often caused by respiratory depression.
When your tolerance for a drug becomes higher and you need to take more to feel its effects, it can be easy to accidentally take too much methadone and overdose.
You can also overdose on methadone if you combine the substance with painkillers, alcohol, and benzodiazepines due to their sedation properties.
It is vital to note that methadone overdose can be fatal if not treated immediately with medication such as naloxone.
How To Avoid Methadone Tolerance
Since methadone tolerance can be dangerous and lead to additional issues, you may be wondering if there are ways to avoid developing a tolerance.
Luckily, there are a couple of tactics that can be used to avoid this issue.
One way your healthcare provider can help you avoid methadone tolerance is by using titration.
Titration involves starting you at a baseline or a low starting dose and gradually increasing that dose over several weeks to see how your body reacts.
Once you develop side effects or you have reached the maximum dose of methadone, your provider will keep you at that dose to avoid tolerance or overdose, keeping you at a steady state.
Another tactic that can be used to help you avoid building a tolerance to methadone is reducing your doses.
This process involves slowly taking fewer doses to see if you can manage your withdrawal symptoms with maintenance doses.
Much like titration, this is sort of a trial-and-error process that requires follow-ups and relies on seeing how your body reacts.
Lowering A Tolerance To Methadone
Though there are a couple of ways that can help you avoid developing a tolerance, sometimes methadone tolerance can still occur.
As a result, you may be left wondering how your tolerance to the medication can be lowered.
The first step in lowering your methadone tolerance is to determine how high your tolerance is. This can help your healthcare provider figure out how quickly they can reduce your dosage.
Reducing your methadone dosage can be done in two ways: by either reducing the size of each dose or taking doses less frequently.
In addition to this, other medications can be used to help you deal with withdrawal symptoms as you lower your tolerance.
Lastly, if your clinician determines that methadone may not be a good fit for you due to previous opioid abuse, they may start by prescribing other medications like buprenorphine or naltrexone.
Buprenorphine is a partial opioid agonist that has a ceiling effect, making tolerance and overdose less likely.
Treatment Programs For Opioid Use Disorder
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- U.S. National Library of Medicine: MedlinePlus — Methadone Overdose
- U.S. National Library of Medicine: PubMed Central — Practice Controversy: Methadone Tolerance Testing in Drug Misusers
- Substance Abuse and Mental Health Services Administration — Methadone
- U.S. Department of Health and Human Service — Dosage Reduction Guide