If you have pain, anxiety, sleep disorders or other health conditions, you might need prescription medications for treatment. But over time, your body may react differently to them, leading to tolerance or dependence. These changes might happen without you realizing it, which could lead to overuse, abuse or addiction.
Understanding the difference between tolerance and dependence can help you use medications safely.
What is prescription drug tolerance?
Prescription drug tolerance is when your body gets used to a medication, so it doesn’t work as well for you. You won’t get the same effect with the same dose you used to take, and you might feel like you need to start taking a higher dose.
“Tolerance is commonly seen in drugs that are meant for short-term use that are used frequently or for longer periods of time,” said Paul Thompson, a pharmacist with Banner Pharmacy Services.
"It is very important to note that tolerance does not always mean addiction," Dr. Thompson said. “People often think that increasing medication use means you’re addicted. But many people develop tolerance without becoming addicted.”
"Tolerance can develop with various medications, including pain relievers, sedatives and stimulants," he said. “If you develop tolerance to one drug, you may also develop tolerance to similar drugs within the same class.”
This response to a drug can be especially worrisome for medications like:
- Opioids (pain relievers): Oxycodone, hydrocodone and morphine
- Benzodiazepines (anti-anxiety and sleep aids): Xanax, Valium and Ativan
- Stimulants (used for ADHD and narcolepsy): Adderall and Ritalin
Developing tolerance isn’t necessarily dangerous on its own. However, it can increase the risk of dependence and addiction if it’s not managed well.
How can you prevent developing a tolerance?
Here are some ways to reduce the risk of becoming tolerant to a drug:
- Partner with your provider: Review your medication with your health care provider and be honest about how it is working and any side effects you’re noticing. Your provider can monitor your prescriptions and help you find alternatives if you need to.
- Consider alternative therapies: Lifestyle changes like physical therapy, acupuncture, counseling, relaxation techniques or changes to your diet may help reduce the amount of medication you need, especially for pain management or anxiety.
- Track your symptoms: Keep a medication journal to document your pain levels, dosage times and side effects.
- Follow prescriptions as directed: Never increase your dose without medical supervision. If a medication isn’t working as well as it used to, consult your provider.
- Consider drug holidays: You can pause some medications under medical supervision. “This may help prevent tolerance from developing,” Dr. Thompson said. Your sensitivity to the drug may return to normal.
- Rotate medications: In some cases, switching between different medications that have similar effects can help prevent tolerance: You should only try this approach under your provider’s care.
- Understand genetic factors: Not everyone develops tolerance at the same rate. Your genes can play a role in how quickly it develops.
- Dispose of unused medications safely: Leftover pills can be a temptation for overuse or misuse. Use local medication drop-off sites or drug take-back programs.
Tolerance vs. dependence: What’s the difference?
Tolerance means your body is less responsive to a drug. "Dependence is when the body adapts to the drug and experiences withdrawal symptoms if the medication is stopped or reduced. Dependence can occur with or without tolerance," Dr. Thompson said.
Dependence doesn’t always mean you’re addicted, but it’s important to talk to your doctor if you feel that you need to take your medication more often or at higher doses. With some medications, you need to taper off gradually, under medical supervision, to prevent withdrawal symptoms.
"Two major classes of drugs stand out above the crowd in terms of dependence — opioids for pain and benzodiazepines for sleep and anxiety," Dr. Thompson said.
What are the symptoms of prescription drug dependence?
With dependence, if you suddenly stop taking the medication you may have withdrawal symptoms like:
- Physical effects: Sweating, nausea, shaking, headaches or sleep changes
- Emotional effects: Anxiety, irritability, depression or cravings for the drug
- Behavioral effects: Taking higher doses than prescribed, seeking multiple prescriptions or having trouble reducing or stopping the medication
What to do if you’re concerned about medication use
Try these steps if you’re worried about how a medication is affecting you:
- Talk to your doctor or pharmacist: They can help adjust your dosage, recommend alternatives or create a tapering plan.
- Know the warning signs: If you feel a strong urge to take more medication, you have withdrawal symptoms or you find it hard to stop, get medical care.
- Seek support: Connect with treatment programs, helplines or other resources for people struggling with dependence or addiction.
The bottom line
Medications can be an important part of treatment, but you need to use them with care. By staying informed and communicating with your health care provider, you can reduce the risks of tolerance and dependence while still getting the relief you need.
If you have concerns about your medication, reach out to your provider or an expert at Banner Health for support and guidance.
