What you’ll learn
We’ll cover what it means to be “opioid naive” versus “opioid tolerant.” We’ll also help you to understand what to watch for when taking prescription opioids for the first time, and why you may face a higher risk of dangerous side effects without tolerance.
Maybe you recently had surgery or fractured a bone. Or maybe you’ve had a tooth extracted. None of these situations is pleasant. To help you deal with physical pain during your recovery, your doctor might have written you a prescription for pain medications.
If you’ve been prescribed opioids for pain, your provider likely asked about your history with these medications. They need to know whether you’re opioid (or opiate) naive. This means you haven’t used opioids regularly or recently enough to build up a tolerance. Knowing your history helps your provider determine a starting dose that’s safe for you. Without tolerance, even standard doses can cause serious side effects like respiratory depression, causing slow or shallow breathing and shortness of breath.
Whether you’re currently taking Suboxone® as part of a Medication-Assisted Treatment (MAT) program or have never had a history with opioids, it’s important to have an open, honest conversation with your provider. This can help you and your provider stay alert for any risks that might stem from being opioid naive. We’ll walk you through some of these terms, what they mean for you, and warning signs to watch for if you’ve been prescribed opioids.
Opioid naive vs. opioid tolerant
“Opioid naive” and “opioid tolerant” are clinical terms your provider uses to determine a dose that is safe for you. You might see them in your medical records, though your provider will likely explain it in plainer language, like, “Your body isn’t used to opioids.”
These classifications are based on your recent opioid use and dosage:
- You’re opioid naive if you haven’t been taking opioids regularly or have only used them briefly at low doses. Your body has no tolerance built up, so you’ll start with a lower dose to avoid serious side effects.
- You’re opioid tolerant if you’ve been taking opioids daily for at least a week at certain threshold doses (like 60 mg of oral morphine, 30 mg of oral oxycodone, or a comparable dose of another opioid). Your body has gotten used to opioids, so you’ll likely need a higher or different dose to get pain relief.
The risks of taking opioids when you’re opioid naive
When your body isn’t used to opioids, even standard starting doses can cause uncomfortable or serious side effects. This is why your provider will start you on the lowest dose that still provides relief.
Respiratory depression and overdose
The biggest risk is respiratory depression. Opioids slow your breathing, and without tolerance, standard doses can be dangerous. Your breathing becomes slow and shallow, you get extremely drowsy, and you can lose consciousness and stop breathing.
Mixing opioids with alcohol, benzodiazepines (anti-anxiety meds like Xanax or Valium), or sleep medications makes this worse. They all affect your breathing, and the combination increases the risk of overdose.
Other common side effects
You may experience a few unpleasant side effects, especially in the first few days. Common side effects include:
- Nausea
- Vomiting
- Dizziness
- Confusion
- Severe drowsiness
These usually improve as your body adjusts, but they can make it hard to drive, work, or take care of daily tasks.
Risk of developing dependency
Even a short 3 to 7-day prescription can lead to misuse and dependence. Your brain attunes quickly, learning that opioids bring relief and sometimes euphoria. The longer you take them, the more likely you may be to want them more often than prescribed or to continue using them after your pain improves.
This can develop into opioid use disorder (OUD), where you keep using opioids even when they’re causing problems in your life. If this is the case, you should not be ashamed. OUD is not a moral failing or mind over matter. It’s a chronic, treatable brain disorder that can affect anyone.
What to do when taking opioids for the first time
If you’ve just been prescribed opioids for the first time, here’s how to stay safe. Even low-dose, short-term prescriptions come with risks.
- Ask your provider about other pain management options you could use alongside or instead of opioids.
- Follow the prescription directions exactly and stop taking them as soon as your pain improves.
- Keep them where children and others can’t access them.
- Don’t drive or operate machinery until you know how they affect you.
- Don’t mix them with alcohol or take other sedatives like anti-anxiety or sleeping medications.
- Call your provider right away if you experience slow breathing, extreme sleepiness, or confusion.
It’s extremely important to watch for early signs of dependence. Call your provider if you’re:
- Taking more of your medication (and more often) than prescribed
- Counting how many pills you have left
- Feeling anxious about running out
- Wanting to continue using them after your pain improves.
These are signs your treatment plan needs adjustment, not that you’ve done something wrong. Your provider can help.
Learn more about QuickMD’s opioid use disorder (OUD) recovery services
If you’re worried your pain medication is becoming a problem, you can get support. At QuickMD, we understand how dependence can develop, even when you’re taking your meds as prescribed. Sometimes you just need guidance to get back on track.
