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Cross tolerance is different from building tolerance to a drug. It’s important to distinguish between the two; drug tolerance and cross tolerance are related and the former can lead to cross tolerance. Drug tolerance occurs when a substance is used often enough, and the body builds up a resistance and requires a greater amount to experience the same effect as it did during earlier, lower doses.
Understanding Cross Tolerance
Cross tolerance occurs when the tolerance for one substance causes a similar tolerance to a different substance. For instance, a person might use prescription opiate pain medication and develop a level of tolerance to other opiates like fentanyl.
This user may have to start taking higher doses of these similar substances because of the tolerance toward the original medication. Over time, a risk of dependence develops because the body recognizes opiates the same way regardless of the difference in the drugs themselves.
Cross tolerance can also occur when substances are used together, such as alcohol and depressants. These joint doses can increase the risk of dependency on one substance due to the tolerance for the other.
Cross tolerance is not always a result of using drugs from the same classification. It can happen with substances from different classifications because brain chemistry reactions may be similar to both. This is dangerous in that the brain may not identify the difference between the two separate substances and could cause an unintentional overdose.
Mixing alcohol with sleeping pills is an example of how cross tolerance can have devastating effects, even leading to unintentional death. For instance, the person who consumes alcohol regularly may require a higher dose of sleeping pills to feel the desired effects. However, taking higher doses increases the overall risk of toxicity and overdose.
Types of Cross Tolerance
The degree of cross tolerance caused by two drugs can vary based on factors like dosage, receptor affinity, and the individual’s biology. For example, tolerance to alcohol may result in partial cross tolerance to benzodiazepines (such as Xanax or Ativan), as they both act on GABA receptors, but the effects will not necessarily be identical for all types of benzodiazepines.
That’s why you should make sure your prescription medications don’t interact negatively with other meds. Even over-the-counter medications can cause a cross tolerance with prescription medication.
Some herbal and vitamin supplements can likewise cancel out the effectiveness of medications. It’s important to discuss the types of medications, vitamins, and herbal remedies with a doctor or pharmacist and learn how they interact with each other.
Drug Classes Where Cross Tolerance May Occur
Using more than one drug within the same class simultaneously can cause cross tolerance as the body adapts to their similar effects on the brain or receptor systems.
Opioids such as those in pain medications like hydrocodone, oxycodone, and morphine, can cause cross tolerance to other opioids, including heroin. Many opioid use disorders begin with prescription medication and evolve into a dangerous addiction because of the need to keep increasing dosage to achieve the same effect.
Medication assisted treatment (MAT) focuses on relieving withdrawal symptoms and drug cravings by using synthetic opiates that have a longer half life, such as buprenorphine or methadone. These medications stabilize opioid dependence, reduce the risks associated with short-acting opioids, and provide a pathway for gradual tapering if desired.
Sedatives cause a suppression of the central nervous system by slowing down heart rate and brain activity. Medications like benzodiazepines, barbiturates, alcohol, and over the counter or prescription sleep medications cause relaxation and drowsiness and are dangerous when combined. Cross tolerance can occur between various types of sedatives like Klonopin, Valium, Ketamine and Ambien.
Stimulants generate an increase in the central nervous system and brain activity. Amphetamines, methamphetamines, Adderall, Vyvanse, Ritalin, and MDMA can lead to cross tolerance. Stimulants increase your heart rate. When cross tolerance occurs, you may require greater amounts to get the same result as a previously used medication.
The risk of adverse effects, such as heart damage or heart failure, escalates. Speak with a doctor to ensure that the combination of any prescription stimulants and other medications you are taking mitigates cross tolerance and dangerous side effects.
Psychedelics and hallucinogens can be naturally occurring or lab-made. This class includes LSD, mushrooms, peyote, PCP, DMT, cannabis, ecstasy, and salvia. People with a tolerance to hallucinogenic drugs may be more likely to develop cross-tolerance to drugs that use certain brain pathways to affect the brain chemical serotonin.
For example, using LSD can cause tolerance to PCP. Salvia is a plant that is used for inflammation and pain and can cause cross tolerance to cannabis, which is also a plant used for pain management.
Antihistamines generate cross tolerance in allergy medications. Some antihistamines are also used as sleep aids. Cross tolerance has been noted by researchers who have studied people who take antihistamines consistently over a long period of time. Different types of antihistamines become less effective to treat allergy symptoms because of the build up of tolerance.
Corticosteroids such as prednisone, dexamethasone, flunisolide and fluticasone, are strong anti-inflammatory medications prescribed for chronic inflammatory diseases such as lupus, gout, and arthritis.
Corticosteroids are different from synthetic anabolic-androgenic steroids that mimic testosterone and are used illicitly for performance enhancement in sports and bodybuilding. Prolonged use can lead to cross tolerance with other corticosteroids.
Cross Tolerance Among Different Drug Classes
Cross tolerance can develop between different drug classifications if they share overlapping mechanisms of action or affect similar receptor systems. One example is the cross tolerance that develops between nicotine and alcohol.
Cannabis and sedatives can create a cross tolerance because they both act as depressants on the central nervous system. Chronic marijuana abuse can result in cross tolerance to barbiturates, benzodiazepines, sleeping medication, and even antihistamines that cause sedation.
The Dangers of Cross Tolerance
Cross tolerance can lead to strong physical or psychological dependencies. This can potentially contribute to a vicious cycle of addiction. Addiction is when a person begins to engage in high-risk behaviors to continue using a substance that they have become dependent upon in spite of negative consequences from using the substance.
Both dependency and the cycle of addiction may be fueled by cross tolerance and drug tolerance as the desire to avoid withdrawal drives continued usage. As the need to increase dosages to get the same effect grows, the risk for overdose and accompanying health risks becomes greater. Withdrawal also becomes more intense because as cravings increase, so do the symptoms of sickness and discomfort if the body is deprived.
Where can I find Information about Substance Abuse Treatment?
There are many resources for finding treatment online. Using any of these sources can direct a person to local, national, or international treatment options.
- SAMHSA National Helpline: The Substance Abuse and Mental Health Services Administration (SAMHSA) help line can connect a person with vital resources to support your recovery.
- Rehab.com: The online search tool helps locate addiction treatment facilities locally. People can search by city and state and then filter the results by level of care, payment options and other factors.
- Addictions.com: This website provides lists of addiction resources for treatment by state and through organizations like SAMHSA and the National Association of Addiction Treatment Providers (NAATP).
- Doctors and Other Treatment Providers: If you or someone you know needs help for substance use disorders, a trusted physician or mental health therapist can provide treatment and/or help direct a person to resources locally.
- Local Support Groups: Groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) can help people find support and solidarity as they navigate their recovery journeys.
What Are the Treatment Options for Drug Addiction?
Treatment for substance use disorder is provided through an individual master treatment plan between clients and their treatment providers. Plans are designed to specifically address the needs of the client.
Based on the severity of an addiction, a step-down program provides the opportunity to stay in treatment longer and provide greater stability in recovery. Treatment options include withdrawal and stabilization (detox), medication assisted treatment (MAT), and inpatient, partial hospitalization, intensive outpatient and outpatient care.
Treatment can occur in group, individual, or peer support educational sessions. A licensed treatment provider will assess the level of treatment needed and work with a client to design the program best for them. A thorough aftercare plan can help clients stay supported and connected to community based supports after their formal treatment program ends.
