What treatment might be preferred for individuals with high opioid tolerance over buprenorphine?

Individuals with high opioid tolerance often require strong analgesics to effectively manage their pain. Methadone is considered a preferred treatment in these cases for several reasons. Firstly, methadone has a long half-life, which allows for sustained analgesic effects and may reduce the need for frequent dosing. This is particularly beneficial for those with high tolerance, as they may require higher and more consistent levels of medication in their system to achieve pain relief.

Additionally, methadone is an opioid agonist that provides potent analgesia while also being effective for opioid dependence treatment due to its unique pharmacological properties. It can adequately manage pain while also having a role in stabilizing individuals who may be managing both chronic pain and opioid use disorder.

Conversely, other options such as hydromorphone and oxycodone, while effective for pain relief, may not provide the same level of sustained management required for individuals with high opioid tolerance. Codeine is less effective overall in this population due to its ceiling effect and lower potency compared to other stronger opioids. Therefore, methadone stands out as the most appropriate choice for managing pain in individuals with high opioid tolerance.