Drug and Treatment Policy Lessons from Cory Monteith's Overdose Death

Maia Szalavitz (an occasional Reason contributor) on some of the policy lessons one might glean (link added) from the overdose death of Glee star Cory Monteith:

[Monteith] did a second round of rehab....Heroin, an opioid, produces tolerance, so that users not only need more drug to experience a “high,” but also higher amounts to overdose. Abstaining for a few weeks, as many rehab programs require, lowers this tolerance so if an addict were to use again, a previously normal dose could become fatal.  Most deadly overdoses occur either in new users or in experienced addicts following a period of abstinence, such as in prison or rehab. Indeed, the first two weeks after prison carry an overdose risk rate that is more than 120 times higher than typical among users....

Abstinence was proving to be doubly harmful— addicts were turning back to their drugs of choice, and when they were, their lower tolerance was putting them in danger of overdosing.

Adding to the danger is the fact that, as in Monteith’s case, most overdoses do not involve just one class of drugs. Monteith combined alcohol with heroin — two drugs that depress breathing, which can be a recipe for death. About 60% of so-called opioid overdoses — overdoses blamed on painkillers or heroin— are actually the result of such combinations. While some addicts will intentionally take such mixtures to intensify the high, many are unaware of issues like tolerance or the dangers of combining drugs.

And there may be one last way in which Monteith’s death can serve as a lesson for how to serve addicts better. There is a safe and nontoxic antidote, naloxone, to treat opioid overdose, which I have argued should be available in first aid kits so more potential victims might be saved. But the drug is currently only available in injectable form, which makes it both difficult and dangerous for untrained people to administer.

So, not trying to force abstinence, encouraging real education on real dangers of the drug (and mixing it with other drug), and wider availability of a drug that can save opiod overdosers lives, are all good things, all good things that a typical "drugs are bad, mmmkay? Don't use and be punished and don't think there should be a freely available way to save your miserable junkie life" mentality too often overcome.

Reason on naloxone.

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  • John||

    Who over the age of 18 doesn't know that mixing opioids and alcohol can kill you? Seriously? Unless this guy ODed because he got a bad batch of heroin that was much stronger than he thought, he died because he was stupid and irresponsible. And no amount of drug education or legalization is going to fix that.

  • sarcasmic||

    Let's play ... How did your favorite dead rock star die?

  • John||

    Hard to pick one. But it seems like most of the dead ones I like, Bon Scott, Kieth Moon, John Bonham, died choking on their own vomit.

    I can't say I like most of the heroin casualties that much. I respect Hendrix but really don't listen to his music. I can't stand Janice Joplin. I think Kurt Kobain is wildly overrated.

    So I am thinking going on a drinking and pill binge and choking on your own vomit is the way for a proper rock star to go.

  • SweatingGin||

    "it was actually... someone else's vomit"

    "you can't really dust for vomit"

  • BakedPenguin||

    Hendrix died choking on puke after a barbiturate OD; Kobain overdosed on lead.

    Alcohol seems more lethal than heroi for rock stars - Jim Morrison, Amy Winehouse. Keith Moon OD'd on a drug that alleviates alcohol withdrawal symptoms.

    Although one possible 'plus' to the talent side of heroin deaths is Phil Lynott of Thin Lizzy. I say possible, since he strictly died of septicemia caused by dirty needles.

  • SweatingGin||

    Keith Moon OD'd on a drug that alleviates alcohol withdrawal symptoms.

    Benzos?

    Lovingly illustrated here: Goodnight Keith Moon

  • BakedPenguin||

    According to Wikipedia, Clomethiazole. I'd never heard of it.

  • John||

    But Kobain shot himself with an overdose of Heroin that would have been fatal had he not let the shotgun finish the job first.

    And yes, alcohol actually can be quite lethal for rock stars and non rock stars alike. It is every bit as dangerous as most controlled substances.

  • BakedPenguin||

    I didn't know that about Kobain.

    I'm always amused when people act as if alcohol is a light or safe drug.

  • EDG reppin' LBC||

    El Duce killed Kurt.

  • EDG reppin' LBC||

    http://www.youtube.com/watch?v=Ho2nK5IQs_g

    He put a shotgun in my face, once. I quit using drugs that day. Scary shit.

  • tarran||

    My favorite one died secretly, which is frankly the coolest kind of death.

    Ham was found dead at his home in Carlton North, Melbourne, on 19 April 2012, where he lived alone. Friends had been unable to contact him for a few days and went to his house to investigate. No cause of death was given.
  • SweatingGin||

    "Best leave it unsolved, really. Some things are better left unexplained"

  • Free Society||

    That's code for "died during an intensive bout of auto-erotic asphyxiation". Best death ever.

  • Robert||

    Andy Breckman's trying to popularize the term "strangubation".

  • John||

    Plane crashes are good too. Otis Redding, Patsy Kline, Buddy Holly.

  • Paul.||

    Stevie Ray Vaughan... helicopter crash. Jesus, how could I forget.

  • John||

    Him too.

  • BakedPenguin||

    Half of Skynyrd, Randy Rhoads.

  • Hyperion||

    You beat me to half of Skynyrd, by one minute.

  • BakedPenguin||

    I had three steps on you.

    Given the relative safety of flying, it's odd. Musicians should avoid light aircraft the way dogs should avoid cops.

  • Hyperion||

    Ronnie Van Zant and Steve Gaines.

  • Paul.||

    Let's play ... How did your favorite dead rock star die?

    Spontaneously exploded on stage.

  • SweatingGin||

    Dozens of people spontaneously combust each year. It's just not really widely reported.

  • Rhywun||

    Only on an episode of "In Search Of..." that scared the shit out of me when I was like six.

  • robc||

    Woosh!

  • BakedPenguin||

    Not everyone's seen Repo Man.

  • Lord Peter Wimsey||

    I think one of the minor members of Toto snorted coke and then decided to plant some flowers in his garden. He inhaled some plant food chemical which evidently should not mix with coke in your head. He died.

    He (literally) died in a bizarre gardening accident.

  • EDG reppin' LBC||

    I head it was pop rocks and a liter of soda.

  • Rights-Minimalist Autocrat||

    I think legalization would reduce heroin OD's. I suspect people would be less likely to shoot heroin if they could go to Walgreen's and buy an opioid inhaler. They'd pass out before they could consume a fatal dose.

    Of course, passing out has its own risks, as mentioned previously.

  • BakedPenguin||

    Not only that, it would mean ibogaine would be legalized, too. It's a lot easier to quit a drug when you have no physical withdrawal.

  • Aresen||

    I fail to see why Cory Monteith's death is any worse a tragedy than the deaths of street level junkies on Hastings Street (literally 10 blocks away).

  • John||

    Me either. And like I said above, unless he got a bad dose of heroin, the drug war had nothing to do with his death. He could have been buying drugs legally and still would have been dumb enough to OD himself.

  • ||

    It isn't for any rational reason, but its obvious that Monteith had devoted fans who felt connected to him by his work they found enjoyable. Spending an hour each week watching his show is still an investment people have made in him and the character he portrays.

    For some (especially those who have never used drugs) I imagine it's also a bit tragic that someone who supposedly "had it all" still couldn't live without his addiction.

    The Hastings Street Junkies (Dibs on the band name idea!!!) on the other hand are faceless, given no previous attention, and had nothing about their lives others would find enviable and therefore not very tragic to others when it ended.

  • Gozer the Gozerian||

    As regards the fans, you are absolutely correct: It is the economic and cultural "loss" that makes it somewhat serious news, which I can concede even if I would never indulge in such dreck.

  • americanexile||

    Have there been any studies done on why beautiful rich successful people are so unhappy with their lives?

    Seriously, if the fame and fortune is too much to handle, what inspires one to shoot drugs into their arm rather than just quit it all, buy a farm in the middle of no where and enjoy life sober?

  • Zeb||

    I don't know. Probably because drugs are fun and the sort of people who would seek out drugs to make their life more bearable would probably be just as miserable living sober on a farm as they would being a minor celebrity.

  • kinnath||

    He had a bad youth and was already in rehab long before he became rich and successful. Becoming rich and successful didn't change whatever was already broken in his life.

  • robc||

    quit it all, buy a farm in the middle of no where and enjoy life sober?

    When you do that, you have to read and hear about how you are crazy. Unless you go totally Amish.

  • AuH20||

    Well, I can only speak to comedy, and I ain't famous or successful at that, but I've heard a lot of interviews with people who are, and I know a lot of amateurs who have their own substance problems. Basically, comedy comes from pain. Social butterflies who get along with everyone and are totally succesful at life don't feel a need to go into a profession where you get up on stage in front of random strangers and try to make them laugh. Also, it's not funny to make jokes about how awesome owning a yacht is (it is funny to make jokes about how, even though you can now afford a yacht, yachts suck).

    People like Woody Allen, or Rodney Dangerfield, or Richard Pryor go into comedy in part because they aren't exactly the most well adjusted, happy, normal people. It's a joke within the circles, "Of course I'm fucked up, otherwise I wouldn't be doing this."

    Now, if you'll excuse me, I need to have a beer at 2 in the afternoon.

  • BakedPenguin||

    Basically, comedy comes from pain.

    A lot of (if not most) art comes from pain. It's a different alchemy. Instead of trying to turn lead into gold, it's trying to turn shit into beauty.

  • Robert||

    I had beer at 1:30 this afternoon, when I'd just gotten in from a hot outside. It led to a nap during which I dreamed Thor called me over to give me stuff from a hand-held machine that turned gold jewelry into base materials, stamping stuff out like a 3-D printer into a hollow tree stump. I think he meant I should get to work and make money to buy useful stuff.

  • thom||

    Unstable people are more likely to take the kinds of risks that are necessary to become rich and successful?

  • Heroic Mulatto||

    The amount of shits I give about an actor from Glee dying from an overdose is a negative number. So much so that the next time I sit on the toilet, fecal matter will be sucked past my anal sphincter and into my colon.

  • SweatingGin||

    A SugarFree-worthy turn of phrase there.

  • Gozer the Gozerian||

    Drug and Treatment Policy Lesson: Denis Leary was right.

  • ||

    But the drug is currently only available in injectable form, which makes it both difficult and dangerous for untrained people to administer.

    I'm trying to figure out how else you'd administer a drug to someone who is rendered unconscious due to lack of breathing. Nasal aerosol?

  • ||

    Also, is it intravenous or intramuscular? Because if you can apply it IM, then it's just like jamming an epi-pen into someone's arm. IV is much harder, especially for the untrained, but IM is a piece of cake.

  • Bryan C||

    According to drugs.com, it works fastest when injected intravenous, slightly slower when used intramuscular or subcutaneously. And there's also a nasal aerosol.

    So the only real problem is FDA approval.

    I wonder how hard it is to synthesize the stuff. Could a drug lab make it? No FDA hassles or worries about reporting requirements on OTC sales. And they're already serving that market.

  • ||

    Soon you will know junkies by their obsessive clutching of scuffed, oft-refilled bottles Sea Mist nasal sprays.

    There's a bottle of saline nasal spray in his car! That's all we need to search it. Quick shoot the dog!

  • Tonio||

    I'm guessing IV, since (what Epi posted).

    But if they've already stopped breathing due to opiate overdose, the worst thing that could happen with a botched injection would be that they'd die anyway.

    Also, I have zero experience with that and with those people, but from what I understand junkies tend to a) cluster together and b) know how to do IV injections. So it would seem that if you found an OD'd junkie you'd be likely to find another junkie who could shoot him up with the antidote.

    This is typical medical profession turf guarding, combined with the worst sort of public health idiocy. Or maybe fear of litigation on the part of the drug maker.

  • creech||

    What struck me is that this guy (and I had no idea who or what he was) started in on drugs as a young teenager and became quite successful in a profession that takes hardwork (and luck). If drugs are so damn bad, how did he become successful? Same could be asked about the Choom Ganger in the WH.

  • John||

    If you smoke a lot of dope in high school, you too can end up President.

  • kinnath||

    but only if you marry a wookie first.

  • ||

    +1 bandolier

  • Gozer the Gozerian||

    He probably succeeded the same way most (talented) comedians succeed: He took the right kind of drugs.

  • AuH20||

    Heroin is a bad comedian drug. Go with pot, coke, or alcohol.

  • Gozer the Gozerian||

    Isn't the speedball what usually gets the good ones?

  • ||

    Brian,
    I may have missed it but where is the original article from?

  • Tonio||

    I'm not Brian, but if you mouse over the linky thingie it shows that the link is to people dot com, which I believe is People Magazine.

  • Brian Doherty||

    Kwix---It was at TIME's website; forget actual link at first, it's there now.

  • John||

    And one other thing, it is really well known now that if you go through rehab and make it through the withdrawals and decide to go back to using, you have to take it like you have never touched the stuff in your life. It really is a gold plated wants to win the Darwin award stupid addict who gets out of rehab and decides to start using again like he never stopped. In fact, someone who does that can reasonably be said to have taken the stuff as a way to commit suicide.

  • Killazontherun||

    Didn't see your comment before posting mine below. You could be right on this, and we still can't discount the possibility that he may have checked out. Didn't they find a note, too?

  • John||

    I don't know. But I find it hard to believe he had been using heroin for years and somehow didn't know or forgot that you lose your tolerance after you kick the stuff.

  • Robert||

    Oh, there are ways. Linda Twigg had been on methadone for years, then gave it up for GHB, which she was a big enthusiast of. Only thing is, it has no cross-tolerance for opiates, but can get you quite impaired, judgment- & awareness-wise, like alcohol. (I found GBL superior in all respects to GHB; it's GHB without the sodium, tastes like bourbon when mixed with water, and has a psychoactive effect similar to booze but without some of booze's adverse effects.) So she was pretty fucked up on it one day when an old acquaintance brought her some heroin, and she apparently did forget she'd been off methadone for a long time and ODd fatally.

  • Killazontherun||

    An OD and not a suicide, that is more respectable in most circumstances. And upon hearing of it, I assumed he had killed himself. After all, he was a star on Glee, why wouldn't he want to kill himself?

  • John||

    Isn't starring in Glee a pretty strong mitigation for offing yourself? I can't honestly say my will to live would survive such an experience. Can you?

  • Hyperion||

    I don't even know what Glee is.

    Just the name of it, makes me not want to know what it is.

    It sounds like the name of a website for wack-o liberals who tired of Salon

  • John||

    It is a show that is so gay it makes Episiarch look straight. NTTAAWWT

  • Killazontherun||

    I've survived worse. As a six year old, there was a local children's show called, 'Old Rebel' where a guy played a Confederate General for the amusement of God fucking knows who, and I was in the cast of kids with my best friend Eugene at the time. A black kid farted loudly and turned and blamed it on Eugene. I was still mortified to be beside the guy blamed for the fart.

    Eugene has been a local radio disc jockey for two decades now, so if the story sounds familiar to anyone, there is a reason why. He is still out for justice.

  • John||

    My wife blamed me for a fart at the Frick Museum once. And it was a bad one. I am honestly surprised it didn't damage some of the paintings.

  • Hyperion||

    You heathen Libertarians, first we start giving in on MJ, and now you want to legalize heroin?! Obviously, you hate the children.

  • BakedPenguin||

    A lot of junkies in the know deliberately use rehab to lower their tolerance.

  • Hyperion||

    I use work to lower my tolerance to alcohol.

    Let's see, what time is it? 4pm? Drink!

  • SweatingGin||

  • Hyperion||

    I like the last one on the page about running out of fuel.

  • SweatingGin||

    The author has some pretty lefty comics, but occasionally hits one out of the park.

  • John||

    Turn out the lights the party's over they say that all good things must end
    Let's call it a night the party's over and tomorrow starts the same old thing again

    Once I had a love undyin' I didn't keep it, wasn't tryin'
    Life for me was just one party and then another
    Broke her heart so many times had to have my party wine
    But one night she said sweetheart the party's over

    Turn out the lights...

  • pmains||

    I don't watch Glee, except as filtered through parodies on rival TV show, Community. So, my question is this:

    How do we know that he wasn't actually killed by Mr. Radison? I mean, he did kill the last glee club by cutting their break lines.

  • Robert||

    Naloxone would not often be used other than as an injection, because the person to whom it was administered would practically always be unconscious or close to losing consciousness. So I don't see a great deal of gain in making it available in other forms.

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