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