drug overdose

Prescription Drug Reduction Creates Unintended Consequences, But No Surprises

With crackdowns increasing on improperly-prescribed and illegal prescription drugs, more pill users are turning to heroin, according to studies in Maryland. Prescription drug overdoses are down by 15%, but heroin ODs are up 41%. The total number of combined overdoses is up about 6%. That’s probably because naïve users have greater difficulty managing heroin dosage than they do with the controlled strength of pills.

This shouldn’t have surprised anyone. Reducing the availability of prescription drugs will probably reduce the number of new addicts to a limited degree, but folks who are already addicted aren’t going to be kept from copping. Most prescription drug users, pushed by the fear or actuality of acute withdrawal, will have no trouble finding street drugs, and when the availability of pills drops on the street, the move to heroin is simple and obvious.

That might sound like I’m against nailing the pill mills. Not at all. Those sorry excuses for physicians are a blight on society, and need to be dealt with. Ditto the folks who sell drugs on the street. But anyone who thought addicts would come flocking to get help when their supplies got scarce really doesn’t get the facts of addiction.

Bottom line: addicts will find drugs. If treatment was supported nearly as well as the so-called “War On Drugs;” if addicts could more easily access detox and primary treatment; if the focus of society was less on punitive measures and more on curative ones, then our drug problems could be dealt with far more effectively.

We’re finally getting the idea across that addiction is a disease, and that addicts need to be dealt with as patients, not as offenders, but until society gets behind treatment instead of spending huge sums supporting the drug suppression/law enforcement industries, we don’t have much chance to make real inroads into the overall problem.

I’m a former law enforcement officer and a recovering addict. I’ve seen it from both sides, and I’m telling you that we are putting our priorities in the wrong place. Deal with the criminals on one end, but reduce the number of customers on the other. Put people first, and we have a shot at making real progress.

Opiate Overdose Due To Reduced Tolerance

In practically all cases, opiates kill by respiratory depression: when we OD, the part of the brain that controls breathing shuts down, and we “forget” to breathe.  This causes death by hypoxia — suffocation. I was reading again today about another addict who overdosed and died because she misjudged her tolerance for Oxycontin after leaving detox and relapsing.

Our tolerance to the respiratory depression of opiates rises rapidly.  It doesn't take long before a frequent user can tolerate doses as much as 10 times higher than those that would kill a non-tolerant person.  This is true of all opioid drugs: heroin, methadone, hydrocodone, oxycodone, and so forth.  When we detox completely or partially, through maintenance use, cold turkey, or in a clinical setting, our tolerance drops rapidly.  We become far less tolerant to the fatal effects of the drug than we were while using regularly. If we manage to stay clean for a while our tolerance drops even more.

I leave detox or treatment, I hit some meetings, I do the right things for a while. Then I start to slide back into my old ways, hanging with the wrong people, around the wrong places, and doing the wrong things.  Since I don't have any real support staying clean, I'm a sitting duck when post-acute withdrawal hits, and I start jonesing for my drugs.  So I go out and score. Maybe I know a little about reduced tolerance, so I decide to start slow…but not slowly enough.  Or maybe a buddy decides to give me a little extra taste.  Or maybe I get a hot shot.  Or maybe I just go nuts.

Maybe I nod off, stop breathing, and don't wake up.

This could literally be the most valuable information of your life.  Remember it.  Reduced tolerance is the number-one cause of overdoses.