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Overdose after Relapse: Loss of Tolerance Can Have Fatal Consequences

This entry was posted in Addiction News, Addiction Recovery, Fentanyl and tagged opioid tolerance, overdose after detox, overdose after relapse on September 30, 2021 by Justin Baksh, MS, LMHC, MCAP, Chief Clinical Officer.

You wanted off the opioids, and you did it! You’ve been through 28 to 30 days of treatment and have a month of sobriety under your belt.

While you should be proud of that accomplishment, you need to know you are at increased risk for overdose if you happen to relapse now. Why? Because of decreased tolerance.

An overdose after relapse is a tragic situation – one that could be prevented through awareness.

What is Opioid Tolerance?

Just as with alcohol and other drugs, individuals who use opioids can build a tolerance to them over time. This means that, as they progress in their drug use habit, they must use more and more of the drug to achieve the same effect.

It’s a function of the brain, which makes changes to adapt to the elevated level of opioids flooding it. It is also a gradual progression… so slow that the person may not even be aware that it is happening. All they know is they need the dose they are consuming now to feel the way they want to feel.

“Typically, a chronic opioid user has developed high levels of tolerance. He or she consumes the drug in such high amounts that it would kill an opioid-naïve person.” (Kumar, 2016)

Someone who has developed tolerance at this level may experience an overdose if they try these same doses after a month of not using.

Overdose After Relapse

It’s so easy to pass away from using drugs nowadays, just because of the amount of fentanyl out there. A lot of people in the past were able to relapse and come back. But nowadays, that’s not the case.” Arman Maddela, a recovering addict who relapsed during the COVID-19 pandemic, in an interview with Times of San Diego (Reuters, 2021)

Glee’s Corey Monteith is one famous case of overdose after rehab. His finished his final treatment stay the end of April 2013. Just under three months later, he was found dead in a hotel room due to heroin and alcohol overdose.

The coroner’s report on Monteith’s death stated that he had a “history of illicit drug use with intermittent periods of rehabilitation and abstinence from drugs… [ranging from] years to months in duration.”

It also stated that individuals build tolerance to heroin and other opioids over time, concluding that “after a period of cessation from opioid drug use, a previously tolerated drug concentration level may become toxic and fatal.”(Kumar, 2016)

Actor Philip Seymour Hoffman also died of an overdose, reportedly after an extended period of sobriety of 23 years. (Neporent, 2014)

What Research Tells Us

what-research-tells-us

Just as tolerance happens over time, so does the loss of it.

One study followed clients addicted to opioids who were admitted to 28-day detox and inpatient stay. Some completed their treatment, some failed to detox, and some detoxed but didn’t stay all 28 days.

By 120 days out from admission, there were three fatal overdose deaths. All of them were within the group that completed their entire stay. Conversely, there were no overdose deaths in the group that dropped out of detox (and were considered “still tolerant”). This points to decreased tolerance over time. Researchers also concluded that an “erroneous judgment of dose” when returning to opioid use was also to blame.(Strang et al., 2003)

Preventing Relapse is the Key

The best way to prevent overdose is to not relapse in the first place.

Most addictions stem from underlying mental conditions or trauma.

That’s why stopping drug use to get through detox and a short residential stay is simply not enough to protect against relapse.

Whether it’s depression, anxiety, bipolar disorder, or another mental condition, it must be diagnosed, treated, and addressed. Otherwise, it can cause issues in the future.

Another way to protect against relapse is to craft a new life built on a foundation of sobriety. This may mean new friends, a new job, even moving to a new location. To ensure the foundation stays firm, it’s important to never stop taking care of your recovery. This includes staying on top of psychiatric medications and counseling appointments.

Setbacks happen to everyone. It’s about maintaining the skills and support system to deal with all of life – the good, the bad and the unexpectedly ugly.

Getting Off Opioids… For Good

Ready to leave opioids behind? Want to get your life back? It’s simply a series of steps. Put one foot in front of the other, just concentrating on today and what you need to do now.

The first step is detoxing from the opioids. It is recommended that you enter a medical detoxification center for your safety as well as your comfort. The reason is that physical withdrawal from opioids can be intense. Symptoms include:

  • Aching joints and bones
  • Anxiety
  • Diarrhea
  • Goosebumps
  • Irritability
  • Nausea
  • Rapid pulse rate
  • Restlessness
  • Runny nose
  • Stomach cramps
  • Sweating
  • Tearing
  • Tremor
  • Twitching
  • Vomiting
  • Yawning

(National Institute on Drug Abuse)

getting-off-opioids-for-good

These symptoms can range from nonexistent to severe and should be monitored by a healthcare professional.

Once past this stage (one to two weeks or so), the real work begins.

The second step can be either a brief (approximately two-week) residential stay or going directly into a partial hospitalization program (PHP).

PHP is full time treatment; however, clients stay at home or in a sober living environment. They have access to their phones and a level of independence yet accountability.

Treatment at this stage is centered on uncovering mental health issues, trauma, or other factors that led to the development of the addiction. These issues must be addressed to give former opioid users the best chance for success. The partial hospitalization stage lasts for approximately 30 to 45 days, depending on the individual’s unique situation.

Next comes intensive outpatient (IOP), or part-time treatment of up to 19 hours a week. There are daytime and nighttime programs to fit work schedules.  three to five times a week. Finally comes outpatient, where the individual is fully on their own, but with a weekly support session of one to three hours. This can last six months or forever, depending on the person’s need.

After An Overdose or Relapse… Here’s What To Do

All of this is good, but remember, even if you do relapse, all is not lost.

Of course, overdose can happen to anyone, at any point while using opioids. However, it’s especially a concern if you’ve been abstinent. Therefore, if you are relapsing after detox, you should know that your tolerance is greatly reduced.

Next, know that relapse can be part of the process to recovery. Don’t beat yourself up; just seek help once again. While you may have to start to sobriety timeclock over, a relapse does not erase all the gains you made. It may derail you (temporarily or permanently) if you keep going down the wrong track, however. Making course corrections is a part of life for everyone.

RELATED: Is Addiction Self-Medication? 
Do You Have an Addictive Personality? (Take the quiz)
Fentanyl Deaths Drive Overdose Rate to a Record High, Tied to the COVID-19 Pandemic

Sources

Kumar, V. (2016, June 6). Former opioid users are at a greater risk of overdosing than the newly addicted. The Jackson Laboratory. Retrieved September 30, 2021.

National Institute on Drug Abuse. (n.d.). National Institute on Drug Abuse (NIDA). National Institute on Drug Abuse. Retrieved September 30, 2021,

Neporent, L. (2014, February 4). Why Phillip Seymour Hoffman’s 23 Years of Sobriety Didn’t Mean He Kicked the Habit. ABC News. Retrieved September 30, 2021, from ABC News

Reuters. (2021, July 15). Encinitas man shares relapse story as U.S. overdose deaths hit record during pandemic. Times of San Diego. Retrieved September 30, 2021, from Times of San Diego

Strang, J., McCambridge, J., Best, D., Beswick, T., Bearn, J., Rees, S., & Gossop, M. (2003). Loss of tolerance and overdose mortality after inpatient opiate detoxification: Follow up study. BMJ (Clinical research ed.). Retrieved September 30, 2021, from National Institutes of Health

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