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For many addicts, a stint in rehab can be a lifesaving choice.  For others, relapse following detoxification at rehab can be deadly.  Reports suggest this was the case for Glee’s Cory Monteith.

The Vancouver coroner’s office revealed that “Glee” star Cory Monteith died of a toxic mixture of alcohol and heroin, weeks after leaving rehab for substance abuse.  His death highlights the dangers of the post-rehab period, and why patients are most vulnerable just after they receive treatment.

– Maia Szalavitz at Time

Heroin addicts develop a tolerance to the drug over time, requiring higher amounts of the drug to experience a “high”, but also requiring higher amounts to overdose on the drug.  Detoxifying through rehab “resets” the body’s tolerance level so that if the addict relapses and uses the drug again, the previous “normal” dose may become fatal.  This is particularly true when the drug is mixed with another depressant, like alcohol.

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, according to one study.

– Maia Szalavitz at Time

Heroin produces its “high” by acting on nerve cells in the brain.  However, many of those receptors are found on nerve cells that regulate and control breathing.  Because heroin acts as a depressant, it slows these nerves, which can slow the rate of breathing.  Essentially, the brain is suppressed in such a way that it fails to tell the lungs to breath.

So heroin suppresses respiration not by damaging the lungs but by damaging parts of the brain that tell the lungs to breathe, [John Brown, attending physician at San Francisco General Hospital’s emergency room] says.

The combination can create a vicious cycle, Brown says.  The brain fails to send the proper signals, so breathing slows.  That causes cells to become deprived of oxygen, which further decreases brain activity.

Addicts can die because they simply stop breathing, Brown says.

– Liz Szabo at USA Today

Alcohol also acts a chemical depressant and will amplify heroin’s effects on brain activity.

Because of the increased risk of overdose following rehab, some experts have suggested maintenance treatment with drugs like methadone or Suboxone.  Such maintenance can lower overdose risk, though many rehab facilities reject the approach preferring total abstinence – the “cold turkey” approach.

According to Time magazine, the Hazelden rehab facility just recently began adding maintenance therapies in addition to the “cold turkey” approach.  Hazelden did so because abstinence proved “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.”

For addicts who do relapse and overdose, there is an available antidote, naloxone.  This medication can reverse overdose from opioids like heroin, Vicodin and Oxycontin.  However, this antidote is not widely available and only approved in an injectible form, which is difficult – and potentially dangerous – for untrained people to administer.  Proponents of the antidote argue that it should be more readily available and with a more user-friendly means of administration, such as a nasal dose.

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(c) Copyright 2013 Brett A. Emison

Follow @BrettEmison on Twitter.


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