Dead is Dead

When you walk into a drug rehab in Laconia, New Hampshire, there’s a bulletin board posted with activity schedules, inspiring quotes about recovery, and facts about drug addiction. Beneath the bulletin board there’s a shrine of sorts, remembrances for a former resident who left addiction treatment and died of a heroin overdose. The love expressed by the shrine – the painted rocks and personal notes – is real but inconsequential. Dead is dead, and loving memories don’t change that dead-ness.

Opioids – prescription narcotics and illegal street drugs – are killing young people across New England in what government, news, and health organizations now call an epidemic.
Why are so many opiate users dying, and why are all users at risk of dying?

Opioids — heroin, morphine, tramadol, oxycodone, methadone, suboxone, and fentanyl, to name a few – act on the parts of the brain that regulate respiration. In other words, they slow or stop breathing. Most overdoses lead to death because the user simply stops breathing.

Opioid Overdose Death: The Risk Factors

The first risk factor that contributes to drug overdose death is drug use. It’s that simple.

The second risk factor leading to drug overdose death is the chemical composition of the “product.” The illegal drug trade markets heroin that is 90, 80, 70 percent pure. Which means the illegal drug trade markets heroin that is 10, 20, or 30 percent something else. No intravenous drug user really knows what’s actually in the heroin, and when that 10, 20, or 30 percent of something involves a powerful additive such as fentanyl, the respiratory depressant effects of the product can increase dramatically. The initial “high” is a little (or a lot) more exquisite, the inevitable “nodding” comes on more quickly, breathing becomes slower, shallower, and then the breath stops altogether.

The third risk factor leading to drug overdose death is mixing narcotics with alcohol and other drugs such as benzodiazepines (Valium, Xanax, Ativan are a few). Alcohol and benzos aren’t a narcotic, but they are central nervous system depressant and they also contribute to a decrease in respiration. When one respiratory depressant is combined with another respiratory depressant, breathing becomes dangerously slow, until, too frequently, it stops altogether.

Tragically, the fourth risk factor leading to drug overdose death is time spent in drug addiction treatment, detoxification, jail, or a voluntary or involuntary period of prolonged withdrawal from opioids. When a drug user stops using, for any reason, within days drug tolerance drops. When an addict returns to drug use – particularly heroin – the amount of product he or she could tolerate in the past has suddenly become a lethal dose.

The fifth risk factor that makes an opiate overdose more likely is using alone.  When respiration becomes dangerously slow, if the user is alone, no one can intervene; no one is watching as lips turn blue, as the cigarette caught between fingers burns down to the bone. Relapse often involves shame and secrecy, causing addicts to use alone at the very time their tolerance for the drug has diminished during a period of abstinence, thus dramatically increasing the risk of overdose.

The sixth risk factor contributing to drug overdose is the overall health of the user.  A compromised liver, weight loss due to malnutrition, and respiratory illnesses leave users particularly vulnerable to tolerance levels and opiates’ action upon the central nervous system.

Think of every needle as a gun, and every plunge of that needle as a game of Russian Roulette. But these days, too many young people are playing the game with six bullets in the chamber instead of one. The odds favor no one.