Heroin is widely recognized as one of the most dangerous and highly-addictive illicit drugs. Yet most users don't fully understand the risks when they start using, particularly the threat of overdose.
Overdose deaths are frequently the result of using heroin after a period of sobriety. People who use heroin regularly develop a tolerance for it (they require larger doses to get the same effects). Then when they stop using for a time, often in rehab, detox or prison, their brains become sensitive to the drug again.
If the user relapses, the first few uses are not "just another dose." In fact, they now face a dual threat: Not only do they have less tolerance for the drug, but because of the effects of addiction on the brain they also have poor judgment in deciding how much to use. Going back to the same old dose with low tolerance can be deadly.
Heroin use and heroin overdoses have spiked in recent years. According to the Substance Abuse and Mental Health Services Administration, the number of heroin users in the U.S. jumped almost 80 percent to an estimated 669,000 in 2012 from 373,000 in 2007. Annual overdose deaths attributed to heroin use rose to 3,094 in 2010, up 55 percent from 2000.
The Essential Elements of an Overdose Prevention Plan
Few people in recovery plan to relapse. Loved ones don't want to prepare for the eventuality because it seems like a bad omen or negative thinking. Everyone wants to think about and prepare for the best-case scenario, especially when they see positive changes in their loved one. But relapse is a reality for many people, especially when opiates like heroin are the drug of choice.
Just as having a relapse prevention plan in place and actively working a program of recovery are critical, so is having an overdose prevention plan. What does this type of plan look like? Here are some of the key elements:
Naloxone. One of the most important overdose prevention tools is naloxone, a safe, non-addictive medication that blocks the effects of opiates such as heroin on breathing, turning would-be fatal overdoses into a second chance at recovery. It can be administered by injection or a nasal spray and cannot be used to get high. Naloxone works within minutes and is effective even when the individual used a mixture of drugs, not just opiates. After receiving a dose of naloxone, the individual wakes up -- in pain from withdrawal, but alive.
Naloxone has been used routinely by emergency personnel for decades. Although most people still don't have easy access to this medication, naloxone has become more widely available in recent years. In some states, anyone at risk for having or witnessing a drug overdose can get a prescription for naloxone, similar to the way people with allergies carry an EpiPen. This policy has been widely supported by organizations such as the American Medical Association, the American Public Health Association and the World Health Organization. Some groups also advocate for naloxone to be available over the counter rather than by prescription only.
A Buddy System. Naloxone has been hailed as a "miracle drug." However, drug users aren't usually in a position to administer the medication themselves because they lose consciousness. This means that having naloxone on hand isn't enough. People also need a trusted friend or loved one to inject or spray the medication. Since two-thirds of overdoses occur when a person is using at home alone, it's critical for an overdose prevention plan to name one or two people who are willing and able to recognize the signs of overdose and administer naloxone and/or call 911 immediately.
Treatment. Naloxone isn't a replacement for addiction treatment. It's designed to keep the individual alive long enough to get back into treatment, whether that's a drug rehab program, a 12-step group, therapy or some other type of support. Other medications such as naltrexone can also be an important part of treatment. Given as a single monthly injection (Vivitrol), naltrexone decreases drug cravings, making relapse less likely, and prevents an accidental overdose if the person slips so that a single bad choice does not become a death sentence.
Live to Fight Another Day
Having an overdose prevention plan in place does not mean that we condone drug use or that all users are destined to relapse. Rather, we create these plans because we are hopeful that the addict will eventually choose health and sanity over addiction given enough time and because we know that treatment works.
We plan for all kinds of eventualities we hope do not come about. We purchase disability insurance when we're still able-bodied. We create wills long before we think we may actually need them. A drug overdose prevention plan serves the same fundamental purpose: to preserve our most valuable asset (life) at a time when recovery seems like a sure thing. Because when it comes to addiction, every day presents new challenges, and having a plan "just in case" offers a second chance to those struggling with drug abuse and peace of mind for the people who love them.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes Promises, The Ranch, The Recovery Place, The Sexual Recovery Institute, Right Step, Clarity Way, Journey Healing Centers and Lucida Treatment Center.