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.

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