How sudden tolerance drops fuel opioid overdoses

Billionaire Matthew Mellon died yesterday at a rehab center in Mexico where he was being treated for his long-standing opioid addiction.

It is unclear what the cause of the 54-year-old’s death was, but overdoses are common – if seemingly improbably – occurrences at rehab facilities.

Intuitively, a rehab would seem like the last place that someone battling addiction could have the kind of unfettered access to drugs that would lead to an overdose.

But, tragically, a lowered tolerance, inappropriate treatments and a poorly-supervised group of people feeling desperate can create the perfect storm and stage for a lethal overdose.

Overdose deaths are not uncommon in rehabs, especially when extreme detoxes lead to plummeting tolerances and extreme cravings

Mellon’s final stint in rehab was one of his several attempts to get clean.

In fact, he met his ex-wife, Jimmy Choo mogul Tamara Mellon in a Narcotics Anonymous meeting in London in 1998, when opioids were gaining popularity as recreational drugs in the US.

Some 88 percent of people with addictions to heroin or alcohol relapse, and, according to his ex-wife’s accounts in her autobiography In My Shoes, Mellon was certainly among them.

Opioids – prescription or otherwise – ease pain by setting off a cascade of dopamine and endorphins.

Both of the neurotransmitter, dopamine, and the hormone, dopamine, trigger feelings of reward and pleasure far more intense than our bodies can naturally produce.

So the only way to feel that rush again is to do the exact same thing over, maxing out the brain’s dopamine receptors with the drugs.

Each time the warm fuzzy flood of dopamine enters the brain, it lights up the reward system – which is intended to make us feel good when we do something good for our survival.

But the brain is not optimally efficient when it is in the constant state of pleasure and reward. After each high, the brain has to regain its balance, but in a habitual opioid user, the brain learns a new ‘normal’ state of over-excitement.

Even the best, most famous rehabs have people dying in their facilities Dr Andrew Kolodny, executive director, Physicians for Responsible Opioid Prescribing.

To counteract that, the brain starts switching off its dopamine receptors. So an opioid user keeps dumping dopamine into the brain, trying to get that high again, but there are fewer receptors to even experience the chemical high and the reward system doesn’t work as well.

In an attempt to make up for it, opioid users try to up their doses, or take their drug of choice more frequently.

The flip side of the ‘new normal’ is a state of withdrawal the feels depressed, so addicts go from getting high to just taking a drug to feel their ‘new normal.’

Tolerance can build up very quickly, depending on how frequently someone is using an opioid drug, and it falls just as fast.

‘Tolerance starts dropping almost immediately,’ after someone stops using drugs, says Dr Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing.

‘In a few days after you’ve come off, an amount of an opioid that you could have easily taken at the height of your addiction is too high,’ Dr Kolodny says.

Billionaire Matthew Mellon died yesterday at age 54 at an addiction rehab center in Mexico. His cause of death is unknown, but many overdose at rehab due to low tolerances and relapses

This is where the trouble can start for someone in rehab, especially if their facility has them detox and do so through abstinence, he says.

In programs that have their clients get off of opioids by simply quitting – rather than using suboxone or methadone treatments to help them ween off – a horrific withdrawal is all but guaranteed.

Without a steady stream of drug-imported dopamine to keep the brain at that ‘new normal,’ people reel through severe flu-like symptoms, depression and anxiety.

‘Severe cravings after they have been detoxed can last months, which speaks to the flaw in abstinence-based programs,’ he explains.

When someone immediately comes off the drugs, their tolerance plummets and their cravings are blindingly intense.

In the throes of withdraw, these cravings give way to desperation and ‘even in the best rehabs, people will find a way to bring drugs in,’ Dr Kolodny says.

Despite the efforts of rehab staffs, drugs get in, through visiting friends and family, or perhaps crafty uses of online orders from the shadowy dark web.

There is no clear way of knowing how, but Dr Kolodny is confident that the vast majority of overdoses are fueled by drugs that have been snuck in, rather than by high doses of methadone or suboxone.

No matter where the drugs come from, Dr Kolodny says that, especially in abstinence-based programs, ‘even the best, most famous rehabs have people dying in their facilities.’

‘I think the public would be shocked at how often this occurs, because they send their loved ones to rehabs because they are afraid of them dying of an overdose,’ unaware that they are still at risk in the very places they go for help, he says.

‘There are lawsuits all the time,’ but you won’t find statistics about theses deaths, because ‘that’s a secret that rehabs don’t want anyone to know,’ Dr Kolodny says.

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