The recent overdose death of Glee star Cory Monteith after his stint in rehab highlights a fact that is well known to researchers in the addictions field: tolerance for opiates drops severely after a period of abstinence and people who use opiates again after a period of abstinence are at high risk for overdose. During the first two weeks after release from prison, former inmates are at 129 times greater risk of dying from a drug overdose than the general population. And the UNODC tells us that the numbers are much the same for those released from drug rehab programs.
Traditionally, topics such as harm reduction and overdose prevention have been taboo topics in rehab programs; apparently there was a fear that discussion of such topics would lead rehab clients to relapse once they got out. Thankfully, wiser heads have come to prevail at some rehabs; there has been a recognition of the reality that the majority of rehab graduates will use substances again after graduating from rehab and that it is common to have a number of slip ups on the way to achieving successful abstinence from problematic drug use. The one thing which will prevent this successful recovery is death, and keeping people alive until they can recover needs to be a top priority. Not only have rehabs traditionally failed to teach drug users about overdose prevention, they have often taught drug users mantras such as "if you pick up again you will pick up exactly where you left off" and "your diseases is progressing even when you aren't using." These bits of misinformation could do nothing but increase the chances of overdose after release from rehab.
Fortunately, the times they are a changing, and in New York City more and more rehab programs, detox centers, methadone programs and even prisons are teaching people about overdose prevention and outfitting them with Narcan kits. Narcan, also known by the generic name naloxone, is an opioid antagonist which literally knocks the opioids off the receptors in the brain and brings people back to life. Even if the overdose is caused by mixing drugs such as alcohol and heroin, and almost all cases once the effect of the opiate is reversed, the life is saved.
Much of this change is due to many years of hard work by Sharon Stancliff, MD of the Harm Reduction Coalition. Thanks to the tireless efforts of Dr. Stancliff, more and more New York City rehabs are incorporating overdose prevention education into their curricula. The following link gives a directory of registered opioid overdose prevention programs in New York State http://www.health.ny.gov/diseases/aids/harm_reduction/opioidprevention/programdirectory.htm
Arlene Gonzalez-Sanchez, Commissioner of the New York State Office of Alcoholism and Substance Abuse Services, fully endorses overdose prevention training as a part of addiction rehab and encourages every rehab program in New York State to incorporate it into their curriculum. What follows are some testimonials from rehabs where overdose prevention training has been instantiated:
"I have been offering overdose prevention training to all of our patients as a voluntary program twice a week. Since the inception of this program, I have trained 210 individuals. The patients are very engaged and eager to learn. On May 2, 2011, I received a message from a former patient who wanted me to know that he had used his overdose prevention kit over the weekend and was able to save his friend’s life! He was ecstatic and as you can guess, so was I! Anyone who has concerns about starting this program should know that if you save only one life it will be one family that is not devastated by this disease."
"Our client Scott, a heroin addict, took the Opiate Overdose Training on his previous admission and then left here and ultimately relapsed. He was using again and locked in a room with a friend who overdosed on heroin. He knew that he had his Overdose Prevention Kit in his car. He could not get out the door, so he crawled out a window, retrieved his kit and crawled back into the locked room. He administered both syringes of Narcan and his friend woke up. Scott is back with us now after his relapse and related this story. What more can I say, except that this training may save a life."
"We are very proud of our involvement with this initiative. We have trained a great many of our own staff and staff of other providers. We have also trained a large number of patients. The patients’ response to this initiative has been overwhelmingly positive. We have had many patients report back to us how they have utilized their “blue kits” to save the life of a friend or acquaintance."
And it is not just in rehab, overdose prevention training is also taking place in prisons and in methadone and buprenorphine programs in New York. The Lower East Side Harm Reduction Center, for example, goes regularly to Rikers Island to teach inmates about overdose prevention and Narcan.
Harm reduction and traditional rehabs can work together to save lives. I hope you are reading this Dr. Drew Pinsky. You could set an example for the nation of you brought back Celebrity Rehab and taught overdose prevention and gave out Narcan kits. Your clients would stop dying, too.