Overdose Is Inevitable

By Christopher J. O’Brien, MS


Overdose Is Inevitable: The word commonly associated with “overdose” is “accidental”. What we will suggest here is that, for substance abusers, overdose is not accidental, but a logical milestone in the progression of addiction. That is, the only alternative to overdose is abstinence and recovery.

Research into the causes of overdose identifies several pathways. Tolerance, recent drug treatment, multi-drug use, and homelessness.

Tolerance- For example, for FDA approval, if the effective dose of a sedative is one milligram, the lethal dose might be 10 milligrams, or10 times the sedative dose. An extra pill in error will not cause substantial harm. Therefore, the likelihood of accidental overdose is slim, under normal circumstances. For the substance abuser, however, tolerance increases the dose required to get high. After one year of use, he or she might be using 9 milligrams, but tolerance increases the lethal dose only slightly. Therefore, if such a person is high and forgets how many they took, a second dose of 9 milligrams puts them at 18 milligrams which might be 3 milligrams over the lethal dose. But that is not the worst of it. In some cases, the tolerance to the drug can increase until the dose to get high is a fatal one. The lethal dose might have increased to 15 milligrams, but the dose to get high becomes 16 milligrams, and breathing ceases. Therefore, the progression of addiction and tolerance moves the user ever closer to a lethal overdose.

Multi-drug use– The use of multiple drugs increases the likelihood of a lethal overdose. This is because multiple drug interactions do not cumulate; they “may combine synergistically”. For example, if one were to take their normal dose of an opiate with an effect of 50%, they feel unsatisfied, so they take a benzodiazepine for the other 50%. The two drugs do not add, however, they multiply. That is, a 5 opiate and a 5 benzodiazepine do not add up to a 10 high. They might multiply and become a 5 x 5 or 25, which might be two times the lethal dose of 12.

Recent drug treatment– During periods of abstinence, as the body adapts, tolerance decreases. In the previous example, where tolerance had taken the lethal dose from 10 to 15, and an addict had been using 12, there was danger, but no overdose. During abstinence for drug treatment or incarceration, tolerance decreases, and the lethal dose might return to 10. The addict, unaware, relapses at their previous dose level of 12, and the result is respiratory suppression and death.

Homelessness-The idea that homelessness increases the likelihood of death from overdose seems, at first, irrelevant. But a closer examination reveals that homelessness means using drugs alone. The active addict should be aware that using drugs alone increases the likelihood of death from overdose. Fatality is more likely when there is no one around to assist in the event of overdose. Strang, et. al. (2008) “Examined the impact of training in overdose management and naloxone provision… (for)… opiate users.” (abstract) Subsequently, 18 overdoses were reported between the training and the follow up. In six overdoses, naloxone was not used and one death occurred. In the other 12 overdoses, where naloxone was used, all 12 resulted in successful reversals. Of these 12, the client’s own supply of naloxone was used in 10.


Of course, abstinence and recovery are the best remedies against death from overdose. But the reality is that not all people will get clean and sober today. A further realistic viewpoint is that many people relapse at least once before attaining long term recovery. Therefore, in the interim, the following recommendations might save a life.

1) Don’t use alone.
2) Learn how to recognize and what to do when a friend overdoses. (Call 911)
3) If you leave AMA, or relapse, be aware that the usual dose might kill you.
4) Be aware of drug interactions, and the idea that poly-drug use is a desperate and dangerous remedy for tolerance on the road to overdose.
5) Further study and thought might be applied to examine the social obligation and/or consequences of a program where naloxone and training in its use might be offered to the addict.

Christopher J. O’Brien holds an M.S. in Counseling Studies, and a postgraduate certification in “Contemporary Theory in Addictive Behavior”. He is a “Certified Addiction Professional” (CAP) in the state of Florida. He has 29 years in recovery, 25 years of active participation in the recovery community, and experience as an addiction counselor. He has published the book: “Understanding Addiction”: Propensity, Progression, Crisis, and Recovery” which is available from Amazon.com, direct from the publisher at Medallionpublishing.com or by phoning Mr. O’Brien at 561-863-1090.

He operates a private practice offering interventions and recovery counseling in North Palm Beach Florida.