Does quitting heroin cold turkey increase the chances of a future overdose? This is a very serious question. Someone who abstains from heroin use for any length of time long enough to complete the withdrawal process is at very high risk for future overdose, especially a fatal one. The method of drug withdrawal wouldn’t be a factor, however. Whether the detox was done cold turkey or not, what matters most is that the person’s tolerance level will decrease sharply after the withdrawal process is over. It will continue to decrease over time as long as the individual continues to avoid heroin or other opioid use.
What is Tolerance?
Tolerance to a drug occurs after a certain period of regular ingestion or exposure to the substance in question. In the case of heroin and opioids in general, this means a time period of at least a few weeks and would involve daily or near-daily exposure. After a month or more of daily heroin use, almost everyone would have developed both physical dependence and a significant tolerance.
Tolerance sets in much sooner than physical dependence does. In fact, tolerance begins with the very first dose. A drug taken orally must go through the liver before it can make its way to the brain in any large amount. This is called the first-pass effect. Some drugs, such as alcohol, are absorbed in part directly through the stomach’s lining, but for the purposes of this article, we shall refer to tolerance as part of the first pass effect.
Tolerance and the Liver
When a drug is taken for the first time, the liver doesn’t recognize it. The liver will always try to detoxify anything it can; that’s its job. It does this job in part by manufacturing special enzymes designed to break the drug down faster and faster. The more often the drug goes through the first pass, the more the liver will learn how to create enzymes to metabolize the substance, faster and faster each time. Eventually, almost 100 percent of the dose will be deactivated at the hepatic level, before it can even reach the brain. The only way to maintain any effect is for the user to take higher and higher doses. Because the amount is higher, the liver cannot clobber the whole dose. Some of it will get through to the brain until the liver learns to make more enzymes. However, when it does, it will destroy the extra drug taken, and that destroyed portion never makes it to the brain. So, the user takes even more. This goes on and on.
Tolerance to opioids can reach truly astonishing proportions. This isn’t true with all drug classes, such as the barbiturates, but people who have slowly raised their opioid dose over time can easily take amounts that would be lethal to someone with no tolerance.
Tolerance and Future Overdose
What does tolerance have to do with lethal overdose? After all, doesn’t tolerance protect you from overdose, at least to some degree? Yes, it does, but only for as long as the drug continues to be used. Someone who discontinues drug use and goes through withdrawal will lose most or all of their previous tolerance over time. The timeframe of this tolerance loss will vary from person to person, but someone who has been drug-free for several weeks has definitely lost a large proportion of their former tolerance.
If this person who has abstained from heroin use for a certain time period, especially long enough to completely go through withdrawal, no longer displaying any heroin withdrawal symptoms at all, were to use heroin again a dangerous overdose situation could easily occur. This is because many past heroin users would not realize how much of their tolerance has been lost. There’s no way to measure this loss. However, if they take their former high dose after their protective tolerance has worn off, they can easily overdose and die. It happens all the time. It’s especially true with heroin because there is never any way to be sure exactly how strong the dose really is in the first place.
If you Need Help
If you’re concerned about possible heroin overdose and would like more information, call us anytime at 772-266-5320. Our professional drug counselors would be happy to answer all your questions. We can also help you find a substance abuse recovery facility for you or a loved one if you’re concerned about stopping heroin abuse. We look forward to helping you set your life back on the right track.