The Real Significance of Overdosing at Home

In a recent speech on International Overdose Awareness Day, the Alberta Associate Minister of Mental Health and Addictions said, “The majority of overdose deaths take place at home, often when someone is using alone.” What is interesting to me is that this statement was essentially off the cuff, and clearly the Associate Minister did not appreciate, or perhaps he did appreciate it, but chose not to acknowledge the significance of what he had just said.

Around two decades ago it was extremely rare for someone to take their usual dose and then overdose in their home. Drug users typically take their doses in the same location, often in their own home. These locations tend to be filled with items that have become drug cues, such as a table used to prepare the dose, the drug box with all the items needed to prepare the dose, the time of day, the other furnishings in the room, and even the same people present.

These drug cues form a complex set of stimuli. They signal the brain that the next dose is coming. In response, the brain mounts a counter response to reduce the effectiveness of the drug. As repeated doses are used this counter response is activated more quickly and becomes stronger. As a result, the user often experiences drug tolerance, which means that they now must increase their dose in order to try to reach the same high (although they never will).

Because the counter response increases with repeated doses, it has the effect of being a valuable protection against the high dose now being taken. This is why, other things being normal, it used to be extremely rare for someone to overdose at home in the familiar surroundings that serve as drug cues. In fact, the vast majority of overdoses used to occur in unfamiliar surroundings, where those protective drug cues were not present.

In fact, the reason for the increased overdoses is that there is an unsafe drug supply. If the government was serious about the opioid crisis, they would talk about the drug supply. The simple, but lamentable, truth is that these home overdoses occur when users take their usual safe dose but are unaware that the dose they have purchased has been laced with fentanyl or carfentanyl, powerful opioids that make the dose much more dangerous and often lethal.

The stark reality is that an unsafe drug supply accounts for these previously very rare home overdoses. The Alberta government prefers not to talk about this. Instead, it focuses on recovery beds, which are available in private centres (see my previous post).

We need to help individuals who are addicted to drugs survive if we want them to have a chance at future rehabilitation. The government needs to focus on the unsafe drug supply; at the same time, we need to keep open safe injection sites. We need to overcome our moral objections to drug use and focus on harm reduction if we are going to help individuals who are addicted to drugs. In particular, we need to ensure that individuals who abuse drugs can survive to take advantage of these private recovery centres.