I thought I was a worldly person, but I've always understood opiate overdoses as miscalculation. For whatever reason, the person mistakenly takes too much.

But I gather something else is at play. It appears that some people start using compulsively and keep going either until they run out or are unconscious. And I suppose, also, at a certain point they are too high for restraint.

I know there are people on this board who know more about this than me. Is the above scenario common?

Because if it is, drug education sure is crappy. Apparently no one tells anyone that the drug gets into peoples muscles and they keep chopping and snorting until they die. Which allows users to imagine, "I'll be careful."

Heroin doses aren't uniform in quality or strength hence a lot of accidental overdoses

People also get clean for a little while, lose their tolerance, and that first relapse dose takes them out.

Yes, I understand there are lots of accidents like those. I'm asking people who know if compulsive use is a common way to die.

I don't think it's common.


They are compulsive people, but the drug won't allow for that type of compulsive behavior in most. It's not that they wouldn't, it's that they can't.

I've known and seen a number of addicts use and they die as mentioned earlier in this thread. Just nod out and die from respiratory depression. I would think that what you're describing would more likely occur in cases of mixing opiates with cocaine, which is more frequent than it used to be. Possibly even the majority at this point as it seems most addicts I see arrested randomly have heroin, crack, and a few xanax pills on them.

This is my understanding of it, too. Not much you can do once you're high but be high, really.

After you're addicted to heroin you don't take it to get high anymore you take it so you don't get sick, I was an opiate addict and nothing feels worse than opiate withdrawal, short of a broken leg anyway

I don't really see what you describe as a "something else".

I think that what you're missing is how incredibly strong the desire is in some to hit that sweet spot (and stay there). In the scenario you describe, these people have still succumbed to opiate overdose as miscalculation. It's just that they're pushing the margins a lot closer either knowing about the risk (but considering it justified by the upside) or through ignorance. The way you describe it is like they lose their autonomy and in a trance like state pump themselves with more drugs, which I don't think is quite right.

I hasten to stress that this is just my gut feeling on what is a very complex subject. While there are a lot of commonalities in the experience of drug addiction, it seems that no two people experience it in exactly the same way, so making broad generalisations doesn't really work.

^^^That's helpful. I'm trying to distinguish between someone who gets a hot bag or doesn't appreciate the difference between 40 mg and 15 mg oxy, versus someone who is not a naive user but gets carried away chasing the "sweet spot" for some reason I'd like to understand.

Another way to ask it: Once people get really high do they just stop taking it, or do some keep going and get way too close to the edge, or over it?

What prompted you to make this thread? Random interest? Or personal?

Lots of people OD because as soon as you start feeling the effects of withdrawal your tolerance goes back down. So they take their normal dose and blamo dead.

My understanding (no expertise) is that the brain's pleasure centres are weakened or damaged by continuous heavy use. This leads to anhedonia even if you get clean, and makes the drug innately less effective. There are doses of the substance past which tolerance isn't relevant, and so more or less inevitably a number of users will end up ODing.

Like any drug the body develops a tolerance. So people gradually increase their tolerance. That's why heroin addicts will tell you "I was taking 80MG a day at that point" or something like that.

The overdose stuff happens like people said above, but I think people without interrupted use do okay for a while because they know what dose they can handle.

Trying to understand what happened to a family member.

Fentanyl is killing a lot of people these days...

https://news.vice.com/article/americ...-drug-fentanyl

A lot has been already been covered here, but a couple additional points.

1. Judgment and inhibition go way down while high, so decision-making regarding additional dosage becomes increasingly poor.

2. The body is incredibly specific in trying to balance drug use with homeostasis. An addict who comes home and gets high in the same room every day will develop specific tolerances associated with their body/brain's response to being in that room, at that time. If that same person goes to a friend's house or decides to use the same dosage in their car outside, their body won't counterbalance effectively and the risk of OD goes way up.

3. Long-term substance abuse typically contributes to general deficits in insight, judgment, and impulse control which - combined with a physiological desire to get high - contributes to a tremendous amount of general risk.

Source: I'm a Ph.D psychologist.

I want to add a couple of thoughts as some one who has bad chronic pain and is a long term user of pain meds. For me it is a necessary evil, and though I have been taking them for a long time I have kept the dose low, despite doctors asking me if I want more all the time. These meds will make you more susceptible to pain and the more you take the more of a problem they become.

If you get injured and are in a lot of pain, it best not to take these medications if the pain is short term. Doctors say that you cannot get addicted to them if you take them as prescribed, but that is a lie. Doctors are responsible for creating many addicts. A certain amount of people will get addicted and for some its the beginning a long painful downward spiral.

Anyway my 2 cents, I hope that it might help somebody down the line.

Reading around the opiate subsection of various rec. drug forums that can be found on the internet might be a useful exercise.

I am an occasional user of codeine and dihydrocodeine. They're the weakest opiates out there and available in over the counter pain medications here in the UK. They're combined with paracetamol / ibuprofen so can't simply be munched to get a recreational high (without doing some serious damage) but it's a very simple task to extract the good stuff.

Anyway, I did some reading when I first started getting into these substances (3 years ago, maybe), in the spirit of harm reduction. If you read enough threads, you start to get a feel for the mindset of the hardcore opiate user. I remember being struck at the time how many users understood that mixing opiates with benzos and/or alcohol is an extremely dangerous game to play, yet would do it anyway.

There was a study in Switzerland in the 90's that showed if heroin addicts were given as much heroin as they wanted for free, most of them would top out at some dose, usually between 300-500 mg per day, and stay at that level with relatively little danger. Here is a link with a small amount of info but you can google for more detail.

A lot of overdoses happen because the supply is so unstable, people don't know what they're getting, and the rare times they get really good stuff they may accidentally use way too much. Or they may see it as an "opportunity" to get extra high, which can be tempting if that "opportunity" doesn't come around very often. They won't need to do that if they know they can always get exactly what drug/dosage they want any time. It becomes much easier for people to self regulate.

Something else which just occurred to me.

Redosing can be quite a variable thing with opiates - from person to person but also at an individual level depending on setting. If you can get the first dose right and remove the need to redose, that's the best way to get bang for your buck. I think something happens in addicts - especially if they're under the influence i.e. not first dose of the day - where they err on the side of taking a dose which will surely get the job done. Safety isn't as high up on the agenda as it ought to be when getting the most out of a limited supply (e.g. because of access or money or both) is a factor.

But I do think it all comes back to the same thing. Chasing and maintaining the high has an importance that a non-addict won't quite be able to comprehend.

Know someone who survived an od on xanax. She was taking one to get to sleep, waking up and thinking "this isn't working", take another and go through the same process forgetting how much she had taken.

I think 'Chasing Heroin' is probably the best documentary on the opioid crisis in America.

http://www.pbs.org/wgbh/frontline/film/chasing-heroin/

My layman's understanding is that there's sort of a double effect where if a user gets clean for awhile the amount it needs to get them high doesn't go down as fast as the amount needed to kill them.

One of my best friends brother has over dosed three times. It sounded so scary when he was explaining what he experienced during his last od to me recently. Said he kept waking up and then passing back out, at his house, in the ambulance, and at the hospital. But he said the craziest part was that the sequence of events that happened to him were jumping around. He'd wake up in the ambulance then back at his house then at the hospital then back in the ambulance. I was shook