Solving the heroin overdose mystery: how small doses can kill | Aeon Ideas
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It was a science journalist, Edward Brecher, who first applied the term ‘overdose mystery’ when he evaluated Helpern’s data for Consumer Reports. Brecher concluded that ‘overdose’ was a misnomer. ‘These deaths are, if anything, associated with “underdose” rather than overdose,’ he wrote.
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There are several reasons why heroin addicts overdose. Some might simply take too much of the drug, especially when the heroin is enriched with even more potent opioids. Others might die because the effect of a usually sub-lethal dose of opiate is enhanced by other, concomitantly administered, depressive drugs, such as alcohol. These traditional risk factors have been extensively publicised. Less widely acknowledged is the risk that addicts face if they administer the drug in contexts that have not, in the past, reliably signalled the drug. When this occurs, victims die because they don’t have a Pavlovian response, and their bodies fail to decrease the pharmacological insult of the drug. If we told addicts about the risk of using heroin in an unusual setting, lives would be saved.