Relapse is often an unfortunate part of the recovery process for many people. According to the National Institute on Drug Abuse, substance use disorders result in relapse 40 to 60 percent of the time, which is similar to other chronic diseases like hypertension and asthma. It’s important to realize that a relapse doesn’t mean that all of your efforts in recovery have been meaningless. It simply means that you need to revisit addiction treatment or that you need to reevaluate your relapse prevention strategies and coping responses. It’s also important to realize that a relapse isn’t inevitable. Still, relapsing on opioids can be inherently dangerous.
One of the clearest consequences of a relapse is a return to active addiction. However, according to Dr. Gordon Alan Marlatt, a psychologist that introduced the Relapse Prevention Model, a full relapse after an initial lapse is common but not inevitable. People who fail to abstain from addictive behavior through a lapse in abstinence may fall into ineffective coping mechanisms. An effective coping response would be to acknowledge that you weren’t prepared for that particularly high-risk situation and that you need to reevaluate your coping mechanisms to try again. However, people often instead feel shame and guilt, which causes them to mask their negative feelings with drugs or alcohol. They may also feel like they are completely powerless against cravings and that abstinence is a pointless endeavor.
Opioid overdoses can occur for a variety of reasons. You may take a dose that’s higher than normal, you may take a drug that’s mixed with a stronger substance, or you might mix the drug with depressants that potentiate its effects. However, one of the most common ways people overdose on opioids is during a relapse. When you use an opioid regularly, you start to develop a tolerance. Your body gets used to the drug and adapts. In fact, the opioid receptor system is highly adaptable and may lead to more profound tolerance than other systems. The more you use, the higher doses it will take to cause the same effects as when you started.
However, that adaptability goes both ways. When you stop using the drug and go through the withdrawal phase, you will lose your tolerance. People that go through a period of abstinence and go back to using their normal dose may be taking too much for their current level of tolerance. Overdose is especially common among people that are forced to abstain because of a medical procedure or are in prison. When they return to opioid use, they may not realize that their appropriate dose has gone down.
When you spend time outside of active addiction, you may separate from the lifestyle of drug abuse. This is a positive step toward recovery, and it means that you are spending more time pursuing your own goal without the burden of maintaining an addiction. However, when it comes to relapse, it can also mean getting drugs from unknown sources. Opioids like illicit heroin are unpredictable. They may be adulterated to the point where it’s impossible to determine an appropriate dose, and it may contain potent additives like fentanyl, an opioid that can be 50 times stronger than heroin. All illicit drugs are unregulated and unpredictable, but a relapse may cause you to desperately seek opioid sources that you don’t know or trust.
CDC. (2019, May 31). Fentanyl. Retrieved from https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
Hayhurst, C. J., & Durieux, M. E. (2016, February 1). Differential Opioid Tolerance and Opioid-induced Hyperalgesia:A Clinical Reality. Retrieved from https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2474170
Marlatt, G. A. (1999). Relapse Prevention – National Institutes of Health. Retrieved from https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf
National Institute on Drug Abuse. (n.d.). Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids
National Institute on Drug Abuse. (2018, July). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery