A coroner's report confirmed last week that actor Cory Monteith's death was a result of an overdose. Monteith joins icons like Heath Ledger, River Phoenix, John Belushi, and Jim Morrison in meeting a premature end by overdosing on prescription opioids, heroin, or some mixture of these drugs with other substances. We all know that stars are "just like us," so it should come as no surprise that celebrities are not exceptional when it comes to risks of overdose.
In fact, Motheith's death is part of a nationwide epidemic that has quietly climbed the charts of America's top killers: drug overdoses now claim more lives than motor vehicle accidents. Opioid drugs (including prescription painkillers and heroin) are the primary culprits, contributing to approximately 17,000 U.S. deaths. Though countless celebrities have tragically died of overdose, there is no high-profile spokesperson, event, or fund dedicated to battling this epidemic.
In the wake of last week's tragedy, many voices have pointed out (for example, here, here, and here) that Monteith's demise -- and that of many others -- could have been prevented. People emerging from detox (or any other period of abstinence, such as spending time behind bars) are many times more likely to overdose than regular users. This is because, when you resume drug use after a hiatus, it is not unusual to pick up where you left off in terms of what and how much you use; one's regular dose can become lethal in such situations because of changes in the body's ability to tolerate the drug. People emerging from treatment may also mix various drugs and alcohol, which proved the lethal combination in Monteith's case.
Given the well-documented risk of overdose following treatment, one would think it should be standard practice for rehab programs to take extensive precautions to keep their patients safe after discharge. But many programs offering detoxification purport to get and keep patients "drug-free." This is great business, as evidenced by Bain Capital's -- Mitt Romney's one-time investment firm's -- shopping spree for for-profit drug treatment facilities all across the U.S. Although this is slowly starting to change, many such centers have traditionally discharged patients without offering the kind of clinical (e.g., medication-assisted treatment using methadone or buprenorphine) and psychological follow-up support that has been shown to help patients avoid returning to problematic substance use and, with that, overdose.
Though marketable (think Celebrity Rehab), the "tough love" abstinence mantra does not jibe with the cautionary message of overdose risk after detox. Nor does this mantra square with the reality that rates of relapse after such treatment programs range from 40 to 90 percent. We do not know what Cory Monteith was told when he left rehab, or the extent or content of overdose education at drug treatment programs in general. Frequent grim headlines and troubling overdose statistics make clear that whatever is being done falls far short.
In our society, substance abuse is shrouded in stigma, which why it is so difficult for friends and families of overdose victims and survivors of these events -- whether celebrities or not -- to speak about their experience. Support groups like Learn to Cope are fighting this silence by providing an opportunity for people affected by overdose to get involved in prevention. So far, such efforts are too few and government action has been unacceptably sluggish.
The good news is that several simple, but critical pieces of information can help address overdose risk in general, as well as specifically among people emerging from drug treatment:
1. Patients, their families, friends and caregivers should know about the elevated overdose risk post-treatment, as well as about specific factors that can increase risk, including mixing drugs, taking prior doses, and using alone.
2. It is critical for everyone to learn the signs and symptoms of overdose, including shallow breathing, ashen skin, and not responding when the victim's name is called.
3. Both patients and caregivers should know how to respond to an overdose, including how to place the victim in a recovery position to prevent choking, the importance of calling 9-1-1, and the availability of naloxone -- an opioid antidote -- that can quickly revive the victim. Largely because of concerns about "sending the wrong message," naloxone is seldom offered to patients upon discharge from drug treatment for opioid abuse; there is an expanding network of programs across the U.S. making this antidote available.
4. Overdose witnesses often delay calling the ambulance for fear of legal consequences until it is too late. But arrests at the scene of overdoses are rare, and a number of states have passed Good Samaritan laws designed to encourage people to seek help by shielding witnesses and victims from drug possession charges.
We will never know for sure if these measures would have saved Cory Monteith, but they can certainly prevent others from meeting the same fate. Let's hope that Monteith's untimely death jolts his friends, colleagues and fans to action. Glee's producers recently announced plans for a tribute episode before the show goes on hiatus to deal with Monteith untimely passage; both the episode and the hiatus present opportunities for the show to use its wide popularity to raise awareness about overdose risk and prevention. Whether focused specifically on the risks following drug treatment or on other aspects of this crisis, any effort to do so is bound to save lives.