‘It’s the secret rehabs don’t want you to know’: Sudden tolerance drops fuel opioid overdoses at the very clinics meant to help people get clean

Billionaire Matthew Mellon died yesterday at a rehab center in Mexico where he was being treated for his long-standing opioid addiction. It is unclear what the cause of the 54-year-old’s death was, but overdoses are common – if seemingly improbably – occurrences at rehab facilities.

Intuitively, a rehab would seem like the last place that someone battling addiction could have the kind of unfettered access to drugs that would lead to an overdose. But, tragically, a lowered tolerance, inappropriate treatments and a poorly-supervised group of people feeling desperate can create the perfect storm and stage for a lethal overdose. Mellon’s final stint in rehab was one of his several attempts to get clean.

In fact, he met his ex-wife, Jimmy Choo mogul Tamara Mellon in a Narcotics Anonymous meeting in London in 1998, when opioids were gaining popularity as recreational drugs in the US.

Some 88 percent of people with addictions to heroin or alcohol relapse, and, according to his ex-wife’s accounts in her autobiography In My Shoes, Mellon was certainly among them.Opioids – prescription or otherwise – ease pain by setting off a cascade of dopamine and endorphins.

Both of the neurotransmitter, dopamine, and the hormone, dopamine, trigger feelings of reward and pleasure far more intense than our bodies can naturally produce. So the only way to feel that rush again is to do the exact same thing over, maxing out the brain’s dopamine receptors with the drugs.

Each time the warm fuzzy flood of dopamine enters the brain, it lights up the reward system – which is intended to make us feel good when we do something good for our survival.

But the brain is not optimally efficient when it is in the constant state of pleasure and reward. After each high, the brain has to regain its balance, but in a habitual opioid user, the brain learns a new ‘normal’ state of over-excitement.

To counteract that, the brain starts switching off its dopamine receptors. So an opioid user keeps dumping dopamine into the brain, trying to get that high again, but there are fewer receptors to even experience the chemical high and the reward system doesn’t work as well.In an attempt to make up for it, opioid users try to up their doses, or take their drug of choice more frequently.

The flip side of the ‘new normal’ is a state of withdrawal the feels depressed, so addicts go from getting high to just taking a drug to feel their ‘new normal.’Tolerance can build up very quickly, depending on how frequently someone is using an opioid drug, and it falls just as fast.

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