Opioid+Overdose+Aftercare

Opioid Overdose Aftercare

Special thank you to our friend John Welch for developing this guidance.

If someone you care about just survived an overdose, you’re probably looking for what to do next to help the person and yourself. The person may be your child, partner, parent, friend, or co-worker, and your relationship may be intense and involved or more limited. You might feel terrified, angry, relieved, helpless, grateful, defeated, all of those, or some combination of those feelings. You may have just discovered that they use opioids; you may have known for a long time and have been through this before; or you may use with the person and know a lot about their use. You may have been the one to rescue them from overdose.

There is no simple, one-size-fits-all advice that covers all these situations and relationships. Each is unique and no one knows the context of your situation as well as you do.

One thing that IS true across the board, though, is that loving and supporting someone who uses drugs in a problematic way is very hard.   Staying connected to a loved one who could easily overdose again requires a lot of care for yourself, soul-searching about what’s best for you, and boundary-setting in which you center your own needs and care for your own well-being. Caring for yourself and remembering that you are in charge of your life and relationships will also help you find the compassion for your loved one you will need to stay connected through the roller coaster ride of problematic substance use.

 An aspirational statement:  Be guided by compassion for your loved one and care for yourself.

PRIORITY #1:  KEEPING YOUR LOVED ONE ALIVE

There is a lot to think about when someone you love has overdosed.  What if this happens again? Do they have a major problem or not? Will they change their relationship to drugs?  Can I tolerate having a person who goes through this in my life? 

But the very first thing to think about is how to help your loved one stay alive. Contrary to what some might hope—that an OD would “teach" someone not to take the same risk again--people who have overdosed before are at a very high risk of overdosing again.  No matter what happens with your person’s drug use and where your relationship with them goes over time, helping them stay alive now is the first priority. If you aren’t already familiar with the steps, you’ll need to learn how to recognize and respond to an overdose. Make sure to check that the people your loved one spends time with do the same (with your loved one’s consent, of course!). Administering Naloxone, doing rescue breathing, calling 911--these are the skills and tools you’ll need, and you’re in the right place to get them. Another source of support for keeping your person alive if they OD again is the people who they use drugs with. People tend to keep drug-using friends away from other friends and family, and family is often glad for the distance. But no one wants to OD or see their friend OD, and people who use drugs often have more expertise than those who don’t, so finding a way to open non-judgemental communication with your person’s drug using community if you aren’t part of it may be your best strategy to protect them. 

 DID YOU JUST SAVE A LIFE?

 Maybe you just rescued a loved one or an acquaintance from overdose.  It’s typical for you to be congratulated by friends (sometimes as the hero) and then forgotten as the focus shifts to the survivor.  Overdose rescue can be a terrifying or uncanny experience for the rescuer too. At times, it can stay with you and be disturbing. It’s often hard to talk about, especially with people who have never done it themselves.  Making the time to debrief from your own perspective with your own feelings and thoughts with a person or people you trust soon after the event can be quite healing. What happened from your angle? What was it like for you?   What did each important moment feel like to you? Telling your own story of the event to trusted people will help you process it and weaken it’s traumatic impact, but you may need to be the one to reach out and ask others to listen because often they just want to thank you and move on.

KNOW YOUR PREVENTION

 Knowing how your person can prevent an overdose even if they continue using opioids can be as empowering for you as it is for them. Practical knowledge helps us face situations that are scary.  Here are some basic opioid overdose prevention do’s and don’ts for those who use. Perhaps your loved one will be up for talking these over with you, or letting you remind them of these points when you’re concerned. 

  • Don’t use alone or behind locked doors if possible (there’s no one there to help you if you OD)

  • Reduce your dose if you go back to using after abstaining for a period of time (tolerance plummets very quickly after you stop using)

  • Test or taste (if you inject, do a small test shot or “taste” the dose in your syringe by administering a small amount of what you are injecting first to see how it affects you before injecting the rest of the dose.)

  • Be aware of your mix.  Mixing opioid drugs (heroin or pain pills) with alcohol, cocaine, benzodiazepines or other drugs greatly increases the overdose risk. In fact, most opioid overdoses are actually a combination of opioids with other drugs which can magnify effects. If you must mix drugs--research potential harms and protections first and make sure folks around you have naloxone on hand.

  • Test drugs for Fentanyl (a pain drug far stronger than heroin that now taints much of the US street drug supply). Ask your local harm reduction program for fentanyl test strips or reach out to us if you need help locating them. 

  • Know how to use naloxone and carry it on you. Make sure friends do the same

  • Talk about the possibility of overdose with friends you use with and supportive people in your environment. What would a good safety plan look like for you?  

 WHAT ABOUT TREATMENT?

If your loved one is open to treatment and you are helping them with it, the person themselves should choose what they are most comfortable with.  People do better when it’s their decision. This can mean slowing down and giving a fair hearing to all the options when you may feel tempted to jump at whatever feels like it can bail you out of a tough situation immediately.   While many people (including people who use drugs themselves) think it’s best to live “drug-free,” consider this: the treatments that are most effective at preventing further overdoses and immediately stabilizing an addiction are medication assisted--Buprenorphine or Methadone maintenance treatment.  These are opioid substitution treatments. Although it is changing, there is still a strong bias in our culture toward12 step-based treatments that promote abrupt change to total abstinence rather than the gradualism of opioid substitution options. Abstinence based approaches help many people, but as you know if you have ever tried dieting or quitting smoking, most long term behavior change is gradual and marked by periods of going back to the old behavior even as you try out the new behavior. Hence, there can be increased risk of overdose for people in abstinence treatment when they “relapse” (a normal and common part of changing). 

Additionally, it is important to be aware that rehabs and long term treatment centers that use the 12-step model vary greatly in quality. Little regulation or oversight in this field has led to predatory recruitment methods and unscrupulous programs in some cases. It is important to do independent research, talk to people who have been there if you can, and find programs you can trust if you and your loved one decides to go the rehab route. If you’re not sure where to start, there is a helpful nationwide treatment locator on the SAMHSA website: https://www.samhsa.gov/find-treatment Self help groups like AA and NA are everywhere and offer helpful structure and community for many (though not all!) and alternative groups like Smart Recovery, Moderation Management and Harm Reduction groups can also be found in many areas.   

Individual psychotherapy with someone familiar with harm reduction approaches can provide an important space for your person to understand their drug use more fully and partner with a professional who can help them start to make positive changes.  Psychotherapy is a great resource for people who are not interested in drug treatment or do not think that drug use is their main problem (or a problem at all). Therapists who use harm reduction start “where [the person] is at” rather than forcing an abstinence agenda the person may not be ready for. This way of working can do much to improve the situation and can take some of the burden off of family and friends.  When looking for a therapist, seek out someone who is upfront about being comfortable working with people who use drugs who may not be ready for abstinence. It’s important to be clear with others about your own goals in accessing support. 

HOW DO I TALK TO MY LOVED-ONE ABOUT THEIR DRUG USE?

When you talk to your loved one, do your best to express your concern and care for the person as a whole up front. Communicate your belief they can change in the ways they want, if they want to and feel ready.  Remember, any positive change they want to make is a step in the right direction. It is fine to tell them what you see in their behavior that bothers or worries you, but avoid getting caught up in arguments or back and forth about whether they are using or not or how much.  It is important not to pretend everything is fine when it is not, but try to avoid critical and negative talk. This kind of talk leads to defensiveness, shutting-down or hiding of what is really going on. Sometimes it is hard to resist, but it is just not useful. Here are some examples of negative talk:   “These drugs are going to kill you!”; “You’ll never be happy if you keep using drugs.”; “ You’re destroying your life!”; “Can’t you see what you’re doing to Mom?!” Negativity can also show up in a sarcastic, dismissive or withering tone that expresses how fed up you are even when you’re not saying it. Whether they say it or not, your loved one probably has the same fears about their future and the same frustration with themselves as you do, and they likely harbor, and use against themselves, their own critical, angry, fed-up inner voice .  They’ve often learned to avoid or bury these voices with drug use. You don’t want to feed that cycle by piling your own negative talk on top of theirs, right? That leads to more of the same. 

If you can manage it, don’t talk to them about drug use when you can tell that they are high or when you are already arguing, and avoid empty threats. If you need to set a new limit with the person for your own well-being, that is your absolute right, and if you can do it with compassion and calm, that’s even better.   People are more likely to change when they have support, understanding and good boundaries from loved-ones. And it is your decision how much of this good stuff you are willing or able to offer.  

Once you start taking better care of yourself though, you may be surprised that your capacity to offer these things is bigger than you think.   It is a truism—and it is a true truism!—that trying to force someone else to change will get you nowhere—you can only really change yourself. But on the other hand, except in the case of parents and small children, we all can expect certain things from those we love in return for staying in relationship with them (for a married person it may be a certain amount of attention and availability, for example) and in the end we all get to decide when it is time to change the terms of our relationships or the ways we interact with one another.

BUT IF I DON’T GIVE TOUGH LOVE, AREN’T I ENABLING THEM TO KEEP USING?

 Abstinence-only approaches will tell you that if you’re not removing yourself from your loved one when they use or refusing to help them out of scrapes, you are enabling them. They must suffer harsh consequences and “hit bottom” to be motivated to change, so the story goes. The wisdom here is that you must consider yourself and put on your own oxygen mask first before trying to help the other person. The flaw here is that harsh consequences actually do not lead to lasting changes, and that many forms of helping your loved one may actually prevent further damage to you and them rather than just cause more hurt.  For example, you may decide to help your girlfriend forge a doctor’s note next time she doesn’t show up for work, so she doesn’t get fired and leave you both homeless. Or that may be a bridge too far for you. Only you can figure out what your limits are in each situation. Beware of cookie cutter advice and one-size-fits all rules about tough love. 

 Some questions to ask yourself are: what do I want and need for my own life? What am I willing to tolerate to stay in this person’s life in the way I am in it now? What needs to change (that I have control over) for me to feel ok?  Getting clear on these kinds of questions over time is your oxygen mask and will help you figure out if you need to make changes to this relationship or set limits in a new way to protect yourself. It’s good to remember that you can often successfully set limits with people even if you can’t stop them from using drugs.  If your partner tends to smoke in bed while nodding out on heroin after you have fallen asleep, what’s most immediately important is that they not burn the house down. Perhaps they may not smoke in your house after a certain hour, for example, and holding them to that may not be the losing battle that getting them to stop using heroin has been...and in the meantime, you work on making sure there’s a working smoke detector in your room.  

If you make a demand of your loved-one as people often do, be sure you are prepared to deal with the consequences if they don’t abide by your ultimatum.  If you’re not willing to allow an adult child to continue to live with you when they are using drugs, are you prepared to kick them out when they keep using? And are you prepared for the consequences to them and to your relationship that may follow?   What are those consequences likely to be? Is there another, less drastic limit that can be set?     

SELF CARE

Here are a few ideas for how to take care of yourself in your difficult situation:

  • Don’t go it alone.  Find a person, people, or a group you can trust not to lecture or judge you—people who can handle that your situation is hard to handle. People who can listen. Share your struggle. Some options include friends, family, clergy, or a mental health therapist. 

  • Make time to do healthy things you enjoy and keep up routines that help you feel good about yourself.  Get these 4 things in adequate supply daily: Sleep, Nutrition, Movement, Rest.

  • Don’t forget to nurture your other relationships!  Are you so obsessed that your daughter is probably getting high in her bedroom that you barely remember your husband exists?  It is very important to stay connected to other people you care about and let them care for you. Confiding in a trusted person is good, but also connect on things other than problems with your loved one.  

  • Don’t take your loved one’s drug use personally.  People don’t use drugs because they don’t respect or care for you or even themselves.   When drug use is problematic, it is usually in place to cope with complicated painful feelings that the person has not figured out how else to address and that they are probably not even fully aware of.  Their use is not directed at you; it is not your fault; and you are not the one responsible for it.

  •  Don’t judge yourself harshly.  You are in a difficult and trying situation for which there is no right answer.   No one does it right all the time and most people who stay connected try everything, including many things that backfire.  

  • Think more about what you need for yourself and less about what will get your loved-one to change.  

  • Manage your expectations. If your loved one has a real problem, know that it will likely not change quickly or easily.  Facing this reality can help you not get thrown by all the ups and downs. 

  • Be with your own suffering.  We all suffer in different ways.  If you can see the importance of having someone else to listen and stay involved with you while you are suffering without trying to fix it or make you do something they think you need to do, you can see how important it is to do this for yourself too.   We tend to avoid our own suffering or cast the other person as the only true sufferer or the only reason for our own suffering (“You’re ruining my life!”). Developing self-compassion and the ability to abide with our own suffering is a life-long practice that we all have many opportunities to engage in and seeking guidance and support through whatever spiritual practice speaks to you can be a great help in this growth effort.   


We’re available if you need to talk. Don’t hesitate to email info@nextdistro.org to schedule a time. Put “overdose responder” in the subject line.