Opioid Relapse and Accidental Overdose

Medically Reviewed by Jennifer Robinson, MD on April 24, 2022
Written by Stacey Jones, MS, BA
4 min read

Opioid addiction is a long-term, manageable disease. Like other ongoing conditions – such as high blood pressure and diabetes – setbacks, including relapse, can happen. About half the people who have opioid use disorder will relapse. That’s why you shouldn't consider a relapse the end of your recovery. Instead, it may be a detour on the road to long-term wellness. If you relapse, it’s best not to dwell on feelings like shame and regret. You can try to learn from your relapse so you can grow stronger in your future recovery efforts.

There’s no single reason. But knowing what might cause you to relapse may help you avoid it. And if you do relapse, you can get back to recovery sooner – and with better results – if you understand what triggered you to start using again.

Many times, people relapse when they try to quit drugs on their own. And most who seek outside help first look to peers, education, and counseling for support. But medication-assisted treatment, which combines medicine with supportive therapies, has proven most effective. The medications typically prescribed to treat opioid use disorder are:

Another common reason for relapse is trying to “test” sobriety. You may feel you have your drug use under control and you can return to drugs at certain times, like vacation or holidays.

Other reasons include:

  • Cravings
  • Stressful situations at home, work, or in relationships
  • Trouble managing emotional or physical hurt without drugs
  • Thinking that using a drug other than the one you’re addicted to may not be as harmful
  • Not being able to avoid the people, places, or things that remind you of the drug
  • Lack of a solid support system as you work on your sobriety
  • Getting treatment because others want you to, not because you’re ready
  • Not going to recovery self-help meetings or not taking part when you do go

The risks of relapse may be different for men and women, one study says. Women who were having withdrawal symptoms, who were depressed, or who had PTSD (posttraumatic stress disorder) symptoms were at greatest risk for relapse, the research found. Men who misused multiple substances and had a history of behavior disorders were most likely to relapse. For both women and men, younger age increased the risk of relapse, too.

During recovery, you may think about using drugs again at times. That’s normal. But when thoughts of using become regular and troublesome, behavioral therapy can help you learn ways to deal with that.

You’re more likely to overdose when you relapse after not using opioids for a while. That’s because your drug tolerance becomes lower. The amount you once used may be too much for your body to handle.

Your risk of overdose grows particularly if:

  • You’ve overdosed before.
  • You’re taking more than 100 milligrams a day of opioid medications.
  • You’ve been recently released from jail or an inpatient rehab setting.
  • You use opioids with alcohol or other drugs.

Statistics show that your odds of a fatal overdose are highest in the first 4 weeks of treatment and in the 4 weeks after your treatment ends.

Totally avoiding drug use may not be possible for everyone. Treatment methods such as harm reduction recognize this fact and work to help drug users at whatever stage they’re in – without stigma, judgment, or bias. Even the smallest changes in behavior while you’re using can lower your risk for overdose and diseases such as HIV and hepatitis C, or keep you out of jail.

If you’re using again, it’s particularly important to:

  • Use clean needles and don’t share them.
  • Avoid mixing drugs and high doses.
  • Never use drugs alone.

You should also make sure you and your close friends and family have naloxone (Narcan) to reverse an overdose and know how to use it. Naloxone can safely reverse an opioid overdose – from heroin, fentanyl, or prescription opioids including morphine and codeine. It works by restoring your breathing and replacing opioids in your brain. You can get naloxone without a prescription in pharmacies in all 50 states, Washington, D.C., and Puerto Rico. It’s available as a shot or a nasal spray. You can’t treat yourself with naloxone in case of an overdose. So if you do carry it, make sure someone who’s with you knows what to do with it.

You may find it difficult to stay off drugs. If that’s the case, then harm reduction should be the goal. If you’re ready to try recovery again, you may need to restart inpatient or outpatient treatment (depending on how long you’ve been using), adjust your treatment, or change it altogether. There’s no one-size-fits-all plan. You and your doctor should work together to find a treatment solution that is right for you and your situation.

Other ways to help yourself include:

  • Get help when you need it. It’s hard to stop using on your own.
  • Use therapy to help change negative thinking and find positive ways to handle your challenges.
  • See setbacks as teachable moments, even when they don’t cause a relapse.
  • Focus on self-care by getting enough sleep, eating well, and being good to yourself.
  • Follow the rules that you and your treatment team have agreed on for your recovery.

To successfully leave a life of drug use behind, you must create a new life that helps you avoid relapse, experts say. You’ll surely be disappointed if you relapse after weeks, months, or even years of living drug-free. But to paraphrase the old saying, to err is human, to forgive yourself divine. With patience and time, you can learn the warning signs of relapse and how to better keep on track with your sobriety.