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A Case Report: Pavlovian Conditioning as a Risk Factor of Heroin 'Overdose' Death

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A Case Report: Pavlovian Conditioning as a Risk Factor of Heroin 'Overdose' Death

József Gerevich et al. Harm Reduct J.

Abstract

Background: The authors present a case illustrating a mechanism leading directly to death which is not rare but has received little attention.

Case presentation: The case was evaluated by autopsy, investigation of morphine concentration in the blood, and clinical data. The heroin dose causing the 'overdose' death of a young man who had previously been treated a number of times for heroin addiction did not differ from his dose of the previous day taken in the accustomed circumstances. The accustomed dose taken in a strange environment caused fatal complications because the conditioned tolerance failed to operate. The concentration of morphine in the blood did not exceed the level measured during earlier treatment.

Conclusion: These results are in line with the data in the literature indicating that morphine concentrations measured in cases of drug-related death do not differ substantially from those measured in cases where the outcome is not fatal. A knowledge of the conditioning mechanism can contribute to prevention of fatal cases of a similar type. The harm reduction approach places great stress on preventive intervention based on data related to drug-related death.

Figures

Figure 1
Figure 1
Heroin concentration levels in a case A after conditioning in an accustomed place (A1) and in a new place (A2), and in a case B without conditioning.

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