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


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

József Gerevich et al. Harm Reduct J.


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.


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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    1. Brecher EM. Licit and illicit drugs. The International Journal of the Addictions. 1980;15:359. - PubMed
    1. Gardner R. Deaths in United Kingdom opioid users 1965–69. The Lancet. 1970;ii:650–653. doi: 10.1016/S0140-6736(70)91414-5. - DOI - PubMed
    1. Gerevich J. Fatal combination of MDMA and heroin. Psychosomatics. 2005;46:189. doi: 10.1176/appi.psy.46.2.189. - DOI - PubMed
    1. Siegel S, Hinson RE, Krank MS, McCully J. Heroin "overdose" death: Contribution of drug-associated environmental cues. Science. 1982;216:436–437. - PubMed
    1. Siegel S. Pavlovian conditioning and heroin overdose: Reports from overdose victims. Bulletin of the Psychonomic Society. 1984;22:428–430.

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