I haven't touched cocaine or heroin in sixteen years. That's a good number. It's also, in one specific way, a dangerous one.
Here's why. After a long time without using, your body loses its tolerance. The amount you used to handle, the amount your memory says is "normal," can now stop your breathing. Add the fact that today's street drugs are often cut with fentanyl, which you can't see or taste, and the danger is simple: the first use after a long break is one of the most likely times to die of an overdose. Your body has healed, and it has no idea what's coming.
I'm writing this because it's the conversation nobody wants to have in recovery. It feels like planning to fail. I think of it more like a seatbelt.
What happens to tolerance when you stop?
When you use regularly, your body adapts. It takes more to get the same effect, and your breathing and heart get used to a level that would floor someone else. That adaptation fades when you stop. Your brain heals some. Your body resets.
What doesn't reset is your memory. You remember what you used to take. Your hands remember. And that's the trap.
A discussion paper by the UN Office on Drugs and Crime and the WHO lays it out plainly. Recent periods of abstinence are a major risk factor for fatal opioid overdose. The time right after leaving prison and right after leaving detox both carry a much higher risk. The main reasons are the loss of tolerance and misjudging how much to take on return.
Years clean is the same thing, stretched out. If anything, it's worse, because after years you're further from the old numbers and more sure you know them.
The supply isn't the one you remember
Sixteen years is a long time on the street. The drugs out there now aren't the drugs I knew.
Health Canada's page on fentanyl says only a few grains can be enough to kill, and that fentanyl and similar drugs are increasingly being found in other illegal drugs, like heroin. People often don't know what they're taking is contaminated.
So you've got a body with no tolerance meeting a drug that may be far stronger than the one you remember. If your thing was cocaine and you think this is only about opioids, please don't count on it. You can't see what's in it.
Why does "just once" sound so reasonable?
Because it's built to. The brain keeps the memory of the relief and files the cost somewhere you can't reach on a bad night. After sixteen years, the version of me who used is a stranger in some ways and a roommate in others. He still has opinions sometimes.
The thought usually shows up dressed as a reward ("you've earned it"). Some nights it's just tiredness wearing a costume. I wrote more about that in do cravings ever go away?. The short answer is they change. Mine don't run the show anymore. I still think about this more than I'd like.
If the thought is getting loud, tell someone before you act on it. A sponsor, a counsellor, your doctor, a friend who knows. In Québec, Drogue : aide et référence answers at 1 800 265-2626, 24/7, free and confidential. Saying it out loud takes a lot of the air out of it.
If you're going to use anyway, how do you stay alive?
I'd rather you didn't. But if you're going to, or you're scared you might, I want you alive on the other side of it. This is harm reduction, and it saves lives.
Don't use alone. Alone, there's nobody to give naloxone or call for help. If you can't have someone with you, call a line. In Canada, the National Overdose Response Service (NORS) is at 1-888-688-6677, call or text, 24/7. They call themselves a virtual safe consumption site, and it's confidential. In the US, Never Use Alone is at 800-484-3731. Someone stays on the line and sends emergency help to your location if you stop responding.
Have naloxone, and make sure someone near you knows how to use it. Naloxone reverses an opioid overdose for a while. In Québec, naloxone is free and needs no prescription at any pharmacy, and in some community organizations. Bring your health insurance card. Honestly, if you're in recovery from opioids, it's worth keeping a kit in the house anyway, and telling the people you live with where it is.
Call 911 if someone won't wake up or isn't breathing normally. Give naloxone, call, and stay with them. Naloxone can wear off before the drug does, so the person still needs the hospital even if they come around. In Canada, the Good Samaritan Drug Overdose Act protects people who call 911 at an overdose from charges for simple drug possession. It doesn't cover outstanding warrants or trafficking. But it means fear of a possession charge shouldn't stop that call.
That's it. No numbers, no tips on amounts. If you need medical help to manage use or withdrawal, that's a conversation with a doctor or a treatment service, and there are good options. I wrote about getting through opioid withdrawal safely.
If you already slipped
Then you're still here, and that's the part that matters. A return to use doesn't erase the years. They happened. What you learned in them is still yours.
What's dangerous right now is the shame, because shame says hide it, and hiding is how people end up using alone. So tell someone. Today if you can. Go back to your group, your counsellor, your doctor. In a decent recovery room, a relapse won't shock anybody.
I wrote about the long haul in sixteen years clean: what it's actually like. If you're in a dark place and thinking about not being here, call or text 988, or in Québec 1 866 APPELLE (1-866-277-3553). What actually happens when you call a crisis line might help if you've never done it.