Hayden Panettiere's death highlights risk of overdose death after stopping and resuming drug use

A coroner’s report notes actor Hayden Panettiere had been in rehab just weeks before her death from an accidental drug overdose.

Although details of her care are unknown, people with drug addictions face a high risk of fatal overdose immediately after a period of sobriety. Experts say they may not realize their tolerance has dropped in that time, meaning a previously tolerated dose could overwhelm the body.

Panettiere, 36, was found unresponsive in an apartment in Greenville, South Carolina, on Aug. 16. The Greenville County Coroner’s Office said several drugs were found in her system, including fentanyl and its chemical byproduct, the anti-anxiety medication alprazolam, a muscle relaxer and a drug used to treat major depression and other serious mental health disorders. The case report says a senior deputy was told she had been in rehab for two or three weeks in Malibu, California.

Last year, about 70,000 Americans died of drug overdoses, down about 14% fewer from the previous year, according to preliminary government data released in May.

How opioid addiction can be treated

For people struggling with addictions, there are various types of care, including therapy and counseling, medication and support groups.

With addictions to fentanyl, heroin, oxycodone and other opioids, treatment may include medications and behavioral therapy. The National Institute on Drug Abuse says medications are the standard of care for opioid use disorder. Treatment options include methadone, buprenorphine and naltrexone, which research shows can reduce the risk of resumed drug use and a fatal overdose. Behavioral therapy for opioid use disorder is most effective when combined with medication, the institute says.

Using drugs after stopping them can be deadly

Using opioids again after withdrawal can be especially dangerous.

According to the National Library of Medicine’s MedlinePlus, most opioid overdose deaths occur in people who have just undergone detoxification. Because withdrawal reduces the person’s tolerance, those who have just gone through withdrawal can overdose on a much smaller dose than they previously took.

This risk has long been known. A 2003 study in the British Medical Journal said “treatment reduces mortality but can sometimes increase mortality transiently," including among people with prior opioid addiction after their release from prison.

Experts at Pennsylvania State University's Social Science Research Institute said the risk of overdose death is higher immediately after opioid use disorder treatment, including after detox and stopping medication for the disorder.

They cited research showing that the month after completing treatment is associated with a much higher risk — five times higher for ending treatment without medications and two times higher after ending medication treatment. That’s compared to periods more than a month after ending treatment.

What friends and family can do to reduce risk of overdose death

The first thing to know is that someone who recently stopped using drugs is at higher risk for an overdose if they relapse. Be ready to respond if that happens.

Death following opioid overdose can be prevented if the person gets prompt basic life support and the medication naloxone, an antidote that rapidly reverses the effects of an opioid overdose if administered in time.

The New York State Department of Health recommends taking these steps if someone witnesses an overdose:

1. Call 911 and say, “I think someone may have overdosed.”

2. If the person isn’t breathing, begin mouth-to-mouth breathing by pinching the nose and blowing into the mouth

3. Administer naloxone if available.

4. Place the person on their side once they have resumed breathing

5. Stay with the person until the ambulance arrives

____

The Associated Press’ health and science coverage receives financial support from the AP Fund for Journalism and private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.