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How the Wrong Approach to Drug Recovery Killed 'Glee' Star Cory Monteith

From his first rehab in his early teens to the intervention staged by Glee co-creater Ryan Murphy in March, the star was failed in every possible way by an abstinence-only recovery culture.

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Apparently, these “experts” suggested Eric Clapton’s  Crossroads rehab in Antigua, an old-school program that does not “believe in” using medications to treat opioid addiction, despite all the data favoring them as lifesaving for people whose problems involve heroin or painkillers. Murphy implies that  Monteith was in another rehab (reportedly  Betty Ford) that “didn’t work”—but that after the second program, “all indications were that he’d gone through the Steps.”

We all know what happened next. Although the intervention did get him into treatment—unlike the one conducted on [Kurt] Cobain, which was followed directly by his suicide—Monteith followed the pattern of the 90 percent of opioid addicts who are coerced into 12-step recovery and denied an adequate period of maintenance treatment: He relapsed. 

He also followed two other predictable and dangerous patterns.

First, the risk of overdose is highest in the initial few months after being in rehab or any other situation where a period of abstinence has occurred. After a complete detoxification, a person’s tolerance drops precipitously—meaning that the dose they took before treatment without even getting very high may now be potentially fatal. The first two weeks following prison, for example, were shown by one study to carry a greater than 120-fold increased risk of overdose death; that extreme risk elevation holds for whenever the person first uses again after a period without opioids.

Second, the vast majority of “opioid overdoses”—overdoses involving drugs like heroin or Vicodin—are not accurately characterized by that name. Instead, they are really “opioid mixture overdoses,” typically including an opioid and other depressants like alcohol and/or benzodiazepines like Xanax and Valium. Opioids are the drug that most often makes these mixes turn deadly—but only one third or fewer of so-called opioid overdoses involve those drugs by themselves.

Monteith took the deadliest possible combination— alcohol and heroin, whose actions to slow breathing are not additive but multiple—at the deadliest possible time. He was likely not informed about the risk because abstinence-focused rehabs typically don’t provide  harm reduction advice. He certainly was not provided with  maintenance medication like methadone or buprenorphine that can dramatically reduce that risk; he may not even have know that maintenance was an option—just as Cobain was told he could not take any more opioids, even for his chronic pain. Nor, apparently, were Monteith or his loved ones given  naloxone, which can reverse opioid overdose, or instructed on how to use it.

And this is where  stigma, and the fact that  addiction medicine generally isn’t practiced like real medicine, take over.

In no other type of treatment are FDA-approved medications seen as appropriate to withhold—without even informing the patient of their existence. No cancer center in the US provides only chemo while refusing to inform patients about radiation treatment or putting it down as something “we don’t believe in here” because it is “cheating” rather than “real recovery.” But the equivalent is done in addiction treatment—even for celebrities—every day. If we don’t want to keep losing patients, we’ve got to actually treat addiction like a disease, by providing evidence-based treatment, not just repeating faith-based philosophies.

Ryan Murphy has said that Glee will soon return and will deal with Monteith’s death in its storyline. “What we’ve been talking about in the writer’s room is that maybe the way we deal with this tragedy might save the life of someone,” he told Deadline Hollywood. If he really wants to do that, Murphy needs to fire his current “experts” and learn the truth about addiction.

Denying people access to maintenance care costs lives—and so does failing to provide harm reduction information and tools like naloxone to reverse overdose. The 12 Steps and abstinence are not the only way. If Glee can teach this, Monteith’s death truly could prevent thousands of others—and help finally bring addiction treatment into 21st-century medicine.