Heroin seizure during heroin W/D (possible benzo influence)

[simco]

I'm asking this question because I've always been under the impression that except for risks like dehydration, it's pretty much impossible to die from heroin withdrawals.

Now, a guy I know (seriously, it's not me, just a dude I know around town) decided to kick a 1g/day intranasal H habit cold turkey. Apparently, things went OK for about a day, and then he had a grand mal seizure. If the EMTs hadn't gotten him to the ER he would definitely have died. As it was, he was in the ICU for three days.

This left me wondering about my received wisdom about non-lethality of heroin W/D. I bet some folks here can clear up my confusion.

Here's where we get to the meat of the issue. Turns out he was also abusing xanax on a regular basis. I'm not sure how much he was taking. Honestly, I'm surprised he didn't up and OD from that combo, but c'est la vie, I guess.

My sense is that benzos lower your resistance to seizures, which is one reason benzo detox is so dangerous. Does this sound like a reasonable hypothesis? Maybe his benzo habit lowered his seizure threshold to the point where the stress from heroin detox pushed him over the edge?

After writing that, it also occurred to me that I guess the seizure could have been *just* from benzo W/D. But I'm pretty sure he was still taking those to help with the heroin trainwreck.

Can anyone weigh in on what might have happened here?

Obviously, I'm not asking for medical advice. Just informed speculation to store away in the old knowledge bank. FWIW, I do know the guy well enough that we had a lengthy discussion about the experience and I'm pretty sure my facts are right and he was telling me the truth.

Thanks!
-Sim

 

[mostly-human]

Benzo detox and heroin detox BOTH lower your seizure threshold, and whilst heroin WD alone is not known generally to cause seizure (I'm sure it has in rare cases, in fact - I've heard it can happenduring those rapid-detox procedures, where people are put 'under' and given naltraxone injections). Certainly xanax is well known for causing seizure during WD. Since xanax WD on it's own can have this devasting effect, I'm sure withdrawing from heroin, in the acute stage, from a relatively high dose (1g/day - is quite high depending on the purity, but even at 20%, that is qutie a large dose, although - I'm not familiar with the bio-availability for that ROI, but even given low BA and low-quality, it's still enough for pronounced WD in acute stage) - combine that with even mild-moderate xanax withdrawal and I'm sure your seizure threshold is dramatically reduced, and of course - some people are far more prone than others to have seizures. As you can see my join date is 10 years ago, well actually - my first BL account was with 99 or 2000, then I lost that one, but basically - I've been around the block a few times, to put it lightly and I've NEVER known anyone, not a single person, to suffer a seizure during heroin (only) WD, let alone die from it. That said, I've known a few people, over my time with such people, to have suffered from serious seizures when suffering xanax WD.

 

[simco]

thanks, mostly-human. very interesting and informative. I figured something along those lines was at work. I absolutely did not know that heroin lowers seizure threshold.

and for what it's worth, you're right: he had a big habit. the gear we get in these parts is almost always pretty strong, so 1g/day, even at low BA, is (at least in my book) a lot of dope.