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Kehler Counseling Blog

What to DO about Opiate Addiction

Our country has turned medical doctors into legal drug dealers.   

It costs our country between $560-$635million in annual costs.

If a patient becomes addicted to the prescriptions they prescribe for pain then they can switch their patient to an opiate blocker and still keep them as returning patients.    Law enforcement tends to hesitate to investigate prescribing MD's for fear that patients who need them won't be able to get the help they need.   Only 2 states do not monitor pharmaceutical sales (Wisconsin & New Hampshire).  Physicians can now get previous pharmacy records through Federal government sites to help limit patients from "Doctor shopping."  

Before starting to understand, confront or acknowledge prescription drug abuse ask these questions:

1- Is TOLERANCE increasing?   

  • Do they/you require more to get same effect?  
  • Are they /you taking more than prescribed? 
  • More doses more often?  
  • Running out sooner than expected?  
  • "Losing" supply or prescriptions?  
  • Require more visits?  
  • More physicians? More pharmacies? 


2- LISTEN to the reason for using the Pain killer.  Are they coming up with new or more reasons to take a pill? 

  •  Are they now using them to sleep? 
  •  Are they adding more injuries or pain sites to rationalize reasons?  
  •  Are they telling you that they will wait until the children are asleep?  
  •  Are they taking them for other reasons than why prescribed in the first place?


3-MONITOR ATTITUDE - Withdrawal comes with irritability but also increased cravings that heightens their determination to get more.

  • Is their anger inappropriate for the infraction? 
  •  Are they telling you that they need their pills to manage social situations and not pain?  
  •  Are they under the influence where you can tell they have had too much by drowsiness, dilated eyes, wearing sunglasses more often? 
  • Are they missing important activities, especially those requiring long drives, time away from home, or events that require one to be 'on the ball?' 
  • Are they 'slacking' in normal activities?  Missing work? Paying bills? Watching children?  Taking showers, washing hair, getting dressed? 


4- WATCH FOR CRIMINAL BEHAVIOR - 

  • Take notice of changing physicians, pharmacies, peers, neighbors who have their own health issues that require prescriptions - that they might be stealing or sharing.  
  • Are small electronics or portable gadgets now "missing" - visit the local Pawn shops - that's where you might find them.  
  • Are your own pieces of jewelry, watches, coins, silver, copper, brass, antique objects missing?   
  • Have you checked your own pill supply lately?   
  • Are they borrowing/asking for  $20 from you, but also 2-3 other loved ones, peers, co-workers in a day - giving them 'enough' for a day's supply?  
  • Ask others around you if they get asked and how much they usually give.  $30-$60 a day will keep an addict from withdrawal.
  • Do they actually have something to show for the money 'lent'?  
  • Are they disappearing for long periods of time- (to get supply) have you checked the car's odometer - start tracking it - they may be taking rides to close by urban areas for supply.  
  • Are they running out to the store after meals  to 'get something' (vague) and taking too long  to return.  

The good news is that there is treatment to get off of opiate based pain killers.  The bad news is that the treatment requires ongoing drug testing, regular office visits and should include good counseling services to create a life that supports a drug free life.   

I used to call the life of a hard drinking client a 'six block life' - as a client had shared with me that when he was busy drinking he lived, worked and drank in a 6 block radius of his home.  He rarely ventured away from his apartment,employer, bank and bar.  The beer distributor delivered to his home.   When we reviewed how much he spent on alcohol and cigarettes over a 20 year period of time - it was over $100,000.   That's just on a beer diet.  Opiate users often spend $800-$3000 a month! Beware-  pills are more than street heroin. 

I call the life of an opiate user a 'Couch Life'.   If you really talk and listen to an opiate abuser - they have created an entire life that consists of getting supply or using supply.  If they don't get a regular supply they will lapse into withdrawal symptoms that are ugly - messy - painful and embarrassing.   Unlike alcohol withdrawal death is not the danger - dehydration, choking on vomit, or falls from muscle spasms and weakness are.    If an abuser can't get a supply - these symptoms begin about 12 hours after their last use.   
What I am seeing is that their lives become completely strangled by being under the influence - getting the next supply -or fearing the beginning of withdrawal.

One thing that loved ones should know and understand about opiate addiction is that it can begin with simple physical addiction.  You do not have to have a vulnerability, family history of addiction or want to 'escape' by using drugs to become addicted.   The addiction is more physical first - than any other type of drug.   This is why you are seeing non-typical people becoming out-of-control addicts.   
It starts with a simple need to manage pain.  I see it after sports injuries, car accidents, recreational injuries, oral surgeries, and outpatient procedures.  Patients are given a prescription, often before the treatment, to deal with the expected pain.  Sounds simple.  Take for initial pain - wait until body heals - get back to work, school, life. . . what can happen too often is that you can become physically addicted- so on that day you're supposed to return to work - and your prescription ends - you're experiencing the beginning of physical withdrawal.   Initially, you will have a runny nose, sweating more than usual, muscle aches, anxiety and trouble sleeping.   These symptoms may get in the way of focusing at your job or school so you ask for either another round or for something to help.  Often this stage is overlooked as having a 'flu' - to both the patient and those around them.   

In less than 72 hours these symptoms get more significant and severe.  The person without a renewed supply will now have symptoms that require them to stay home, in bed, in the bathroom and or in the shower.   Nausea, vomiting, diarrhea, abdominal cramping, goose bumps and intense cravings  begin.   A person can 'survive' them - but the discomfort is remarkable and more often than not - the person will seek relief by finding more supply.   This can go on for years.   

The family or friends surrounding them either ignore it, support it or try their best to manage it.  Many don't realize that the addict is in their most euphoric state when they look like they are sleepy - when they are actually 'nodding' under the veil of a drug induced high.     The 'couch life' is because there now has to be constant -nonstop management of staying high.   Addicts spend that 12 hours between 'fixes' to obtain their supply - whether it's 'road trips' to an urban area to a 'quick stop' location where users simply drive around a block 2x+ times and dealers make their drop right at their car.  Many have female friends wait in the car while they go into a dealer's place - because cops are less likely to suspect drug using if a female is in the car.  Some go as far as having a baby seat, child or dog along to act as decoys.  

There are hundreds of ways an addict can secure the next fix.  The easiest is to have not just one physician but several coordinated to provide multiple prescriptions of the various drugs popular to consume: Percoset®,Vicadin®, Oxycontin® .  Some will obtain their supply through others who can get them through insurance and government covered prescription programs - that they exchange for cash.  This is more often done by the 'working poor' and/or senior citizens who need cash to pay for heating and basics and have limited ways to increase their income.   It's why the problem gets ignored or discussion avoided.  It's a secret that families keep because there are real benefits.   
More often than not the addict will 'befriend' someone they know who is already using them, has had a need for them and doesn't need them now or they check out 'stashes' in the medicine cabinets of others.   Teens usually start in their own homes - then share them with peers.   Pills and pocket change are probably the most 'stolen' items in a household - they're small - people rarely count them, most don't lock them up and more often than not - they are accessible.   

Faking pain is easy - you can't tell at what level it is - so 'patients' can lie easily.  Hospitals and their physicians are required by law to 'treat pain' - but if you don't have insurance they don't want to admit you if they don't have to - handing you a prescription of pain killers keeps you 'happy' and they followed the law.   Now you just need to keep having 'injuries', 'accidents', 'procedures' or treatments that require ongoing pain management.  

This can go on for years.  The addict will become more dependent and tolerant.  They will go to more risky levels to secure their fix.  Many switch to heroin -finding it cheaper and actually 'easier' to secure.  No appointments, co-pays, sitting in waiting rooms.  Laws have required the manufacturers of most opiates to change formulation so that they don't give a 'buzz' if ground up and snorted so heroin is the replacement.  Everyone who has come into my office after using heroin all started with the pill form first.  It is the same thing.  As I said in the beginning - opiate pain killers have made MD's 'legal' drug dealers.  

Now what do you do to stop the insanity?? 



  • First you need to admit you have had ENOUGH. . . That you have just wasted 1 , 2, 5, 7, 10 years on the couch.  Admit that you have pretty much slept through it.   You have not done or missed out what your clean friends, co workers and family have been doing.   You were 'on the couch' nodding out while the rest of life was passing you by.  You missed the fun stuff, the laughs, the rewards of really living a clean life.  While you were 'nodding' kids grew older, friends moved on and family deserted you - even if was just because they were bored with your 'so - called life' .  Watching a person 'nodding off' or incoherent is NOT amusing, fun or interesting.  It is sad, sickening and a horrible place to be.  If you care about the person you want to snap them out of it, yell or scream to stop it or offer real help.  Intervention style discussions can help - but have a solid plan, place to go and stick with the ultimatum.  If they refuse you will have to follow through with 'tough love' of stopping support, employment, housing, or allowing them to raise or see children.  I have seen mothers of children chose prison over getting clean - so it may take everything you've got to follow through.   In 'worst case' scenarios - prison means that the loved ones can sleep at night.  They know where the addict is and that nothing will be stolen and pawned.   It may even take several prison sentences to 'get it.'    
  • If you're ready - pick up the phone.  If a physician has been prescribing them - call them and meet with them to start a program to get off of them.  They can write the prescriptions for the opiate blockers as easily as they could for the opiates.  

  • If you're getting supply from illegal routes call your regular MD and ask if he/she will prescribe Buprenorphine or Suboxone.  These are the 'opiate blockers' now used to help wean a physically addicted patient off the original pain killers.  
  • If you don't have insurance make a call to any Drug Treatment center, facility or hospital near you and ask how their programs work and what can be done for someone without insurance.  Local government agencies - differ by county and state - but have funding to help addicts get treatment - you may have to wait but follow through - especially if there are children involved! Reporting a mother of children may be upsetting but if the 'system' is working - she will get professional treatment, the children will be monitored and the 'system' can be the 'bad guy' instead of a spouse or loved one.  
  • Use the Internet.  There are hundreds of sites for real help - education, support, message boards, and what to do as you're going through the withdrawal that you will have to deal with.  There is plenty of support for everyone - the addict, parents, siblings, children,employers - this issue has lead to the deaths of more people than cocaine and heroin combined - you will not be alone in reaching out and seeking support!  Just Google or BING Opiate addiction and millions of sites offer help.  Find those that 'speak' to you - for women, men, older/younger, families, professionals - there's plenty of help and the more you know the more confident you will be moving forward. 
  • Reach out and find someone to stay with you for the initial week or two as you deal with the physical symptoms and start to create a drug free life.  For many pain management will still be an issue - if you really do have issues with pain then you will need to address them - get creative with how you deal with pain - seek alternatives including massages, physical rehabilitation, acupuncture, electronic devices, even brain control through bio-feedback.  
  • If you still have a real pain management problem - seek professionals who specialize in pain management.  It's now a niche and the good professionals will work with you to address your pain history, injuries and work to reduce-even eliminate the pain you have.   There are non-addictive medications as well as treatments that work together.  If you have pain and using your medications as prescribed you are NOT an addict.  It's when you're not  following the physician's directives where the trouble begins.   Of the arrests made of MD's overprescribing opiates - only 3.5% were MD's in Pain Management - 39% were Family/ General Practioners - that may have not monitored, made a good assessment or had a poor diagnosis to start with.   
  • Reach out to others - going to Narcotics Anoyomous Meetings may give you the added support and positive feedback you need.  If that doesn't work for you - try hospital based support groups.  The more you share with others - the less negative you will feel about making major changes.  


So hopefully this information helps - I see too much of this to stay quiet.  It is blindsiding families, employers are seeing it and I just want everyone to know there is a way out!     If you are in my area - contact me for an appointment today!   

Peace, 
Karen 




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