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5 Tips for Family and Friends of Opiate Addicts

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5 Tips for Family and Friends of Opiate Addicts

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1. No “negative enabling.”
2. Seek outside support.
3. Offer the opiate addict the opportunity to change.
4. Make other family members and friends aware of the situation.
5. If your loved one suffers from opiate addiction, there is very real risk of incarceration, overdose or death. You should know this.
(Discovery Place, 2015)

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1. No "negative enabling."

Do not engage in "negative enabling." Negative enabling is a term that refers to giving an active opiate addict some form of resource that allows the addict to progress in addiction.

The two most common forms of negative enabling I see are giving an opiate addict money or a place to live. It also includes any form of resource, like transportation, that allows an opiate addict to maintain the lifestyle.

Family and friends should learn to say no and stick to it. Saying no is perhaps the most powerful ally in attempts to bring about change in an opiate addict. Do not expect an opiate addict to respond positively when this tactic is put in play. People with addiction grow accustomed to getting what they want. If they have difficulty getting what they want, addicts tend to resort to manipulative behavior. In response to family and friends saying no, an opiate addict might say things like, "you must want me to be homeless... you know what will happen to me if I don't have a place to stay... I thought you loved me... if you loved me you would..." Statements like these represent emotional booby traps designed to return family and friends to negative enabling.

Say no, and stick to it.

Family and friends of those with opiate addiction should seek outside support from qualified professionals, such as therapists, or support groups like Al-Anon. These individuals and organizations can offer guidance for people in emotionally volatile circumstances.

When these support pillars are in place, family and friends are less likely to return to negative enabling. I am often shocked at the rate of behavioral relapse in family and friends of opiate addicts. There are times when family assures me they will no longer provide money or shelter to an opiate addict, and a few months later, they return to "old behavior." This form of relapse bears remarkable similarities to opiate addict's relapse.

Family and friends who work with qualified professionals and support groups have a better chance of staying the course when it comes to refusing to participate in negative enabling.

You can find meetings of Al-Anon family groups here, and search for licensed addiction therapists in your local area here.

I have also added a list of helpful educational resources at the end of this article.

3. Offer the opiate addict the opportunity to change.

This principle allows family and friends to begin positive enabling. Positive enabling refers to behaviors that encourage change in a person suffering from opiate addiction. The first step towards positive enabling requires an end to negative enabling behaviors. Once the opiate addict no longer receives financial support from family and friends, it is time to offer the opportunity to change.

Let your loved one know you care about him/her, but that you cannot continue to contribute to their addiction. Let him/her know if they desire to change, you will help them find treatment.

Make sure you do your research before choosing an appropriate treatment center. There are a variety of treatment centers, and cost is not always indicative of a treatment center's effectiveness. I usually suggest a nonprofit treatment center with a strict focus on 12 step recovery. This suggestion comes from years of medical research that substantiate 12 step recovery's effectiveness. It is also the only medically-proved method to bring about sustained, quality sobriety. I also recommend a same-sex treatment center. Co-ed treatment centers tend to have issues with guest interaction. Discovery Place offers all of this with our 30-day residential recovery program and long-term recovery program. Long-term care for someone with opiate addiction offers the best chance for sustained sobriety. Medical research states 90-days, minimum, provides an ideal opportunity for a lifetime of recovery. You should also consider offering articles on the topic of opiate addiction detox, the first step in the treatment process.

Almost all opiate addicts do not possess the means to financially contribute to treatment. If you are in a position to assist, I highly encourage it. Without the assistance of family and friends, many people with opiate addiction would never have the opportunity to recover. If an opiate addict is not in a position to contribute, and no family or friends are willing, direct them to SAMHSA's website. This resource can help an opiate addict find a state-funded treatment center.

One of the best times to offer help (in the form of treatment/rehabilitation) is when an opiate addict faces legal consequences. These situations can be a wake-up call and hasten an opiate addict's decision to change.

This video offers some very helpful advice for those looking to bring about change in an opiate addict.

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5 TIPS FOR FAMILY AND FRIENDS OF AN OPIATE ADDICT - Discovery Place

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1. No "negative enabling." Do not engage in "negative enabling." Negative enabling is a term that refers to giving an active opiate addict some form of resource that allows the addict to progress in addiction. The two most common forms of negative enabling I see are giving an opiate addict money or a place to live.

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Opioids are used for analgesia, or pain relief.  It is estimated that one-third of U. S. adults suffer from chronic pain. Chronic pain is the most common reason for long-term opioid use.  Long-term opioid use can also lead to tolerance, dependence, and addiction. (Pain Doctor, 2017)

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Opioids are among the world's oldest known class of drugs. They are used for analgesia, or pain relief. Opioids are derivatives of morphine, a narcotic pain reliever. The term opioid generally refers to morphine and other opium poppy-based medications. Opioid medications work by decreasing pain signals being transmitted through the nervous system, which suppresses our perception of pain.

Examples of opioids are:

Hydrocodone

Oxycodone (OxyContin)

Morphine

Fentanyl (Duragesic)

Hydromorphone (Dilaudid)

Hydrocodone and oxycodone can be prescribed in combination with acetaminophen (Tylenol), which are marketed under the brand names Vicodin and Percocet. Opioids are available in many different forms such as pills, liquids, or suckers. Other methods of administering opioid medications include shot, skin patch, and suppository. While these narcotic pain medications can help in cases of intractable pain, because of their risks of abuse and overdose, they're not a first-line defense for pain management.

Conditions Associated With Long-Term Opioid Use

It is estimated that one-third of U. S. adults suffer from chronic pain. Chronic pain is the most common reason for long-term opioid use. There are many causes of chronic pain. The following chronic pain conditions may require treatment with long-term opioid use.

1. Low back pain, from many different causes that include:

2. Hip pain, from many different causes that include:

3. Daily headache. Categories include:

5. Fibromyalgia
6. Multiple sclerosis (MS)
7. Inflammatory bowel disease:

Crohn's disease

Ulcerative colitis

8. Post herpetic neuralgia
9. Neuropathy, or nerve pain

Do opioids work for chronic pain?

Over the last few decades, opioid medications have been prescribed for the above-listed chronic pain conditions. However, in the last few years, more and more pain clinics and governing agencies are beginning to discourage their use. And this is mainly because more research is showing that they simply don't work for long-term, chronic pain. As the National Institute on Drug Abuse reports:

"It is not simply an issue of safety. Recent reviews of the science have found surprisingly little evidence supporting the effectiveness of opioids in the treatment of chronic pain conditions (defined as pain lasting longer than 3 months). In some cases, opioids may even contribute to a worsening of pain (hyperalgesia), leading to a vicious cycle of taking more opioids to treat a condition that the medication itself has made less tractable."

In response, the FDA has also released a comprehensive action plan to reduce the impact of opioid misuse and abuse. And, at PainDoctor.com, we use a 12-step opioid medications protocol to ensure that any patients who do receive opioids are taken off them completely or moved to a lower dosage.

While opioid medications do play a role in pain management, they should only be used in cases when all other treatment options have been exhausted. This is because of the risks of opioid use, abuse, and overdose in addition to their ineffectiveness. Instead, many counsel their use only for acute cases of pain, intractable pain, or as pain relief for those with terminal conditions.

Side Effects And Risks Of Long-Term Opioid Use

Most medications have adverse effects and opioids are no different. Opioid medication side effects may include:

Fatigue

Opioid induced constipation

Sedation

Nausea

Vomiting

Confusion

Dry mouth

Constricted pupils (miosis)

Itching (pruritis)

Other, more serious opioid side effects may include:

Urinary retention

Hearing loss

Respiratory depression

Hallucination

Hypothermia

Delirium

Hyperalgesia (increased sensitivity to pain)

Abnormal heartbeats (arrhythmias)

Large doses of opioids can lead to:

Serious respiratory

Depression

Oxygen deprivation

Unconsciousness

Overdose

Death

Other less known adverse effects of long term opioid use include:

Immunosuppression. Opioids can lead to a diminished immune response.

Amenorrhea. Opioids can cause hormonal disturbances that culminate in the absence of the female menstrual cycle.

Galactorrhea. Opioids can cause inappropriate secretion of milk from the breasts.

Decreased libido. Libido can also be referred to as sex drive.

Androgen deficiency. Long-term opioid use, especially long-acting opioids, is a key risk factor in the development of hypogonadism, which is characterized by lower than normal levels of the male sex hormone testosterone.

Osteoporosis. It is characterized by thinning and weakening of bone making it more susceptible to fracture.

Long-term use of opioid medications

Long-term opioid use can also lead to:

Tolerance is an adaptation characterized by the need for increasing or more frequent dosing of an opioid.

Dependence can be physical or psychological. Physical dependence is a scenario in which the abrupt cessation of an opioid results in a withdrawal syndrome. Psychological dependence is an emotional need for a substance that has no underlying physical need.

Although a concern, research has shown that a small percentage of patients with long-term opioid use suffer from addiction. Addiction is characterized by a persistent pattern of dysfunctional opioid use that may include any or all of the following:

Loss of control over the use of opioids

Preoccupation with getting opioids, even when adequate pain relief has been achieved

Continued use despite adverse physical, psychological, or social consequences

Increased rate of overdose and death

Mental effects of long-term use

Other consequences of long-term opioid use are:

Patients may exhibit aberrant drug-related behaviors such as tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids, and refilling prescriptions early.

Diversion of opioid medications is a growing concern, but research has shown only a small percentage of those requiring long-term opioid use actually divert their opioids to others. The motivation for diversion is typically money, as mass quantities of opioids can fetch high prices on the black market. As a result, we have seen increasing trends in deaths attributed to opioid abuse.

Conclusion

Opioids are a very old class of medications for treating pain. Long-term opioid use is usually associated with a chronic pain condition. In the U.S., one-third of all adults suffer from chronic pain. Most opioids do a nice job of relieving pain, especially the strong opioids who outperformed non-steroidal anti-inflammatory drugs ( NSAIDs) and tricyclic antidepressants (TCAs). Adverse effects are commonplace with long-term opioid use and can range from annoying to life-threatening. They are best dealt with in an urgent manner.

Long-term opioid use can suppress the immune system making one more susceptible to infection. Many hormonal imbalances can be triggered by long-term opioid use. Ominous signs in the long-term use of opioids include tolerance, dependence, and addiction. Today, many more deaths are a direct result of the abuse, misuse, and diversion of opioid medications. As a result, interest in abuse-deterrant and tamper-resistant opioid formulations is on the rise and may be a tool against opioid medication abuse.

For more information about opioid medications, or to talk to a pain specialist about other treatment options, click the button below. A certified pain doctor can help you find help from your pain without relying on opioid medications. Or, in extreme cases, they'll use a combination of therapies to reduce the amount of these narcotic pain medications you need to take.

References

1. Alexander GC, Kruszewski SP, Webster DW. Rethinking opioid prescribing to protect patient safety and public health. JAMA. 2012 Nov 14; 308 (18): 1865-1866.

2. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010; 11 (11): 1230-1239.

3. Brush DE. Complications of long-term opioid therapy for management of chronic pain: the paradox of opioid-induced hyperalgesia. J Med Toxicol. 2012 Dec; 8 (4): 387-392.

4. Painter JT, Crofford LJ. Chronic opioid use in fibromyalgia syndrome: a clinical review. J Clin Rheumatol. 2013 Mar; 19 (2): 72-77.

5. Schneider JP. Rational use of opioid analgesics in chronic musculoskeletal pain. J Musculoskel Med. 2010; 27: 142-148.

6. Levin M. Opioids in headache. Headache. 2014; 54 (1): 12-21.

7. Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. Can Med Assoc J. 2006; 174 (11): 1589-1594.

8. Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013 Mar; 126 (3 Suppl 1): S12-8.

9. Rubinstein AL, Carpenter DM. Elucidating risk factors for androgen deficiency associated with daily opioid use. Am J Med. 2014 Dec; 127 (12): 1195-1201.

10. Rubinstein AL, Carpenter DM, Minkoff JR. Hypogonadism in men with chronic pain linked to the use of long-acting rather than short-acting opioids. J Pain. 2013; 29 (10): 840-845.

11. Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic non-malignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008; 9 (4): 444-459.

12. Belcher J et al. Diversion of prescribed opioids by people living with chronic pain: results from an Australian community sample. Drug Alcohol Rev. 2014 Jan; 33 (1): 27-32.

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What Are Opioid Medications? - Pain Doctor

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Opioids are among the world's oldest known class of drugs. They are used for analgesia, or pain relief. Opioids are derivatives of morphine, a narcotic pain reliever. The term opioid generally refers to morphine and other opium poppy-based medications. Opioid medications work by decreasing pain signals being transmitted through the nervous system, which suppresses our perception of pain.

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Of all children, this age group [teens] is most likely to be hospitalized for opioid poisoning, and teens are more likely to do be poisoned deliberately — likely, the researchers wrote, because teenagers are at a particularly high risk of depression and suicide. In 2012, 10.17 per 100,000 teenagers were hospitalized for opioid poisoning. (npr, 2017)

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Young children and teenagers are increasingly likely to be poisoned by opioid painkillers that are often prescribed for other family members, a study finds.

The rate of children hospitalized for opioid poisoning increased 165 percent from 1997 to 2012, from about 1.40 per 100,000 kids to 3.71 per 100,000. In six years in which mortality data was available, 176 children died.

"Opioids are ubiquitous now," says Julie Gaither, a postdoctoral fellow at Yale School of Public Health and the study's lead author. "Enough opioids are prescribed every year to put a bottle of painkillers in every household. They're everywhere, and kids are getting into them."

The study, which was published Monday in JAMA Pediatrics, examined more than 13,000 hospital-discharge records from 1997 to 2012 for opioid poisonings and used census data to extrapolate rates. The discharge data was collected by the Agency for Healthcare Research and Quality.

The data stops in 2012, so it may not reflect more recent trends in opioid prescribing and public awareness. But the findings track with adult rates of abuse and addiction, which have dropped since 2012 but remain troublingly high, experts say.

The rate of toddlers hospitalized more than doubled, going from 0.86 per 100,000 to 2.62 per 100,000. It's likely that these very young patients take the drugs because they think they are candy or a treat. Opioids can be dispensed as pills, patches or a flavored lollipop.

Teens are also at risk of overdosing on their parents' meds. Of all children, this age group is most likely to be hospitalized for opioid poisoning, and teens are more likely to do be poisoned deliberately - likely, the researchers wrote, because teenagers are at a particularly high risk of depression and suicide. In 2012, 10.17 per 100,000 teenagers were hospitalized for opioid poisoning.

The findings, Gaither and her co-authors say, indicate a need for public health approaches that not only address overprescribing, but also try to raise awareness about the need for safe storage of these painkillers.

Doctors need to to talk to patients about ways to store drugs safely, especially if children are in the household, Gaither says.

That's a good idea in theory, says Jonathan Chen, a physician at Stanford Medicine who has researched how guidelines for prescribing opioids affect primary care. But doctors already face a lengthy list of sensitive subjects they should discuss with patients. And they aren't always conditioned to consider how a patient's medications could affect other family members.

"Conceptually, yes, of course that should be part of the conversation," Chen says. But he notes that doctors have a long list of things to discuss with patients, and "there's a lot of things we should discuss." Chen was not involved with the study.

Pediatricians could also play a role by asking parents at well-child and well-baby visits about whether there's a risk of children being exposed to opioids. But that sort of screening hasn't traditionally been drilled into doctors the same way as discussing other risks, such as safe storage of cleaning supplies, whether the family has a swimming pool and whether there are guns in the home.

Doctors also may not be conditioned to considering toddlers as particularly at risk of opioid poisoning.

"This is largely seen as an adolescent problem or an adult problem," says Sharon Levy, who directs the adolescent substance abuse program at Boston Children's Hospital and is an associate professor of pediatrics at Harvard Medical School. "But this paper really highlights that this really knows no age boundaries." Levy was also not involved with the study.

It's also unclear, Levy says, what the long-term health effects, including addiction, are for children who ingest opioids they weren't prescribed.

And there are serious short-term risks, including death. "Opioids cause respiratory suppression," she said. "If you are a 30-pound person and getting into the medication that was supposed to be for a 150-pound person, it's going to be a whopping dose for you."

The findings also suggest doctors should be more thoughtful in prescribing to children, especially teenagers. About 1 in 10 high school students reports having taken opioids for a nonmedical reason, and close to 40 percent of them say they got those drugs through their own prior prescriptions.

The American Academy of Pediatrics notes that the rate of young patients being prescribed opioids almost doubled between the 1990s and 2000s.

The Centers for Disease Control and Prevention has been pushing doctors to prescribe opioids more safely by prescribing for just a few days. That could help reduce the number of leftover pills. Large prescriptions - coupled with the fact that many people don't know how to dispose of drugs when they no longer need them - can make it easier for children and teens to get ahold of them, Gaither says.

That's an important factor to consider, Chen says. "Leftover pills aren't used, but do they get returned to the pharmacy, or thrown in the trash? Nope. They're stored in the medicine cabinet."

Smaller prescriptions will likely help, but they won't solve everything, Chen notes. After all, there are situations where a larger opioid dosage makes sense. For instance, someone suffering long-term cancer probably needs a larger amount of heavy duty painkillers, even if he or she has children in the house.

But the risk to children must be a part of the conversation, Gaither says. "We've got to pay attention to children and the toll the opioid crisis is taking on them," she says. "Kids make up about a fourth of the U.S. population, and they're suffering from this crisis, too."

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More Children Are Being Poisoned By Prescription Opioids

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Young children and teenagers are increasingly likely to be poisoned by opioid painkillers that are often prescribed for other family members, a study finds. The rate of children hospitalized for opioid poisoning increased 165 percent from 1997 to 2012, from about 1.40 per 100,000 kids to 3.71 per 100,000.

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This episode explores how opioids can lead to dependence and addiction, and the effects that abuse have had in America.

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Best Advice for People Taking Opioid Medication

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You can directly support Healthcare Triage on Patreon: http://vid.io/xqXr If you can afford to pay a little every month, it really helps us to continue producing great content. Thanks, in part, to the generous support of the NIHCM, this month we are releasing four special episodes on Opioids.

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Effects of Popular Drugs on the Mind and Body

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Effects of Popular Drugs on the Mind and Body

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Drugs included: Marijuana, Mushrooms, Opioids, Cocaine, and Alcohol

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What 5 Popular Drugs Including Weed And Booze Do To Your Body And Brain

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A puff of this, and the world transforms into a colorful kaleidoscope of dancing patterns and waves of sound; a sip of that, and the muscles in your body r