Affect of heroin abusers: is "normal" plausible?

June 1, 2011 7:35 AM

Someone in my family is into something (more inside), we're thinking drugs, but his affect is quite normal-seeming. Dredging through my mind thinking of stuff where dependency could look that way, and coming up with heroin. Am i off-base?

Warning signs are the usual: No money for essentials, but can afford peculiar luxuries (tooth whitener, strange tobacco products); telling lies about money, school, and car accidents to people he has reason to believe won't compare notes (e.g. divorced mother & father); strangers coming to the house with strange stories about why he owes them money; others, I could go into them but they're not the point.

Point is this: How plausible is it that he could be a "functional heroin abuser" (who's advanced to the stage of stealing to support the habit).

Under 21 and no obvious signs of alcohol abuse. Used to be a pothead, and isn't behaving the same way he did when he was using heavily. Frequent nausea and vomiting that he attributes to flu. Frequent migraines. Speech patterns normal, when he comes out of his room, and able to hold coherent conversations without pressured speech. Eyes look normal, though occasionally bloodshot (we assumed either smoking pot on those occasions or being around a lot of cigarette smoke). I wrote off stimulants because of the lack of obvious agitation and that he spends lots of time asleep. Wrote off pot because he looks and acts differently from when he was using pot.

posted by anonymous to human relations (30 answers total)

possible prescription drug use? lots of narcotics available for a price, and don't always have same results as other stuff... it is possible... can you do a drug test, get a clip of his hair and run it?
posted by fozzie33 at 7:39 AM on June 1, 2011

Seconding fozzie33. Some kind of opiate (of the non-heroin variety) or anti-anxiety?
posted by greta simone at 7:43 AM on June 1, 2011

Nausea and vomiting is a symptom of opiate abuse - whether it's heroin specifically is not really possible to say with the information you've given here.
posted by something something at 7:48 AM on June 1, 2011

Nthing others. Percocet and Oxycontin, as well as heroin, can cause all these symptoms that you're describing, as well as being just as addictive.
posted by Melismata at 7:50 AM on June 1, 2011

Just a note on the drug-testing side of things: Make sure your family member doesn't consume a poppy seed bagel or lemon poppy seed muffins the day of the test. They WILL create a false positive, which I know from experience.
posted by Grither at 7:51 AM on June 1, 2011

Could be bath salts. An upstairs neighbor behaves the same way. Abuse of the stuff is on the rise here in Central Jersey.
posted by tidecat at 7:51 AM on June 1, 2011 [2 favorites]

: "Point is this: How plausible is it that he could be a "functional heroin abuser" (who's advanced to the stage of stealing to support the habit). "

Possible, but extremely unlikely. Heroin users have unmistakable signs. "Lots of time asleep" is definitely one, but "lack of obvious agitation" is definitely not. You'd see significant weight loss as well, and not just around the belt.
posted by mkultra at 7:52 AM on June 1, 2011 [1 favorite]

Could be bath salts

Bath salts aren't really bath salts, they're chemical analogs to known drugs and they're just sold as 'bath salts' because you can't sell them as consumables.
posted by empath at 7:53 AM on June 1, 2011 [6 favorites]

Couldn't this just be depression, btw?
posted by empath at 7:54 AM on June 1, 2011 [4 favorites]

Nthing others as well. First thing i though of was oxycontin as heroin addiction is very hard to hide for long (by the time stealing is happening he would be emaciated and a complete write off i suspect).
posted by chasles at 8:02 AM on June 1, 2011

FYI: bath salts
posted by MrMoonPie at 8:08 AM on June 1, 2011

Nthing opiates. Its possible he's holding it together, and generally track marks are apparent for heroin usage ( yes, some people smoke heroin but usually at that point people begin to shoot up).
Opiate usage generally will make someone pretty sleepy.
Assuming he will just lie, I suppose asking him is out the question for validity reasons.
best of luck
posted by handbanana at 8:08 AM on June 1, 2011

Wanted to add, opiate abusers generally do have moments of slurred speech and loss of coordination. I vividly remember being around a guy who would abuse opana and would fall asleep mid sentence and fell down the stairs at one point. Abusers take pretty large doses if they are not shooting/snorting/smoking which has a more delayed effect
posted by handbanana at 8:12 AM on June 1, 2011

As a recovering drug addict my first instinct is oxycontin as well, but I have to say that a lot of what you describe could just as easily be bipolar mania and depression (hey, me too!) compounded with a gambling addiction. Age of onset is about right, shopping and sleeping habits consistent, and would explain the debts to strangers. Just as a counterpoint to the drug addiction ideas listed above; obviously this and everything else is pure speculation.
posted by mireille at 8:15 AM on June 1, 2011 [2 favorites]

Don't "bath salts" currently enjoy pseudo-legal status in some places? Wouldn't that tend to disindicate their involvement, given the more typical shady "he owes me money" types that they OP describes? I suspect that there's a higher possibility that they're involved given their current fandom, but this sounds like a more traditional drug scene.

Be careful checking into any news sources concerning bath salts. The descriptions used by major media outlets sound very much like Reefer Madness, whereas product reviews of the substances tend to provide a more clear picture of what the high is like and what a user might look/behave like. The review I read recently didn't describe any of the agitation that you might suspect with a drug of this type.

All that said: does it really matter what substance is being abused, if any? You have observed that this kid has some problems, seemingly lacks appropriate coping skills, and unfortunately has had the resources to maintain this status quo. (Disjointed support/accountability network, funding, etc.) If you're thinking about intervening or mentioning something to this kid, I would caution you against finding a boogey man like heroin or bath salts or weed or whatever, because that will be what the issue becomes. And you don't want to be having a "weed is the problem" conversation, you want to be having a "your coping skills are the problem" conversation.
posted by jph at 8:21 AM on June 1, 2011 [7 favorites]

You may want to consider non-drug addictions, such as internet, gaming or online poker or sports betting. He may very well be staying up all night to keep up with these activities, as some of his symptoms align with sleep deprivation. The car issues, money issues and such can also easily be explained by a gambling problem.

You may associate old men with problems like these, but online poker and sports betting are very much a young, university-aged man's game.

It seems like it's time to organize some intervening acts, gentle at first and more direct if need be. Get to the bottom of the situation.
posted by cior at 8:25 AM on June 1, 2011 [6 favorites]

I wouldn't rule out heroin. The thing I've noticed with "functional" heroin users is a tendency to ramble, even when they're not slurring -- going on and on, tacking into different tangents, etc. They get pretty self-absorbed, too. Nothing seems to matter except for how it relates to them. Though that goes for a lot of addictions in general, it seems more intense with heroin users. They get divorced from every-day reality pretty quickly, even when they seem functional. Whatever it is, the money/lying stuff is pretty tell-tale, especially the nonsense purchases. I have an addict close to me that, while homeless, (by choice) came into $100.00 and went to a toy store and spent it ALL on cheap useless crap. You've most likely got some sort of addiction going on there.
posted by Devils Rancher at 8:28 AM on June 1, 2011

I have no idea whether your relative is using heroin.

But I know people who were using heroin regularly, whose lives were messy, but didn't have anything that might be regarded as a 'telltale sign of heroin addiction'. In line with empath's question, I would say there was really nothing that could have distinguished their behavior at the time from chronic depression. One friend described her addiction as 'a stupid $10 a day habit' - not the stuff of stolen vcr's and scammed relatives.

(I'm not saying heroin use is indistinguishable from depression, but that a user hiding it from close friends - functioning at least as well as a depressed person, is not implausible)
posted by compound eye at 8:29 AM on June 1, 2011

Another thing to pursue, regardless of the outcome of any intervening acts, is to get this young man in to see an MD for a routine physical. If able, speak with the physician in advance to explain some of your concerns. This could very well be a chronic health issue he's had difficulty recognizing over time.
posted by cior at 8:32 AM on June 1, 2011

Just chiming in to offer it could definitely be opiate abuse. I've known a couple pretty "functional" heroin users who even held a job and hid it from family and significant others. Also, if he's taking vicodin or smoking heroin or other pills, he won't look as emaciated and "unmistakable" as mkultra describes above. In fact, my relative with an opiate addiction loses some weight when he's using but can be homeless and stealing money without looking like an addict to outsiders. Young men especially seem able to hide the signs as their bodies recover quicker from damage. The vomiting seems a pretty strong sign that something is definitely wrong. Good luck and memail me if you have questions about what to do next.
posted by thankyouforyourconsideration at 9:11 AM on June 1, 2011

Friendly advice: based on the description, not only is heroin and/or opiate abuse possible, but quite likely. In my experience, the best course of action is actually quite invasive and severe. In most states you can, often with a doctor's recommendation, place someone on an involuntary psychiatric hold. In California, this is known as 5150 and lasts 24 hours, but there are other holds of varying lengths of time and again, depending on state, with varying names.

Even a short hold would allow for at least a cursory psychiatric evaluation, which would (assuming the doctors are not complete idiots) reveal drug abuse, depression or whatever other condition(s) may be present. While this may seem rash as a solution, I would urge you to consider which you value more: polite patience and social graces or the actual condition of your relative?

Another tip I did not see mentioned above: Opiate abuse has a very specific effect on the pupils. They will look remarkably small. like pinpricks.
posted by aretesophist at 10:38 AM on June 1, 2011

It doesn't matter what the drug is. It's some drug, and the family member needs professional help.
posted by theora55 at 10:45 AM on June 1, 2011

Regardless of the cause, it might be helpful to consider what you'd like to see:

Less time spent alone, more participation in family dinners, eye contact, ask me how my day was or some equivalent indication of care and family membership, talkonabkut things that interest you, contribution to household upkeep, etc.

If there's something in your life that keeps you from being a part of your family community, then somethings got.to change --- doesn't matter if its tv watching, a cult, or drugs -- he's inviting scrutiny.
posted by vitabellosi at 10:56 AM on June 1, 2011 [1 favorite]

Anyone on opiates will have contracted pupils ("pinned"), enough so that it would be noticeable when you are talking to him; he will also be scratching at his face. My best guess would be something in the prescription drug family.

On preview: as aretesophist says.
posted by jokeefe at 10:57 AM on June 1, 2011

Just a quick note about pupil changes: not everyone is the same, ymmv applies here. I have pupils that are naturally larger, they rarely "pin" without direct light shining on my eyes, even when hopped up on Vicodin.
My pupils are large enough normally that, as a child, I remember a police officer remarking to my father, "Wow. You're never going to be able to tell if she's high."
True story.
posted by ApathyGirl at 11:18 AM on June 1, 2011

In most states you can, often with a doctor's recommendation, place someone on an involuntary psychiatric hold. In California, this is known as 5150 and lasts 24 hours,

It's far from that simple, and is incredibly unlikely to happen if your relative's only actions are drug use.

5150. When any person, as a result of mental disorder, is a danger
to others, or to himself or herself, or gravely disabled, a peace
officer, member of the attending staff, as defined by regulation, of
an evaluation facility designated by the county, designated members
of a mobile crisis team provided by Section 5651.7, or other
professional person designated by the county may, upon probable
cause, take, or cause to be taken, the person into custody and place
him or her in a facility designated by the county and approved by the
State Department of Mental Health as a facility for 72-hour
treatment and evaluation.
Such facility shall require an application in writing stating the
circumstances under which the person's condition was called to the
attention of the officer, member of the attending staff, or
professional person, and stating that the officer, member of the
attending staff, or professional person has probable cause to believe
that the person is, as a result of mental disorder, a danger to
others, or to himself or herself, or gravely disabled. If the
probable cause is based on the statement of a person other than the
officer, member of the attending staff, or professional person, such
person shall be liable in a civil action for intentionally giving a
statement which he or she knows to be false.

cite; emphasis mine.
posted by rtha at 11:22 AM on June 1, 2011 [3 favorites]

In most states you can, often with a doctor's recommendation, place someone on an involuntary psychiatric hold. In California, this is known as 5150 and lasts 24 hours, but there are other holds of varying lengths of time and again, depending on state, with varying names.

Even a short hold would allow for at least a cursory psychiatric evaluation, which would (assuming the doctors are not complete idiots) reveal drug abuse, depression or whatever other condition(s) may be present.

Please pardon the derail:

You can only "5150" someone if they're a clear and present violent danger to themselves and others. "Acting mildly crazy and or addicted" isn't on that checklist.

Doing this would put the subject in question at risk from some pretty severe violence and manhandling by the LAPD. They don't screw around when it comes to this kind of thing. If the subject/patient resists in the slightest amount - say, putting his hands up and sincerely asking "what the fuck!?" - he stands a pretty good chance of being tasered and/or hogtied.

Further - the doctors at the psychiatric emergency services (PES) ward at LAC-USC (basically the only public emergency psych ward left in LA county) are not going to sit down with him and give him a detailed diagnosis. They aren't going to discover depression and/or addiction. PES doesn't work like that at all. PES works mainly on self-reporting or pulling existing medical records, if any.

What will happen to the subject is that he will get a bed, no lights out and constant observation for up to 72 hours. If the subject is agitated they will be sedated. Often by way of Seroquel, which is pretty fucked up because it's a physically addictive anti-psychotic and anti-schizophrenic drug. It's not a "nice" drug like, say, Valium or Xanax. If the subject continues to be agitated and anything but perfectly calm and sedate they'll give him a private room to bounce off of and more sedation.

What will absolutely not happen is any in-depth analysis or discovery of addiction or depression or any other mental health issues. That's not what PES is for. PES is for stabilizing suicidal and or dangerous people. That's it. They don't have the time or staff to do anything else. They also don't have the tools or the ability to assume that risk. They're honestly too busy running around dealing with earnestly dangerous batshit insane people arguing with the luminous voices in their own heads.

The subject runs a high risk of being misdiagnosed. The actual doctors on staff in the PES ward may see a subject for a total of 1-2 minutes in thirty second increments per day. If they're lucky. There's not going to be any analysis there. The docs are mainly there to prescribe drugs and make sure you don't die on them in their ward. They don't care if Seroquel or other drugs make the patient a zombie, or lead them to an addiction - because PES is a crisis ward. They'll do extreme things to "save" your life, and if you're actively suicidal and/or having a psychotic episode they may indeed save your life.

The only function of a PES ward is to save someone's life from self harm. That's it. Period.

After a 48-72 hour hold and observation period in PES the patient will either be released or sent on to an inpatient psychiatric ward. If they've been misdiagnosed in/by PES they may continue to be misdiagnosed and mistreated in an inpatient facility. If that happens they may be held and "treated" for a long time against their will.

If they aren't misdiagnosed, yeah, they might actually be able to find help. But this route is the very bottom of the barrel and the very last resort of psychiatric treatment in California. If the subject isn't actually suicidal - or is even capable of tying their own shoes - this is absolutely NOT the route of treatment they want to take. They will be housed with people who are actually violently, psychotically ill. The risks of violence in a mixed-patient inpatient facility are very real. There's also the very real risk of abuse, mistreatment or neglect from staff.

Don't read me wrong... a PES ward is a fine place for someone to be if they're actually suicidal or a danger to others. But it's not a place to seek treatment for depression or other more mild mental illnesses or addiction.
posted by loquacious at 11:48 AM on June 1, 2011 [12 favorites]

Yeah, just nthing that you can't 5150 him unless he's going to stand in front of the doc and say, "I want to kill myself," or, "I plan to hurt someone else." I sadly know this from firsthand experience.
posted by BlahLaLa at 12:38 PM on June 1, 2011

Here is what pinpoint pupils look like. It is noticeable.
posted by Houstonian at 7:19 PM on June 1, 2011

You can't rely on whether his pupils are pinpoint or not. I lived for a year with a very, very serious opiate addict. His pupils were naturally on the large side, and even when he was very high they always looked completely normal.
posted by feathermeat at 8:47 AM on June 2, 2011