Harm reduction and Norco?
December 28, 2011 9:13 AM Subscribe
What can I do to warn my father about the risk of acetaminophen overdose while he is abusing Norco? Harm reduction for my own dad?
I inadvertently found out that my father has a problem with Norco. That's 325 mg of acetaminophen per tablet, for the record, plus hydrocodone. He drinks a lot, but not as much as he used to(!).
Important: he is getting them from a dealer or the internet, so there's no upper limit on how much he can get hold of.
There are other such threads, here and on the rest of the internet, that will tell you that a harmful dose of acetaminophen is in the 4-8 g range. He's a big guy, 200 lbs.
My mother (who has her own vices) knows about it. I inadvertently found out through her, so I am sure of this. (Sadly, this was not a snooping situation.) Never in 100 years would I think that there's anything to be gained by getting between them. Nor do I want to embarrass my father, ESPECIALLY when no positive result will come of it. My concern is that their yelling and screaming (and who can blame them?) will drown out the stealth ODing problem here.
If he is in imminent danger of overdosing on the acetaminophen, I can't be standing by, no matter how futile my efforts might be.
One mechanism I thought of is passing him a card with some doctor referrals and a brief note to the effect of:
"Dear Dad, I'm sorry I discovered this, but now that I know, please watch out for that acetaminophen. Here are some doctors for when you're ready. Love, Anon."
What do you think? It's impossible to call this without knowing how many he takes a day. As I say above, this is not coming from an Rx, so there's no way to put a ceiling on his probable dose.
People who've been there--any better ideas than passing him a note? My throwaway email is nobody.testing@aol.com.
Thank you. We are all of us tough people, even though we don't get along, so I pray he'll get through this as long as his liver holds up.
I inadvertently found out that my father has a problem with Norco. That's 325 mg of acetaminophen per tablet, for the record, plus hydrocodone. He drinks a lot, but not as much as he used to(!).
Important: he is getting them from a dealer or the internet, so there's no upper limit on how much he can get hold of.
There are other such threads, here and on the rest of the internet, that will tell you that a harmful dose of acetaminophen is in the 4-8 g range. He's a big guy, 200 lbs.
My mother (who has her own vices) knows about it. I inadvertently found out through her, so I am sure of this. (Sadly, this was not a snooping situation.) Never in 100 years would I think that there's anything to be gained by getting between them. Nor do I want to embarrass my father, ESPECIALLY when no positive result will come of it. My concern is that their yelling and screaming (and who can blame them?) will drown out the stealth ODing problem here.
If he is in imminent danger of overdosing on the acetaminophen, I can't be standing by, no matter how futile my efforts might be.
One mechanism I thought of is passing him a card with some doctor referrals and a brief note to the effect of:
"Dear Dad, I'm sorry I discovered this, but now that I know, please watch out for that acetaminophen. Here are some doctors for when you're ready. Love, Anon."
What do you think? It's impossible to call this without knowing how many he takes a day. As I say above, this is not coming from an Rx, so there's no way to put a ceiling on his probable dose.
People who've been there--any better ideas than passing him a note? My throwaway email is nobody.testing@aol.com.
Thank you. We are all of us tough people, even though we don't get along, so I pray he'll get through this as long as his liver holds up.
Make it clear that you're concerned about danger that is both short-term and lethal, and maybe leave the long-term consequences of addiction out of it altogether - that's a big deal, yes, but depending on how much he's taking per day, the possibility of acetaminophen overdose is an overriding concern here. People tend to be defensive about long-term health risks that they've willingly undertaken, but "you could seriously die in agony tomorrow morning because of this" is a different matter entirely.
posted by Holy Zarquon's Singing Fish at 9:37 AM on December 28, 2011
posted by Holy Zarquon's Singing Fish at 9:37 AM on December 28, 2011
http://www.nlm.nih.gov/medlineplus/ency/article/002598.htm You need to talk to him - overdosing on acetaminophen even once can destroy one's liver. This is not one of those too much will damage you over time kind of deals - it's the kind of situation where one can end up needing a liver transplant or dying.
posted by leslies at 9:58 AM on December 28, 2011
posted by leslies at 9:58 AM on December 28, 2011
In the name of harm reduction, maybe you can encourage him to perform a cold water extraction on the pills. This is an at-home method that people use to remove the acetaminophen from pills like Norco and Vicodin. I am reluctant to include any specific links here because I can't speak to the reliability of any particular set of instructions, but the method is described in many places online and is easily found by Googling.
posted by enn at 9:58 AM on December 28, 2011 [2 favorites]
posted by enn at 9:58 AM on December 28, 2011 [2 favorites]
If he's drinking and abusing a drug with acetaminophen, he's probably going to have a short, very unhealthy life from here on out.. I think that's probably worth a face to face conversation.
posted by empath at 10:01 AM on December 28, 2011 [2 favorites]
posted by empath at 10:01 AM on December 28, 2011 [2 favorites]
I don't know your dad, but my instinct would be to be very, very clear that your concern (for now) is solely with the acetaminophen, and not the opiate addiction. If he gets scared by any intervention-like talk he may become less willing to listen about liver failure, death, etc.
Although I can't say how far I would be able to go with that---is it ethical or wise to seek a more appropriate opiate for him just to avoid the acetaminophen danger? I don't know, man. You're in a difficult spot, my thoughts are with you.
posted by TheRedArmy at 10:10 AM on December 28, 2011 [1 favorite]
Although I can't say how far I would be able to go with that---is it ethical or wise to seek a more appropriate opiate for him just to avoid the acetaminophen danger? I don't know, man. You're in a difficult spot, my thoughts are with you.
posted by TheRedArmy at 10:10 AM on December 28, 2011 [1 favorite]
Absolutely concur with empath. He is in imminent danger of a very brutal, painful, and relatively quick death or, at best, a life-shortening and awful ordeal as a transplant patient. The lethal dose of acetaminophen shrinks with long term abuse and certainly in conjunction with chronic drinking. And it's not just binary. His liver is being damaged even if he isn't at imminent risk of liver failure. He's a few drinks at most from that risk, however, if he's taking 1000mg a day of acetaminophen (just assuming he's taking three of these given the half life of the hydrocodone, you should try to find how how much he's taking and how much he's drinking because immediate harm reduction might mean limiting this somehow even if you can't get him to stop immediately).
If that isn't a case for face-to-face this-is-an-emergency get-the-whole-family-involved intervention, nothing is.
So he'll be embarrassed? So he'll shout? The option is worse. Take it from someone who has spent the past week at a parent's bedside in the ICU watching machines keep him alive. You do not want to be there.
posted by spitbull at 10:38 AM on December 28, 2011 [2 favorites]
If that isn't a case for face-to-face this-is-an-emergency get-the-whole-family-involved intervention, nothing is.
So he'll be embarrassed? So he'll shout? The option is worse. Take it from someone who has spent the past week at a parent's bedside in the ICU watching machines keep him alive. You do not want to be there.
posted by spitbull at 10:38 AM on December 28, 2011 [2 favorites]
I would not send a note. I would talk to him in person. And here is why: Because you will be doing this primarily because you want to feel that you've done everything you can to make him aware of the dangers. If you send a note, and he dies next week of liver failure, will you feel the note was enough? Would you feel you could have made more of an impression on him by speaking with him face to face? I know that, were in I in your shoes, I would have preferred to have had the in-person conversation, despite it being undoubtedly more uncomfortable and difficult.
However, I will also say this: I can't help but wonder if you're latching onto the acetaminophen aspect as a "legitimate medical concern" that makes it okay to confront your dad about his addiction. I obviously don't have statistics here, but I would be surprised if most abusers of opiate/acetaminophen painkillers die from the acetaminophen content in the pills. The opiates themselves are an extremely legitimate concern as well, from a long term health and potential-of-sudden-death perspective. I think you are hoping that if he's confronted with the (very real) statistics about acetaminophen overdose that he will quit using the drugs, and I will tell you, in the absolute nicest way possible, that that is not likely to happen. I would be surprised if your dad doesn't already know that acetaminophen destroys livers. He surely has heard that alcohol does, and continues to drink regardless. Drug abusers know that drugs kill people. They know their addiction is risky and dangerous and unhealthy, and they do it anyway. That's what makes them addicts.
My main point is: Do what you have to do to be at peace with yourself. But don't expect a positive outcome, especially not immediately. You may plant a seed in his head that makes him think a little harder about what he's doing, but that doesn't mean he will stop the behavior.
posted by something something at 10:44 AM on December 28, 2011 [1 favorite]
However, I will also say this: I can't help but wonder if you're latching onto the acetaminophen aspect as a "legitimate medical concern" that makes it okay to confront your dad about his addiction. I obviously don't have statistics here, but I would be surprised if most abusers of opiate/acetaminophen painkillers die from the acetaminophen content in the pills. The opiates themselves are an extremely legitimate concern as well, from a long term health and potential-of-sudden-death perspective. I think you are hoping that if he's confronted with the (very real) statistics about acetaminophen overdose that he will quit using the drugs, and I will tell you, in the absolute nicest way possible, that that is not likely to happen. I would be surprised if your dad doesn't already know that acetaminophen destroys livers. He surely has heard that alcohol does, and continues to drink regardless. Drug abusers know that drugs kill people. They know their addiction is risky and dangerous and unhealthy, and they do it anyway. That's what makes them addicts.
My main point is: Do what you have to do to be at peace with yourself. But don't expect a positive outcome, especially not immediately. You may plant a seed in his head that makes him think a little harder about what he's doing, but that doesn't mean he will stop the behavior.
posted by something something at 10:44 AM on December 28, 2011 [1 favorite]
He needs to look up cold water extraction if he plans on continuing his use/abuse for further harm reduction. Its a very simple process, and actually gets the opiods in the system quicker (water is absorbed with opiates in the stomach/intestines quicker than breaking down a pill).
Ideally, your father wouldn't be in this situation, but here is an easy harm reduction. Opiates have essentially no ceiling dose unlike acetometaphin (which sucks, I have railed on multiple times)
First, crush pills in a small bowl, and fill with cold water.
Stir the crushed material in the water, place container in freezer for about twenty minutes. Do not let the mixture freeze over. After twenty minutes or so, a white crystalline structure the acetometaphin, will form at the bottom. Using a coffee filter and/or cheese cloth, gently drain the liquid into a glass. If done right, it should be bitter, that is the opiates. Take the particles, acetometaphin, back in the bowl and follow the steps 2 or 3 more times. When the liquid you are extracting is no longer bitter, you've successfully pulled the " good stuff" out.
This works because opiates are water soluble and acetometaphin is not at lower temperatures. I had to do this when scripted Darvon, and in general I hate acetometaphin as it is practically useless as a pain killer. European countries have confirmed this and the FDA is finally seeing the harm caused by pairing these chemical together.
posted by handbanana at 11:45 AM on December 28, 2011 [1 favorite]
Ideally, your father wouldn't be in this situation, but here is an easy harm reduction. Opiates have essentially no ceiling dose unlike acetometaphin (which sucks, I have railed on multiple times)
First, crush pills in a small bowl, and fill with cold water.
Stir the crushed material in the water, place container in freezer for about twenty minutes. Do not let the mixture freeze over. After twenty minutes or so, a white crystalline structure the acetometaphin, will form at the bottom. Using a coffee filter and/or cheese cloth, gently drain the liquid into a glass. If done right, it should be bitter, that is the opiates. Take the particles, acetometaphin, back in the bowl and follow the steps 2 or 3 more times. When the liquid you are extracting is no longer bitter, you've successfully pulled the " good stuff" out.
This works because opiates are water soluble and acetometaphin is not at lower temperatures. I had to do this when scripted Darvon, and in general I hate acetometaphin as it is practically useless as a pain killer. European countries have confirmed this and the FDA is finally seeing the harm caused by pairing these chemical together.
posted by handbanana at 11:45 AM on December 28, 2011 [1 favorite]
This is something that has been prominently discussed in the news over the last few months. There's a pretty good chance he's heard about it already. If not, I don't see any reason to make a big deal about it.
Just bring it up in conversation, like any other odd/interesting thing you've heard lately.
If you're not going to see them in person for a while, you can either email a link to a story or clip one from the newspaper and mail it to them.
Everyone will know what you're talking about, but you can all still pretend you're just discussing the news. Plausible deniability is the key to making this a successful mission.
posted by ErikaB at 3:29 PM on December 28, 2011
Just bring it up in conversation, like any other odd/interesting thing you've heard lately.
"Wow, I was reading this article about acetaminophen. Did you know how much damage it can do, even in small amounts? And it's found in a lot of other drugs, so you can totally overdose by accident.Then just change the subject after your parents both politely murmur "that's terrible, dear." Which they will do, but you'll have to trust that the message registered with your dad.
I looked through my medicine cabinet, and I was surprised how many things it's in... Nyquil, cold medicine, all kinds of stuff. Scary!
You can destroy your liver without even realizing it. Just 4000mg a day can be fatal and even smaller doses on a daily basis can cause liver damage. Slate Magazine even called Tylenol one of the most dangerous drugs on the market.
Crazy, right? Who knew!"
If you're not going to see them in person for a while, you can either email a link to a story or clip one from the newspaper and mail it to them.
Everyone will know what you're talking about, but you can all still pretend you're just discussing the news. Plausible deniability is the key to making this a successful mission.
posted by ErikaB at 3:29 PM on December 28, 2011
Mod note: From the OP:
"I'm glad to report that my father entered rehab yesterday. Hopefully this is the first step in a positive direction. I thank everyone for their support (and concrete advice)."posted by jessamyn (staff) at 8:20 PM on August 9, 2012
This thread is closed to new comments.
posted by xingcat at 9:30 AM on December 28, 2011 [4 favorites]