Help me help my family, please.

January 22, 2007 6:21 PM

A doctor has gotten my sister-in-law addicted to meds (Oxycontin). She lives in a small town with no treatment programs available, has no insurance and no money. How can I get her help?

I don't have the full details, but apparently he started prescribing them after the birth of her last child for pain. He didn't cut her off of them, and she became addicted. He admits some level of guilt in private, but I'm sure he'd never attest to it in court, of course. Proving his duplicity would be impossible, I'm sure. He keeps telling her he'll get her into a program, there's one only months away! There's no program being created in the area, we've checked.

Anyway, she's 20 years old and addicted to drugs. She's unemployed and uninsured. She has medicare, which will only pay for therapy, not treatment. We haven't been able to find a program that will take her, and I'm even willing to let her move in with us temporarily if it means we can get her closer to treatment. The family's not financially set in any way (nor am I) and unable to help.

How can we help her? (She does want help)

1. Any suggestions on going after the doctor?

2. Any suggestions for getting her in to a program?

I don't even know for sure what kind of help to ask for, so feel free to reply with requests for more info if it'll help.

Thanks.

posted by Spoonman to health & fitness (19 comments total)

Where is she (what state)?
posted by dilettante at 6:33 PM on January 22, 2007

Where are you? As in, what state do you live in? That information is crucial to finding out whether a doctor who prescribes Suboxone lives near you. Read up on it, it's a life saver for kicking Oxys. It's also on the expensive side, something like $450 dollars for a full detox worth of pills but don't quote me on that.

Beyond that, in Philadelphia there's BHSI which is the city funded agency that provides treatment for addicts with no insurance. You'd be surprised, in Philly the best way to go to rehab is on BHSI, you're almost gauranteed a full 4 days in detox and 28 in rehab if they have funding. You will almost never get that kind of stay from private insurance. You'll get a detox but they will short you on rehab days no matter how bad you want or need them. I would recommend looking into any similar local resources.
posted by The Straightener at 6:52 PM on January 22, 2007

Spoonman, your first priority should be getting help for your sister. I would put "going after the doctor" waaay on the back burner until you sister is better.

I'm sure your sister isn't the only unemployed, uninsured person in your community dealing with addiction. Grab the phone book and start calling around town - chances are you'll find some sort of program for her. Call your local women's clinic, AA group, crisis center - just about any of these places should be able to refer you to the proper place. Even with no money or insurance there should be something out there.

Once you have an idea of the programs available then you can figure out the logistics (whether she needs to live with you or whatever...)

As for the doctor you can either walk away or if you TRULY (and I mean TRULY) feel that you have a case then all you need to do is call any one of the numerous medical malpractice lawyers in your phone book. However their is a heavy burden on your sister to prove this. Unless he did something completely fraudulent you probably don't have a case.

There is no law against being a lousy doctor.
posted by wfrgms at 6:55 PM on January 22, 2007

You've also got to realize that if your sister in law was in any way subverting the time release (she probably was) I would imagine she pretty much forfeited any shot at a legal case of any kind. I.e., if she was chewing them, crushing and snorting, crushing and shooting, etc.
posted by The Straightener at 7:01 PM on January 22, 2007

It's time for sis to start taking responsibility for her own actions in this. That's step five.
posted by caddis at 7:09 PM on January 22, 2007 [2 favorites]

If she's unemployed and uninsured with a new baby, surely she qualifies for something other than Medicare (perhaps you meant Medicaid)... Call your state's social services department and find out what programs are available for an uninsured addict.
posted by amyms at 7:19 PM on January 22, 2007

The above advice is good so I won't repeat it. I'd also like to add another piece. It's very important for you and the other people trying to help her to determine how motivated your sister in law is to get sober. How you will help her will vary greatly upon her.

If she's cagey about her use, often caught lying, or misrepresenting things it's an indication she is going to fight sobering up. If she openly admits she's abusing and wants help, it will be a lot easier to help her get clean. There's also the possibility that she'll act like she wants help to get everyone off her back and to protect her addiction.

As you follow through on everybody else's advice, talk to the people you are also trying to help her and try to come to some consensus as to where she is on the addict continuum, so to speak.
posted by milarepa at 7:27 PM on January 22, 2007

Based on my experience with addicts -- including one in my immediate family -- any attempt to end the addiction that begins with the premise, "So and so got me addicted to...." is bound to fail. One relative has always insisted that her various doctors "got her addicted" to Valium... and Percodan... and Fiorinal. They kept prescribing them, the fiends! (And she kept filling the prescriptions, but to her that's beside the point.)

I'm not justifying the doctor's behavior; for all I know he's a criminally negligent quack. But it was your sister's choice to keep taking the pills as her addiction grew.

In any case, she can't do anything to change the doctor's ethics. She can do something to change herself, and every bit of energy she spends focusing on blaming others will hinder her recovery, IMHO.

In other words: Seconding and thirding what's above.
posted by ROTFL at 8:24 PM on January 22, 2007 [1 favorite]

I second Caddis
posted by crewshell at 8:40 PM on January 22, 2007 [1 favorite]

Has she tried to detox herself yet? Are you getting information from her face-to-face or over the phone or secondhand?

Seconding The Straightener, suboxone/buprenorphine will allow her to undergo primary withdrawal/detox and still feel reasonably human. It is truly a lifesaver. Regardless the financial means for acquiring treatment, methadone should be an option only when everything else has failed... though methadone would likely be unavailable in a small town.

Do you have any idea whether her doctor is her only opiate source or if she can obtain any other kind of opiate in her small town? With use of buprenorphine, a lack of availability of opiates, treatment of the issues underlying her addictive behavior, an educated support structure of caring people, and a burning desire to be free, she should be fine. That honest, naked desire to be free of the addiction really is key.

Then again, I know little about the severity or length of her addiction. How much she uses, her method of administration, and how long she's been using will really make a difference. Some pill poppers taper and quit, never relapsing. It's rare, in my understanding, to never relapse with more chronic users.

As others above have said, she will qualify for state assistance given the circumstances you've stated.
posted by chudder at 10:24 PM on January 22, 2007

Quite the response, I knew I could count on the Mefites. Let's see how much I can update on:

She lives in New York state, specifically Delaware County (for those not familiar with the area, it's best described as a place with more cows than people).

The part about the doctor...that's the claim. Her parents and siblings seem to believe it to be true, and they've dealt with her in the past and believe little of what she says (yes, she's had other problems in the past), so I'm inclined to believe there's a grain of truth in there. But, I'm also hesitant to worry as much about that as getting her some help.

I was incorrect, I meant Medicaid, not Medicare.

I know nothing about her method of administration, how it all started, etc. In regard to the addiction itself, I gave as much info as I have.

My belief is that she does want off the drugs. She's stated it clearly that she's got a problem, knows the path her health has taken (she's down to just over a hundred pounds, for example) and how it's been screwing up her life. In the past, she's never asked for help from anyone, so this is a huge step for her.

I'm going to pass this info on to my wife to help her get a little closer to finding something. Suboxone looks like it might be something we could do for her, at least as a first shot. But, we'll let the more knowledgeable heads prevail once we find some. :)

Thanks to all who replied. There's a lot of good info here. As someone who's never had to deal with this, I know I've got a lot to learn. If anyone has a follow-up based on the newly provided info, feel free to chime on in! :)
posted by Spoonman at 6:11 AM on January 23, 2007

The part about the doctor...that's the claim. Her parents and siblings seem to believe it to be true, and they've dealt with her in the past and believe little of what she says (yes, she's had other problems in the past), so I'm inclined to believe there's a grain of truth in there.

Do not press a claim against the doctor unless there is absolute proof that he was negligent, like a recorded statement saying, "I was willfully negligent." Irresponsible claims have been helping the DEA wipe out practices that dare to actually do pain management left and right. The bar for closing one of these practices is incredibly low, and a frivolous claim could result in many people with truly chronic pain being denied their meds.

Sorry to get huffy, but this is a subject very close to my heart, one that has caused members of my family much agony and grief.
posted by PinkStainlessTail at 7:06 AM on January 23, 2007

No problem, I understand the huffy. I live in America, too. I understand the over reactive stupidity we all live with these days. :)

I should've mentioned one critical point about the doctor: he's still prescribing the pills after all this time. I don't know if a year plus is a reasonable amount of time to have someone on Oxy, but I'm thinking it's not.
posted by Spoonman at 7:18 AM on January 23, 2007

Have you spoken with Delaware County's Alcohol and Drug Abuse Services director?

Also, according to the searchable database of substance abuse programs in NY state there's an in patient treatment center near her.
posted by The Straightener at 7:34 AM on January 23, 2007

Alcohol and Drug Abuse Council of Delaware County

There are two physicians approved to prescribe buprenorphine in Delaware County, NY: David Dea Williams, M.D. at Bassett Healthcare--Delhi. 460 Andes Road, Delhi, NY 13753 [phone] or Mamdouh Shahata Lozah, M.D. at 2 Titus Place Walton, NY 13856 [phone]. The second doctor seems to be at pretty much the same address of the inpatient center that The Straightener posted.

Buprenorphine doctors are only allowed to treat 30 patients at a time, but it is certainly worth calling them and relating the situation, especially with regards to her insurance and ability to pay.
posted by chudder at 10:23 AM on January 23, 2007

I would call the people at the Alcohol and Drug Abuse Council of Delaware County first. They are non-profit and can likely help her sort her situation out and refer her to treatment. It may be worth calling the Delaware County Dept. of Mental Health at [phone] as well.
posted by chudder at 10:32 AM on January 23, 2007

Thanks for the input. At this point, Delaware County is a lost cause. The few doctors and facilities there are at capacity with at least a one year waiting list (she'll be dead long before then). The address listed from The Straightener is the local hospital where she gets her scripts from currently. These databases are useful, though. I'm compiling a list of facilities and doctors in my area instead, since we're an actual city the choices are plentiful. Finding one with an opening, though...

Boy, I knew the War on Drugs was an utter and complete failure, and now I see exactly why....
posted by Spoonman at 10:46 AM on January 23, 2007

I don't know if a year plus is a reasonable amount of time to have someone on Oxy, but I'm thinking it's not.

Just to speak up and say that chronic pain patients are indeed treaded with long-term narcotics when nothing else works. There are people out there who will spend the rest of their lives in pain, and many will be on drugs their entire life. Those people do build a dependence on such drugs, but in the context of valid medical treatment it is not considered 'addiction.' You would no more say that a person being treated for chronic pain using OxyContin is addicted than you would say that a diabetic is addicted to insulin.

The details are too sketchy to say, but given what happens to doctors who mis-prescribe narcotic medications, those who prescribe such drugs tend to be careful and watch for signs of certain kinds of activity by the patient. If it turns out that she misrepresented herself as having pain to get drugs but otherwise did not give overt signs of drug-seeking behavior (getting caught obtaining medications from another doctor at the same time, constantly dropping pills down the drain, etc.), then you would basically be blaming the doctor for being concerned for her condition and not being a mindreader. In some places it is hard to find doctors to treat patients with chronic pain because too many doctors fear such situations and avoid prescribing certain substances altogether.

Since the drugs here were taken in the context of doctor treatment, I would suggest seeking pain management doctors or pain management centers--look specifically for that specialty--as they will be the most knowledgeable at titrating the dose downward and minimizing whatever level of real pain exists, if there is any.
posted by troybob at 2:11 PM on January 23, 2007

Well spoken troybob. I really only asked about the doctor just to mention it. I figured there weren't many options, nor too much chance that he was actually involved to the extent she stated. But, I have no idea. I've never been on a pain management program, nor knew anyone who was. At this point, I've turned over all of the info you all have given me and we shall see what we shall see. It's up to them at this point (and mostly her).

Thanks again to everyone that responded, I think you all have been a huge help.
posted by Spoonman at 5:46 AM on January 24, 2007