What Should I Tell The Doctor?
August 12, 2009 7:41 PM   Subscribe

Doctor-Filter: I have an appointment scheduled to see a doctor this afternoon about some... sensitive issues. I'm wondering how free I should be with the information I give them, and whether or not certain factors might discourage them from giving me the treatment I feel like I need.

To cut a long story short, I'm under a lot of stress and anxiety of late, and I have been for a while. I've spent many a sleepless night in various states of freak-out, and many restless days gnawing my own nerves ragged. Now, I know the standard reply is "get thee to a therapist"- which is good advice, and I have an appointment booked to see a psychologist next week... I'll see how I go with that, and take it from there- I feel like it could be beneficial... but meanwhile, I need help...

Here's the sensitive bit. I use heroin.. I guess it's a misguided attempt at self-medication. I have done off and on (/often on) for the last few years- not to the point of physical dependency (though on my days off I definitely go into minor withdrawal).. but I consider myself an addict. It's getting to the point where I'm ready to stop, and move on with my life. But I need help to do that.

Of course, when I go see the psychologist next week I'll be straightforward and upfront- no good to obfuscate the facts of the matter, of course! But when I see the doctor today, what I really want is something to help me get through the next couple of weeks without using- I want something for the anxiety, and something to help me sleep. I know that medication isn't an ultimate solution to these problems of mine- it goes to deep and runs too long- but I feel that pharmaceutical assistance would go a long way towards surviving the next few weeks.

I guess my question comes down to this: should I be open about my habit with the doctor when I go to see him (this will be the first time I've attended this particular doctor's surgery)? Or should I just focus on the general stress, anxiety and insomnia that I'm suffering at the moment? Telling a doctor that you (ab)use hard drugs probably wouldn't do me any favours when what I'm ultimately asking for is... psychotropic drugs. What do you think? What are the chances of them prescribing me anything anyway, one way or the other.

I really need help- and at last I'm reaching out for it. But I just don't know what to expect, or whether or not they'll even be willing to help me in the first place, considering as I'm one of "them"- a miscreant who has made a few wrong turns along the way, and now finds himself painted into a corner.

Any advice is much appreciated- thanks guys.

Oh, and I'm in Australia, if that makes any difference.
posted by anonymous to Health & Fitness (20 answers total)
You are deluding yourself about your ability to do this yourself. It's part of addiction. You need to let the doctor refer you immediately to an inpatient detoxification clinic or to a specialist who get you into such a facility. I don't know how that works Down Under, but you cannot self-manage this with a few pills to help you through. And you are far from alone, and hardly a miscreant for being hooked.

You talk a brave game here. Good for you. It's the right thing to do and it will save your life. But don't let your resolve to do it substitute for doing it -- the addicted mind plays tricks on itself.

Tomorrow, straightforwardly tell your doctor you're an addict, that you want to quit, and that you need a referral for the only effective way of getting off that shit, once its teeth are into your flesh, which is under medical supervision throughout, ideally in a specialized clinic or ward.

No one can give you any advice here -- at least advice that's worth anything -- that doesn't boil down to: get professional medical help, don't be ashamed of what is in a very real sense a disease, and don't let go of the clarity that led you to decide to get clean.

I recommend you ask the mods to anonymize this question. You don't want your user history (and your user history to come) linked to this if there's any chance you could be identified from things you casually reveal here and there.

posted by fourcheesemac at 7:54 PM on August 12, 2009 [6 favorites]

You MUST tell this doctor about your heroin use. I'll refer you to a paraphrase of the sign hanging in the office of a peridontal surgeon that yanked my wisdom teeth a few years ago: if you don't give your doctor a full account of the drugs you ingest, there's a chance a newly prescribed or administered drug could really fuck you up.

Your doctor will help you and will not provide this information to the police.
posted by Inspector.Gadget at 8:01 PM on August 12, 2009

If you're asking permission from us to minimize your problem with addition--sorry, you're not going to get it here. You can't solve the other problems until you work on the addiction first. You may not like this route, and you may not like what the doctor has to say, but as fourcheesemac says, that's part of the addiction. In fact, all of what fourcheesemac said was right on.
posted by Melismata at 8:19 PM on August 12, 2009

Your habit is part of your medical history. In order to properly diagnose you, the doctor needs to know about every possible thing that is part of your medical history. Even if for no other reason than "hey, this drug causes fatal tumors in people who've used heroin, I'd better not prescribe it."

They have this kind of thing on episodes of House all the time, where they're going crazy trying to diagnose a patient and finally find out that the patient was hiding some information from them that suddenly explained everything and finally are able to cure him of the mysterious disease, but at the same time they grumble about why didn't That Guy just tell us about his habit beforehand, it would have saved him all this other trauma...yeah. Don't be That Guy.
posted by EmpressCallipygos at 8:27 PM on August 12, 2009 [1 favorite]

He can't effectively prescribe chemicals to change your body's chemistry if he does not know the true state of your body's chemistry.
posted by Billegible at 8:33 PM on August 12, 2009 [2 favorites]

If you're are in Australia you should definitely call this out with your doctor. Aside from the issue of contraindications, there's a wide support infrastructure established to help you deal with your addiction - up to and including methadone as a substitute, which could very well help with some of the other issues your falling too.

You should raise this with your doctor wherever you are, but know that in Sydney and Melbourne particularly there is a very wide and good support network that will help you get through this in a wide variety of ways (it's not all packing up to rehab for three weeks, etc.).

Best of luck. You can do this.
posted by smoke at 8:36 PM on August 12, 2009 [3 favorites]

Yeah, you gotta tell the doctor. I'm sure she's heard far worse. Good luck!
posted by otherwordlyglow at 8:54 PM on August 12, 2009

Seconding the methadone option, mentioned by smoke. This page gives you some contact numbers and (vague but maybe helpful) info about possible options in SA. There are probably pretty similar structures in other states.
posted by jacalata at 8:57 PM on August 12, 2009 [1 favorite]

Hey, this isn't rounding down how many packs a week you smoke or "forgetting" that you did have a hit off that joint once within the last ten years -- it's a pretty relevant part of your biochemistry, and you acknowledge yourself that it is related to your current psychological issues. Yes, it'll probably bias the doc to some extent. However, it shouldn't mean that they'll label you as "LYING JUNKIE" and refuse you treatment for any other issues.

Good luck, and congrats for seeking help!
posted by desuetude at 9:08 PM on August 12, 2009 [1 favorite]

Don't know where you are, but this used to be my area. In Sydney. Happy to help a bit further via email or you could talk to the good folk at N.U.A.A. or your states equivalent. They'll help you with all of this, and they're all current or ex users.

A lot depends on the doctor. There are lots of problems with methadone, long waits to get on the list... you might find that buprenorphine is better for you. Maybe a methadone prescribing psychiatrist is better for in the long run...

And if you decide to tell the doctor, and you get a bad reaction.... try another doctor. Not doctor shopping for drugs, but looking for a compassionate listener.

In your corner possum. I'm in your corner.
posted by taff at 9:50 PM on August 12, 2009 [1 favorite]

While everyone is "right" in their insistence to disclose your heroin use, it's going to negatively impact your ability to get benzodiazapines to deal with the anxiety. Heroin addicts are well known to use benzo's when heroin is unavailable and it will come off as simple drug seeking behavior. You can always play the "oh hey and I also do heroin" card if you don't get drugs for the anxiety.

Before you take whatever drugs are prescribed, you need to inform your doctor that you use heroin to avoid so called "fatal drug interactions". However, you can do this after the prescription is in your hand, or by phone after you fill the script. Tell your psychologist about the heroin use of course.
posted by zentrification at 9:59 PM on August 12, 2009 [2 favorites]

I'm not sure if it's a good idea to wait to disclose your heroin use until after you've received the prescription. If you put it all on the table beforehand, odds are good that the doctor can even recommend other potential programs and assistance mechanisms you haven't thought of. If you show a sincere desire to be free of the drug, then I'm sure the doctor would be more than willing to help you. Your doctor has to be well aware of the anxiety and other problems that come with withdrawal.
posted by scrutiny at 5:26 AM on August 13, 2009

A lot of these responses are putting a lot of faith in doctors and their understanding of opiates and addiction. Anonymous is right to be cautious about what and how much he discloses. Anon- memail me to discuss if you want...
posted by hellboundforcheddar at 6:36 AM on August 13, 2009

should I be open about my habit with the doctor when I go to see him?

Yes, particularly since s/he has several options available to help you not need heroin.

Telling a doctor that you (ab)use hard drugs probably wouldn't do me any favours when what I'm ultimately asking for is... psychotropic drugs.

Anyone trained in the last 20 years or keeping up with the times knows that substance abuse and anxiety are frequently comorbid. You might not get script for 20 xanax@ 5 refils, but you'll not get the boot "out druggie!" either.
posted by a robot made out of meat at 6:39 AM on August 13, 2009

Heroin addicts are well known to use benzo's when heroin is unavailable and it will come off as simple drug seeking behavior.

Because it usually is. I read that between the lines in the question, actually. What else is it when an addict wants to self-medicate for anxiety while quitting alone? Bullshit, is what that is. I've seen it. I've had addicted friends.

hellbound, one has to put faith in medical professionals when one has a serious disease, which is what opiate addiction is. You cannot get clean alone, and you take huge risks trying to do so.

This -- a GP not really getting it -- is why I recommended that you ask your GP (assuming that's who OP is seeing today) for a referral to an addiction specialist. This area of medicine has come miles in recent years. There are safe and reliable ways to detox under medical supervision.
posted by fourcheesemac at 6:53 AM on August 13, 2009

Of course you have to discuss it with your doctor. So the key is choosing a really good doctor who will listen and give you good treatment. People do successfully deal with addictions on their own, but it's not easy. One reason inpatient treatment is preferred is that you are an addict, and giving addicts Xanax, Valium or other drugs is sketchy, with good reason.

Many people who are dealing with addiction report that diet, esp. avoiding sugar, is helpful. Good luck.
posted by theora55 at 6:57 AM on August 13, 2009

It may surprise you how little many doctors, especially GPs, know about the biology of addiction and treatment approaches. I would be a good idea to carefully research a specialist in addiction sciences, preferably one who is familiar with buprenorphine.
posted by hellboundforcheddar at 6:59 AM on August 13, 2009

um, yes, tell your doctor about your drug use.

then detox and talk to both a psychologist and a psychiatrist. (i'd recommend hightailing it to rehab, where you'll get both.) you probably have underlying psychological problems (depression, bipolar, etc etc) that contribute to your heroin use.

you NEED to get clean. you know this. most hospitals will allow you to stay for 72 hours while you detox -- but then you need to get yourself into some sort of treatment after that.

and, as an addict, don't expect that you'll receive a script for benzos. if you do, you are seeing the wrong doctor.

(i have lots of experience with the other side of heroin, so if you want to talk, feel free to mail me)
posted by unlucky.lisp at 1:22 PM on August 13, 2009

Speaking as a physician, your chances of being prescribed anything to help you sleep will go up significantly if you see someone with a special interest in addictions. The textbook, learned-it-in-med-school training about addiction is heroin+benzos = BAD, because a) there is a much higher risk of respiratory depression when those drugs are combined, and b) if there's anything shittier than being addicted to one drug, it's being addicted to *two* drugs. A doctor who doesn't have a high comfort level in addictions will stick to this very reasonable advice, because s/he will not feel experienced enough to assess how high risk you are for either of those very bad complications. Someone who does addictions all day, however, will be used to dealing with the raft of sleep problems which many addicts face, and will be able to suggest some medications to help you. The first choice will likely not be a benzodiazepine, but there are several drugs I can think of which can work just as well for both sleep and anxiety, without the respiratory and addictive side effects, and I know that many addictions specialists prescribe them liberally.
posted by TheLittlestRobot at 5:50 PM on August 13, 2009 [2 favorites]

Go HERE to get the phone numbers for addiction treatment counseling in each Australian state and for the AOD's guide to providers and treatment services for addiction. Here is a link where you can get online counseling for addiction treatment questions in Australia.

We're all with you, in case you're struggling to process this thread. Some of this is tough advice. You need to hear it. It's tough love.
posted by fourcheesemac at 6:13 AM on August 14, 2009 [2 favorites]

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