Why give her pills?
June 24, 2010 11:24 AM   Subscribe

Why do doctors keep giving my clearly drug-addicted friend pills? Is there anything I can do to encourage her to admit she has a problem?

My friend was addicted to Percocet and Xanax. She went to a pain specialist (one of only a few in the area who has a license to write for suboxone) who switched her to suboxone to get her off the Percocet, and her psychiatrist has been slowly weaning her off Xanax. Because of an insurance change, she can no longer see the pain specialist and he let her go off her suboxone cold turkey, and she's now miserable in withdrawals. (I should mention that at least once while she was seeing this pain doctor, her urine test came back positive for methadone, which she vehemently denied using, saying he must have gotten a false positive.) Her general doctor gives her Soma for her pain and spasms, and she takes too many and runs out a week or two early. (She did/does the same thing with her Xanax.) At this point she is seeking surgery on her knee to get narcotics, but the doctor (a third doctor, a joint specialist) did put her off that for a few weeks.

In the past her family has written to her old psychiatrist and told her how she abuses her Xanax, and the psychiatrist A. ignored them and B. told my friend about the letter, which obviously made her furious. (This psychiatrist later moved away but we've heard some negative things about her practice, and she's now seeing a new psychiatrist who is weaning her off the xanax. He has also taken her off a few other meds such as Geodon, but my friend is bipolar as well.) Since she is now abusing Soma and seeking surgery for pain meds (and will drink an entire bottle of liquid benadryl each day), I asked her family about writing to these doctors and informing them about the abuse. One family member said to me "Most doctors will only listen to the patient, not their family/friends, and they don't care about the abuse as long as they get their money."

My friend *badly* needs to be in rehab even though she won't admit she has a problem. After she recently asked me if I had any Vicodin (to which I said no), I told her that a steady dose of Soma in her system, as prescribed, will keep her from running out of pills early and feeling miserable for those 1-2 weeks, and she called me a control freak and I nearly lost her as a friend. (She seems to have no other in-person friends, just 2 online friends who don't know.) Her husband's tried hiding her pills and doling them out to her on a daily basis, but she searches until she finds them. (He finally said fine, do whatever you want and gave them back to her after months of her constant complaints about being treated like a child.) Her family has tried an intervention before (I didn't know her then) and it didn't work, it made her furious for a while. In the past, she has been hospitalized for threatening to kill herself, but it was never long enough to completely get off the pills... after a week or two she would tell them she's feeling better and they'd just let her out. From what I understand from her family (and I may be wrong), she's never been arrested but she has been caught writing her own prescription and the police/paramedics have been to her house at least once for an OD, and last year her husband rushed her to the ER when she stopped breathing, where she talked about wanting a DNR if that happened again. (Can a DNR be denied if a person is impaired when they sign it?)

Why would doctors know that a patient is an addict (by being told by numerous family members, or by blood/urine tests) and keep giving her the drugs she's abusing? How is it legal for her pain doctor to let her go cold turkey off the suboxone - couldn't the withdrawal kill her? Is there any way at all, besides her admission that she is an addict, to commit her to rehab (USA)? Is there anything I can say or do to encourage her to admit she has a problem? Temporary email at addictionaskme@thankyou2010.com.
posted by anonymous to Health & Fitness (13 answers total)
How is it legal for her pain doctor to let her go cold turkey off the suboxone - couldn't the withdrawal kill her?

No. Buprenorphine withdrawal is not life threatening.
posted by OmieWise at 11:59 AM on June 24, 2010

Sigh... that's a bad situation to be in. Not being in the US, I can only respond to your last question. It sounds like she is very, um, fanatical about her freedom and right to choose for herself, to the point of self-destruction. That might just be the self-justification of an addict, but the addiction might also be an assertion of her need for control. It may be both.

But clearly, trying to convince her or going around her is not working. She's willing to fracture her relationship with everyone - family, husband and you - to continue her habit. When she's so invested in being "free" in this way (to the point of wanting a DNR), you can't really encourage her because anything contrary to what she wants will be perceived as interference, and she doesn't want to admit to having a problem. Even if you forced her into hospitalization for suicidal behavior, she probably will not have to commit to rehab, which is what she needs, and it will surely kill your friendship. In such a situation, the best you can do is be there for her as long as that's something you can handle. Try to focus on whatever's positive... the new therapist, for example, or any non-destructive steps she might be taking in her life in general towards making herself happy. Try to draw out those qualities in her that attracted you to her friendship. Surely she is more than her addiction, so do things with her that remind her (and you) of that.

It seems that you are somewhat alone in this - that her therapy is proving counterproductive and her family and husband have been trying and have stopped trying too hard - so one thing I do want to say is: don't feel guilty. It's incredibly painful to watch someone destroy themselves or their relationships, but on some level you have to accept that you're powerless because what you want for her and what she wants for herself are totally at odds. If you get to the point where you can't just stand by and watch any more, give yourself permission to leave the friendship. Don't beat yourself up with guilt.

Sorry that that's not very hopeful or helpful... I hope others will have better strategies to offer. Take care of yourself.
posted by mondaygreens at 12:02 PM on June 24, 2010 [2 favorites]

Is there anything I can say or do to encourage her to admit she has a problem?

No, because she's an addict and she needs to decide for herself that the addiction is less important than the rest of her life or relationships.

Is there any way at all, besides her admission that she is an addict, to commit her to rehab (USA)?

Not a lawyer but have some similar experience here. No, unless it is part of a criminal sentencing or she is declared incompetent.
posted by liketitanic at 12:03 PM on June 24, 2010 [1 favorite]

Okay, doctors do care about abuse, but writing to a psychiatric/psychological doctor is a sure way to get your concerns blown off.

Attempting to interfere in a psychiatrist's treatment of a patient is overwhelmingly insulting to the doctor and the patient; trying to get the doctor to ignore patient confidentiality is ridiculous. I've had family who tried that (ten page "I know what's wrong with her and you don't and she's in denial" kind of a thing). My doc told me he was not even going to read the letter, but that he wanted me to know about it and the family's multiple attempts to speak with him, and that he+staff had refused to even acknowledge that I was a patient there. All of this is precisely the right way for a doctor to go about dealing with interference and someone trying to violate a patient's confidentiality.

If you try contacting the doctor yourself, you may even make it so that he CAN'T ask her about abuse. Confidentiality is super-serious stuff.

Perhaps a friend or the husband could accompany her into a visit and discussing it with her there. That won't violate confidentiality. But don't think it's okay to try to contact the doctor without her knowledge; it is entirely right for the doctor to ignore you.
posted by galadriel at 12:08 PM on June 24, 2010 [4 favorites]

Is there any way at all, besides her admission that she is an addict, to commit her to rehab (USA)?

Not against her will unless she is in imminent danger of harming herself or another, and it sounds like she will probably just check herself out after the 72 hour waiting period. See these previous comments on commitment, and if you are in the Philadelphia area, that poster would be a good resource. 1, 2, 3
posted by desjardins at 12:10 PM on June 24, 2010

One of the most, if not the most, challenging dilemmas that psychiatrists face every day is managing/treating the dual diagnosed person ( mentally ill and drug abusing ). Of those probably the most difficult to treat is the person with bipolar illness and addictions. Everything is conspiring to make it difficult--compromised impulse control, genetic predispositions, poor judgment, distorted judgment, poorly defined experience and perception of what are "normal" emotional states and an inner turmoil that can be devastating for the person with bipolar illness. Physician's skills vary tremendously but I did not see anything in your post unnecessarily alarming. They appear to be doing what they can--weaning from benzodiazepines, maintaining antipsychotics, using less addictive alternatives. There is a constant struggle between easing pain, working to achieve compliance, maintaining a relationship, finding safe(er) alternatives. I would stop worrying about the physicians and focus on what you can do--and that is an issue for another post. My guess is you will find yourself feeling just as helpless as the physicians often do. BTW, involuntary admission for addiction is very very difficult if not impossible in most States. If it were easy there would be 10,000,000 + persons involuntarily admitted for care. In almost all States the criteria are some variation of "imminent danger to self or others" and "as a result of a mental illness".
posted by rmhsinc at 12:54 PM on June 24, 2010 [3 favorites]

This is an really hard place to be in. Mr. Zophi's exwife has a serious prescription medicine addiction, and no amount of telling someone that they are an addict will make it so they listen unless they know and will admit it. I also know that he found in his experience that often an overworked medical staff would find it easier to just give someone the pain meds and go on to the next person than to really work in-depth with a person, especially one who is just looking for a fix and not looking to make the necessary changes.

desjardin's comment about not being able to commit her is spot on.

Ultimately, all I can tell you is that you need to decide if it's worth the stress on you to worry about this and continue this friendship.
posted by Zophi at 12:58 PM on June 24, 2010

Why do doctors keep giving my clearly drug-addicted friend pills?

They feel that the dangers and side effects of the pills are outweighed by the benefits.
posted by zippy at 1:00 PM on June 24, 2010 [1 favorite]

Also, many doctor's (in my experience with addiction and recovery) aren't that educated about addiction. Western medicine is pretty closely tied to treatment through medication. And addiction is still widely misunderstood. You cannot control what goes on between your friend and her doctors.

Nthing what everyone else has already said: until she decides she wants help, you can't do anything for her. Take care of yourself and decide if the friendship is worth it to you. Cold turkey off suboxone won't kill you. Only benzodiazepam and alcohol withdrawal can be deadly. As far as the DNR...it seems you can get her comitted (5150'd) if she is a danger to herself. So if she od'd I don't think a DNR would be honored but I'm not sure exactly how that would work.

Good Luck.
posted by thankyouforyourconsideration at 2:23 PM on June 24, 2010

Feel free to memail me if you have questions about addiction/recovery.
posted by thankyouforyourconsideration at 2:29 PM on June 24, 2010

The problem is that there are people that do legitimately suffer from chronic pain and who do need a steady supply of narcotics; the goal of the abuser is to manipulate doctors into believing that they are one of these people. From the doctor's standpoint you can never be sure that you're not being manipulated (and abusers seem to have above-average skills in this area) so it's not quite so black and white as to be able to say, no, you're abusing these, you can't have more. Some physicians have turned to using the narcotic contract but the current state of research shows only weak evidence that contracts and urine tests help reduce abuse.

In short, it's hard to deal with extremely manipulative people that are dead set on getting what they want. It may very well be that they only thing to do is offer her support and wait until she hits rock bottom and wants to kick.
posted by Rhomboid at 4:37 PM on June 24, 2010

Successful addicts are always charming to those who can help them get through today. And her ability to justify any and all paths to relief are part of that personality. Your involvement with her will only end badly if you think you can do anything about it. The doctors that she sees know she has a problem but she also has a symptom that they know how to treat. There's nothing you can do about that, either. Be a friend. Listen. Wait. Pick her up when she falls down. Don't be in the way when she falls, however.
posted by ptm at 6:46 AM on June 25, 2010

I have a family member who is/was also addicted to prescription pain pills. What finally got things under control was having his wife intervene, have him own up to the pill abuse and speak with all of his doctors and explain that all prescriptions written to him were to be picked up by his wife, and that she would be informed of all medications as part of a narcotics contract. I also believe that a letter explaining this is in his medical records.

Also ptm is 100% on the money. She'll need to fall a lot further before she decides to turn things around, if she ever does. Any lasting changes will need to be initiated by herself, and typically that comes when she's hit rock bottom. If she can still believe that addiction is better than sober, she'll stay addicted. You can kindly point out just how close she is to that bottom, but that's all.
posted by fontophilic at 7:53 AM on June 25, 2010

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