How do I talk to my brother, who I think is abusing pain pills?

June 18, 2016 9:34 AM

For a few years I’ve had the suspicion that my brother is misusing? overusing? addicted to? pain pills. Something. He was having lots of back pain, which is how he began taking the pills about four years ago.

We live on opposite coasts and I see him only rarely, but we grew up in an alcoholic home and I think I’m hypersensitive to substance issues. Recently his wife corroborated that he takes the pills regularly – and that he’s had to go to different doctors to get them. This was not something she volunteered but something I asked about. I got the sense that she has minimized the whole thing. There’s a lot more background here but the real issue for me is, How do I talk to him about this? We’re not that close but I really love him. I know he will deny that it’s a problem. His wife is leaving him because he’s been cheating on her, so I don’t know if anyone close to him is seeing this as a problem they want to confront. I’m 3,000 miles away, and I have the sense that he’s on a downward spiral. I don’t know what to say or do.

posted by gigondas to Human Relations (7 answers total)

The first thing you can do is go to an Al-Anon meeting, because your life has been affected by someone else's drinking or drug-taking. You can find a directory of meetings on that site...they're basically everywhere. When you go to your first meeting, when they get to the part where they ask if anybody is a newcomer, raise your hand.

If you don't like your first meeting, try another. Each one is different.
posted by BlahLaLa at 9:44 AM on June 18, 2016 [8 favorites]

Well, he is your brother and you love him, and his wife is leaving him because he's been cheating on her. What would you say or do if you were completely unaware of the pain pill issue?

Do that, first.
posted by juniperesque at 10:43 AM on June 18, 2016 [4 favorites]

What else is going on besides a suspicion? People in constant/chronic pain do take their medications regularly; that's not weird, and in some parts of the world getting appropriate pain control can be a real hassle and one could legitimately need to "doctor-shop" -- I went from being barely mobile with a POS GP who wouldn't prescribe a thing, landed in the ER when I couldn't take the (hip) pain anymore, have now been on a steady dosage of opiates for years with a new GP and no longer fetch up in the ER, etc. But there are so many scary articles about pain pills in the news these days that some people's eyebrows shoot up if they find out I've been taking X and Y for years.

Did his wife suggest that his use was problematic? Is he taking more than what he's prescribed? Is he seeing multiple doctors at the same time without the other ones knowing? Is there anything that tracks that sort of thing in the area he lives in? I would want to do a little more digging and make sure there was an actual abuse issue before telling a chronic pain patient that you don't like his medication regime.

I would be offended if somebody suggested I was abusing my prescribed medication. I am not offended, though, when somebody says "I've read all those scary stories about that stuff in the paper -- what's it really like? How do you manage to not get addicted?" (Pretty much everybody on long-term opioid therapy is physically addicted, but that is quite a lot different from being in a situation where you're abusing the drugs.) "Do you ever worry about it?" (No; I've read that opiates do things somewhat differently in your brain when you are taking them with a lot of pain vs taking them with no pain -- I don't get the recreational use; I've got nothing against drugs but my pain pills are just not something I could ever get my jollies off of. They are as exciting to use as an asthmatic's rescue inhaler -- relatively quick relief, but not something with a fun side effect.) Does that follow? I don't mind at all when somebody is curious, but the assumption that these drugs have abuse potential so as a user of these drugs, I must be having a little fun with them or something is a bit of a "@$#* off" thing; chronic pain is a huge quality of life issue and for somebody to imply that I might use recreationally is to imply that they don't take an often disabling and deeply unpleasant problem of mine seriously.

Do you get on well enough with him to just start a conversation about how his health is doing? And throw in "hey, I don't want to be a jerk, but I keep reading these stories in the news about those drugs and they make me nervous for you sometimes, have you had any problems or is it just tabloid Fox news silly stuff?" Be polite in case you are way off base -- and so if he doesn't have a problem now but does end up with one he won't avoid you as Mr Judgmental -- "mostly I'm just feeling bad for you about your back; years of problems there sound like a big pile of no fun. Are there any surgical options?"

You can browse Reddit's /r/opiates to see what life looks like for people who do abuse opiates. I suspect you might be able to pick up enough clues from a friendly chat about his health -- like, if he hasn't asked his doctor about surgery, hasn't done anything like see a physiotherapist or tried exercise/stretching, he's not going around with heating pads or topical pain relief goo, and his sole thing for the back is the pills, that would be a bit red-flaggy -- people in real pain usually look for other ways out besides just pills (not to say there's always a way out, but they'll have at least looked). Is he on other meds, has he tried different ones? (Painkillers are not the only thing prescribed for pain -- for example.)

Other than making gentle inquiries and touching base with him in a caring fashion, I don't think there's much else to be done by you; addicts often need to sort the underlying problems. Perhaps the relationship breakdown has been something of a catalyst here? It's trite, but, "be there" for whenever he might want to reach out.

The physical addiction involved is no joke; there is no way to avoid it. If he feels agitated and lousy when he's off his meds, well, so does every other chronic pain patient treated with opiates. So if he seems addicted in that sense -- yes, he is physically addicted, but this is not necessarily a problem. If he is using them properly, he should be using them regularly to avoid unnecessary, painful withdrawal symptoms.

(One thing to think about: his wife might not be interested in painting him in a good light at present, and if she is the only conduit for the suggestion that he is abusing drugs...it wouldn't be the first time an angry ex has manufactured a story of misbehaviour.)
posted by kmennie at 11:02 AM on June 18, 2016 [13 favorites]

Response by poster: Kmennie, to speak to your last point first, his wife didn't bring this up -- I asked about it after she described the litany of weird stuff he's been doing, some of which I knew about, but not really. As I said, I think she minimizes things. My family tends to operate with a "don't ask don't tell" mindset that comes easily when you've grown up around substance abuse. But my sister in law said he takes oxy-whatever daily and has had to switch doctors at some point to get it. That's all she said. He did have surgery a year or two ago, and when I last asked him about his back in December he said it wasn't too bad. At times he's just seemed "different" to me. Yes, this is really just a hunch on my part, which from 3,000 miles away, is sort of all I have. But there are a number of psychological reasons, including the fact that we come from addiction and he's spent 30 years being a workaholic who's out of touch with his feelings. He's recently lost a lot of weight (my sister just told me), and she said he seemed really hyper when she saw him last, and that he was acting weird. Just this morning I read that people on opiates can be hyper, which is not what you would expect.

But I take your larger point, and I don't want to come at him in an accusatory way. That's why I posted here. I don't know what words to use. I would just feel bad if he has a problem and no one is saying so. I'm worried about him.
posted by gigondas at 11:42 AM on June 18, 2016

His getting divorced is a natural entry point for you to try to reconnect with him. I would start with that--emails, calls. If he's "merely" having other life problems, then a friendly presence will still be helpful to him.
posted by praemunire at 12:38 PM on June 18, 2016

Re. "oxy-whatever daily and has had to switch doctors at some point to get it" -- earlier I suggested peeking at /r/opiates to get an idea of how life rolls for opiate junkies. Now I think I should have also suggested peeking at /r/ChronicPain; it seems in the US some patients are required to go through "pain clinics" and not their regular family doctors for these sorts of drugs, and fears that one's pain doctor is quitting or re-locating and a long-standing medication regime will be changed are pretty common. (Warning: /r/ChronicPain does have a delusional contingent, people who keep taking more than their prescribed dose and then being irritated with their doctors for not regularly calling in early refills. The people who like to make life hard for everybody else, essentially.)

If the back pain is daily, the Rx will be daily. There's nothing at all noteworthy or alarming about daily use or one doctor switch. I mean, I switched GPs because I could barely walk and was being told "take ibuprofen" from a doctor with so little experience/interest/understanding she didn't even mention cortisone injections or any other therapies; "I can barely walk" was just dismissed with "ibuprofen or Tylenol." Switching to the GP who was interested in shooting me up with cortisone and putting me on a pain control regime that worked was not drug-seeking behaviour, but just what needed to be done to maintain some mobility.

(If you discuss it further with your SIL and are both being open about the possibility of psychological addiction, two things I would want to know are: has his dosage been escalating or has it remained relatively consistent? And: how often does he have to refill his Rx? I once had a chat with a homeless addict {addicted to other drugs} with I forget what kind of pain, and as he was a drug addict he was forced to pick up every day's painkillers from the pharmacy every day, to prevent misuse/OD. I pick up a 3mo supply 4x year from Costco. Some state regulations/insurance issues might not let him get away with a 3mo supply, but I would be concerned if his physician was making him pick it up weekly or something and not trusting him with a full month's supply at once; if there was legit pain but a suspicion of abuse I think one of the 1st things a GP would do would be to limit access to large quantities at once like that.)

"Hyper" is...well, all sorts of things are in the realm of possibility, but (again, check out /r/opiates) people who use to abuse do not tend to end up/aim for "hyper" and I think that's a thing that makes it more unlikely. Maybe he is an addict and other drugs are in the mix, who knows, but "hyper"'s got to be a very rare effect. Drowsiness is common.

Really, I'd just use the "I've read the scare stories in the news and I was worried about you. How are things with your back and the pain meds?" People with zero suspicion that I might be a drug abuser have had similar questions for me -- geez, all those stories in the paper, it makes it sound really dangerous, like if you take it for a week next thing you're under a bridge shooting heroin; obviously you're not doing that, what's it actually like? Does it interfere with your driving? Do you even notice when you're on it? (No, and, no; I notice when I'm not on it.) Blame all your concerns on newspaper scare stories and just express curiosity about what it's REALLY like being on opiates, because you get that the newspaper scare stories are scare stories, and not reporting on ho-hum things like people with back pain. If you are for-real scared and want to tell him that, I might make reference to Prince's death and say "I know I'm paranoid given our background, but when I read about Prince dying I thought of you and your back and it scared me. It was a little too close to home and I thought if he could die from them, so could anybody, and I freaked a bit. I hope you're okay, for real."

Depending on your relationship, you could even lighten the mood by saying you tried to do a little reading on it and (and here is where you definitely don't come off as accusatory) found out that, tee hee, pain patients on opiates require a "bowel management program" (opiate-induced constipation is not a thing you can bran muffin your way out of; patients do gobble various laxatives to maintain normal bowel function) and you can giggle a bit and ask how he's enjoying that and isn't Metamucil delicious? Hee hee, sorry, sounds like quite a crappy (ha ha, ho ho) side effect...
posted by kmennie at 3:40 PM on June 18, 2016

My mother was in unbelievable pain the last 15 years of her life. Unbelievable. Incomprehensible. Her shoulder joints were worn down to bone on bone. Her hips were the same. It was too late for any surgery(s) which might have been able to help her. The pain was a constant. Ever present. Daily. Pain wore on her, frightened her, ate at her.

She knew to the instant what minute she was to have her next pain medication. To the minute. She watched the clock like a hawk.

Was she addicted to opiates? Of course. Physical addiction is an absolute. You put the stuff in your body any amount of time, you will become physically addicted to it. Was she out running the streets, trying to score China white? Some nice, warm Mexican brown? No, she was not. She was a human being suffering huge pain and lucky enough to live in a time where intelligent pain management was available.

Pain management or not, she was in pain, but without the pain management her life would have been a howling agony.

~~~~~

A few years ago I had an amazing bicycle wreck, just outstanding. I broke a bunch of bones in my face. I ripped the rotator cuff tendon right off the bone. I shredded flesh off my face, my legs, my arms. I knew to the second when I was to get my next pain medication. To the second. I was out of the hospital the next day because fuck hospitals; my only stop going home was a pharmacy. I have a history of really liking drinking and drugging but a longer history of not allowing myself indulgence in these matters. I knew, to the second, when I was prescribed my next pain pill, and what dosage was prescribed, and I didn't miss that tick of the clock. Unlike kmennie, I dug the fuck out of how it felt. I questioned, every time, deep in my heart, if I could knock off maybe 1/4 of one of the tablets. If I could knock off 1/4 of the tablets I did so. It took time -- bone pain is real pain, the x-ray of my maxillofacial bones is something to see, and a big, honkin' tendon ripped off a bone will catch your attention also -- it took some time but I weaned off, fast as I was able, as it healed. Because I dug the fuck out of the stuff. And, because I know myself well enough to know that my own accountability to myself is suspect, I kept all of the cards face up on the table with my doctors, my mentor, my friends, my shrink.

But -- and this is crucial -- those bones healed. The pain lessened. Then it was gone. It was *not* like my mothers situation. It was *not* like kmennies situation.

~~~~~

I have a friend here in town who suffers like my mother did, like kmennie does. Hips. Knees. *Really* bad in his low back. Mid-60s. (And carrying too much weight doesn't help him; in recent months he's shed about 30 pounds, is working at shedding some more, and about to embark on a physical rehab routine to help him rebuild muscles that haven't been used since he was a college basketball player, it'll be focused mostly in his core.)

While my friends pain is huge, and constant, and chronic, as was my mothers pain, as is kmennies pain, there is a difference that is present -- my friend has a history of drinking and drugging. And at least every third month he goes way out of his prescription, and he has used his allotted amount of medication a week (or more) before more will come his way. And then he's kicking. And it's an awful spectacle, in the truest sense -- it's awesome. To see it is to be in awe. Not only is he kicking but he is kicking in the kind of physical pain that could be considered torture. One day last year I spent with him, I have rarely seen such naked human suffering. It was horrifying -- this is my good friend, this spectacular artist, a good person -- it was horrifying, and it was awesome.

Smart money would be laid upon him dying in one of these kicks. Kicking at 24 is one thing, kicking in your mid-headed-toward- late 60s another thing entirely. A good thing would be if his drugs hit his doorstep daily, and no more than that, to prevent these complete, naked kicks. He is a drug addict, and I am certain he would find a way to get more than his allotted when mental pain demands he do so. So there's that. But he'd never have those naked kicks, with nothing between him and hell.

~~~~~

kmennie got me to writing here. kmennie is dead on, a bulls-eye. There is that side of the picture, and it's real as rain. Then there is the other side of the picture, shown clearly by my friend. More accurately, they are not different sides of a picture but rather they are two pictures.

~~~~~

You're 3000 miles distant. Call your brother. Open a wider connection to him, with him, if that's possible. You can't just jump in waving your arms around about drugs and divorce without a connection with him. Do that and you'll get eye-rolling you will be able to even *hear.* Go to some AlAnon meetings. Seek peace, ask for peace in your heart, and you needn't be religious or waving crystals around or smudging sage to do so -- get near some trees, some water, some nature, some quiet. I have found peace on a massage therapists table. I have found peace in talking with understanding friends. (Including my pain-ridden, broken, drug-addicted artist friend, who has remarkable wisdom and humor.) I have found peace in reading; in my youth, reading was my only place to find peace. People often don't know that Texas has these wonderful creeks; one of the most peaceful afternoons I have ever spent was in a fast-running creek, dunking under and then laying back, watching the water flow, listening to it burble, except burble isn't the right word because it was too fast-moving for burble but the right word isn't showing up just now so pretend. If I get away from city lights and it's quiet, I absolutely find peace *and* awe in looking 13.6 billion years into the beauty of the past and the present; sometimes I can do that even in the presence of city lights, because I know what's there, or rather I don't hardly at all know what's there and it humbles me no end and peace rides in and comforts me. Try this.
posted by dancestoblue at 6:21 PM on June 18, 2016 [13 favorites]