Recovery options for 10+ year abuser of opiates
December 8, 2016 12:14 PM   Subscribe

My friend's brother is abusing heroin again and we're trying to figure out if Vivitrol would be a good/realistic option?

A year ago, my friend flew her brother out to the West Coast to get him away from an unhealthy environment and easy access to drugs. He had been snorting heroin and using hydrocodone daily. Her brother went back home to the Midwest but relapsed within 3 months. My friend lives far away, so she was unable to see/know for many months. Just recently everything has been falling apart and his debt is getting insane.

Her brother has been abusing prescription painkillers since he was 17. He is now 27. The past 2.5 years he has been using heroin. (Snorting, not injecting.)

About a month ago when everything was falling apart, he detoxed with suboxone and was relatively functional. He made it 3 weeks on just suboxone before he started "cheating" with dosages and amounts and just using the suboxone to manage withdrawal symptoms and scoring heroin when he could.

He voluntarily allowed his long-term girlfriend and my friend to track him via GPS because he felt it would keep him in check. It did work for a while, but then he left his phone at work once and left early to get heroin.

Now he's back to nodding off at random times whenever he's home and finally admitted he was using again. (This past week, any time someone confronted him about dozing off, he would get very upset and insist he was still just on suboxone.)

My friend's parents are heartbroken. (They just found out he was using heroin a month ago, but they suspected he was on something because of his weird behavior and reluctance to come around.) In addition to us tracking him via GPS, his girlfriend manages all of their money and doesn't give him any physical access to cash. However, she did this last time and he still managed a way to run drugs to earn enough money to get his habit going.

Since he is out of control again, my friend's parents confronted him. He agreed to go see them to talk over treatment plans.

He refuses to do NA, because he hated the meetings and having so many heart-to-hearts with his sponsor. He's not much of a talker.

We are hoping we can get him to commit to a consultation and to try Vivitrol. (Suboxone just isn't working, since it's so easy to play with the dosage and still do drugs.)

Do you think Vivitrol is worth a shot? Do any of you have treatment plans you felt were really effective? I realize getting off of opiates completely is ideal, but we really don't think he'd be able to resist the temptation. My only worry about Vivitrol is that he will need to get 7-14 days completely clean before he is able to take it. We're not sure how we'll manage that.

We wish we could send him off to rehab, but even intensive outpatient programs in our area are upwards of 6k a month, and we just can't afford that.

Any comments/suggestions/advice/encouraging experiences are welcome. Thanks so much to everyone that took the time to read this.
posted by anonymous to Health & Fitness (10 answers total)
Honestly, my advice for you is to find an Al-Anon meeting in your area and go. Your language in this question is full of "we" statements but the only thing that's going to get this guy sober is himself. You say "We're not sure how we'll manage that" and you need to come to the understanding that you won't. He might, or he might not.

Every Al-Anon meeting is different. If you don't like the first one you go to, try another. You can find women's-only meetings, or men's-only. There are phone meetings, online meetings and international meetings. Go to one, please.
posted by BlahLaLa at 12:22 PM on December 8, 2016 [12 favorites]

I'm sorry - I don't know vivitrol well. But I'm wondering why he isn't trying methadone? it sounds like suboxone git him partway there, and according to your description maybe methadone would be a better fit.
posted by pintapicasso at 12:27 PM on December 8, 2016

his girlfriend manages all of their money and doesn't give him any physical access to cash. However, she did this last time and he still managed a way to run drugs to earn enough money to get his habit going.

His girlfriend, family, and basically anybody who rides around in a car with him are at huge legal risk if he's dealing heroin.
posted by showbiz_liz at 12:34 PM on December 8, 2016 [6 favorites]

I'm married to a recovering addict who has been clean for ten years. I know you want to help your friend and that he's telling his family right now he's open to ideas. But my husband didn't get clean until he came up with the ideas on his own and did the work himself. I know it seems like addicts are helpless and can't handle investigating their options and doing the work it takes to get and stay clean. But this guy is managing to get heroin despite having a girlfriend who locks down his money and a family tracking him via GPS. He is smart and resourceful. He can do it if he wants to. So that's the question, really: does he want to? If he wants to, anything can work. If he doesn't, nothing will.

So, obviously, I am seconding the suggestion of Al-Anon (or Nar-Anon) here.
posted by something something at 12:35 PM on December 8, 2016 [14 favorites]

Ibogaine clinic
posted by hortense at 1:02 PM on December 8, 2016 [1 favorite]

As you probably know, Vivitrol is an injectable form of naltrexone. People who like Vivitrol like it because, as an injectable, it means the addict doesn't have to face the decision about whether to take a pill every day to continue to abstain.

Research suggests it's a promising practice, but it's a *lot* more expensive then oral naltrexone, and it's certainly not a silver bullet. Addiction pervades many aspects of people's lives and psyches -- it's not only the desire to get high that drives people to shoot up. I know that many people don't like NA, and that's fine - it's not for everyone. But I think it would be highly desirable for him to get involved in some form of treatment in addition to using medication, rather than just hoping that the medication will do the trick by itself. Here's a self help book that some of my clients have found useful in thinking about how to approach their own recovery.

Just fyi, one of the dangers of these medications is that, if he relapses, he'll likely take a much higher dose of heroin to try to recapture the euphoric feeling that the naltrexone / vivitrol short circuits. This could result in overdose.
posted by jasper411 at 1:12 PM on December 8, 2016 [4 favorites]

He refuses to do NA, because he hated the meetings and having so many heart-to-hearts with his sponsor. He's not much of a talker.

Your friend's brother isn't ready to get clean. Yeah, NA "isn't for everybody", but particularly for addicts that don't want to quit using.

Nthing Al-Anon. For you. You can't get this person sober. He will (or won't) get clean whenever the time is right. In other words, when the consequences get so bad that there's no other choice.

Oh, and on the subject of treatment. Treatment centers are most helpful for folks who are willing to admit they have a problem and are willing to work on resolving that problem. Otherwise a huge waste of time and money. I have been to treatment twice myself. It didn't help b/c I had to get to a point where I was completely beat to a pulp, which happened years later.

Addiction sucks. Sorry you're going through this.
posted by strelitzia at 3:49 PM on December 8, 2016 [3 favorites]

This really sucks. I think your ability to impact the situation is very limited here. Perhaps focusing on being a supportive friend to your friend in the form of listening, empathising, communicating love, is really valuable, and maybe all you can do.

There is no magic way to quit heroin. Some people quit using NA, or a residential program. Medication assisted treatment, like with saboxone, naltrexone (vivitrol), or methadone are more effective, but also not full proof. Naltrexone is not as well researched for heroin treatment as methadone is, btw. Expensive residential programs are not especially effective.

I think it's great that the family is looking into all strategies, but I don't think they can ensure he stays free of heroin. There's no great answer.

Frequent metafilter contributor Maias published this book this year. Worth checking out. She is well read in the available research about addiction and comes from a very humane perspective.
posted by latkes at 6:26 PM on December 8, 2016

From what I understand, NA isn't ideal in that a lot of people are there only because of a court order, and so they're not only not interested in getting clean, they might be actively dealing and/or romanticizing past use and/or just not being constructive.

But Al-Anon really is a good option, in my experience, for taking care of yourselves and for creating boundaries to protect yourselves from someone else's destructive behavior.

Also, hortense's comment above: that might be as close to a miracle cure as exists at this point. I would seriously look into that, if I were this guy.
posted by witchen at 9:28 AM on December 9, 2016

Sounds to me like he wasn't on a sufficiently high dose of suboxone or he was not taking his full dose for some reason. (Perhaps sharing with "friends" or selling it for money?)

The whole point of it is that with a high enough dose it is satiating. It is typically taken once daily, but some people, especially those who have been taking particularly high doses of opioids do better taking it twice daily.

I know it seems like an emergency to you, but he'll be fine trying another round of Suboxone therapy at a higher dose for a while before moving on to more expensive/invasive treatments. It would help if he would get some form of therapy, whether group or otherwise, in conjunction with the medication.

All that said literally nothing will work if he isn't ready to quit or has someone in his life nudging him toward using.
posted by wierdo at 10:54 AM on December 9, 2016

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