Heroin A bit worried about my friend.

[AcidRAEn]

I'm sorry if this belonged in a mega thread..but I wasn't quite sure how to classify this.

I've been clean for about 2 years now, and I tend to stay away from the people I was around during the time I was using. However, I have a few friends who are serious about getting clean and I still keep in touch with them (although usually over the phone, not in person because I have a child now..the reason I got clean) I try to give them tips on staying clean and I'm there for support when they are feeling weak.
And then there's "M".
M is pretty much my best friend. She's one of the very few people in my life who understands that darkness inside that drove me to use in the first place. She understands all too well. "M" has had a very, very, fucked up life. I mean it's just one thing after the other, and it has all been out of her control. (I'm not one to make excuses for people, but seeing what she has gone through I can't even believe in karma anymore, because she is such a good person and it's like evil haunts her) M wants to get clean, but I don't know if she has the self-control, and as far as support systems go...I'm all she's got. Her family is dead and she has "burned" any friend she might have had in some way or another.
I know, I know, you can't help those who don't want to help themselves...but in a way I feel obligated. She lived with us for a while after her parents died (she was 16 at the time) and ever since I've regarded her as a younger sister...someone I felt the need to protect and take care of...because if i don't...well who the hell is?
Anyway, I've always been concerned about her drug use..well, after getting clean that is..but now I'm starting to fear that it is severely affecting her health. I've tried to talk her into going to a doctor but I think she's just afraid. I know none of you are doctors, but I was looking for some opinions on what might be going on with her, because i don't know if I'm becoming an over-protective mom figure, or if there is real cause for concern. If it is as serious as I fear it may be my plan is to pretty much force her to go to an ER. Right before I got clean I had a friend who died after bacteria from his mouth entered his blood stream via intravenous heroin use and it shredded his heart. He had two metal valves put in and the other two were patched with pig heart. He lived. But he started to use again. The infection came back. It spread to his brain. He went blind. He died.
I can't lose another friend like this, especially if I knew that i could have at least TRIED to do something.

Her symptoms include: legs/ankles that swell up at least twice their normal size. She will seriously gain 15 pounds in a day's time just in her legs. She also is starting to get these huge boils/abscesses all over her legs. Once "healed" they almost look like massive cigar burns. It's not just one or two...there are many. She doesn't shoot into her legs..only her arms (which are covered in gnarly track marks) but my friend who died..his infection started with swelling of his ankle. These symptoms have been going on for months. I don't know if it's some sort of infection, some form of Staph or what is going on, but it's gotten to the point where everytime the phone rings and it's a number I don't recognize my heart just kind of stops for a split-second. I don't know what to do. Any advice or ideas on what could be going on? Am I just being overprotective and a bit of a hypochondriac?

 

[ThaDudeAbides]

First off you sound like a really nice person. "M" is lucky to have you in her life. As far as her addiction you can't force her into anything. She must come to this on her own and hit rock bottom and decide she needs to change her life. Now regarding her health, it "could" be related to her addiction, but it could also be something completely different. If you can convince her you seriously think there is something wrong with her health and not make her think you are forcing detox on her she may listen. I had a friend with a nasty staph infection in his legs before and he barely made it. Eventually the infection came back and thankfully he made it again. In short it sounds like she has both health and an addiction issues. You can only fight one battle at a time and IMHO focusing on her health would be best and may, MAY possibly give her the wake up call to handle the other issue in her life...her addiction.

I pray things end well. I too have lost friends and also been that person who tried to help people. Keep on fighting the good fight. "M" clearly holds a special place in your heart.

God bless.

 

[RTrain]

Am I just being overprotective and a bit of a hypochondriac?

Umm...no. It sounds like she needs some medical attention without a doubt. That swelling can be a sign of heart failure. In this case right sided, which has a gradual onset but will eventually kill you if the cause is not treated. This could be a sign of endocarditis of the right side of the heart effecting the tricupid valve. A common infection from IV drug abuse.

 

[speedballs_over]

You're trying to be a good friend is what it sounds like to me. Cheers to you, and best wishes. I know it isn't easy, don't forget to care for yourself - be sure you don't start craving or thinking about using as you work with your friend. Obviously, you can't be much help if you relapse. If you do find you're craving or feel you're getting pulled back in stop helping your friend and help yourself to stop any backsliding on your own progress, then get back to your friend - that's my opinion...

I hoping that good treatment options are available in your area. Since we're talking about a female, presumably of child bearing age, if you're located in the US she will be the second most priority patient for treatment, just behind pregnant women. Government aid for services may be available in your area, check into this if you have time /resources.

But most importantly:

The gold standard approach to opioid dependency is to begin medication assisted treatment ("MAT") immediately. MAT, as I'm going to discuss it here, is the on-going medication assisted treatment of opioid addiction using a long-acting opioid, almost always with methadone or buprenorphine. I am NOT referring to any program or agreement with a doctor that doesn't maintain patients on stable doses of long-acting opioids.

I'm referring to the long established methadone clinic model for treatment, most of what I have to say about methadone treatment also applies to the newer buprenorphine programs run by individual physicians or clinics. In the US these programs are known by many names and acronyms: OTPs, MMT, methadone, buprenorphine ("bupe"), Suboxone, etc..., they are all forms of MAT and involve either methadone or bupe.

I prefer methadone for those with serious habits, as this one certainly appears to be. However, bupe can be an easier treatment to access for some. It varies by location. Insurance coverage and cost may be issues to look into as well, public assistance is typically available to those who need it, particularly females of child bearing age, but it too can be a headache to get. Most clinics will assist you in finding help with funding. It's all worth the hassle, and we are here to help you! It's important to weigh these two options, methadone vs. bupe, if they're both available to you. I prefer methadone, and feel it's best for those in dire straits. Others will disagree. They each have +s and minuses. One can switch b/w the two but it isn't super easy.

I'll be blunt, I have too many dead friend's pictures on my wall for me to believe that any non-medical approach they took to manage their dependencies will work better than MAT, none of them were in MAT when they OD'd or died in accidents while intoxicated. Nobody I know who has entered MAT and stuck with it has died, a few have come close with massive opioid & alcohol and/or benzo complicated ODs. We can't prevent every OD, infection, bad out come, or whatever... but let's help protect your friend, 'K?

Discuss this approach with her after you feel you are well informed and can help address some concerns she may have - if you appear comfortable when you suggest a new approach to helping her I think she'll be more receptive to the idea. If you aren't able to do some research for her it's ok - maybe get her to go to an intake appointment (or however MAT is accessed by people in your community) where she can ask questions of a professional and hopefully get decent answers. You can always ask people here what they think of what you've read or heard or been told. You can ask here for help with finding a facility based upon where you live, we just need to know that and we can help point you in the right direction.

In the US you can go to [ http://dpt2.samhsa.gov/treatment/directory.aspx ] to find MAT providers, also called "OTP"s ("OTP" = opioid treatment programs, Medication Assisted Therapy i. You can ask us BL-ers for ways to assess clinic options if you need help. If you don't find a facility in your area, or only find an option or two and would like to see if more is available search for methadone providers on the Internet, as the directory I liked above is not perfectly up to date. The directory above will point you to gov't qualified providers in the US. I suggest it as the best way to find a clinic other than a direct referral from another patient.

If you can go with her to a first appointment, often referred to as an "intake" appointment that would likely help hep. Facilities tend to use the term "intake" however most methadone programs are out patient only. In-patient methadone treatment in the US is not MAT in the genuine sense, it's probably a 28 day detoxification using methadone, this is an option if you don't want to be dependent upon methadone, but I'd steer clear of these programs as they tend to turn people loose only to see them relapse, often fatally. Your friend would do best with a methadone maintenance program support her, she'll likely be apprehensive. In the US, she can go to an intake appointment and bail on it if she doesn't like the facility, the people, anything about it... If she decides to initiate treatment, then you can do what you can to support her as she rebuilds her life. The rebuilding won't really be able to begin until she's stable or close to stable on methadone (or bupe). Getting to a stable dose of either can happen pretty quickly or take a while (months maybe), in my experience bupe will stabilize people faster, but may not work for some folks with very high tolerances / habits, which is why I prefer methadone, but it could take a little longer to find a stable dose of methadone.

"Stable" (as I'm using the term here) = no cravings or withdrawal symptoms and a decent amount of protection from OD while taking other opioids. Methadone will put a major block on the effects of opioids when the person is at a stable dose, bupe even more so IME.

Anyway, you can read up on MAT, methadone and/or "bupe" by searching BL. If you're searching the wider Internet be careful of running into bad information, a lot of people who haven't been through what we've been through dismiss MAT as a continuation of one's addiction, when it is actually a management of one's addiction, one that goes a long way towards ensuring the longer term safety and health of the person.

I think I'm probably making this process sound too easy to be possible, or that I'm blowing off the difficulty of her life. I'm not at all doing that on purpose. I'm suggesting that once she gets her opioid dependency well taken care of, so that it isn't impacting her life to the degree it is today, she will be able to begin the very difficult process of improving her life, and dealing with what she's been dealt.

Methadone or buprenorphine ("bupe") replacement therapy sounds like they are the best options for her. Get other opinions for certain, read up on MAT if it's a newer concept to you or if what you know is only what you've been told or heard about it - there's a lot of misinformation about MAT and I'd hate for your friend to miss out b/c of misinformation about MAT.

Abstinence based programs (NA / AA / 12-step programs / sober living houses w/o MAT) are not so good for people who are not ready to quit opioids, the opportunity for OD or infection if IV-ing, is too serious to trust in abstinence based therapies, IMO. "MAT versus 12-step programs" has been an on-going debate in the user and treatment communities and in public health policy discussion about treating opioid addiction. I don't believe your friend has time to sit out these debates and wait for a clear 'winner'. MAT will work if administered and taken properly. 12-step programs might work, then again like someone recently in the news here in the US, she could end up kicking opiates only to relapse and fatally OD while trying to remain abstinent without medication to assist. One last thing about MAT - any therapy that uses primarily any medication other than methadone or buprenorphine I would show to the BL-ers here before you place trust in it. There are forms of MAT that use full opioid antagonists - I haven't heard anything good about those programs and have read a lot of grim outcomes, genuine quality MAT is "methadone," "buprenorphine," or "buprenorphine/naloxone combination" therapies, the use of any other drugs should be checked out closely - ask here. Some doctors will give mild medications to help with withdrawal symptoms as one tries to quit opioids "cold," while those are generally safe medications that approach is not MAT, it's just medications to help get through withdrawals but not to help with cravings - the intrusive thoughts, dreams and wanting to use that leads people to relapse.

Sorry to be blunt. Time's over for being discrete when someone gets to the condition of your friend.

 

[RTrain]

^I think she might need more than opioid replacement therapy. It sounds like she is sick, like legitimately sick, not "I have a disease because I got addicted to drugs" sick. She should be seen at an urgent care or by some type of doctor. There is really nothing else that can be said. I mentioned a potentially worst case scenario because maybe it will help stress how you are not over worrying about this person's health. Unfortunately the big problem is convincing this person they should be concerned, not convincing you. There are lots of possibilities and hypothesizing on them is pointless, but just for an idea here is a link.... http://www.surgwiki.com/wiki/Leg_swelling

 

[LSDiesel]

Look into methadone.... I admit that I tried it and I relapsed eventually but I did put together months of relative clean time (like one or two uses a month) while on methadone. I'm just too stubborn to follow a meth clinic's rules. However, at your bottom, methadone is like the best thing for you. It's a powerfully long lasting narcotic.

 

[ThaDudeAbides]

I think she needs medical attention regarding her leg. You can approach this without her drug use being brought up.

Once that's handled, speedballs_over gave you a GREAT guide IMO to help her with the other problem. Like I stated before it sounds to me like she has a health issue AND an addiction issue. Basically two health issues. But if you get her to the Doctor for her leg and keep the drug use talk out of it there could be hope for her. If you mention drug use, I fear she will think you have tricked her into rehab.

I've been down this road; got clean off subs. There IS hope.

 

[missmeyet?]

I agree with RTrain, though her addiction may be a concern that is not the immediate, emergent problem. She definitely needs medical attention for acute health issues...and soon.

 

[Treefa]

Yeah she obviously has some form of infection or something...edema and abcesses.

I guess a lot of heroin addicts probably get sick and don't even know it because, at the same time they could be in WD and think it's part of that. And then just keep using more drugs to control the pain and symptoms until their illness is past the point of no return..(and i'm not talking about addiction lol but physical illness like infections and shit)..and then they end up succumbing to some disease they don't even know they have.

Not trying to worry you but, makes sense doesn't it??

Anyway good luck helping your friend, hope all turns out well.

 

[AcidRAEn]

Thank you all for your advice and encouragement. It is much appreciated. I live in a small town that doesn't have much in the way of treatment options, but she lives over two hours away in Richmond Virginia which I would assume has far more options than here in Rockbridge County. I have been trying to convince her to come back here and stay with me to get clean..because it is harder to find those substances (but not impossible). She says she is interested but always hesitates to come back (she has a lot of very bad memories of this town..and i remember when I was still using that I said I wanted to get clean but never took the necessary steps to do so.) I've tried to get a few friends who live in Richmond to keep an eye on her and to try and talk to her but she is an extremely guarded person and doesn't open up to many. I'm going to call her this afternoon and try to convince her to at least go to the ER, and if she wants me to be there I will try to find a way to do so. As a single mother of a 15 month old it is hard for me to be there physically.
Thanks again everyone for the advice. you're good people.