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Addict In The Family
by Dr. Andrew Byrne
To demonstrate the diversity of heroin addiction, the following is a group of sample stories based on personal events related by patients presenting for treatment at a doctor's surgery. These vignettes are necessarily brief windows into the lives of drug users. By their nature, they only include those whose drug use has become unmanageable.
COMPLICATIONS, THEN ABSTINENCE
DEATH IN A PRISON CELL
TEN YEARS ON METHADONE
TWIN SISTERS WITH DRUGS IN THE BLOOD
MIDDLE CLASS ADDICT
DISASTER TO DOMESTICITY
METHADONE JUST IN CASE
SABOTAGE FROM WITHIN
THIS TIME, FOR SURE!
Victor, an asthmatic aged 25, is asking for help. Having begun with alcohol and cannabis as a very young teenager, he first used heroin at the age of 16 with his elder brother. He never had a regular job and spent four episodes in boys' homes and jail for burglaries and shop stealing offences. He is currently using half a 'weight' of heroin daily, worth approximately $200, in two to three injections. He had 'hepatitis', but never returned to find out which type.
He is requesting methadone treatment in order to kick his heroin habit. The police have given him 'one last warning' to stop his small time dealing which he does to finance his drug use. His girlfriend is pregnant and he says that he wants to 'settle down and get a job'.
This man is prescribed methadone by his GP, with dispensing from his local pharmacy on a daily basis. Over a couple of weeks, he receives 40mg, then 50mg and after that, 60mg daily. Once on 60mg, he ceases the use of illicit drugs and he also decides to give up cigarettes. He is accepted into a computer training course. Victor wishes to reduce his dose to 40mg immediately, but is persuaded to continue the higher dose until after the computer course is over when he may be in a better position to address his dependence issues.
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Nicholas was a nice child who was always polite and agreeable. He was shy with other people and not comfortable in crowds. Alcohol made him more 'confident' and by the age of 20 he was drinking heavily. He was offered some heroin at a party in which the same needle was shared. The drug made him feel bold and assertive for the first time and he began to use it every day. He ceased drinking at this period also.
Six weeks later he developed fever, vomiting and jaundice. He was diagnosed with hepatitis B, probably from the dirty needle at the party. After the worst of the illness, he was admitted to the local hospital where he was transferred to the 'detox' ward. Here he learned about addiction as a disease, Twelve Step programs and Narcotics Anonymous. He felt a great rapport with others in the group and after four days drying out, determined never to use heroin or alcohol again.
It took him two months to get over the fatigue brought on by the hepatitis. He used the time to become active in the N.A. movement. Nicholas attended meetings every day at first, reciting his sad story of alcohol and then heroin abuse. He developed a confident manner in public speaking, quite reversing his former shyness. He then decided to pursue a career in radio, feeling that this would be an opportunity to spread the good news and help others.
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Michelle went to an exclusive ladies college and was first introduced to drugs at university. She dropped out in the first year after first using cannabis and then smoking opium. She lived with her six-month-old baby and her boyfriend who was injecting heroin.
Her family disowned her but she secretly kept in touch with her alcoholic aunt who helped with the baby. Michelle spent some time in Asia and did some 'trips' importing drugs. On one such, she was caught by customs and committed to prison on remand. Since she was in severe heroin withdrawals the prison medical staff recommended methadone treatment. She refused the offer as she had been told that methadone was more addictive than heroin and that it blocked out the 'rush' from heroin.
A week later, Michelle was found dead in her cell from a heroin overdose.
Although previously a heavy heroin user, her tolerance may have abated after a week without the drug. In the prison system as on the streets, there is often little time to gauge the strength of a drug owing to risk of being caught and the nature of contraband substances.
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Peter went to the local selective high school where he was first introduced to injected heroin. He started a successful computer business, using heroin intermittently for five years before moving to Hong Kong for a year. While away, he used no opioids, but drank a lot of duty-free alcohol and smoked cannabis occasionally.
On his return to Australia he rapidly developed a heroin habit, spending over $200 in three daily injections. He borrowed from his father who was a dentist. He was also caught growing his own cannabis plants and court proceedings were under way when he presented at the local community care centre for assessment.
He was prescribed oral methadone syrup which enabled him to cease heroin altogether. He resumed his computer work and paid off his debts.
After six months he was given weekend take-away doses by the clinic. He often took both doses together on the Saturday, leaving him short and a bit jaded by the Monday morning. He did this for three years without apparent problems. Tuesday and Thursday take home doses also caused problems. His work colleagues found that on Mondays and Wednesdays he was vague and sleepy with small pupils.
He asked his clinic to give him daily doses, but was not frank about the reasons. They could not understand his request, as he was their 'best' patient ... he had a regular job, he was married and his (non-drug using) wife recently had a baby. He never put in a 'dirty' urine test (only abusing methadone) and he seemed to have everything going for him.
One Easter holiday revealed what was happening. He had used up all his doses by Easter Saturday, having taken two extra on the Thursday night and the rest on Good Friday. By the Monday night, he was in a panic with severe withdrawals coming on. His wife called the emergency doctor who diagnosed kidney stones and gave an injection of morphine.
He now became frank with his wife and his new methadone prescriber about his 'double dosing'. X-rays demonstrated no kidney stones, so his backache was put down to withdrawals. Peter stated that he just could not help himself when he had extra doses available, and just swallowed them. His doctor ordered a methadone level which showed a low level. Thus his dose was increased slightly and his wife offered to supervise the weekend doses.
Peter continued on with these arrangements for a further six years. His business prospered, his daughter is growing up and he feels that he is a full member of society. Further business trips to Asia have been accomplished by utilising the availability of methadone in Hong Kong. He was also permitted to take extra doses on brief stop-overs in places such as Singapore, Seoul and Bangkok where methadone was not so readily available.
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Twin sisters Stella and Stareen were born to one of the city's best known drug dealers. Mrs Smith had a council house near the airport. From here, she arranged Asian drug trips, couriers, false passports and visas as well as an efficient local distribution network. She also unwittingly developed a habit of her own by first sniffing and then smoking the heroin which she had been dealing with.
The twins were growing up with drugs all around them. Their early years were punctuated by clients coming and going, police raids, people shooting up out the back and other drug world goings on. It still came as a shock for Mrs Smith to learn that her twins, now aged 15, were using heroin taken from her 'stash'.
In spite of seeing all the problems of drug use, they had sniffed it the first couple of times and then found a way of injecting each other with the drug.
This all came to light when Mrs Smith was raided for the last time and caught with a large quantity of heroin. She was charged with drug dealing and sentenced to ten years jail. The twins were placed in the care of a country rehabilitation service, near to the mother's prison farm.
In jail, Mrs Smith became a born-again Christian. She started a prison drug support group and renounced her life of crime.
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James is a 32 year old council engineer. He was referred to the drug and alcohol centre because his girlfriend of six years broke off the relationship when she discovered he was using heroin. He had used cannabis since his teens, and at age 30 began using oral amphetamine. He stated that it helped with his second job as a session guitarist. His dealer had run out of 'speed' and suggested he try heroin, saying that 'you cannot get addicted if you don't use the needle'. After trying the heroin nasally he gave up all the other drugs. He 'snorted' heroin on a daily basis for twelve months prior to presenting for treatment.
James had lost interest in food, work and sex. He was sleeping poorly and he was under-weight. He had infected gums and several dental cavities. He had an episode of double vision which prevented him from driving and he had used up all his sick pay. He was negative for HIV and hepatitis B and C. He had tried to cease using heroin on several occasions, both at home and in a detox centre.
He opted for methadone treatment and after six weeks had used no heroin and was talking to his fiancée again. He had no more time off work. While on 25mg of methadone daily he paid off some debts, attended the dentist, got back into training and put on some weight. Once stable on methadone maintenance treatment, he was better able to decide when and how he wishes to deal with his dependency.
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Cheryl had been a street working prostitute for ten years. She used $800 worth of heroin in five to six injections daily. She also took up to 60mg of temazepam for sleeping and was a regular cocaine user. The clinic told her that her hepatitis C infection was 'active' and treatment was needed. Though having epilepsy as a child, there were no recent fits. She was wanted by the police for unpaid fines.
Her two children's foster parents were killed in a car accident and she determined to get her life into order to care for them again. Methadone treatment was commenced through her GP who was a licensed prescriber. A conciliation visit to the chamber magistrate permitted an extension on her outstanding fines. Public housing was then arranged on an urgent basis due to the plight of the children. At the patient's request, she was also placed on a reducing scale of diazepam (Valium) which was dispensed at the same time as her methadone.
In this time she ceased all illicit drug use. Liver tests showed significant improvements and specialist opinion advised continued observation. She was reunited with her children after satisfying the family court officials of her home situation.
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Fritz had been out of jail for three months this time. He was diagnosed HIV positive three years earlier after a bout of shingles. His doctor said that his immune function was good with T cells greater than 250.
Now living in the country with his sister, Fritz had used no heroin since coming out of jail. On many occasions over the years he had been apprehended with heroin in his possession, or committing crimes to support his habit. He was on a good behaviour bond which would see him jailed again if he had any further convictions. During previous episodes on methadone he had used little heroin, but he had returned to heroin use after dose reductions. Although he did not have a current habit, he requested methadone again since he was moving back to the city.
He commenced oral methadone at 15mg daily which was gradually increased to 35mg over two weeks. After six weeks, he got a job in the city and kept out of trouble. His immune function remained good and he did a course in HIV education and counselling.
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Sarah, a university graduate, ceased using heroin on low-dose methadone. She was looking after her six year old son and doing some part-time work at her old school. Several attempts at methadone dose reductions had led to relapses to heroin use. She was never happy on methadone treatment and eventually joined a Christian fellowship with whose help she managed to kick drugs, including the 'methadone habit'.
She subsequently become a veritable nuisance to her old clinic. In her belief that methadone was bad for patients, Sarah began hanging around the office. With her new-found evangelism, she tried to 'convert' methadone patients to a life of abstinence with Jesus.
The difficulties and doubts harboured by those with chemical dependency make this sort of talk very unsettling. They were being told that there is an 'easier, more virtuous way' to give up drugs, by using 'faith, hope and charity'.
After being banned from the clinic, Sarah began a 'methadone support group'. By past performance, this may turn out to be another thinly disguised 'methadone hate group', serving no useful purpose except to appease Sarah's insecurities.
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Michael's family no longer spoke to him as he had persistently stolen items from the house, including his mother's jewellery.
He attended the methadone clinic again after an absence of some months. He said that he really wanted to kick the habit this time. He had worked up a number of drug debts since getting out of prison. Reminded of his previous poor performance and three 'false starts' on methadone, he was permitted another trial of treatment.
Attending for his second dose the following morning, he was chased by a man with an iron bar. The attacker bid a retreat when he realised he was in a drug referral clinic.
However, he apparently later caught up with Michael, who arrived two days later with several broken ribs and a black eye. Michael carried his worldly effects with some difficulty and said that he was leaving town for good. He had one last dose and was not seen again.
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On to the Appendix
|Dr. Andrew J. Byrne received the prestigious Marie Award at the 2006 national conference of the American Association for the Treatment of Opioid Dependence.|
|For more information about pain management and opiate pain medication, check out ManagingChronicPain.org.|