Heroin: The drug that you were not worried about


Elizabeth is a 31 year old married, mother and Registered nurse; not who you would depict as a heroin addict. Well, it did not start that way. Five years ago, Elizabeth was involved in a motor vehicle accident, which left her with moderate to severe neck and back pain. She was prescribed Vicodin and Ibuprofen, which, when taken together mildly alleviated her pain for some time. She then began taking two tablets, and told her doctor that “just one was not as helpful”. Her doctor increased her dose to two tablets, three months after the accident, and she was content. Her pain was well controlled, she had increased energy, was able to complete her nursing duties, tend to her children, and felt "good", also known as euphoria. After one year, her doctor felt that she should be recovered, then letting her know that she would no longer be prescribed Vicodin. Her doctor gave her instructions on decreasing her dose over two weeks, and she began decreasing her dose, as instructed. However Elizabeth realized that she continuing to have pain, was no longer experiencing the euphoric or “high” feeling, and having decreased energy. About 12 hours after taking her last dose of Vicodin Elizabeth began to have flu-like illness, then with nausea, vomiting, diarrhea, hot/cold flashes and generalized muscle/bone pains. Due to her knowledge from working as a nurse, Elizabeth realized that she was having opiate withdrawal symptoms. She recalled that her husband had some old oxycodone tablets at home, in the medicine cabinet. Desperate to feel better, Elizabeth took the oxycodone, and experienced relief of her opiate withdrawal symptoms. The oxycodone made her feel even more euphoria, and quite frankly, everything was great, even though she was taking medications which were not prescribed to her. She then took the last oxycodone tablet, approximately one week later. She visited the Emergency Room attempting to obtain a prescription and was given a refill of hydrocodone, to treat her “pain”, although she had minimal to mild pain remaining from the motor vehicle accident. The euphoria was minimal when she took the hydrocodone, compared to taking oxycodone.

While working as a nurse one shift, she took two tablets of a patient’s medications, successfully, without her being discovered. Elizabeth knew it was wrong, as it was unethical and illegal, however she thought, “I’ll just do it for a little while”. She began taking more than she did previously, from more than one patient. It was later discovered that she was diverting the patient’s opiate analgesics and she was brought before the nursing board, and then mandated to inpatient substance abuse rehabilitation for treatment of her opiate use disorder.

The story above is not uncommon, and happens all too frequently. Whether illicit abuse begins secondary to prescribed use, or as a primary abuse of opiates, the end result is the same; opiate addiction. Opiate addiction is an illness in which the brain has become physiologically dependent, and in response to not having the continued opiates, there is a cascade of variable severity symptoms.

There are options for Elizabeth, or any other person addicted to opiates.

Read more regarding treatment options for opiate addiction available at Bridge to Integrated Living

Some patients, addicted to opiates, may benefit from Suboxone because it may be prescribed on an outpatient setting. Additionally, Suboxone has been found to have a ceiling effect, due to it being a partial agonist, meaning it does not exert the full effect opiate receptor (Samsha, 2004), unlike full agonists such as methadone. Therefore, Suboxone has fewer incidences of overdose, provided it is not combined with sedative medications such as Xanax, or alcohol. Initiation of Suboxone is carefully completed under physician supervision, to an effective, safe dosage. From my experiences in treating patients addicted to opiates, opiate withdrawal symptoms/cravings to abuse opiates, can be controlled with as little as 2/0.5 mg, to as much as 24/6 mg. Suboxone is medications, successfully, without her being discovered. Elizabeth knew it was wrong, as it was unethical and illegal, however she thought, “I’ll just do it for a little while”. She began taking more than she did previously, from more than one patient. It was later discovered that she was diverting the patient’s opiate analgesics and she was brought before the nursing board, and then mandated to inpatient substance abuse rehabilitation for treatment of her opiate use disorder. The story above is not uncommon, and happens all too frequently. Whether illicit abuse begins secondary to prescribed use, or as a primary abuse of opiates, the end result is the same; opiate addiction. Opiate addiction is an illness in which the brain has become physiologically dependent, and in response to not having the continued opiates, there is a cascade of variable severity symptoms. There are options for Elizabeth, or any other person addicted to opiates. Read more regarding treatment options for opiate addiction available at Bridge to Integrated Living Parts of blog taken out. I can write another blog on treatments. Some patients because it can be prescribed in an outpatient setting. Additionally, Suboxone has been found to have a ceiling effect, due to it being a partial agonist, meaning it does not exert the full effect opiate receptor (Samsha, 2004), unlike full agonists such as methadone. Therefore, Suboxone has fewer incidences of overdose, provided it is not combined with sedative medications such as Xanax, or alcohol. Initiation of Suboxone is carefully completed under physician supervision, to an effective, safe dosage. From my experiences in treating patients addicted to opiates, opiate withdrawal symptoms/cravings to abuse opiates, can be controlled with as little as 2/0.5 mg, to as much as 24/6 mg. Suboxone is taken sublingually (under the tongue). For patients with insurance, most if not all, cost is covered. There are programs for patients without insurance, utilizing coupons. This is not by any means a comprehensive list of all the characteristics of opiate addiction or treatment options available to patients. I encourage you to ask your physician about treatment options which are available in your treatment area. There is hope for all patients, this being simply the tip of the iceberg, so to speak, in helping yourself, or a family member suffering with this illness.


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