Expert: Charles I. - 1/8/2008

Question
QUESTION: My son is 24 and in treatment for substance abuse. Cocaine and Opiates. I believe he is taking selexa, seraquil - and another he says is called oxybrutine - I am sure the spelling for all are incorrect. On Thursday he looked stoned... his eyes were closing and he looked very tired. I took him to the cottage where he has no access to drugs and is by my side the whole time. He swears he hasn't used in almost a year and his treatment will be finished in about seven weeks. He was perfect by Sunday. He does drink, but not much. I am scared to death. What do you think, could this be a side effect of these drugs. Can he cover up his tox screans they have come back clean in the past although I haven't seen one...he says they have or they would not let him stay in the program...but that could be a lie as well.

ANSWER: Hi Ginny, thanks for your question. It is possible that that the Seroquil or Celexa could be causing some drowsiness...I'm not sure what "oxybrutine" is...the closest I know of is Oxybutynin Chloride (brand name is Ditropan XL) and it is used for overactive bladders. It can have some drowsiness for a side effect as well.
His actions and look you described on the Thursday that he looked stoned does sound somewhat consistent with "nodding out." This is very typical of someone who abuses opiates. I obviously can't say for sure that was the case...but it sounds like it could be a possibility given his history of use.
The fact that he is continuing to drink is a concern. It is very common for opiate abusers to begin using alcohol when they are trying to kick opiates and vice versa. Alcohol and opiates activate similar areas of the brain even though the buzz is somewhat different. The main thing to remember is that they are both central nervous system depressants. The big concern here is the fact that he may be beginning to substitute alcohol for opiates...I know you say he isn't drinking too much, but it all has to start somewhere.
Finally, it is not that difficult to manipulate a drug test and yes there are quite a few products that can be used that can be purchased on the Internet ,local head shops, as well as at places like GNC. There are other ways to alter a urinalysis' results with basic items such as bleach.
I know you want to believe him and give him the benefit of the doubt...but remember, he has lied to you in the past about his drug use...what is going to keep him from doing it again. Substance users and addicts are some of the greatest liars in the world...take it from an addict!! See if he is willing to sign a consent for release of confidential information so that you can speak with his counselor abut his progress and your concerns. If he doesn't want you to speak with them that could be a sign that all isn't up to par. I hope this helps and if you have any other questions please don't hesitate to contact me.
Good Luck,
Charles

---------- FOLLOW-UP ----------

QUESTION: Thank you for the quick response. Today we found out he is lying about working. I have feeling the third drug might be methadone not the oxy...another lie. I looked up the clinic we take him to and it is mainly for dispensing methadone. O.A.T.C. Do you think it is a good idea to confront him...about the job and the clinic - He must go everyday for treatment.

Answer
Hi Ginny, I think it might be fair to talk to him and to let him know that you are aware of what is going on and that you have some real concerns. I would suggest doing it in the most loving way possible...confrontation often does more harm than help.
Methadone can be a good tool for someone SERIOUS about their recovery from opiates. On the other hand it can become a way to score drugs legally. As I said, it is a tool, not a cure. The people that succeed with methadone tend to be those who are not using other substances with the methadone(ie. smoking weed, drinking...etc.), who attend counseling and actively participate, as well as finding a twelve-step program such as Narcotics Anonymous and begin working the steps and finding a sponsor. A question that pops into my mind is if he isn't employed where is he getting the money to pay for his methadone? None the less, I would recommend, if he is seriously trying to kick opiates, he looks into taking Suboxone instead of methadone. Suboxone is a combination of two drugs called buprinorphine and naltrexone and it has some great advantages over methadone for people who are serious about eventually getting off all opiates. It works very well as far as taking care of the cravings and withdrawals for opiates; it in itself can't really be abused and when taking this medication the user can't supplement it with other opiates because they will not work...the Suboxone will defeat them and the user is just wasting their money. It has a shorter taper time when coming off it than methadone and many report that withdrawals from the medicine is not as severe as methadone. The one bad thing about Suboxone is it can cost substantially more than methadone. I'm sure the clinic he is attending could give him more info if he is interested.
Another thing I want to bring to light is if he is on methadone maintenance he really should not be drinking at all! As I told you in your previous question that opiates and alcohol are both central nervous system depressants. In short they both have effects on the brain stem which controls our involuntary muscle action such as heart beat, breathing...etc. Many times users will combine the two substances which, of course, causes drowsiness...they fall asleep and never wake up because their body forgot to breath while they slept. During my year working as a counselor in a methadone clinic when someone overdosed or even died it was usually a result of combining substances that effected the CNS (substances like xanax, valium, other opiates, alcohol...etc.). I'm not trying to hit you with some scare tactic...this is a real possibility and sadly I have seen it first-hand too many times.
I can't tell you what to do, but I do say this; if he is living under your roof and you are providing for him, you have a right to know what he is doing. If he is living on his own and providing for himself, then that is a different story; he is an adult an he has every right to live his life the way he wants to...even as self-destructive it may be. He needs to know that you don't condone what he is doing...but you will be there for moral support to help him if he wants help. That's the key..."If he wants help." Sadly you as a parent or even I as a professional counselor can do very little when the person we are trying to help doesn't want to be helped. Recovery is ALWAYS the responsibility of the addict and change will NEVER occur until that change becomes the most important thing in their lives. I know that can be a tough pill to swallow...but that is the truth. I truly wish you the best in however you chose to handle this.
Good Luck,
Charles