Expert: Sherrie Sweet - 1/23/2012

Question
I know a young man who is a recovered heroin user.  Earlier this year he had to have surgery and he was put on medications. For a while now he has been taking valium 4 pills (I don't know the actual strength but will assume 5mg each as this is the lowest dosage tablet which would equal 20mg) 10 times a day and Adderall 30XR (don't know how many times daily). He also is taking Gabapentin (6 times a day).  Is it safe for him to be taking all this medication?

Answer
Hi Jennifer,
Your question has a multi faceted answer, I will do my best to give you all the information you might need concerning your friend.
If a person is in recovery from any given drug or alcohol, they are always in danger of becoming addicted to another substance. In this case, your friend successfully stopped using heroin. Medications that are often used after surgery, pain pills, narcotics, etc. are from the same class of drugs as heroin, called opiates. The short story is that heroin/pain pills are the same drug in different forms.
Cross addiction is a term used to refer to a recovering person becoming dependent upon another substance or behavior, other than their original drug of choice. For example, a person addicted to heroin who always hated alcohol, can suddenly find himself drinking alcohol and developing a problem. The message here is once an addict, always an addict, and the drug used is irrelevant. Any mindaltering substance is dangerous for someone with the disease of addiction.
Tolerance is a term used to describe the inevitable, increased use of a substance over time. For example, someone starts out taking one or two pills for pain, but after a period of time they need 4 pills to control the pain level. Tolerance is built up in the brain and two pills is no longer adequate to cover their needs.
Valium is an antianxiety/calming medication. These medications were never developed to be used long term but often are. Interestingly enough, long term use of medications like this also increase anxiety symptoms. Valium is habit forming, and it is important to note that the amounts you describe your friend taking would not be prescribed by a reputable physician.
Adderall is a substance that is used to treat symptoms of ADD or ADHD. This medication is classified as a stimulant and is habit forming. Because of the chemical differences in the brain of a person with ADD and a person without this disorder, adderall has very different effects. The non affected person can use adderral like speed.
Gabapentin, trade name neurontin, can be used as an opiate alternative for pain relief. It does contain some mind altering substances, but is often used effectively in certain situations with people who are trying to avoid opiate use. It is prescribed several times a day, usually three times a day. However, I have seen this medication abused by people who suffer from addictive disorders. I have also seen it used safely and appropriately.
So, the short answer to your question about the safety of your friend taking these medications as you describe is unlikely. Firstly, he suffers from the disease of addiction. If he is committed to sobriety and recovery, medications with addictive properties will never be safe for him. It sounds like his tolerance for these medications has already increased. Taking any medication other than how it is intended or prescribed is dangerous. Lastly, Taking a medication to calmdown (valium,) coupled with a stimulant appears counterproductive and dangerous for his heart and brain.
Have you spoken to your friend about your concerns? Encouraging him to speak with his doctor about his current medication use is important. I would also ask if he had a sponsor or a counselor he worked with to help with his heroin addiction. Getting back in touch with them would be help at this time. I would also recommend self help meetings such as AA or NA and a group called Al-Anon for you as a concern friend or family member. Information about these meetings can be found at AA.org or NA.org. I hope this information was helpful to you.
Good luck to you and your friend,
Sherrie