What to do if someone you care about has an opioid problem

Last Sunday, as part of our yearlong series examining the impact of opioid addiction in Indiana, we shared with you the stories of people who have been affected by the epidemic. You heard the heartfelt words of parents grieving the loss of children, the personal accounts of people in recovery and the concerned voices of lawmakers and medical and public safety experts.

In the weeks and months ahead you will hear about the scope of this crisis: More children are being removed from their homes because of parental drug abuse; jails are becoming defacto detox centers; emergency rooms are full; and more people are dying of drug overdoses than in car crashes.

But today, we want to begin providing you with information and advice that might help keep you and your loved ones safe or put them on the path to recovery.

We have spoken to  drug addiction and treatment experts. Here are their suggestions.

Offer support

When approaching someone about opioid drug use, it should come from a place of compassion and support, experts say. 

Opioids are a class of drugs that help block pain. The term opioids can refer to prescription painkillers such as oxycodone, hydrocodone, tramadol, as well as illegal drugs such as heroin. 

“Express to the person you think something is wrong and that you’d like them to have it checked out, like any other health condition,” said Dr. Tim Kelly, an addictions specialist with Community Behavioral Health. “You don’t want to be nasty or punitive. It just makes people less receptive to treatment.”

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Steve Johnson, executive director of Indianapolis Comprehensive Treatment Center, said to make sure you understand the situation.

“Just barreling in with someone and doing a big confrontation will drive them away from getting help from you and anyone else,” Johnson said. “But once you’re sure you do have all the facts, you want to make sure that you can find a good time to sit down with the person and have an open-ended conversation about it.”

Kevin Moore, director of the Indiana Division of Mental Health and Addiction, said it is imperative to get the person help as soon as possible. While finding a treatment provider, Moore said you should do what you can to make sure the person who needs help does not have access to opioids.

The state's Next Level Recovery Indiana website, which is devoted to combatting the opioid crisis, has information on finding treatment. 

Understand the disease

Families and friends of people using opioids need to understand that opioid addiction is a chronic disease, Moore said.

“Once a person is addicted, the brain changes,” Moore said. “That’s why medicine-assisted treatment is effective. That’s why clinical-therapy treatment is effective.”

By understanding that the addiction is a disease, family members will then understand the recovery process, which typically includes relapses. From 40 to 60 percent of people in treatment for substance-use disorder relapse, according to the National Institute on Drug Abuse.

“Once they get into treatment, they’re going to relapse,” Moore said. “It’s going to happen.”

Although it can be frustrating, relapse is part of the disease, Moore said.

“Just like diabetes or heart issues or kidney function, things happen,” he said. “When the disease pops up again, you’ve got to intervene again — it doesn’t mean you have to start back at square one agai,n but it means you’ll be in various stages of their recovery for the rest of your life."

Help find treatment

Once a person addicted to opioids is ready for treatment, he or she has several options available — but more than one should be used, experts say.

Medication-assisted treatment is the evidence-based practice of treating people addicted to opioids, Moore said. 

Known as MAT, medication-assisted treatment entails using one of three drugs to help a person in recovery remain free of opioids. Methadone, buprenorphine and naltrexone can be used. 

“They tamper the craving of opioids; it blocks the effects of opioids. Medication allows them to continue their normal life with family and kids and work and school and whatever they’re pursuing,” Moore said. “But medication is only one part of it.”

Without medication-assisted treatment, Kelly said, the success rate is 10 percent or less. 

People with opioid addictions also should have addiction treatment that focuses on changing thought patterns, who their friends are, who they associate with and other patterns that lead to drug use, Moore said.

If you feel you need immediate help, the state offers a 24-hour addiction hotline at (800) 662-4357. The hotline has bilingual services.

What if it doesn't work?

Not all people addicted to opioid addicts will respond positively.

About 40 percent of people using opioids aren’t interested in treatment, Moore said.

This is for a variety of reasons: The shame and stigma of the disease; they’re not in the right stage to make the decision; and using the drugs could still be enjoyable.

All family members and friends can do then, Moore said, is to continue urging them to go to treatment and get help.

“It’ll be a life-changing and life-saving decision,” he said, “when they do get into it.”

If you are afraid a loved one is at risk of overdosing, you can obtain Naloxone, which can reverse the effects of the opioids. In Indiana, doses are available without a prescription at one of nearly 500 pharmacies, nonprofits and local health departments. The website www.optin.in.gov includes a database to search for Naloxone entities.

“Somebody who says they’re ready for treatment doesn’t mean they’re ready to stop using,” Moore said. “Having access to Naloxone, being able to deliver it if there is an overdose, is important for that close circle of family or friends.”

How to prevent addiction

Although many addictions start after someone begins taking prescribed painkillers, there are steps people can take to prevent or lower the risk of becoming addicted.

The National Institute on Drug Abuse recommends that people taking prescription opioids follow the directions. Never stop taking or changing the prescribed dose without talking to your doctor. 

Moore with the Indiana Division of Mental Health and Addiction said one of the best ways to prevent addiction is to limit prescriptions to what is needed.

“Part of why we got into the current situation, in the first place, was the over-prescription of opioid pain medication,” he said. “People would just get lots of them after getting wisdom teeth pulled, orthopedic or some other surgery. It’s important to limit the amount in the home.”

If the medication is essential, be sure to store the drugs safely, such as in a lockbox, to prevent someone else from taking them. 

People with addiction problems can be crafty and resourceful, said Kelly, the Community Behavioral Health addictions specialist.

It is also important not to share prescription medicines, experts warn. A safe dose for one person could be a deadly dose for someone else. 

After painkillers are no longer needed, leftover drugs should be disposed of properly. The state's Next Level Recovery Indiana website has information on where to take drugs for safe disposal. 

Recognize the signs of addiction

The state's Next Level Recovery website suggests watching for these seven signs that you or someone you care about might have an opioid-use disorder:

• Needing higher doses of the opioid to get the same effect that a lower dose used to provide.
• Trying to quit more than once without having success.
• Thinking about getting high as soon as you wake up in the morning. 
• Getting anxious or agitated within several hours of your last dose.
• Experiencing vomiting, diarrhea or nausea after quitting for a short period of time.
• Having less interest in activities you used to enjoy.
• Using opioids when driving or caring for children.

Call IndyStar content coach Jennifer Morlan at (317) 444-6921. Follow her on Twitter and Facebook. 

IndyStar’s “State of Addiction: Confronting Indiana's Opioid Crisis” series is made possible through the support of the Richard M. Fairbanks Foundation, a nonprofit foundation working to advance the vitality of Indianapolis and the well-being of its people.