He Ransacks the House for the Drugs I Confiscated

oneofsome wonders if she did the right thing. She has confiscated her Loved One's heroin when he's passed out, in the past. He often tries to convince her later that he'd be better off getting a little bit of what she confiscated than going out to score, and she does worry about the many risks involved with him going out in search of more drugs. She's held strong to her boundaries, but his responses complicate the situation and she's in need of sound guidance. 
 

My 26 year old son is a heroin and meth user, though he prefers heroin. He lives with us and we don't allow him to have drugs in our house, which he seldom obeys that request. If I happen to catch him passed out and find his heroin, etc., I will confiscate and not return. He now is trying to convince me that he would be better off just getting a little bit of heroin from me rather than going out and getting more, or using something else. I don't relent, he takes meth, and then stays up all night ransacking our home searching for his heroin. I go to bed worried that he will leave and OD somewhere else, or get in a car crash, but then I wake up to a total mess of a house. He says that he wants to go back into rehab. but wait until the end of the month because of the quarantine and the minimal service that they are receiving. Plus, he has a court case he wants to look good for in July! I guess my question is, should I have provided a little bit of heroin to get him through until he goes back into detox/rehab or let him go out and just get more with all the implied risks?
 

Your son is using methamphetamine and heroin. He has a court case coming up and knows that getting treated for his addiction will look good to the judge. You have a motivated Loved One.

The question is whether to give your son a little heroin each day so he would not re-offend, and so that he would otherwise calm down a bit in your house. He is really running rough-shod through your house and this all must be extremely trying to your patience. It’s good that you wrote in to share your situation and seek some guidance. What a huge decision to be faced with.

Families are often stuck with the best of various bad choices when it comes to addiction. While on the surface, the question you pose may sound outrageous, in fact your question has merit.

There are countries that are set up to provide heroin to those with opioid addiction. Switzerland, UK, Canada, and the Netherlands provide patients with a clean syringe and some medication-grade heroin each day. See this article from the Transform Drug Policy Foundation to read about their alternative approach. I recently learned that the province of British Columbia uses morphine as a replacement therapy. And in the UK, programs give those with a drinking problem a little alcohol each day, sufficient to keep them from withdrawals and to keep them at a maintenance level. This article published by the University of Oxford outlines the practice. As you probably know, in the US, the answer is to use methadone or buprenorphine. Both are long-acting opioids that, when taken appropriately, replace the body’s need for another ilicit opioid.

Finally, there is evidence that between intimate partners, one can dose the other with medically ordered medications. The family member gives the Loved One the drug treatment each morning with an affirmation (or a repeat of the promise to one another). See this article from the Journal of Substance Abuse Treatment for a summary of this process.

Your question is provocative, and yet you see the trend in these case examples towards caretakers using a wider array of replacement therapies, including alcohol. I suspect something like this may work with cannabis as well.

In the time of COVID, I suppose, many more bets are off. I don’t know if your question comes after attempts to get your son onto methadone or buprenorphine? This is what the court is going to be looking for, and many jails have started bridging inmates who are incarcerated and already on a medication. So getting on a medication TODAY could reduce his sentence and ease the transition into jail, should he get jail time when he appears in court this summer. In our jail in Western Massachusetts, the hope is to lead with bridge prescriptions for those on MAT when incarcerated. Those coming in with an elicit opioid disorder would get cared for next, in the next phase.  

If I read your question correctly, you are concerned that by holding out with the drugs you have confiscated, you may be  setting him up for more risk if he chooses to seek out heroin elsewhere. Theses risks, including more criminal behavior and overdose, are very real, and your concerns are absolutely valid. By administering small amounts of the heroin would you also be hoping in part to reduce some of the risk of his doing destructive things in your house? Do you anticipate that he’ll be calmer, in part due to not turning to the methamphetamine and ransacking the house every night?
 

I am worried your son is capable of more than angrily searching through drawers. Methamphetamine creates violence. Here is an excerpt from a 2013 study:

“This study describes the extent to which methamphetamine users perceive that their methamphetamine use has resulted in violent behavior, and describes the level of self-reported prevalence of specific violent criminal behaviors irrespective of methamphetamine use. Predictors of these two violence-related indicators, in terms of potential correlates from substance use history, criminal history, and health risk domains are examined. Data are from extensive interviews of 350 methamphetamine users who received substance use treatment in a large California county. A majority (56%) perceived that their methamphetamine use resulted in violent behavior; 59% reported specific violent criminal behaviors. For more than half of those reporting violent criminal behavior, this behavior pattern began before methamphetamine initiation. Thus, for a subsample of methamphetamine users, violence may be related to factors other than methamphetamine use. Users' perceptions that their methamphetamine use resulted in violence appears strongest for those with the most severe methamphetamine-related problems, particularly paranoia.”

We are concerned about potential risks to you in this situation. Please revisit and take some extra time with Learning Module 2 to help ensure that you are staying safe.

So, while it may sound far-fetched to give your son daily heroin, there is some evidence that it could work… but it should be tried only as a last resort. Rather, first focus on staying safe. Secondly, follow Learning Module 8 to learn how to engage your son into Medication Assisted Treatment. And in the meantime, please make sure that you have Narcan on hand and know how to administer it.

Your situation is serious. Your son is going to need more than MAT but this would be a huge start. It would settle his urge for heroin and put him in front of professionals who can assess the opioid and methamphetamine addictions. This doesn’t prevent your son from going into a rehab as he’s expressed the desire to do. If he’s still reluctant to go to rehab for any reason, though, it would be an excellent start to have this under way while he decides about next steps. For today, though, please consider our suggestions.

We appreciate your writing in with this incredibly challenging question. Kudos to you for sharing your situation and the thought process that you are going through. I hope this has provided some context to help you make an informed decision when the question next comes up. And please continue to keep your safety at the forefront. You’re doing a great job in a very tricky time. Keep taking care of yourself. We’re all here for you and we are rooting for your family.