He’s Not Taking The Suboxone…

mw2018’s Loved One struggles with addiction as well as a serious psychiatric condition. He’s had periods of stability, involving medication and other solid supports, but he’s showing signs of another relapse. Should she pay for another 3 weeks of suboxone even though it seems like he’s selling it on the street?

First, thank you so much for this website. I turn to it often to learn, get calm, and get gentle reminders about how to navigate the chaos. My son (35) has been dealing with substance use disorder and a serious psychiatric diagnosis since age 17 (so, over half his life.) He's been in and out of treatment through the years, with temporarily good results until the next relapse. His drug of choice has changed over time, from alcohol and marijuana when he was a teen, to meth in his 20's, and now to heroin for the past 5 years. His most recent period of stability was when he was seeing a good psychiatrist on a regular basis, taking his meds, and going daily to a methadone clinic. He went to the clinic for almost two years and chose to taper off the methadone very slowly until he was off it completely. He had a good stable, sober year after that. Then he stopped his antipsychotic medication and everything fell apart again: a relapse, an eviction, a criminal charge. His psychiatrist won't see him anymore because of drug-seeking behavior and not being honest about relapsing. Read mw2018’s full comment here.

Your son suffers from a serious mental illness and problems with substance use. Despite this, your son has had some stable periods, most recently when he was on methadone, seeing a psychiatrist, and taking his psychotropic medications.

You are ahead of the game to some extent, since your son has discovered what it takes to be stable: methadone and antipsychotic medications were at the core of his longest stable period. He managed another year without any opiate medications, after titrating off the methadone. His relapse back to opiates led him to Suboxone, which he has a history of diverting (probably selling the suboxone on the street and using the money to buy heroin).

You are now faced with whether or not to pay for the Suboxone clinic for another 3 weeks, since you suspect a relapse.

Suboxone clinics monitor their clients with urine tests. The test looks for Suboxone as well as illicit drugs. When there is no Suboxone in the urine, the clinic thinks the Suboxone is being diverted… and probably rightly so.

This happens with clients attending MAT clinics. Clinics are trained to handle this, though the protocol of what to do with patients that divert can differ from clinic to clinic. Our advice would be to let the clinic make its determinations of how to handle your son’s relapse. If diversion comes up, he will probably be kicked off the clinic. I would need an entire blog post just to tell you how I feel about the various clinics’ protocols or how I feel about psychiatrists who can’t work with clients with addiction. People with addiction seek drugs and relapse… this shouldn’t be a huge surprise, or cause for discharging someone from life-saving care.

Our suggestion therefore would be to pay for the clinic. Let the clinic manage the relapse. Let your son manage his probation. If he doesn’t show up for probation, they can tighten his mandate for treatment, they can ignore it, or they can put him back in jail. The probation system, in our experience, is still subject to the personality and biases of the officers in terms of the choices they make with clients who relapse.

What you can do…..

1) do whatever it takes to keep your stress down (Learning Module 7), so that you can relate to your son with compassion and in partnership to find solutions. I’m glad our site is some help with this.

2) Suboxone is too easy to divert. Methadone kept your son more in line with treatment. He may need to go back to methadone. Can you get yourself informed about what that would look like? Where, how much $, wait-lists, etc.

3) The current Suboxone clinic doesn’t seem to be managing your son’s need for psychiatric care. If this is the case, then you will need to find your son another psychiatrist. This won’t be easy. There are wait-lists everywhere for psychiatry. Can the old psychiatrist be convinced to take your son back?

It is a dangerous time. With that in mind, any effort your son is making to take an addiction medicine is important because it helps with cravings and withdrawals from heroin. It is the first line of defense against overdose.

You provided us with a good summary in step with your son’s history. Thank you for being there for your son. Life with a Loved One with addiction and mental illness can be so up and down. Your comment shows that both of you have come a long way in learning what to do. We just need your son to step back into the safety zone, which starts with methadone and psychiatric care.

I couldn’t find a Double Trouble or dual recovery meeting in Massachusetts. Does anyone know of any? If you are outside Massachusetts, here is one link, but I couldn’t find a good resource list.

https://www.dualdiagnosis.org/resource/ddrn/self-help-support-groups/support-groups/

You may also find it helpful to read (or re-read) the other posts we have on the subject of dual diagnoses. Family members with similar situations will agree that navigating situations with dual diagnoses can be exponentially more challenging. You have been there in significant ways for your son throughout these battles.  Your love and support will continue to be a life-line to him. There will be new windows of opportunity that open for you to work in partnership with him to get him back on more solid ground.

It is always wise, so that you are able to operate with clarity and compassion as you continue your battle, to keep up with every practice you can to take care of yourself in the meantime. This can provide you with the peace of mind needed to approach each conversation with your son anew, with a clean slate. As you keep practicing making incremental shifts in your communications as the CRAFT method suggests, you can find new ways to be there for him without falling into the same old traps that we know too well. It sounds like you are already on the right path here. Keep it up!

I’m glad you reached out – please keep us posted about your situation. We are all rooting for you both.