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Overdose – Who is Responsible?

father on phone upset daughter passed out on bed

This is a hard post to write. I have been thinking about the opiate crisis and the response from officials and the medical establishment. I am interested in what our Members have to say on this subject. At the end of this post I pose some questions to further the conversation. Your input (via a comment to this post) would be most appreciated.

I spoke to a large coalition meeting a few weeks ago and was struck by something I heard. For me it raises the core point we’ve talked about in other posts and that you’ve commented on: the very real risk our Loved Ones take with their substance use – the risk of killing themselves either purposely, or through overdose, or accident.


Be Careful What You Suggest

A well-meaning police officer at that coalition meeting I attended suggested that parents should follow behind their kids, ready with Narcan, the antidote to an opiate overdose. Narcan is being distributed ever more widely to emergency personnel, caseworkers and family members. With Narcan, now in a one-step nasal spray, you can reverse the effect of an overdose from opiates.  It is a critical intervention that is saving lives.

Her message caused me to wince, though. Are we now telling families that they should be responsible for surveying their Loved One somehow – as if this were even possible – by being at-the-ready at all times to swoop in with Narcan?

Many of us with Loved Ones who are actively using opiates would quickly answer YES, if it can save a life.


What About Natural Consequences and Stepping Away?

But what happens to the process of recovery if you throw everything out that we teach with the CRAFT approach? What happens if you no longer step away when you see use, and you no longer allow natural consequences to occur?

Bear with me for a moment and hear me out: if we step in rather than stepping away when they use, shadowing them, keeping them home, being ever more vigilant when they sleep or lock themselves in a room, when they spend a few too many minutes in the bathroom….what’s the message we’re sending? 

I’m here… it’s best we hang together on the couch even though you’re loaded…I’m with you…

Are we then unintentionally supporting the use? When does vigilance turn into enabling?


Can Our Life Be Limited to Watching Over our Loved One?

I worked with a mom who would call me whenever she wanted to travel, even for a weekend. Her adult daughter lived with her and used periodically, despite being on methadone. She worried that if she were gone, even for 24 hours, she would miss the moment her daughter passed out. Mom no longer traveled, not even an overnight to see family or friends.

The advent and availability of Narcan are pushing the responsibility for a Loved One’s behavior onto the family EVEN MORE!  The unintended societal message – that family members should/could be there when a Loved One overdoses – has the power to destroy family members who aren’t there when the unthinkable does happen. 


Whose Responsibility Is It?

I don’t have the answer to this and would appreciate comments. Where and how do we draw the line?  How can you remain prepared to address a potential overdose and yet avoid making your Loved One comfortable and safe, thus emboldening them to take more chances through continued use? How do we avoid extending active addiction by normalizing it and inadvertently enabling it?



In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. My 20 year old son passed 2 years ago from overdose. What helped me the most was finding others who understood my particular type of child loss pain. There are a number of support groups that deal exclusively with grief from loss from substance use. GRASP (Grief Recovery After a Substance Passing) is a national group and there are many independent local groups. I actually run two in the South Shore of MA area. It would be helpful to know what state she lives in.

  2. I have a friend whose son moved across the country a few years ago and fell into opioid addiction. She found out a year ago and tried to get him to come home, but he did not. He entered treatment a few times but then left the treatment center and went back to using; he just died of an overdose. I don’t see many resources for those who are in this terrible spot after trying so hard to help their loved one. As a friend, I could use some advice on how to help out though I’m sure it is very personal. Any resources for this? It is all of our worst nightmares and I’m sure there are others who have lived through this horror.

    1. I am very sorry to hear about your friend’s son. Death from overdose is particularly difficult for the family. Isolation is great, the family feels stigmatized or ashamed. There is the terrible feeling that more could have been done to avoid the death. Other family members may not be as supportive as they could be.

      This two-part article does a good job of laying out the difficulties of losing someone to overdose. As a friend, understanding what the family is going through will feel important.

      Check out the 2-part article and read Dominique Simon-Levine’s full response here:

    2. I am so sorry to hear of this, I have actually been in your situation. I have two friends who have both been through this tragedy, each losing a son within the last five years to an overdose. They live in different states and don’t know one another, yet I have noticed similar things as they both journey very differently through the grief. The pain for both has been at times unbearable, sometimes seeming impossible to bear. As their friend I try to give support and relief as much as possible (being sensitive to what might not be helpful as well). Dominique’s articles are very helpful, I return to this site often for counsel and support.

      I have found that when it comes to both of my friends, reminding them often that I am accessible and willing if they need me, along with asking questions about what they need (or don’t need) has been the best way I can think of to ease some of the burden. I also intentionally remain mindful of dates; birthdays, death anniversary etc. That is when I try to be extra sensitive to send cards, give extra comfort and attention, listen more etc. A comforting presence can go a great distance when someone is hurting so bad. Love and kindness – you can’t go wrong using those. Kindnesses are extra appreciated during despairing moments and sometimes are what my aching friends have told me they existed on through the worst of times.

      Love heals (as much as possible when pain is so deep).

      I had lunch with one of them recently, she told me that reminding her that “the love of a parent for a child runs so deep and so strong, nothing can overpower it. Not even the temporary separation of death. Even though it feels like forever, it truly is not” is sometimes all anyone can do, because she will always be heartbroken, it’s just a matter of managing it and continuing life honoring the memories.

      Being a friend near someone grieving is a commitment to kindness, over and over again in my opinion. Hope that helps. You are wonderful for having such compassion. I wish you extra strength, kindness and discernment as you give support and comfort to your friend.

      1. Thank you so much for this thoughtful and kind reply. I really appreciate it; I found I had to strengthen myself because of the fear of the same thing happening to us and now I am able to reach out more to let my friend know I am here if she needs it.

  3. I am at such a loss right now. As much as I don’t want my son out of the house and out on the street I feel I have no choice. I have been trying with him for at least 11 years now. I have had him sectioned, in treatment centers and in counseling. I have also been in counseling, gone to group meetings and did the AIR Program a few years ago. I do think AIR did help with my older son but the younger one is so headstrong. I’m constantly told by family members that I have to do something about him but no one ever can give me any suggestions. I’ve been accused by some family members of never trying to help my son. They haven’t got a clue, so I try just to ignor them. I just see this son going nowhere. He won’t try to get a job sits and watches TV all day or goes out to try and sell his suboxone, he is in the suboxone program but does not work it right. I am totally worn out. I just don’t feel allowing him to continue this way is helping him. I would appreciate any suggestions anyone might have. Thank you

  4. You asked, “How can you remain prepared to address a potential overdose” and the answer is we can’t because we don’t know the lethal amount that they’ve taken. I believe in order to ask this question you might also need to know what they’re tolerance is. When someone’s using they don’t mean to commit suicide or overdose their tolerance changes over time and they think that they need more to get the same high as before. But the same high never comes as the first time you’ve used.

    Narcan is good but unfortunately it’s a Band-Aid for society that doesn’t really know how to deal with the epidemic that’s killing half the population so for the time being Narcan will do and it does its job well.

    When administered Narcan reverses the effect of overdose but when that happens the person who was dying suddenly wakes up and becomes extremely combative because you’ve just ruined they’re high. EMT’s go through this all the time and that person will be back out on the street sooner than later to overdose again. Hospitals see the same people overdosing and receiving Narcan. Gov. Charlie Baker sign a bill that states that if hospitals, counselors, all other health care workers believe that someone is using then they have the right to keep them for 72 hours which might save their life and lead them to services they would normally need for SUD treatment.

    Addicts need someone to walk with them through this process because they don’t think for themselves anymore. They haven’t been able to think for themselves in a very long time because the drug has been doing all the thinking for them for many years. Most the time you’re talking to the drug and the drug has no conscience or any other emotions connected to that person so in effect the person is just a shell of what they were before any drug use and they let the drug make all the decisions for them because the drug tells them to “sit down and shut up, I’ll take care of this”.

    You see I know when I’m talking to my son and when I’m talking to the drug. He’s been on the Methadone Clinic for years and many relapses later, knock on wood, he’s doing better and fights every day for sobriety.

    Narcan can be the first part but treatment should be a requirement as a second part and behavioral health therapy is necessary as the third part. Only then can abstinence have a chance in someone’s life.

  5. Having a relationship with an addict is a balancing act anyway, NARCAN is just another element to balance. My understanding is that an addict is going to use when an addict is going to use, they have no thought about the risks, therefore whether someone is around with NARCAN does not even enter their mind. It becomes my decision to follow my son around with NARCAN, or to live my life with NARCAN in my tool belt. I liken it to air bags in my car, I don’t choose to drive around recklessly knowing I can rely on the air bags, but I am glad they are available just in case.

  6. Thank you for the courage to take a stance on this sensitive subject and to open the door for discussion!

    I think most everyone is agreement to save lives whatever it takes. I have read responses from individuals whose lives were saved with Narcan and they are adamant that it was a horrendous experience, that does not make one want to rely on it again. I have also heard that when one is using there is no thought of whether or not there is a Narcan or someone there watching ready to step in and save their life if needed. The only thought – goal is to get and take the substance. I am also aware that there are many grants and efforts in states to reduce their numbers of opioid deaths. (very simple -nothing about increasing treatment – relapse rates etc just reduce the number of deaths). It may be true that Narcan is the fastest way to bring that number down, but as you say what are the ancillary effect?

    think Narcan is a good thing and I am glad it is available, but I think it should be accompanied with mandatory treatment. If you received/needed Narcan you have an addiction problem. It seems to me that Narcan also has potential for a number of other complications like raising the bar on co-dependence, not in the moment when one choses to use, but later when having regrets – “where were you when I needed you?” “Why wasnt I there when he/she needed me?”

    As a society we criticize and make fun of “helicopter parents” yet we encourage that behavior with Narcan. I remember back in 1969 once running into the liquor store after my husband, saying, “You said you weren’t going to drink any more today.” I deliberately (desperately) made a scene hoping ( I think expecting) that the sales clerk would not sell to him – after all they cut you off at the bar – he was obviously drunk… and who was I mad at ? my husband? perhaps, in a suppressed way – but the sales clerk – for selling to him…We all want someone else ( or something like Narcan) to save the day. Instead we find it is only the long hard daily work of commitment and consciousness in our choices and our actions that will change lives.

    Rather than reliance on another drug like Narcan to save the day …we need more treatment and more programs and support like AIR for families and loved ones who are using…

  7. I have over the years given up trips, going places and just enjoying myself because I was afraid to leave the addict alone. I have actually performed CPR on my son because he overdosed. It was at night, mostly everyone in the house was in bed and I heard a loud crash. I found him on the floor. I had no more narcan in the house. He did survive. I decided though that I can’t spend my life following him and no one can watch someone 24 hours a day. If addiction is truly an illness, then comparing it to other illnesses,would one watch a diabetic 24 hours to make sure they don’t go into a diabetic coma or an elderly person to make sure they don’t have a heart attack. I have lived in fear for so long, (I have been dealing with drug addiction in my family for about 15 years), that everytime I get a call from home I fear it is my older son telling me my younger one overdosed. It is a horrible way to live. I now have decided to enjoy myself and do what I want to do and I just pray when I’m away that everything is ok. I can’t say though that if something did happen I wouldn’t live in guilt for the rest of my life. I have 2 sons that have addiction problems, one has decided that he wanted to change his life and is doing wonderful, the other still struggles. I have tried so many different things to help them, but until the day comes that they decide they want to help themselves, then they will truly go into recovery

  8. At a local coalition meeting yesterday a man who lost his son said he believes every addict should be incarcerated to keep them alive. My son is in a 12 Step Retreat and he is ok for now…I am resolved to the fact that I can do nothing to help him, that he needs the support and fellowship the recovery community offers. He did not go there willingly, I had to take a restraining order out to keep him out of my home, but I told him he had an option…..I gave him the number to call, and after one night in a homeless shelter he made that call and seems to be ok…for today. I was only able to make that happen through tremendous support via support groups…keep this rolling. If the family is strong and clear with the message, the addict MIGHT survive.