addiction and treatment

[jennetic]

Hi,

My fiance is about to undergo Peg-interferon treatment for his Hep C. His dr said he has bridging fibrosis and that he should start treatment immediately. He quit drinking last June, but has recently gone back to heroin (!!!!) which he took as a teenager but hasn't done in nearly a decade.

I've been reading the boards- if he can't tolerate the stress of upcoming treatment without going back to drugs, I don't see how he will be able to go through treatment while staying clean, but there's always hope.

He's really lucky- he's a 3a genotype. My main concern right now is for him to get through treatment. If he can, his chance of beating the disease is very good.

So I have two questions: 1. If he is unable to stay clean, will doing heroin counteract the Peg-interferon, and 2. Is there anyone who started treatment from Hep C coming off any other addiction? He is detoxing now, and is scheduled to have his first shot just as the detox should end (this is by his own scheduling- he hasn't told his dr. about his active addiction). If so, is there any advice you can offer?

Thanks!

[tbradnc]

Hi,

It's great to hear you're hitting some Nar-Anon meetings!  I'm pretty confident you'll be picking up some valuable insights regarding the situation you've found yourself in.

I wish you the best through this.  And always remember, you didn't cause it and you can't fix it.  You can only take care of yourself.

See ya,
Thomas

p.s.  Get a sponsor!  ;-)

[tbradnc]

Hi Jenn,

I've only got my own experience as a frame of reference but the one thing about addicts is that we're not very unique (although we like to think we are.. <g>)  

One commonly accepted principle is that the closer someone is to an addict the harder it is to help them get clean.

I will go out on a limb here and suggest that you might consider attending an Al-Anon or Nar-Anon meeting in your area.  You'll learn quite alot about addiction but most importantly you'll learn how you've been affected by your fiance's addiction and how *you* can stay sane through all this yourself.

It's really, really tough to go at this alone.  There's a bazillion people out there who have been and are going through exactly whay you are - find some of them and learn how they do it.   It might not get your fiance clean but it'll keep you together.  ;-)

Again, just my opinion - this is just what worked in our family - I'm not trying to push or promote anything.

Take care!
Thomas

[jennetic]

Hi Thomas,

Thanks for the comments. I have been attending the NA-aron meetings- they are very helpful. I don't know that my fiance and I will stay together- in fact, if he can't/won't get clean, I won't stay with him. But the meetings are great for reality checks and sanity!!! They have echoed you: those closest can generally do the least to actively help, but they do have the power to actively harm. I'd like to do as little harm as possible. But it's hard to tell sometimes if I'm helping or harming! I guess that's what the message boards and meetings ar for!!

Jenn

[jennetic]

Hi Kimberly and TB,

My fiance is definately physically addicted. He kicked this habit eight years ago, but he's returned to it in the face of this illness and losing his job, and probably getting engaged as well. Too much for him.

I am extremely worried for him. He is a mess- he won't do methadone, he wants to kick, but only lasts a few hours into withdrawal. He says that he's not sharing needles but he is definately shooting up.

If you have ANY advice, please post it here, or email me at: ***@**** .

Many thanks,

Jenn

[tbradnc]

I apologize - I reread the initial post and I missed the part about her fiance being in detox right now so you can disregard most of my previous message.

Shows what I know....

In this case I definitely think the physician treating his HCV should be aware that he's working with an addict.  Not to prescribe methadone but to be aware of his condition when considering potential medications to treat side effects related to HCV treatment.

I'd let the detox center handle all the methadone stuff.  It still isn't a given that methadone is the answer.   12 step programs can be as effective.  

It's too bad there aren't any concrete answers, isn't it?  Everybody has to just figure it out on their own, more or less.


Thomas

[ringading]

yah its a really tough one alright thomas and there is a place for the differing types of approach to treatment,( meaning, meth, maintance, alcohol etc,and or abstinance spl.? in conjuntion w tx for hep c) guess it is purely individual with each person who presents... and is dependant on SO MANY factors and that is why a well informed doctor is the second, if not first line of defense in assessing need....first being hopefully the client is able to disclose the addiction....
thanks thomas
kimberley

[tbradnc]

I fundamentally agree with you on all points, I think we're just coming from different points on the plane.  :-)

In this case, from what I can gather from the initial post, her fiance is not at this point physically addicted to heroin and may never develop a drug habit for all we know.   I can't see the logic in putting someone who isn't physically addicted to an opiate on methadone.  

There are other ways not to use drugs besides taking another drug if that's what someone wants to do.  Not that methadone doesn't have a place in certain instances.  I just don't think it should be the first line of treatment when the word heroin is used.

[ringading]

thanks for the awareness and post.  while it is an in-accurate assumption ( and one that frustrates me ), that all IDUs 'share' needles, the sad reality is that not knowing where her fiance is..in the world, and if he has access to unlimited new syringes can be problematic.

as importantly an issue is that HIS DOCTOR BE AWARE that he is having difficulty 'not' using and hopefully can be put on a meth program in conjunction with treatment. with Doctor Assisted Methodone Maitanence the issue of new syringes should not be an issue for him.
cheers!

[jennetic]

Thanks, Kimberley and TB, for the info and thoughts. My fiance swears that he won't do any drugs during treatment, but of course I am extremely skeptical. I hope he can make it through without using, but it's at least good that the drug use per se shouldn't interfere with the meds. It's the only positive thing I can come up with right now, as the situation is pretty much horrible (can't imagine it's going to get any better- he's to start the Peg any day now, as soon as his dr. and insurance company talk to approve the medication).

[ringading]

hey kiddo.....just to make sure you understand correctly, as it can be confusing......it is important that he feels able to be HONEST and NOT SHAMED about his drug use, so that SHOULD he be unable to stop,he won't be deceitful about it, but open and HONEST...and  that he is IMMEDIATELY put on methodone......as 'street' Junk..(herion) has many many unknowns in it and i would not recommend, he was doing herion bought on the street, in conjuntion with treatment.( only methodone if needed )....good luck and if you need more info leave me your e-mail addy and i can send you the info you may need....
good luck sweetie...
kimberley
p.s...it is not at ALL so very unusual for someone that has a history of drug use/addiction/alcohol use etc to feel the need to 'cope' with these frightening new feelings around needing to be treated for hep....and for them to go on binges...while working out the feelings/emotions surrounding this....

[tbradnc]

QUOTE:

[There is a VERY high Hep C re-infection rate among intravenous drug users. Why go through PEG-interferon treatments, if your fiance plans to continue sharing needles? By sharing needles, he is setting himself up for almost certain re-infection.]

It is possible to be an IV drug user and not share needles.

Thomas

[Med Help]

It is IMPERATIVE that your fiance tell his doctor that he is using heroin!!!! PLEASE make sure that your fiance does this BEFORE beginning the PEG-interferon treatments!!!

There is a VERY high Hep C re-infection rate among intravenous drug users. Why go through PEG-interferon treatments, if your fiance plans to continue sharing needles? By sharing needles, he is setting himself up for almost certain re-infection.

MED HELP INTERNATIONAL

[tbradnc]

Active drug addiction isn't a pretty thing, that's for sure.   As they say, "There's no such thing as a social addict."

Having said all that, I do know people who've used herion and other narcotics through treatment.   Technically speaking, as long as you don't share needles you're not going to get reinfected that way.  All things being equal, if I had to pick herion or vodka sours I'd pick herion.

As far as the effects of narcotics on the liver - they're relatively minor compared to a lot more commonly prescribed medicines.  

The only issue (and it's a major, heavy duty issue) is how pure the heroin is and what it was cut with.  To me, this alone would be enough not to do it, but then I'm not addicted.   If I were, it wouldn't matter.

Then there are the legal issues... You can get busted, and if you need money to feed your habit you're liable to do some things to get the money that might land you in a bit more trouble.

As you can see, I don't have any answers....  As a recovering addict I don't have the option of using herion - really, really bad things happen to me when I'm using.   I'm not in charge of the rest of the world though and if that's what someone chooses I  just hope they go into it with full awareness.

[ringading]

hi there, while most are encouraged to avoid additional drugs as well as alchol while treating, there are places and doctors that DO TREAT people that are struggle with addictions, in canada, united states as well as the UK and other parts of europe....also....it is very possible to do treatment AND METHODONE, (for herion addicts ) at the same time, or alcohol maintainace....this is a touchy subject here though as it seems to mess with peoples 'mantras'...but it IS done  as part of a Harm Reduction Strategy and has proven to be successful for those in need of treatment that can not ...for whatever...reasons.... manage to stop using.
kimberley

[BobK]

Treating Hepatitis C in Substance Abusers

link goes to a pdf file download.

http://www.projectsinknowledge.com/Init/G/1599/1599-TxReporter3.pdf

regards,
BobK

[Steve']

Hi ... I think its time to get Serious for your fiance'I know you do too "Methadone" is his only chance & here's why I say that .... I don't know if you know this but the Interferon + Ribavirin Tx (treatment) has many possible side affects & one of them makes ex-addicts & alcoholics feel a kind of "withdrawing", "Hanging out" or "Strung Out" feeling ... Its hard for some to experience this even though they know that they are NOT withdrawing from narcotics, the feeling over powers some .... some have even reverted back to old habits ... my point is if your fiance' is doing heroin now then he has almost no chance in my opinion of going through treatment clean ... there are people I know that have gone through Tx on methadone & cleared the Hep-c virus ... even some people on methadone that frequent this forum might comment ... the good news is methadone is a pain killer & it helps you get through some of the aches & pains we get while on Tx ..... I wish you both <b>Good Luck</b> with your desiscion ... always remember the "Goal" ... <b>...Steve...</b>

[jennetic]

Thank you all so much for your comments.

Bob, thanks for the .pdf file.

Steve, thanks for your thoughts. I think you're probably right.

We're going to talk with his GI tomorrow, and either my fiance or I will tell the dr. about his heroin use. I'll ask about going on methadone to get through it.

Pharoah, I think you're right on the "tough love" thing. I went to an NA-alron meeting with my finace's parents tonight. It's like a double whammy, dealing with his addiction and his Hep C.

[Pharaoh]

Good deal!  Make sure the doctor knows, even if you have to tell him yourself.  A little tough love right now is probably in order.

[jennetic]

We are going to tell the Dr. tomorrow. I only found out about it yesterday. This is an extreme mess. :( You're right: there is never a good time to do heroin.

[Pharaoh]

I can't give you the bio-chemical ratioanle for not doing heroin in combination with Hep C treatment, but answer this to yourself:  Is there EVER an OK time to do heroin?  Your fiance' is getting off on the wrong foot by not telling the doctor everything.

GT