Did I do something wrong?

I wouldn’t be so concerned with the alcohol and IBU as I would be the tylenol. His liver will not be fond of him if he’s drinking and maxing on his 4g APAP a day for 2 weeks straight I wouldn’t think. But still it likely beats dying from a heroin overdose.

Uh, other than him probably taking 1000mg of tylenol every 4 hours + suggesting he drinks with it, you should of sent him home with some Mucomyst. :)

I think the advice is good, however recommending alcohol to someone who obviously cant say no is like handing a retarded kid a loaded gun. I’m sure he’ll love the heroin withdrawls + nasty hangover + liver failure.

I’m only saying this because its my job.. no.. DUTY to bust your balls.. :)

From a Nursing perspective, it sounds like good advice. I believe pharmacists have the knowledge to best answer this type of question. I applaude your willingness to tackle this challenging problem and help this dude. A knowledge of Chemistry is so pertinent in helping solve these types of problems. Unfortunately, Pharmacists don’t get the credit they deserve for the knowledge they have. I respect my Primary Care Physician for acknowledging the fact that the Pharmacist is the best resource for any issue involving chemical therapy. Thanks for taking the time to share your knowledge with someone williing to learn.

I think you gave fine advice… I mean, you gave the good and bad, I think the only addition I would have done was still give him the docs number and tell him to not be afraid to use that or NA (Narcs annon)…

I don’t think you did anything wrong at all. if he is serious and does all he can, I hope he comes back and thanks you, or at least gives you an update.

I would stress NA. There are many there who have already gone through what he will and could be just a phone call away.

The last thing an addict needs is religion thrown down his gulley….which is what the AA and NA groups do — from what I’ve heard from friends that have experienced them. They make it seem as if a person is incapable of beating an addiction without giving their life to Christ — which is a bunch of bologna.

You did a great job. The Alcohol might pose some problems here but hey, compare to Heroin it should not be a problem as long as he will not take Tylenol and Alcohol for a long period of time. I am just a Tech but I am also at Med-school (2nd year) and I LOVE my Pharmacist. You all really do not get the respect you ought to have.

I think you did the right thing in terms of doing as little harm as possible. I’d much rather see the guy mainlining Tylenol for 2 weeks than lying dead in a pool of his own fluids thanks to his addiction. I might have insisted he take the number for a methadone clinic and suggested the local NA group as well, but honestly, if it helps the guy kick a habit that’s sure to lead to death, taking the chance to save his life is the most humane thing to do imo.

Too bad he wouldn’t see a MD – Valium 10mg q6h is probably a better choice to manage the DT’s than EtOH. AND dirt-ass cheap too. Although – one vice for another.

good info – maybe a bag of Depends and some Anusol for the burning ring of fire?

Tramadol would be a less addictive option. Or Clonidine has its use in addition management…

All valid points, the benefit of NA is that there’s someone to talk to when he has a particularly strong craving that has already been there that can help him get through that phase. Yes, they are their own religious cult though. My only other suggestion would be to have a close friend on speed dial for when he feels like he’s about to lose his mind and give in to his addiction or if anyone is willing to stay with him for a few days-couple weeks.

I would have probably also told him to keep himself hydrated when the diarrhea starts. Looks like pretty good advice though.

he’s got a high chance of ODing if he takes heroin during or after the treatment, tolerance for heroin drops relatively quickly

That’s a really good point that I left out. I’ll have to remember that! I’ve heard that this is why most heroin ODs happen. People stop, lose their tolerance, reinitiate and die cause they cannot tolerate the amount they once did.

I wouldn’t advise so much paracetamol.
Booze – yes
Brufen- Yes
Milder opiates like codeine – yes.
Plenty of of water+diorylite

I’d venture that the key “substance” in this formula is a non-dependent human being who will stay by his side and slap him about the face when he tries to score more smack.

Reminds me of that documentary maker who “went native” and became addicted to heroin. His camera-man was his link.

That list looks very much like the prn meds on my hospital’s addiction recovery protocol. With the exception of the alcohol, of course. I think you’re pretty bulletproof–you advised him to see a physician, and gave him accurate advice on OTC products that can be used for withdrawal. The only issue is the dosing, and frankly, within the fairly short period of time that detox symptoms are truly severe (generally around a week at most), ibuprofen is more likely to cause bleeding than tylenol is to cause liver damage. And in a 20-something guy, he’d have to be in the cohort of extremely susceptible individuals for either of those things to happen.

I think you did the best you could, given the situation, to make a positive change in the world. I wish there were more people like you around.

I for one know what this man is about to go through. Due to some Degenerative Disc Disease in my spine and other areas of my body. I have been on various types of opiate pain killers over the past 16+ years. This is the hardest thing to go through. For someone who has never gone through such an ordeal can not and would not understand the withdrawals he is about to experience. I tried on a few occasions to ween of the med’s to no avail. The strong withdrawal feelings were to intense to bear.And I mean BEAR! Not the other way around! I think you gave him some solid advice from a pharmacist standpoint. Being unable to actually give this man the Suboxone he will so desperately need was and is a nobble gesture. His best effort would be to try and sleep it off as best as possible. The Diphenhydramine will only help for a short time. As his body begins to go 48 hours without the heroine. This drug will be virtually useless for trying to sleep. He will need a stronger med such as Ambian or some other sleeping medication. The first 7-10 will be pure HELL! and then again after about 3 weeks or so and then again after about 3 months. He will go through some cycles of withdraws that will be his most challenging in being drawn to the heroine again. Suboxone was my only way off the Oxycontin and loratabs for me. I wish this guy the best of luck going cold turkey! But if he would of taken your advice to see a doctor, some will give the Suboxone through some sort of NA for free. Here in NY, there is some aid available for this type of drug treatment. Methadone is not the way to go. It is also addictive. But so is the Suboxone if not weened off from it.

I too am not found of the ETOH being added, he should get an rx for diazepam and clonidine, both cheap generics…This story says a lot about the trust level that the public has for pharmacists and makes me proud to be one.

LifeRing Recovery is another option to NA. It is secular. Can be found at http://www.unhooked.com. The group doesn’t use sponsors or have twelve steps, and it would give him a chance to connect with people.

Wow – thanks for this. I will write it down and remember it for my patients to consider looking up.

I think it’s sensational that you could provide him with a stack of drugs to affectively get off heroine. Generally it takes a newfound addiction to replace a current one, and I’m not surprised you asked him to drink a bit. The knowledge you guys have is inspiring and why I want to be a pharmacist someday. I doubt he’ll go through with all of it but at least you set him up for success.

The advice about taking diphenhydramine to help him sleep was well intentioned, but he won’t sleep. You could shoot him with an elephant tranquilizer and he won’t sleep. He’ll be exhausted & miserable & WANT to sleep, but he’ll be awake for a solid 3 to 4 days.

Is there something over the counter that would help with the back-breaking muscle spasms??? That would be a big help.

Also, I’m going to second what tsp said – he definitely should have someone with him, or at least checking in on him, for the first 4 to 5 days. No, you won’t die from withdrawal pain, but you definitely CAN die from dehydration. And believe me, when you are too weak from convulsive vomiting & body-shaking diarrhea to crawl from the bathroom floor to a clean water source, it looks grim.

(Been there, done that, thanking God I had someone who cared enough about me to check on me & pour some water down my parched throat.)

Overall though it was good advice. He was obviously not going to see an MD or contact NA so the info you gave him was valuable.

NA is not what you think.
I worked for 4 years in an addiction hospital and I am nearly atheist. (unrelated)
But, my point is that I have seen how the meetings work and they do not push Christianity on their members. They tell their members to find a “higher power.” This is just acceptance that they are not in control of everything in their life. Addicts often have control issues. One patient chose Georgia Power (company) as his higher power b/c they did have more power over his life at the time than he did. It’s basically a way of letting people say, “oh well shit happens.” It’s about giving up control. (and sometimes responsibility). But if it gets people to be functioning parts of our society, let them think a magical alien controls the weather.

I think you gave excellent advice, and I know that I would not be able to think that quickly on my feet. The only thing that I don’t really agree with is the Tylenol + EtOH. I can see why you would recommend it, however I don’t agree with it.
A few weeks ago an MD from the area called in an Rx for a person withdrawing from suboxone that she had been on for years. He gave her loperimide, meclizine, and tramadol. I assume the meclizine was used for the vomiting from the withdrawal. Benadryl would work for this as well and hopefully for the anxiety he will be getting as well.
The only other things I could think that would help would be a few gallons of gatorade, ginger ale, and let him know to take a week off from work. If you hear back from him keep us up on the news. It would be really great to see if he kicked the habbit with your help.

I have to say that what you did probably helped more than you know. As a former heroin addict who withdrew with nothing but my will to stop i wish (looking back) i had had the foresight to go ask someone what would help. Instead, i shit, pissed, & puked all over myself for 3 weeks. i also didn’t want to go the route of methadone (suboxone wasn’t around at the time) i had too many friends who were on the program just to get well in the morning & shooting up in the afternoon. i was determined to not be addicted to anything (12 years sober). I will say going through that made sure i never touched the shit again. so, my point? you did a good thing & probably helped him to actually go through with it. not many can take it. most fall off the wagon after about 2 days of hell. hopefully he’s able to withstand it.

Sounds to me as if your advice was spot on. The alcohol is a good idea – as long as he doesn’t become an addict to it – as alcohol IS one of the oldest, and best, analgesic sedatives around. I might have added 25mg of Doxylamine succinate prn to help him sleep. I would have really pushed the suboxone, as that has proven itself in withdrawal as a VERY effective therapy. The trick with ALL of this, which is something that only he can deal with for certain, is the desire for true change and dealing with the psychological aspects of withdrawal – the cravings and the desires for the drug. I would have added either a 12 step group (which is not always my first choice) or some kind of talk therapy long term to help him deal with the longer term issues of why he became dependent on the heroin in the first place. All told though, what you said was both medically and common sense wise excellent advice!

[...] Codeine Addiction here’s what an american pharmacist suggested for a do-it-yourself detox: The *Angriest* Pharmacist ? Blog Archive Did I do something wrong? admittedly this is for heroin but the principles would be the same if an individual was [...]

Agree with everything you told him. Hope it sticks, everything you suggested is all well and good, but won’t do anything if he doesn’t want to stop.

You forgot to tell him that before he quits he is not, under any circumstances allowed to watch Trainspotting ;)

There are definitely avenues for treating chemical dependency that cost little or nothing if he makes the right contacts. Doing it without medical supervision sounds like a real bitch. Regarding the stuff you recommended, I also read somewhere about valerian root being used to treat the psychological symptoms of opiate withdrawal (paranoia, anxiety, general uneasiness) because it’s (in theory) a GABA agonist. I know I’ve recommended it before to people with mild opiate withdrawal symptoms to help them sleep with good results. My personal experience is limited to my brother who’s gone through intermittent withdrawals (big-time oxycodone abuser), and it seems like almost nothing but Suboxone or more dope would have helped his symptoms… although maybe this fellow has a little more constitutional fortitude than my dear bro.

I am currently dealing with withdrawls (not a pharmacist) from opiates. I have a spinal injury(s) and have been on opiates for almost 2 years. I have made an effort with my doc to start weening off. One reason being that im young and the other is that i dont like the way i get treated in pharmacy even tho i use insurance and go to the same pharm each time. Turns out that i got ahead of myself and the pain got to great and went through my supply in no time. I have 4 perc 5/325 to last me a week until i can get my refill. I have had to cut these into 8 pieces to last the week. So you figure less then 1mg a dose 2x day. This is a drastic deduction from what i was taking, about 100-200mg oxy ir a day. Although this alone is letting me beat the sweats and jitters i still have the runs and pain is very acute. What i am finding to work is that i space 4-6 hrs between the doses and then make sure to knock myself out a couple hours after last dose with tyenol pm or Xanax 3mg xr so that i can sleep through the night time hell. I am prescribed the xanax but never take it because i dont like how i feel so now i have a reason to use it and dont think it will be addictive. Believe it or not the best help has been Amphetimine salts(also prescribed) that i have for my add, i dont take often but it does do a great job at keeping your mind off the pain and focused on some other task to keep your mind occupied. The downside is if you dont take it early enough you will have trouble getting to sleep which could be bad. The big issue is bordem, when your body does not have its usual dose you lack inerest and the hours grow longer and longer. I have been taking walks to take up some time and doing suggested stretches for back pain and it does help but its hard to find the motivation. I have considered the alcohol but i think it depends on the person. Me personally i dislike alcohol and have never been drunk, i can only take the taste of rum the few times i have tried so in my case it my not be a bad idea to ingest a little bit to ease the nerves and pain. Other then that i suggest some super-strength ben-gay rub and patches to help, it does not always work but it helps a little. Try not to sit or lay down too much and keep a fan near by if you start to go thru sweats. So far the pooping, pain and bordem are the hard parts. Hope this info helps, and by all means dont score off the street because those sort of people make it worse and you risk going into jail and having no help at all.

The only thing I would add, if you took off your work hat and spoke man to man, is tell them to try marijuana for withdraw…i know that many would yell at this….but withdraw is the WORST time and even though alcohol will help a little it will cause some problems of it’s own. This guy (anyone getting off street drugs) has access to the stuff, and though NOTHING will make it easy….smoking enough throughout the day and night might keep him from giving up and just going back to the hard stuff. The problem with long term addicts is rarely wanting any high….they are just trying to delay the most horrible pain and misery in thier lives a little longer…..

ibuprofen and tylenol, hah
won’t do anything for pain especially if you are used to real painkillers, anti histamines are good for some for the sniffing on w/ds as you say. i went through withdrawals, alcohol, xanax and music, oh yeah lots of pot helped too and someone to abuse and blame for all thats wrong in the world. otherwise as pharmacist i would of just given him a few 10mg endones, not enough to get high but enough to soften the fall

Yeah, because we just give away narcotics to any schmuck that walks up.

NICE!! GOOD JOB! AND YES I WOULD’VE PRESCRIBED THE ALCOHOL TOO!!

You did fine :).
Don’t sweat the alcohol, “double dosage” advice…he’ll be sweating enough for the both of you. As for the suboxone, subutex, there’s finally a generic for the subutex. Pesky, sinice they like to start folks on the ‘tex, then long-term (if needed) with the ‘one. His best hope is to not mention the I.V. drug use…. Perhaps for him to say, “I sniff a couple of bags daily”, and to try to hide those track marks… subutex can be I.V.’ed, thus making it a less than stellar choice for long term use, which is becoming more the norm and less the exception with treatment. Since the doc knows the high recidicism rate, and that said fellow will probably decide the suboxone is way too expensive, honesty could be the best policy. After all, it’s better to have some odds than no odds. In other words, the subutex, though a risk, is still better than no chance at a drug he most likely cannot afford. (Going through his mind will be, “I could be getting high, instead”). My two cents.