Question: My boyfriend is addicted to heroin. I recently found syringes in his room which means he's shooting up. How much would he have to do to overdose and die? This is my greatest fear.

Dr. David Sack Says...:

You are right to fear that he will overdose. There is not a specific amount of heroin that I can state would cause an overdose. Statistics show that the longer someone uses heroin the more likely they are to overdose. Street heroin is rarely just heroin, so this increases the risk of accidental overdose because it is hard to gauge the actual dose you are injecting.

For your own sanity you might consider going to Nar-Anon meetings – this is the equivalent to Al-Anon for family members of the addicted person. http://www.nar-anon.org/Nar-Anon/Nar-Anon_Home.html.   You want to learn how not to enable the addiction and how to set boundaries so you give him the best possible chance of choosing recovery over continued heroin use.

Question: I've been on Xanax since 2008 when my dad died and they give me a high dosage, 2mg 4x day. I'm creating a huge tolerance where i'm eating up too 20 mgs at one time and i'm functional but now it's catching up with me because i'm going to be without if i dont set a plan to get 28 2mg tabs until i go get my refill and that's the day i'm going to treatment, on oct 10. please any advice will help

Dr. David Sack Says...:

Xanax is not a good medication for the long term treatment of anxiety for the reasons outlined in you question.  First, people develop tolerance.  Secondly, because Xanax has a relatively short half life, many patients experience break-through anxiety.  When this occurs they take more Xanax, more often to less and less effect.  The best thing you can do is to come clean with your doctor(s) and work with them to come up with a safe and effective detox plan.  You should not try to manage this on your own.

Question: I am a 67 year old man, recently diagnosed with Parkinson’s and prescribed pramipexole. My doctor told me to be aware that in some cases pramipexole can cause people to develop strange behaviors, like developing gambling problems. My wife and I have gone on seniors trips to Atlantic City 2 or 3 times a year for since we both retired and we enjoy them quite a bit and they serve as very affordable mini vacations. Both of us like to gamble but not at high stakes. Now that I am using pramipexole should I avoid gambling at all, to ensure that I don’t develop any problems with it? I can take it or leave it, at the moment, but it would be a shame to not go on these trips any longer.

Dr. David Sack Says...: The likelihood that an individual will develop compulsive behaviors on pramipexole is generally low. Compulsive gambling, spending, and sexual activity have all been reported. If you and your wife decide to go to Atlantic City there are some ground rules you may want to adopt as a precaution. First, don’t gamble alone. Your wife should accompany you whenever you are on the casino floor. Second, agree to an amount you are willing to lose before you go. Your wife will need to be comfortable being the enforcer here. Third, no credit or debit cards can be used to access money for gambling. Leave them locked in a safe in your room! Finally, and most important, if you or your wife notice other changes in your behavior (agitation, insomnia, spending etc.) call your doctor immediately and be prepared to leave early.