Question: My pregnant girlfriend was a pot head. Since she found out she was pregnant she has stopped smoking marijuana but she will still eat hash brownies that she makes. She will get high almost every day. She says it doesn’t harm the baby as long as she doesn’t smoke it. Is this true? I don’t want to give her a hard time because I am proud of her for stopping cigarettes and smoking pot.

Iona Health Says...:

First, I would like to acknowledge this young mother for taking the difficult step of stopping her smoking of cigarettes. Most people agree that cigarettes are not good for the health of the mother or baby. Here is some information about the harm of cigarette smoking on the baby:

• http://www.healthguidance.org/entry/4197/1/The-Dangers-of-Smoking-Cigarettes-While-Pregnant.html
• http://www.webmd.com/baby/smoking-during-pregnancy

Secondly, have you considered that your girlfriend could be dependent on marijuana? There is some controversy surrounding marijuana dependency because it is a natural substance and does not seem as harmful as the legal drug, alcohol. I have known individuals who were unable to stop smoking or using marijuana without treatment and/or 12 Step recovery. For information about marijuana dependency, go to these websites:

• http://adai.washington.edu/marijuana/factsheets/dependence.htm
• There are differences between marijuana abuse and marijuana addiction. This article makes a fine distinction between the two: http://alcoholism.about.com/od/pot/a/pot_addiction.htm

As for your question about reduced harm from ingesting marijuana laced brownies in place of smoking marijuana, we must consider first if marijuana use/abuse could be harmful. There is a favorite study of people who believe that marijuana is not harmful but is helpful to children born to mothers who smoked marijuana almost daily during pregnancy. This is a link to a study by Dr. Melanie Dreher who wanted to know if pregnant women in Jamaica who smoked marijuana daily had any effect(s) on their children. Contrary to previous reports, Dr. Dreher found that children born from mothers who used marijuana were not born underweight or with birth defects. Instead, she observes positive differences in these children; such increased prosocial behavior(s), attention, improved eye contact, and easier social engagement, to mention a few.

So that you know, there is another argument against the use of marijuana by pregnant mothers, in any form, by another camp. Their claim is that the use of marijuana could harm the baby’s brain, cause hyperactivity, learning difficulties and reduced memory processing, and without any apparent birth defects. This argument can be found at this website.

So you can see there is no definitive answer for your question except by individual cases. I think the best move would be to include your girlfriend’s OB/GYN doctor in this discussion and any decisions. This doctor needs to know that your girlfriend is using marijuana in brownies daily. One reason is that the mother and baby will be tested for drugs at the time of the baby’s delivery. Hospitals often report these results to the Dept of Child and Family Services. There could possibly be legal implications for your girlfriend if the baby and she are found to be THC positive by the hospital. To avoid any future problems, it is better for her to be honest and talk to her doctor about her use of marijuana and any concerns she may have for the baby while in uterus or after delivery. Another consideration would be if your girlfriend plans to breastfeed her baby. How could the daily use of marijuana affect the practice of breastfeeding when mothers are nursing their babies?

I recognize that I have offered more details than you requested. However, this is a common and complicated problem for mothers, fathers-to¬¬-be, doctors, social workers, and hospitals. The ideal situation for babies is that the mothers not introduce anything into their bodies but good nutrition. My hope is that this information will provide you with more knowledge so your girlfriend and you can make informed decisions about this mother and baby’s health and future.

If I may of further assistance to you, please do not hesitate to contact me. I wish you and your new family every kind of success.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I am using like 800mgs of tramadol a day. I was prescribed them for back pain and I came to really like the energy and buzz they gave me and I started taking more than I was supposed to. That was 4 years ago. This has become a very expensive habit and I feel like I am on an emotional roller coaster. And that I totally cannot function without these pills. I have tried to quit using but I could not. I feel like the withdrawal from tramadol is not recognized as a very serious thing. I have tried to reduce my dosage but it is not really working. I do not really want to get on a stronger drug like methadone because that seems ridiculous but I am not sure what I can do? How can I get past tramadol withdrawals without taking any more strong medications that are also addictive?

Iona Health Says...:

Unfortunately, you are not alone in your suffering from a dependency on tramadol. This medication is frequently dispensed without warnings about...

the potential and danger of increased tolerance and dependency to this medication,increased dosing to obtain the desired or required benefits/effects, andthe lack of resources and information for discontinuing this medication without a serious disruption in functioning and well-being. For common reports about others’ difficulties with tramadol detox, please go to this online forum at: http://www.drugs.com/forum/featured-conditions/tramadol-addiction-withdrawal-37722.html

The members of this forum echo the horrors you have described in your posting. The typical dosage for tramadol is 50 mg per day with the maximum oral dosage of 400 mg per day. You have well exceeded the maximum recommended dosage, i.e. 800 mg per day, which may be risking your health. The biggest published concern for tramadol is its potential to cause grand mal seizures. Whenever someone has a grand mal seizure, the administration of tramadol must be ruled out before any treatment for seizures is offered; especially with patients taking 700 mg or more daily. Commonly reported withdrawal symptoms are reported if a patient is weaned off to quickly from tramadol; such as nervousness, panic, sweating, difficulty falling asleep or staying asleep, runny nose, sneezing, or cough, numbness, pain, burning, or tingling in your hands or feet, hair standing on end, chills, nausea, uncontrollable shaking of a part of your body, diarrhea, or rarely, hallucinations (seeing things or hearing voices that do not exist).

Some patients are gone to stronger medications, e.g., Suboxone, to avoid the more severe withdrawal symptoms from tramadol. Since this is not an option for you, it appears that you may need to be gradually titrated off this medication. To do this, I would recommend a medically supervised detox from a physician since you are...

self-administering a very high tramadol dosage,need to avoid seizures andsevere withdrawal symptoms.Although it has been reported that some individuals have attempted to titrate themselves off of this medication, it has been reported that they did not completely avoid withdrawal even after they administered a small amount of this medication. In my professional opinion, I do not recommend any action without medical involvement and supervision. You may need to contact physicians or treatment programs who have provided safe medical detox and managed any withdrawal symptoms from tramadol. For more information about tramadol, please go to: 

• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000960/
• http://en.wikipedia.org/wiki/Tramadol

As you know, tramadol is used typically for pain management. Because of your back pain, you may continue to need some relief from it. A physician, who specializes in pain management, would be a good resource for you to consider.

On a more positive note, it has been reported that many individuals have slashed their withdrawal symptoms by exercising, improving their diet, and managing their sleeping difficulties. I would encourage you to consider, any or all, allopathic or complementary interventions proven to be effective with this serious medical problem.

If you need anything else from me, please do not hesitate to contact me at your convenience. Please know that this serious health challenge is manageable and can be resolved with the help of trained professionals. I wish you every success in managing your health and wellness.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: My boyfriend is addicted to heroin. His mom doesn't seem to care or want to help him at all because he has always been a troublemaker. He does not have health insurance or the means to get the help he truly needs. He is on probation and yet is driving to the city to get heroin. He doesn't seem to care about it either yet 2 of our close friends have overdosed and died from it. How to I help him?

Iona Health Says...:

Brienn,

First, it is apparent that you care very much for your boyfriend as evidenced by you seeking ways to help him. I would encourage you to find out as much as you can about heroin addiction, its effects on the addict, its effect on significant others, and treatment. Here are two websites which may be helpful to you in this way: http://heroin.net/ and http://www.heroinaddiction.net/

There are resources available for people who do not have the ability to pay for treatment. This website http://heroin.net/ discusses options for those who have no resources to those options for people who have resources to pay for treatment. Many people on probation are able to get excellent treatment through their probation office. It would be better for your boyfriend to admit that he has a heroin problem before it is detected by a drug screen. My first thought is for your boyfriend to find out what is available for addicts on probation through the probation office. You also could research this on the Internet in your county and/or state. You can always call the probation office, not identify yourself, but ask what resources are available for heroin addicts on probation.

If your boyfriend is going into the city to purchase heroin, he could be putting himself in harm’s way, i.e., going into a high crime area or by getting arrested by an undercover narcotic agent. From your description, your boyfriend appears to be more motivated to stay in his addiction than find a way into recovery. This is not uncommon and it can be changed; particularly if his family and friends do not enable him to continue using heroin. Your boyfriend may need an intervention to make a new decision about going into treatment rather than continue to go down with his addiction. Here is a resource which has a free downloadable E-book about intervention http://www.floridahouseexperience.com/

The best way to help him is to arm you with knowledge about the disease of heroin addiction and to seek support for yourself. Most friends and family seek help for themselves through Al-Anon http://www.al-anon.alateen.org/ or Nar-Anon http://www.nar-anon.org/Nar-Anon/Nar-Anon_Home.html. When you find out how others have helped their loved ones with heroin addiction, you will have a greater idea of how to help your boyfriend. It is important to recognize that he has the final choice and may need his friends and family to help him make better decisions about his addiction.

Lastly, I would encourage you to seek the advice of a professional substance abuse professional about your boyfriend’s heroin addiction. He needs to have a substance abuse assessment performed so the appropriate level of care (outpatient, intensive outpatient, residential, or inpatient) can be identified and offered to him.

I hope this is helpful to you and your loved one. If I can be of further help to you, please contact me at your earliest convenience.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: My brother is a very good guy and he has never played around with drugs or alcohol. He has been unemployed for about 6 months now since he hurt his back on the job while landscaping. Last night he got really drunk and pretty much passed out after having only a few glasses of wine at dinner. It was pretty weird. My husband and I helped him to bed and I guess I was suspicious that something wasn’t right because I looked through his pants pocket after he was in bed and I found a small bag of powder. It was heroin. My brother confessed to it after I confronted him with the stuff the next day. He said he didn’t want me to worry but that money was really tight and that it was a lot cheaper for him to buy heroin than buy prescription pain meds and that his doctor wouldn’t give him as much as he needed to control his pain. He said he started off by buying extra pills from this guy he knew until one day that guy didn’t have pills but did have heroin. I know that he is in a lot of pain. He told me not to worry and that he only used as little as he could every day to take away most of the pain and that he never used it to get high. On one hand I have to believe him because I know that he is broke but I didn’t know things were so bad and I know that he is in a lot of pain still. He is also not the kind of guy that likes to get drunk at all. But on the other hand the fact that he is using heroin is really shocking and I am very worried about him. He could get arrested and who knows what is really in that stuff he buys. I am scared he could OD. I have told him I don’t want him using it anymore and that I will help him with money. But he says that sometimes he needs more than his doctor will prescribe so he may sometimes even still need to buy heroin. Can a person ever just use heroin like as a medicine for pain control without becoming a junky?

Iona Health Says...:

You indicated that your brother became intoxicated last night, after only a few glasses of wine, may suggest that he already had some kind of other substance which may have increased the effects of the small amount of alcohol. Your intuition was confirmed when you found the small bag of heroin in his pants pocket. So it hard to know what you were witnessing, i.e., it could be the combined effects of heroin and alcohol or prescribed medication? What is clear is that your brother is engaged in substance abuse with a narcotic, i.e. heroin. As for your brother’s rationalization about cost, a small bag of heroin can cost between $10 and $25 per bag, depending on how the heroin is cut and processed. Individuals with “hardcore” addiction to heroin can pay from $150 to $200 per day for its use. See this website for more information: http://heroin.net/about/how-much-does-heroin-cost/.

Since I do not know the cost of his pain medication, I cannot confirm, whether or not, his rationalization is based on fact or desire. What I do know is that anyone who regularly uses a narcotic, prescribed or otherwise in an unmonitored fashion, is highly vulnerable to narcotic addiction.

Your brother sounds like he has several problems:

1. First, he is treating himself medically without medical supervision,
2. he is in acute and chronic pain from a work-related job injury,
3. has financial problems and limited financial options,
4. is using heroin to self-medicate his pain and perhaps his “feelings” about his injury and current life situation,
5. does not understand the nature of heroin addiction and its true costs,
6. has been secretly using heroin with prescribed medications (?) and alcohol until confronted by his family,
7. may be building increased tolerance to pain medications and street drugs,
8. is unemployed due to a work-related injury,
9. runs the risk of legal difficulties associated with illicit drug abuse, and
10. puts his family at risk by possessing heroin inside of their home. As you know, this is not a simple situation and has far reaching potential consequences, i.e., heroin addiction or polysubstance abuse (heroin with other substances, like alcohol or other pain meds). Mixing heroin with alcohol can be dangerous and fatal. See this website for more info: http://www.thegooddrugsguide.com/heroin/mixing.htm

Would your brother qualify for Workmen’s Compensation insurance since he was injured on the job? If so, the insurance should pay for the treatment of his job-related injury. I would pursue this avenue so he can receive appropriate pain control treatment. Many pain control patients frequently request or demand more pain meds than their providers are able to supply. There are many treatment modalities for pain control, as adjuncts to pain medications. I would seek the services of a pain management specialist who has experience with addiction/substance abuse and is inform his of your brother’s medical condition and heroin use. For an overall informative source about heroin, please go to this website: http://www.thegooddrugsguide.com/heroin/index.htm.

We do not know how long your brother has been engaged in polysubstance abuse, and may need to have it evaluated for substance abuse or dependency. The user, in this case, your brother, is usually not often a reliable information.

I would like to offer you some websites for safer pain management for back pain . They are:

http://www.webmd.com/pain-management/guide/pain-relief-without-pills

http://pain-topics.org/patient_resources/

To assess your brother’s chronic pain, he can assess it by taking a chronic pain inventory on this website:

http://www.webmd.com/pain-management/chronic-pain-health-check/default.htm

Your brother and your family are dealing with two tricky subjects: chronic back pain, and substance abuse. Please do not rule out having your brother evaluated for potential addiction. Many chronic pain patients also use mental health professional to address the emotional side of this illness.

I hope this information serves your brother, family, and you as you needed. May you have an incredible New Year!

Respectfully,

John W. O’Neal, Ed.S, LPC, MSW, MA, NCCC

Question: I have arthritis and my doctor has suggested that I might want to try medical marijuana to control some of the pain and stiffness. I have never used drugs and I have only drank alcohol a few times in my life and I am certainly surprised to be considering using drugs now that I am past 60 years of age. I am willing though to do anything that will help me to regain some quality of life. What I want to know though is, will I get addicted to marijuana if I start using it every day? If I decide to use medical marijuana how can I keep myself from getting hooked?

Iona Health Says...:

Arthritis can be very painful and debilitating as you know. There are several issues which must be addressed when considering the use of marijuana for medical purposes. These issues involve legal, social, medical issues.

As for legal issues, there are number of states which have legalized the use of marijuana for medical purposes. The Federal government does not sanction the use of marijuana for medical use, but doctors and state governments have the final say, in most cases. If your doctor and the state have sanctioned the medical use of the marijuana, there is no legal issue. For more information go to: http://www.safeaccessnow.org/article.php?id=4560#whylegal

As for social issues, most people are beginning to understand that enormous benefit stems from the medical use of marijuana. It must be made clear that you are NOT getting high from the medical use of marijuana, but are using it for effective pain control and immobility.

As medical issues, there is enormous information appearing in the public and research arenas, which have proven the usefulness of medical marijuana for a wide variety of symptoms; to include pain control. A book which is highly rated and endorsed on this subject is “Marijuana Gateway to Health: How Cannabis Protects Us from Cancer and Alzheimer’s Disease” by Clint Weiner. This book can be obtained on http://Amazon.com

For more information about the use of medical marijuana in the treatment of arthritis, go to these websites:

http://www.safeaccessnow.org/article.php?id=4560#research

http://www.mcsocal.com/blog/medical-marijuana-for-arthritis-an-alternative-treatment-dr-sean-breen

As this article states “Marihuana is also far less addictive and far less subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics.” Since you do not have a history or expressed tendency for addiction, and with your doctor’s recommendation, I think it would be safe for you to use medical marijuana with little risk for substance abuse or addiction.

I hope this helps you make the best informed decision that you can make. Your questions and inquiry was excellent and shows you have a desire to have optimal health and treatment. If I can be of further assistance, please let me know.

John O’Neal, Ed.S., LPC, NCC