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Self Medication: Polysubstance Abuse for Chronic Pain Control is Russian Roulette

answered 06:55 PM EST, Thu December 29, 2011
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?

Delisted Expert 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:



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


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!


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

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Page last updated Dec 31, 2011

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