Choosing Life by Risking Death

Last updated on November 4th, 2019

The philosopher Camus claimed that “There is only one really serious philosophical question, and that is suicide.”

While I disagree with Camus about suicide being the only question, I believe it is an important one. Even more important, in my opinion, is the question about choosing to live. For some people, this question is even more complicated when their choice to live may well increase their chances of dying. This is exactly the reality that people struggling with heroin addiction face when deciding to use a medically prescribed drug that blocks the high, but can be deadly when a person relapses.

The heroin addict faces a daunting existential dilemma.

Of all the drugs to which people can become addicted, heroin is one of the most difficult to quit. Heroin withdrawal can be absolutely brutal; a person becomes violently ill. As described in an official US government publication:

“…symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements. Major withdrawal symptoms peak between 24–48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months.”

While some who have successfully quit heroin report that is it really like a nasty flu, others report debilitating symptoms that have lasted for months.

Withdrawal, though, is not solely physical. Psychological symptoms are important and just as weighty. Imagine the pain of knowing that there is a simple fix (pun intended) to the physical illness even though that is the cause of the problem.  It is tempting to think just a little bit would take the nasty edge off.

Imagine that a person experiences withdrawal and manages to be free from heroin for at least seven days. If under the care of a physician, this person may be offered Vivitrol (injectable naltrexone given monthly) to help reduce cravings. Cravings are both physical (the body wants what it has become accustomed to) and psychological (the mind wants relief or pleasure). Vivitrol blocks the euphoria of heroin. The assumption is that, without the high, cravings will subside and so too will use.

The fact that Vivitrol is effective for a month relieves a person of having to make a daily decision about taking this prescription medication and gives him time to work on treatment, counseling, and other activities related to sobriety.

Vivitrol offers great promise and many people have used it to very good effect. It is not intended for long-term use as a maintenance drug. However, for it to be effective and not life threatening, Vivitrol must be administered only under certain conditions and these warrant serious consideration.

If a person has fewer than seven days of being opioid or heroin free and takes Vivitrol, he may experience sudden and severe withdrawal. If a person has been taking Vivitrol and relapses, he has a very high chance of overdosing for two reasons. The first is that his tolerance will have decreased during his abstinence. Taking the same amount as his last days using can lead to overdose that may be fatal. The second reason is that a person who knows how Vivitrol blocks the high may try to shoot through those blocking effects. Heroin overdoses often involve a cessation of breathing.

To be clear: Vivitrol only blocks the high; it does not block the effects of heroin on systems in the body such as cardiac and respiratory.

The National Institute of Drug Abuse states:

“The chronic nature of addiction means that relapsing to drug use is not only possible but also likely. Relapse rates are similar to those for other well-characterized chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components.”

The estimated relapse rate for all drugs is 40-60%. The rate is much higher for heroin addiction; 78% seeking treatment had been in treatment previously. Additionally, of those seeking treatment for heroin addiction, 23% indicated alcohol abuse. Some people are living in a perfect storm.

The very drug that may help to save a person’s life may also directly contribute to this death. So how does one make the decision to take Vivitrol?

Individual Assessment

Each person’s addiction to heroin is similar in some important regards (its effects on the brain and other systems in the body) but also unique. The guiding question is, “Is Vivitrol a good choice for this person?”

Answering that question needs to take into account a person’s using history, reasons for using, other addictions or medical concerns, past relapses, and sources/networks of support among other considerations. It is crucial that Vivitrol is one element in a treatment program that is appropriately individualized and managed. This may be very difficult to achieve.

Certain areas in the country are facing significant physician shortages, especially in addiction medicine and psychiatry, which means that reliable and informed sources of information are scarce.-Peg O’ConorCertain areas in the country are facing significant physician shortages, especially in addiction medicine and psychiatry, which means that reliable and informed sources of information are scarce. Having undergone the requisite training to legally dispense this medication for opioid dependency, some physicians may still be largely unattuned to its risks and the necessity of pairing it with other treatment methods. Even if one has the good fortune to have the right physician and access to treatment, one still may have a significant battle with an insurance company that may balk at the $1500.00 price per shot.

Ultimately, a person needs to make the decision for himself to take Vivitrol. A free choice is one made with good reliable information and in the absence of pressure or coercion. Vivitrol has received very favorable press because it has worked for some people. All that favorable press may cultivate an attitude or expectation Vivitrol is a “miracle drug.” This may become pressure that one should take it if really serious about getting clean. Not taking it may be taken as an unwillingness to go to any length necessary for one’s treatment.

Vivitrol holds great promise and equally great risk, each of which deserves the most serious consideration by a person confronting the choice to try to save his life by possibly losing it.

 
Image Courtesy of iStock

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