Start the conversation about opioid dependence with compassion and education
There are few things more painful than watching a loved one struggle with addiction, particularly one as harrowing as opioid addiction. Sharon Osbourne, beloved TV personality, is all too familiar. “When my adult children Jack and Kelly had to face their own opioid addictions, I was frustrated and filled with worry,” she said as part of a recent campaign for Let’s Change the Conversation, which arms caregivers with resources and encourages them to know about all available treatment options for opioid dependence.
After Sharon saw her husband, Ozzy Osbourne, struggle for years with opioids, she’d let herself believe Jack and Kelly would never experiment in similar ways. She was devastated when she learned about Jack and Kelly’s addiction to opioids. “What I know now is that even through the emotional pain and hurt and guilt, we as caregivers have to take action,” she said.
That action starts with a conversation. We spoke with two psychiatrists familiar with opioid addiction about the best way for caregivers to start a conversation about a loved one’s opioid addiction. Although they are not affiliated with the Let’s Change the Conversation initiative, both have expertise in treating individuals and families impacted by opioid addiction.
Though it can be painful and difficult, approach the conversation without finger-pointing or blaming, according to Dr. Anish John, associate medical director of the Positive Sobriety Institute, who notes the most important thing is to speak "from a place of concern and support."
"I never gave up on him," Sharon wrote in a blog post of her experience with husband Ozzy. "Even though we went through some very tough times."
It can be easier to have empathy for your loved one if you have a better understanding of what they’re going through. “I always appreciate those parents or loved ones who end up reading up on treatment options,” Dr. Peter Breslin, a psychiatrist in Virginia, shared. “It shows that they’re really behind this person.”
A good thing to understand is just how deeply the brain is affected by opioid addiction, Dr. John added. “From a medical standpoint, we now have decades of research solidifying that this is a medical condition,” he said. “The parts of your brain that are involved in reasoning, judgment, looking at consequences, the ability to hold off on immediate gratification — that prefrontal cortex in your brain, I would say, is sort of impaired, hijacked.” Sharon found this to be true first-hand with her husband. "I wanted to blame him. But Ozzy wasn’t choosing drugs. Yes, he chose them in the beginning, but over time, opioids had taken control. He tried to stop, but he couldn’t do it on his own," she wrote.
Educating yourself on the many ways the brain and body are affected isn’t about giving a free pass to people struggling with addiction, he clarified, but it is about understanding what they’re going through. Speaking with a healthcare professional can help you understand the complexities of addiction and better help your loved one on their recovery journey.
Don’t be discouraged by denial
Even as you approach the conversation compassionately, don’t be surprised if your loved one isn’t ready to admit they have a problem. “Usually, it’s denied initially,” Dr. John said. But that doesn’t mean you should give up. He recommended approaching the conversation from a factual standpoint — your observations of changes in their behavior or missing medications or money — removed from guilt or shame.
Acknowledgment is unlikely to happen quickly. “It’s an ongoing process of engaging them and seeing if this denial does soften at some point,” he said, adding that it’s also about looking at the ways you or others may be enabling the addiction and trying to slowly back away from those habits.
Speaking with healthcare professionals is also a huge part of the process, particularly if the problem continues to escalate. Dr. John explains, "It really helps to have the professional and unbiased opinion of someone looking at things as they are and giving you appropriate clinical information.”
"It’s overwhelming. It’s scary. And it’s heartbreaking," Sharon wrote. "But you are not alone. And more than ever, you can take real steps to help someone you love through the cycle of opioid addiction."
The journey with a loved one experiencing opioid dependence isn’t something anyone would choose, but there are tools and treatment options available. Don’t lose hope.
Watch Sharon Osbourne discuss how she handled opioid addiction in her family.
BRIEF SUMMARY OF IMPORTANT FACTS ABOUT VIVITROL (naltrexone for extended-release injectable suspension)
What is the most important information I should know about VIVITROL?
VIVITROL can cause serious side effects, including:
1. Risk of opioid overdose. You can accidentally overdose in two ways.
- VIVITROL blocks the effects of opioids, such as heroin or opioid pain medicines. Do not try to overcome this blocking effect by taking large amounts of opioids—this can lead to serious injury, coma, or death.
- After you receive a dose of VIVITROL, its blocking effect slowly decreases and completely goes away over time. If you have used opioid street drugs or opioid-containing medicines in the past, using opioids in amounts that you used before treatment with VIVITROL can lead to overdose and death. You may also be more sensitive to the effects of lower amounts of opioids:
– after you have gone through detoxification
– when your next VIVITROL dose is due
– if you miss a dose of VIVITROL
– after you stop VIVITROL treatment
Tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.
2. Severe reactions at the site of injection. Some people on VIVITROL have had severe injection site reactions, including tissue death. Some of these reactions have required surgery. Call your healthcare provider right away if you notice any of the following at any of your injection sites:
- intense pain
- the area feels hard
- large area of swelling
- an open wound
- a dark scab
Tell your healthcare provider about any reaction at an injection site that concerns you, gets worse over time, or does not get better within two weeks.
3. Sudden opioid withdrawal. To avoid sudden opioid withdrawal, you must stop taking any type of opioid, including street drugs; prescription pain medicines; cough, cold, or diarrhea medicines that contain opioids; or opioid-dependence treatments, including buprenorphine or methadone, for at least 7 to 14 days before starting VIVITROL. If your healthcare provider decides that you don’t need to complete detox first, he or she may give you VIVITROL in a medical facility that can treat sudden opioid withdrawal. Sudden opioid withdrawal can be severe and may require hospitalization.
4. Liver damage or hepatitis. Naltrexone, the active ingredient in VIVITROL, can cause liver damage or hepatitis. Tell your healthcare provider if you have any of these symptoms during treatment with VIVITROL:
- stomach area pain lasting more than a few days
- dark urine
- yellowing of the whites of your eyes
Your healthcare provider may need to stop treating you with VIVITROL if you get signs or symptoms of a serious liver problem.
What is VIVITROL?
VIVITROL is a prescription injectable medicine used to:
- treat alcohol dependence. You should stop drinking before starting VIVITROL.
- prevent relapse to opioid dependence, after opioid detoxification.
You must stop taking opioids before you start receiving VIVITROL. To be effective, VIVITROL must be used with other alcohol or drug recovery programs such as counseling. VIVITROL may not work for everyone. It is not known if VIVITROL is safe and effective in children.
Who should not receive VIVITROL?
Do not receive VIVITROL if you:
- are using or have a physical dependence on opioid-containing medicines or opioid street drugs, such as heroin. To test for a physical dependence on opioid-containing medicines or street drugs, your healthcare provider may give you a small injection of a medicine called naloxone. This is called a naloxone challenge test. If you get symptoms of opioid withdrawal after the naloxone challenge test, do not start treatment with VIVITROL at that time. Your healthcare provider may repeat the test after you have stopped using opioids to see whether it is safe to start VIVITROL.
- are having opioid withdrawal symptoms. Opioid withdrawal symptoms may happen when you have been taking opioid containing medicines or opioid street drugs regularly and then stop. Symptoms of opioid withdrawal may include: anxiety, sleeplessness, yawning, fever, sweating, teary eyes, runny nose, goose bumps, shakiness, hot or cold flushes, muscle aches, muscle twitches, restlessness, nausea and vomiting, diarrhea, or stomach cramps.
- are allergic to naltrexone or any of the ingredients in VIVITROL or the liquid used to mix VIVITROL (diluent). See the medication guide for the full list of ingredients.
What should I tell my healthcare provider before receiving VIVITROL?
Before you receive VIVITROL, tell your healthcare provider if you:
- have liver problems, use or abuse street (illegal) drugs, have hemophilia or other bleeding problems, have kidney problems, or have any other medical conditions.
- are pregnant or plan to become pregnant. It is not known if VIVITROL will harm your unborn baby.
- are breastfeeding. It is not known if VIVITROL passes into your milk, and if it can harm your baby. Naltrexone, the active ingredient in VIVITROL, is the same active ingredient in tablets taken by mouth that contain naltrexone. Naltrexone from tablets passes into breast milk. Talk to your healthcare provider about whether you will breastfeed or take VIVITROL. You should not do both.
Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any opioid-containing medicines for pain, cough or colds, or diarrhea.
If you are being treated for alcohol dependence but also use or are addicted to opioid-containing medicines or opioid street drugs, it is important that you tell your healthcare provider before starting VIVITROL to avoid having sudden opioid withdrawal symptoms when you start VIVITROL treatment.
What are other possible serious side effects of VIVITROL?
VIVITROL can cause serious side effects, including:
Depressed mood. Sometimes this leads to suicide, or suicidal thoughts, and suicidal behavior. Tell your family members and people closest to you that you are taking VIVITROL.
Pneumonia. Some people receiving VIVITROL treatment have had a type of pneumonia that is caused by an allergic reaction. If this happens to you, you may need to be treated in the hospital.
Serious allergic reactions. Serious allergic reactions can happen during or soon after an injection of VIVITROL. Tell your healthcare provider or get medical help right away if you have any of these symptoms:
- skin rash
- swelling of your face, eyes, mouth, or tongue
- trouble breathing or wheezing
- chest pain
- feeling dizzy or faint
Common side effects of VIVITROL may include:
- painful joints
- decreased appetite
- muscle cramps
- cold symptoms
- trouble sleeping
These are not all the side effects of VIVITROL. Tell your healthcare
provider if you have any side effect that bothers you or that does not
go away. You are encouraged to report all side effects to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
This is only a summary of the most important information about VIVITROL.
Need more information?
- Ask your healthcare provider or pharmacist.
Read the Medication Guide, which is available at vivitrol.com and by calling 1-800-848-4876, option #1.
This Brief Summary is based on the VIVITROL Medication Guide
(Rev. July 2013).
ALKERMES and VIVITROL are registered trademarks of Alkermes, Inc.
©2018 Alkermes, Inc. All rights reserved.
VIV-003945 Printed in the U.S.A.