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Old 22.04.2021, 15:17
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What to do when a dear friend won't seek help

Hi there,

I don't want to get into full details, just in case they may see this...

But I have a dear friend who has been suffering with depression for years, so much so that we worry things could go very very wrong. She has a dependency on opiates due to past health conditions, that only make her physical health and mental health worse. In all honesty, she is a fraction of what she once was and it is devastating to see. Her husband is incredibly loving & supportive, to the point where he is completely blinded by the fact she is in real danger and doesn't think she needs medication. We managed to help her get into a therapist a couple of years ago...but well, that isn't going to cut it.

I never mention her addiction, I am only starting to touch on the fact that she should really consider taking medication for her depression by discussing how well it works for me. What else can I do? I feel paralyzed seeing someone I care for not get the help they need. If I say too much, I risk losing the friendship and not being able to be there for them & only get much much worse. I am normally the person to speak my mind, so I have been walking on egg shells here just to try and be a good friend. I care about her husband and her very much.

Anyway ... thanks for the advice.
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Old 22.04.2021, 15:29
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Re: What to do when a dear friend won't seek help

Regardless of the effort you make, you could lose the friendship...


My mum's closest friend turned on her when she developed an addiction to sleeping medication after having surgery... there was nothing my mum could do...



She ended up suiciding... at 60. With four kids, 10 grandkids and a doting husband.


What you can do is care for the carer, and also use a helpline or support service for yourself....
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Old 22.04.2021, 15:43
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Re: What to do when a dear friend won't seek help

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Regardless of the effort you make, you could lose the friendship...


My mum's closest friend turned on her when she developed an addiction to sleeping medication after having surgery... there was nothing my mum could do...



She ended up suiciding... at 60. With four kids, 10 grandkids and a doting husband.


What you can do is care for the carer, and also use a helpline or support service for yourself....
Yes that is the kind of outcome I foresee too & it breaks my heart. I don't understand how her intelligent & very well put together husband can't see it. If it were my husband, I'd have him in rehab. Essentially he is enabling her ... the only outcome where we could see a lightbulb going off in his head is if she overdoses.

Thank-you for your advice
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Old 22.04.2021, 15:52
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Re: What to do when a dear friend won't seek help

Oh, Susie-Q, that's a really heartbreaking situation to be in, looking at what's happening, seeing things turn for the worst, and not knowing the wisest way to intervene, if at all.

Who is prescribing the addictive medication? If your assessment is correct, that she is addicted and going downhill as a result, then it is not only her husband but also her doctor who is enabling her addiction.
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Old 22.04.2021, 15:56
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Re: What to do when a dear friend won't seek help

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Who is prescribing the addictive medication? If your assessment is correct, that she is addicted and going downhill as a result, then it is not only her husband but also her doctor who is enabling her addiction.
Thank-you so much. Well, part of the recent problem is that I believe her doctors have figured it out and she isn't able to gain access to it as she used to. She went to the hospital recently and they refused to give her something stronger.

What I don't understand is that they didn't communicate why to her husband or address the issue ... are they allowed to do this in Switzerland?
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Old 22.04.2021, 16:01
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Re: What to do when a dear friend won't seek help

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But I have a dear friend who has been suffering with depression for years, so much so that we worry things could go very very wrong. She has a dependency on opiates due to past health conditions, that only make her physical health and mental health worse.
I've re-thought what I wrote, above.

Could it be that the health conditions you thought were past, are still persisting, such that the doctor thinks it is a good idea for her to continue to receive those opiates? I ask because sometimes people with chronic illnesses or severe symptoms give up talking about them, because it's boring and/or depressing, and that can give the impression, to those around, that the actual health issue or the agonising symptoms have past when, in fact, they're still there.... just no longer mentioned.

If someone like that still has a serious condition which causes her significant pain and distress, it may be that she has to weigh up not merely "continuing to take opiates" vs."kicking the habit" but that her choices may be much more limited, such as "stopping opiates, but being in a crippling amount of pain" vs. "accepting being addicted, but somehow still managing to cope with getting through the day".

She may be having to choose between bad alternatives. You see that it is the opiates and her dependency upon them which "make her physical health and mental health worse", and that may very well be true. But her underlying condition, whatever it is, could be doing that, by itself, and being addicted might, in fact, be the lesser of two evils, sad as that sounds.
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Old 22.04.2021, 16:02
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Re: What to do when a dear friend won't seek help

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Thank-you so much. Well, part of the recent problem is that I believe her doctors have figured it out and she isn't able to gain access to it as she used to. She went to the hospital recently and they refused to give her something stronger.

What I don't understand is that they didn't communicate why to her husband or address the issue ... are they allowed to do this in Switzerland?
Ah, okay, our posts crossed, so I've only just read this.

Certainly, a doctor, in Switzerland, ought never to communicate with a patient's family members unless the patient has given consent for this.
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Old 22.04.2021, 16:04
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Re: What to do when a dear friend won't seek help

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She may be having to choose between bad alternatives. You see that it is the opiates and her dependency upon them which "make her physical health and mental health worse", and that may very well be true. But her underlying condition, whatever it is, could be doing that, by itself, and being addicted might, in fact, be the lesser of two evils, sad as that sounds.
You are correct to ask this and I myself have wondered about that myself, but without saying too much, the particular condition she has is only worsened by opiates and is sometimes caused directly by them.

Some really good weed would do the job with a far less damaging effect, but alas, Switzerland is behind there ...
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Old 22.04.2021, 16:09
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Re: What to do when a dear friend won't seek help

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Certainly, a doctor, in Switzerland, ought never to communicate with a patient's family members unless the patient has given consent for this.
I see, well I can understand why...but I would hope if I were incapacitated with something like her, a doctor would be able to guide my caretaker in the right direction in order to save my life.
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Old 22.04.2021, 16:13
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Re: What to do when a dear friend won't seek help

https://www.suchtschweiz.ch/ueber-uns/portraet/ offers help & advice also to friends & family on how to best adress situations like this.

I would also try to inform the prescribing doctor(s) on what is really going on.

Due to cases like this is exactley why I dont like the pharmacy system here, no centralised setup to prevent ppl going from one pharmacie to the next to obtain larger amounts of medication than prescribed.
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Old 22.04.2021, 16:16
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Re: What to do when a dear friend won't seek help

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Ah, okay, our posts crossed, so I've only just read this.

Certainly, a doctor, in Switzerland, ought never to communicate with a patient's family members unless the patient has given consent for this.
True, but maybe letter informing them what is going on.
If they act on it its up to the doctor.
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Old 22.04.2021, 16:17
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Re: What to do when a dear friend won't seek help

I think there's very likely a link between the opiate use and the depression itself. One of the effects thereof is to dull your sensitivity, not only to pain, but also pretty much anything. I recall when I was on morphine for a few months, having a lingering feeling that I really should address a few issue but feeling in no way inclined to do so. Small things can therefore be allowed to build up, and become insurmountable barriers to normal functioning without the drugs.

I was able to reduce the dose as the underlying pain (post trauma) reduced, and eventually stopped using them altogether, although there's still a decent supply of Morphine and Codeine if I ever should need them. The key to this, though, was the self-awareness that they were making things worse, not better.

On top of this, as I also experienced, long-term pain can, in and of itself, induce brain chemical imbalances which are the clinical signs/causes of depression. I spent years on anti-depressants, which helped to rebalance the head most of the time, but that's also a difficult path to tread, as you can become dependant on them as well. Not as harmful as opiates, mind.

Sadly I think you need to leave your friend alone. She will not appreciate any sort of intervention from you or, most likely, from her husband. "Sending her to rehab" might get her off the opiates but without addressing underlying issues you can almost guarantee she'll be back on the asap.
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Old 22.04.2021, 16:22
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Re: What to do when a dear friend won't seek help

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Due to cases like this is exactley why I dont like the pharmacy system here, no centralised setup to prevent ppl going from one pharmacie to the next to obtain larger amounts of medication than prescribed.
Rubbish. A prescription can only be used once. Repeating ones only have a finite time limit before a new one is required, although in some cases the pharmacy may just call the doctor instead. if they're local and known to each other.

So unless the patient is somehow going to multiple doctors, outside of her health insurance, and getting multiple 'private' prescriptions from them, there's no way she can get more than is prescribed. I doubt if that would be possible, but don't know enough about medical reporting to know for sure.
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Old 22.04.2021, 16:47
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Re: What to do when a dear friend won't seek help

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Rubbish. A prescription can only be used once. Repeating ones only have a finite time limit before a new one is required, although in some cases the pharmacy may just call the doctor instead. if they're local and known to each other.

So unless the patient is somehow going to multiple doctors, outside of her health insurance, and getting multiple 'private' prescriptions from them, there's no way she can get more than is prescribed. I doubt if that would be possible, but don't know enough about medical reporting to know for sure.
It definitely is possible for a patient to go first to one doctor, and then to another, slowly collecting and filling prescriptions from a range of doctors and a series of pharmacies. Unless the patient has the kind of restrictive medical insurance policy which requires her to go to see her G.P. (Hausarzt) first, before seeing anyone else, this system of drifting along, rolling the system, works. And the medical insurance will pay for all of it.

That is, in fact, the very way that patients obtain not "more than is prescribed" but certainly more than ought to be prescribed. There is no reporting between doctors, nor between pharmacies, nor doctors and pharmacies, nor any of these to their patient's families.

If someone in a medical insurance (Krankenkasse) office is very observant, (or were the software to be written that way) they may pick up this kind of tourist circuit through the doctors' practices and the hopitals, but it would take a lot for this to be queried, especially if the medication(s) was/were being obtained from doctors in different fields. And if there were but one doctors' report stating that this medication was necessary. For some special medication, like cannabis extract, a special permit must be obtained from the BAG (health authorities) and they, do, indeed, monitor applications and map them according to the amount that a doctor wishes to prescribe.

Some patients use the extra medication to support their own addiction, some to sell the pills to make profit out of someone else's addiction, and some to hoard up a stash with which to try an overdose.
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Old 22.04.2021, 16:47
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Re: What to do when a dear friend won't seek help

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Rubbish. A prescription can only be used once. Repeating ones only have a finite time limit before a new one is required, although in some cases the pharmacy may just call the doctor instead. if they're local and known to each other.

So unless the patient is somehow going to multiple doctors, outside of her health insurance, and getting multiple 'private' prescriptions from them, there's no way she can get more than is prescribed. I doubt if that would be possible, but don't know enough about medical reporting to know for sure.
Rubish? I dont think so.
Its not rare to have a prescription valid for up to 6 month at a time.
With that one can happily go from pharmacie to pharmacie since different brands do not
communicate with each other.
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Old 22.04.2021, 16:53
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Re: What to do when a dear friend won't seek help

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True, but maybe letter informing them what is going on.
If they act on it its up to the doctor.
Yes, a letter from a patient's family member or friend or neighbour, to the doctor, might be a help. The doctor, however, will either not write back at all, or will send one line thanking the person for their letter, or maybe a second line saying that they do not discuss their patients.

For this reason, it can be useful to state, in the letter, that one does not expect a reply, but would appreciate acknowledgement of receipt.

Better still is to inform the patient that you've decided to write, and then to state that in the letter.

Sometimes, a patient would even like to say something to the doctor themselves, and a friend can gently help them to put the letter together, especially when they are feeling drained, depressed or spaced-out.
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Old 22.04.2021, 16:59
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Re: What to do when a dear friend won't seek help

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I see, well I can understand why...but I would hope if I were incapacitated with something like her, a doctor would be able to guide my caretaker in the right direction in order to save my life.
If you wish for this, then I highly recommend that you make a Living Will (called Patientenverfügung, in German) to state that. You can get a pre-printed one from your doctor, or from several other organisation such as Exit or pro senectute.

There, you can choose or strike any of the paragraphs, specifying what you would like done if you cannot care for yourself, giving (or withholding) permission for information transfer and decisions, stating whether you would or would not like to be put on life-support machines and, should you die, what permission you give for what should be done with your body.

Once you have it, give a copy to your doctor, and to the family members or friends whom it involves. This can take a weight off their shoulders, when a critical situation occurs, because the doctor will know to whom he/she may speak, and the loved-ones won't have to take difficult decision about machines and treatments, because you will already have set down your will yourself, while still compos mentis.
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Old 22.04.2021, 17:04
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Re: What to do when a dear friend won't seek help

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I think there's very likely a link between the opiate use and the depression itself. One of the effects thereof is to dull your sensitivity, not only to pain, but also pretty much anything. I recall when I was on morphine for a few months, having a lingering feeling that I really should address a few issue but feeling in no way inclined to do so. Small things can therefore be allowed to build up, and become insurmountable barriers to normal functioning without the drugs.

I was able to reduce the dose as the underlying pain (post trauma) reduced, and eventually stopped using them altogether, although there's still a decent supply of Morphine and Codeine if I ever should need them. The key to this, though, was the self-awareness that they were making things worse, not better.

On top of this, as I also experienced, long-term pain can, in and of itself, induce brain chemical imbalances which are the clinical signs/causes of depression. I spent years on anti-depressants, which helped to rebalance the head most of the time, but that's also a difficult path to tread, as you can become dependant on them as well. Not as harmful as opiates, mind.

Sadly I think you need to leave your friend alone. She will not appreciate any sort of intervention from you or, most likely, from her husband. "Sending her to rehab" might get her off the opiates but without addressing underlying issues you can almost guarantee she'll be back on the asap.
I think you hit the nail on the head ... I think she has always struggled emotionally, pre-opiate use ... but since it has been 10+ years of using them, she doesn't even know how to help herself at this point. It is just a big mess...

Yes, I think I need to leave her alone too. Sometimes it is nice to seek advice from others who aren't involved & I thank y'all for your help.
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Old 22.04.2021, 17:19
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Re: What to do when a dear friend won't seek help

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Rubish? I dont think so.
Its not rare to have a prescription valid for up to 6 month at a time.
With that one can happily go from pharmacie to pharmacie since different brands do not
communicate with each other.
I often have prescriptions that are valid for 6-12 months at a time, I don't also go to the same pharmacy, but have noticed that whichever branch I'm in the pharmacist writes/types on the prescription itself every time something is issued to avoid exactly what you are describing.
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Old 22.04.2021, 17:24
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Re: What to do when a dear friend won't seek help

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I think you hit the nail on the head ... I think she has always struggled emotionally, pre-opiate use ... but since it has been 10+ years of using them, she doesn't even know how to help herself at this point. It is just a big mess...

Yes, I think I need to leave her alone too. Sometimes it is nice to seek advice from others who aren't involved & I thank y'all for your help.
I agreed with all of Ace1's post except the last part, about leaving your friend alone. It will, of course, depend on the nature of your relationship, but if it were me, I would write to the doctor (if you know there is a regular doctor in the picture). I've done this, once.

I knew a lovely, friendly, old woman in our area. Not personally, directly, but enough to stop when we met while shopping, or in the bus or tram, even sitting at a bench for an hour or so, chatting. We knew each other's names. After some years, I began to notice changes in her behaviour. She looked increasingly slow and tired, aging. Then once I met her in a completely different part of the city, and she was so pleased to see me, she said, using a wrong name, and asked me to take her to... a city in a country in which she had previously lived, but where she now said that she lived. I suggested we sit on the bench and talk a little, (so that I could try to decide what to do) but a tram came and she said: "Oh, that's the one, going to Othercity Othercountry, bye-bye!" and before I could stop her, she was gone.

As I happened to know the name of her doctor, I wrote to him, telling him what had happened. He replied (without any reference to her ailments or condition) to thank me very much, and that thanks to my letter he was now taking new steps to address her situation.
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