Does heroin interact w/ Prozac (fluoxetine) or other anti-depressants? My partner wants Prozac for depression instead of heroin?

Hello, My 32 year old partner

Hello,

My 32 year old partner / boyfriend of almost 15 years currently uses heroin for depression - quite successfully for almost a year now. He would like to start using an anti-depressant before he quits heroin to help overall with the transition / withdrawal. He needs to quit heroin ASAP for several reasons - mainly it's illegal, expensive, you have to snort it, and it's time consuming and scary to purchase.

He started his opiate addiction by taking pills like Norco, Vicodin, etc. on a regular basis for back pain and Migraines about -5 years ago and they worked really well for multiple symptoms. He noticed when taking the opiates, not only was it great for reducing pain but it actually stopped his depression or worked really well at controlling it. He slept well, was more socially active and wasn't the recluse he could be when not using opiates. He was just more himself in a way! He was happier (similar to how he was when he was younger and had less worries). He was basically the way he is when he's doing OK (if that makes sense). Using opiates for depression was kind of a phenomenon to us until we began to speak to other opiate addicts who all said the same thing. They began to use because of a legitimate pain reason and then discovered how they became more active, less socially awkward, or depressed when using the opiates. I attended several conferences on addiction and had experience with my parents so I found out after talking to many ex-users or current users that yes indeed they believe that opiates work well for managing depression. In fact many of them weren't getting high but the opiates kept them from getting low.

A little less than a year ago my partner was cut of from his opiate pill prescription and without health insurance he turned to a friend we knew that had end stage cancer and was supplementing his pain medication with heroin. He could have bought Oxycontin pills or other high end pain medication pills but it is actually more expensive than buying pure un-cut heroin. He obviously turned to heroin and immediately his tolerance for opiates went up and so did his opiate budget (although it is less than if he had turned to Dilaudid or Oxycontin - not sure if I spelled those right but they are both pills for severe pain as opposed to Vicodin or Norcos which are meant for more moderate pain).

He's been good about keeping his habit in control. Once he switched to heroin he has not upped his tolerance or budget (except for when he switched to heroin from pills). He has been using heroin just under one year and gets one gram of pure heroin which he then cuts with an inert vitamin supplement (for better nasal absorption and to make it last longer) making the one gram into 2.7 grams. Since he began he would require one pure gram for every 3-5 days. He would use more when he was sleeping less, working a bigger or higher demanding job, anything requiring difficult physical labor so that would put him more towards the 3 day. But on a typical work week it would last 5 days. Since he began his tapering several weeks ago he has gone from one gram every 3-5 days to one gram every 6-8 days. We hope to have him down to one gram every 10-12 days before switching to just one line in the afternoon (if he's feeling bad) and at night so he can sleep. Then finally switching to just a line at night to prevent insomnia. He's been good not stepping over the line or getting too out of control with the heroin because he has me to monitor his use and we don't have an unlimited budget. Already the $300 per week is not crazy expensive for us but it is not easy. He will never inject the heroin because of my parents negative experiences which is good for us.

But ultimately he still has a problem and would like to quit. The only down-side of quitting is the relatively medicinal uses he gets from the heroin - it helps with depression, restless leg syndrome, social awkwardness, etc. I am not sure why they never extracted part of the opiate molecule for an anti-depressant that doesn't have major side effects (they'd have to remove the addictive side of it - although most other drugs including anti-depressents are also physically addicting). They would also have to remove the part of it that gets you high. Although to be clear he doesn't get high anymore like he did in that first month (and even then he never took so much that he was nodding out, passing out, super high. He's not that type of user. In fact most people would never know he was using unless he or I told you. He is just maintaining his habit. They have extracted the anti-diareah medications like Imodium from the opiate molecule (opiates constipate you) so why has there not been more research on the other beneficial qualities it's good for?

On a side note - the opiates also help with sleeping problems such as insomnia and restless leg syndrome. Which I would normally laugh at the RLS notion except no one with restless leg syndrome really knows how bad their afflictment is until they ask their partner. I am the one who got kicked all night from the jerking. Not the falling asleep single jerk that can happen to anyone when they doze off. This would go on for hours and would be worse if he had 2-3 beers (so he stopped drinking) but the RLS was definitely there. We didn't know what it was until we saw those commercials. But the restless leg syndrome almost disappeared completely 4-5 years ago when he started taking opiates on a regular basis but I never knew why except when he would run out of opiates on occasion the RLS would come back strong.

I have quite a bit of experience dealing with heroin because both of my parents injected heroin for many years. I have also attended several conferences and my partners mother is an addiction specialist who has every book on the subject and who can speak about the subject. I know that tapering is the best method and have seen every method except the rapid detox where they knock you out for the major withdrawal or the ibogaine treatment but both are out of the question right now because that can cost anywhere from $5,000 - $10,000 or more not including the 1-2 weeks they require. We know cold turkey is debilitating and includes excruciating pain not to mention the insomnia, constant diarrhea, throwing up, hot and cold sweats, physical pain, mental cravings, etc. And unless you can take 2-3 weeks off work to deal with that it's not possible. I guess the worse part is that you're delirious from the insomnia and it's truly impossible to work in that condition.

One of the things we look forward to most after kicking his $300 a week habit is being able to afford health insurance so until then we can not fit it into our budget. the last 2 years we have seen a large decrease in business and are not able to afford anything extra because of the $300 a week heroin habit. For some they might laugh at that cost because they may have had $300 per day habits but I can witness that whether you have a $300 a week snorting habit compared to a $500 a day injecting habit (like my father did) the withdrawal is the same! So don't dismiss the size of the habit. You are still chemically dependent on heroin. And believe me when I say some of the most intelligent and kind people can be chemically dependent so this is not a moral issue. You can't out smart or out love your way out of chemical dependency. It truly is a disease and anyone who repeatedly uses will be dependent and in the same situation he is in. Of course we both regret that he made a very bad choice when he escaped a few bad nights of pill withdrawal and chose to switch to heroin for a few days because it is a much bigger ballpark when it comes to dependency. And when he never got more pills after 3-4 days he was already addicted to heroin and even if he had gotten the pills a few days later the mistake was already made. My point is that there is no going back. So without making him feel any worse about the awful mistake he made or the really bad choice we need to move on and figure out how to fix the issue and not dwell on a really big mistake he made once.

The question is that my mother has 30 40mg Prozac (generic fluoxetine) pills she wants to give us that she thought helped a lot when she kicked heroin. We researched prozac online and think it will help more than the natural options have (we've tried St. John's Wart and Sam-e). We would like to start him on 20mg per day making the prescription last 60 days instead of 30. (we plan to split the capsules in half).

Is there any danger or worry when mixing the Prozac with heroin? It is low levels of both but is there any dangerous interaction or is there any record of Prozac helping with drug or opiate withdrawal? Also, is it ok to split the capsules in half? I have read online of doctor's who suggested doing this to their patients if the dose made them nauseous. We'd like to do it for several reasons - first because the script will last twice as long and by the time he kicks the heroin he can afford to see a doctor to get another prescription if we feel the Prozac is helping the depression or over-all benefiting him. Secondly we want to split the dose because we want him to start out slowly. We don't want him to be addicted to both substances and hope the one will help him successfully ween off the other.

Please feel free to comment anyone or send me your comments, suggestions at the email depressionquestions@gmail.com or by posting your comments here.

Thanks for your thoughts, support, comments, questions, stories or advice in advance. BTW If you have complaints please shove them up you know where. I am not looking for people who want to waste my time with anything other than something that can benefit our specific situation and yelling at someone never helps in this situation.

I have read studies where

I have read studies where prozac does have an effect on some opioids because prozac is an inhibitor of CYP450. I have tried to find some drug-drug interaction studies for these 2 but have had no luck so far.

Not being a doctor or

Not being a doctor or pharmacist I can't answer your questions, but I can point you to some resources I found. These are links to abstracts of scientific studies on opioids and SSRIs (of which Prozac/fluoxetine is one)...they're a little heavy on the medical jargon, but they have reliable scientific information that might help you learn a little more.

My suggestion would be for your boyfriend to try a community health clinic. They usually offer sliding scales so you only have to pay what you can afford. You can search for them here:
http://findahealthcenter.hrsa.gov/
http://therapists.psychologytoday.com/rms/prof_search.php?t=custom

The studies:
Morphine-fluoxetine interactions in healthy volunteers: analgesia and side effects:
http://www.ncbi.nlm.nih.gov/pubmed/11075315

Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?:
http://www.ncbi.nlm.nih.gov/pubmed/16005413

Serotonin toxicity caused by an interaction between fentanyl (on opioid) and paroxetine (an SSRI):
http://www.ncbi.nlm.nih.gov/pubmed/18676387

Abstract of a study on SSRIs in treating heroin addiction: http://www.ncbi.nlm.nih.gov/pubmed/14598513

-V-

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