Setting boundaries with someone who uses opiates

Keeping someone alive is never rescuing in the bad sense. Naloxone, a ride to the emergency room and a phone that stays on are always on the supporting side.

SAMHSA’s advice to people supporting a loved one is direct: tell them what you are willing and not willing to do. It gives this example: “I can pick up the mail and check on your apartment while you’re in treatment, but I don’t have the money right now to help you pay for treatment.”

• Pick one or two limits, not ten.
• Say them when everyone is calm, not in the middle of a fight.
• Pair a no with a yes. Say what you will still do.
• Only name a result you are ready to carry out.
• Agree on them with the other adults in the house, so the person hears one message.

Expect pushback. A boundary that gets tested is not a failed boundary. If you slip, start again the next day. The guide on how to talk to someone has wording that keeps these talks from turning into fights.

Money

Money is where most families feel torn. A simple rule helps: pay bills, not people. If you want to cover rent, a phone, food or a prescription, pay the company directly.

• Keep cards, cash and checkbooks out of easy reach, and change PINs if you need to.
• Do not co-sign loans or take on debts you cannot afford to lose.
• Offering to pay for treatment is a fair use of money if you have it. Many people qualify for free or low-cost care, so read free and state-funded programs before you spend savings.

Housing

Whether the person lives with you is your decision, and there is no single right answer. Many families settle on house rules instead of an ultimatum: no using in the home, no drugs kept in the home, no other people brought in to use.

If you reach the point where they cannot stay, plan it. Tell them ahead of time, not at midnight. Make sure they leave with naloxone, a way to reach you and the number for SAMHSA’s National Helpline, 1-800-662-4357. Tell them what would let them come back. Asking someone to leave does not have to mean ending contact.

Some limits are not up for discussion, because they keep people alive.

• Lock up medications. That includes anyone’s prescription opioids, sleeping pills and anxiety medicines. SAMHSA warns that mixing opioids with these, or with alcohol, raises overdose risk.
• Get rid of leftovers. FDA says the best way to dispose of unused medicine is a drug take-back site, often at a pharmacy or police station, or a prepaid mail-back envelope.
• Keep naloxone where everyone can find it. See how to get and use naloxone.
• Your own safety counts. If you are threatened or hurt, leave and call 911. If the person talks about suicide, call or text 988.

Children come first. That is not disloyal to the adult who is using. It is the one boundary nobody should talk you out of.

• Store every medication up, away and out of sight. SAMHSA notes that children are especially at risk of accidental overdose from medicine not meant for them. FDA warns that some opioids can be dangerous to a child with just one dose.
• If a child may have swallowed an opioid, or is hard to wake or breathing oddly, call 911 at once.
• Do not leave a child in the sole care of someone who is impaired, and do not let that person drive them.
• Tell children the truth in words that fit their age. They usually know something is wrong, and they often blame themselves. They need to hear that it is not their fault.

A parent who gets treatment is protecting their children. If fear of losing custody is holding someone back, your rights in treatment explains the privacy rules. When they are ready, the state directory lists programs near you.