Is there always a sign that someone is an illegal drug user?

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No, there is not. Even people within the immediate family often don't know a parent, child, or spouse is using until an incident, such as an arrest or an overdose, occurs that reveals the extent of the problem.

This is largely because illegal drug use takes different forms and occurs in different degrees or levels of severity. People can use illegally even if they have been issued prescriptions. Patients engaging in "doctor shopping" will obtain prescriptions for the same drug from multiple doctors (which individually may be legitimate) so they can obtain more than the normal dosage for that one medication. Doing this is illegal. State governments have established monitoring procedures over the past several years to prevent this practice, but they aren't foolproof.

The ploy of not using obviously illegal methods (such as going to a dealer) isn't the only thing preventing drug use from being recognized by others. The effects of being on various drugs are complex, highly varied, and not always recognizable. A person high on oxycodone, for instance, may behave in an outwardly "normal" way in which only a trained specialist would be able to tell the person is high. It's the same way with alcohol: some people have the ability to act the same, drunk or sober. Often people are also not prepared to recognize the secondary effects of addiction, such as the inability to hold a job, sleeping through the day, and so on. Unusual behavior tends much of the time to be dismissed or attributed to some other, more benign, cause.

The problem of seeing the signs of addiction is complicated by the fact that parents and other family members frequently are in denial about their children's using. They can't believe, for instance, that an eleven- or twelve-year-old would smoke marijuana, and even when the tell-tale signs occur, they turn a blind eye or attribute them to something else. In the case of opioids, since these are often prescribed legitimately (at first) for an injury or surgery, people often still aren't educated to know that the patient develops a tolerance to the medication and then needs more and more of it to get the same effect—the goal then becoming just to get high rather than pain relief. This, which is perhaps better-known by now, is the reason many graduate from pills to heroin, since one can't take enough pills to get past one's tolerance level and needs something stronger. Eventually the addict doesn't get high at all anymore and has to use simply in order to be "well" (not to suffer from withdrawal). Users are often adept at hiding even the signs of injecting heroin or other drugs, just by wearing the right kind of clothing to cover up the needle tracks.

Usually the first sign to the family comes when an addict is arrested for shoplifting or has a car accident and is tested for drugs, or, in the worst case, overdoses. But when addiction becomes severe enough, one or more of these things will happen. End-stage addiction generally does give itself away, but unfortunately and tragically, it is often when the one using ends up in jail or dead.

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