 I had a long talk with the patient and his mom.  I am not prescribing him any narcotics or controlled substances.  I am not in the practice of trading one addiction for another.  It has been one week without any sort of drugs at all.  I do not think he needs weaning.  I think right now it is mostly psychological, although there still could be some residual physical addiction.  However, once again I do not believe it to be necessary to prescribe him any sort of controlled substance at the present time.  I do believe that his depression needs to be treated.  I gave him fluoxetine 20 mg one tablet daily.  I discussed the side effects in detail.  I did also warn him that all antidepressant medications carry an increased risk of suicide.  If he should start to feel any of these symptoms, he should call #911 or go to the emergency room immediately.  If he has any problems or side effects, he was also directed to call me here at the office.  After-hours, he can go to the emergency room or call #911.  I am going to see him back in three weeks for the depression.  I gave him the name and phone number of Behavioral Health and I told him to call so that he can get into rehabilitation program or at least a support group.  We are unable to make a referral for him to do that.  He has to call on his own.  He has no insurance.  However, I think fluoxetine is very affordable.  He can get it for $4 per month at Wal-Mart.  His mom is going to keep an eye on him as well.  He is going to be staying there.  It sounds like he is looking for a job.