I am sorry you are facing this challenging dilema. Your sister most definitely needs psychological help and to also stop using drugs. If she is advanced to taking pain medications and opiods, that is bad and can lead to her being in danger of trying heroine.

Your sister's use of drugs to help her avoid feeling the emotional challenges she is feeling is getting dangerous. This can lead to her having significant health problems along with her experiencing worsening psychological challenges.

I can understand your "fear" of reaching out to Child Services, but if your sister is spiraling into drug addiction, she is not going to listen to you and as you have stated this is something that is probably heriditary too. The way to finally break the chain is to "break the chain" which means reaching out for help even if that help seems harsh.

I happened to end up in the ICU because when I had a colonoscopy my spleen was injured and I began bleeding internally. When I was in the ICU the patient next to me was a young woman only about 20ish who OD'd by mixing drugs and her heart was badly damaged, only half her heart was working and this damage was going to change her entire life. It was so upsetting to witness what this young woman was going through and no one was there to stop her and while she was brought out of the OD, she was facing significant challenges.

It's hard to understand how individuals can get so far into drug use, and often the best way to help in this is making the choice to reach out before you end up regretting you didn't.