I have to weigh in here and give support to exitwound's comments; and to point out that Trust4me's specific point that her husband is "abusing" oxycodone versus oxycontin is a very important one that I think some of the responses are overlooking: that is, if you crush / snort the oxycontin you will get a higher dose of oxycodone at one time because instead of getting the 20mg (for example) released over 12 hours of time you are getting the whole 20mg at once - it will peak at a higher level at a faster time; whereas if you crush oxycodone you do not get any increase in dose (if anything you may lose your whole dose from particles sticking to instruments, etc). So the comments made that there really doesn't seem to be any advantage to snorting oxycodone is probably very sensible, and I think what s/he said about
it being looked at as a unfortunate route based on familiarity is also something to consider (but I wonder at the damage that it is doing to his nasal membranes). That being said, I do find it odd that him knowing how much this resembles out-of-control behaviour
that he continues to use this route to administer his meds. Plus the fact that he seems to be hiding it from you - but there could be many reasons for this too. I believe that what PA lady said about
getting more supervision from an addictionologist is one way to approach this as an interim step between divorce and doing the same-old, same-old.
As far as the tough-love mentioned in some of the previous posts.....the way I am reading your first post here is to ask for advice about
holding strong with the divorce threat; that you are wondering if this is the time to invoke the walk-out (?). While I understand that a threat without meat is a useless threat I also believe that marriages should not be looked at as control tools either, at least without serious thought of the consequences. I know you have gone through the separation route already so maybe it is time for the next step but you need to be very careful of that, I would think, and I am not sure if linking his drug use at this point with staying married as an incentive. Again, I think that a trained counselor that deals with addicts and marriages would be the person to help you with this decision. I can speak for myself that if I had to choose between pain control and marriage that my pain management would come first. Because it boils down to either being able to live or not.....and I can live without my husband; maybe not as well but at least I would be alive. Being asked to give up pain control for my marriage is the day that I am being asked to die for him (which I guess in other circumstances I would - if it came down to his life or mine - but I don't think pain control meets that criteria).
As far as providing pain control to addicts - yes there are specialists that do this. Most of the time, it is done under very intense oversight -even hospitalization. And I also second PA ladies advice that it is a family affair and that the burden of rationing his meds should not be your sole role in the process. You should not be the "bad guy" overseeing his meds but the one offering support - and tough-love is support. And asking for help from trained professionals - both in addiction medicine and family therapy may be the best thing you can do for both of you to get over this latest "hump".
I think you have to see that your husband is making progress and that it is not uncommon to have either set-backs (without it necessarily being a full-blown relapse) or to encounter new road blocks in the process and that it can be hard to change certain habits. Maybe the best thing is to list what you see as his progress and list what you see as his "relapses" or "setbacks" and then sit down and talk to him about
this (praising the progress; showing disappointment at the setbacks) and creating a plan on what his next goal should be: e.g. learning to take his meds with the right dose using the right route of administration, etc. And to state clearly a plan to get to this goal (professional help, etc) and coming up with an "or else" that you can stick to (if it is a divorce, then so be it) and then you have to be resolved that you will stick with the "or else" condition and to also have a "reward" for when he meets this goal.
I think exitwound is right in her / his perspective about
not understanding the former addict's side and that there may be lot of judgements about
his action and a possible lack of compassion (which is probably based on frustration). I cannot help but think that we could be showing the same type of prejudicial reaction to his situation that many, many of our friends and family show to us: that is, our friends do not understand the difference between legitimate pain management and addiction behaviour
and WE may not be understanding the legitimate difference between a full blown relapsing addict and a recovering addict who has a real need for chronic pain management who is slowly getting a hold of his addiction problem and is only exposing the human frailties that we all have.
Your situation has no easy answers and none of us knows exactly what is going on with your husband. The best advice is that you should find a professional who is truly willing to look at the whole situation and work within the circumstances of your family and blend his professional expertise with a sincere desire on both your parts to do what it takes to resolve the complex issues involved with treating chronic pain in a former addict. I think that a addiction counselor will be very good with interpreting body language and is very familiar with the excuses that addicts give to explain behaviour
; it is only by face-to-face encounters that an adequate assessment can be made to determine if he is relapsing and this same professional can advise you on how to get back on the right path again if he is relapsing or what you can do to keep him on track.
Post Edited (Disce Pati) : 9/9/2008 2:21:03 PM (GMT-6)