abused Oxycontin and Fentanyl patches

Hi Folks,

I have posted here in the past, and received so many helpful responses. I'm back again with new questions.......

To refresh your memories...my husband is the one one who abused Oxycontin and Fentanyl patches after being prescribed them for osteoarthritis and several back surgeries. He is also a compulsive gambler. He detoxed from those meds, was clean a year, then decided to go back to his doctor as he told me his pain had increased. His doctor prescribed Methadone and Oxycodone. He didn't like the Methadone, said it made him want to sit on the sofa all day, so he would take all his Oxycodone the first 2 weeks of each month, then use the Methadone to keep from getting drug sick during the last two weeks. I also caught him trading some of his Methadone for Oxycontin on a few occasions..."for his pain". I had also caught him snorting his crushed Oxycodone. I told him to leave our home, and he was out of the house last year for 3 months. He asked if he could come home if I were to hold his pain meds for him. He promised there would be no more snorting. I told him he would have to go back to his doctor and get something he could take all month for his pain (other than the Methadone). He did this and his doctor discontinued the Methadone and gave him more Oxycodone. He said that was perfect and that he would be all set, as he would have enough (8 15 mg. tabs of Oxycodone daily) medication to get him through each month. While I was holding his pain meds, he would search the house, sometimes finding the meds and helping himself to more. He said his doctor said some days his pain would be worse than other days, and this would be alright. I haven't seen him high or nodding out since he's come home, but last weekend I did catch him snorting his crushed Oxycodone. The top of my head came off as I had told him when he came back home that if I caugh him doing this again, I would divorce him. He asked me to please let it go, said he didn't do it often, only when he needed to get the Oxycodone into his system faster for pain. He does this after I go to bed at night. He told me that things are sooooooo much better now than when he used to abuse Oxycontin or Fentanyl. He's working, and hasn't gambled for more than a year, and once again reminded me that I haven't seen him high or nodding out since he came home. He's also attending Gamblers Anonymous.

Has he made progress since the old days? And what do y'all think is going on now?

Thanks for the help.

As someone who deals with people on both "sides of the street" out of compassion and understanding as well as personal friendship with these people.....snorting alone doesn't mean anything. People who do it are simply used to doing things that way and think that it's giving them some kind of benefit. You don't really get any "higher" that way than you would any other way -- and anyone taking oxy as long as he has can't really get anything from it "high"-wise anyway at this point.

Oxycodone absorbs into the system more efficiently by mouth than by any other means -- even intravenously. Few people know this, because they're confused with other opiates such as morphine & diacetylmorphine ("heroin") which absorb more efficiently by non-oral methods.

Snorting alone doesn't mean anything whatsoever IMO, other than this person has a bad, basically useless habit of administering his medication by non-oral routes. He should know it's not even doing him any good anyway....it barely gets into the system any faster than oral in the first place. It sure as heck isn't really any difference versus oral....

I can understand your reaction, and he does sound like a person who has had serious psychological addiction issues -- gambling is a hallmark of this -- which extend beyond the pain problems. However, few people with these issues/histories are properly understood by the people around them, and this is what causes a lot of the mayhem surrounding those with addictions....a lot of the problem isn't just simply the person themselves but the resentment that it creates when others just don't get it, can't understand what it's like to be on their end of the stick.....

All I'm trying to say here is that compassion is important. I'm not suggesting that anyone make themselves a sucker in the face of abusive addict's behavior.....but a lot of people get self-righteous and lose sight of the compassion & understanding which are all important to handling these situations reasonably & correctly.

Approach with care; show your husband that the snorting isn't even really doing him any good, based on the SCIENCE and not emotional arguments. He's not getting anything out of snorting; crushing and swallowing causes about the same "speed up" -- basically just turning a time release into an instant release form. I don't condone it specifically, but it *does* have a legitimate reason for being done in some cases.

The problem of doctors not understanding these people's experience or what it's like to be in their shoes is at least as bad as the one of friends/family not understanding.....sometimes one has to do things which may not seem proper or right on the surface to cope with this; but lines DO need to be drawn somewhere, and the real problem I see happening with many people is that the lines are just not drawn in the right places, IMO.

Dear Trust,
I responded to you in the past, and remember the history. While I do not lack compassion, the compassionate thing is to insist your husband remain active - ACTIVE - in an addictions treatment program, and that should have a family component in which you're involved and educated. Slips and relapses are part of addiction, but if your husband doesn't see his behavior is a problem (most active addicts won't), then he's in full blown relapse. And I do have to disagree with exitwound re: snorting. With the oxycontin it can make a difference, and one can get a high quicker. But healthy, non-addicts do not snort their meds. Period.

I think I had noted before to you I've got some professional background in this area, although I'm not here giving professional advice. Addiction is a problem that stays with someone forever, and someone who has chronic pain and is an addict - like your husband - needs to be closely managed by an addictionologist. I'm doubtful the doctor prescribing the oxycodone really has strong knowledge of addiction medicine - along with chronic pain. Your husband shouldn't be the one directing what is prescribed to him. Methadone is used as a substitute for a reason.

If you don't take some action you will just enable him; it will only get worse over time. Get yourself to some Al-Anon meetings for support, and see if your husband will re-enter a formal addiction treatment program which helps chronic pain patients (and I'm not just talking about AA - that's only a part of the overall plan). As I said, relapses and slips are common with addiction, but it's how the addict and those around him/her deal with those relapses that's important.

PaLady

Thanks everyone for all of the information. It is always so helpful.

I just wanted to mention that it's oxycodone that he snorts, not oxycontin with the time release.

Is there a difference between someone who has a substance abuse problem and a full blown addict?

What do people witih chronic pain, osteoarthritis and substance abuse issues do to treat their pain?

Exitwound....don't you think the following facts make a difference:

he saves his oxycodone until I've gone to bed, and THEN snorts it;
he continues this behavior, in spite of the fact that he was out of the house for several months last year because of the behavior. Also, I told him when he came back home that I would divorce him if I caught him snorting/abusing again? He promised he would not do it again, and that he WOULD take his meds as prescribed if he came back.

Also, you mentioned that snorting DOES have a legitimate use in some cases....I'm wondering exactly which cases those would be.

Thank you all again.

Thank you Sandi for taking the time to help.  I DO know that what you are saying is the truth....I just need to hear it every time this happens.  I thought he had made some progress, and maybe he has, but definately not enough progress.  I will make an appointment with his doctor.  His doctor is on vacation for three weeks, but I WILL keep you all posted.

I also told my husband that he now has to come off narcotic painkillers completely and forever.  Right thing to do?  He has another script filled this Friday, and he said he would begin a taper then with me holding his meds.  I will also insist on random drug tests.  I hope he'll be able to find another way to control the chronic pain.  He has tried nerve blocks and a number of other things in the past, with no relief. 

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)

Hello all,  I feel that I must step in here as I have a daughter who has an addition problem and am living it day to day with her.

First I would like to convey to Trust that I really feel for you because it is a hard road to walk what ever way you decide to walk it and it is a life time battle with times that are good and times that arent. But it is a battle that will be with him always.  He will either learn to control it and move on and reinvent his life outside of the pain meds or he wont. 

The one thing that I have learned from it all is that you really have no control over him Trust.  If he wants to use and abuse he will no matter what you threaten or do, your actions have no baring on his with his abuse.  Its called personal responsiblitly. 

I tried everything with my daughter and nothing made a difference expect letting her go and letting her decide if she wanted to get better.  YOU CAN NOT FORCE him with threats or with support to get better, that has to come from him because he sees he has a problem and wants to get better for him and him alone or he will continue to relasp.  I know that this is a hard thing to accept but it is true.  NO amount of compassion will help him want to get off the drugs he is misusing and he is misusing them!  When an a person is hiding what he is doing it is because he knows that he is not doing what he is supposed to do and there is no way to sugar coat that one.  All additics hide what they are doing... if he really wanted to get clean then he would be coming to you or to someone else telling them that he is struggling and needs your support to help him through this ruff time.  And there will be many ruff times.

For me Trust, I went to my daughter and told her that the past was the past and there was nothing that either one of us could do to take it back, but we can go on from here and she could do what she needed from this day forth and that if she was stuggling then to come to me and we would talk it out and I would help her without condiming her for any weekness.  Its like climbing a mountian, there will be many slips and falls along the way but as long as she contiues to climb then she has my full support and help.  And for a time when she wanted to stay clean she would come to me and we would talk it trough, It was hard to listen to but I did and we just found ways to overcome it.  It is so important to get outside help with this as well.  It is almost impossbile for family and friends to be total support with a recovering additic as so much trust has been lost and distroyed. 

My daughter has fallen several times in the last 3 yrs of here addition.  When she starts hiding and lying to me I know she is off the wagon and I kick her out.  There has to be rules and boundries that can not be crossed with additics.  YOU have boundries with KIDS and what more so you need to have them with additcs.  Its not that you dont have compassion its that with an additic if there is always a selfty net then they will never stop, why should they if they always be somone to bail them out. Is it not thet way with any bad behavior.  It is hard to do but when you have others in the house your jop as mother is protect the younger ones and they are adults making there own decissions and they chose to use, there is help out there to help them get off and stay clean.

He is snorting his meds and that is not the way they are prescibed weather its ocxicodone or oxcocotion, what difference does it make which med it is at the end of the day its still worng and in voliation of his contract. As a supporter of a additic its up to you not to provide excuse for him.  I dont understand how some can made that distinction between the 2. and he is lying about it as well that raises red flags for me all over the place.  And this is coming from one who has been there and done that.

I do agree though that it is worng for you to treaten to divorce him and not follow through.  That has to be your decission weather or not you can continue to support him through this or you have had enough of it and I would never blaime you either way because I know how hard it is to live with and deal with and its not just his addition its everyones.  But say what you mean and mean what you say Trust as it will only make things harder on him, you and your kids and family.  Only you can decide what that is and there is no shame in divoercing him over this if you cant deal with it( its an alwful thing to deal with) and there is no shame is staying with him if thats what you decide to do( if he comes clean you will both be stonger for it)

There are alot of treatments plans avabale for additics.  My daughter is on suboxone and it is a pain med as well.  It blocked the opiate respoters in the brain so they cant get high off of the opiate based pain meds or drugs. It is a long term program and It has it own problems but it is an option as well as a pain reliver.  I am not a doctor just a person who is dealing with a family member with an addition problem altho its not to pain killers but herion but to me its almost the same thing an addtion is an addtion.

I would really encourage you to seek out prefessional help for you and your husband. Im not sure if I would go to his Doc right off but would deff seek advice from and additionologist or someone trained with addtions.  There is no clear and cut answers when dealing with additions Trust what works for some doesnt work for others but if you and your husband are both willing to work through this together with honesty then there is a hope for him as well as your marriage just know it is a long road but not impossible.  I always have hope.

Even though my daughter has fallen several times she always comes back when she wants to try and my door is always open if she is serious about wanting to stay clean.  I know this is a bit different from you sitition but its the same in some ways as well. 

I hope that I have offered up some help to you Trust and my prayers are with you and your family and dont foget that I am not a doc and at the end of the day we all are offering up opions and you must decide for you what is best.  You after all have to live with the results.  I hope that I didnt offend you or anyone else here as that was not my attention. 

Take care and wishing and praying for you

Lara

PS...PAlady I think addition is CP in its own right  and I think that its a just subject to talk about on here as well and as always it just my opinion and I hope I dont offend you at all love I do care about you all of you in here...:)Just my thoughts but I can see why you would think not.  It is a touchy subject and one most of us dont like to confront, but in the minds of many that support this forum and so many that struggle with long term pain management.

Im glad your not offended Palady was a bit warry of righting that but I am a true to myself person and have to say what is indside me or it eats at me lol... it can be an annoying trate sometimes.  I really didnt mean any harm by it at all...

I so do agree with you though Palady about having a support group to go to it is so important.   It gives you insite on the addited and the addition as well as support and helpful advise that is proven to work.

Also Palady I didnt think you came arcoss harsh at all just infomrative and caring and as always with a caring heart

Lara

Trust, I completely remember your posts from previously. I also remember that we understood one another because we were going through similar situations. Admittedly, I have not read every word that everyone else has written, but your current post raised some questions for me....

1. He is being given 8 oxycodone per day...which is the absolute maximum you should take because of the Tylenol content (unless he has compound which has no Tylenol)...so...when he is exceeding 8 pills for his increased pain days, he is adding to the death of his liver, and shorting himself on other days.
2. If he has to take 8 pills every day, he should be on a long acting medication where he only needs to take it 2-3 times a day.
3. Why is it he only takes them at night? He has NO pain ALL day long, then boom, he needs to take 8 pills because he hurts terribly and needs to snort them to get them into his system faster???? C'mon, I don't buy it and neither do you.
4. I agree that taking his medication by any other route than orally, with the pill intact, is a huge red flag and is a complete violation of his pain contract. He is one of the reasons why it is difficult for CP patients to obtain medications in the first place. He is playing his doctor like a fiddle to obtain the medication he desires, not what will work best, believe me there are many bigger better ways to treat his pain than 8 oxycodone a day. I am willing to bet his doctor is playing into this because oxycodone isn't high up on the food chain as far as narcotics.

I made my addict leave the home over 2 months ago...and I couldn't be happier. Of course, I did not do this lightly, I had also put up with it for 20 years and did all of the addiction counseling/marriage counseling/Al-anon/AA, blah, blah, blah ad nauseum. YOU CANNOT CHANGE HIM, You can only be accountable for YOUR actions. He needs to be accountable for HIS.

As a matter of fact, my sons wanted me to tell dad it was his last chance and allow him back this time....However, the previous time I booted him out I had told him it was the last time.... so, if I allowed him to stay then my word meant absolutely NOTHING and I was not being true to myself. He still suffers his addiction, but I (and the kids) no longer suffer with it. He was counting on me to cave in and it has not happened. He even told me so, that he thought after 3 weeks or so apart that I would "get over it" and the argument would be over.....the argument is over all right.....and I FEEL AMAZING!

I wish you well.

Frances - That is PERFECT....If the husband believes there is no harm nor foul in snorting his medication, then by all means, be right there with him when he tells his doctor this fact. He is counting on you to be gullable enough to believe that there is ANY justification for him to be snorting his meds. He, however, won't be able to convince his doctor of such just cause. I guarantee his doctor will cut him off....if he is lucky the doctor will give time for a taper, but I don't think he deserves that UNLESS he goes to counseling in conjunction with the taper.

I don't mean to be cold, but your husband is an addict. When someone is an addict, their behavior may change with hard work and therapy learning to try and control their addictions, but they are still an addict. If his gambling has decreased, that doesn't mean he is any less an addict. You husband need professional help from someone who specializes in Addiction Medicine.

If/when a situation has improved, you are aware of it. Your husband is trying to convince you his situation has improved because he doesn't want yo to know the truth. You also need to get into counseling. What would your husband do if he could no longer get his drug of choice from a dr ? Would his gambling increase to try and supplement the cost of buying it on the street ? Could you pay your rent and utilities if he lost his job because he was arrested for drugs ? Could you afford to pay an attorney and still eat ? I don't mean to be cold, but these are things you have to think about, because your husband isn't. You don't mention having any children. But, if you have children, that makes the possible risks of his continued behavior much worse.