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About Jacqui
Expertise
Harm reduction (is it a dirty word in America??) - ie: needle and syringe programs, prevention of blood borne viruses such as HIV and hepatitis C, questions about dependency on opiates and other substances. Questions about treatment (particulary methadone and buprenorphine).
Experience
Manage a primary health service for people who inject drugs, and have worked at that centre for 6.5 years
Organizations
Registered as a provisional psychology with the Victorian Psychologists registration board (this is for psychologists working under supervision or currently studying a masters). Much of my experience is related to my work rather than to my studies
Publications
conference proceedings - IHRC 2004 & 2005, NSP Conference 2005, Stigma-Pleasure-Practice conference 2006
Education/Credentials
Bachelor of Arts (Humanities), Bachelor of Psychology with Honours,
currently studying a masters of clinical psychology, completed one half of a graduate certificate in Addiction studies (transferred to psychology as it had better career prospects) - lots and lots of short training courses.
Awards and Honors
Presented at international conferences (Harm Reduction Conference in Thailand and Melbourne)
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You are here: Experts > Teens > Health for Teens > Addiction to Drugs > girlfriend is a chronic pain suffer which has lead to severe addiction
Expert: Jacqui
Date: 5/19/2008
Subject: girlfriend is a chronic pain suffer which has lead to severe addiction
Question
QUESTION: HI AND THANKS FOR LISTENING. i AM INVOLVED WITH A WONDERFUL WOMAN...BEFORE THIS HAPPENED SHE WAS THE WOMAN OF MY DREAMS. SHE WAS ON ANTI-DEPRESSION MEDS (EFFXOR),SLEEPING PILLS AND WITHOUT MY KNOWLEDGE A MILD PERCOET HABIT. sHE HAD SOME DEPRESSION DUE TO A FAILED RELATIONSHIP PRIOR TO OUR MEETING WHICH WAS WHY THE ANTI-DEPRESSION MEDS CAME IN. SHE ALSO HAD A TRIGGER POINT BACK PROBLEM WHICH IS WHERE THE MILD PERCOCET ADDICTION CAME IN. tHE FIRST TWO MONTHS WERE WONDERFUL AND WE EVENTUALLY MOVED IN TOGETHER. sHE DECIDED TO GET OFF ALL MEDICATIONS DUE TO OUR FUTURE OF HAVING CHILDREN. THIS IS WHEN IT SEEMS SO MANY OF THESE PROBLEMS STARTED. I though she was only withdrawing from effxor which I have heard was not pleasent. It wasn't to say the least since I wasn't aware she was trying to withdraw from percocet at the same time. The withdraw was bad enough that she couldn't do it and incurred some chonic back problems on top of the previous that she had where she was stifled in pain. Now due to being in chronic pain she has gone back on all medications and due to the pain increased not only what her pain clinic has prescibed but also we have bought over and above pain medications on the street to alievate the pain. She now is on sleeping pills, effexor, 50mg fenantyl patch and resorts to 12 to 15 percocet mixed in with doses of 40mg Oxycontin. It has costs me 500/week and now I am in financial distress and I have only provided the pain killers since she was in legimate pain and couldn't see her like that. Now though this has turned in full blown addiction where she is afraid of the withdrawal and going through what she went through previously. She does want help since she knows the drugs are destroying her life but at the same time without the drugs would have debilitating pain. We have fought on this subject and I feel like I am enabling her but at the same time have no choices and don't want to treat her as an addiction since she is really a pain patient without proper care or compassion. SHe is very scared, suicidial and has extreme guilt and low self esteem. I am now in a position where I can't provide the monies nessary to keep to meds up and have low self esteem from not being able to take care of this wonderful person. I should add there is a 5 yr old involved that she had from a previous marriage that has been witnessed to all of this and the fighting unfortunately. I am worried about her and despite everyone saying just leave her I want to stand by her and provide love and support for her cries of help yet don't have the financial resources to find proper care for these withdrawal programs that she would enter into. I have been looking into methadone treatments yet don't want her to feel like a drug addict when this started not from recreational use but from pain treatment. Any help would be beautiful and thanks again from listening. I wouldn't wish this on anyone from with point of view.
ANSWER: Hey Marty,
Sounds like you have been a fantastic support, but it is all just getting too much. Also, don't feel the need to make excuses for her drug dependency (I hate the word addiction) as I have empathy for anyone in this situation, whether they started from recreational use or from pain or whatever. Unfortunately the way the system is, if you want to drink copious amounts of alcohol a day, that is fine, but if you want to take copious amounts of opiates, that is not. Anyway, that is the world we live in (well the world you live in is a little less sympathetic than the world I live in - I am in Australia with a slightly more humanitarian way of looking at drug use issues).
There seems to be a lot of complexities going on with your partner. So, I will tackle each drug one by one:
Effexor can be habit forming. The thing that annoys me about the use of this drug is that it is not meant to be used as a treatment for depression on its own. The best results from the clinic trials from Effexor and drugs like it, combined it with psychological therapies. On its own, it can lift mood, but even the drug companies own literature says that it isn't by very much. So, firstly I would suggest some counselling would be helpful. I particularly think this is the case given that you said her depression came about after a bad break up with her last partner. Think about it this way, the depression is caused by a situation - so isn't it better that it be solved by looking at better ways of dealing with the situation, and trying to make sure it doesn't happen again? We do live in a "pop a pill" society, so people feel that they need to take something every time they feel bad.
You haven't given me much detail about the sleeping pills, but remember that these drugs can be extremely habit forming as well. In fact, benzodiazepines can have very very serious withdrawal effects that can result in seizures and extreme anxiety. Ultimately though, the problem with sleeping tablets is that they are good for occasional use, but unfortunately after you form a tolerance to them, they actually make it harder to sleep and make you more anxious.
Finally, opiates are difficult to come off. And if there is a legitimate pain problem, then they are a legitimate drug. I don't know what city you are in, but one option is a methadone program. I know that this probably doesn't sound like fun, and I must say that the US is not renowned for its methadone programs - they are generally quite restrictive. If you let me know what city you are in, I might be able to do some investigating. The reason that I suggest methadone is that it is not going to cost you much and you won't have to risk getting arrested when you are buying pills off the street.
I wonder what the back problem is. Has your partner been linked in with a (good) medical practitioner who can offer some advice about this? Do you guys have health insurance? If the back problem is unfixable, then the only option may be staying on some kind of opiate pain relief, and the fentyl patches are good. Is the issue that she is having breakthrough pain, or the tolerance is getting too high? I know of people who have been on the same methadone dose for ten years or so and never needed to go up, but they were people who were on it because of depdenency problems not chronic pain.
The last thing I wanted to say (and I note I said 'finally' two paragraphs ago, sorry have just got carried away!) is that you are a great support, but you also need to look after yourself. $500 a week is a lot, and it is a shame that you have to pay this. I know you love your partner, but you also need to look after your own needs. If the fighting gets too much, couples counselling might be a plan. Conflict can have really negative effects on children, so you are right to be concerned.
If you would like to get back to me and provide a bit more info, I would be happy to follow up on a few things for you.
Best of luck and stay safe!!
Jacqui
---------- FOLLOW-UP ----------
QUESTION: Hi Jacqui,
Thank you for the quick follow up. To answer some of you question in the quest for hope. We live in London, Ontario in Canada. Therefore we do have federal medical insurance exept it doesn't cover prescripions or drugs off the street which we have had to resort to unfortunately which is whythe costsis so high and also brings with it the feeling of guilt for her of doing something wrong. The sleeping pills she is taking are 7.5mg loazapam I think but I could be wrong. I haven't had much experience with meds since I don't even take aspirin for headaches.
I have been thinking about a methadone clinic yet here in Canada is it much like the US and highly regulated. Also the stigma with having to have judgement on her that she is a 'drug addict' when she is a chonic pain suffer and is dependent on these opiates just to be somewhat functional gives her so much guilt and shame. I have heard that methadone is a good med for chronic pain suffers but I have heard horrible things in regards to the withdrawal since it is so heavy. I dohave to admit the financial situation will more than likely make this happen regardless.
WE haven't had a definite diagonsis from her pain clinic but many tests to rule out what is not therefore we are still in the dark. Whatever it is its real since I have felt the muscles in her back ad the are always so tight. I have done some research on what else could be happening in terms of how she feels, acts and her mental state and think BPD-brodeline personality disorder might have some aspects in play. Alas I did also read that with drug dependency this behavior is also exhibited. I am pretty new to this and our relationship is new before muchof this happened so I can't be certain but she was great beforehand.
I really appreciate the help since it is hard to come clean with my family and friends when discussing her and when I do sometimes they make me feel like I am dependent on drugs as well for even staying by her side. More than one person has accused me of using drugs when it is the fartherest thing from the truth.
I do have to admit it is hard finding a compassionate doctor to deal with her chonic pain or prscribe proper amount of mediction to at least make her feel stable and not go to the street and not be monitored for he use. Very sad and that has been the most difficult for her.
Answer
Hey Marty,
Thanks for getting back to me with so much info. It makes it easier to try to come up with a better option.
Anyway, it is good you are in Canada as they do have a slightly more liberal (read - realistic) drug program there. I found a harm reduction service that might be able to provide you with some information. The Ontario Harm Reduction Distribution Program (1-866-316-2217) may be able to provide you with information about local methadone programs and services in your area. Yes, methadone can be difficult to get off, but probably not any more than what your partner is on right now. It is quite a good pain reliever and lasts for about 24 hours, which means that you only really need one dose a day. She may still get some breakthrough pain, but it might be managable with non-opiate pain relief. Also, the are some good psycholical therapies for pain management which, in conjunction with the methadone, may be a good treatment option.
Borderline Personality Disorder is a complex psychological problem and is not generally managed with medication. You probably know from your own research, but personality disorders are a collection of traits that make it difficult for an individual to fit into society in a way that others find acceptable. People with BPD often have difficulties with relationships (either loving or hating people and often loving them and then hating them in a short period) as well as self harming behaviour. Drug dependency can affect anyone, but yes there is certainly a high proportion of people with BPD who use drugs, often because they find the pain of life is just unbearable without them.
If your partner has BPD (and without a proper assessment, we don't really know for sure), then there is an intensive psychological treatment called Dialectical Behaviour Therapy. It is a specialist treatment and you would be able to find a psychologist who practices it at the Canadian Psychological Assoc web site - http://www.cpa.ca/
Lorazepam is a benzodiazepine, and has addictive properties. I must admit, she is on an awful lot of medications, and I am concerned that there is the possibility of overdose and/or complex side effects from withdrawing. I know that there is a lot of stigma and shame associated with drug use, and this is something that I work to reduce in the job that I do in Australia. This doesn't much help you in Canada though! I would suggested trying the number I gave you above (Ontario Harm Reduction org), and asking them if they know of a non-judgmental service or medical practitioner who could support your partner and undertake a managed reduction of her medication and switch to methadone. Harm Reduction organisations realise that humans will also use drugs, and getting all high and mighty about it only hurts people. Abstinence is a pipe dream for the human race, and the best we can all do is support people, so that when they do decide to stop using, they don't have HIV or brain damage from an overdose, or be in jail, etc. Explain your situation to them, and ask them if they know someone in London who can assist your partner.
Finally, and this is the main thing - your partner won't stop using unless she wants to. So all of this will be in vain if it is only you who wants to her stop. Obviously, you don't have to keep paying for it though! This is the hardest thing about drug dependency - knowing that no one else but the person can decide to stop using. We know this because prisons are full of people using drugs - and if the prospect of going to jail doesn't make you want to stop, then nothing will! I would really encourage you to seek your own support, whether it be an organisation for family and friends of drug users or individual counselling. It can be hard being in a relationship with someone with a drug dependency problem and you don't want to stress yourself out too much by all of this (although I am sure you are pretty much stressed out already).
Good luck and I would be really interested to hear how you go. I you do decide to follow up any of the numbers I have given you, let me know if they treat you ok.
Best of luck and stay safe!
Jacqui
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