Desperate for help with friend

[Lisa2You]

And don't worry, by "friend" I do not secretly mean myself. In fact, I have been on high levels of pain killers and never had a problem at all, so it's actually hard for me to get my mind around this.

Anyway-I'll start with the short version and can add more later. I'll call my friend Mary. Mary and I have been friends for years. She's been a good friend to be, but it hasn't been that way for a number of years now. She is a young person but had a hip replacement in her 30s and that's when I really noticed the problem. No matter what the pill bottle said, she took the pills as she pleased and ran out early. So when she had to go way down on pain killers, she went through major withdrawel. She does not remember this. She talks to her doctors about how she's not worried about that this time (I'll explain in a sec) because she went off of them "just fine" after hip replacement.

Jump ahead five years. Mary was having pain in her back. She has arthritis in her back due to the hip thing, so doctors assumed it was that. Finally ordered an MRI and found that there is a vertabrae that has slipped and is resting on another. Suddenly, though she had been going to yard sales, taking care of a toddler, working a demanding job, and so forth, she had to take oxycontin and oxycodone. I'm sorry to talk poorly about my friend, but she really lives for these things in a sick kind of way. She relishes the attention and exaggerates her symptoms. I knew her mother, and she is just like her.

I went with her to a pain clinic 50 miles away. She was completely loaded. I was actually glad because finally a doctor would see what I did. She could not write her name on the forms. She could not speak coherantly. She moved slowly and could not follow a thought. So finally, I made up an excuse and went to the front desk and leaned in close. I said, "please, my friend needs help. She has a real problem with these drugs. She will not control what she takes. Make her bring the pill bottles in, please." A little while later, the nurse took her into the bathroom and UA'd her. All the while, I'm feeling like the shittiest friend ever. Why can't I help her without having to go behind her back? The doc asked me if she's been like this since being on the oxycontin; she jumped in and said she hasn't and that she accidentally took another medication too late the night before. I told the doc this was a problem but left it at that.

The U.A. showed too much of another med and not the oxy. I can't believe it! She not only takes too much of the breakthrough med (oxycodone) but she chews it too "to make it work better." I'm not an idiot; I know she's doing it for the high.

I can see this will be too hard to tell you the whole story here. My question is this. How can I help my friend? As I see it, my options are to confront her (in a different way than I've already done); call the prescribing doctor; or do nothing and hope she'll be OK (can't do that because she won't).

Mary has a ton of emotional pain and she is using the drugs, any drugs...to dull that. She is very much alone in her problems and I am the only one she has let in long enough to see them.

Any help at all would be so much appreciated. I can't sleep for worrying. And I have health problems of my own and can't afford this. ~K

[houghchrst]

Hi and welcome! You are a great, patient friend. Mary is lucky to have someone who has stuck by her all this time.

I hate to say this because it is obvious that you care for Mary but honestly the only thing you can do for Mary is make sure she understands that you know what is going on, that she seriously needs help and that you will be there for her when she is ready to get some help.

You cannot make her stop abusing the meds. What will happen if you try to force the issue is she will stop confiding in you, she will probably grow to resent your presence and distance herself and you will lose her 'friendship'. I put that in quotes because I understand that the condition she is in isn't much of a friendship but if things change I am sure that you two would remain friends. If she finds out you called her doctor she will just find another and drop you like a hot rock or she may lie to her doc and still drop you.

There is nothing you can do, she has got to want to do it herself.

Don't let her use you, don't enable her, but be there for her. You have to create boundaries.

For you there is always Alanon for friends and family. While the meetings are geared towards alcoholism the basis is the same for any addiction. Attending the meetings may give you a better understanding of how an addicts thinking works and the friend/family dynamics.

I am sorry, I know you so want to hear of something that will make things better but it just doesn't work that way. It takes a lot of work and time on her part and a lot of patience and time on yours. Just be there for her, let her know you care but with boundaries. Like you said, you have your own life to take care of also.

I understand totally. I am in the same spot only it is my mother and alcohol. I am glad you stopped in. Let us know how it goes.

[Lisa2You]

You are right. It's not what I wanted to hear. I"m so sad that I can't do anything to help her. I have talked to her about it but she justifies everything with the fact that she has pain.

She soooo needs help. She needs counseling but is paranoid that if she gets counseling and somehow "they" find out, she'll lose her granddaughter, who lives with her.

All of the medications that are a problem are prescription meds. So my thinking was that if the doctor knew, he could just cut her off. I know that won't solve the emotional problems but at least I would know she's safe and won't accidentally kill herself. I'm just rambling. Thank you for the response. I'm glad I read it before doing anything too drastic.

One more thing. There is a young child and her own teenage daughter in the home. The (adult) teenager is very co-dependent with her mom. It was only when I called her personally and voiced concern that she seems to be seeing things more realistically now. Still---there is a lot of reason for concern with her as well. Should I continue to try to help the daughter, or not? And if I have another conversation with my friend, voicing my concerns would it be advantagous to do it in front of her daughter?

One recent conversation, after the doctor's appt., I told her daughter, in front of her that she would need to take control of at least the narcotics. Her mom was taking too many medications to keep them straight. She said she'd tried that before and that her mom gets crazy and screams (with gritted teeth), "give me my meds!"

I think I"m going to have to go back to what I've done for a year or so. And that is that I keep the relationship but on my terms. I worry too much and get too involved and it doesn't do anyone any good. In fact it sucks me dry.

Thanks for your response. I do appreciate it! ~L

[houghchrst]

Lisa maybe get the daughter to go to a meeting that I mentioned with you. I really hope the children are not being left alone with your friend.

I am sure her pain is real but it can be exaggerated by rebound pain, here is a bit of an explanation

Rebound pain is most commonly associated with the treatment of migraine headaches, although this may be an important concept in other pain treatments. In Migraines patients who take routine doses of analgesics may end up with a phenomenon known as rebound. This occurs with medications ranging from aspirin and Acetaminophen to muscle relaxers and opioids. It is less of a problem with long acting medications than short acting ones.

The problem with rebound pain occurs due to routine use of medication with increased pain between doses. This pain is then reduced when the next dose of medication is taken, giving the patient the belief that the medication is treating the pain. In fact, the problem is that as the medication lowers in the blood stream between doses, pain increases. When the next dose of medication is taken, pain decreases, but this is due to the end of a mini-withdrawal, rather than the therapeutic effectiveness of the medication. With migraines, this can become so severe as to precipitate a hospitalization and treatment with IV DHE, while withdrawing the offending medication.

This problem can be particularly vexing to treating physicians, because of the constant pull on the part of the patient to use a medication which is causing the problem, rather than treating it. It is difficult for physicians to explain to the patient that the one medication that helps is actually the source of the increased pain. The pull to just give the prescription as requested is a strong one that should be resisted and replaced with a consistent message about rebound pain.

It is really hard when someone who has addictive tendencies needs to take pain medication. The addictive nature needs to be dealt with while the pain is managed also. I am a recovering addict and am very careful with my meds. I deal with the pain other ways instead of taking my meds everyday. There are some days I admit that I just have to have a break from the pain, but that is exactly what it is, to relieve my pain.

I am glad to see you here. Keep in touch.

((((HUGS))))

[Lisa2You]

Thank you once again. That makes a lot of sense. Her surgeon said that the problem is not an emergency and that she could even wait until next summer to have the surgery. It was I who then asked, "But is it safe to be on oxycontin for a year?" Then he went into a litany of how unsafe it is. He said that although the physical problem may be rectified, the patient will actually still feel pain because the brain has changed. So anyway---doesn't really matter because she doesn't seem to ever believe that these things apply to her anyway.

Thanks for the help. It has put my mind at ease and helped me to formulate a plan. ~L

[houghchrst]

Lisa I am glad to see you take a proactive role with her doctor and ask questions. You are right she will act like it does not apply to her and will be in denial until things become so out of control that something serious happens.

I hope your plan includes you setting up boundaries for yourself and keeping your sanity intact.

((((((((hugs))))))))

[Lisa2You]

Yes, my plan does include setting up boundaries. I am amazed that I really cannot have a conversation with her. She doesn't track and is ridiculously paranoid about things. She has always been a bit this way, but now it's out of control.

Last week, she called me and said she'd had a phone interview with her insurance company. She was truly distraught because she said they'd "tricked" her into telling them that the back problem happened when she was wearing a brace on her ankle and she was sitting down and sneezed. She was so upset that they'd "tricked" her. Her fear was that now they wouldn't cover her medical care because she had caused the back problem herself by sneezing. Sheesh! Thanks in part to you, I didn't empathize (not sure that's the right word) but just told her point-blank. "Mary, you are being paranoid. No one is out to get you. I'm sure they ask everyone these questions. What they may be looking for is whether this might be a Workmans Comp case or something." I emphasized over and over that she was being paranoid. When she kept going back to it, I made that my mantra. It made me feel more in control and eventually she got the message. This is just an example.

I am going with her to get another shot this week. That will be a hard one as this is the doc that she was so out of it with. This time I know I will have to watch her manipulate everyone from the receptionist to the doctor. I still wish I could anonymously call and tell them to ask her to bring the original pill bottles with her. What do you suggest I do if the doctor asks for my opinion again?

This conversation with you has really helped me stay sane in an insane situation. I hope that it will help someone else who might be in a similar situation too. Wish there were more people active here. Looks like plenty of people "view" but just don't comment. Anyway---thanks again!

[houghchrst]

If the doc asks your opinion then be totally honest. You have to be for your friend's sake. If she is out of it try telling her to bring her original bottles with her, she may not even remember that they didn't say it.

You know I reread your original post and you said her doc says she has a vertebrae resting on another. That is terribly painful. The same thing happened to my mother whose vertebrae finally just disintegrated. Sounds like your friend it also trying to get around like nothing is wrong with her and is chowing down the pain meds to do so. She is not taking precautions for her condition, may have taken so many pain pills to deal with the pain and became addicted.

This must be doubly horrible for her. Not only is she addicted she is in terrible pain. Why is her doctor waiting to do anything until next summer? THis is only going to get worse for her. Has she had a second opinion? What about getting a different type of medication? Something like a patch that is a bit stronger? I am fully aware that any pain medication can be abused but it is easier for her daughter to hand out a long acting patch rather than fumbling around with pills every 6 hours.

Ask the doc why he is waiting so long. Explain to him that this is terribly painful for her. The meds aren't working for the pain.

Your friend needs help two fold. If she begins to resent your help then you will have to take a step back. Let her do what she is going to do. When she hits bottom there will be a point where she can go no where but up. That is when you need to be there for her. Let her know you care and are willing to help as long as she is willing to get help. You may reach a point where you will just need to stay away from her until then.

Yeah we got a lot of views but not enough action. That's alright I always have the hope that someone lurking is also learning.

Thanks for letting us know how things are going. I wish your friend luck on the next doc visit.

[Lisa2You]

Yes. I do believe she is in pain. But from watching her (even when she had run out of the "breakthrough" meds), I do not believe she is in as much pain as she is letting on. She has been a drug-seeker for years. I have even wondered if she purposely hurt herself to get the narcotics. But yeah, it's a tough situation. And honestly, I do not understand her doctor's reasoning, except that she was not honest about how much medication she was taking. I do believe that she would rather be in some pain with the possibility of having narcotics for a year, than have surgery and have them cut off.

I will go with her to get the shot and then will pull back again. I just can't do it. It makes me crazy. There is a lot more to the story. Her daughter is an adult but will not get a job. She does not support her own son, so Mary has done that. But they both say it is best this way. It's not. It's ridiculous that she can't (maybe won't) have the surgery because she's worried about bills and the time she will have to take off. So yeah, it's a long and convoluted story. And it's really hard to watch and be involved in. I have to pull out but before I do, I will have a talk with her about her addiction. I'll tell her that I know she has a problem and that when she's ready to get help, I will be there for her. When she is ready to face the demons that make her believe this is the answer, I will help her get hooked up with some good help. Until then, our friendship will be on my terms. It's the only way I can remain sane and healthy.

[houghchrst]

Lisa how terribly sad. Sounds like mother and daughter have a real enabling type of relationship. Sounds like family therapy is needed.

Yes it also sounds as though she has come up with the typical excuses to remain in need of the meds.

If I were you I would have to completely withdrawal after this until she got help. Tell her that when she is 'sober' then she can call. When she is 'sober' then she will get a ride where she needs to go etc. Otherwise she will continue to use you.

I know how hard it can be. How much you want your friend to get better. How painful it is to sit idly by knowing you can't force the issue. Just be her friend but like you said, on your terms.

[Lisa2You]

Getting therapy appears to be impossible. They are both paranoid that somehow the courts will find out and it will affect the custody of Mary's grandchild. It's a ridiculous premise because the father has no job, and is constantly being arrested for drugs or whatever.

When you say "sober" what exactly do you mean? I mean, eventually, they will cut off the narcotics. But she is on so many other medications and many of those are mind-altering too. I don't know what is realistic. She does have health problems so probably needs some medications. It's such a gray line.

[houghchrst]

When she is no longer abusing any mind altering substances. When she is taking her medications for the reason they were meant and not to get high. She may very well have to take meds for the rest of her life but she needs to be in rehab so she can get off of the ones that are addicting and be treated with ones that aren't. A rehab center that has training to deal with medical issues. Then later on if she absolutely has to have something that has the potential to be addicting she will have the skills to manage it.

There are many that are recovering that manage their pain without narcotics.

It is hard to be a recovering addict and have to take medications that are mind altering. For me my drugs of choice were never pills. I hated pills because the few times I took them for what they were prescribed I had lousy reactions. I discovered that I am med sensitive so a lot of medications for pain or depression make me suicidal rather than high. When I became clean and sober from drugs and alcohol unfortunately chronic pain and illness followed on it's heels. Then came all the medications. Or I should say trying to find the right medications. We are still looking but there is no magic pill lol. So a happy medium will do. I do take methadone and percocet for pain but I have developed a healthy fear, through outpatient rehab, of addiction so I use them sparingly. I would rather hurt than be addicted again. The fear is of the life I was leading. Do I miss my drugs and alcohol? Well that is for another posting I guess.

Is there already something going on in the courts with them? The courts have no reason to know unless they run out there and shout it to the judges. Just another excuse? How on earth could it affect the granddaughter if Mary is the one using? One has nothing to do with the other. Well except that they live in the same house; the child is being affected now!

What happens if Mary is there with that baby and she is stoned and falls and smashes her head on something and bleeds to death and the mother is gone? Or has a stroke from all the meds?

She is going to hit bottom. Today, tomorrow, maybe next month but it will happen. I hope she survives it to get help.