I have no words other than good luck. Recovery isn’t a straight road and she has to commit to it herself. You’re going to have the really tough choice of staying or not. Protecting your child with or without her. Making choices for the best outcomes are hard and no one but you and your support network will know enough to give you actual sound advice.

Open communication. If she isn’t in therapy beyond her treatment seems like family therapy could be beneficial. Frank and honest discussions. Not being gas lit when you SEE what is happening and she says it’s something different will cause more friction but may be needed.

Best of luck, what a rough road you have to go through. Hope you have the support you need.

RA is Rheumatoid Arthritis? Her joints hurt and it feels like she’s burning alive from the inside out? That’s how I feel, though I don’t have RA specifically. I do have other autoimmune problems though, and I think we’re eventually going to confirm that RA, fibromyalgia and other autoimmune diseases are just different expressions of the same problems.

I’ve been in chronic pain for most of my life, getting worse as I aged. Doctors were not very helpful until I got the right ones, but even then I had to do a lot of the work on my own.

If she’s in chronic pain and her diet is shit, then I’d bet you dollars to donuts it’s because of that (perhaps coupled with autoimmune issues). I recently had a Mediator Release Test done which measures food sensitivity. There are a ton of things that I eat on a regular basis that I didn’t know were bad for me, and I’d already stopped eating gluten a year ago.

I can’t have corn, soy, beans, jalapeños, sunflower, wheat, chicken, cheddar cheese (specifically), mushrooms, etc. Do you know how hard it is to find prepared foods that don’t contain any of those things? Nigh impossible.

I’m doing my best to get all of it out of my diet though because I can’t stand to live in so much pain all the time. It eats who you are as a person no matter how tough you think you are. Eventually it changes your brain to be wired differently.

Even if food isn’t what’s causing her problems, consider having her (and you too) read the book Back In Control by Dr. David Hanscom. It’s not just about back pain even though Dr. Hanscom is a back surgeon. He’s been through suicidal levels of chronic pain, driving him into unemployment and despair. He found his way back, and in the book he outlines the steps to get out of the Abyss your wife is in. The book should help her see straight enough to be able to do the work it’s going to take for her to get better. It’s possible I’d be dead today and not able to tell you about all this had it not been for that book - though it was only a starting point.

I’m cutting off my wall of text here, but if you have questions or whatever, let me know.

You seem to be a great partner. As someone that’s lucky to have one as well I know how much that can matter. Doesn’t mean it’ll all end up roses, but you seem to be doing everything you can to support her (including, critically, getting support/intel for yourself). No guarantee, but a critical element in it all.

It might not be just the pain making her behave like that, for what it’s worth. As someone that’s been on a half dozen different opioids (though admittedly never heroin, but from codeine up to fentanyl and many between/beside), I know I got… irritable. Easily and instantly aggravated. Not that I chose to behave like a bastard, but every little thing needled me, rose my hackles in way even the most intense stuff didn’t do before I got on opioids every minor annoyance, pain, distraction, interruption hits ten times harder. I tried to contain my response, and often failed. Realizing that was one of the things that pushed me to quit, despite the pain (not a pain survivor, just trying to stay pain surviving). None of that excuses the behaviour. I was not reasonable, I was sharp, and with a deep internal aggression and at times meanness. Nor does your wife’s state excuse hers. But it might partially explain her altered behaviour. She’s not just dealing with the pain, she’s dealing with a soup of junk messing with her brain. They reinforce the other, too. Methadone was one of the ones that brought it out more in me, but ymmv.

Are there friends (hers or yours) that understand and can offer support? Either in helping to guide her to a better path, helping you stay upright, or helping the both of you stay sane together. People with experience with addiction, chronic pain (or, ideally, both) especially, but aside from that anyone close to you (& trusted by your wife) with a good head on their shoulders.

“enough to remove the pain and not be jonesing for another fix” is a trap. They get linked, even if you’re careful. If you’re desperate for another fix, you’ll experience it as pain (physical, or ‘just’ mental anguish). One way to try to keep stuff level would be to have a set ration per day that’s limited enough it takes budgeting but expansive enough she’s not in too terrible a state. Depending of the dose/opioid I had set a ration for myself (max X pills per day, max Y pills per week. Any exception I had to get my housemate’s ok on, and a no was final.) This will only work if she’s willing to cooperate, and only if she can make herself (with help) to actually follow through on it. But it dropped my dose a good 20%, which made a big emotional difference. It came with a secondary boost due to the added sense of control. I chose to give my meds to my housemate, so that I couldn’t break my own rules. She gave them only when I could convince her. If you can be that person for her, or if someone else can, it might help. A risk here is hoarding. “I don’t need the pills now, but I might in an hour, it’s my last dose for the day so i’ll take the pills and put them somewhere safe if I need them later”. I’ve fallen into that trap. If your wife isn’t fully willing to cooperate, this entire idea is on shakey ground. I chose to let my housemate search my room (in I “I trust you but should/will verify” kind of way). If stuff got caught, all of those were taken away, and i’d have a harder time convincing her to give me any for a while. I hadn’t hoarded much, but for your wife that also depends on how well she’s able to stay away from that.

It sounds like your wife is struggling. It sounds like she’s probably trying her best, but not succeeding. She’ll need to accept that before she can change her path. You’re there for her though, so she has a shot. If she’s willing to work for it. It would also greatly help if she’s accepted that she’s taking the stuff for the pain, yes, but also the high. And that’s understandable; it’s important to understand that because if she doesn’t, she won’t be able to better her behaviour around it. It’s fine that she’s got the urge to take it to feel not-shit (because post-high you very much do feel shit), but it’s not fine to hide from that fact or not act on it.

That sounds like a difficult situation and you sound like a very supportive partner. There never seems to be a “one size fits all” solution, but I’ll try to offer some of my experience.

I am a nurse and have given many many pain medications (obligatory: this is not medical advice). I have never had cancer, but have been told by patients that cancer pain and fatigue can be grueling. I have also given opioids to people that have used a few times and had been actively withdrawing. Their tolerance can sometimes be incredibly high, especially with heroin. Like, doses that would sedate or kill a large adult can barely change their perception of pain. It’s honestly a nightmare for treating their pain, because it’s a tight range for safety.

All that to say, absolutely talk to a pain management MD and include her history of heroin and cancer. There may be alternatives like ketoralac or cannabis that could give her actual relief. They will be familiar with navigating “managing the pain without getting them high.” From the context you gave, it sounds like she may have actually had unrelieved pain and resorted to what she knows works. Extreme stressors can be triggering that way.

She is acknowledging what happened and working with you, so that’s a good sign. The angriest and worst people I’ve ever dealt with were withdrawing from opioids, so the crankiness isn’t unexpected. Do your best not to take it personally and keep reassuring her that you’re going to do your best to be there for her.

Just be cautious not to enable. I had to think to myself what I truly would and would not do for my family member (eg, no lending of money, would not buy them drugs) and stick with those things no matter what. Because a craving will use literally any excuse or crack in the logic to get the relief they desire. The part you mention “enough not to be jonesing” and the irritably sound concerning and could honestly be excuses. But you also don’t want to belittle the person’s experience if they are actually having that pain. That’s where the pain management doc would probably help. And just point out to her that if she’s not getting the right pain management or not able to function with the rest of life, some help is needed.

And be careful not to emphasize to the point that it fatigues you. I am an empathetic person and found myself with no time or energy left because I gave my family member a “blank check” for support. Make sure you recharge yourself, how ever you do that.

I hope any of that helps. Feel free to message me if you’d like.