Compliance

MARIE: We’ve had a bit of a fraught couple of days, and are still far from settled. The trouble stems from an on-again/off-again argument we’ve been conducting for the last several weeks about what degree of freedom and flexibility Jon can safely allow himself with his medication. The technical term is compliance, which means a patient's adherence to a recommended course of treatment.

Jon wants to be able to take his L-dopa and Ritalin when he feels the need, including splitting doses into several smaller portions and/or adding extra doses, rather than having to adhere to the schedules set in collaboration with the neurologist and the psychiatrist. Jon says that if he waits with the next dose until he goes OFF, then not only does he feel pretty awful, it also takes him longer to get back ON again afterwards.

I, on the other hand, feel that while some flexibility is both reasonable and desirable, this needs to be managed within a safe framework, preferably one set out by the prescribing doctors. While the neurologist is always happy to discuss and adjust Jon’s medication, she has said that she prefers him not to experiment on his own (but he does so anyway). And the psychiatrist has set up some quite wide, but very clear guidelines within which Jon can be flexible (which he only partially observes). Jon thinks he is being perfectly reasonable, while I think he is out of control.

The trouble is that I have no idea how problematic it is when Jon doesn’t comply with his prescribed doses and timings. I know that both L-dopa and Ritalin are strong drugs, but I don’t know if over-use or sloppy use can cause any lasting problems. Is Jon being a bit careless (like going for a winter walk without a hat) or is he being reckless (like riding a motorbike without a helmet)? And if the latter, is that any of my business?

There, I suppose, is the real heart of the matter. Jon has come close to drug abuse before, partly because the drugs themselves were addling his mind, so I feel it would be mega-negligent if I didn’t react now that I see the same patterns of behaviour repeating themselves (plus, if something goes wrong, I will suffer for it too). But are they really the same patterns, or am I projecting the past on to the future? I wish our psychologist wasn’t on holiday …