Opiates and delusions

I am still trying to sort all of this out…after 15 years of marriage my husband suddenly developed a notion that I had an affair. He has accumulated evidence to support his notion, but will often give me the opportunity to prove my innocence as if he knows that his notion may not be real. His episodes of believing I had an affair come and go, though more frequently now than they used to. It has been five and a half years since this began. For the past three years he has been under the care of a psychologist and a psychiatrist who both diagnosed him with OCD, and he has been treated with Lexapro and ERP. He recently had a car accident, an arrest for DWID, a week long hospitalization and it was revealed that he had an opiate addiction.
Since then he has gotten more volatile in terms of standing his ground and insisting that I have been a liar, a cheater, a their and impossible to live with. A week ago I made him move out of our home but I have still be in contact with him most days.
As far as I know he is off the opiates and benzo's, but I can't be sure. He was never forthcoming with the information before about his addiction so I am not sure I can trust that now.
Anyway, my question is: do opiates actually cause delusions/psychosis (or what is the right terminology) and once he is off for a period of time might the incidence of delusions improve? Can opiate induced psychosis be permanent?
After the accident they put him on Risperdol but only .5 mg…any experiences would be helpful.

Anyway, my question is: do opiates actually cause delusions/psychosis (or what is the right terminology) and once he is off for a period of time might the incidence of delusions improve? Can opiate induced psychosis be permanent?
After the accident they put him on Risperdol but only .5 mg…any experiences would be helpful.

My guess, as an untrained person, is that the opiates have been masking/hiding his psychotic symptoms for the entire time that he's been using opiates.

Many people who have psychotic symptoms, get addicted to opiates - quite often, heroin. They use these drugs to 'shut up the voices' and to otherwise 'self medicate'. Others use alcohol in a similar way.

The substance abuse rate for people who have one of the major psychiatric disorders, is rather high - something around 50%.

When the person stops taking opiates, their psychotic symptoms appear to be much worse.

Basically, when the opiates are no longer being taken, the psychotic symptoms are free to do their thing.

Opiates do, in fact, hide psychotic symptoms. But opiates are not a good treatment for psychotic disorders. They are addictive, for one thing, and put you in with a criminal element who does not care about their customers, and for another, the drug is often 'cut' with other materials so they make more profit selling it, and those materials can be toxic. Plus often the concentration of opiate varies from batch to batch so one day the person gets x amount and the next day, gets a fatal dose.

If I were to make a comparison, I'd say that opiates are like just shutting off the whole nervous system by whacking it with a hammer, where as antipsychotic medication actually treats the disease that causes the symptoms.

When you STOP whacking your nervous system with the hammer, well, the mental illness has still been merrily chugging along doing its damage, all that time. So opiates only mask, rather than treat, the illness.

The trend today is to start treating the mental illness as soon as possible with appropriate medication, and then try to help the person stay clean and sober - and hopefully, one coordinated team does both - not two separate offices or groups.

Clearly, medications for psychosis can't do their job very well when a person is using opiates or alcohol, but the hope is that medication may help the person get some insight into his situation.

.5 mg isn't much medication for an adult. That's odd. Maybe that's just as much as he would agree to take, maybe that's just his starting dose (smart docs often start with a low dose and gradually increase - that avoids a lot of side effects) or maybe he has some other metabolic or organ problems from taking opiates, I dunno.