Mom and Opioids

The opioid epidemic hits one of my nerves, partly because I believe it had a lot to do with my mother’s death.  It was more than a decade ago.  She was 86 and had underlying health problems, so her prospects for a longer life were limited anyway.  But I think her life over the previous fifteen years or so could have been more enjoyable and less anxiety riven if not for opioids.  
It’s hard to know when it started.  It may have been with some hairline fractures in her lower spine that caused a lot of pain, and for which she endured not altogether successful surgery.  Never one to tolerate physical pain easily, she was given opioids to “keep ahead of the pain.”  She never got off them.  It might not have been so bad had her physician monitored them, but she had several physicians, and they all got into the act.  It wasn’t just opioids.  Her pill box contained dozens of daily doses to treat all kinds of things – I have no idea what all the meds were for.  After dad died our visits became more regular, though she lived 2,000 miles away, and with each one my wife would try to get them organized to be taken in order as prescribed, but there were so many.  Mom would often forget if she had taken her pain pills on schedule, and she knew she had to “keep ahead of the pain,” so just to be certain would take another.  And was it half a pill, or a whole one, or one and half – it was all so confusing.  I have two sisters, one of whom lives not far away, and she recalls doing the same on her visits.
A few years before her death, she signed up with a local doctor who took over supervision of medication, and made house calls to see that all was in order.  It was not inexpensive, and it didn’t last.  He got a big offer from a large research hospital and was gone too soon.  There was no replacement.  In her last few weeks we had to evacuate her from hurricane threatened Florida, and get her into assisted living in our home state of Minnesota until the hurricanes had passed.  Getting ready for the trip I counted up all her opioid prescriptions and realized for the first time that her daily dose would probably kill me if I took them, but she had become accustomed to them, certainly not addicted, perish the thought, they were prescribed medicines.  
She hated assisted living.  The facility was brand new, the staff abundant and well trained, her youngest daughter and family near, but she hated it.  One thing she hated most was that they took her meds away, and brought her doses as prescribed.  It was an instant and dramatic reduction in her daily intake of opioids.  I believe the shock of unintended detox was too much for her 90 pound, 86 year old body because she died within a a few days of her “incarceration.”   
I got the call from the coroner’s office while driving to our oldest daughter’s wedding in NYC. 

Mom was not some addict cowering in a back alley trying to get high.  She wasn’t one of “those” people who live in “that” neighborhood.  She wasn’t an addict at all.  She was just a woman of means doing what the doctor told her to do, ignorant and innocent.  I wonder how many like her have a similar story.  I wonder how many without her means have a worse story.  I wonder how so many physicians trying to do the right thing could get it so wrong.  I wonder how one’s medical record could be so balkanized in uncoordinated folders.  I wonder why I was only vaguely aware of how dangerous opioids could be.  I mean, for Pete’s sake, I worked with addicts, the homeless, medics, and the coroner.  It’s not like I wasn’t there to see it happening to others.

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