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TrentLucy

Parkinson's patient abusing opioids?

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My family is seriously concerned in regards to over prescribing, as well as the misuse of drugs with our mother.  This has been a growing concern which has become more clear over the past few weeks.  She was diagnosed with Parkinson's over a decade ago and has several doctors: primary physician, neurologists, psychiatrists, to name a few.  All prescribe her meds and there is very little communication, if any, between them.  Along with the necessary Parkinson's meds, she takes clonazepam for anxiety and has been prescribed various pain killers (Tylenol 3, hydrocodone, perhaps others) over the years (for falls with broken bones and arthritis related pain). 

For the past year we have been advocating with our father (primary care giver) that a hospitalization would be helpful in allowing the professionals to have a comprehensive idea of what meds she needs, in what dosages, and at what times.  He has been resistant to this because she has been - she claims she has her meds completely under control.  Our father continues to allow her to administer meds herself as a way of preserving her dignity - it's one of the only things she can do independently at this stage.  That being said, she is living a tortured existence: unhappy, paralyzed with anxiety, and plagued with health incidents that keep her a frequent flyer to doctor offices and emergency rooms. 

recently, after several unusual incidents (slurred speech, confusion, passing out) our concerns increased.  In the past two weeks several of my siblings have spent prolonged periods of time with my mom and we have suspicions that she is abusing pain meds.  We think she is secretly and regularly taking them, we believe she has stashes hidden; we've noticed out-of-it behavior that she attributes to Parkinson's and blood pressure problems but we wonder if it is an indication she has "popped some pills."  We have confronted her about our concerns and she has become very combative and nasty.  We have tried sharing these concerns with our father but he doesn't believe them - or doesn't want to.  He has been her caregiver 24/7 for the past 2 years and we wonder if he is (subconsciously) going the peace-at-any-price route.

Help.  How should we proceed?  I'm feel a long term hospitalization to get all her meds in order is the only way we can determine and treat all that is wrong with my mom.  If so, how do we go about making that happen?  What facilities can you recommend for quality treatment that could address all of her issues.

Thank you in advance for your response and advice.  I truly believe that what we do next can save her life.

Edited by TrentLucy

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Hi TL,

This sounds like a question that should be posted in the Ask the Doctor section of this forum. I'd guess that if your parents are still making independent decisions about their life, finance and healthcare, they won't let their children have much say over what happens to them. You're basically powerless unless your parents sign over those rights. Is there a "favorite" child, who can use that status to make some changes? 

-S

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You don't mention how old your mom is.

PD can be painful, so give your mom a break. Clonazepam is a BAD drug, and very tough to get off of. That may need professional involvement. The opiods are another matter. You need to find out how much she is taking. A few a day is not THAT big of a problem in reality. Lots of pills is a BIG problem. So you need more info.

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1 hour ago, MusicMan said:

You don't mention how old your mom is.

PD can be painful, so give your mom a break. Clonazepam is a BAD drug, and very tough to get off of. That may need professional involvement. The opiods are another matter. You need to find out how much she is taking. A few a day is not THAT big of a problem in reality. Lots of pills is a BIG problem. So you need more info.

Thank you for your response.  She is 73.  We can't be sure how much she is taking because we aren't confident she is accurately reporting her doses.  She was hospitalized a few weeks ago and when I moved her purse out of reach (for the night), she became very agitated and angry.  I found several plastic bags with unmarked meds in it.  I don't know what I was looking at but she did confess that the green pills were her clonazepam.  I witnessed her take 2 a few hours earlier and she would NOT allow them to be out of her reach.  When I argued that she shouldn't be taking any outside meds, she said she needed them in case the hospital didn't bring her her regularly scheduled doses on time.  I spoke to my dad about it and he echoed her feeling that this particular hospital disregarded her highly regimented pill schedule for what worked for them. I can understand how that would be a terrible thing for someone on a strict Parkinson's med regiment.  However, I'm worried that he believes what she reports to be taking, but perhaps what he is being told isn't the  truth.  This is just one of many, many incidents that are happening with increasing regularity which make me worry the pain and anxiety meds have become a serious problem.

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PD meds do require a fairly strict schedule.  Opioids are an "as needed" drug and other than pain increasing there's no downside to minor delays in administration.  I don't take benzos but I thought those were once, maybe twice a day at most.  If so she shouldn't be soooo worried about that coming on a strict schedule.

 

I would suggest you call something like a nurse helpline and find out what your legal options are to get a handle on the medications.  Without a medical power of attorney you can't force anything to happen.  As someone above mentioned if there's a "favorite" sibling that your parents (or at least your dad) will actually listen to you might be able to get him to do something productive.  At least figure out if she really is abusing the opioids.

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If your mother s in pain, your not going to be able to take her pain meds away. Jus because she’s asking them does not mean she is abusing them. The doctors are not going to over prescribe pain meds. All of the doctors can see what she is taking without talking to each other.  Based on the current war on opioids, her doctors are going to be very stingy in prescribing them.

My suggestion would be to talk to her about your concerns. If she wants to share, great, otherwise leave it be.

Dave

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22 hours ago, TrentLucy said:

 I don't know what I was looking at but she did confess that the green pills were her clonazepam.  I witnessed her take 2 a few hours earlier and she would NOT allow them to be out of her reach.  When I argued that she shouldn't be taking any outside meds, she said she needed them in case the hospital didn't bring her her regularly scheduled doses on time.  serious problem.

I was on clonazepam for about 4 months, 1/2 of a pill once a day. I ended up so screwed up from that small dose that it took me 6 months to kick it. I would say that if your mom is taking 2 pills at one time, that is a problem. This is the drug that Stevie Nicks (Fleetwood Mac) got strung out on. It has a very quick "tolerance withdrawal" effect.

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To me there is a difference between taking more than needed and when someone needs a drug and is terrified of not getting them when needed.  If your mom is taking what was prescribed and it works for her then she know her body.   I don't think there is anything wrong with making sure she has her pills with her at all times in case someone neglects to give them to her.  When my mom was hospitalized last year we had to write down every pill she took and show them.  I was allowed to administer the meds to my mom so I wouldn't have to worry about her missing one.  Perhaps your dad can be the gate keeper for her so everyone will have peace of mind with this.

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