My mother (86), who was diagnosed with Lewy Body Dementia in 2020 (with symptoms becoming noticeable as early as 2018), has become dependent/addicted to a couple of different medications. It seems so strange this late in life. She had a serious back injury back in the 70's that caused her daily severe pain. She worked full time as a nurse practitioner until she was in her 70's. Due to the need to be clear headed and focused, she refused to take anything other than Ibuprofen. She also suffered from migraines, for which she occasionally took Imitrex. She didn't like the way the Imitrex made her feel, so she quit using it and made do with Exedrin.
First drug problem: In 2019 she told her PCP that she was having tension headaches. He prescribed her Fioricet (butalbitol/acetaminophen/caffeine) for OCCASIONAL use for headaches. He prescribed 30/month, and for a long time, she only had to refill it every few months. In late 2020 she began taking more. In 2021, she went through 30 pills in two weeks. I tried to explain to her that Fioricet is famous for causing rebound headaches. When I suggested to her that she try cutting back, she adamantly told me no, that she has to have them and that I don't know what I'm talking about. We got her doctor involved. He explained to her that she had become dependent on them, and had us start cutting her dosage until we got her completely off them. That was a monumental task, as she would beg, cry and yell about needing it.
Drug #2: In mid 2020 she expressed acute back pain. XRay showed a mild compression fracture. PCP prescribed 2.5 - 5mg of Norco. Helped ease her pain, but definitely affected her balance and made her groggy. Based on a follow-up XRay and her complaints of pain, doctor refilled 2 more times. She then told PCP that the pain was still unbearable. He refilled for only 2.5mg, and told her she needed to wean off of it. She was completely agreeable, while we were in his office; at home was another story. She watches the clock, waiting for 2:00 so she can have her pain pill. When I reminded her of what her PCP said, and that we need to be cutting back so we can get her off the Norco, she became very distraught, literally wailing, "No, no! I have to have it!" Same reaction every time I mentioned it. She began hiding her pills and telling us we forgot to give it to her. (We had, by this point, already been checking for and finding her hidden pills.) She was still watching the clock, waiting for 2:00 - it's like her day revolves around taking that stupid pill. After asking her PCP if it was okay, I began weaning her off the Norco. 2.5mg is half of a 5mg pill. I got some plain white acetaminophen caplets and began swapping out a half caplet of it for one dose of Norco, until I finally had her completely off of it. She still thinks she is taking Norco. She still watches the clock. She doesn't know the difference, which tells me she's not actually addicted to the drug. Seems she is more addicted to the routine of taking it. I let her PCP know what I had done, so now when mom asks for a refill, he tells her he'll call it in.
Her behavior when told she needed to quit taking it, along with seeming to live for her next pill, reminded me of an addict waiting for their next fix.
I am just curious as to why she would become an addict so late in life?
Your mother is not an addict if you were able to wean her off of low dose Norco and replace it with acetaminophen. She has dementia and her brain is misfiring.....sending out signals it shouldn't be. Plus, chronic pain mixed with dementia is no joke and pain pills make things just a bit more bearable in a life strewn with difficulties. To you her day revolves around taking a stupid pill. To her, with pain and a broken brain, she's come to rely on it as her comfort.
I never thought I would be requiring opiates on a daily basis, just so I could stand up and walk and do my life without the searing pain of a bad back.
I started out on a big dose of Norco prior to 2 back surgeries. Very slowly, my doc cut me back from 10 mgs Norco, to 7.5, to 5, to 2.5.. then i went to Tylenol #4 (60 mgs of codeine) and now am stable and relatively comfortable on Tylenol #3.(30 mgs of codeine) We tried Tramadol, but it was useless for me.
I have to see my PCP every 3 months for refills. I can't have bad days and take extras. So a lot of responsibility is on me to 'behave'.
I'm not proud of this. But I want to have some quality of life and this is what is my life. I do PT, try to move as much as possible and not give up and spend my days packing a hip, back or knee in ice so I am, well, able to stand the pain.
If were 86 and my kids were doing this to me, I'd slap them into tomorrow. If she is legitimately in pain, why withhold the drugs that help her?
I recognize the opioid crisis--but I know (2 drs in the family) that the actual % of abusers are not regular folks, but DOCTORS and people in the healthcare system. My DIL is an anesthesiologist and she has 2 drs who work for her who are addicts. They are constantly on probation--she still employs them, but does strict drug testing. She's the one who told me that anesthesiologists have the worst track record as to addiction/abuse, but it's a dirty little secret.
The pendulum has swung so far away from center--and people are suffering. we'll see some relaxing of the intense fear docs have of prescribing these meds. They have a place in helping people have more comfortable lives.
I have this memory of my poor dad, in agony from a fractured back, trying to hold out the 4hrs between his Percocet doses. He'd literally cry he hurt so bad.
So, yes, he died "addicted" but out of pain. (Morphine from Hospice saved his sanity).
You can tell I have a real beef with the AMA or whomever it is who decided to withhold medication from people.
The irony of all this, to me, is that our local 'drug dealer' (the teenage kid who sells to whomever has some cash) NEVER ran out or couldn't get what you wanted. My mom couldn't even get Tramadol, but her next door neighbor could acquire ANYTHING 'cause he had hookups.
Sorry--this is kind of a hot topic for me.
Our church just hosted a visit from the in-patient women of MN Adult and Teen Challenge, a nationally well-known and highly successful recovery program. The "patients" give their testimonies about their lives and recovery. MANY of them are Grandmas. Some of them didn't become addicts or drunks until much later in life. Your Mom is no different.
My sweet lil' MIL became addicted to Oxy when recovering from a broken back. We didn't realize it until very late, because no one "suspects" a timid, grey-haired Granny to be an addict. She was over-medicating herself and running out of pills too soon. She freaked out about getting her doses. She acted no differently than a heroin addict. We did eventually get help weaning her off the oxy.
Please consider a long-term program for your Mom so that she finishes strong in life. Adult and Teen Challenge is an 18-month in-patient program with a 68% success rate and a very high second recovery rate (falling off the wagon once out of the program, but the patients are given good tools so they can "right" themselves more successfully). The programs are long-term and in-patient. Maybe watch some episodes of the cable show, Intervention. It's very eye-opening.
Age goes bring some quite dreadful complications so it's important that the POA for your Mom let all MDs caring for her know of her addiction. It is crucial that your Mom never enter care, hospitalization, rehab without all being aware of her addiction, as sudden withdrawal of her meds could result in serious--even life-threatening-- reactions.
Addiction is much more common in our aging populace than is generally recognized. I have a good friend with lifelong back, leg problems, who is s/p hip and knee surgeries and must use braces and Canadian crutches for mobility. She is in her late 70s and badly addicted to both uppers and downers. It is recognized by both herself and her doctor that is is addicted.
It began in 2020-2021 when even the doctor agreed that she had a problem with a drug and he prescribed yet another drug that has addictive tendencies.
You are right that it is the routine of taking the medication.
Many times with dementia some OCD tendencies kick in so watching the clock does not surprise me. (try this...tell her the doctor said instead of taking the pills at 9am and 2 pm he wants her to take the pill at 8am and 1pm...I can almost bet that at 2 she will want that pill)
But..addiction can happen at anytime. Often older people are seeing multiple doctors and sometimes even using different pharmacies so there is no clear record of what they are taking and how often. Not to mention that older people are very often over medicated. And getting older confusion can happen and doses are mixed up or taking extra happens.
When things like this happen it is time for a caregiver to step in and manage meds or the transition to Assisted Living or Memory Care often happens as it is unsafe to leave the person home alone.
https://www.goodtherapy.org/blog/drug-addiction-among-senior-citizens-a-growing-crisis-0405197
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