Helpful advice for the journey ahead…

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Medication Education

I was having a very interesting conversation with a client last week about prescription medication, medication abuse, prescription regulation and other fun topics one would hope to discuss while getting a massage. It was so interesting in fact, I thought it would be something worth bringing up here.

This particular client suffers from a debilitating disease that causes muscle atrophy and serious nerve pain. She has been prescribed several types of pain medications, anxiety medications and anti-depressants. She brought to my attention how quick her doctors are to up her doses or change her medication. Most of her pain medications make her nauseous, so she opts for bodywork over opiates.

As we were having this conversation, she began to ask me several questions about how we dealt with the medication changes, medication disposal and other issues surrounding the mini pharmacy we were building in our kitchen.  The conversation led to stories of negative assumptions, lack of trust and disappointment in the way our medical system deals with proper medication disposal.  All issues that patients and caregivers alike will have to deal with.

For those of you unfamiliar with my personal story, I will give you a brief synopsis: My mother was diagnosed in 2002 with breast cancer; I was eighteen years old. In late 2003 she was given a clean bill of health. After a year of caring for her, I ran as far away as any young college student who was still living at home could run; Hawaii. After two years of living the dream in Maui, I received the call from my Dad stating mom’s cancer was back and in her spine this time. She had a few months to live. The call came in around 11am on August 14th, 2005. By August  15th I had my condo up for sale, my dog at the vet receiving proper medication to fly to the mainland and a flight home to California. I immediately stepped back into the role of caregiver, escorting mom to all of her appointments; which leads me to the first story about negative assumptions.

After several weeks of three different doctors prescribing numerous pain medications, it was apparent that a Pain Management Physician should be brought into the picture. By having one individual solely responsible for her pain treatment, there would be no negative interaction of medications or over medicating.  The first step was to stop taking all the medications the other three physicians (Oncologist, Radiologist, GP) had prescribed and start from scratch. The first day we were prescribed a thirty-day supply of pain med#1. Mom was to take one pill every 4-6 hours as needed. (For those of you without a math brain, that is 180 pills of med#1). After four days, it was apparent that med#1 was not close to alleviating her pain. Not to worry! Mr. Pain Man had all kinds of things up his sleeve we could try. He chose to discontinue med#1 and prescribed a month supply of med#2. Med#2 was a more potent opiate than med#1 and should do the trick. After six days, Mom had given up on med#2 as well. The pain could not be touched. After several more attempts of trying to find the correct combination of pain medication, it was suggested that she try a fentanyl patch; a time released pain medication that she would wear on her skin. The only requirement was that there be a lock box in the house and that I would have to access to this lock box.

At first I didn’t understand what Mr. Pain Man was insinuating. Once I absorbed the accusations, I wasn’t sure if I should start crying or fly off the handle.

“Are you suggesting I am not responsible enough to give my mom her medication properly?”  I asked.

“No, but I can’t allow you access to this drug. Do you know what the street value is on this?” He replied.

“Street value?? Uhhh…not a clue! But I can assure you that I would never do what you are implying!” I responded in a very defensive tone.

Then it occurred to me; this guy had prescribed us 180 pills of med#1, 180 pills of med#2, 180 pills of med#3 and 180 pills of med#4.  Mom had only used 24 pills of med#1, 36 Pills of med#2, med#3 and med#4. That left us with a combined total of 588 pills of unused medication to dispose of on our own.

It was later brought to my attention, by Mr. Pain Man himself, that because of my age (now 21)and my nose piercing ( a tiny stud), I looked like a “shady” character. I then had the opportunity to heatedly explain to him that I was in fact a successful individual who owned a home and was living the dream on a tropical island, but was willing to give it all up to be by my mother’s side in her final days. Hows’s that for “shady”?

So where is the issue here and who is responsible? This is the million dollar question. I know Mr. Pain Man had good intentions and little choice in how much he could prescribe my Mom. Unfortunately, medical insurance makes it difficult to approve prescription and it was “easier” if Mr. Pain Man prescribed her a thrity-day supply of her medications. Most of the medications mom was prescribed required a “triplicate prescription”, meaning there were three copies of the prescription; one for the doctor, the patient to take to the phamacy and one for the state regulating body. If any of my mom’s medications had ended up on the street, it could have fallen back on Mr. Pain Man.

So what do you do if you find yourself with 588 pill of unused medication? I have my own theories about how our medical system should deal with prescription disposal and help control drug abuse, but I’m on my own in that department as of now. Organizations such as Hospice and our hospital recommend taking leftover medications and placing them in a gallon size freezer bag with coffee grinds, detergent and water. This concoction will break the medication down into a safe substance.

What one should not do is flush medication down the toilet or simply throw it in the garbage can. Please take the time to dispose of the medication properly. As of now, medical facilities and pharmacies will not accept surrendered medication; which brings me to my theories on prescription abuse and proper medication disposal:

In the incident mentioned above, my mother was left with 156 pills of med#1 when she was given a prescription for 180 pills of med#2. Had the medical doctor required her to surrender the 156 pills of med#1 once she received med#2, there would be no chance of our extra medication being sold on the black market, a family member taking the medication for recreational use or the patient having the opportunity to over-consume or abuse the product. I mentioned this is only my theory, so take it or leave it, but I believe that if the medical community (doctors, hospitals, pharmacies) accepted and disposed of unused medication, there would be a much lower change of abuse.  But as of now, it is your responsibility as caregiver or patient to dispose of these unused medications in a responsible manner.

2 thoughts on “Medication Education

  1. I clicked off by accident-sorry. I don’t know if my other comment posted. The doctor probably had a few reasons for the lockbox. I’ve had 2 friends who O.D.’ed on pain meds. They forgot they had already taken them-a definate problem w/pain meds. 1 had a caregiver but no lockbox. My point is, the lock box was probably for multiple reasons. By the way, 1 friend survived the O.D. & went on to do it 2 more times. The other poerson died.

  2. This post reminds me Tory of when I returned from the hospital w/ 2 bottles of pain meds after my fibula was bolted back together. I didn’t want to take the drugs if I didn’t need so after 3 days I stopped. Our neighbor asked my husband about them saying he had some issue coming up he could sure use a pain pill for. Both my husband and I were naive about the fact that this neighbor had completely calculated that I had returned from the hospital and had meds. His request didn’t feel right in my gut and I told my husband but he was our friend and neighbor and it seemed unfriendly to question his motives or say no. So with an uneasy feeling I begrudgingly said yes. The very next day I started asking my husband to ask for them back-something just wasn’t right. This went on for a few days till finally the neighbor said he had started abusing them by mixing w/ alcohol and decided to flush them down the toilet so there was nothing to return. I’m sure he either ate all of them or kept them for the future and I was angry that I had not listened to myself. I learned later he had a past of addiction and went on to lose his marriage, job etc. We had all been friends for years and I had no idea this was going on behind closed doors. Very sad. On another note as I said in the beginning I wasn’t into pain meds. In the hospital despite my fathers lecture – “don’t let the pain get ahead of you” I tried to get around the pain meds ( a morphine drip which felt totally icky under my skin and in body) and I drank these gawd awful natural pain tinctures I had prepared from roots and herbs and meditate my pain away. After being up all night in pain and not having an ounce of sanity to wish my pain away I was a total wreck. The pain had a hold of me and I was too weak mentally & emotionally to heal anything. My father called in the morning to see how I was doing and I was a blubbering idiot. He said call the nurse and ask for some other pain med option besides morphine. I did as I was told and thank goodness. It took till late that evening for the pain to get under control and to feel some relief. When I left the hospital after a few days I stopped needing the pain meds but they had given me enough for weeks-thus the incident with the neighbor.

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