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My 88 year old mother lives in a county nursing home and is administered a 75 mcg fentanyl patch every 72 hours. The patch, however, delivers a rapidly diminishing dose starting about 6 hrs before the patch is changed. As a result, my mother goes through living hell once every three days. It's very clear what the problem is. The problem is opioid withdrawal. One does not need a medical education to see the pattern. But I cannot get a doctor to prescribe a low-dose orally administered opioid - like a 5 or 7.5 mg vicodin - once every three days to take care of this difficulty.


So I have been giving my mother a one teaspoon dose of kratom for the last three months... once every three days, about six hours before the patch is changed. This is very effective but what I need to know is if the nursing home can stop me. Kratom is legal and it's safe. I diverge here to say: I suspect there are many who might want to jump in at this point and caution me against giving my mother this herb. But before anyone does this, kindly educate yourself on kratom... and to do that, you do not do a general Google search or go to FDA or AMA sources of information. While safe, kratom is also effective and the drug companies are therefore trying to demonize it because it's cutting into their profits. If you want to know about kratom - and you want to know the truth - go to the AKA, the American Kratom Association. Honestly, I have no more patience with people who come hysterical off an FDA site, just have been thoroughly misinformed by said site, pronouncing doom. So please educate yourself before commenting in this respect, though this is not what I'm writing about or seeking comments on.


I'm trying to find out if the nursing home can legally stop me from giving my mother kratom. Others may say I should not do anything against doctor's advice, but the doctors in this nursing home are the most incompetent bunch of physicians I've ever met.


They've tried to kill my mother twice. The first time, they gave her a cocktail with an anti-psychotic drug in it that made her seem to be in the grips of rapid onset dementia. She forgot how to eat. She forgot my name. She sat and drooled and cried. A hospice RN recognized that the drug she was being given could cause these effects. So my mom was taken off them and she was reading National Geographic within a month! The doctor didn't have a clue that the drugs could cause those side effects and, if it was up to him alone, my mother would be a drooling vegetable or dead by now.


I'm not going into the rest of the stories with these doctors. They don't notice basic problems like congestion but they pass psychiatric drugs, (drugs with black-box warnings against prescribing to the elderly and those with dementia), out like candy. I'd have to write a small book to say it all. These doctors at this nursing home are not people who I can, in the slightest way, professionally respect. Quite simply, I need to know if I can give my mother kratom without the nursing home interfering. Bringing this up at Plan of Care of meetings won't work; everyone there stands staunchly by the doctors. There's a deep inhibition against letting even a shadow of doubt emerge regarding their pronouncements. So again, the question: Can I give my mother this legal herb, kratom, even if the nursing home disapproves? Can it stop me?And if no one has the answer to this question, does anyone know where or how I can find it? Internet searches on this question are leaving me without an answer. Thank you.

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In the two nursing homes I’m familiar with giving a resident ANY kind of “medicine” is a huge no-no. The one my mom is in even has signs posted everywhere against doing this. They even consider vitamins & over the counter eye drops as medication. If you get caught doing this, it will cause serious problems. Especially if the nursing home administers something that reacts with what you’re giving her.

My mom is on a 25 mcg Fentanyl patch which isn’t quite strong enough, but the 50 mcg kept her in a drugged stupor. (She’s supposed to get hydrcodone for break through pain but the the Nursing Home Dr. won’t follow the previous orders) I’m so sorry for your poor mom!
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Can they stop you? To be on firmer ground I think you would need to employ a naturopathic MD to review her care plan and prescribe it, and to advocate with you at a care plan meeting. If you are just going in with a sheaf of papers gleaned from the internet, especially if you are presenting information from anti big pharma conspiracy theory sites, you could very well be accused, demonized and even banned from the facility.
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Shane1124 Apr 2, 2019
I very much agree with you cwillie. Why risk all this for the OP perceived right to come into a Medicaid/Medicare regulated/ funded NH and give your mother a herbal supplement not on their formulary and without a doctor’s order? What if this causes your mother to be transferred to another nursing home because of your actions? All so you can waltz in there and self administer an herb that may or may not be advantageous for your mother’s needs?

I think it’s pretty selfish of the OP. If you don’t trust your mother being treated with “Western” medicine then take her elsewhere to an alternative provider or just don’t give the Kratom. Easy peasy. No brainer here. But if your mother suffers adverse effects don’t be looking to sue the NH. Imagine if something did happen to your mother after she received this Kratom and they do blood work to assess what’s going on and this herb shows up. Will you blame the staff?
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I certainly do respect the efficacy and potency of natural drugs. Hemlock, for example, is as all-natural as it gets, and that's extraordinarily effective. I once read that feverfew was used as a febrifuge for centuries before anyone discovered aspirin. How interesting! I thought, and nibbled on a leaf as I weeded my herb bed. I can tell you that it is also a tremendous laxative, should you ever need to know that, which I didn't at the time.

To answer your simple question: can you give your mother an unregulated but potentially potent medicine against medical advice without the Nursing Home interfering? I expect so; but I would also expect not for long. The NH might fear that if it did not take this to court at the earliest opportunity they would be liable for any harm that came to your mother as a result of their failure to protect her. They will seek guardianship. You will be lucky if you are still permitted to visit her unsupervised.

Look. The prize is improved pain management for your mother. That's all you want, and it's a perfectly reasonable thing to demand. Just don't go about it this way.

Why is your mother prescribed Fentanyl?
[They prefer the patches because the patches are much harder for abusers to steal and sell; and much easier for qualified but overstretched nursing staff to administer]

You may be right about the last 12-24 hours of each patch, I haven't checked but I wouldn't be surprised; though I doubt if the dose drops quite as sharply as you fear.

Go back to square one. Ask for a review of your mother's pain management, and ask especially for a holistic approach. Get your journal together, your observations of her over the last weeks or months.

Advocacy in this situation is very difficult because the relationship has already become adversarial. Doctors ought not to allow dislike of dissent and criticism to distract them, but they are human and they do. But no matter how far they have strayed from ideal two-way communication and discussion, it doesn't make you right, and it certainly doesn't make an association that approves of its own product a reliable source of information.

If I were you I would look for a mediator or advocate who can help you reset the relationship. There seem to be a fair few out there - choose wisely, choose one who is interested only in helping your mother, first, and you, next; and not so much in putting the world to rights.
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As someone has already mentioned, drug contra indications is the biggest concern here. They may not legally stop you from administering this, but certainly need to be aware. My mom who is on a multitude of meds....has stopped all her “natural”products since some of which she was taking was interacting and reducing the potency of the other meds.
Since you so severely disagree with the docs, and question their ability.....Is there any way to move her to a different facility?
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anonymous895340 Mar 31, 2019
I can't move my mom to a different facility. This is her home and all her friends are here. Thanks for your reply.
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I am not against using herbs. I use them myself, but my concern is drug interaction with eachother. I get that you don't want your mom to suffer withdrawals, but have you thought about the ramifications if your mom was to have an emergency and the Dr/hospital has to give her other medications and they don't know that she has been taken Kratom and how these drugs will interact with eachother?

Fentanyl is a strong drug and her Dr probably won't give her Vicodin because the Fentanyl is still in her system. Yes, she may have withdraws but the Fentanyl is in her deep tissue (in her cells) and adding Vicodin would be a bad idea. The combination of these two drugs could be fatal. Just as you giving her Kratom without them knowing could cause serious problems if mixed with other drugs.

I am not against Kratom; but I am against not telling her Drs! Drs can only make the right decisions if they have all the information. Thousands of people die every year because Drs don't know what their pts are taking! Then the Dr is the bad guy although he/she didn't have all the information.

I am sorry that you feel that her Dr doesn't know what he is doing, but like any professionals there are good ones and bad ones.

Like always you should consult her Dr before giving her anything even if it is a supplement.


Just my 2 cents!
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anonymous895340 Mar 31, 2019
Thanks for your two cents. I can't remove my mother from this institution. This has been her home and her friends are here. But the doctors are incompetent. I only scratched the surface of the problems with the doctors in what I wrote above.
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Decided to Google Kratom turns out it has dangers too, addictive and causes withdrawal symptoms. Probably would come with a black box warning as well if tested by the FDA. You certainly need to consult with her doctor and let them know.

https://www.healthline.com/health/food-nutrition/is-kratom-safe
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cwillie Mar 31, 2019
People have this belief that herbal = safe, many of these drugs are every bit as risky as their pharmaceutical counterparts, perhaps more so because they are not regulated as rigorously.
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Review her admission agreement to see if this is referred to in the admission ppwk. Talk to the NH administrator as well; she/he may have a facility policy on this. Look for something that states the NH is required by law to provide all medications written by physicians or physician extenders orders, as that may be a Medicare/Medicaid requirement and thus you would be jeopardizing their Medicare certification. *That is serious* & the NH will protect themselves from adverse effects. The NH does not have a written order for the Kratom to be administered in that center from a physician with privileges to write medication orders legally, therefore it may be illegal. Tylenol, ie, is OTC but still in any health care setting you need a doctors order (hospital, NH, rehab) for this. Seems to me Kratum is essentially in the same category.

They (NH) may ask that you sign some sort of acknowledgment to waive their responsibility if they allow it at all.

I wouldn’t give her anything without telling your mother’s doctor however but I got the impression you have told them. Is that right?

You have the right to make decisions for your mother-but in this setting collaboration may be best. If you think she needs more narcotics tell her doctors & ask for an increase in dose.

But why are unwilling to keep your mother’s doctors in the loop about your decision to give her this herb?

It sounds like a supplement with is OTC but imo I would share this with her providers.

Reverse roles here for a moment. How would you feel if her doctor ordered something without telling you?

As far as the time between fentanyl patches these symptoms are of an opioid wearing off vs withdrawal.

She won’t go into withdrawal as you are not discontinuing the opioid. Opioids are metabolized out by the liver & kidneys. I will bet your mom’s liver and kidney function are impaired and that all the fentanyl is not metabolized out yet meaning it’s in her bloodstream. It’s not out of her system (no withdrawal) just the therapeutic level may drop a bit. That fentanyl is absorbed through skin into the blood. There is no way it clears her system to zero as it is in her tissues.

I would collaborate with the doctor and inform him of what you are giving your mother. Given the info above about opiods staying around for awhile I question why you are giving it to her at all, but I am a RN & follow Western Medicine and it’s all good as long as everyone knows what’s really going on.
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anonymous895340 Mar 31, 2019
I appreciate some of your advice here but Western medicine is not all good. Far from it. Far, far, far from it.
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Why do you need their permission? My little Internet check says that it is not illegal. You can give her candy if you want, why tell them about this special candy? I take quite large turmeric doses for pain (I can't tolerate OTC anti-inflammatories), and it works for me (at least to help). Sure I've told the doctor, who thinks it is snake oil, but he can't stop me!
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I would read any contracts that were signed. Sometimes there is a clause that covers giving anything not prescribed by her doctor.

I guess I wouldn't tell them if I thought they were going to let my mom suffer every three days because of their ignorance. If you have been using it effectively for months, I see no problem.

I personally think that the doctors today are just using us as guinea pigs and if you find something natural that helps, use it.
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anonymous895340 Mar 31, 2019
You and I are on the same page. In full agreement.
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You should not give her anything that her doc has not prescribed. Yes, you should stop. Yes, the nursing home can and should stop you.

Read those black labels on everything. There is always danger in some of the population.
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