Right when I think I've made good progress with acceptance, coping, etc something ELSE comes along and I don't know how to deal and just want to scream.

Since late 2014 my mom has been taking opiate pain meds. It started out legit with a major shoulder surgery, but after that healed other pain ailments started popping up, mostly back pain. I didn't see her as often then and she always downplayed her use. As the years went by I noticed she always had a script.

Eventually an MRI of her entire back was done & it showed nothing to warrant chronic pain let alone pain that required daily opiates. So that doctor stopped prescribing and referred her to a pain management place.

I know she got pills from them but also injections that "never worked" & the scripts continued. Still the whole time she minimized her use saying she only took them "once in a while" when she was "really in pain".

Then she moved here.

Found a PC right away & he would not prescribe opiates & told her she would have to go to pain management. So she went to a "wellness" clinic of some sort, basically where people go to get pain pills. She had to sign a "pain contract" that she could only get pain meds from them.

By this time I'm paying closer attention & even mentioned it on this board before. Again, she played the game & got pills and injections but the injections never worked. She would never let me go to those pain appointments & keeps me totally out of it. So I started to count her pills. I was able to determine she was taking between 1-3 a day, depending on her supply. This whole time she lied to me when I would casually ask if she had needed any pain meds lately... "Oh no, only every once in a while". Meanwhile I'm counting the pills and know that's a lie.

Talked to my sister & husband about it. Mostly my husband because my sister is out of state & likes to keep this situation at arms length & always has. We decided not to confront her because the use didn't seem excessive. My impression was that she used the pills to kind of regulate her mood. I was also afraid that if I confronted her & told her I counted her pills she would hide them & make sure I couldn't do it again as her defensiveness around me has gotten worse with time.

When she left for PA she left with 150 pills. My guess is she told the pain doctor she would need them for several months, but what happened is when she got to PA she got a pain doctor there too.

Anyway- I have no idea when she had her last opiate but by her second day here she was complaining of tooth pain & made an appointment for the dentist. Turns out all she needed was a cleaning. No other issues. No reason for "pain". Then some vague complaints of abdominal pain started, but nothing too bad. She then went to an Urgent Care center, without telling me & only told me when she got back last Friday that she went "because my side has been hurting". She got checked out but they did not give her any opiates. Just said it was likely muscular. That Friday she made an appointment with the pain doctor for the following Monday (yesterday).

Sunday we always watch football, so I invited her over to eat & watch the games. She came over but left after about an hour. She ate & seemed okay. Next thing I know she calls me and wants me to take her to the ER for her pain. I was afraid not to so I had to call Uber to take us since I had drank 3 beers.

LONG eve & she got admitted. End result, all scans & tests were negative. NOTHING wrong, but she got some opiate doses. She canceled the pain doc b/c she didn't think she would be released but she was by 11:00 the next day, with NO opiates. Her nurse told me she had "concerns" about the opiates.

We're home less than an hour and I see she is gone and track her. She's at the pain doctor even tho her discharge instructions were to take Tylenol. Later she lied and told me she hadn't gone anywhere.

I'm at a loss as to what to do about this.

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I know your mom has been diagnosed with dementia. My MIL has begun to travel the road of vascular dementia. There are things that are way off while others seem perfectly reasonable. One thing I have really noticed in her is that some traits are really enhanced. In MIL case major case of vanity. (To the extreme) Doesn't want to use her cane or O2 in public because "they will think I'm old", um you're 92, you are old tho I'd never say it to her. Oh these bags under my eyes, I need to do something about them they're terrible, maybe I should have a doctor remove them. Oh look at this wrinkle, how am I going to get rid of it. And on it goes. She can be stubborn and sneaky, she has also lost her stops and doesn't care what hurtful things come out of her mouth as long as she gets her own way, I actually stand there and watch her take her meds so I don't find them later. She can and does manipulate people to try and get her way when told no. Your mom has been addicted for a while and is use to manipulating everyone to get her fix. These actions which are ingrained into her way of thinking may be enhanced. She will appear more convincing and more adept at obtaining them for a while. The hiding her problem and lying about taking the drugs or getting a new refill are also her old normal. You've got a can of worms going on. As her poa and her diagnosis of dementia is there any way you can have a meeting with her doc, set an appointment up for her the following week, have her admitted to the hospital for "testing" to find the source of her pain and then have her transferred to detox unit? In my opinion, an outpatient program would not work. Too many do outpatient programs because they are ordered to and stop off to get their fix on the way home from meetings. Depending on how she is doing after detox, time for placement for her safety and your peace of mind that she will not be able to go to pain clinic and relapse. What's going to happen when she forgets how many pills she took and overdoses? Tough decisions and tough love needed to help her and by extension helping you and your husband. Either that or time to make the state her guardian and you jump off the carousel before she drags you down any more than she has.
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I am so very sorry for the situation you are in. It’s horrible. I lived with a heroin addict since I was 7 years old. My oldest brother got hooked at 13. He succumbed to peer pressure with his best friend. The rest is history. It’s a long road to travel with lots of bumps along the way.

Yeah, he tried methadone unsuccessfully. It’s sad that I have memories of being in the car parked outside of a methadone clinic as a little girl. There are so many memories that I wish I could erase from my mind. So many things that a kid should not have seen and heard. The worst was watching him overdose. About the only positive thing that came from it is that I have never nor will I ever stick a needle in my arm.

Addicts will do ANYTHING to get a fix. They can’t help it. It’s a medical issue. No one truly wants to be an addict. It usually takes more than one stint in rehab to beat these demons. Hell, even a stint in prison didn’t help my brother beat it. They do drugs in prison.

He tried getting drugs from the pain clinics but he always tested positive for street drugs so he would be turned away.

When he got HepC I arranged for him to go on hospice. My Lord, he tried lying to the hospice nurses by saying his OxyContin meds fell on the floor and he stepped on them or he dropped them in the sink and they went down the drain. Nurses aren’t stupid. They didn’t buy his crap. He quit hospice at that time and went back to buying heroin on the street.

He had a horrible motorcycle accident, just about died but he had such a high tolerance for drugs that what they gave him in the hospital didn’t even take the edge off of his pain. He actually asked me to go score heroin for him. I went out into the hall and broke down. A lovely nurse told me to cut him off and take care of myself and my mother would have to deal with me no longer caring for him. It was hard. I loved my brother. I hated the addict. I had limited contact with him, then eventually no contact because he made my life a living hell. Even though he didn’t want to hurt me, it’s what addicts do. I stepped away for good. He was furious with me for not going to buy heroin for him.

Then one day I got a phone call from his friend. He was back in hospice. He was like a cat with 9 lives. He walked out of the facility. Shortly afterwards though he went back in. I took my mom to see him. Everyone was there. I forgave him. He died. That was how my brother finally quit drugs. I made arrangements for his cremation and burial.

I always told my kids that if they followed my brother’s footsteps they would possibly end up with Aids, HepC, in jail or dead. My kids told me the reason why they didn’t do drugs was because they saw the devastation that it caused.

He had a good heart. He did many good things in spite of being an addict.

At one time he even owned his own business and was successful. He lost his partner and his business due to drugs. He was controlled by drugs but somehow controlled it too. I would see him throw himself into a room and ‘cold turkey’ it. Was bizarre. Most people cannot do that. But the urge to go back to using always sucked him in.

I tried so hard to help him. I begged him to do rehab. They have to want it to work. You can’t make them. I pray that you will be able to resolve this issue. It is so difficult and challenging.
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Piper, BEFORE her PCP visit, write out a list of what you've told us about the opiates, the driving and whatever else is relevant.

Send it to the doctor by certified mail. Pass a copy to the receptionist before you go in on the day of the appointment.

This way, you've put the doc officially on notice about her unsafe behaviors and the opiate addiction.

Yes, she'll blow a gasket.

So, what? Her anger can't hurt you. You are an adult. It's time to stop letting mommy make you walk on eggshells.
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Ppiper, explain to me how that dx and recommendation from her doctor NOT add up to your POA being in force? Has the lawyer seen the paperwork from the doctor?

I think in your shoes I would tell mom I'm resigning as her POA and she can manage her own life from here on in.

You are going to drive yourself mad trying to tiptoe around her. She needs a professional guardian that cant be manipulated.
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Piper, is there anyway you can open the conversation with your mother about her drug problems without revealing you have been counting her pills? Just talking about the fact that she is still using opiates years after her injury and then expanding into all the problems/side effects of prolonged use? including adding to her cognitive and balance problems? How once someone becomes addicted, a doctor's supervision is necessary to stop?

I would look for a rehab program (maybe outpatient) with experience helping seniors with other health problems. They may be able to advise you how to get your mother into treatment. Even if your mother remains on an ORT drug for years, it's much safer than the opiates.

You may have to pursue guardianship to get your mother into treatment and keep her clean. Vascular dementia is "strange" in that some regions of the brain are very degraded at the same time other areas still seem to function almost normally. Some states have granted limited guardianships over adults (not just seniors) based on just drug addiction. I suggest you consult an elder law attorney to see what the legal environment is in FL.
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This is a post date 3/31/2019 from ExhaustedPiper:

Have you noticed any other changes? My mom has vascular dementia with significant memory problems but I also noticed a change in her executive functioning. She wasn't just forgetting things, she was making bad decisions. Things that would never come to pass, like wanting to buy a pontoon boat when she can barely walk across the parking lot. She brought this up AGAIN last night. It's bizarre how she thinks she can own this big boat HERSELF and also navigate it in the intercoastal waters! 

So dementia is more than just being forgetful. At least in what I am seeing.

You could ask your mom's doctor to give her a short evaluation. It's called a MMSE test. It's a screening test, but your observations are also very important. I wrote mine down for the neurologist and it was helpful.

Good luck. I hope you are NOT dealing with dementia.
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I'm stuck on trying to image someone with dementia being as successfully sneaky as this mom. Are you SURE she has dementia? I just had a discussion with someone who came into town to their parents' home to help the dad for a medical problem. Then they realized their formally all-together mother was a confused mess. She was taking who-knows-how-much of her Tramidol and Ambien. Hiding pills all over. Not remembering what she had taken and when or how many. When family and docs finally discounted any other medical problem, or lasting effects of the over-medication, they diagnosed her with dementia. But prior she was not able at all to go about to doctors looking for more meds or figuring out how to refill her prescription. My own MIL was addicted to opioids after back surgery. We realized this after she kept running out of pills too soon every month. But she had short-term memory issues and was totally unable to figure out how to get more meds from other sources. I keep reading Piper's posts but for the life of me I can't understand how someone with dementia can behave like her mother. Did I miss where it was posted that the mom was formally diagnosed with dementia by a doctor? Nothing about the addiction behaviors described indicate the mom is incompetent. I think this one piece of information is essential to what kind of path Piper will need to take in dealing with her mom.
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Geaton she was diagnosed last Spring following a neuro-psych exam. The exam itself took about six hours and she did it over two days. The diagnosis was Major Neurological Disorder, which is the new word the DSM 5 uses for dementia.

The recommendations included that she stop driving, have supervision and that her pain control involve an addictions specialist (among other things). That was based on her long time use of opiates and mixed reporting in her medical history regarding alcohol.

My mom does not willingly comply with anything. She resists anyone, especially me telling her "what to do". She now "hates" the doctor who ordered the neuro-psych evaluation and refuses to go back or even acknowledge it happened. At the ER she told the admitting doctor she didn't have a neurologist in this area yet because she just moved from PA. Total lie.

Yeah she sure is resourceful isn't she? Scarily so. I can tell you one thing, I won't be taking her to the ER again for "pain" unless I see actual distress. Oh and here's a kicker. My career was in nursing. I still have an active license and worked for over 20 years in the field. I am trained to notice distress. But with this fruitcake who has this pathological emotional hold on me I may as well not have had any training at all.

I am really angry over this latest opiate stunt. Last night my husband and I were over at her place because she made soup and invited us over. I could tell she was feeling good now that she had her opiates, but for show she had to voice complaints about her "pain" and would rub her rib area, while denying she went anywhere after we came home from the ER. Meanwhile I checked when she was distracted talking to my husband and she indeed had a new bottle of pills.

She's lying to everyone to keep getting these opiates, and unless the doctor giving them to her is completely unethical she's lying to him too. I'm facing that this needs to be confronted I just don't know exactly how or when.
Great suggestion about getting social services involved on next er trip. Dementia and you have medical poa, they can assist in getting her admitted to detox, medically controlled since it is opioid addiction, then once clean on to AL facility where she will not be able to access them or get out to refill her perscription, especially if facility is aware of her issues, they will take appropriate steps to ensure she has zero chance to get more. As medical poa you can "lock" her down in AL. No trips unless she's physically with you and only you. She knows how to play others and will do so to get her fix. Be prepared for her to promise, be sweet, transform into agression directed towards you, accusations that she needs meds, how cruel you are. Ignore it, especially when in front of her. You can break down later when you get home. Alanon is a great suggestion, they can help teach you how to deal with your situation that is good for you. Good luck, keep us posted.
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Piper read the durable POA. It may have gone in to effect the moment it was signed.
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I suggest that u call the neurolgist and see if his findings include incompetence. If they say she is incompetent than ask that a letter be written so ur POA can go into effect. You will now be the Parent and her the child. Yes, its hard and she will fight you all the way but you need to know u are doing it for all the right reasons. As her Dementia progresses she will become like a child who can no longer make informed decisions. Know that this will not be the Mom u grew up with. Your job now is to keep her safe. It is no longer what she wants, its what she needs.

I had a hard time with Caregiving and my Mom was fairly easy. Mom went to an AL, better but I still had certain responsibilities. Money ran out so she went to LTC. Her Dementia was in the last stage. I found a really nice NH. Mom was always clean as were the residents. So I allowed them to do her laundry. All her needs were met and my responsibility was to visit. Please, don't take Mom into ur home.
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Oh, and DON'T show up at the ER. If they see she has no support, she'll get help.
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Piper, try this.

This is not YOUR mother. This is Barb's mother. This is the mother of a dear friend, but this mom has always been somewhat selfish, narcissistic and has a "my way or the highway" attitude.

What would you advise this friend to do?

We all know that you can't save an addict if they dont want to be saved.

Frankly, other than telling her treating physicians what you suspect, I don't think there is a lot of intervention you can accomplish on your own.

How about start going to AlAnon meetings and let mom's chips fall where they may?

Yes, she might die. But perhaps THAT is precisely what she is seeking.
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I would tell you to stay far, far away.

Thanks Barb. Ultimately it probably will come down to letting the chips fall.

Last night I was thinking about how I fear and avoid confronting her, like her wrath is the ruling force of the world, but really, when I break it down I can see how irrational my own thinking is on this.

If she gets furious and doesn't speak to me, so what? If she decides she's going to be her resourceful self and move, that's even better.
Barb I don’t know why, or rather I don’t know why after so much therapy I can’t control it when I thought I was doing better. Logically I know I should just be assertive and take control of the situation. But I couldn’t do it on Sunday in the way that I should have.

I’m going to keep trying. I’m also aware that I can’t take forever to get a grip. That ER stunt was the worst one yet by far. It had to be WD which puts this on a different level. I must deal with it.

I’m trying to figure it out step by step at this point. First I am going to see how much she got from the pain doctor and check her pills when she leaves to see how much she is taking. I have a feeling her tolerance increased over the summer and another WD situation will be coming and as Alva pointed out WD can’t be ignored. I have to balance my resentment at her use and lies with the fact that she needs compassion because when someone is physically addicted it’s no loner just a psychological thing.

I did discretely tell the nurses at the hospital she had a dementia diagnosis from a local neurologist but her deficits were obvious so they knew, I could tell.

Since her tests there were negative as far as gall bladder etc she got the boot pretty quick.

She is refusing to go go back to the neurologist that resulted in her diagnosis so I don’t know if calling them will help? But she does have an appointment with her PC in two weeks so maybe I can do something there? He refused to prescribe opiates from the start but as far as I know he’s not suspected addiction/physical dependence.

Thank you for the support, it helps more than I can say.
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I Think I read somewhere that people who have taken opioids over a period of time when they go off of them feel pain where there isn't any. I just read that you need to be weaned off of them. Which I feel a pain specialist should be doing that for Mom. Finding other alternatives not continuing to give her the opioid. I wonder who Mom is going to. Pain management teaches you how to control your pain. Not making u an addict in the process. Read this article.

If it were me, I would have Moms records sent to the new PCP. I would ask for an appointment to see the doctor and pay out of pocket for it. No, he can't discuss what has been done for Mom and why but u can tell him what you see. The phantom pain she has. You can request that she have a blood test just to see how many pills she does take. And then tell him about the pain management, not working. Here's another article about how over time opioids lose their effectiveness.

Does ur Mom have Dementia? If so, she may be just imagining the pain.
With Dementia there comes a time when family needs to take over. Try to get Mom to an neurologist. Tell a white lie and say he maybe able to help with the pain. Make a list of what you have been seeing and give it to the receptionist. It will help the doctor ask the right questions. Tell the receptionist you are there for a competent evaluation because Mom is not handling her healthcare correctly.
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I read your update for us, Piper. You say your mom has dementia? Is this diagnosed? Because you also say she is NOT incompetent. If she has dementia why is she still driving?
You also say that you have POA. But that you are afraid of her and what she might do "if she gets angry". That you cannot even speak to a doctor out of her hearing. At this point I cannot tell if even her doctor thinks her competent. If she is competent your POA doesn't figure in anything at all.
You are wondering if this could be cut down to 2 pills a day. Nope. Not at this point because from what you are saying she is currently using many more than that. And likely no one knows just HOW many. This escalates badly and you are not a medical person, not in any place to titrate down her medications. At this point that will have, likely , to be done in a facility, especially if she is demented at all.
This is a terrible situation. Terrible. But no worse than any other family member out there dealing with this, exCEPT for the dementia and your having POA for her health care.
IF Mom is suffering from dementia, you need to speak with her Doctor and tell him/her how she is getting the drugs and you need to do that without her if you are her health care POA.
You need the help of Al-Anon NOW. If not yesterday.
As to being afraid of your mother, she is currently an addict. An addict will do anything from cheat, steal to threaten. That is what an addict is and what an addict does. Her anger doesn't figure in anything.
You have only one other choice, and that is to walk away. Resign as her health care proxy if you intend to do this. Let her deal with her addiction, which will almost certainly kill her. IF indeed she is demented enough to be out of control I am afraid you must act.
If however she is "competent" them you need not. And other than telling her you are aware of her addiction, if she is competent there is little else you can do.
At this point I cannot tell if you think she is suffering from dementia or not (someone suffering from diagnosed dementia is not competent in decisions).
I am so sorry you are going through this, but right now the least of anyone's concerns needs to be whether Mom is "mad" or not. Someone hopped up on opiates is frankly quite easily mad unless they are also scoring downers. Which she may be.
So sorry you are going through this. There just aren't any happy choices here. You may decide that there is nothing you can do but be supportive to her where you are able. If that is the case I surely understand, but lock up EVERYTHING, and freeze your credit. And get the narcan dose.
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Why are you so terrified of your mother's anger?

You are trying to save her life (and with the driving issue, the lives of others).

Why didn't you say in the ER, "My mother has been diagnosed with dementia by a neurologist here. Here is his/her phone number and contact information".

You have a DURABLE POA. When she is in the ER, you have the opportunity to get things put in motion to get her declared in need of supervision. Next time this happens, get social services involved the minute you get there and spill your guts to them. They've seen this all before, many times.

I'm so sorry if this sounds cruel or cold. But you need to stop being afraid of your mom. Stand up to her and say something like "no, mom, I can't let you do this".
Helpful Answer (1)

Piper; I don't have a lot of advice for you, just huge empathy for you in this increasingly unbearable situation.

Have you spoken to your mom's doctor (her PCP or her neurologist) about this?

I assume that she is still driving, and doing so "under the influence" perhaps?

I think in your shoes, I might call MY OWN lawyer and ask what protections you need to put in place so that your mom doesn't forge your signature on something, take out credit in your name or other actions that might ruin you. Addicts will stop at nothing.

Demented addicts? ALL bets are off.
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Thankfully, the medical community is more defensive about prescribing opiods anymore, although the determined addict will work very hard at getting them. You can contact a drug rehab clinic and talk to a counselor and maybe discuss an intervention. You can only do so much, but that's probably as much as you CAN do...except do not enable her in any way (that's where AlvaDeer's suggestion of Al-anon is spot on). You need to know very clearly what enabling is and looks like in your relationship if you don't want to be part of the problem. Also, lock up your valuables and mind your wallet when she comes to visit. Seriously. Yes, the addiction will cause your mom to steal from you. I'm so sorry for this situation and your mom is yet another victim of those drugs. FYI I think it's Narcon that they use for overdoses. Peace to you in the midst of all of this.
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AlvaDeer Oct 2019
Yes, thanks. I couldn't remember narcan. Think it goes by another name now as well, nonoxalone or something. That should be on hand. And wow, Geaton, good on the locking stuff up.
I am afraid these pain clinics still exist, esp. in the South, and they give these out like candies to this day. My friend is in California and she is having a hard time getting her "stuff" now, but I think close to time in this state where you will be forced onto the street or not at all. The hospital ERs are sincing their "drug seekers". And the info is being spread. But wow, what a problem.
If anyone withdraws this woman suddenly, as in no more opiates she could well die. You know that, I hope. She needs pain withdrawal help. With access to the "pain clinic" (and I didn't even know they existed anymore) she will get her opiates. I have a friend who is addicted and this is recognized by both her and her MD. She has the pen to address an accidental overdose (works like an epipen, but has the instant antidote to opiates) and you need this on hand as well.
In all truth there is nothing that you CAN do about this but do not EVER let her move in with you, stop taking her to ER, and level with her; the entire family to meet with her and tell her that she is suffering from addiction. Do not get POA for health care for this woman if you don't want to suffer what the families of addicts across our country suffer.
When she is admitted someone with her should suggest drug testing on blood so they know what they are dealing with.
And above all, when she chooses (IF she chooses) to stop it must not be sudden, or indeed it will end tragically almost certainly at this point.
You need now to go to Al-anon, and you need to get all the information you can on what you can do. You are the daughter of an addict. I am so sorry. You are not alone in this nations where Moms, Dads, Sisters and brothers, children, friends are trying to deal with rampant addiction.
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Thank you. At the ER and when she was admitted Vicodin PRN is listed on her med card, so they knew. Her blood work only showed impaired kidney function but that is not new.

I know she got a script yesterday so she won’t go into WD anytime soon but I know this needs to be addressed.

Alva I don’t know how to tell my mom I’ve basically spied on her to find out what’s been happening, she will be so furious I can’t even imagine and she will go to great lengths to make sure I can’t do it again. Even at the hospital when I was a short distance away from her and talking to the doctor giving him basic info for her admission she yelled from the bed “Come over here and talk to ME!”, meanwhile he had tried and she was all over the place with basic questions so he wanted me to answer so it wouldn’t take forever. Her cognitive impairment was apparent to them I’m sure.

At times I don’t know how she can be so resourceful, like with her drivers license and scoring these pills yet she also has dementia. Maybe because she was always so smart and lived independently for so long? My dad died when she was 54 so she’s been living alone for 20 years. Oh she also told the doctor she didn’t have a neurologist here “No I didn’t get one yet, I just moved here from PA”. So afraid they might find out about her diagnosis.

For now, as in the coming days I am going to check her use. Do you think if she keeps it at no more than a few pills a day I should make an issue? Is it harmful, physically, if she doesn’t go into WD? I need to find the answers to those questions. I don’t think she risks taking too many because she doesn’t want to run out, but I’m going to look into that pen you mentioned that seems like a good idea to have just in case.

I’ve also considered talking to the pain doctor myself and asking him to wean her off appropriately, even though he doesn’t have permission to talk to me, she made sure of that. But again if she finds out I contacted him she will be livid.

BTW I do have a DPOA, but I don’t see how that matters here, what am I missing? She’s not deemed incompetent so I was under the impression it is useless unless she instructs me to act on her behalf.

Thanks for listening and the advice.
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