I must side with Janet on this one, at least in caution. I have been accused of being an addict. First by my previous 'stalker', who really knows nothing about what he's talking about - he's a ratbag with a big mouth who promptly told everybody, just as he had earlier accused a neighbour with MS as being anorexic - "if you don't eat something, you'll die!" even though she WAS eating, just the disease was making her muscles waste away.
And second, and this time I took notice - by my specialist.
When the specialist said to me, "you are addicted to this medication," I was hostile about it. But when I pinned him down, what he meant was, "You are dependent on this medication to ease your pain, and you've been on it for so long that your body has adapted to it so you will have withdrawal symptoms if you stop taking it."
I had earlier had a GP express grave concern about the medication I was taking. At the time I was taking a pill which is a combination of 500 mg paracetamol and 30 mg codeine. My liver function was not great and my GP blamed my codeine intake. He suggested I gradually taper off to see if my liver function improved. "Just ease back so you're only taking the paracetamol," he told me.
Rather than taper it off, I thought, "I'll show him - I don't need to taper off," and I just stopped taking it, cold turkey. Instead I took plain paracetamol. I did try to take aspirin instead, which at first was fairly effective for the pain (not as good without codeine, though) but then I began reacting to the aspirin.
Withdrawal symptoms - hardly a thing. Apart from PAIN.
I stuck it out for a week then went back to my GP. "OK, it's been a week. Do more bloods. Paracetamol on its own isn't doing much so I'm not taking it wither - a good thing, since I've found out codeine is perfectly OK for the liver, it's the paracetamol that is bad - and you wanted me to take more of it?"
I went on to explain - the only side effect I had was pain, which is why I was taking the stuff in the first place. Had I proved my point? Could he now prescribe with a clear conscience?
And here it was, a couple of years later, and my specialist is getting tongue-twisted on exactly what he means when he says "addiction". I actually rang an addiction clinic - in their mind, you are an addict if you take anything like this, whether it's controlled carefully or not. They urged me to get off the stuff. "So how should I manage my pain?" I asked. They had no answer, simply said there was no pain. yeah, right. This is MY body, mate. I know how it hurts.
I happened to be going in to hospital. One of the first people in the multidisciplinary team that my specialist organised, was the hospital pain specialist and rehab expert. He immediately overruled my specialist's concerns about my "addiction" and told him to pull his head in. And yet, I wanted to prove the same point to my specialist. I happened to be on the AIDS ward with a lot of other addicts - methadone doled out in cups - and here they were, with me refusing my pain medications because I was on purgatives anyway for kidney X-rays. "No point taking it," I told them. By this stage I was taking sustained release morphine, which wouldn't get absorbed before the purgatives whisked it out of my body. I insisted on NOT taking my morphine. Of course, the side effect of not taking the morphine was more diarrhoea, but since I had taken purgatives anyway, so what? Once I'd had the tests and the purgatives were out of my system, I agreed to take my morphine.
It's now over ten years later. I began seeing a pain specialist at the time. And what I have been taking then, and since, IS what is prescribed for end-stage cancer patients. Because it is administered and strictly supervised under the care of a pain clinic, I can get my medications. Yes, I DO get anxious if I start running out because I don't think I can do my little trick of refusing my medications any more - the dose has increased over the years but because the pain has also increased over the years. partly increased tolerance - it does happen - but mostly, increased pain because this disease (which some would call fibromyalgia, although many would argue about that, it's also been called CFS, Guillaine-Barre and MS) is moving further into my body and aggravating more nerves.
I have a lot of hoops I have to jump through, to get my medications. I can't doctor-hop because every prescription is regulated and monitored by the government doctors. I get no repeats on my prescription, I can only go to one doctor to get my prescriptions, and I have to go every month. I can't go more often than three weeks and even then, only with a good reason. Two appointments three weeks apart instead of four, and the government body the doctor has to ring to order my prescription (and who record the prescription number as well as my name and Medicare number, and the doctor's prescribing authority number plus his registration number) would refuse to authorise the prescription. "Come back next week," they would say.
If I lose any, I have to justify it. If I dramatically increase my dose, I will run out before the month is out and I won't be able to get more.
And the reason I take morphine - because it is the safest. I still have to take some paracetamol (which I also take with codeine for breakthrough pain) because the paracetamol has a synergistic effect on the morphine. Aspirin would also work the same way (better, probably) but I can't take any of those any more. Paracetamol for me now has to be rationed - too much damages the liver. Although, when we looked back through the records, we finally worked out why my liver had been so bad - my GP, in trying to ease my pain, had prescribed Tegretol. And it was THIS, and not the opiates, that sent my LFTs through the roof and made me so ill.
One day the dosage I need may finally be too great for my body to tolerate. However, it's been a few years since my last increase and I'm still managing fine without having to change my dose.
Please be aware - this is not stuff I have shared on this site before, in this detail, outside a PM. But I am sharing this now because there seems to be so much misunderstanding on this thread.
Now, back to your mother - she may be abusing her medication. I really don't know. But if the US system is anything like the Australian one, she won't be able to, not legally. And the illegal route is too difficult. Plus, if your regular doctors get the faintest hint that you have become an addict, this is notifiable and she would be in rehab so fast her head would swim. They would also stop prescribing the morphine and put her on something else instead, like naltrexone,
Some people do not have such a manageable time on morphine as I do. I count myself very lucky that I can manage my condition as well as I do. The morphine has freed me up to lead as normal a life as possible. If I were living in the UK, I would probably be on heroin, which for medicinal purposes is a better drug. You also do NOT get addicted to these drugs, if you take them properly, as prescribed. If you allow yourself to enjoy any "high", then you can quickly escalate to dependence, tolerance and addiction.
I know my body is now physically adapted to the morphine. By this I mean, if I don't take it (or I'm ill and have either diarrhoea or vomiting, and so don't absorb it) I do get some physical withdrawal symptoms. But with all this pain, who gives a rat's about a little bit more diarrhoea? I have no problems with the few, mild withdrawal problems I've had when my medications are late or not absorbed. I DO have BIG problems with the pain.
I do get headaches. I've had doctors describe them as migraine - they can be that bad. Amazingly, I can often still read a book or eat a meal. However, I get very sensitive to light and activity. If I've missed taking my morphine and I get one of these headaches, I often need an injection of antiemetic plus morphine, to block both the headache and the vomiting, and to replace what my body is not absorbing.
If your mother is abusing her medication, her doctor should be aware of it. Although he cannot comment to you, you could at least ask him to consider the possibility. However, I think by your denial of her apparent need for morphine, you are not helping the situation. All you will do is make her feel more desperate, and afraid her lifeline of medication will dry up. because if you're suffering enough pain to justify morphine - you will do almost anything to stop that pain returning.
If your mother is unbalanced in other ways, it COULD be a reaction to the morphine (my dad would hallucinate on it; he was taking morphine in his last days, dying from emphysema and TB) or it could be entirely unrelated. But be thankful - morphine is one of the safest drugs to take, as regards to the rest of the body's functions. The biggest problem is in the case of an overdose, the respiratory centre of the brain can be affected to the point where breathing stops. This is what happens to addicts who overdose in the street. There, they've taken an unknown quantity (because so often it's been cut to an unknown varying degree, with any one of a number of potentially nasty substances) and they are also taking far too much for any pain needs.
I've been on morphine for over ten years. Maybe 12. Without it I simply cannot function - my body freezes up and the pain just stops me cold. With it, I seem to be almost normal, to most people. I function better now, on morphine, than I did for years trying to keep uncontrollable pain, under control - and failing. At first when I went onto morphine I was able to switch back to my previous codeine/paracetamol mix, but not for ten years now. And fibromyalgia, especially after some time has passed, can stop relapsing/remitting and simply go into a chronic phase.
What I do, to ensure I'm at least living a 'normal' life and not letting the disease rule me - I take my SR medications on time. I carry spares with me - a few days' supply. I also carry spares of my top-up medications. And I keep a diary in which I write down what medications I take, when, and what for. I also score each day from 1 to 10 and note down anything else relevant. This diary is available for my doctor. I choose to keep it. My specialist (the one who raised the concern of addiction and who then backpedalled when told to pull his head in) was a really great guy and it was HIS suggestion to keep the diary, from well before I was taking any serious pain medications.
I hope I've explained things and put them in a better perspective. TV shows like "House" make me cranky, because they are very misleading on this topic (and a lot of others). To insist House stop taking all pain medications because he's an addict - it's simplistic, cruel and just plain wrong. But to perhaps insist he take his medications more appropriately - yes, that should have been investigated.
I've learned to be discreet when I take my medications. I've even taken my codeine dry, if asking for a glass of water would be too obvious. Those things are really bitter; to
them like a lozenge is not pleasant. But since my former friend and later stalker began his attack on me and then slandered and libelled me, I've learned to not trust people. That is why I've even been reluctant to share here - until now.
But I want to help you understand, and I want to help you to help your mother, more appropriately.
If you still feel there is a problem, then maybe this can give you a better sense of direction to know what to do next. But please believe me, her pain management doctor could not get away with being her "pusher". If she's taking more than she should, then she's getting an illicit supply somewhere else. And I doubt that. I'd be looking for possible reactions, or maybe an independent cause for instability.
Good luck with this one, it is a very emotional issue.
Marg