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.
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!
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?
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.
Since you so severely disagree with the docs, and question their ability.....Is there any way to move her to a different facility?
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!
https://www.healthline.com/health/food-nutrition/is-kratom-safe
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.
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.
Read those black labels on everything. There is always danger in some of the population.