Coping with the Psychotic Side Effects of Narcotic Pain Medications

By: Loolwa Khazzoom, Founder, Dancing with Pain

January 4th, 2009 • Patient AdvocacyPrint Print

The last week has been extremely intense.  I’ve been working my ass off bringing my mother back from Crazy Land, following the psychotic side effects of her narcotic pain medications. Here’s the scoop:

My mom was doing very well for about a week.  Though she was not yet at “baseline” – i.e., her normal self – her personality was back to a certain extent; and she was able to communicate.  Then last Friday morning, she crashed.  Hard. 

It started off with her being completely out of it in the morning. When I asked the nurse about the cause, I was informed that my mother had been given double the dose of Oxi-something-or-other, a narcotic pain medication.  My mother had been complaining that the 5 mg she’d been receiving was not enough to alleviate the excruciating pain in her left leg, so they had given her 10 mg.

By the time I called my mother on Friday evening, expecting to light Hanukkah candles with her, she was crying and screaming hysterically about how, any minute now, the hospital staff was going to murder her.  She wouldn’t even let me get off the phone to call the nurse, because as soon as I would hang up the phone, they would kill her.

It was clear to me that my mother was having yet another psychotic reaction to her pain medications. I’d been through the whole they’re-going-to-kill-me-immediately episode numerous times, while my mother was on Vicodin.  In fact, that’s why, at my behest, they had switched her to this new med.

I had been planning to come up to the Bay Area on Sunday night, to stay for a week and take care of the million administrative things that needed to be done in my mother’s life. My inclination therefore was to spend the weekend at home, so that I could get all of my things done first and leave emotionally grounded. 

But my mother sounded so desperate and frightened that I decided to drop everything and race to the airport, to catch the last flight out to San Francisco.  I usually drive myself to the airport, park, and take a shuttle, but I knew there was no time. 

I called a friend and asked for a lift. Little did I know that he had been in the middle of Shabbat dinner at a friend’s house. G-d bless him, all he said to me was, “I’ll be right there.”

We tore down the freeway and made it to the airport in time for my flight.  Then, 15 minutes before boarding, when I was sitting at the gate, I realized that I had not checked whether I’d turned off my coffeemaker.  Damn thing is a cheap $15 contraption from Walgreens and doesn’t turn off automatically.

I called my mom, to gauge the situation and see if she’d calmed down. She hadn’t. She was desperate, going on and on about how she’d be dead within a few hours, but it was OK; I should go on with my life; she’s old anyhow.

Oh yeah, and how could I possibly even think about going back for the coffee maker at a time like this, but never mind. I should take good care of myself and not bother coming the next day, because she’d be dead.

I lost it. I had a total meltdown in the middle of the airport, crying hysterically. Which crisis should I avert? My mom’s paranoid delusions or my apartment building burning to the ground? Ultimately, nerves shot to hell, I chose to put my bags on hold at the San Francisco airport (they’d been sent on an earlier flight) and take a cab back home.

The coffee maker was off.

I called the hospital in the middle of the night and again at 5:00 am, to make sure my mom was OK. By 10:00 am, I was physically ill from the whole episode. When I called to speak with my mom, she was pissed about my purported neglect.

“You promised you’d come in the morning,” she accused me bitterly, then proceeded to ramble on and on and on about how I needed to come immediately; how she wasn’t eating or taking her meds; and how everyone was going to kill her.

Something deep inside me took over. “Mommy!” I commanded her. “Pull yourself together. I am coming tonight. I am physically sick from all the drama last night, and I am spending the day getting well. Period, end of issue. In the meantime, you need to get it together and take care of yourself. Eat your food, take your meds, and I will see you tonight.”

Silence. “Okay,” my mom answered.

I spent the day at the beach, pulling my own damn self together. Then I went to the gym to swim, take a dip in the jacuzzi, and relax in the steam room. At 10:30 pm, tired but grounded, I arrived in San Francisco and drove to the hospital.

When I entered my mother’s room, expecting to comfort her, my mother began screaming hysterically that I had to get out. The hospital staff was plotting to kill me, and I was in terrible danger.

“Listen lady,” I said to my mom in a playfully stern tone, “You just hauled my ass from Southern California to protect you. You’re stuck with me now, so get used to it.”

The next two days went pretty much the same: I’d get an hysterical, emergency phone call about my mother’s imminent death at the hands of the evil hospital conspiracy participants. I’d arrive at the hospital, and my mother would begin hollering at me to run for my life.

If I stayed, she was insane with anxiety. If I left, she was insane with anxiety. I felt like a rattled ping pong ball in a game from hell.

Meanwhile, I was instructing the medical staff to decrease the dose of my mom’s pain medications – thereby sending my mom into an hysterical fit about how her touchy-feely, crunchy-granola, anti-drug daughter was poisoning the minds of the nurses who already were giving her insufficient pain medication.

How could I make her suffer so much, she asked. Did I have no idea of what it was like to be in pain? Oh yes, of course I did, so even more so, how could I inflict this suffering on her?

I also was busy requesting a psychiatric evaluation and arranging a strategic discussion with the psychiatrist. When we finally spoke, the psychiatrist suggested giving my mother a psychotropic drug to stop the hallucinations. There was, however, a slight chance that the drug would give my mom a stroke.

No f***ing way. I told the psychiatrist that I wanted to leave that route as a last-ditch emergency option. Instead, I either wanted to keep my mom’s dosage of narcotic pain meds low, to switch her narcotic pain meds to a different brand, or to get her off narcotics altogether. I also wanted to implement holistic measures such as getting my mom outdoors for some fresh air and getting her involved in artwork again.

The psychiatrist agreed with my plan and promised not to prescribe any risky treatments without first consulting with me.

My mom became increasingly incensed about how I was “being so bossy” (for doing things like insisting on cleaning her poop- and piss-drenched comforter), how I wasn’t listening to her (as I was asking questions of clarification during her incoherent rants), and how I was causing her more anxiety than anything else (by being in the hospital and therefore putting myself in danger of the grand murderous plot). 

Every minute I was with her, she was cranky, anxious, bitchy, and even violent — scrunching up her face in fury and grabbing or throwing things at me. Meanwhile almost every waking hour of mine was spent in service to some aspect of my mom’s needs.

On the verge of losing it completely, I called my mom’s best friend and had a long conversation about what was going on. “You can’t let your mom make decisions about whether you’re going to visit her or not,” this friend said. “She’s out of her mind right now.  You need to be the one making decisions, whether she likes it or not.”

Right.

So I went to an art store and bought a million cognitive- and hospital-friendly art supplies (air-drying clay, glitter paint pens, beads with big fat holes…) Armed with two shopping bags and an attitude that I was taking charge of the energy field, I arrived at my mom’s side on the third day. She was sitting in her wheelchair, near the bed, her whole body sunken. “Mommy,” I announced, ”We’re going to have fun today.”

My mom agreed to let me take her outside to the patio that day, and she kept her bitching down. A little. We also spent about an hour hanging out, me playing with all her art supplies, her looking at them out of the corner of her eye.

That relaxed time was when I figured out another source of my mother’s delusions: As nurses spoke with other patients, and as the televisions in the three roommates’ areas blared, my mother mentioned how everyone was lying about and plotting against her.

The proverbial lightbulb went off. “Mommy,” I said, “You’re sharing the room with three other people. The nurses aren’t talking to you. They are talking with those patients. You’re only hearing snippets of their conversations, because the surgery messed up your hearing. Also, the television has violent dialogue going on. I think you’re putting all those things together in your mind, and you’re left thinking there is a conspiracy against you.”

After three rounds of confirming with the nurses that they were talking with someone else, and asking what they had said, my mom went, “Oh.” And that was the end of the paranoid fantasies.

It took a few more days for my mom to warm up to the idea of doing artwork, but today she let me wheel her to the room down the hall, where there is a big table. I put out all the art supplies, and my mom played with clay and paint, while I drew with colored pencils. It was the first time I had fun with her all week.

Then she kicked me out of her room in hysterics about my going outside late at night (ie, after 7 pm), but what can you do. One hurdle at a time.



Comments

B. Thorne January 23rd, 2010

I wanted to thank you so much for your post.  My mother is currently in the ICU after having surgery and is acting in the same manner as what you had described.  It’s horrible to see because she was very normal and active before her surgery.  Any other medical causes have been ruled out, which was also reassurring.  It was helpful to be reassurred that this will hopefully pass and she will be on the road to recovery. 

ShawndieNYC September 19th, 2010

Thank you for your post. My brother was just admitted into the ER Psych unit after having back surgery and behaving the same way. He is only 19 and was prescribed Vicodin and Oxycontin, prior to surgery  he was a normal outgoing young man the week after his surgery he turned into another person altogether. My family and I are a mess over this but I am trying to be strong and will be meeting with the psychiatrist tomorrow via conference call. I hope all goes well and I get my brother back soon.

Loolwa Khazzoom September 22nd, 2010

May you be blessed. Get support so you can stay strong and intervene on your brother’s behalf. We make a difference in the care people receive in hospitals.

LPS November 11th, 2010

I am wondering how much your Mom’s psychotic reaction was due to the oxycotin and how much due to her illness.  I have been taking oxycotin in a regular basis for about two months…it is awonderful pain reliever and mood lifter. I have also been very sick and in a lot of discomfort and extremely depressed about my condition.  I have wondered why my doctors aren’t treating me better…sometimes like your mother I get fed up with them and think they aren’t doing enough for me (and maybe they aren’t).
But the oxycotin has been a wonderful comfort and best friend.  My doctor has encouraged me to keep the dosage at a high level, and when I do I feel better, my mood is good, I actually get out of bed and do things, and I think the drug actually has helped me improve.  It lifts my depression and makes the illness more bearable.

CMG May 29th, 2011

Oxycontin is a mood lifter when you start it, and as long as you have it, all is well…but I hope you never run out for more than a day! Talk about depression & mood swings….and the pain is magnified 10-fold when the chemical completely leaves your body.

Sandy in KY July 30th, 2011

I am currently taking care of my Mom.  She has been in the hospital for 6 months now and to 4 different facilities.  Every time she moves someone decides to put her back on Oxycodone or some other narcotic for her back pain.  Whatever happened to an aspirin?  I can tell you – she has a complete psychotic break with reality every single time and we have to beg them to take her off.  God – isn’t there reasonable alternative between hallucinogenic drugs and some milder form of pain meds.  I empathies with you

mary August 26th, 2011

I believe the Dr. can prescribe medication to stop the psychosis. My husband is having delusions because of pain medictions. His Dr. put him on tylenol and he was going crazy with pain. They put him back on narcotic pain releiver which helped his pain, but now he is getting phycohtic again. the nurses told me the dr. can prescribe some thing for that. I will let you know what happens. Phychosis is horrible to deal with and horible for the pateint.

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