How Do You Comfort a Mom?

By Farzana Musawwir, Pharm D., BCPS

How do you comfort a mom who is sitting by the bedside of her 17 year old, who is brain dead?

How do you comfort a mom who is begging her son to wake up, when he has left for no-mans land?

How do you comfort a mom who comes home to find her teenager, unresponsive, in the bathroom?

How do you comfort a mom who has lost her baby for an accident which was avoidable …..

I do not know the answer.

I do not want or try to comfort this mom.

I just go home and hug my kids with utter thankfulness.

Working in the ICU is absolutely gratifying at most times, since you get to help people in their most vulnerable period. Again, times come when we, the  caregivers ourselves, have to deal with the physical and more importantly, emotional trauma, that comes with this job. After all, we are all human being, and in health-care true professionalism only comes when professional judgement is mixed with solid ethics and empathy.  

Another promising life lost because of heroin.

Is that the drug only which is responsible for the loss?

Is there anything that could have prevented this kid from using drugs to begin with?

Why do kids use drugs ?

I am sure psychologists have spent trillions of hours in research to find out the answers of this mare question, numerous researches & studies have been done along with publications on this single topic. Still, this problem is prevailing in our society as a vicious ailment.

Studies show that 10 million young people (12 to 29  year olds) in America are in current need of treatment for substance abuse and addiction. According to Center for Disease Control (CDC), more people die each year in the US from drug overdosage than from car crashes. The death rates from prescription opioid pain reliever (OPR) overdose has increased 4 times during the last decade. Interestingly, the data in 2010-2012 points to another trend. The death rate from OPR overdose has decreased while the death rate from heroin overdose has doubled during this period. Thus heroin is one of the major killers of illegal drug users in recent years. Again, according to studies, approximately 23% of the heroine users become addicts and about one in 10 heroin overdoses end in death.

One of the main reason of this increasing trend of heroin overdose is the cheap price of heroin. The reason is simple, greater supply with increasing demand of the relatively cheap product. The domestic seizure of heroin by the US Drug Enforcement Administration (DEA) has almost doubled  in the last 5 years alone, which is reflective of the increasing amount drug shipment in our country. This is an alarming fact indeed.

Heroin is an opioid drug that is synthesized from morphine. According to a study of 2011, 4.2 million Americans aged 12 or older (or 1.6 percent) have used heroin at least once in their lifetime. Heroin can be injected, smoked or inhaled by snorting and sniffing. All three routes of administration deliver the drug to the brain pretty rapidly and contributes to its health risks. After administration, heroin is converted back inside the body into morphine, and act on cells known as opioid receptors. These receptors are located in many areas of the brain that involves sense of pain and perception including brain stem. After an intravenous injection of heroin, users experience a feeling of a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same.

Because of the location of the receptors in the area of the brainstem,  which controls body’s automatic processes that are critical for life, such as blood pressure, arousal, and respiration, a tiny overdose of this medication can be fatal and detrimental to life. A most common phenomena, Heroin overdoses frequently involve suppression of breathing. In literal term, the body forgets to breathe. As a result, brain cells suffers from hypoxia from lack of oxygen supply and dies. This hypoxic brain damage can have short and long-term psychological and neurological effects, including coma, permanent brain damage and death.

Unsafe intravenous administration of heroin also make the users susceptible to infections at the site of injection. This infection can migrate to the the surface of the heart causing life threatening condition like infectious endocarditis which causes heart failure. No wonder that IV heroin users are 300 times more likely to die of infectious endocarditis. Heroin use can also cause pulmonary edema, a condition caused by excessive fluid accumulation in the lungs causing breathing problems. Pulmonary edema can lead to heart attack or kidney failure. These days we are seeing more and more contaminated or adulterated narcotics including heroin that comes with other toxic contaminants. Often times these synthetic contaminants are hard to detect with conventional screening methods and hence hard to treat.

The problem of teenage drug abuse is as complex in nature as the issues the age itself present with. Often times adolescent drug abuse co-occurs with many other clinical problems with alarming frequency. Conduct or behavioral disorder, depression, anxiety, sexual acting out, and academic problems are few common ones that co-occur with this drug abuse problem for teens. Obviously, family has a greater role here to play in creating, exaggerating or preventing this problem of drug abuse among its young members.

Parent and sibling substance abuse, poor relationships with parents, and inadequate child-rearing practices are thought to be closely linked to adolescent drug problems. Several studies have demonstrated the direct effect of parental monitoring on levels of adolescent substance abuse. Positive parental attitudes that minimize the dangers of drug use can definitely has a bigger role in creating a safe and healthy drug-free life for children. Studies shows that just by monitoring kids peer environment and limiting the access and connection with antisocial and drug-using peers, parents can monitor, protect and limit unsafe behavior of young adults and teens.

Positive parent-adolescent relationship also facilitates adaptive developmental outcomes which is another factor in limiting unsafe behavior in adolescents and teens. In one of the largest studies to date on adolescent health, family relationship variables such as feeling connected to and cared for by one’s parents, high parental expectations about school performance, and parents’ presence and interest in the adolescent’s life all are seen to be strong predictors of positive adolescent development.

Yes, we all love our kids. It is love that is of utmost importance in the healthy development of our kids. However, this love of ours for our kids needs to come with the action of CARE and close monitoring, so that every need of our teens, mental and physical, environmental and behavioral are addressed in loving and caring manner. We want to see a society in our lifetime where no mom has to go through the pain of this mom of 17 years old. We want to see our child grow as confident, healthy and happy citizen of the society.

Finally, I will finish with a quote-

“When you hold your baby in your arms the first time, and you think of all the things you can say and do to influence him, it's a tremendous responsibility. What you do with him can influence not only him, but everyone he meets and not for a day or a month or a year but for time and eternity.”  -  Rose Kennedy

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Useful Sites for Parents:

http://teens.drugabuse.gov/parents/drugs-and-your-kid

http://www.drugabuse.gov/publications/drugfacts/heroin

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a1.htm

References:

  1. Dettmeyer R, Friedrich K, Schmidt P, Madea B. Heroin-associated myocardial damages--conventional and immunohistochemical investigations. Forensic Sci Int. 2009;187(1-3):42-6.

  2. Burke AP, Kalra P, Li L, Smialek J, Virmani R. Infectious endocarditis and sudden unexpected death: incidence and morphology of lesions in intravenous addicts and non-drug abusers. J Heart Valve Dis. 1997;6(2):198-203.

  3. Liang LJ, Huang D, Brecht ML, Hser YI. Differences in Mortality among Heroin, Cocaine, and Methamphetamine Users: A Hierarchical Bayesian Approach. J Drug Issues. 2010;40(1):121-140.

  4. Andrews, J.A.; Hops, H.; Ary, D.W.; Tildesley, E.; Harris, J. Parental Influence in Early Adolescent Substance Use: Specific and Nonspecific Effects. J. Early Adolesc. 1993, 13, 285–310

  5. Brook, J.S.; Brook, D.W.; Gordon, A.S.; Whiteman, M. Identification with Paternal Attributes and Its Relationship to the Son’s Personality and Drug Use. Dev. Psychol. 1984, 20, 1111–1119

  6. Dishion, T.J.; Loeber, R. Adolescent Marijuana and Alcohol Use: The Role of Parents and Peers Revisited. Am. J. Drug Alcohol Abuse 1985, 11, 11–25. 29.

  7. Simmons, R.G.; Burgeson, R.; Reef, M.J. Cumulative Change at Entry to Adolescence. In Development During the Transition to Adolescence; Gunnar, M.R., Collins, W.A., Eds.; Lawrence Erlbaum Associates, Inc.: Hillsdale, NJ, 1988; 123–150