Reporter’s notebook: Opioids, a death and the story that never ran

There’s been a big, heavy box of papers under my desk for the past two years. Inside is a story about opioids and the chaos of the American medical system.

The papers are private medical records given to me by the family of Peggy Larson. She died at the age of 62, just three days after Christmas 2015.

There’s no order to them. Some aren’t dated; many are illegible. Together, though, they form a grim narrative of the last 10 years of her life and her addiction.

The Twin Cities woman bounced from doctors to emergency rooms to pharmacies in search of opioid painkillers. After she died, her two daughters found enough pill bottles in her Minneapolis apartment to fill a grocery bag.

“My mom was crazy, crazy smart,” said Peggy’s daughter Andrea. “When she became addicted to opiates, she used those smarts to take advantage of the system. And the system is set up in such a way that it can be taken advantage of.”

I wrote a draft of Peggy’s story two years ago, focusing on weakness in the state’s prescription monitoring program. But some reforms of the program went through, and the systematic part of the story lost its immediacy.

The draft never got edited, and I was waylaid by other projects. The story never ran.

But Peggy and her family’s story stuck to me. An unfinished story gives a reporter the same feeling you get when you can’t remember if you left a stove on. The nagging box of medical records under my desk were an anxious, almost-constant reminder.

Part of it is that I know the family paid a price for talking to me. Reliving and retelling Peggy’s addiction rekindled their trauma. But they’d heard a series I did on the opioid epidemic just months after her death, and it had helped them. They wanted to help others.

“It sucks. I don’t want to be doing this thing. You are a very nice person, but I’d rather never have met you, to be honest,” Andrea told me two years ago. “This is a publicly rare example of someone who fell through the cracks in the system, that I feel obligated to share because I hope that it changes something.”

‘Smarter than the box’

The records I’ve been holding onto offer a glimpse into how the medical system failed Peggy and her family.

They show doctors and nurses asking Peggy over and over again to rate her pain on a scale of one to 10. Her answers escalate over time. The doctors treat her — often prescribing her painkillers — and then they move on. There are too many doctors to track.

Peggy’s family lived this. I talked to them in a plush library at Saint Mark’s Episcopal Cathedral in Minneapolis, where Peggy had once been an active member.

David Larson, Peggy’s husband for three decades, told me her problem with medical opioids stretched back 15 years, to when he caught her stealing Percocet from her youngest daughter. After that, it seemed like she was always seeking more painkillers from doctors for a variety of ailments, or apparent ailments.

“Over the years, as questions became drilled down — both from her family and the medical community, sisters, parents — she became more secretive, more clever,” David said. “She was smarter than the box.”

David has a lifetime of stories about how Peggy got around systems that are supposed to prevent what’s called ‘doctor shopping,’ convincing dentists, doctors or other prescribers that they should legally dispense narcotics.

David was with Peggy during appointments documented in her medical records, where doctors she had never seen before ripped up current prescriptions and wrote all new ones. He brought her to the emergency room when she overdosed. And he brought her to the hospital at all hours for her many and varied ailments.

“She’d been brought in for back pain, given a morphine pump, every time they asked her, ‘What’s your pain level, 1 to 10?’ She answered automatically, ‘10,’ and they’d just up the morphine,” David said. “I had a doctor tell me, ‘I’ve never seen someone take that much morphine and keep her eyes open.’”

The documents in Peggy’s medical records tell part of this story, but leave blank the impact painkillers and alcohol were having on the people around her.

David tried, but couldn’t deal any more. His own futile anger was too much. The couple separated.

Peggy’s daughters became her main support. Her daughter Andrea told me the drugs doctors prescribed would cause Peggy to nod out at the dinner table or get so confused that she got lost in the mall.

“There’s this point…where you sort of go, ‘Is this really happening? This can’t be happening,” Andrea said. “‘Is this actually a problem? But doctors are prescribing it.’”

‘Right thing to do for an addict?’

Andrea remembers a time she visited her mother at a hospital and saw how easy it was for her to get the drugs she wanted. Andrea knew her mom was already highly medicated, but Peggy told a nurse that she was still in pain. The nurse said she’d boost Peggy’s morphine.

“I blurted out, ‘Is that the right thing to do for an addict?’” Andrea said. “The room kind of stopped. The nurse just looked at me. My mom’s parents had just passed away, she’d moved out of her house, and [the nurse] said, ‘Your mom has had a really hard time,’ and just walked out of the room.”

Peggy’s family told me she was persistent. But she was also a white, middle-class, highly-educated woman.

“I think people were profiling and thought, ‘She can’t be an addict,’” Andrea said. “I highly doubt had she been poor or had she not been white that she would have been able to do this.”

Even when one prescriber caught on, there were always more doctors. Peggy’s family found a note after she died from a doctor who told her she was taking too many opioids. The doctor assured her that he’d fill one final prescription.

The family admits that most doctors probably had the best intentions. Looking through the pages of medical records, I can’t disagree. Most of the diagnoses and prescriptions seem benign on their own, but together, the family says, their damage added up.

“Doctors, as I sit here, are giving a fourth, fifth, sixth prescription to somebody that’s been on it for ten years, and never blinking an eye,” David said. “If she was approached she’d say, ‘I’ve done nothing wrong. Everything I’ve done has been under doctors’ orders.’ How to dispute that?”

About 50,000 Americans now die each year of opioid overdoses. Although headlines, including some attached to stories I write, blare about heroin and fentanyl, half of those dying of opioid overdoses in Minnesota are still killed by prescription painkillers. More than 3 million opioid prescriptions were prescribed in the state last year.

Big numbers and terms like ‘epidemic’ emphasize the seriousness of the issue. But they can obscure the people whose lives have changed or ended, and the loved ones they left behind.

All broken

Peggy was a valedictorian at the University of Minnesota, a leader in her churches and a successful educator. She sang in her church choirs and was a statewide piano champ.

Her obituary in the Star Tribune on Jan. 3, 2016, included the following passage:

As a mother, sister, daughter, friend and spouse, Peggy was most interested in ensuring that those around her felt loved and cared for.

Ultimately, this desire to care for others at the expense of caring for herself resulted in her passing, after struggling with addiction.

We share this in an effort to reduce the stigma around mental health. Peggy was a lovely, witty and complex person who left her mark on many.

In the months after Peggy’s death, David said he learned more about opioids than in 15 years of living with a woman addicted to opioids.

“Peggy had a disease,” David said. “I don’t hold Peggy responsible, because if she had cancer she’s not responsible. What I do have anger for, and probably will never get rid of all of it, is somehow we lost our way.”

David is not hopeful that doctors, drug companies, medical boards and politicians will take responsibility for making changes that can actually save the lives of people like Peggy.

It’s all broken, he tells me.

“My views are different because of my role, because of my love affair with a beautiful woman that I still love today,” David said. “Who’s to blame? There is no blame — it’s the system.”

Peggy’s family entrusted me with her story. But the scribbled notes in those heavy boxes of medical records, those burdens of memory and grief, are ultimately shouldered by the people who love Peggy.

On Friday afternoon, I put the box and another overflowing pile of medical records into the trunk of my car, and drove them over to Peggy’s daughter’s house. I set the boxes on the floor of the dark garage, next to a baby stroller, then pulled the garage door shut again.

Related: ‘Her addiction stalked her and stole her once again’ (NewsCut)

From the archive: A father’s story: How a ‘really good kid’ died of a heroin overdose (NewsCut)

  • chlost

    Am I correct in thinking that you finally pulled those boxes out again after Bob’s most recent column about an opioid overdose? It feels almost like a rebuke to one of the comments about “let the families deal with it, it’s not the taxpayer’s responsibility”. In any event, the pain of this family is palpable in this column. Although I am lucky to have not suffered through a family member’s addiction, I have many, many very young clients who are suffering through addiction, its repercussions and multiple treatment attempts, and will continue to do so throughout their lives. It is a societal issue. I hope we figure it out before many more smart, loving folks are lost to all of us.

    • No, this piece has been in the works since more than a week ago.

      • jon

        I don’t want to distract from the story itself… but I like the format, especially for newscut, story that was literally “cut” from the mainstream MPR news.
        Bravo to Jon for taking the time to write it up.

        I don’t know how many other stories are under peoples desk around the MPR building like this one was, but I like the style of the stories that went untold…

  • AL287

    “Who’s to blame? There is no blame — it’s the system.”

    A system that underestimated how many patients would ultimately become addicted to opioids.

    Doctors whose first choice for pain relief is a narcotic and continue to write prescriptions for them as if they are candy.

    Medical professionals who were paid to steer patients to a particular brand being hawked by the manufacturer.

    Pharma companies insisting their formulation could not be tampered with and then ignoring the evidence to the contrary when opioid addiction exploded across the country.

    The dearth of treatment beds available for the afflicted and the refusal of communities to have them built, who take the attitude—“Not in my backyard.”

    All of it is too little too late for the many thousands of families who are fighting this battle, day in and day out with no hope in sight.

    I truly understand your frustration, Jon.

  • Al

    Thank you, Jon.

    One of the best pieces of advice I got prior to my C-section was from a friend: “Your husband is in charge of your pain meds. You are not. He will hand them out at the proper time, and he will take care of refills if you need them.” Sure, whatever, okay.

    When my pain meds ran out a week after the twins arrived and my post-partum depression–previously held at bay by said meds–reared its head, you can be damn sure I wanted that refill (the refill that was prescribed and okayed by my doctors). I’ve lost two family members to addiction. I work in public health. I know the data. I wanted the refill. Anything–ANYTHING–to quell my panic, anxiety, insomnia, terror. I wasn’t in physical pain anymore; my brain hurt. Husband was in charge of the meds; husband said no. Husband was right.

    It’s not so cut and dry for everyone, I know. But I get the really slippery slope when pain and availability and generous doctors and a genetic predisposition to addiction all align.

    • chlost

      When I was discussing my upcoming major surgery with my (at the time) doctor, I specifically told him “I coded on 2mg of morphine, I can’t take morphine or other opioids.”
      The post-surgical med prescribed to me was Dilaudid, which I only learned much later is a mixture which includes an opioid. I couldn’t believe it. Not only does the medical profession underestimate the power of these meds, they apparently feel free to ignore patient requests to avoid it.
      When I called him on it, he told me, “You aren’t allergic to morphine (I have listed it as an allergy on all medical records), you are just very sensitive to it.”
      Yes. As in I nearly died from a small dose.

      • Jack

        I had an allergy doctor tell me to just try codeine again because maybe that wasn’t the cause of my anaphylaxis (I had it and a high powered sulfa drug in the same week).

        Not willing to risk my life on that test. My overseas doctor warned me to never take either again. I trust that doctor more, she saved my life.

        Doctors need to listen to the warnings that patients give.

  • Sybil Twilight

    This story is a mirror of my mother’s experiences, the only difference is moms death certificate cited a stroke as the cause of death. She was 72, had been on escalating amounts of Oxycontin, Vicodin, and Percocet for 20+ years for chronic back pain. During that time she gained 200 lbs, developed COPD, Diabetes, Congestive Heart Disease, and ultimately Kidney Disease and Kidney Failure, as well as a number of lesser conditions as a result of her crappy diet and addiction.

    Her personality, already something of a narcissistic bully got even more aggressive, manipulative and down right cruel. During the 20 year period 2 of my siblings became estranged because mom didn’t like that they had called her out on her addiction, and they didn’t want to experience any more of her manipulation and playing the 4 of us off on one-another.

    When my sister and I began questioning her doctors, she cut us off from any contact with them. Eventually because of her illnesses she needed home health aides, and a social worker. Each time we asked anyone associated with her care if the level of narcotics was safe or sensible she would refuse to speak to us for extended periods of time. It got to the point where we would tag-team it so that one of us would be able to monitor what was going on and report to the other.

    She went through 7 pain management programs in the last ten years of her life. She would just get a new program every time anyone suggested she learn other ways to manage the pain. After a fall and a 6 week stint in a nursing home, she cut of communication with my sister and myself because we asked the social worker if it was realistic to expect that she continue to live alone with just a home health aide for 4 visits a week.

    We found out that she was hospitalized after her kidneys failed and her life alert system called me to tell me that her life alert pendant had not been in contact with the base for more than 72 hours. I called my aunt to see if she knew where mom was and her response was “I can’t tell you or she will never speak to me again.” I finally got it out of her by telling her I would lie to my mom.

    6 months of hospitalization and transitional care followed. During this time my sister and I toughed it out and finally got a social worker to agree that mom couldn’t live alone anymore, and given the level of care she needed she couldn’t live with either of us. She had a stroke at approximately 2pm while returning to the transitional care facility from dialysis, and she had DNR orders in effect. It took 17 days for her to die.

    When we were cleaning out her apartment after her death we found almost 500 doses of her opiates in varying strengths stashed in drawers, backs of closets, even the freezer But according to the health care professionals her addiction to pain meds had nothing to do with it.

    • Al

      I’m sorry, Sybil. Thank you for sharing this.