Diaries reveal the disastrous extent of the ‘Anne of Green Gables’ author’s prescription drug addiction, as well as parallels to the current opioid epidemic.
Even today, the red-brick house in Norval, Ontario, is a magnificent mansion, located just a stone’s throw from the imposing spire of the Presbyterian church where Ewan Macdonald preached on Sundays nearly a century ago. A large plaque honoring Macdonald and his celebrated wife, the author Lucy Maud Montgomery, who wrote the Anne of Green Gables novels, is displayed in the church sanctuary.
But the beautiful home in this idyllic setting just north of Toronto has kept a secret for many years. Doctors prescribed barbiturates and bromides to Macdonald and Montgomery for anxiety, nerves, and insomnia. Montgomery wrote extensively in her diaries about the medications they took and the accompanying physical and mental deterioration. Montgomery died in 1942 of what her family believes was an overdose suicide. No autopsy was performed. She was 67 years old.
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When barbiturates stopped working, they’d add a spoonful of bromides, and when that didn’t work very well, [Montgomery] carried the standard medicine for the time, which was brandy, and you’d take a swig of that, according to Mary Henley Rubio, an emeritus professor of literature at the University of Guelph. Her 2008 Montgomery biography, based on three decades of research, revealed for the first time the extent of the couple’s drug use.
Their harrowing story has disturbing parallels to the current opioid epidemic, lending it new resonance. Both involve patients who unknowingly became dependent on highly addictive drugs prescribed by negligent physicians. And it is especially pertinent for Canadians, not only because Montgomery is such a beloved icon, but also because Canadians are among the highest consumers of opioids in the world. According to the International Narcotics Control Board, in 2017, Canadian use of oxycodone, one of the leading causes of prescription drug overdose deaths, was second only to that of the United States when measured by tonnage.
Kate Macdonald Butler, the granddaughter of Montgomery, states that the family was aware of the author’s drug use but rarely discussed it. She was clearly overmedicated, according to Butler. Butler believes it is essential to gain insight from Montgomery’s horrifying experience. And so does Elizabeth Epperly, founder of the L.M. Montgomery Institute and former president of the University of Prince Edward Island.
ADVERTISEMENT The brightest can also be tarnished by prescription drugs and their misuse, through no fault of their own, according to Epperly, who adds: She saw herself as a healer of people’s spirits and sorrows, and how fitting that her darkest hours and deepest pain could also give others hope.
Montgomery writes that in Norval, where she lived from 1926 until her husband’s retirement in 1935, he was sometimes so confused that she had to give him a shot of homemade wine before he could stumble across the yard and deliver his sermon. According to Rubio’s tally of the diaries, he had a number of psychotic and suicidal breakdowns while in Norval, each accompanied by heavy prescription medication use.
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After moving to Toronto in 1937, Montgomery describes a disastrous road trip the couple took in 1937. Macdonald, who has been asked to preach at his former church in Leaskdale, Ontario, is so confused that he cannot decide which roads to take. His shaking hands prevent him from holding a cup to his lips. He is too disoriented to read his sermon, babbling instead before sitting down. When they return home, his physician prescribes additional bromides to treat his extreme nervous prostration.
ADVERTISEMENT As for Montgomery, she keeps track of her increasing use of barbiturates and bromides. Her husband tirelessly searches for additional prescriptions from new doctors. Their nightstand and bathroom cabinet are full of medications. She writes that she fears transforming into someone else. She stumbles, experiences hallucinations and terrifying nightmares, and loses weight rapidly.
At one point, her son Stuart Macdonald, a physician and Butler’s father, was so concerned about his mother’s behavior that he took a blood sample, according to Rubio. It contained bromides, and he begged his mother to stop giving them to him. She had not. Montgomery wrote near the end of her life that she was unable to work without a hypo (hypodermic injection) of one of the drugs. On the final afternoon of her life, she encased her final manuscript, mailed it to her publisher, and then went to bed before passing away. For her numerous fans, it is a heartbreaking image.
Through the lens of contemporary knowledge, specialists observe a couple gripped by prescription drug dependency.
Sarah Konefal, a researcher and policy analyst at the Canadian Centre for Substance Use and Addiction in Ottawa, considers the situation to be a case study of barbiturate addiction.
ADVERTISEMENT Edward Shorter, a psychiatry professor and holder of a chair in the history of medicine at the University of Toronto, states that the introduction of barbiturates in 1903 revolutionized the treatment of mental illness. Once on the market, they flourished long before physicians realized that they are addictive and have a razor-thin margin between a beneficial dose and a lethal one. According to Shorter, author of the 2009 book Before Prozac: The Troubled History of Mood Disorders, barbiturates were as common as grass.
The manner in which we discuss opioid addiction has hardly evolved.
Montgomery was not alone in her use of prescription medications. Concern over widespread barbiturate consumption in the United States prompted the first clinical study of chronic barbiturate intoxication in the late 1940s, a few years after her death. According to a study published in 1950 in the Archives of Neurology and Psychiatry, barbiturates were responsible for a quarter of all acute poisonings of hospitalized patients in the United States and were the leading cause of death by poison, whether intentional or accidental. The study catalogs the adverse effects of excessive use, a list that is eerily similar to what Macdonald and Montgomery experienced: confusion, tremors, emotional instability, hallucinations, and depression. The study concluded that barbiturates are addictive in every sense of the word. Prolonged use is detrimental to both the user and society.
Bromides, which were introduced in the middle of the 19th century, depress the central nervous system, slowing the processing of information in the brain, according to Vivienne Luk, a forensic toxicologist and chemist at the University of Toronto. For a number of decades, physicians were unaware of their harmful effects. Personality changes, hallucinations, and delusions can be symptoms of substance abuse.
ADVERTISEMENT In the late 1990s, opioid pain relievers, such as oxycodone, were increasingly prescribed. Professor of Forensic Toxicology at the University of Toronto, Karen Woodall, asserts that pharmaceutical companies and medical schools assured physicians that the drugs were not addictive, especially if they were in pill form. Before people realized that opioids were addictive, we were already in a state of emergency.
Now, some patients dependent on the drugs seek out alternative sources for prescriptions to manage their pain, a trend that the government is attempting to curb. For instance, many walk-in clinics in Canada now refuse to prescribe opioids. When unable to obtain prescriptions, some individuals intentionally injure themselves and visit emergency rooms. Others turn to illicit sources of drugs, which are frequently contaminated with fentanyl.
Since 2016, nearly 14,000 Canadians have died from opioid overdoses involving both prescription and illicit substances. Theresa Tam, Canada’s chief public health officer, has called it the country’s most significant public health crisis in decades. According to Statistics Canada, life expectancy has plateaued due to the high number of accidental opioid poisoning deaths. Five provinces have filed a class action lawsuit against drug manufacturers, alleging that the defendants promoted opioids despite their dangers.
ADVERTISEMENT In the decades since Montgomery’s passing, a number of changes have occurred. Woodall asserts that many modern medications are safer than the barbiturates and bromides used by Montgomery and Macdonald. Mental health issues are now more socially acceptable to discuss. However, none of these developments prevented the epidemic of opioid deaths.
According to Woodall, it takes two steps forward and one step back. The opioid crisis occurred despite physicians being more aware and prescribing medications with more safety precautions.
Rubio, the biographer who pieced together Montgomery’s drug use, hopes that the story will assist others. She is currently located in Norval at a caretaker’s cottage adjacent to the mansion, munching on banana bread, and planning to open a museum in Montgomery’s former residence. A chevron of Canada geese honks in flight outside, soaring above the tranquil Credit River in a brilliant blue sky. Montgomery adored this location, where she wrote five novels while coping in silence with her own mental health issues.
ADVERTISEMENT All of this will be on display when the museum opens in 2024, the sesquicentennial of her birth, along with the repercussions of the plethora of medications prescribed by doctors. Rubio describes it as a cautionary tale about how ruthlessly drug side effects can ravage a person’s life.
Rubio asserts that its historical significance is significant. This is a caution for the future.
This article appears in the March 2020 issue of Macleans with the heading Lucy Maud Montgomery’s secret. Here you can subscribe to the monthly print magazine.
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Diaries show the disastrous extent of the ‘Anne of Green Gables’ authors addiction to prescription drugs, as well as parallels to our modern-day opioid crisis