Your ER Doc » Drug Abuse

Corey Haim and Doctor Shopping

Your ER Doc — Thu, 08 Apr 2010 04:02:21 +0000

Corey Haim’s tragic death recently highlighted an epidemic problem our country faces with prescription drugs. The question I hear repeatedly is “How could a doctor prescribe powerful pain killers and other sedatives to a person who is clearly abusing them?”
Well, the answer is as multifaceted as this unfortunate young actor’s career and life. Doctors do not want to contribute to an addiction, but when we encounter a patient with chronic pain we find ourselves in murky waters. In the emergency department, patients frequently ask for pain medications because their chronic pain has “become much worse,” or they reinjured something. They might complain of an area of new pain, or there may be no available history whatsoever, so the doctor may not know that the patient has chronic pain at all. When I am unsure about a patient’s history and whether they are simply “doctor shopping,” for pills, I am faced with the following dilemma: Do I prescribe pain medications and risk contributing to an addiction, or even a potential overdose? Or do I deny the medications and risk leaving a patient suffering in pain? In the short time I have to make this decision, I try to play detective and sort out whether the patient is being truthful with me. To say that this strains the doctor/patient relationship is a gross understatement. No physician wants to accuse a patient of dishonesty, and no patient wants to feel that they are being judged. It is no coincidence that a common complaint among patients is that “the doctor thought I was a drug addict.”
Superimposed on this prickly problem is the fear that the patient will complain to the hospital, or even threaten legal action. I’ve actually had patients become physically violent when the desired prescription is not forthcoming. Unfortunately, the prescription drug problem has blossomed during the last 10 years, becoming a daily battle waged in our nation’s emergency departments and doctor’s offices. Perhaps the one positive result from Corey Haim’s death could be a greater understanding of prescription drug abuse, and the motivation to stop it.

Chelation therapy

Your ER Doc — Mon, 01 Jun 2009 19:10:45 +0000

Last week a physician colleague of mine mentioned that chelation therapy is a completely valid and useful treatment for coronary disease. He noted that there are countries where patients can’t even get bypass surgery unless they have been through chelation first.
Chelation therapy is when a substance, usually EDTA, is given in order to “sponge up” minerals and heavy metals that can cause inflammation, and perhaps contribute to coronary disease.
My recollection was that chelation therapy had never shown a benefit in clinical trials for coronary disease. My colleague said that there was plenty of good research out there that was beneficial, but that the drug companies, and cardiovascular disease establishment were squashing the data in order to maintain the status quo.
That’s quite an accusation. That would mean that thousands of doctors and scientists were engaged in a gigantic conspiracy to keep a valuable, and relatively inexpensive treatment from patients in order to make money through prescription medication, bypass surgery, angioplasty, etc. When you consider that coronary heart disease in the number one killer of men and women, and that many people suffer significant disability from it, this would be a conspiracy far more destructive than any genocide on record. It would make Pol Pot seem like a harmless old curmudgeon.
I decided to do a little research myself and eventually found myself on one of my favorite sites, Quackwatch.com, written by Saul Green, PhD. He has an excellent review of the chelation for vascular disease issue.
There have been some good studies done on chelation therapy, with no benefit shown. There also are a couple of large trials ongoing. There are no studies that show any significant benefit that I could find.
Now maybe Dr. Green has a garage full of Ferraris with bumperstickers that say “I love angioplasty” given to him by the American College of Cardiology, I’m not sure.
Or just perhaps there are some alternative practitioners making some claims (and a lot of money) that are based on marginal science. Hmm, that sounds familiar.

Prescription drug abuse

Your ER Doc — Fri, 26 Dec 2008 09:12:15 +0000

Dear ER Doc,

In the past, I have given my teenage daughter medications that were prescribed to me. Some of these were pain pills when she had a sprain, other times, antibiotics. When is it okay to give my medications to someone else?

Marley, Witchita Kansas

Dear Marley,

In a word, NEVER! This is a very dangerous practice, indeed. When you treat another person with pills prescribed to you, you can cause an allergic reaction, unexpected side effects, and possibly even worsen the condition you are trying to help.

Also, prescription drug abuse among teenagers is a very serious problem, and what you are doing could be opening the door to that. Teenagers are much more likely to abuse prescription drugs than illegal ones, possibly because they think it is completely safe. I strongly encourage you to keep your medications out of the hands of other people, especially kids. You should also dispose of medications when you are not taking them anymore. Vist this site for more information about prescription drug abuse among teenagers .

Allergic to cocaine

Your ER Doc — Sun, 21 Dec 2008 16:48:18 +0000

I picked up a chart recently and it was a middle aged man with a laceration on his hand. I noticed that under allergies, he had written “cocaine.”

I asked him what happens with it, and he said, “It’s the strangest thing doc. Every time I use cocaine, I break out in handcuffs.”

Acetaminophen Overdose

yourerdoc — Mon, 24 Nov 2008 17:37:06 +0000

I just found out that 2 days ago my daughter had a fight with her boyfriend and she took a handful of acetaminophen pills. Should I have her stomach pumped?

First, I am sorry that you and your daughter are going through what must be a very difficult time. Unfortunately, intentional drug overdoses like these are common. There are a couple very important things to think about with an overdose of any medication. First, you should get evaluated in an emergency department right away to find out if the medicine is causing any serious bodily harm. We don’t usually “pump the stomach” these days, but there are many things we commonly do to prevent and treat toxic effects of medicines. Acetaminophen can have some very significant toxic effects when taken in high doses, in particular liver damage. I would strongly advise that your daughter be evaluated immediately.

Second, if it is clear that no adverse medical effects are happening as a result of the overdose, we always consider why the patient took the pills in the first place. Usually, a crisis worker or other psychiatric professional will talk to the patient and family in detail to determine if the patient remains suicidal.

I have found that young people sometimes overdose on pills as an impulsive act, or as a call for attention, not necessarily to kill themselves, but they often underestimate the potential danger. Quite a few patients have unfortunately died as a result of taking acetaminophen pills, thinking they were completely safe.

To learn more about suicide prevention, visit the American Foundation for Suicide Prevention .

21st Birthday Binge Drinking

Your ER Doc — Thu, 13 Nov 2008 01:39:27 +0000

A word to the wise on your 21st birthday.

It is a time honored tradition for young people to celebrate their newly acquired drinking status by going out with their friends and drinking far more than they or their livers can handle. I have lost count of how many unfortunate 21 year olds I have seen in the sorry aftermath of their revelry. But I do know that young people who are extremely drunk are not funny or cute, despite what the movies would have us believe. ER nurses are never pleased when they have to take care of the ridiculously drunk young adult, because invariably they also must deal with vomit, urine, and attitude problems. Usually the patient has some relatively boisterous “friends” in tow, probably the characters that a few hours prior to arrival were shouting, “Drink, Drink, Drink!” But by far the biggest problem with the 21st birthday tradition is that people can get very sick or hurt from heavy drinking, especially if they are not used to it, and their friends are egging them on. I have treated patients with broken limbs, head injuries, dehydration, and even a fraternity member with hypothermia from being stranded outside by his brothers.

I recently treated a 21 year old who was already completely intoxicated when his friends encouraged him to gulp down a drink known as “Adios, Motherf—er.” The drink was so successful that he went into an unconscious state, and his friends ended up calling 911 when they could not revive him. He required IV fluids, and observation for several hours. His friends may have paid for the drinks, but I doubt seriously they picked up the ER tab. If you are about to turn 21 and are looking forward to a wild night with your friends, here’s my recommendation–pick your most responsible friend, ask him/her to watch out for you, and slide you into bed when you’ve had enough. Your brain and liver will thank you, and so will I.

Meth – Methamphetamines and Bugs Under the Skin

Your ER Doc — Tue, 11 Nov 2008 02:11:40 +0000

Methamphetamines (aka Meth)

Drugs can make people do some amazing, incomprehensible things, and sometimes you don’t know whether to laugh or cry.

One night, a phone call was directed to the ER by the hospital operator, who said, “I don’t know who else can help these people.”

Not good.

The call was from two men sitting in the hospital parking lot in a car, and they were clearly distraught. They spoke very quickly and and hysterically. They stated that they were infected by some kind of bugs, and didn’t want to infect anyone else by coming inside.

I certainly appreciated their desire to not make anyone else ill, but explained there was very little we could do over the phone. They both agreed to come in eventually, but made us agree to wear protective gowns and masks. We were only too happy to comply.

When they stepped in through the ambulance doors, I could not believe my eyes. They were both wrapped head to toe in aluminum foil. Apparently they had decided that the foil would protect themselves and us from the “bugs.”

As it turned out, these men had been smoking methamphetamines for days on end. They had become very paranoid, and began picking at their skin, as methamphetamine users tend to do. Each person made the other more paranoid until they both were convinced that they were seeing bugs underneath their skin crawling around, which only made them pick and scratch more. They both were covered with many sores all over their skin from all the scratching. I sincerely wish that anyone considering meth use could have seen the sorry state of these unfortunate men. If that didn’t stop them from using meth, I’m not sure what would.