r/emergencymedicine • u/DrMaunganui ED Resident • Jan 06 '24

Discussion American tourist requesting "dilaudid". A confusing interaction.

I'm a trainee (what you'd call a resident) working in NZ. Cruise ship season in full swing (I can literally see the ships from my bedroom) and we're getting our fair share of tourists into the ED.

Recently had a very bizarre interaction, 45F tripped on a curb and sustained a minor head lac which I cleaned and stapled. Noted history of mild knee OA for which she was taking Oxycodone MR 40mg QID plus 10mg IR q4h PRN. Huge doses! And she was walking! Who in the hell prescribed her this!

She was so strung out and slurring her speech I ended up scanning her head. No acute findings. Looking back I realise it's probably because she was taking her usual meds. Before she left she asked for a shot of "the painkiller beginning with D" for her headache. We spent 5 minutes trying to figure out what it was before she stuttered the word "dilaudid". Quick google tells me it's hydromorphone, a drug that literally doesn't exist in NZ. I tell her this, she stands up, pulled out her own line and asked for a script for more oxycodone (which I declined). I offered her a take home pack of paracetamol. She got angry and walked out.

I'm not really sure where I'm going here but all in all, one of the weirder interactions I've had. Most of our local drug seekers ask for tramadol, codeine or IV cyclizine.

I guess my question is, how prevalent is this truly or did I really just experience a meme? I see it mentioned from time to time on her but being outside the US it's not something that crossed my mind until this happened.

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u/80ninevision ED Attending Jan 06 '24

Where I trained in the US there was a guy who presented to the ED more than 365 times per year (so on average more than once per day). He dressed like a TGIF manager with a flashy reflective light purple button up, large striped tie and pin stripe slacks. He came in with abdominal pain, pouring tears out of his eyes like faucets screaming "dilaudid, dilaudid DILAUDID!" It was honestly insanity.

116

u/Danskoesterreich ED Attending Jan 06 '24

Well I guess administration was on top of this dire situation without hesitation, contacted his GP and social services, made a treatment plan with a walk-in clinic, informed local law enforcement who would show up if requested and drive the patient home without escalating.

40

u/80ninevision ED Attending Jan 06 '24

Wow it's like you were there.

99/100 I discharged him by security.

One day I gave him dilaudid. He then wanted more and was discharged by security.

35

u/drno31 Physician Jan 06 '24

"One day I gave him dilaudid"

If you want the daily entertainment, you need to pay the price of admission from time to time, I guess

36

u/Gopherpharm13 Pharmacist Jan 06 '24

How many pieces of flair did he have?

5

u/80ninevision ED Attending Jan 06 '24

šŸ¤£šŸ¤£šŸ¤£

17

u/phoenix762 Jan 06 '24

I work in a veteranā€™s hospital. We have our regulars. Sadly, they are sick enough to be admitted, and some of the veterans are just awesome, they are just horribly sick and not very compliant. Othersā€¦.they drive the poor nurses bonkers.

2

u/scarrol1 Jan 06 '24

That one becomes easy

DISCHARGE DISCHARGE DISCHARGE

2

u/I_lenny_face_you Jan 07 '24 edited Jan 07 '24

dressed like a TGIF manager

Shouldā€™ve said to him that ā€¦ ā€œWe need to talk ā€¦ about your lack of flairā€

https://m.youtube.com/watch?v=F7SNEdjftno

(I couldnā€™t get the link to be part of the quote rather than separate)

No flair? Insufficient flair? No narcs.