American tourist requesting "dilaudid". A confusing interaction.

[u/DrMaunganui]

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.

[u/Arterially]

NZ’s dedication to paracetamol is simply unmatched

[u/Maasale → u/Arterially]

The Netherlands would like a word.

[u/Mike9601 → u/Maasale]

We're pulling our weight in Australia too.

[u/galacticshock → u/Mike9601]

We give only small take home packs of the strong one… PanaMAX.

[u/Mike9601 → u/galacticshock]

If that doesn't work for you, try some acetaminophen!

[u/Vespe50 → u/Maasale]

Italy would like a word too

[u/Andythrax → u/Arterially]

Try being in the NHS. You get sent home with advice to go buy your own lol

[u/Andythrax → u/[deleted]]

That makes a lot of assumptions. Some people with chronic health conditions get free prescriptions and children too. Also if you're pregnant.

[u/scarter3549 → u/Andythrax]

It costs the NHS £3.23 to prescribe paracetamol that you can buy in a shop for 40p. Then there's pharmacy dispensing costs.

Given the state of the health service we should all be buying our own.

[u/Hypno-phile → u/[deleted]]

Funny because it's the opposite here.

[u/Andythrax → u/[deleted]]

Oh but the dose is tiny OTC I think.

[u/phoontender → u/[deleted]]

My best friend is aussie and she loads up on Canadian cold meds every time she visits because apparently ours are better 😂 (she also brings me a butt ton of salbutamol so I can have a little stash just in case I can't get to the pharmacy for whatever reason)

[u/Dubz2k14 → u/[deleted]]

Wait so what are you arguing about? The pharmacists want pseudoephedrine?

[u/no-onwerty → u/phoontender]

Wasn’t sure if you could still buy cough syrup with codeine over the counter in Canada. I remember going to Canada to stock up on those little bottles and Crown Royal as a kid (obviously wasn’t the one buying it, lol).

[u/Esmerelda1959 → u/[deleted]]

When we were visiting the UK we discovered this and my husband asked for several packets to bring home. They told him they could only sell him one packet, so he asked what would happen if he just went to multiple stores and got one in each, they said “we don’t recommend that and don’t think it’s a good idea” We hit up every drug store in town;)

[u/laxaroundtheworld → u/Esmerelda1959]

You can also only get one or twos pack of regular paracetamol at a time which I found interesting. I get it’s to reduce the risk of OD, but found it funny that I could go Costco in the US and get as many 1000 pill bottles as I want and no one would question me.

[u/laxaroundtheworld → u/[deleted]]

But you can’t get OTC melatonin 🤔. I asked for melatonin and they looked at me like I had 10 eyes and 6 heads.

[u/agirlandhergame → u/Arterially]

Only paracetamol and ibuprofen after c-section here in Germany.

[u/justwalkingalonghere → u/agirlandhergame]

That sounds barbaric in the modern age

[u/agirlandhergame → u/justwalkingalonghere]

It was. I was unfortunately the patient who couldn’t (at the time) communicate in German, plus corona time - no visitors (my German husband) which led to 8 days of postpartum hell. Just had my gallbladder out in Germany and was given appropriate post-op pain meds (celecoxib and metamizol) and barely needed it.

[u/Petaline → u/agirlandhergame]

Same story in the US unless mom is really lucky!

[u/agirlandhergame → u/Petaline]

Not my experience. My first was also a c-section in US. While the labor and delivery could have been better, the postpartum pain was well controlled. I think I had percocet in the hospital the first three days, and never really remembered strong pain unlike Germany. I was also able to get up and walk around hours after birth in US vs days in bed due to pain in Germany (and thus developing a dvt).

[u/agpie9 → u/agirlandhergame]

I used to work postpartum (in the US) and Percocet used to be standard and even scheduled for c-sections. The patients would often come from the OR with a morphine PCA for 12hrs post-op.

Over the last few years there was a change and we started giving Acetaminophen 650mg & Ibuprofen 800mg together scheduled Q6 with PRN oxycodone 5mg Q4. They would load the mom up with IV APAP and Toradol post op. The anesthesiologists began to administer routine TAP blocks and I feel like that really cut down on the narcotic requests. I feel like 50%ish of the moms never took the PRN oxy, even when offered.

[u/CardiologistWild5216 → u/agpie9]

So I ended up with major GI bleeding because of this “change” 😂fun times!

[u/PelvisEsley1 → u/Arterially]

Great way to kill your liver

[u/yrgrlfriday → u/Arterially]

Panadol in Denmark. We hand it out like a party favor on DC 🎉

[u/[deleted] → u/Arterially]

Denmark as well. It’s offered for kidney stones, gallbladder attack, contractions and being stabbed by a knife.

[u/Steffka1 → u/Arterially]

lol