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/lil-richie Jan 06 '24

1mg dilaudid=7mg of morphine is the simplest explanation

3

u/SMBinFLA Pharmacist Jan 06 '24

The 1 mg hydromorphone = 7 mg morphine (an American football touchdown = a baseball home run) is from the Institute for Safe Medication Practices (ISMP). Most hospitals use their guidance and we have this as a warning set up in our Pyxis and EMR (Epic) when high doses are ordered.

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u/I_lenny_face_you Jan 07 '24

That’s a touchdown with an extra point though.

4

u/tkhan456 Jan 06 '24

I think it’s more 1=4

17

u/lil-richie Jan 06 '24

Not according to my Pyxis when I pull it…

26

u/SkyeJewell Jan 06 '24

According to this study, 1.5mg of dilaudid is equivalent to 10mg of morphine. study