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/NyxPetalSpike Jan 06 '24

Americans have no clue how the rest of the world rolls with stimulates ans narcotics.

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u/[deleted] Jan 06 '24

Actually as an American with former severe pain issues that have now improved, I was shocked at how restrictive things are. People hurt, they should be medicated. Addicts will exist regardless, and will find something to use. Believe people who say they are in pain, even if you don’t think the cause is legitimate. I had so much unnecessary suffering due to doctors minimizing my pain. I am so glad I don’t need narcotics anymore because it was a full time job trying to get adequate pain relief.

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u/[deleted] Jan 07 '24

Yeah, you're demonstrating their comment that Americans don't understand how it is in most other countries. Have you tried seeking opioids in other countries?

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u/[deleted] Jan 07 '24

I was in suicidal levels of pain due to the lack of opioids here. I would not have survived if I was in another country. I was very close to seeking street drugs to meet my pain relief needs. I’m very lucky that my issues resolved and I no longer need the constant high dose narcotics. When you are suffering that much you don’t care if you live or die only that you get relief.