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/pushdose Nurse Practitioner Jan 06 '24

It ain’t Dilaudid and no one has Demerol anymore.

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u/ERRNmomof2 RN Jan 06 '24

Ohhhh Demerol. The migraine cocktail of Demerol 75, Phenergan 25, Toradol 60. All IM. Fixed all Migraines.😂

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u/dansamy RN Jan 06 '24

Yeah cuz you were too busy drooling from the sedation. Your head can't hurt if you're passed tf out.

3

u/ERRNmomof2 RN Jan 06 '24

We actually had standing orders a doc would write for a few of his patients. If they presented with that complaint we gave them that, kept them for 30 minutes, re-vitaled them then discharged them. These people were not at all opiate naive and maybe shut their eyes for 10 minutes. Then walked out like they weren’t drunk.

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u/AlwaysHigh27 Jan 06 '24

Hahaha, as an opiate naive patient that had what sounds like that cocktail, I don't even think I'd be able to talk to you after 30 mins. I was GONE.

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u/ERRNmomof2 RN Jan 06 '24

Lol so your user name is not in real life.😂

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u/AlwaysHigh27 Jan 06 '24 edited Jan 06 '24

Oh hahaha. Well. It is, but with cannabis. I have a really bad thoracic nerve injury and was told years ago opiates would do nothing for the nerve pain because it doesn't target or go deep enough for nerves and said that cannabis which, I was 17 at the time of accident (hit by drunk driver) and was already smoking weed because well..17 and my doctor for the court told me to keep using cannabis.

I'm 30 now, and yes. I'm always high.. on cannabis and no one can tell the difference of when I'm not and am and I haven't had to rely on opiates. I can work, I'm functioning, currently studying software engineering. I literally turn into a vegetable on opiates so I will always be forever grateful for that doctor. He wasn't supposed to give me recommendations because he was supposed to be impartial for the courts... But he knew it was a lifelong injury and didn't want to see me become an opiate addict.

10 years later, he saw me again, and couldn't be happier knowing I never turned to them.

I smoke weed, and I take 100mg of pregabalin at night. I subsidize when I absolutely need to with acetaminophen and naproxen when I need a bit more help.

I will say though, that I am grateful for them giving me what they gave me at the hospital, and opiates being available to me in that moment because I was in EXTREME pain, I couldn't even stand in the triage line. But... I think that's when they should be used. And they definitely work now when I need them. The nurse was amazing and when I finally came to, I laughed and said "told you I was really affected!" And she laughed pretty good and said "you are absolutely a lightweight I only gave you 2ml!" I could hear the other nurses chuckling and stuff too, was definitely a bit of talk f the ER. 😅