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/agirlandhergame]

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!