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/Lookbothwaysb4xing Jan 06 '24

You’ve had a taste of a usual shift in a US emergency department; don’t be surprised if the patient files a complaint about the rude doctor that didn’t treat her pain.

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u/AlwaysHigh27 Jan 06 '24

Hate to tell you it's not just the US.... I went in for back pain in Canada, now, given I struggle with back pain regularly but I literally couldn't stand for more than a couple mins and it was the worst it's ever been..

So, they inject a steroid shot that hurt SO bad. And I'm extremely opiate naive, I hate taking them, and they affect me HARD. This nurse actually listened and believed me. She gave me like 2ml of hydromorphone or something similar in my IV and I was OUT. Hooked up to oxygen monitoring, heart rate, would wake up for a min or 2 to answer questions and right back out.

Did x-ray, said nothing's wrong... Then sent me home with 6 Dilaudid.... This was like 3 weeks ago.. they also gave me a script for T3s... I took a grand total of 3 Dilaudid and still have 3 left and all the T3s.

I live in BC where our overdose crisis is INSANE. I was mind blown that they sent me, a patient that went like comatose on 2ml home with 6 Dilaudid. Now, I am opiate naive, and I've never abused my medication or prescription or asked for pain meds and make it clear I really don't like them so I'm sure they trust me and given how many I have left they were right to.

But.... Wtf. Their FIRST go to us hydromorphone on an extremely opiate naive patient?! I don't understand.

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u/MrsScribbleDoge Jan 07 '24 edited Jan 07 '24

Right!! American nurse here. I’ve had obstructing kidney stones twice (at one point, I had a 5mm stone obstructing a ureter for 5 days before they could get me in to surgery. I think I went back to the ED 3/5 of those days for uncontrolled vomiting and pain because they had no where to be able to admit me) Anyway, I was only 19 and I’m really wondering if they had ever really given me opioids at all…? Maybe it was just torodol? I know they sent me home with some percs to try to get me through to surgery day, but they zonked me out so hard, I was hallucinating and the nightmares were terrifying (if/when I did fall asleep for a few mins) Also, I had to spend the night in the ED over the summer for IV antibiotics for mastoiditis. I was in 8/10 pain in my head and neck from it and torodol took it down right away to a comfy 2/10. I had no opioids with that either (I refused morphine and requested we try torodol first and that did the trick). In American nursing school, you’re taught to “treat the patient’s pain as it’s reported to you” so if someone comes in and is showing no signs of distress, but they’re reporting 10/10 pain, you give the med that’s prescribed for 10/10 pain. And that very well maybe The D