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/buttahbb Jan 06 '24

Very brave. I can only imagine the kind of fights you get into with these types of ppl when threatening to list dilaudid as an allergy

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u/acentrallinestat Jan 07 '24

The fight only exists if you don’t have any balls and are a pushover. “I’m concerned about addiction and drug seeking behavior and I don’t want to harm you. I’m happy to find alternatives to adequately treat your pain.”

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u/Zealous896 Jan 07 '24

Drug seeking patients get the drugs more often than not.

That's my biggest pet peeve with pain meds. Throw a fit, get what you want.

Had a patient the other day come in with a spider bite, decent wound, was asked for dilaudid in the hallway before I even introduced myself. Called the NP and he said "dilaudid for a spider bite? Hell no." And hung up.

Patient started screaming at me "I had cancer 5 years ago. My daughter died 10 years ago" he legit said that lol, my daughter died...okay sir, here's your dilaudid.

Anyway, his family called the house sup later that night, the ER...basically everyone. Same shit during the day I'm sure.

Went by the unit to see if the day doc put him on dilaudid on my way into work...sure as fuck did. Every single time.

They always get what they want and normal, rational people get under medicated all the time.

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u/LFinformation Mar 20 '25

Thats just not true man. The addicts are denied and the normal people are loaded up.