A patient arrives drunk at 3 a.m. with a chief complaint of back pain, toothache, headache, or toe pain. He is allergic to ibuprofen, all non-narcotic medicine, employment, and accountability. He is out of his insulin, inhalers, and hydrochlorothiazide, but he really wants his Vicodin refilled. He normally gets extra-strength Vicodin, 2,000 tablets with 20 refills, but darn-it-all, he just lost his prescription.
You know this man; you have seen this man. He is easy to treat the wrong way and hard to treat the right way.
Now, do not get me wrong. Vicodin is a great medication that is prescribed all the time. However, prescription drug abuse is at an all-time high. Almost a third of those who use drugs illegally start by taking prescription drugs for nonmedical reasons. Since they are prescribed, these medications have an illusion of safety that leads to accidental overdoses.
I cared for a patient who returned to the ED after her prescription for Vicodin ran out. She also “ran out” of medicine for her UTI. She stated she had only enough money for the Vicodin, not the antibiotics. However, we have many pharmacies where that antibiotic is free! Some patients refuse to take their prescription for high blood pressure or high cholesterol or their diabetes medication – but they always fill their Vicodin.
We have a noncompliance epidemic.
Perhaps considering the logical extreme could work. We could just embrace the narcotics and put them in everything.
Now I hear you wailing in agony like a rabid Chihuahua yipping violently at the vacuum. Just hear me out.
The medication is half hydrocodone, half … anything. Patients know the name Vicodin, so just add that to the name and see how we do.
Vicocillen will have amoxicillin (and hydrocodone) in it.
Vicodolololol will be for your high blood pressure.
Vicodistatin will treat your high cholesterol.
Vicoformin is for your diabetes.
Trying to get someone to take a daily vitamin? It never works – they always forget about it. But they always remember their daily Vicomin.
Some of you might be a bit worried about constipation. Vicofiber! Simply put a heaping spoonful of Vicolax in your morning orange juice, and you are good to go.
OK, maybe that’s the worst idea of all time; but I am sure people would be compliant. Extremely compliant. But there are other medications that can cause scary results as well.
I have found that many patients want “natural” remedies for things. As far as I can tell, the word “natural” means that somewhere on the label the word “herbal” or “from nature” appears. These words magically make a product safer (and better) than anything prescribed.
I had a patient who overdosed on an herbal supplement. I forgot the name of the product, something like “ThrusTastic 16X.” Note that random numbers and X’s on products also makes them better. If metoprolol’s name was changed to “natures natural herbal LowBlood1000X,” people would take it.
So the patient had taken several packages of this supplement, but instead of a fun evening with the wife, he spent the night acting like a spastic dragonfly. He did sailed through his hallway at full speed with the mast all the way up.
This got me to thinking. What would happen if you overdosed on other medications? I am just curious what would happen if some nice little old lady overdosed on one of the “memory enhancing” herbal products. Would it cause the most steel-trap memory ever?
Me: “How many pills did you take?”
Grandma: “I took 34 tablets over the last 74 minutes, unless you are talking about all tablets ever taken since the Reagan administration; in that case I’ve taken 2,821 tablets. Now, would you like to hear about my 19 grandchildren, or shall I recite every episode of ‘Matlock’ from memory for you?”
The challenge of convincing patients to take their medication continues. Some people will continue to forget to take their high blood pressure medications while others will take narcotics recreationally. But we must continue to strive to help our patients to the fullest of our abilities.
Personally, I will start working on the FDA to get “memory enhancer” in the water supply.
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