My final rant on this topic (I promise) is the issue of methadone clinics and Suboxone maintenance. Methadone clinics have been around longer and have always carried a degree of controversy with them. The idea is to replace one addiction with one that is more easily controlled. Methadone is also an opiate, but not as impairing as heroin and as it has a longer half life, only needs to be taken once daily. The hope is to get the addict of the crave-rush-crash-crave roller coaster they have been on. In general, the patients are supposed to go through a rigorous screening process to assess their motivation to truly get clean from opiate addiction and are regularly drug tested to ensure compliance with treatment. Most patients must come to the clinic daily to receive their once daily dose of methadone to ensure it is not abused. In some cases, it is given in a liquid form that must be taken in front of staff, but not always. Tablets are sometimes used, and it is not unusual for patients to "cheek" their tablets and turn around later and sell them, often in exchange for more potent drugs. The sale of methadone often occurs in close proximity to the clinics themselves and there was a recent legal battle with a community and a methadone clinic that wanted to open a clinic in close proximity to a school for that exact reason. Many of the clinics out there turn a blind eye to the extent as which this drug is being diverted and abused and how the services they provide are being manipulated.
In order to ensure compliance with treatment patients are subject to routine drug screening, but there are clinics that do not strictly enforce standards about abstinence. The idea with methadone use is that the patient must abstain from use of all other opiates to remain in treatment and unless prescribed by a physician, any other drug that could be abused. Truly good methadone clinics will not tolerate use of any controlled substance, even prescribed ones as addicts are likely to replace one addiction for another. Methadone, although an opiate, is screened separately from other opiates and does not test positive on general opiate screen. If a patient tests positive for opiates and methadone, he/she is using again. If the test is negative for methadone, one often would suspect that the methadone is not being taken at all, and perhaps being sold for something else. Other common drugs of abuse are tested for as well. In general, repeated "hot" urine's are grounds for dismissal from a clinic but this is not always followed like it should be. We have had several circumstances of patients admitted to the unit who tested positive for several drugs, often freely admitting to using numerous drugs, even returning to IV drug use. When their methadone clinic was notified they stated that they had no intention of discontinuing services. I have had patients who have told me that some clinics never kick a patient out of services. As long as the insurance is paying, the patient gets his methadone.
Eventually patients work their way up to a status where they only need to come in once a week for their methadone and receive a weeks supply at a time. While one hopes that this is because the patient has been compliant and motivated to get well, manipulation is part of the addiction process and many patients given a weeks supply abuse the methadone or sell it for something else.
Suboxone is a newer medication that has been used in treatment of opiate dependence. It is a combination of an opiate with a medication that blocks the absorption of the medication if it is taken IV or snorted. The idea is to discourage misuse of the medication. Its use is not as strictly regulated and can be dispensed by family physicians who have had the training and licensing to prescribe the medication. Physicians are limited on the number of patients they may treat at any time preventing this from being dispensed in a clinic setting. Since the number of patients a given physician may treat is more limited and the monitoring is more easily done, this medication is not abused to nearly the degree that methadone is. Overall the outcomes generally tend to be better and patients on Suboxone do tend to be more compliant. With time, however, people have found ways to get around the opiate blocker and misuse this medication as well. This medication also has a street value in that it prevents withdrawal symptoms for an addict who cannot afford his/her next fix, so it is always worth keeping a tablet or two around. Suboxone is dispensed in one month prescriptions at a time, and many patients take less than they are prescribed and sell the rest so even this is not the perfect answer.
The opiate addiction problem in this city grows daily and as a result, the methadone clinics also grow in number and their locations spread further into remote areas putting more young people are risk of exposure to an unhealthy environment.
None of this is speculation. I work with addicts every day and they tell me the stories about what happens on the street. Sometimes they admit to what is going on, sometimes they do not, but when a patient in methadone maintenance has a drug screen positive for cannibanoids, cocaine and benzodiazepines but no methadone, the patient is not being compliant with treatment. Somehow methadone is being used in a manner it is not supposed to be. And rarely is anything done about it.
Although the city has put in place various drug reporting programs, educational programs and increased security in the schools, as long as there is a continued influx of court ordered addicts and drug pushers from larger cities like New York, Philadelphia and Brooklyn this problem is going to continue to grow. Court ordered treatment rarely does any good. Too many of the persons ordered into treatment choose not to return home, either running from drug gangs or having found a new place to market their deadly product. I hope that city leaders will see what damage that all the drug rehabilitation centers, methadone clinics and halfway houses have done to the city and put a stop to it soon. I am tired of hearing about "mystery people" being found dead of heroin overdoses in public. I am tired of hearing about my teenage patients dying of drug overdoses. And I am tired of dealing with the grief of the parents who have lost a child to drug addiction and not having any comforting words to give them.
Sunday, April 25, 2010
Friday, April 23, 2010
The Silent War - Part IV
There have been a few very high profile deaths by heroin overdose here in the past few months. People die from overdoses every day, but they are usually at home or in a shooting gallery out of the public eye, hence the vague and brief obituaries in the paper. These occurred in public. There were two cases, one person dead, and a companion nearly dead who survived only by heroic efforts at the hospital. Names are not given publicly to protect the families, but we found out the names dealing with the inevitable emotional breakdowns that are associated with this sort of tragedy.
Heroin addiction, and addiction to other drugs in general is not a victimless crime and I would argue that point with anyone who advocates legalizing drugs to the bitter end. I have seen families that have been forced to declare bankruptcy because a family member has stolen all their money to buy drugs. I have seen an epidemic of hepatitis C from women, and men for that matter, that prostitute themselves to get money for drugs. I have seen a local carry out burned to the ground over a robbery intended to obtain money for drugs. I have seen the elderly held prisoner in their homes out of fear. I have seen people murdered over a few dollars.
And I have seen the grief that a mother feels when her child dies of an overdose. I am a mother myself and could not begin to imagine the pain these women must go through. It starts with watching their child become enslaved to such a powerful master, to fighting with the battle of how much to support to give or not. Or when set limits with this person and send them away homeless to the streets. And finally to the final day when that dreaded phone call comes through. We get patients admitted every day that are dealing with the grief over the death of a child, but this kind does not need to happen.
But despite all of the warnings, the death, and the horror stories, kids continue to experiment with heroin. The rehab facilities are thriving, and continue to bring in court ordered drug addicts and dealers from larger cities every day. We see them on the inpatient unit frequently and most of them plan to remain here after their stints are completed, rather than returning home. They continue bringing their illicit business with them. Now though, the rehabs are filling up with local people who have been drawn into a culture that they were ill prepared to face. The number of methadone clinics and suboxone prescribers grows daily.
The rehab facilities' answer is to move their sites and methadone clinics further out of city limits into the outlying suburbs ensuring that the school populations of the smaller cities are exposed and addicted as well. And with time, a problem that had been largely focused in the inner city has grown into the suburban population. Some of these communities have challenged these placements in courts and lost. Those living within the city say that the wealthy and middle class are being unfair for attempting to block the placement of drug rehab facilities in their borders, why should they get special treatment? To that I have one response. These communities did not invite these businesses, and yes, they are for profit businesses, into their communities in the first place. Why should they suffer for the mistakes of the larger community? The break in rate in the suburban communities is increasing, and if anything makes for a much more enticing hit since the homeowners are generally much wealthier and have more to offer and the rates of drug use in the high schools is increasing even higher than the larger city itself.
Somehow, I do not see this as the great savior of the economy that the city leaders had expected and the people of this area deserve an answer on what they intend to do to reverse the damage done.
I will touch on the farce of the methadone clinic and the misuse of taxpayer's dollars (via Medicaid) that go to fuel the drug diversion industry and finally put my rant to an end next.
Heroin addiction, and addiction to other drugs in general is not a victimless crime and I would argue that point with anyone who advocates legalizing drugs to the bitter end. I have seen families that have been forced to declare bankruptcy because a family member has stolen all their money to buy drugs. I have seen an epidemic of hepatitis C from women, and men for that matter, that prostitute themselves to get money for drugs. I have seen a local carry out burned to the ground over a robbery intended to obtain money for drugs. I have seen the elderly held prisoner in their homes out of fear. I have seen people murdered over a few dollars.
And I have seen the grief that a mother feels when her child dies of an overdose. I am a mother myself and could not begin to imagine the pain these women must go through. It starts with watching their child become enslaved to such a powerful master, to fighting with the battle of how much to support to give or not. Or when set limits with this person and send them away homeless to the streets. And finally to the final day when that dreaded phone call comes through. We get patients admitted every day that are dealing with the grief over the death of a child, but this kind does not need to happen.
But despite all of the warnings, the death, and the horror stories, kids continue to experiment with heroin. The rehab facilities are thriving, and continue to bring in court ordered drug addicts and dealers from larger cities every day. We see them on the inpatient unit frequently and most of them plan to remain here after their stints are completed, rather than returning home. They continue bringing their illicit business with them. Now though, the rehabs are filling up with local people who have been drawn into a culture that they were ill prepared to face. The number of methadone clinics and suboxone prescribers grows daily.
The rehab facilities' answer is to move their sites and methadone clinics further out of city limits into the outlying suburbs ensuring that the school populations of the smaller cities are exposed and addicted as well. And with time, a problem that had been largely focused in the inner city has grown into the suburban population. Some of these communities have challenged these placements in courts and lost. Those living within the city say that the wealthy and middle class are being unfair for attempting to block the placement of drug rehab facilities in their borders, why should they get special treatment? To that I have one response. These communities did not invite these businesses, and yes, they are for profit businesses, into their communities in the first place. Why should they suffer for the mistakes of the larger community? The break in rate in the suburban communities is increasing, and if anything makes for a much more enticing hit since the homeowners are generally much wealthier and have more to offer and the rates of drug use in the high schools is increasing even higher than the larger city itself.
Somehow, I do not see this as the great savior of the economy that the city leaders had expected and the people of this area deserve an answer on what they intend to do to reverse the damage done.
I will touch on the farce of the methadone clinic and the misuse of taxpayer's dollars (via Medicaid) that go to fuel the drug diversion industry and finally put my rant to an end next.
Sunday, April 18, 2010
The Silent War - Part III
The short commute from work to my home is only about eight miles long but the change in environment is astounding. I live in a quite area at the edge of the woods where bears are the biggest threat we worry about. A much smaller town is only a mile away and relatively quiet. The city I work in is only a few miles further.
The city where I work is fraught with decay that only feeds the heroin culture. As I drive home, I drive through rows of tightly packed homes, separated by barely a few feet in a few limited designs that seem rather indigenous to this area. Not quite row homes, most of them are the same ones that were built when the city was founded in the late 1800's. Aside from a few major thoroughfares, the streets are narrow, in a tightly laid out grid pattern. A pretty impressive feat considering this is a mountain town and hills are not usually amenable to this degree of order.
The center of town is divided down the middle, much like Chicago, only not with a scenic river, but with a very polluted system of railroad shops and tracks. The tracks run the entire length of the town, north to south and in most of the city, one cannot traverse east to west without crossing a bridge. The grime and dirt permeates the inner city and only adds to a feeling of decay. It reminds me of the grime I saw coating the towers of the now ill-fated Charity Hospital in New Orleans years ago.
Ruined in Hurricane Katrina, the building is considered a total loss and will eventually be torn down, but for the uninsured of New Orleans, Charity Hospital was the only public hospital they had to turn to pre-Katrina. I saw Charity Hospital when I took my Board Certification exam in 2004, before Katrina hit, and it gave me an uneasy feeling that never left me. Ironically, I passed my board exam, a very difficult thing to do in psychiatry. A victory for me that day, a loss for many more not much later. I have since returned to New Orleans for the Sugar Bowl, but I felt the need to visit this now defunct institution and pay my respects. The photograph above was taken on New Years Eve 2009 and the top of the building does not look much different than it did all those years ago. Although this town has not suffered the tragic loss near the degree of New Orleans, sometimes I see the same creepy sooty grime dripping off the taller buildings of the city here and that same feeling comes to me. Something is not well in this town.
Many of the residents of the inner city are retirees on fixed incomes who do their best to maintain their homes. They often live in fear but cannot or will not leave their lifelong homes. There is a certain number of working class families that remain in this area, but a large part of this area has fallen to low income and section 8 housing. The crime rate has skyrocketed and those that have the luxury of moving out of the inner core of the city do, often without being able to sell their inner city homes. Many elderly residents, and there are quite a few here, pass away and the homes are left abandoned. Foreclosures have left many properties vacant as well.
This has left a growing problem of blighted homes, many with red condemned signs posted so long ago that they have long since faded to pink or even white. Absentee landlords have little interest in paying the money to demolish a property that has been condemned. This will only cost them money and leave them with an empty lot that will go unsold. Better yet to ignore the property. The city has limited ability to demolish blighted homes without a lengthy legal process and since the age of the homes is quite old, many contain asbestos and lead paint making the demolition quite expensive. Funding for this is limited. Most abandoned homes have long been stripped of any resellable items. Copper pipes, light fixtures, and wood paneling that could have been salvaged and sold to finance the demolition are stolen by drug addicts desperate for money for their next fix, cutting a viable source of funding for these projects out, also.
Abandoned home are well known to be obvious health risks, attracting rats, pigeons, raccoons and the like, but they have other lurking hazards. Abandoned homes are a perfect cover for "shooting galleries" and make for a discrete location from which dealers can make their transactions out of the public eye. The number of blighted homes grows daily. Not all of the heroin use in the city is restricted to abandoned homes but to me they are a constant reminder of a city in pain. The middle class flees to the outlying communities with sprawling rows of new subdivisions that offer safety and respite from the troubled inner city where they work. No different than Detroit, just on a smaller scale.
Something needs to change....
Tuesday, April 13, 2010
The Silent War - Part I
There was another obituary for a young person in the paper a few days ago. I am not a morbid person, but in this field, one tends to scan the obits to see if a patient has died, especially in a town as small as this. It happens more than one would think, especially since we are the only hospital and mental health center in the county. We know everyone who has been in treatment for anything more severe than mild depression or anxiety. I digress. These obituaries stand out from the others. Brief, listing no details about the person except to say where the person died, no reason given as to why, no listing of surviving family members, funeral information, nothing. Just a note that this person died. Usually they are in their late teens or early 20's. No emotion is conveyed, no sense of loss, no sad story. Many of them are well known to the mental health system.
There are always obituaries for young people that do give details, long stories about the tragic loss and the mourning family members, where to send donations, etc. These are different. The families are involved for one, and have nothing to hide. They are proud of their lost loved one and want the world to know about what a wonderful person the world has lost. The reasons are always sad: leukemia, auto accidents, military casualties. All with stories that have a great deal of emotion and angst that make one feel like they know the family, if they do not already.
The reason for these brief obituaries are many, but the primary one being that those involved do not want it to be known how the person died. The family may in fact be in a great deal of pain but too ashamed to admit the details of their loved ones demise. Sometimes the person has burned all his/her bridges with their family and friends and no one is there to care. Sometimes the cause of death is never made public, but all too often the people who work in the mental health system find out. Sometimes before receiving official word, we know already. It has overtaken this city in an epidemic the likes I have never seen before. It is the unfortunately all too silent killer...
Heroin.
There are always obituaries for young people that do give details, long stories about the tragic loss and the mourning family members, where to send donations, etc. These are different. The families are involved for one, and have nothing to hide. They are proud of their lost loved one and want the world to know about what a wonderful person the world has lost. The reasons are always sad: leukemia, auto accidents, military casualties. All with stories that have a great deal of emotion and angst that make one feel like they know the family, if they do not already.
The reason for these brief obituaries are many, but the primary one being that those involved do not want it to be known how the person died. The family may in fact be in a great deal of pain but too ashamed to admit the details of their loved ones demise. Sometimes the person has burned all his/her bridges with their family and friends and no one is there to care. Sometimes the cause of death is never made public, but all too often the people who work in the mental health system find out. Sometimes before receiving official word, we know already. It has overtaken this city in an epidemic the likes I have never seen before. It is the unfortunately all too silent killer...
Heroin.
Friday, April 9, 2010
The Silent War - Part II
Heroin has been a specter looming over this city for as long as I have lived here and it amazes me how long it has been allowed to continue without public outrage. Our young people die at rates that never cease to astound me. I am not trained to deal with substance abuse, my training is in general adult psychiatry, but every day a significant portion of my time is devoted to dealing with the walking dead. I cannot stand to keep my silence any longer.
This city is of moderate size, about 100,000 if one included the outlying suburbs, two hours away from any truly large city and quite industrial although the surrounding areas are quite rural. Much smaller than my hometown of closer to two million, but wracked by a heroin problem like I have never seen anywhere else. Not even in much larger cities have I seen this. Too small and naive to understand the problem and too underfunded to fight it, the epidemic grows like a cancer in our youths, mostly high school aged and early 20's who are too young to know any better. Before they know it, they are enslaved to the big drug dealers in Brooklyn and Philadelphia who supply them with their so desperately needed hits. Desperate to fund their addiction, they turn to trafficking themselves and go into the high schools creating more and more addicts to fuel the fire.
The problem, I am told, is of recent origin. Many of the mountain towns in this area were founded by the railroads for the purpose of supporting the westward movement of the railways, some time in the late 1800's. Entire towns were built for this purpose and the entire economy was dependent on the railroad. The emergence of the high reliability diesel engine which replaced the high maintenance steam engine guaranteed the loss of a lot of those jobs. Further job losses due to environmental safety concerns and robotic repair facilities left an indelible mark on the community, and the companies that once built the city, seemed to have turned their back on it, leaving the economy in a shambles.
These cities appeared to be the perfect place to build a series of drug rehabilitation facilities and halfway houses to send court ordered addicts from Philadelphia and New York. They were miles away from any large city, and surrounded by conservative Amish and Mennonite communities. It seemed the perfect way to keep these people out of mischief. The cities themselves facing soaring rates of unemployment and a faltering tax base jumped at the opportunity to bring new jobs and money into the area and allowed these facilities to be brought into what was otherwise a quiet community, one by one.
But they bit off more than they could chew. Court ordered rehab does little to solve a problem when the person ordered to treatment does not wish to change. AA members will be fast to remind you that the "geographic cure" never works as the addict has to take him/herself along. Not to mention the fact that while the city may be a few hours drive from Pittsburgh, interstates are the major route of travel of the drug traficking trade and this city is on an interstate.
I have been told that within the past fifteen years, this area has gone from a quiet working class community to one of high crime, drug gang warfare and urban blight....
to be continued
This city is of moderate size, about 100,000 if one included the outlying suburbs, two hours away from any truly large city and quite industrial although the surrounding areas are quite rural. Much smaller than my hometown of closer to two million, but wracked by a heroin problem like I have never seen anywhere else. Not even in much larger cities have I seen this. Too small and naive to understand the problem and too underfunded to fight it, the epidemic grows like a cancer in our youths, mostly high school aged and early 20's who are too young to know any better. Before they know it, they are enslaved to the big drug dealers in Brooklyn and Philadelphia who supply them with their so desperately needed hits. Desperate to fund their addiction, they turn to trafficking themselves and go into the high schools creating more and more addicts to fuel the fire.
The problem, I am told, is of recent origin. Many of the mountain towns in this area were founded by the railroads for the purpose of supporting the westward movement of the railways, some time in the late 1800's. Entire towns were built for this purpose and the entire economy was dependent on the railroad. The emergence of the high reliability diesel engine which replaced the high maintenance steam engine guaranteed the loss of a lot of those jobs. Further job losses due to environmental safety concerns and robotic repair facilities left an indelible mark on the community, and the companies that once built the city, seemed to have turned their back on it, leaving the economy in a shambles.
These cities appeared to be the perfect place to build a series of drug rehabilitation facilities and halfway houses to send court ordered addicts from Philadelphia and New York. They were miles away from any large city, and surrounded by conservative Amish and Mennonite communities. It seemed the perfect way to keep these people out of mischief. The cities themselves facing soaring rates of unemployment and a faltering tax base jumped at the opportunity to bring new jobs and money into the area and allowed these facilities to be brought into what was otherwise a quiet community, one by one.
But they bit off more than they could chew. Court ordered rehab does little to solve a problem when the person ordered to treatment does not wish to change. AA members will be fast to remind you that the "geographic cure" never works as the addict has to take him/herself along. Not to mention the fact that while the city may be a few hours drive from Pittsburgh, interstates are the major route of travel of the drug traficking trade and this city is on an interstate.
I have been told that within the past fifteen years, this area has gone from a quiet working class community to one of high crime, drug gang warfare and urban blight....
to be continued
Wednesday, April 7, 2010
Health care reform
Well, we may, or may not have some kind of health care reform passed in Congress now that may or may not be amended to death in the next few months, but hopefully we will have some kind of change for the better. I have nothing witty or interesting to say, but I can say that we have had a lot of patients being admitted recently who have Medicare and have hit the "doughnut hole" already and are falling apart because many of the generic medications available in psychiatry are in no way related to the newer, name brand ones. Even some of the second generation medications that have come out in generic are still running in the several hundred dollar range a month. Somehow I do not see that the prescription drug benefit program for seniors and the disabled has done what it is supposed to and it does not make a lot of fiscal sense. Sure, Seroquel can run around $1000 a month, but a patient who decompensated and ends up on the psych unit for seven days costs the taxpayer $7000. I would not worry about us having enough patients to keep us busy on the psych units. The drug dealers will always make more. This reform bill is supposed to closed the so-called doughnut hole, but it is going to take years, and I fear that partisan bickering is going to whittle the bill into some worthless piece of bureaucratic nonsense and the Medicare patients will fall by the wayside. I hope for the best. My patients do not have much time to wait.
Monday, April 5, 2010
Weird news week
I am not that inspired this week but there have been some interesting events on the unit lately। We have had a larger than normal number of really psychotic patients so the interactions tend to be a bit more interesting. We had a woman who came running out of her room insisting that her roommate had died and we needed to start planning the funeral right away. She managed to drag several staff members back into the room to find her sleeping roommate who woke up to shouts of "Look! She's dead!" and responded "I'm not dead yet!" This had all the Monty Python fans on the unit buzzing. For those who are not Monty Python connoisseurs, I would suggest renting "Monty Python and the Holy Grail" for an explanation. You will only have to watch about 15 minutes into the film to get the joke. Unfortunately, she called someone else who was a patient somewhere else in the hospital and told this person that her roommate had died and now there are rumors that a patient died on the psychiatric unit.
One of our nurses caught one of our patients trying to fly, Superman style in her room. Once she knew she was being watched, she backed down, but I would have been interested in the results had she been able to pull it off. Maybe she could have brought our not dead patient back to life.
We also had a faith healer who tried to purify a patient of some horrible trauma that she was not aware that she had not endured. She was not very happy about the laying of the hands on her very much. He was a decent singer which was good since he spent hours serenading us after that incident. Most of the time, when we get budding American Idol contestants, they are generally in the does not make the cut catergory.
So the news is just a little weird this week. One would have to be here to get the effect in its full glory, but hopefully one can see why I prefer this to treating this to diabetes and hypertension. My stories are better.
One of our nurses caught one of our patients trying to fly, Superman style in her room. Once she knew she was being watched, she backed down, but I would have been interested in the results had she been able to pull it off. Maybe she could have brought our not dead patient back to life.
We also had a faith healer who tried to purify a patient of some horrible trauma that she was not aware that she had not endured. She was not very happy about the laying of the hands on her very much. He was a decent singer which was good since he spent hours serenading us after that incident. Most of the time, when we get budding American Idol contestants, they are generally in the does not make the cut catergory.
So the news is just a little weird this week. One would have to be here to get the effect in its full glory, but hopefully one can see why I prefer this to treating this to diabetes and hypertension. My stories are better.
Friday, April 2, 2010
The Hall of Lame
The Hall of Lame was established to honor those whose stupid actions go above and beyond the call of duty. For example, we have all worked with people who have gone to ridiculous efforts to call off sick from work, but have any of you had your Mom call in to say you were sick? Especially when she lives 600 miles away. Lame, very lame. Have you ever had that coworker try that stunt twice? - That goes in the Hall of Lame.
Some of my patients are very sick. Many come from dysfunctional homes. Some are addicted. Some are just not that bright. I hate to say that, but sometimes one needs to face reality. I have had a few situations where a patient was caught trying to tamper with a prescription I wrote in order to get more of what they were supposed to receive on a few occassions. It happens to all of us. This situation stood out in its sheer lameness that it bears noting.
For a patient to write on the prescription she was given at discharge from the hospital while still on the psych unit is not too with it. Most would run off to their car where no one can see them. When the prescription was written for 28 tablets, one might have thought to "go for the gusto" as it were and add a zero at the end of the number and try to get 280 tablets. No, this lady tried to alter the number 2 to a number 3 so she would get 38 tablets. And she was on parole from prison to boot. And I had a carbon copy of the script to show that it had been tampered with. And she did this in plain view of one of the psych nurses who does not put up with a lot of bull#@*. Tampering with a prescription for a controlled substance is a felony. So she got caught, and her PO violated her and she went back to prison. All for an extra 2 1/2 days worth of pills.
At least she was nice enough to plead guilty so we did not have to go to the court hearing that day. That would have really make my work difficult. But I did dress really nice in case I did, and I got a lot of compliments that day.
So I present to you the newest inductee to the Hall of Lame:
Some of my patients are very sick. Many come from dysfunctional homes. Some are addicted. Some are just not that bright. I hate to say that, but sometimes one needs to face reality. I have had a few situations where a patient was caught trying to tamper with a prescription I wrote in order to get more of what they were supposed to receive on a few occassions. It happens to all of us. This situation stood out in its sheer lameness that it bears noting.
For a patient to write on the prescription she was given at discharge from the hospital while still on the psych unit is not too with it. Most would run off to their car where no one can see them. When the prescription was written for 28 tablets, one might have thought to "go for the gusto" as it were and add a zero at the end of the number and try to get 280 tablets. No, this lady tried to alter the number 2 to a number 3 so she would get 38 tablets. And she was on parole from prison to boot. And I had a carbon copy of the script to show that it had been tampered with. And she did this in plain view of one of the psych nurses who does not put up with a lot of bull#@*. Tampering with a prescription for a controlled substance is a felony. So she got caught, and her PO violated her and she went back to prison. All for an extra 2 1/2 days worth of pills.
At least she was nice enough to plead guilty so we did not have to go to the court hearing that day. That would have really make my work difficult. But I did dress really nice in case I did, and I got a lot of compliments that day.
So I present to you the newest inductee to the Hall of Lame:
The Great Benzo Heist
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