Prescription drugs......

Factual Questions
1

I hesitate to ask this, but…

I had a friend about a year ago who had some major bowel surgery. I brought her a video game about a week later, and to my surprise and dismay, I saw a mirror with white powder residue!

I started to have a serious talk with her, but she said not to worry, she had just crushed up her painkillers and snorted them.

My questions are these:

Is this legal?

Would it have a different effect?

Would there actually be an advantage? (she claimed that it took effect faster)

What about smoking or shooting?

Would it make a difference if the drugs were over-the-counter?

2

Actually it would depend on the drug. The effect should be faster. Also since even in non time released forms there isn’t as much absorbtion. You might get a stronger effect. Though maybe not so great.

Is it legal? That is questionable. Though I would say it is due to the directions. Some meds I have say take one tablet by mouth.

If she is taking a time release form, the effect would be much greater. This would be in effect getting a days dose all at once instead of spread out over 12 hours. Think the differenc between drinking a shot of whiskey at 7am, 3pm, and 11pm and drinking all three shots at once at 7am. You definitely would feel different.

There was a big deal on this with some time released pain killer that was called OXY something or other.

3

OxyContin. This has been in the news recently what with Rush and the Osbourne kid getting hooked on it. Somebody will probably come along that knows more about it than me, but I have heard this is somewhat similar to heroin.

4

I’ve also heard that snorting certain drugs is a way to get said drugs into your system faster. I doubt her nurse told her to crush the pill and then snort it, this was probably prior knowledge. This could also be a sign of prescription drug abuse. Snorting drugs and innocence rarely go hand in hand, if ever. Your friend should seek help before the problem gets out of control.

5

Just a WAG … is it possible she was advised to do this so as not to irritate her intestinal system with the drugs?

6

I have an acquaintance (I hesitate to call her a friend, because she has nothing to offer in a relationship) who is addicted to prescription pain meds. For some number of years, she was shooting Dilaudid, at the height of her Dilaudid use, she was shooting about 20 4mg tablets a day. Now she’s off the Dilaudid and eating Fentanyl (sp?) instead. It might sound like taking something by mouth is better than shooting, but Fentanyl is in the form of a skin patch, and one patch is meant to be worn for 3 days. She eats 2-3 patches a day (cuts them open and sucks the gel out of them). Fentanyl is said to be stronger than morpine.

Your friend may well have started snorting the pills innocently enough, but the fact that she’s snorting them does concern me. It’s my understanding that snorting produces a “rush”, and this rush can be very addictive! Combined with the fact that the pain killers themselves are addictive, she could be on a fast train for trouble.

7

I was watching the news recently and I remember hearing something about people in England I think snorting alcohol up their noses. That sounds like a plan for brain damage if I ever heard one.

8

{off-topic: Snorting alcohol is nothing. It was widely reported in 1999 that some Finnish girls were getting their buzz from alcohol-soaked tampons. (And to think: despite the fact that Finnish men drink as much or more than any other nation, Finnish women traditionally didn’t drink alcohol appreciably because it was “unladylike”.)

OXYCODONE comes in several formulations, from different manufacturers [OxyFast™, OxyContin™, Percolone™, Percocet™, Roxicodone™ etc.]

The OxyContin formulation, in particular, has a reputation for having such a high abuse potential that lawsuits have been launched for even making them available despite their predictable addictive properties. However, it is a valuable pain control drug, especially when long-term tolerance is a problem.

I am not an expert in opioid pharmacology, but I believe OxyContin’s is more due to factors that don’t strictly lie in the oxycodone itself: a) it is specifically prescribed for the long term; b) it comes in high dose variants for opioid tlerant patients (80 and 160 mg, while the effective dose of Perco- formulations is 4-7mg oxycodone); c) there were several highly publicized “OxyContin pharmacy robberies”. Percoset abuse, for example, has certainly been well known for years, but didn’t acquire quite the same aura.

OxyContin is never prescribed “prn” (use when needed). It should only be used in a regimen that keeps the blood levels fairly stable and constant. Taking a drug nasally -especially this drug- is a strong warning sign that the effect they are seeking is not the effect their doctor is seeking.

I’ve never prescribed a crushed pill intranasally, or heard of a pill being prescribed that way. Pills contain ‘excipients’ or inert ingredients that may be harmless orally, but may not do the lungs much good. Similarly, oral medications are rarely crushed for injection - for most drugs, a safer IV form is available. If I wanted a patient to take a drug nasally, I’d write it in my prescription, so the pharmacist could crush and package individual doses. [Pharmacists have a huge range of techniques that doctors rarely learn, and they usually love working on a challenge.]

Oxycodone’s effects on the GI tract are much the same as any other opioid: most commonly, it it slows the movement of food, and decreases secretions, causing constipation. Taking it nasally would not help. It’s not irritating by direct contact; the drug in the bloodstream would still “sedate” the GI tract. On the other hand, oxycodone can cause histamine release, so administering it nasally could be very irritating. Think about why you take antihistamines. Red eyes are a common side effect, even when it is taken orally.

If a patient has a problem with pill (e.g. after major GI surgery), or needed faster absorption, I’d prescribe the liquid form. This would also allow greater precision in titrating the dose (e.g. they could take 3 or 4 ml instead of 5 ml) to avoid the side effects (e.g. low blood pressure and fainting) that may occur with rapid absorption.

Even if I told a patient to “snort” a drug that wasn’t packaged for nasal administration, I definitely wouldn’t suggest “doing lines” from a mirror – nor is that an idea that a non-abusing patient is likely to choose on their own. This is purely an artifact of the drug culture.

No, sir, I’d strongly suspect that something is up. In fact, I wouldn’t be so sure that the powder on the mirror was prescribed oxycodone at all. Drug abusers often offer bizarre excuses in a blind frenzy to conceal the truth. I’ve seen them “confess” to things that are (to my eyes) worse than what they are trying to hide (e.g. “I wasn’t high when I got in the accident. I felt a bump, and I thought I’d hit someone, so I was trying to get away.”)

BTW, many abusers convince themselves (or want to believe) that a scrip is a sort of magic shield that legitimizes everything. This simply isn’t the case.

IANAL, but as far as I know the instructions I write on a prescription are not legally binding on a patient, per se, but a prescription won’t necessarily protect a patient from “drug abuse” charges if they aren’t using the drug as directed (esp. in jurisdictions make abuse itself a crime). To cite a more “commonplace” example, if a patient takes all of his day’s pills first thing in the morning “because it makes him feel better”, and he ends up on his office ledge singing “I Dream of Jeannie”, he can still be charged for public intoxication or nuisance (and in many jurisdictions, the cost of rescuing him for his own safety).

A prescription isn’t even an airtight defense against “unlawful possession” charges. I trained in an urban hospital, and it was not unheard of for patients with valid prescriptions to buy pills from a dealer rather than a pharmacy. Some were arrested, but I don’t know if they were actually prosecuted for “illegal purchase” (or whatever the proper charge would be) or if it was just a “catch and release” I suspect the police and DA don’t usually don’t want to argue a scrip in court). I was never entirely certain why they’d buy from a dealer (Convenience? Loyalty? I can only hope the street price was higher than pharmacy prices!), but I can only presume there was more to the story than I knew.

9

If she was sent home with oral meds for a bowel surgery, then her bowel is capable of handling oral meds.
Lines on the mirror mean what you think they mean: drug abuse.