An Ethical Question

So the other day we get this drunken, obtunded 22 year-old woman into the Resus Room, and maybe she’s overdosed on something-or-other and maybe she hasn’t — and then EMS gives us a present:

1) a large Ziplock bag chock-filled with hundreds of Percocet tablets and,

2) a smaller sandwich-sized Ziplock bag similarly filled containing Oxycontin 10 mg tablets.

So of course we gave her Narcan. This had no effect: she was just plain piss-drunk.

But what to do with her alternatively-acquired, non-pharmacy dispensed narcotics? Do we

a) give them to the police (who were actually attending, because Drunk Girl was found in a public place)?

b) pretend we didn’t see them, and leave them under the stretcher?

c) give the to her skeezy-looking “boyfriend”, who’s looking all anxious and nervous around the police?

d) throw them all away?

e) actually follow hospital policy (for once) and secure all home medications in the hospital pharmacy?

a) is very tempting, but ultimately must be rejected on two counts: first there is a huge patient confidentiality issue here, and somewhat related to this point, Emergency staff are definitely not an extension of law enforcement agencies.

b) might be a good option, except that everyone knows about them, so if they go missing, there’s going to be a lot of finger-pointing and recrimination and general nastiness. Besides, they figured in her treatment, so we can’t ignore them. Officially speaking, anyway.

c) has the same problems as b). No means of accounting for them to the patient, though skeezy-boyfriend, I’m guessing, has a financial interest in their disposition.

d) from a practical point of view, might be the best answer. No fuss, no muss, tell the patient they “got lost” somewhere. We know best after all, and someone carrying narcs in a plastic bags is obviously up to no good, right? But apart from the obvious dishonesty, there’s a more fundamental issue of patient autonomy. Bottom line, they’re her property, and we don’t know for a fact they were illegally acquired: we’re merely speculating on a strong suspicion.

Which leaves us with d) as the correct answer.  So I call down to pharmacy, and get the persnickity pharmacist who insists on coming up to count all 834 Percocets and 213 Oxycontin tablets.

Heh.

Unfortunately I had to stand watching him count them out.

Oh, the price of being ethical.

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  1. #1 by atyourcervix on Saturday 24 April 2010 - 1202

    Totally, the right choice. Even though it’s obvious that those were not all obtained for personal use. AND no one carries that many on themselves for “personal use”. I hope the police were able to formulate some kind of possession charge, and took control of the pills eventually.

  2. #2 by Maha on Saturday 24 April 2010 - 1529

    That is a LOT of percs and oxy!!!

    I heard that the street value of a tablet of percocet is $80/tab. That would be enough to pay off a lot of stuff – or buy a whole lot more :S

    • #3 by Anonymous on Saturday 24 April 2010 - 2110

      I know… it frightened me a bit, really. You start seeing amounts like that, and you start thinking there some pretty heavy stuff going ….

    • #4 by torontoemerg on Saturday 24 April 2010 - 2112

      I know… it frightened me a bit, really. You start seeing amounts like that, and you start thinking there’s some pretty heavy stuff going … better of in pharmacy.

  3. #5 by Art Doctor on Saturday 24 April 2010 - 2025

    Good work—it’s hard for me to comment on anything else but your good work and decision making. Hopefully the woman will find help for her addiction and drug sales/use.

    • #6 by torontoemerg on Saturday 24 April 2010 - 2113

      Heh… good name for her …. “Unauthorized Pharmacological Sales Representative”.

  4. #7 by Zoe on Monday 26 April 2010 - 1610

    Wow….that’s a lot of drugs! We had something similar happen, and the police confiscated them right there…although that may have had more to do with the large quantity of cocaine we also found in this lady’s purse!

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