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.
Unfortunately I had to stand watching him count them out.
Oh, the price of being ethical.