People must be bored today, because out of three jobs, two were to drug related cases.
The first was to a GP surgery, where a man with no shoes (just socks) had walked in and thrown himself on the floor. When I got there he wasn't making any sense at all, but when asked if he had taken an illegal drug, he answered me “Yes”.
It is here I feel duty bound to inform you of an occupational hazard of the job – you may have heard about the health effects of shift work (gawd knows I've made enough of it so far on this very blog), you've heard about ambulance crews being assaulted, spat at and driven off the road. Without wanting to diminish the seriousness of these problems, there is one hazard that you are never prepared for…
…halitosis.
When I first walked in the room I thought that he had left a brown, sticky 'present' for me in his trousers, it was only when I got closer to examine and talk to him that I realised that the smell was his breath. He smelt as if he had been chewing on excrement.
I can still taste that smell, even a couple of hours after the job.
It also didn't help that I had to wait 35 minutes for the ambulance, not their fault, just that it has been rather busy today. Luckily the patient was stable, and content to lay there, groan and chase imaginary butterflies. My professional opinion was that he had taken either Ketamine, or GHB and was just starting to come round.
Although I did wonder why his trousers were around his ankles when he entered the GP surgery…
The next job was a drug related patient as well. One of our regulars who decided to smoke some heroin “…and something else” before going to pick up her Methadone. She had collapsed in the chemist shop, but by the time the ambulance and I got there (only five minutes) she had made a full recovery.
Patient was taken off to hospital for a check-up.
I wonder – does Methadone actually work? I hear a rumour (I must put it on Heardsaid at some point) that more people die on Methadone than they do on Heroin.
Something to look up when I get home.
I heard that too. I think for some reason Methadone is either easier to overdose on and is just as addictive than heroin. I could be wrong but I am sure that is what I heard.
I've had to deal with two children who went so deep into sleep after taking methadone, that they went into a deep coma never woke up and died, it's sad, but peacefull apparenly? – they just shut down. thats what one little bottle will do to two young teens. I think its more oftern that they dispense it as a daily dose these days, but people can store it and take it in one go.
This particular regular caller is under a “supervised administration”, which means that they have to take the methadone in from of the pharmacist.That's sad news about the kids – still I guess they didn't know anything about it.
GHB makes you very horny. so that might a reason for your first patients condition… Its also very, very, very, very nasty stuff. But compared to Tina (aka Crysta) its nice. (Never taken either, just had to deal with others…)
A long time ago a friend of mine was at a gay S&M club. There he was with some stranger tied up, ready for whipping and God knows what else, when the other guy said “I'm sorry, I can't go on with this.” “Oh? why not?” “Your breath smells of garlic.”
Methadone is difficult to dose because metabolism can vary so widely between patients. I use it as often as I can and find it to be an excellent pain killer. I usually start my patients at of the dose of Oxycodone or MS Contin and work up from there. As to Astrids question about overdosing on methadone you are correct. It can accumulate in the body because of slow metabolism and cause an overdose. This usually happens slowly during the first 3 or 4 days of dosing thats why you have to start with very low doses. As to the addictive qualities I would say that they are probably the same as other opiates. I would classify a deadbeat welfare cheat who as been on methadone for 14 years as a drug addict the same as a heroin addict who was on heroin for 14 years.
You would think having to drink your methadone in front of the pharmacist (and anyone else in the chemist) would be embarrassing enough to try to put an end to your habit. I saw a guy a couple of years ago doing just that and it seemed so undignified – but I suppose better than overdosing.
Faecal odour on the breath could also be a ruptured appendix. If so, it's bad luck for him he was too out of it to give the right information
Did you get this very interesting wired news about buprenorphine ?It seems much safer than methadone, and yet its use doesn't spread:
http://wired-vig.wired.com/wired/archive/13.04/bupe.html
Methadone is not safe and has extremely bad withdrawal symptoms. The more people wandering around on drugs the less safe our community is.