Tuesday, August 22, 2006

Dear Junkies at the Emergency Room

I cannot say "no one," because if I do say "no one," sure as night follows day I will receive a comment of the following form:

Actually? You said "no one ever x," but as a matter of fact, you ignorant slut, I x. All the TIME. I x like you wouldn't believe. A lot of people x. We've formed a society, in fact, and I'm going to post on our forum right now about how STUPID some people (you) are.

So I can't say "no one," but, junkies in the ER? ALMOST no one lists allergies to morphine and Toradol. Listing your medication allergies as "morphine and Toradol" is ALMOST exactly like hanging a big ol' sign around your neck:


Allergies to morphine and codeine are sorta common. Intolerance of NSAIDs like Toradol due to gastric upset, you see some of that too. But ALMOST the only people who put down "morphine and Toradol" are people who have faked some pain at the ER before; received, well, morphine or Toradol to treat it; and found, to their disappointment, that those didn't have quite the sweet, sweet kick of Dilaudid. Toradol has no kick at all, actually. But how much of a junkie snob are you when you're turning down morphine?

"I am sorry, but this delectable opiate does not meet my junkie standards. I demand Dilaudid."

What the fuck?

At least put down "penicillin" or something nonanalgesic for the sake of realism. I just don't think you're putting as much effort into this as you could be.


Caltechgirl said...


No one ever said junkies were the brigthest bulbs on the tree....

ilyka said...

I know someone's gonna get on my ass for picking on addicts, but you know, addicts fuck up my life when I go to the ER (not that that's very often anymore, thank goodness), because thanks to junkies, if I say "Please don't give me compazine for my migraine, it wigs me right out," I get the "Uh-oh, JUNKIE" glare. And then they give me, yes, Toradol, which helps about 50% of the time.

So I have selfish reasons for hating this.

Other, less selfish reasons for hating this:

--While the nurse is dealing with your junkie ass, she's not dealing with actual emergencies. Ditto everyone else involved in the junkie's care.

--The junkies are getting more blatant. Had one last week who disconnected his IV and just walked the fuck out after getting his fix, but not before attempting to steal the wallet of the patient in the next bed.

--It's particularly cute when junkies do this at a COUNTY HOSPITAL, and that's all I'm going to say about that.

Just buy the shit off the street like Lou Reed used to do, junkies. Have some stones already.

Auguste said...

Dear ER Staff Members Who Are Not Ilyka Damen (or, How to push Auguste's buttons in one easy blog post)

Actually, my wife's not allergic to Toradol. But the looks she gets when she says "morphine and demerol" have led her in the (now-distant) past to say, "okay, I'll try it again, the reaction really wasn't that bad last time" and then undergo a little more wheezing, rashy fun as she realized that yeah, it really was that bad.

So no, Ilyka, you didn't say "no one says x." But a shit-ton of your colleagues-in-arms imply it all the time and it gets really tiresome.

(And this despite her additional allergies to latex and betadine and intolerances to reglan and inapsine. Gee, ER staff, do you think she's maybe just an overly-sensitive person?)

Auguste said...

you know, addicts fuck up my life when I go to the ER (not that that's very often anymore, thank goodness), because thanks to junkies, if I say "Please don't give me compazine for my migraine, it wigs me right out," I get the "Uh-oh, JUNKIE" glare. And then they give me, yes, Toradol, which helps about 50% of the time.

And that, too. Well said.

Although my wife's experiences with Toradol are more like 10%.

Auguste said...


Did I just completely think you worked at an ER and get it completely wrong?

ilyka said...

Oh, it's all right, Auguste. I types 'em, only. I don't do the dirty work. I get to sit here and poke addicts in relative comfort.

But no WAY should your wife put up with that treatment. I would guess (underline, bold, and put asterisks around "guess') that what's setting the staff off is her requesting the narcotics by name (which the addicts are also infamous for doing).

Write something like, "TORADOL--ANAPHYLAXIS" on the intake form, and they shouldn't even suggest the stuff. Even the most jaded ER nurse does not want a code blue on his/her watch.

Addendum: I picked on the allergy to morphine/Toradol in this case, but that wasn't all. The patient in question left without being discharged ("got my drugs, bye!") after requesting a prescription for Percocet and getting rejected. And why didn't the patient get a script for Percocet? Because a quick check around revealed that said patient had filled 3 similar prescriptions for Percocet, written from surrounding area ERs, in the last 10 days.

So just so no one thinks I'm presuming junkieness based solely on the allergy (crosses fingers) . . . .

Helen said...

I remember when I had migraines, the first thing I used to do is wave them down: "I don't want narcotics! I just want you to rip my scalp off, turn off all the lights, give me imitrex and shut the fuck up!"

It's bad enough having migraines, but I too am one of those that's allergic to codeine (I learnt this the hard way following a tonsilectomy). Everytime I have to list what I am allergic to, I feel the defensive strategies going up: "Yes, I'm allergic to codeine. But I'm also allergic to penicillin! And I'd never abuse drugs, not ever! I mean, there was this brownie I ate in Amsterdam that one time, but that didn't count! I was drunk already, nothing happened! I only take vitamins! Stop looking at me like that!"

Oh yeah. The ER brings out the worst in all of us.

Miss Robyn said...

Wow- I never even thought that or knew about that. I'm allergic to codeine, vicodin and probably oxycontin since my sister is- but I've never taken it. As far as painkillers go, I've only taken those two and ended up being severely allergic to them. Suffice it to say, I am not looking forward to getting my wisdom teeth out (yes, I'm 25 and still haven't gotten them out), since I'll probably end up being allergic to whatever other one they give me, and end up looking like a junkie to whomever ends up typing my stuff up :).

Rob said...

My wife is allergic to codeine, too, and all of its derivatives (Percodan, Percoset, Vicodin, Lortab, etc ... basically all of the ones that work pretty good on me, especially the Lortab. I never ask for it but I'm usually relieved when it's prescribed. Damn, that stuff works.). She's asked for Demerol by name. I always thought those dirty looks were the "Oh she must be a know it all hypochondriac" variety. This post puts them in a whole new light.

John said...

auguste - being allergic to one narcotic may mean an allergy to several or all of them (eg. Miss Robyn), so morphine and demerol on the allergy form should not be as much of a warning sign as allergy to morphine and an NSAID. Explaining that slowly to the admission staff might help (and it might not). Perhaps your ER is in a bad neighborhood? But then again, I guess a lot of them are.

NSAID allergies are really, really rare, but can be specific to one drug, so I suppose that allergy to morphine and ketorolac is possible, but it's really, really unlikely.

Susan B. said...

I found out that I'm very, very allergic to NSAIDs. I'm talking hives, numbness in my extremities, difficulty swallowing, etc. This has happened to me when taking both ibuprofen and naproxen. I'm scared to death to take aspirin now, and I had taken aspirin all my life.

Somebody told me that if you are allergic to NSAIDs that you will probably be allergic to morphine, too, although I don't know how true that is. I thought morphine was an opiate, not an NSAID.

I can take Tylenol and opiates fine, though. I take a very mild one (Balacet) for my back pain.

Susan B. said...

Oh, and I'm allergic to penicillin and sulfa drugs, too. So I guess that's why nobody has ever looked at me funny in the ER. :-)

John said...

susan b. - Opiates and NSAIDs are very distinct chemically, and they work on different biological targets in the nervous system, so allergy to one class is not a likely indicator of allergy to the other. The NSAIDs as a class have a much more varied chemistry than the opiates, which is why allergy to one NASID is not always a sign that you can't tolerate them all - that is if it is a chemical allergy, rather than an inability to tolerate the biological effect. If it is the biological effect (inhibiton of the COX-1 and COX-2 enzymes) that you can not tolerate, then all NSAIDs are going to raise the allergy.

BTW, Ibuprofen and Naproxen are both in the same chemical class (Anatomic Therapeutic Class M01AE - Propionic acid derivatives).

Most NSAIDs are not sulfonamides, so a Penicillin allergy really has nothing to do with NSIAD allergies, although an awful lot of nurses (and even doctors) are really, really bad at pharmacology and might think that there is a link.

Ilyka - sorry for the excessive geek-speak. Can't help it when chemistry is involved.

ilyka said...

Ilyka - sorry for the excessive geek-speak. Can't help it when chemistry is involved.

Are you kidding me? Geek away. Makes it seem as though my petty bitching about a very minor aspect of my job actually has a shred of authority.

Caltechgirl said...

one other geek point that john didn't raise: People who have one severe allergy are more likely to develop others. Penecillin and Sulfa allergies are actually relatively common. I suffer from them myself.

The connection between them and an opiate or NSAID allergy may simply be a hypersensitive immune system, which slowly becomes allergic to things it is repeatedly exposed to, like common drugs: antibiotics, NSAIDs, and opiates.

John said...

caltechgirl - IIRC, you also have RA? Hyperactive immune system, indeed. In many cases pharmacologically obtuse medical personnel arre right for the worng reasons - and a Pennicillin allergy may be a sign of general hypersensitivity to any drug.

Anonymous said...

I'm glad that at least someone else gets funny looks in the ER. When I tell them I am deadly allergic to asprin, I get the Oh Sure! look, like I don't know what I am talking about. Grrrr.

Sherry C said...

My mother, aunt, and cousin are allergic to demerol. My sister is allergic to Morphine, and my daughter is allergic to codiene. I had an allergic reaction while taking Ultram. After telling my doctor about this family allergy he suggested I just say I'm allergic to opiades because there is a strong chance I'm allergic to the others too. So any medical forms for me or my daughter under allergies I just list opiades and be done with it.

KC-RN said...

I Have been an ER nurse for 11 years and have given thousands of doses of toradol and have NEVER seen an allergic reaction to Toradol. I have asked numerous other nurses and physicians with far more years of experience than I and have found 1 Doc who actually saw one anaphylactic reaction to toradol. So it happens but it is extremely rare. So the thousands of people that come through the ER doors and say that they are allergic to Toradol, BULL SHIT!!! I wish just once, someone would come in the door and say "I am addicted to narcotics and I need a fix." Rather than feeding us lies and bull shit all the time!!

LissaBP said...

I both work in the medical field and I am also allergic to torodol, dicolfenac, and naproxen(s?). I have varried reactions to each the worst being torodol, where I start vomiting and my lips swell. I was in my own hospital being treated by a person I knew (for a kidney stone)when he put it in my IV and before he got three steps away I threw up all over him. I never even knew a person could be allergic to torodol, he treated the anaphylaxis and told me to always double check the nurses before they put anything into my IV because we were lucky this time. I have unfortunatly since then found out I have a kidney problem where I have had more than 350 stones in the last four years and over 8 surgeries for stone destruction and removal. Since torodol is a very common treatment for stones I have to police everything that comes near my IV because some nurses will never believe that allergies to NSAIDS exist!!! Because of its rarity I was given Diclofenac by a pharmisist who didn't understand that people with a allergy to torodol generally means a allergy to that too.I found out about the naproxen by my own stupidity(I thank god it wasn't a severe reaction but enough to scare the crap out of me), and now stay away from ALL over the counter NSAIDs. KC-RN Because of nurses like you I stay as far away from ER's as possible, I don't go in until I haven't kept anything down for longer than 24 hours. ESWAL isn't fun maybe you should come tell someone after surgery that it shouldn't hurt to bad. oh and BTW there have been many different pain studies done over the years on flaged drug seeking pts. and most say both that a very small percent 10 out of 2000 in the one my hospital did, are drug seeking, the rest have uncontroled pain and unfortunatly get sent to the ER by their doctors. You want to ID junkies look for tracks, asking for benidril(s?) when they are not having allergy issues, other things like that. Because allergies to NSAIDs is not a very relieable indicator in my humble opinion.

Kathy said...

I came across this post googling Toradol and allergy. My 17yo son is in the hospital (Mexico, we live here) with a pneumothorax and it is looking like he is reacting (rash and hives) to ketorolac and diclofenac. He has had a ton of drugs in his system due to 2 chest tube placements and abx so maybe his immune system is a little compromised. But he is definitely reacting to the ketorolac and diclofenac. I'm trying to research something that will work for him better.

Sarah Pepin said...

Just wanted to say I am highly allergic to Toradol. Full on anaphylaxis. Just because you haven't seen it doesn't mean it doesn't exist.

ilyka said...

Just because you haven't seen it doesn't mean it doesn't exist.

1. Maybe that's why, in literally the opening sentences of this very post upon which you are commenting, I clarified that I wasn't saying it existed for "no one."

2. I don't know what achievement you unlock by successfully commenting on an 11-year-old post, but I hope it's a good one.