Addicts

I had seen lots of drug addict during my service with the MOH. But not in Taiwan, most of my colleagues do not have the awareness of such dangerous patient presented to us. Whenever I saw one, I would advised my staff to don double glove. Most of the drug addict cum HIV user would revealed themself without fear back in Malaysia. But in Taiwan, these group of peoples would try to hide the facts - deny deny and deny....

Most of the addicts around our area are also stilnox(zolpidem) abuser. They came to our clinic and asked for large supply of stilnox. They were given 2wks to 1 months supply but many of them returned before the time was due. They had many reasons - drug lost, I gave it to who and who.... Lately the narcotic drug control bureau had instructed us not to prescribed extra medication to those before their drug ran out.

I had this young man presented to ED for epigastric pain earlier this week. After the routine Q&A, I had concluded that he had acute gastritis and asked him how would the treatment to be ( you had to... some would not get healed if your treatment doesn't meet their expectation. eg - some like a jab, some want a IV....) He said he wanted an injection. Just when I was entering my order, the patient told met that the normal pain killer doesn't work on him as he had undergone "80+" times of surgery before(he is 23). I then asked him what kinda of pain killer he preferred - as I expected :narcotics. I told me I could help him and would give him a H2 blokcer parenterally as he had received 2 injection ( 1 is a prohibited drug - avapyra, the other as ketoprofen ) prior to his visit[he showed me a prescription during the Q&A. ]
Another drug addict trying to crave narcotic from us.

Later that night, a couple came by and the nurse had pulled me out from my bad dream. I saw the girl before , she was young, thin with tattoo. She showed me a few ampules of drugs( diphenhydramine and solaxin) and said that she could not inject her self. She had wanted us to put in a veno-cath for her as she couldn't get any vein by herself. Her vein was bad....another drug addict...I asked her for prescription and she told me she get the medication from a clinic(drug addict rehab clinic). I politely turned her down and told her that without any prescription we couldn't help her. They walked off and try their luck elsewhere. Most of the drug addicts use insulin needle and sometimes with the insulin needle it is hard to get the femoral vein. So "highway" user become less.

I still remembered back in my kiddi days the RTM would aired those documentary regarding dadah (malay term for narcotics drug) - those addicts would add lime juice to heroin powder and heat the mixture over candle/lantern. Recent I googled and found out that the lime juice would kept the heroin in the liquor form during the process. The liqour is then aspirated to a needle and injected to the vein.

sponge and syringe

Nowadays -those addicts had a new toy : zolpidem. There is no parenteral form of zolpidem, but some of our nurses had seen them crushing zolpidem pills and mixed it with normal saline then inject it into they veins. Those addicts had 'used' everyone they could to come to hospital and get zolpidem and buy it from them.