After telling people I’m currently working in the ER, the question, “What’s the craziest thing you’ve seen so far?” has come up quite often. In the past two weeks I have seen a lot of cool stuff and a lot of boring stuff, too (no offense to the patients). I suppose I was least prepared to witness patients who come in from abusing illicit drugs, such as heroin, and are often on more than one drug. The opioid epidemic is quite apparent in New York City, as well as throughout the rest of the country. According to a report published by the CDC, between 1999 and 2014, the number of opioid overdoses has almost tripled in the United States. Of the 47,055 drug overdose deaths that occurred in 2014, 61% involved an opioid (1). A report from the New York State Department of Health estimated a crude rate of 6.1% of outpatient emergency department visits were due to an opioid overdose and a crude rate of 3.2% of hospitalizations were due to an opioid overdose (2).
I have not personally interacted with these patients when they have come to the emergency department but I have observed them. The first time I witnessed a patient on heroin, the patient was aggressive and not at all cooperative. He kept yelling at everyone, especially at his mother, cursing at everyone who tried to talk to him and touch him. It was quite interesting to watch the doctor and nurses work amidst the chaos and aggravation. I remember the nurse assigned to the patient’s bed had an extremely frustrated look on his face because he was nearly wrestling the patient to give him sedation medication. Once the patient was sedated he slept for a few hours and when he woke, the same happened again, only the following times it took even more medication to sedate him. It was hard to watch this patient, who was a healthy young guy, succumb to some white powder.
The National Institute on Drug Abuse lists drowsiness, mental confusion, nausea, constipation, respiratory depression, and euphoria as the effects of opioid abuse. Additionally, “restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements” are withdrawal symptoms that may occur with opioid dependence and addiction (3). Though these are the effects listed on paper, I feel they are far more detrimental. The patient’s family was distraught with worry and fear because their son/brother turned into a monster of sorts under the drugs and he had threatened to kill them at home. So even though the patient was experiencing the effects of drugs in his body, everyone around him was being affected to varying degrees, some more than others.
Another patient who came in on heroin was extremely physical and it was a little frightening to witness. He had handcuffs on his wrists and was restrained to the hospital bed but even then, I felt like if became even more enraged he could have turned into the Hulk right then and there. Because he was thrashing and yelling so violently, three built men (two security guards and one policeman) had to hold him down while he was given sedation medication.
When working with patients, you have no idea what you will see next. These two patients were most definitely difficult to manage and their cases were anything but predictable. Indeed, these two scenarios were like nothing I had ever seen before, but I would prefer that these encounters not just end as a riveting story. They beckon increased awareness about the opioid epidemic that is occurring right now, an epidemic that stems from addiction that can start from a regular or longer-term prescription. Not only awareness is needed, but also education for prescribers of opioids, people prescribed opioids, people abusing opioids, and support systems to know what to look for, where to look, and where to turn to for assistance. My heart hurts when I see patients in a state where their body—their lives—have fallen to such a dangerous addiction. Prior to rotations I had heard and read about the opioid epidemic, but seeing it in person is something else.
- Rudd RA, Seth P, David F. Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?s_cid=mm655051e1_w. Published December 29, 2016. Accessed July 8, 2017.
- New York State – County Opioid Quarterly Report. https://www.health.ny.gov/statistics/opioid/data/pdf/nys_apr17.pdf. Published April 2017. Accessed July 8, 2017.
- Which classes of prescription drugs are commonly misused? NIDA. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused. Accessed July 8, 2017.