Dear wretched sisters of a patient

[MillCreek]

Dear wretched sisters of a patient:

I hope there is a special place in Hell for siblings who would use their mentally-disabled sister to scam Tramadol for themselves.  The attending and I spoke to the patient today without the sisters present (I had them in the waiting room on a pretext). The patient herself, who has the mental capacity of about a six year old, denied ever having any back pain and she denied ever taking any Tramadol that we have been prescribing for the past couple of years.   

When we brought the sisters back and told them the good news that we were no longer prescribing any Tramadol because the back pain was all better, the look on their faces should have turned us to stone and then burst into flame. I took care to take the patient aside afterwards and told her if the sisters were mean to her after this, to call us and we would take care of it.  I have Adult Protective on speed-dial and I am itching to use it.

[Perd Hapley]

I fault you for improperly changing from second to third person, but most importantly for teasing us with descriptions of these smack-downs, while failing to provide images thereof. That gives me a frowny-face.

[BlueStarLizzard]

If they are using the sister to get drugs, I'd call APS anyway.

[MechAg94]

To bad you can't proscribe sugar pills with the same label.  That might be entertaining.

[Northwoods]

To bad you can't proscribe sugar pills with the same label.  That might be entertaining.

Lots of drug trials do that for the placebo portion, and in such a way as the patients don't know whether they're getting sugar pills or the real thing.  There's probably a way, but with something like Tramadol which isn't in any trials that I'm aware of that might be difficult.

[230RN]

To bad you can't proscribe sugar pills with the same label.  That might be entertaining.

You are eeeevvvvvillll.

The kind of eeeevvvvvillll I like.

Terry

[wmenorr67]

If they are using the sister to get drugs, I'd call APS anyway.

BSL beat me to it....this in spades.

If they are scamming the system with you for drugs, what is to say they don't start going elsewhere, and also what else are they using the sister for?

[MechAg94]

BSL beat me to it....this in spades.

If they are scamming the system with you for drugs, what is to say they don't start going elsewhere, and also what else are they using the sister for?

Also, when they get into withdrawal and start blaming the sister for telling the Doc she didn't need the drugs, it could get ugly.  I guess it was already ugly.

[KD5NRH]

To bad you can't proscribe sugar pills with the same label.  That might be entertaining.

To hell with sugar pills.  Lomotil.

[K Frame]

To hell with sugar pills.  Lomotil.

No.

Industrial laxative.

[230RN]

^, ^^

Hey, you guys.  Beware of targeting the wrong species, as in pesticide control.

What if the sister actually takes them?

Sugar pills, OK.  The other stuff not so much.

I fully realize these are all "theoretical" and "humorous" suggestions, but the careless mindset bothers me.

OK, now let's hear all the defensive "Yeah, buts..."

(ETA after mulling it over.... 

I'm ambivalent about calling Protective Services for many of the reasons cited by others, notably that it might reflect negatively on the sister... unintended consequences and all that.  I, myself, might print out the legal penalties for this activity and just turn that over to the relatives without comment, or making up the story that it's somehow required by law or ethics or something.  But I'd think twice about that, too.  I'd add in the factor that not reporting a known crime is a crime in and of itself.  The legal question here, I guess, is what is "knowing?" High suspicion is not "knowing" or maybe just a "should have known"  is involved. 'Tis a puzzlement.)

Terry

[KD5NRH]

No.

Industrial laxative.

Ever 'OD' on Lomotil?  It's worse.  When it wears off, you'll discover new meanings of constipation.

When the bottle says "take one or two as needed," take one and if it passes through undissolved, then take another one.  Never assume you need two just because you can pass anything virtually unchanged in 15 minutes or less; you will regret taking too much.

Wonder what would happen if combined with a laxative, though.

OTOH, if they're scamming narcotics, maybe Naloxone would be a better one to slip in unannounced.

[K Frame]

Yes.

And if they take it with alcohol, and let's face it, they're more than likely bottle hounds if they're also skieving their sister for Tramadol, the results would most likely be fatal. Lomotil OD and alcohol interactions are even worse than straight narcotics because Lomotil has atropine in it.

Giving them colonoscopy prep squirts is one thing.

Flat out killing them is another entirely.

[KD5NRH]

And if they take it with alcohol, and let's face it, they're more than likely bottle hounds if they're also skieving their sister for Tramadol, the results would most likely be fatal. Lomotil OD and alcohol interactions are even worse than straight narcotics because Lomotil has atropine in it.

Pretty sure my former brother in law tried that combo after he got through stealing all my Norco and was just eating whatever was in a pill bottle looking for a fix.

I don't recall seeing the usual huge "DON'T DRINK ALCOHOL WITH THIS" warning on the bottle, but given how fast things were going through, I would have been afraid to drink anything less gentle than water or milk at the time anyway.

[BlueStarLizzard]

(ETA after mulling it over.... 

I'm ambivalent about calling Protective Services for many of the reasons cited by others, notably that it might reflect negatively on the sister... unintended consequences and all that.  I, myself, might print out the legal penalties for this activity and just turn that over to the relatives without comment, or making up the story that it's somehow required by law or ethics or something.  But I'd think twice about that, too.  I'd add in the factor that not reporting a known crime is a crime in and of itself.  The legal question here, I guess, is what is "knowing?" High suspicion is not "knowing" or maybe just a "should have known"  is involved. 'Tis a puzzlement.)

Terry

If calling protective services is something the sisters will take out on her, then the one with special needs should be removed from their care anyway.

[Hawkmoon]

If calling protective services is something the sisters will take out on her, then the one with special needs should be removed from their care anyway.

^^^ This!

[Tuco]

I miss skidmark

[Scout26]

I would go ahead and call Adult Protective.  If the disabled sister never had the alleged back pain, then chances are they are doing other things that would make a required reporter call.

[Perd Hapley]

Dust off, and nuke the site from orbit. It's the only way to be sure.

[K Frame]

You can take Lomotil with alcohol.

What you can't do is OD on Lomotil while drinking alcohol, especially not at the levels a habitual abuser would consume..

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