Misuse of Rx meds is another issue I've blogged about. Today you will see both issues come together like a tarball in a gulf pelican's ass.
I have been treating this guy with Bipolar/Anxiety disorders for a year now. He also has a significant opiate dependence history, but that has been stable thanks to the methadone clinic. The guy has his ups and downs, and usually bounces from job to job, mostly stocking/warehouse type stuff. Aside from some social anxiety, he's done really well. No manic or depressive episodes since I've treated him. He's still young and didn't seem to have much direction. Until last week.
He came in for a regular appointment last week. He seemed pretty level-headed and was very pleasant. He hasn't worked for a while but is planning to go to community college next term. He asked me if I would write a letter to the college, indicating that I thought he would benefit from various classroom accomodations. I was really impressed by his new goal and he seemed to have a good outlook. While such a letter is extra work and no pay for me, I was glad to do it. Besides, an education could keep this guy off welfare for a few years. I gladly typed up a letter this morning, faxed it to the school's disability services, and sent a copy snail-mail-style to the patient.
This afternoon, I hear the registration clerks and the nurse laughing hysterically. The patient had called in with this story.
"I was wondering if Psych Doc could write me a new prescription of Xanax. I accidentally spit in the bottle." He went on to describe how he dips snuff, and he sometimes uses empty Rx bottles to spit in. He claimed that he reached over, grabbed a bottle and spit in it before he realized it wasn't an empty bottle. He said all the pills were ruined.
I have heard some great "I lost my Xanax" stories in my time bout this one beats them all. I asked the nurse to call him back and let him know that I would not give him an early refill on prn xanax. There's no way he spit so much he ruined a whole bottle. And what are the odds that it was the Xanax bottle that was open (not Prozac, etc.)
To paraphrase the nurses' conversation.
"Sir, you have a med contract and Psych Doc won't give you early refills."
"What am I gonna do?"
"I suggest you get in that bottle and salvage all that you can."
"But there's all kinds of matter in there."
"Well, you're the one that puts that nasty dip in your mouth. I'm sure you didn't spit enough to destroy them all. Try to do the best you can until your next refill is due."