Enlightenment or Crisis of Conscience

[Guest guest]

This week I had a talk with a 17 year old patient of mine

because his mother brought him in for depression. He tells me he

has been depressed since he was 13 or so (8th grade). The only

time he remembers being happy is when he is on drugs. He has been smoking

pot and drinking which his parents now know. But he is taking

Percocet and smoking pot before school every morning. He abuses Suboxone

and Subitrex often. He says he is taking a lot of Benadryl and OTC

sleeping aid because he can’t sleep and his thoughts are racing. He

has tried pretty much everything I know of.

So I battle with what I can tell his Mom. He has

thought of suicide but doesn’t actually want to do it because of his

dog. He is very close to his brother but they can only talk when stoned

and he can’t tell him about the other drugs. The brother tried

suicide a few years ago and was using drugs. Diagnosed bipolar and my

patient doesn’t want to upset his brother as he had a problem with

suboxone (On an aside, how are suboxone and subitrex drugs of abuse? I

thought they were opiate blockers but my patient assures me you get high).

He says he is taking enough Benadryl every night to kill him

(my word). I have seen people who take 20 Benadryl and they don’t

wake up for 2 days. He gets up at 6 AM and goes to school so I

can’t believe his quantities. He isn’t actively suicidal but

could accidentally kill himself He did agree to treatment. He did

go to his mom for help. I made him promise no more than 2 Benadryl at

night until he gets into treatment. But I am very afraid for him. I

can’t betray his trust unless he is going to kill himself or

others. So it’s a fine line.

But what hit me an hour or two later is that he could be

taking drugs I have prescribed for someone else. Most of what he takes

are prescription meds. This is hardly new, I know that. You here on

the news that kids are abusing prescription drugs but they say it’s from

their parents medicine cabinets. It’s not. How do we, as

doctors that are morally and socially responsible keep this stuff out of our

kids mouths. Can we? Why do our patients sell

them? I just suddenly got the guilty feeling that I am

dealing the drugs to the kid; it’s me. I know

it’s not, not directly. But do I know that all of my patients

take their own meds? (I am not a prescriber of Suboxone or

Subitrex). To what lengths must I go to reassure myself that my patients

aren’t lying to me and do need their pain meds or Klonopin or whatever?

Do you all think about this too? That

night, I felt like I had been smacked in the face and it’s been on my

mind ever since.

Kathy Saradarian,

MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03,

Practicing since 9/90

Practice Partner

5/03

Low staffing

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