Alleged Patient Exposure to HIV/Hepatitis After Drug Diversion

I want to start this post by saying "Oops, it happened again." The problem is, I shouldn't have to blog about this topic considering how serious it is and the potential risk to patients.

I live in Colorado. In February, 2016, it hit the news that one of the Denver areas largest hospital, Swedish Medical Center, was testing close to three thousand patients for possible exposure to HIV and Hepatitis after a surgical tech was suspected of diverting drugs.

What is drug diversion? Drug diversion is using a narcotic for anything other than its intended use. The most mildest form is not wasting drugs properly. It requires two licensed personnel to waste a drug and sometimes you just can't find another person at that moment and then you forget. Not excusable but understandable. The most serious form is healthcare workers using the drug themselves and not giving them to the patient or using the "waste" or overage for themselves.

The problem is, a relatively similar scenario happened at another Colorado hospital in 2008 and 2009. This was the case of Kristen Parker, a surgical tech who is currently serving a thirty year prison term for infecting three dozen patients with Hepatitis C. She was stealing unlocked Fentanyl set aside for surgery, injecting it into herself, and then drawing up saline into the same syringe where then an unsuspecting provider injected it into the patient causing transmission of the virus.

In fact, one of the anesthesiologists involved in this case went public and even wrote a novel based upon her experience. This wasn't a quiet news story.

In this blog piece from The Daily Beast in February, 2013, Gorman states:

“At that time, we didn’t think about locking drawers,” she says. “No one ever told me I was doing anything wrong. If there were rules to enforce locking the drugs up, they were not enforced.” Rose has said it sent memos to its anesthesiologists in 2001 and again after Parker’s crime, warning them “never leave controlled substances unlocked or unattended.”

In light of this incidence, it is unbelievable to me that a case of suspected drug diversion involving a surgical tech could happen again in this state and it makes me wonder if potentially the same process of drug diversion was used as Kristen Parker employed-- unsecured narcotics awaiting injection for surgical procedures.

The tech, Rocky Allen, has been arrested and has pleaded not guilty. Thus far, it appears two patients have tested positive for Hepatitis B.-- although the hospital currently denies they transmitted the virus as part of this case.

So please, hospital OR's everywhere, can we please develop a system where narcotics can be dispensed safely to surgical patients?

Opium Abuse during the Civil War Era: 2/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Today, Jocelyn continues her discussion on opium abuse during the Civil War. Here is Part I.

In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

Common Opium Abuse Withdrawal Symptoms

If the patient suddenly stops taking opium, either by choice or from lack of supply, which often happened among Confederate soldiers especially, the following symptoms could be present.

§  emotional instability §  depression §  feeling shaky §  nightmares §  exhaustion

§  general body weakness §  lethargy §  mental fogginess §  anxiety §  nervousness

Signs of Opium Abuse Withdrawal

§  trouble sleeping §  nausea and vomiting §  heart palpitations §  headaches §  clammy §  sweaty skin

§  decreased appetite §  unusual movements §  hand tremors §  alterations of the pupils §  pale skin

Severe Opium Withdrawal Symptoms

In extreme cases, the following might present themselves.

§  irrational thoughts §  irritability §  anger §  confusion

§  fever §  seizures §  convulsions §  hallucinations

Treatment

So what did doctors do when a patient was overdosed on opium? The following case study from the archives of the University of Virginia offers some answers. Though this example took place a decade before the Civil War broke out, we can imagine many doctors may have used similar methods.

“On May 7, 1850, Dr. John William Ogilvie traveled eight miles to a plantation in Barnwell County, SC in response to a reported overdose of Laudanum, or a tincture of opium. The patient had attempted suicide, swallowing the tincture at 4:15 that morning. Arriving at 7:15 AM, Dr. Ogilvie found him still alive. Apparently in a state of melancholy, the patient was conscious and calm, but expressed regret that the doctor had come as he still wished to die. Dr. Ogilvie, however, proceeded to treat the patient without any apparent difficulty. Initially, he administered ten doses of zinc sulphate solution, five minutes apart. The patient began to vomit fifteen minutes after the last dose, and Dr. Ogilvie smelled and saw the drug in his regurgitated fluids. The doctor then proceeded to put a tube down his patient's throat and forced four pints of warm water into the man's stomach. Dr. Ogilvie left at 10:45 AM, his patient stabilized and quickly recovering.”

Historically, southern whites were the most susceptible to opium addiction, and prior to 1900, the addiction primarily affected the middle- and upper-class. Country physicians actually had the highest rate of addiction among nineteenth-century professions, so it was not a big leap for me to give an opium addiction to a Confederate surgeon in my novel.

Dependency on the drug during the Civil War was likely magnified by soldiers' traumatic experiences. Opium helped calm frayed nerves and brought sleep to those who otherwise may not have been able to rest. Not only did it numb physical pain, but it numbed emotional pain, as well.

Up until the Civil War, opium use and abuse was so widespread it was not frowned upon. It was not until the significant abuse during and after the Civil War that doctors began to take drug abuse seriously and medical opiate addiction finally began to disappear.

For further reading:

Courtwright, David T. Dark Paradise: Opiate Addictionin America Before 1940. Cambridge: Harvard University Press, 1982.

Hodgson, Barbara. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Buffalo: Firefly Books, 2001.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Opium Abuse during the Civil War Era: 1/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!


As you can image by the title of my novel, Widow of Gettysburg, writing it required extensive research into the condition of wounded soldiers and their treatment. I soon discovered that opium was considered a wonder drug by battlefield surgeons. It was sprinkled on wounds to help slow blood loss, and taken orally to relieve pain and induce sleep. Opium and morphine were the most popular painkillers—but they were also used in the treatment of cholera and sometimes dysentery.

The most significant incidence of opium abuse in the United States occurred during the Civil War, when an estimated 400,000 soldiers became addicted to the drug. Two of my characters in Widow of Gettysburg struggle with it. The following signs and symptoms helped guide those storylines.

Opium Abuse Side Effects

These side-effects depend on factors such as the dose, how the drug is taken, and the individual’s metabolism. In addition, these side-effects depend on the duration of time in which the drug has been taken. Opium abuse brings about side-effects such as:

• Drowsiness
• Sedation
• Depressed or slowed breathing
• Glazed or red eyes
• Slurred speech
• Headaches
• Confusion
• Dizziness
• Small pupils
• Nausea
• Sleeping disorders
• A runny nose
• Sinus irritation
• Excessive energy
• Rapid speed
• Mania
• Loss of appetite
• Mood swings
• Depression
• Apathy
• Slowed reflexes
• Vomiting
• Constipation and other gastrointestinal problems
• Extreme anxiety
• Restlessness and tension

In most cases, side-effects are experienced at the early stages of abuse and decrease as time goes by.

Depression was one of the most serious side effects of long-term users, and could lead to suicide.

In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Drug Screens

I think there is a general misconception in the public that all drugs can be detected by a basic blood or urine drug screen. This is not true.

First, when is a drug screen done?

There are several instances where we would likely run a drug screen. Here are a few.

1. You are having suicidal ideation. Suicidal ideation means you are having thoughts/feelings of hurting yourself and either you have presented or someone has brought you to the ED. This is fairly standard to see what might be in your system. What also will be added will be an acetaminophen (Tylenol) and salicylate (Aspirin) level. These are blood levels.

2. You are acting crazy. Meaning-- you're hearing and seeing things that aren't there. There are gait disturbances, a decreased level of consciousness. Perhaps even seizure activity. A common set-up for this scenario is a child or teen that begins to act funny at school. Here, there is a concern for ingestion and it will be best to sort out what we might be working with.

3. An actual ingestion in any age group. The history will be looked at very closely but if it is--- toddler got into grandma's medicine cabinet (this happens more often than you would think) and the youngster just flat out began to go through boxes/bottles swallowing everything in sight-- he will get a urine drug screen.

A urine drug screen can be an effective screening tool. But it definitely does not rule out all substances. That is the most important thing to know.

So-- the following drugs are on a basic drug screen. It may also be called a "drugs of abuse" of panel. Something along those lines.

1. Amphetamines-- interesting thing about this is some ADHD drugs contain amphetamines so kiddos on these will show positive. If they are on an ADHD med in this drug class-- it doesn't mean that they are not also abusing other types of amphetamines.

2. Barbiturates: The Truth Serum Drugs (Amytal Sodium, Phenobarbital and Luminal). But, do these drugs really act as truth serum? Interesting article here: http://www.damninteresting.com/the-truth-about-truth-serum/

3. Benzodiazepines: Drugs like Valium, Versed and Ativan are in this drug class.

4. THC: Tetrahydrocannabinol. Cannabis. The active ingredient in marijuana.

5. Cocaine

6. Opiates: Stuff of the opium poppy seed plant. Morphine, Fentanyl, Vicodin, Lortab, Codeine

7. PCP

Notice what is not on the basic drug screen? Alcohol... we would have to test separately for this.

Is this what you thought was on a drug screen?