How Many Pills Were in the Bottle?

“I came back to the room, and my Vicodin was gone.  The maid threw it out when she cleaned.”

“And how many pills were in the bottle?”

“Almost two hundred. I’ve had four back operations.”

“That’s a lot of Vicodin.”

“Check me out. I’ll show you the scars. I need your help.”

Plenty of drug abusers lead productive lives although it depends on the drug. You can’t do this for long with speed. Amphetamines and cocaine poison tissues, the brain most of all. Alcohol is also a toxin; alcoholics wreck their health. This doesn’t seem true for narcotics (Vicodin, Percodan, Oxycontin, heroin, etc). One can consume high doses for a lifetime with no noticeable harm except chronic constipation. Street addicts die from overdoses, contaminated drugs, disease, and violence. In countries that provide clean narcotics to addicts, they have a normal life expectancy.

Narcotics are probably OK for selected patients with chronic pain and a competent doctor. But there’s no denying that too many people are taking more narcotics than they need. Good doctors object because there are better ways of treating chronic pain. Moralists object on the grounds that doctors should make patients feel normal but never better than normal.

“As a hotel doctor, I encounter this problem now and then...”

“I swear I’m not a junkie, Doctor Oppenheim. I have chronic spinal pain, and I’m under a doctor’s care.”

“I’m glad to hear that, because I’ll have to speak to him.”

“He’s in New York. It’s midnight in New York.”

“I know. So I’m going to phone ten Naproxyn to the Walgreen’s at Santa Monica and Lincoln. Tell your doctor to call me tomorrow.” 
  
“The damn hotel threw out two hundred pills! They said you’d replace them!”

“I don’t work for the hotel. It sounds like the Naproxyn is unacceptable to you. So…”

“I’ll take the ten.”

This would satisfy him temporarily, but the odds were one hundred percent that his doctor wouldn’t call, but he would. There was a small chance he’d be in another hotel and pester another doctor. There was a large chance he’d behave in a sufficiently obnoxious manner that the staff would take any complaint about me with a grain of salt.

The End of Narcotics

I once carried narcotics but gave it up. It’s too much hassle.

For garden-variety pain, codeine, Vicodin et al are sometimes but not always superior to over-the-counter pain medicines. I liked them because hotel guests have usually tried ibuprofen, Advil, Motrin, naproxen, etc. During the visit, I can hand over a few days of narcotics, and the guest knows he’s getting something different.

Nowadays, when I determine during the phone call that the guest only needs a pain medicine, I have nothing to offer, so I end up not making the visit. Many guests don’t want to pay the housecall fee in exchange for a prescription.

In an effort to fight the raging opioid epidemic, states have passed laws to keep track of narcotics. Pharmacists now send a report to the state for every narcotic prescription they fill. That’s easy because pharmacists already record everything on their computer, so they merely hit an extra button to send the report. 

If I hand out a few narcotics, I must sit down at my computer when I return home, find the reporting form, and fill it out. Some of the questions seemed cryptic, so I worried that I wasn’t doing it correctly. It seemed safer to stop handing them out.

When Stupidity Takes Over

In 2002 I had the satisfying experience of reading a front page story about my leading rival hotel doctor.  The California Medical Board had lifted his license, and he was in serious trouble for providing narcotics to more than one celebrity. You can google it.

Most drug abusers must take to the streets and run risks, but a few are rich enough to pay a doctor to make housecall to give a single shot of whatever they prefer.  A doctor for luxury hotels gets such request regularly (“My back went out, and I have a meeting I can’t miss...”).  If a doctor is quick with the needle, the word gets out.  Calls pour in.  Money pours in.  Most likely the doctor realizes he can charge a good deal more for this service and related services. Stupidity takes over.

Eventually, prescriptions labeled with this doctor’s name are sitting in medicine cabinets, purses, and glove compartments throughout the city. Their owners are fairly careless. This doctor is doomed.

I Don't Do Adderall

“A guest at the Century Plaza wants his Adderall refilled. Can you go?” asked someone from the office of a local concierge doctor.

“I can go, but I don’t do Adderall,” I said.

“No problem.” She would find another doctor. Prescription refills are easy house calls.

You’ve heard of childhood attention-deficit disorder. Recently psychiatrists have discovered that it also affects adults. Treatment is the same. That includes drugs related to amphetamines; the most popular for adults is Adderall. As a hotel doctor my only experience with attention-deficit disorder comes from guests who need more Adderall.

None sounded like drug-seekers. All were happy to pay my fee for a visit during which I would check them out. Since there is no way that I can examine a guest and determine if he or she suffers adult attention-deficit disorder, I told them I’d have to speak to his or her doctor. None ever called.

It’s been decades since I made a similar decision on narcotics. Guests occasionally forget their heart pills, but soon after becoming a hotel doctor, I grew puzzled at how many needed more Vicodin or Oxycontin. Some sounded suspicious from the start, but many were clearly in great pain. Their distress tore at my heart, and they often produced a sheaf of X-rays and letters from a doctor. With no reliable way to tell the fakes from the genuine, I gave up on narcotics.