When the war on drugs reaches your front door and leaves you guessing

A patient has requested her prescription early. I have never met her, but I can see in her notes that six weeks ago she got them early because she said she had lost all her pills in a waterfall. All of them, the morphine and diazepam for her and the methylpheni­date for her son.

And I am ready to pick up the phone and ring this woman with a righteous strut, knowing the generals from the war on drugs are at my back

The receptionist has just explained about the time the patient had come to the desk enraged because her regular doctor hadn’t fallen for the water story and had refused to give her extra medicine, but by then it was his afternoon off and so she sat in the waiting room looking both hard and limp, until the last doctor standing, a young GP, gave her the script, mainly so she could get out the door to her car at dusk, without intimidation.

I kind of like the waterfall story, I imagine the soggy trio of pills dissolving in the foam, churned up in the surge of water and floating away.

Where would the waterfall be, I wonder? We are in the middle of a city and I am reading the notes of a woman with no car, who is on a benefit. And then the rational bad cop in me goes, oh yeah, that’s right there is no waterfall. We are talking about the metaphorical river of diversion, we are talking about the fact that most injected drugs in New Zealand are sourced from doctors writing prescriptions for medications they think are helping with the patient’s pain of life, but how each pill is a money-generating unit for someone’s drug enterprise.

And I am ready to pick up the phone and ring this woman with a righteous strut, knowing the generals from the war on drugs are at my back.

But then the good cop in my head says, well she probably needs that money to feed her kids and how am I to know whether she takes it, sells it sometimes, gives it to her son sometimes, sells it other times, gets hassled to sell it. I could do a urine drug test or a blood toxicology to see if she has morphine and diazepam in her body, but these people are not stupid and she can easily fill her blood­stream before the test.

THE NEXT ENTRY in her notes is from three weeks ago, when she went to the after-hours doctor for an extra prescription, claiming the drugs had been stolen out of her car while she was at the beach with the kids. Beaches are a little closer to us than waterfalls, so the older GP relented and she got a week’s worth.

We are in COVID-19 lockdown at the time, so I am grateful I don’t have to do a face-to-face appointment with her, but I sure don’t want to ring her and I am hoping she doesn’t pick up. Of course, she does answer and she tells me the drugs were stolen off the kitchen table last night by some of her boyfriend’s dodgy associates who won’t ever be allowed back after doing that.

And I’m back to bad cop, feeling emboldened because she is not in my physical space, and I probably won’t ever meet her as I am just a locum here, so I say, “Well you can’t leave meds like that on the table, you have to lock them up, no one should know you are taking them and if your boyfriend has dodgy mates then he should not even know where you hide them.

“You don’t want to be put under pressure,” I say wisely, as though I know all about living in a house with drug-crazed traumatised violence and an empty fridge. But really I’m saying, “You need to do better than that young lady and I am going to ask the team, but I doubt we can give you a script to replace that one”, and I’m liking the idea I can say, “No”. Mainly because in lockdown the front door of the medical centre is shut so she can’t just walk in and yell over the desk.

“I’ll get back to you,” I say, feeling the tide has turned and I am not being duped like that young GP or that after-hours doc; I am in control of this situation and I will not be taken for a ride by lies and deceit.

BUT JUST BEFORE I hang up, the boyfriend appears down the phone and I realise he has probably been there in the background all along and I can feel a sinister, creepy sneer from him. I feel a bit weak but hold my ground. When I get off the phone I ring five or six other patients who just want normal things like Ventolin and blood pressure pills and reassurance, and I feel a bit better. But I know I have to ring her back and my clinical director has said “no don’t give it to her”, but he has now gone home because he is more efficient than me, and I start hesitating. My good cop starts thinking about the remote possibility she is taking the medications for good reason and has run out, and what if I don’t give it to her and she goes into withdrawal, that would be bad, or what if she is in danger from that creepy boyfriend and will be beaten if she can’t produce the drugs for him to sell. And I’m feeling weary and cornered again.

So, I spend some time working out the minimum I can give her for the next five days, just to prevent possible withdrawal. I ring her back and say I will give her that much, and get in my car and drive home and open my fridge.

In three days’ time, I will get a letter from the hospital. She will have been admitted with a smashed-up face, claiming she had fallen down a mountainside, and they will have given her the 100mg dose of morphine that they can see she is regularly prescribed. She will have had a respiratory arrest, literally stopped breathing in front of her kids sitting by her hospital bed because, of course, she was well overdosed by 100mg because she had never actually taken that amount.

The hospital will resuscitate her and blacklist her and refuse to give her another script. But by the time her local pharmacy is informed, the boyfriend will have already picked up the last repeat and likely sold it on the street, and the kids have been put into the care of the boyfriend’s uncle and aunt, who I will later learn have their own sinister way of being bad cop to kids.

When all that unfolds and more, I will wonder, as I stare into my fridge, choosing between camembert and Mediterranean dip and organic lamb, what story might lead me to have these choices, and what story might lead her to have the ever-constricting life she has?

And I will make a donation to the food bank and feel a little better. Then I will make another to the women’s refuge so I can sit down and eat my tender lamb and enjoy deciding whether my next weekend trip away will be at the river, the beach or in the mountains.

Lucy O’Hagan is a GP living on the Kapiti Coast