Street OxyContin

Last week I was sent to a park downtown on the report of an overdose.  We found a mid-twenties year-old male who was pale, diaphoretic, and tremulous lying in a fetal position, loudly crying.  The firefighters, who were on scene before us, were working him up as an overdose. 

Like the Men In Black, I hate doing my job in view of the public (for them it is “discharge their weapons in view of the public” but close enough) so after getting the basic picture my partner and I got the dude on the bed and moved into the ambulance.

Over the course of the initial exam and history, we found out that the patient was a methadone patient, with a 10+ year history of opiate use and dependence.  That day he had decided to take a leap off the sobriety wagon.  He went to the seedy downtown park and found a nice gentleman with OxyContin to sell.  He bought a tablet of 50-milligram controlled-release Oxy for the bargain price of $20.  At least, he said it was a bargain price – I have to take his word for it.  I thought it sounded weird.  Fifty milligrams sounded like a big dose of Oxy.  Especially for twenty bucks.  But what do I know.

Anyway, he took the pill and found a nice, shady tree under which he planned on enjoying his first non-methadone high in a long time.  Instead of riding a sweet opiate high, he developed nausea, abdominal cramping, sweats, and shakes.  You just gotta hate bad Oxy.

When I asked him what the pill he bought looked like, I was surprised that he could accurately describe it.  He had paid attention, because he wanted to make sure he was getting the right stuff.  It was a round yellow pill with 50/902 on one of the sides.  His salesman, who should be a millionaire with sales skills like this, said that the 50 obviously meant that it was 50 milligrams.  And the 902 was the FDA code for Oxy.  Doesn’t everyone know the FDA code for OxyContin?  The stones on that guy.  Awesome. 

I really hope he looked all "salesman-ish" like this... Source (CC BY-NC-SA 2.0)

I pulled out my phone and typed “pill round yellow 50 902” into the search bar.  Try it and see what you get.  I will wait.

The top hit shows the pills he described.  Naltrexone. 

For those of you who could use some work on medication knowledge, naltrexone is an opioid antagonist like naloxone.  Narcan is more for acute, emergency use and naltrexone is used for more ongoing, chronic management of opioid (and alcohol) dependence.  Both can cause immediate withdrawals in opioid-dependent people.  I love it when a bunch of information all clicks together.  It all made sense.  My patient had to sweat, cramp, and otherwise withdraw his way to the hospital while I sympathetically explained the meaning of caveat emptor and tried not to giggle.  He had the first step of buying something from a stranger – look at the product – he was just so excited about getting high that he never went to the second step - checking for himself what 50/902 meant. 

So there is a dude in the park who sold naltrexone to a junkie wanting OxyContin for twenty bucks.  Classic.