Why do patients so often lie to medical folks? I saw a patient a little while ago who was somnolent and had slurred speech. Her chief complaint, as described by her and her boyfriend, was hematemesis. Large amounts for two days. No history of melena, actually no history of bowel movements at all. I was concerned about her mental status and wondered about her volume status and how low her hemoglobin was going to be. She and her boyfriend denied narcotic use. She was on Xanax (bad drug, bad drug) but was only using one a day.
On physical exam, I saw two squares of dirts on her right lower anterior chest wall. They were caused by the adhesive from two patches. She said she had been using nicotine patches there.
Wondering about narcotic use, I gave her some Narcan with a UDS pending. Wow, acute narcotic withdrawal! She and her boyfriend continued to deny narcotic use. They weren't fooling anyone.
Her agitation was so bad I finally had to remedicate her with morphine to calm her down. Her boyfriend finally admitted the squares were from Duragesic.
I saw no evidence of hematemesis in the ER. Her rectal (which I did think to do before the Narcan, was mildly heme positive. Her hemoglobin was normal.
Now she's sleeping peacefully somewhere else in the hospital. BTW, the drug screen was positive for benzos and THC. It doesn't indicate legitimate opiates, even in supratherapeutic levels.
If she had told me up front about chronic narcotic use, I would not have used the Narcan and she would have been spared the discomfort.