Ok so it was the third day on service. I was called down to the ER to evaluate and admit a patient for tylenol overdose. I have seen and managed many overdose patients in the past but this one was unique.

A 42 year White female who was previously seen by me 7 months ago for a drug overdose came in again, but this time brought it in by the cops. This patient had a history of narcotic dependence and was addicted to vicodin and oxycontin.

Apparently she got into some "legal problems"....The exact nature of the problem I cannot find out from the patient because its not ethical to ask the patient why she went to jail. Anyways, she was taken to the court to be presented in front of a judge. For those of you who have treated patients from jail Or who have actually been in jail, you would be well aware that the infirmary
is very strict about dispensing narcotics.

Now this lady was a bit too smart and well prepared.. She knew that the judge is going to sentence her to jail and she also knew that she wont get her usual high in prison because they wont dispense any narcotics. So once she was sentenced, she went in the ladies room and stuck all her stash of vicodin and oxycontin up her vagina.....yes, you heard it right, in her vagina; in essence using her female reproductive tract as a pill storage for rainy days.

Now the vagina has mucus membranes and the poor soul didnt know that the pills would get absorbed and they wont even go through first pass metabolism. Well soon after she became delirious and the cops got suspicious, they asked a female cop to strip search her and when the officer asked her to squat down, 37 partly digested pills were obtained. What surprises me was that this desperate person was actually planning to take the same pills she had stored in her vagina and yes, the pills were not in a plastic bag.

anyways, she didnt die as she was too tolerant to narcotics. We just kept her in the hospital for 2 days and gave her some NAC. She asked for more pain meds but obviously, I didnt give her any except Toradol and discharged her today.

GLOSSARY

First Pass metabolism

After a drug is swallowed, it is absorbed by the digestive system and enters the hepatic portal system. It is carried through the portal vein into the liver before it reaches the rest of the body. The liver metabolizes many drugs, sometimes to such an extent that only a small amount of active drug emerges from the liver to the rest of the circulatory system. This first pass through the liver thus greatly reduces the bioavailability of the drug. Alternative routes of administration like suppository[dubious – discuss], intravenous, intramuscular, and sublingual avoid the first-pass effect because they allow drugs to be absorbed directly into the systemic circulation.

NAC (N-acetylcysteine) Antidote for acetaminophen/tylenol overdose. Vicodin has 325 mg of tylenol in it.