I am surprised. Nothing has changed!

Jp Enlarged

It hasn’t changed one bit in 45 years.

My drug store is right next to the University of Texas Medical Branch. This is an 11,000 employee medical center and school. They teach aspiring MDs, nurses and other assorted medical professionals. The area around UTMB is the historical district. Doctors own beautiful renovated oak-shaded ante-bellum mansions that are right beside homes that are marginal, run down and ugly, owned by little old widows who have lived there for decades. They’ll become a doctor’s place when she dies.

I’m just giving you a little flavor. That neighborhood is where they opened up The Galveston National Laboratory two weeks ago. An eight floor high security lab that studies that worst shit on the earth. Ebola and stuff like that. The GNL is drawing scientists from all over the world and bio-tech firms to the neighborhood like ants to a picnic.

Galveston will be okay. The face will change. Eventually the “Redneck Riviera” will be gone. That is the area to the east end of Seawall Blvd. The seawall sidewalk hookers are already gone. The lowest level of drug dealers too. They will never be back. The poverty-level enclaves were destroyed by the storm. The residents went to Houston.

You know that JP is a bleeding heart liberal, but I do not think that the loss of this group of people is a bad thing. I have a grandson who I want to be able to attend Ball High School in safety in about 13 years.

Hard Luck dvdrip

I will talk about “The Storm” (as Hurricane Ike is referred to in Galveston) a lot because The Storm has had a profound effect on me, my family and every one living in our town. The stress is insidious. I went over to the spa at The Moody Gardens Hotel today. (Right near my townhome) and got a deep tissue massage in Guangzhou with all of the panache and ambience of the first class hotel. They like locals. They took good care of JP. My back and shoulders were so tensed up, she found little knots to work on. It hurt so good.

There is worry about UTMB. Just a few less than 3,000 employees were laid off this week. All levels. Yesterday.. 126 faculty members. All clinics are up and running, but only a few are at home in Galveston. They are spread all around the county, in borrowed or rented offices.

Now, my essay for today. A blast from the past, 2008 style. The UTMB medical school is running full speed. A first year student presented an Rx for Ritalin 20 mg, #60 1 tab q AM and 1 tab q HS. I took the packet to her myself and asked her to come over to the consultation window and talk with me.

“Do you usually take this at bedtime?” She seemed like a normal kid. Why give a girl with ADHD a bedtime dose? Was it a doctor’s error?

“Well, yeah, I guess.”

“You are not going to sleep,” I said. I watched her and she got a little skittish. “Talk to me,” I said and grabbed her eyes with my eyes and smiled. No judgment. Just talk with your pharmacist.

“Well, it is not for that,” she said, “It is for studying. I tend to let my mind wander when I am tired.”

“And this is crunch time. Medical school! This is finally the real thing.”

She nodded. “The real thing,” she repeated. “I like that.”

“It’s time to act like a grown up.”

She nodded gravely, “That’s right.”

“Now, Bristol,” I said, “You gotta sleep. You can’t take this to study every night.”

“Oh no, not every night. The doctor gave me a lecture about it, but you are easier to talk to.” She frowned. “Can it hurt me?”

“It can if you take it every night.”

“Oh, I promise. Not even every day. Maybe not even every week.”

I laughed and told her that nothing has changed since 1963. Forty-Five years and students in the medical universe are using drugs to get wired to study. I told her about Eskatrol Spansules and Dexamyl Spansules. They were popular diet drugs. No more controlled than Penicillin G. There was no DEA. At my home drug store, we had rolls of samples down in the drug room in the basement. I’m telling you hundreds of spansules. Every pharmacy student I knew brought a stash to school for mid-terms and finals.

Eskatrol, by the way, was dextroamphetamine and prochlorperazine. Dexamyl was Dexedrine and amobarbital. Yeah. I know. The last time I took a Dexamyl was for a mid-term in 1963. There were three or four Kappa Psi brothers studying at my basement apartment off campus. I was a very good student. I was on my bed reading comic books. My studying was done by midnight. But with 15 mg of dextroamphetamine being released slowly into my blood stream there was no hope of sleeping. Why did I take that shit? Ritual. That is what we did. Young men whose dorsal lateral prefrontal cortexes were just maturing. Certainly, my impulse control was not good enough to tell my friends that I was not partaking.

Madhouse trailer My studying buddies left at around 3:00 AM. My roommate was sound asleep. The basement was dark. My mouth was dry and I felt hot. I was horny like only a pharmaceutical amphetamine can make you horny. No hope. No girl friend. I had the five bucks but I didn’t have the car to drive over the river to that famous farm house with the clock on it. We called it “The Clock” and the clock replaced the red lantern. Shit, you guys would feel like I did too. I have no clue what amphetamines do to you girls, but there is one universal and brilliant consequence that turned many housewives into prescription forgers after they lost the weight and their asshole doctors cut them off from the drug. I told Bristol.

That night in 1963, I took a long shower for my itchy skin. After the shower, I had to walk through a dark laundry room to get to where Faber and I lived. I took three steps and had an auditory hallucination. A voice as compelling as any I knew said in a loud stage whisper, “Jim, come here.” As I write this, the 45 year memory in my limbic system is making the hair stand up on my legs. I retreated into the bath room and took another shower. I tried again and again, “Jim, come here.” Three tries and I locked the door and stayed in the bathroom until morning. After that, it was no problem to say, “I’d rather sleep tonight” and refuse one of the speckled green capsules

I told Bristol about my experience (minus the horniness). She was my buddy now. We shared something. We had laughed together.

“Bristol,” I said, “There is something that I have to warn you about.”

“What is that?”

“Euphoria, Bristol. Flat line euphoria. The EVERYTHING IS ALL RIGHT EUPHORIA. NOTHING CAN HURT ME EUPHORIA. I AM QUEEN OF THE MOTHERFUCKING WORLD EUPHORIA.”

“Is that a real bad thing.”

“It is a very bad thing. That drug will make you experience a sense of well being that is so powerful that you might want it when you go to a club on the seawall on Saturday night. You might want to feel that good on your breaks at your parent’s house. You might be going back to your doctor telling her that you lost your pills or had shared them to get more. This class of drug could sabotage your goal to be a doctor. You could flunk your ass out because of Ritalin.”

Bristol looked at her pills, then at me. “You are scaring me.”

“Good. You’ll know exactly what I am talking about with your first pill. It is going to make you feel very good, Bristol. Promise you will come and talk to me, Bristol. Come and talk or call me if you sense it could be getting dangerous.”

“Promise. I promise, sir.” She took my card. “I really promise, sir, thank you.”

I watched her cute little bottom as she walked away. I sighed. I wasn’t her dad. Just her pharmacist.

6 Comments

6 Comments

  1. Lipstickatthemailbox  •  Nov 27, 2008 @12:15 am

    Applause from me. Excellent post JP.

  2. The Ole' Apothecary  •  Nov 27, 2008 @4:07 pm

    There are pills that make you happy.
    There are pills that make you blue.
    There are pills to kill our streptococci.
    There are pills to cure your cockeye too.
    There are folks whose pills have made them healthy.
    There are folks whose pills have cure their chills.
    But the folks whose pills have made them wealthy
    Are the folks who make all the pills.

    (There are) Dexerine and Miltown, to pick you up and let you down.
    (happy) Or if you’re sufferin’, swallow a Bufferin.
    (pills) Vitamin C’s a pill for folks who shiver.
    (sad) And there’s a pill for Carter’s little liver.
    (pills) And if you’re sleepng in the hospital, because you’re ill,
    (pills) Betcha the nurse will wake you up to take a sleeping pill.

    There are pills for young folks and for old folks,
    Each disease has got its remedy.
    But no pill can cure the common cold, folks,
    So if you sneeze, please don’t sneeze on me.
    Achoo!
    Gesundheit.

    –Allan Sherman

  3. The Ole' Apothecary  •  Nov 27, 2008 @4:15 pm

    Now that I got that out of my system for another few blog years (grin)..

    I suppose the Controlled Substances Act, which went into effect on May 1, 1971, blocked my generation from going through that. I started pharmacy school in 1973. Heck, I didn’t even have an upperclassman tell me to go down to the bookstore and buy a box of benzene rings.

  4. Cathy Lane RPh  •  Nov 28, 2008 @9:05 am

    Excellent post and responses.

    After experiencing a childhood brain tumor (and subsequent craniotomy) never could figure why folks would deliberately do something to effect a hallucinatory response…symptoms of my astrocytoma included auditory, bugs crawling, olfactory hallucinations, ataxia, nausea, vomiting, extreme cold and fatigue, and the constant headache. On reflection, I cannot recall frustration (and given the effect of the overwhelming HA, I probably was NOT aware that I would normally have been feeling frustration and anxiety from not being able to understand complex school assignments or form a cohesive thought or sentence.

    Maybe the effect of a brain disturbance is to take away abilities for reflection, self-analysis, and self-motivation. After the tumor was removed, there was 1st a tremendous sense of ‘release’ and then I had to go along with Dr’s orders for rest and patience and just keep repeating classes until ability to concentrate returned and I mastered concepts, graduate high school and try to get into pharmacy school.

    Anyway, I think undergoing the whole brain growth experience really first struck me as valuable (since I did recover quite well from the surgery and was 4th year pharmacy school when the hospital’s tumor board contacted me to check if I was still alive) when Art Linkletter’s child died of PCP OD, …about weirdness of deliberately or inadvertently ingesting hallucinogens.

    JP did a great job (as usual) explaining why someone wouldn’t want to go through it, even the first time.

  5. Medical Advice  •  Sep 2, 2010 @5:00 am

    I think patients need to understand that if they want their solo/two-doctor group to be there in the future that they will have to accept an alternative payment model (i.e. cash pay). Some of the future changes will certainly be welcome, such as new technologies that make both patient’s and doctor’s work easier and more efficient, but there will also be less-desired changes of more governmental interference, red tape, and an increase of insurance companies’ efforts to collect as much money from the patient and give as little as possible to providers. By breaking this unhealthly addiction to insurance/government patients would find their doctor to be able to provide a much better quality of care. I hope it happens.

  6. Dr. Joey, MD, PhD  •  Jun 23, 2012 @5:57 pm

    I ‘m a few years late…niy was double-checking on Esakatrol’s ingredients (not what they were, but in what proportion and was always puzzled that it was assumed that 10mg for Compazine — the usual dose is 5-10mg q6h PRN nausea — could modulate 15mg of Dexedrine. I graduate from medical school in 1978 and, although did my Residency the first of three in Psychiatry), I also was pursuing a PhD (on a “full-ride fellowship’ — they actually paid me in addition to full tuition and I needed the money; it was only one upper-division medical) at the same school that is only tangentially related to medicine — English and American Lit. I think I passed Med Boards and was licensed after I completed my first year as a resident. That Ritalin script was not written if good faith; I hope you didn’t fill it. We’re taught that the pharmacist as this discretionary power. Only a moron would write for a HS dose of Ritalin, even though Ritalin isn’t a very powerful stimulant. I have treated addicts, but never a Ritalin addict; my feeling is that we’d having to be looking at longterm use of 100mg or so QD. T last last time I took Dexedrine (after a 25 year hiatus) was in combination with Wellbutrin, Prozac and Tofranil-PM for treatment-resistant Depression. I still take amphetamines, but we use Adderall because the Dexedrine 5mg generics (all manufactured by Barr Labs and used by ALL the local pharmacies, are therapeutically inequivalent to say the least. We stopped at something like 105mg/day. I had occasion to go to my endocrinologist, Dr. Dave, and I listed the psych meds for him. When he saw Dexedrine 30mg TID, he said,that I hope he didn’t mind his checking my vitals again! “I give a few patients Adderall (since he also does Internal Medicine) and the most is Adderall XR XR 20mg/day. Dave earned a PhD in Microbiology from Yale and before going to med school.” My BP is always textbook perfect and I have the misfortune of being a “Non-Responder” or “Reducer” to CNS drugs. I cannot take new migraine meds and NSAIDs because I had my Aortic Valve replaced and take Coumadin. When I haste a Migraine (and I get about four different types, as well as the muscle-contraction classic Fiorinal headache), I need one, sometimes two 1 or 2 Percocet 10/325 and brand-name Valium 10mg ONLY as a muscle relaxant…and sometimes even 10 or 20mg of generics Compazine.

    Incidentally I did take Dexedrine, Dexamyl, Preludin and Ritalin to study for both my MD and my PhD and to do those long rotations. I had the same experience you did with plain Dexedrine — but I knew that Thorazine is a direct amphetamine antagonist; booth my parents are MDs and it was really easy to grab a script blank for an “uncontrolled” substance with a 25mg q-4h PRN nausea directions. I never liked Spansules when prescribing as a psychiatrist. I can understand an antihistamine, even the combination diet pills, Appetrol (d-amhetamine and meprobamate), Obetrol — now made over as Adderall. However the ORIGINAL Olbetrol formula contained three different methamphetamine salts and three different do amphetamine salts (I started medical school in 1976.) I have a good memory and I couldn’t imagine ANY drug company marketing an ADD drug containing Desoxyn for this use. Yep, they replaced the methamphetamine salts was dl-amphetamine salts, where most of the speedy side effects reside. I never had trouble getting amphetamines even when I was an undergrad. I’m gay, I was a very attractive kid (or so I’m told) and, although I never promised any boy what I didn’t deliver, I could do so with a doctor friendly to begin with — and anything else I needed, I obtained from the Medical Director of Student Health Services in return for positive stories about him, the place, the staff, in our student newspaper. I went to a large university with not only a College of (Allopathic) Medicine, bit also a College of Osteopathic Medicine. I stayed around for medical school.

    I’m very lucky that I didn’t get into serious trouble taking all those meds, especially the Seconal and Doriden (secobarbital – no longer available in capsule form) and Doriden (had the advantage of being a refillable C-III sleeping pill; easily as strong and as addicting as the worst barbiturate; it went to C-II status) and I haven’t been able to find it. I actually wanted to prescribe it for a reliable patient who cannot take barbiturates (although the only one around that I know of is Tuinal, a combination of 50-mg Seconal and 30mg of Amytal; used to come in several strengths and now only available as the 100mg Pulvule) and who suffers only occasional insomnia. I remember that the 500mg pills were scored; she’d only need about that much). Since my parents are (retired) physicians, I knew how to cook the books when it came to writing for C-II drugs — but I never did, just as they never did. No laws or regs EVER stop the “bad guys” (and women) from abusing our prescriptive privilege.

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