Knowing oxymorphone, or the frustrations of work

So far, my experience in the ICU indicates to me that the trust of your co-workers and medical doctors has more to do with projected self-confidance than competence. Probably, critical care isn't the only field of work where this is true.

As an illustration of this point, I relate the following anecdote:

I had a surgical recovery patient recently who, during verbal report from the anesthesiologist, told us that a certain disease he had was from a blood transfusion. The anesthesiologist said, "I didn't know you had had a blood transfusion before?!" Said the patient, "I forgot to tell you." After the anesthesiologist had left, the patient told me, "I never had a blood transfusion, I got it from sex." All night, the patient told me he was narcotic naive, but the next morning he told a doctor he was prescribed oxymorphone.

(As I mentioned last month, patients lie, which is why I think the FDA can be a bunch of regulation-happy morons.)

As I was telling this story to some co-workers, one particular co-worker who started in the ICU at the same time I did and has been "advanced" to a preceptor position interjected twice to tell us, in a tone of confidence, that said disease is contracted from IV drug use, not from sex, and that oxymorphone doesn't exist. Neither of these points were germane to my story, which was about patient deceit, but also, what he told us in a tone of confidence was wrong on both counts. Said disease can be contracted from sex, and oxymorphone is a real drug.

Very frustrating to me.


I would have been more upset, but the surgeon that talked to the patient the next morning also claimed he hadn't heard of oxymorphone.

Like the much better known hydromorphone (Dilaudid), oxymorphone (Opana) is an opioid analgesic.
Why don't we use oxymorphone more in health care? I'm not sure, but I suspect it has something to do with the low oral bioavailability, which means it has to be produced in high strength tablets, which makes it attractive as a recreational drug, which is probably why my patient was familiar with it.