Uppers and Downers

By Jim McVeagh 19/09/2009

There’s a sad story in the Herald today of a young doctor who has been charged with forging prescriptions for weight-loss pills to keep her awake while working long hours. On the face of it, the judge was probably correct to reject the defenses plea for a discharge without conviction. I have absolutely no wish to see one of my young colleagues dragged through the court for a relatively minor matter, but the affair does point to an alarming lack of judgement on her part. Reductil is not habit-forming like some of the amphetamine derivatives, but it does have a pretty impressive list of side effect including exacerbating depression and high blood pressure and producing other psychiatric effects, including psychosis (fortunately, rare). This is not a drug that you want an emergency doctor to be taking, unsupervised.

The year before me, in medical school, the story was told of a student who decided to cram before the exams and took some sort of upper to keep him awake for 18 hour days and a sleeping tablet (a “downer”) to get him to sleep. After four weeks of this, he walked in to the exam and proceeded to decorate it with colourful swirls, happily oblivious in his psychotic episode, that he had just thrown away his medical career. I thought that this story was an urban legend (although it has been described in medical literature) – designed to keep medical students from taking drugs. Then a good friend of mine, who was having trouble sleeping due to all the Coca Cola he was consuming, took a single Halcion tablet to get him to sleep. He woke up in the morning with retrograde amnesia (a relatively common side effect of Halcion) and couldn’t remember anything he had studied the previous week! Fortunately for him, his memory recovered in time for exams (he did very well).

The point of this trip down memory lane, is that drugs with potential psychotrophic side effects are not to be messed with and the very least you can do is get one of your colleagues to provide you with a legal script (if they are willing) and monitor you when you are taking it. Fraudulently trying to obtain an drug merely demonstrates that you know that it is wrong and you are trying to cover your tracks. Not a good look (as our treasurer, Mr. English might say – sorry Bill, couldn’t resist)

This young lady’s medical career is not over. Medical council will almost certainly put her onto the “sick doctor” list, where she will be intensively monitored. She may find some of the more competitive disciplines such as surgery and orthopaedics may be closed to her, but emergency medicine would likely still be willing to take her for specialisation, amongst many other disciplines. And general practice won’t say no to another doctor unless they are either incompetent or an unrehabilitated drug addict…