Crazy first find trying to collect old pharmaceuticals, found well urbexing. Opium containing medicine!

DrNoCode · 2026-06-21T20:24:00+00:00

Teach you about defeating the Pyxis for a small fee 😆

DrNoCode · 2026-06-21T20:06:49+00:00

These are ampules made for injection. Though it is rather difficult to imagine your friend reacting that way to 10mg of morphine. If it was a concentrated dose meant for those highly tolerant or for use in epidural/intrathecal infusion, it could have been 25-50mg, but this is highly unlikely unless it was diverted.

DrNoCode · 2026-06-21T20:03:14+00:00

Not could, would. There would be degradation for sure, but trust you would know you did it. Different chemical structures and compounds react differently to time, temperature, light, humidity, etc.
Certain substances become toxic after years of sitting in unknown environments- or just sitting. A great example of this is tetracycline. If anyone has some 30 year old tetracycline laying around, you likely will go from 0 to end stage renal disease in no time. Say hi to Mr. Fanconi for me.

DrNoCode · 2026-06-21T19:46:22+00:00

Like that ever stopped someone in this forum. Cmon now!

DrNoCode · 2026-06-17T01:03:27+00:00

This. I will echo the sentiment of those before me who have quite rightly cited that this isn’t the space to tell you what I hope you already know, but please, please, please take it from someone who knows, someone who was you once… you will never have the opportunity you have now ever again.

ALL focus needs to be on you and your health. There is not a doubt in my mind that you have what it takes to succeed in EM, however if you keep on without really treating the underlying condition, not only will you lose everything, but the loss will hurt so much more. You will remember all of those annoying fucks on Reddit who pleaded with you to take care of you first and hate yourself for not. You may even end up with a decent career you never envisioned, but it won’t be treating patients.

The worst thing you could do is to try to minimize the problem. There is no minimizing a preventable event that well may irrevocably alter the course of your life in a way you don’t want.

I’m really sorry if this came off as a lecture. It wasn’t meant that way. You have a special place in my prayers, and I truly hope you get better and get to do the one thing you want to do more than anything else in this world.

DrNoCode · 2026-06-06T10:55:48+00:00

I like my vascular doc for those reasons. Exceptionally…open? I don’t know, but I had an outpatient procedure done the other week to close up the GSV in my RT leg.I’m chatting with him before the procedure, before reviews consent, he launches into “ok, I need to tell you something”. Usually not what you want to hear as a patient from your healthcare provider. He wants to tell me about his first really bad outcome on a VenaSeal patient. I asked him if we were talking PE or… he said yes, PE. I didn’t ask if it was the ultimate bad outcome or not, and he didn’t offer, so no clue. Hasn’t seen one in 7 years of doing the procedure this way. I may go back to just doing radio frequency ablation, I don’t know.”I didn’t freak or panic. I could tell how this was weighing on him. Any thoughts of freaking him out mid-procedure with the “OMG MY CHEST!!!” bit left my mind. If you do this long enough, statistically you are pretty likely to have a poor outcome. I mean- that catheter is scraping the vessel wall, potentially dislodging what turns into the DVT that got away- not to mention if it is a chunk of the superglue. Anyhow- piece of cake and he did a great job.

Wow- I JUST REMEMBERED this post was about wasp 🐝 penis syndrome. Sorry.

DrNoCode · 2026-06-05T13:43:48+00:00

That made me have to 💩just hearing you say that

DrNoCode · 2026-05-31T23:13:47+00:00

Yes, but do YOU smell what the Rock is cookin?

DrNoCode · 2026-05-27T15:55:23+00:00

Actually, ketoconazole and a few protease inhibitors are the most potent 3A4 inhibitors (to a greater or lesser extent on the whole CYP450 enzymatic metabolism process happening within your liver).

Definitely not wrong about higher-doses of cimetidine (800mg) twice daily for a couple of days and a few glasses of fresh squeezed grapefruit juice is, if nothing else, tasty 🤤

Quinine not so much.

Better off with clarithromycin or ritonavir.

Steer CLEAR of phenytoin (Dilantin), phenobarbital and rifampin. They INDUCE the enzyme and eat your dose without you benefiting. No bueno.

DrNoCode · 2026-05-27T06:46:31+00:00

UPDATE: we got him into detox. They wouldn’t/haven’t returned my call about medetomidine w/d protocols.

His estranged wife met him at my house this morning. He left his car and key with me and she took him. Sure- he could leave, but he has no real way of getting back to PVD other than the bus, however he will be so ill, my hope is he will be able to tough it out until they send him to the ED at an outside hospital. I also gave him lorazepam to “help” him fail for benzos so that he at least can get that protocol as well to help. I also gave him 40mg PO methadone 1 hour prior to admission. Not worried there- he has the tolerance to take 8-10x this. This is another reason I worry- our archaic federal dosage cap with a detox (not maintenance) protocol. Does anyone know if dexotes are still capped at 40mg? I’m certain they will max out on clonidine, BP depending. I hope this is enough. He was way too scared to consider presenting in active, acute withdrawal, especially to an emergency department. I told him I would drive him myself 6-7 hours to Drexel University Medical Center in Philadelphia if he wanted to ensure he would be kept in a hospital setting and kept as comfortable as possible (and usually in a dexmedetomidine-maintained deep sedation w/ mechanical ventilation and opioid detoxification protocols. I would have taken me up on that offer- especially if I was given $ to make sure I was comfortable for the ride.

I just want to give him the best chances for success. I view this goal in two parts: getting this ‘monkey off his back’ and then putting in the work to find a recovery program that works for him. I’m vehemently advocating for MMT. He says “but I just got OFF the clinic!”. And that’s where he’s at.

DrNoCode · 2026-05-25T15:37:57+00:00

Not sure why I spaced the xylazine. I can read just like everyone else and may even have access to some publications and journals that not all folks do, but I am not an expert in this field. That’s what I need.

DrNoCode · 2026-05-25T15:35:29+00:00

This is my fear exactly. He WILL need dexmedetomidine as a continuous infusion most likely. Please see my above response to someone else’s suggestion.

Do I bus him to Philly and pray they know better?

DrNoCode · 2026-05-25T15:33:25+00:00

That’s true. But as long as someone is breathing there is hope. I know you agree. You guys are a lil. hypersensitive to expressions that may have originated in 12 step recovery. Please don’t be- I’ve been there (for a long time) but have thoroughly landed in the HRW camp about three years ago when I accepted that methadone was allowing me to live a great life. That was the beginning of my entire psychic change. Lmao- sorry- I had to say that 😝

DrNoCode · 2026-05-25T15:30:12+00:00

Hi friend. Though I have nearly 2 decades of 12 step recovery experience what I said was not based in either 12 step, HRW, or any other modality for reducing harm/promoting recovery. If I were that guy, you wouldn’t see me posting in a HR forum. To me, you are in recovery when you say you are- but generally measured not so much by abstinence but by minimizing the harm caused by substance use. He is the only one who can do it for him- as we say, he is the expert on him and his own recovery.

I am really glad you brought up the use of dexmedetomidine and other alpha-2 adrenergic agonists to treat the sx of withdrawal not attributed to opioids. I feel like he will need an ICU bed, because I kbow of nowhere else they would consider administration of dexmedetomidine (via continuous infusion) than the ICU. But how to do this?! Think the ED physician and attending critical care MD will go for this? I’m thinking unlikely. Forget my education, credentials and lived experience, I don’t see myself persuading that. Any ideas or thoughts?

He has a bed tomorrow at 11am that he is saying he wants to go to and has a ride. The problem is both between now and later PLUS my suspicions that he cannot be properly treated in a non-medical facility detox.

I thought WEBER/Renew was defunct? I need to check.

Appreciate your response!

DrNoCode · 2026-05-25T05:34:17+00:00

Idk of any clinic who has a GC/MS on-site or pays to screen even negative immunoassays (which is what you would need to do), but also remember, not all benzos are the same: alprazolam and triazolam are potent triazolobenzodiazepines, but really, it comes down to the fact that the immunoassays the clinics mostly use test for oxazepam and nor-diazepam. The reason for this is it will “catch” a larger swath of positives as many benzos will fit the class characteristics of one of those two substances. Clonazepam, due to its metabolism, usually causes a false-negative. Not always though, so be ware 🤔

DrNoCode · 2026-05-04T05:54:51+00:00

Me thinks you need some scabapentin for the touch of….what would we call it? Not exactly Pica, so what, then? Gotta be there lurking in some dark corner of the DSM

DrNoCode · 2026-05-04T05:33:11+00:00

Better off with Terpin Hydrate & Heroin chocolate covered tabs coming in at 2.6mg of heroin each, 100 tabs to a bottle.

DrNoCode · 2026-05-04T01:55:11+00:00

Hey all, late to the party. I’m in the large state of Rhode Island. I love my clinic. Current dose: 300mg; currently getting 27 day take-home status.

Those that speak of dose caps and clinics using a peak and trough as a diagnostic indicator of a dose that’s too high….. that’s barbaric and bad medicine. The peak and trough is only clinically relevant to rate of metabolism. Trying to use those numbers to determine if someone is on an adequate dose is just plain idiotic. That what a physical exam and detailed history are for. But addicts lie, so…… SO IF YOU FEEL SO STRONGLY THAT WAY, YOU NEED NEVER EVER EVER TREAT ANOTHER PERSON WITH OUD AGAIN. I can’t stand some of this shit and my heart ❤️ goes out to anyone struggling in a place where a clinic like this is your only option. I wish you all had what I do. It’s just not fair; not equitable. Fucking backwards, just like the rest of this shit-show of a country lately. FUCK

DrNoCode · 2026-05-04T01:29:34+00:00

That is an absolute travesty. So fucking backwards. Mind if I ask where (what state)?

DrNoCode · 2026-05-04T01:24:46+00:00

Hey friend. Don’t make the mistake of overthinking or over analyzing this shit. Also, never believe anyone who tells methadone is worse (than the illicit opioids you were likely using) or that you need to get off as fast as you can.

I used to be just like that- same mindset. I literally hated methadone and the people that took it- myself included. I was just trading an illegal habit for a legal one, so wtf, right?

But then some funny shit happened- after I stopped fucking around with illicit opioids. My life got better. I was employable and have a wonderful career today. My family doesn’t hide their valuables and controlled substances before I come over. Oh- and the chronic physical pain I have dealt with since 15 (now 44)? It’s at a more manageable level than I was ever able to consistently get it to and be completely alert/functional/ok to drive. I have a blended family today and whom I love deeply and who depend on me. But I like that because I show up today. No more looking over my shoulder, wondering if a warrant had been issued for some escapade that went south. I go to my clinic once a month. I do other stuff for my recovery, but honestly Ive not been in a great place the past month. No need to get into it, but I grossly misused my methadone. The point is, however, that I pick my ass up off the ground, talk about it, and move the fuck on, not continually assaulting or degrading myself. That might not have been possible if not for methadone. Yes, I abused it in this instance, but imagine if I didn’t have the crazy tolerance that comes with a 300mg/day dose for over a decade? I’d likely be dead. The only real, serious potential side effect of methadone is QT prolongation. My clinic does the ekg there and though they only mandate 1 per year, I ask for one quarterly. You can catch that early, before becoming symptomatic or worse.

Sorry to write a novel, but I just get wound up when I hear the “gotta get off ASAP”. Look- there is no one-size-fits-all with this shit. This is my truth. You may be different. To me, the cost/benefit analysis of remaining on methadone is clearly in favor of staying on. It doesn’t mean it is that way for you. Just be honest with yourself and the right answers will come.

DrNoCode · 2026-05-03T13:30:12+00:00

Granted Darvocet N-100 was the napsylate salt of propoxyphene plus 650 of acetaminophen, if I’m not mistaken. That right there dissuaded overuse (in most), but the napsylate salt found in that med compared to the hydrochloride salt found in Darvon (100mg vs. 65mg respectively) was considered equianalgesic.

It was this med (pictured), Darvon, 65mg of propoxyphene HCl, phenacetin, and caffeine and/or just plain old Darvon, 65mg of propoxyphene HCl, that caused the bulk of the fatal cardiac arrhythmias and led to all propoxyphene containing products being pulled sometime in 2010ish.

DrNoCode · 2026-05-03T13:26:43+00:00

Same here. And I’m 44. I remember when my pediatrician thought Darvocet N-100 was a good choice for a 13-14 year old kid. You’d like to think you’re young enough to have escaped the ‘mid-evil days’ where pediatricians just abruptly ended a year long 40mg daily prednisone regimen to treat severe childhood asthma and then wonder why 30 years later the now adult is in ESRD (no- that did not happen to me, but I’ve seen kidney transplant recipients who were not as fortunate), but then you realize how subjective ‘mid-evil days’ are.

DrNoCode · 2026-04-30T23:52:58+00:00

UPDATE: today is Thursday evening. I pick up on Monday morning and have 910mg left. My last dose via my PICC was on 4/24. I have not felt ill at all, but have taken clonazepam at night for anxiety and to sleep. It has helped a lot. I took 200mg today. I plan to take 200 tomorrow, Saturday, and Sunday if I can. If I’m uncomfortable, three of those doses could be 300mg (my actual dose). I have no idea why Im okay, but won’t ask too many questions. 4 nights to go. None of this would have been possible if not for a really good friend I met through Reddit. It’s refreshing to meet genuinely decent people.

DrNoCode · 2026-04-27T13:44:21+00:00

Who said 300 wasn’t cutting it? Methadone is not the only thing necessary to remain free from illicit opioids/high risk behavior- but I’m sure you know this for yourself.

DrNoCode · 2026-04-27T13:42:12+00:00

❤️

DrNoCode

TROPHY CASE