Is this unethical?

[NeuroKlitch]

Is it immoral to ask ur inpatient nurses for low doses of commonly prescribed second generations and first generation antipsychotics like haldol or abilify 5 in order to understand what exactly I'm giving my patients . There's something icky about the idea of being given meds that aren't prescribed but my intention isn't abuse either obviously , I just feel llke I want to know what it is I'm giving , like truly .

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[PikminOC]

Wut?

 

[wolfvgang22]

Is it immoral to ask ur inpatient nurses for low doses of commonly prescribed second generations and first generation antipsychotics like haldol or abilify 5 in order to understand what exactly I'm giving my patients . There's something icky about the idea of being given meds that aren't prescribed but my intention isn't abuse either obviously , I just feel llke I want to know what it is I'm giving , like truly .

I wouldn't put someone else in that position, no. You know how to prescribe if you are a physician. Whether that is a risk you are willing to take personally and professionally is up to you. Personally, I abstain.

 

[finalpsychyear]

I'm confused. You want to take these meds to see what they do to you so you can understand them better?

 

[Stagg737]

Some of my older attendings in residency said this was actually a fairly common thing back in the day and several of them had taken low doses of meds like haldol, thorazine, and lithium in single doses to get a better understanding of what they were giving to patients. I realize that different patients will experience them differently, but I do think that for some people it can give a better appreciation of the effects of what we prescribe. Relevant non-psych side story from one of my old IM attendings:

When he was a resident in the 90's, an intern on his team gave an inpatient a dose of lasix by mistake and when called out by the attending said it was a low dose and that they didn't think it was a big deal. So the next day at the start of rounds, the attending pulls out a pill and tells the intern to take it. When the intern questioned it, the attending parroted the intern's response the day before that it was just a low dose of lasix and didn't know why it was a big deal. So the intern took it and the attending told them to use the bathroom if they had to, because no one would be allowed to until they finished rounds, which he then proceeded to drag out for an extra couple of hours. You all can imagine the results, but the intern supposedly learned a valuable lesson about not taking even low doses of medications for granted.

Eta: No, don't ask a nurse to divert medications so you can take them. I figured that would be common sense, but just in case...

 

[Liquid8]

Wouldn't do it myself, but some years back can remember chatting with an old psych nurse who would "experiment" on what the patients were given to see what it was like. Apparently it wasn't that uncommon in those days. But for this nurse, he stopped after taking 25mg of CPZ and waking up a week later...

 

[jbomba]

I actually like this idea. No one is being harmed by you doing this and if it ultimately influences the way you prescribe in a positive way, I don't see the big deal. I'm probably much more liberal when it comes to such matters so take my opinion with that context.

 

[MedMan80]

I've had an attending that tried a little haldol, like 1mg and he told me he couldn't really move for a few hours after it. Another told me he took 12.5mg of Seroquel before a flight and had to be dragged off the plane! Always made me think that folks that need these meds likely have an over-reactivity of the receptors that are the target of them and that they get benefit rather than side effets.

 

[randomdoc1]

I think the idea of the concept is pretty cool. There may be ethical ways to go about this for a truly different level of medical education. In medical school we were given a project to consume a diabetic diet, monitor our finger sticks and simulate what we’d do with an insulin regimen if we had certain levels. It was such a massive pain and the food tasted terrible. I definitely really really appreciate it. My personal journey of losing 25 lbs was also highly educational. I think these experiences put me in a better position to appreciate the situation and patients sense that and build a stronger alliance with you. It also helped me generate more user friendly ideas of how to approach metabolic syndrome and patients are very grateful. On another note, I once dated a guy who evolved into developing bipolar I. Full out classic mania with psychosis. The clinical vignette sticks in your mind that much stronger. He even had that fondness of smoking cigarettes many psychotic patients have, the cognitive limitations (insight, abstraction, etc). Watched his life trajectory change to eventually going on ssdi with case management. He may have been more schizoaffective though. It was very sad to see the stark difference from the earlier chapters in life to what it is now. And he’s so resentful of losing me and in a broader context another life he yearned to have. There was a very interesting article about the more severely mentally ill and their struggles with dating. Imagine metabolic syndrome from being on an antipsychotic and trying to take a girl to a nice dinner on your ssdi income….let alone explaining all this and why you have a case manager.

 

[mistafab]

Slippery slope my guy. Cool it with the curiosity - you'll get yourself into trouble.

 

[TexasPhysician]

I think it is unethical to ask nurses to be involved in this as it is likely an offense worth terminating if admin finds out.

If you want to do this with an understanding colleague, it would probably be fine, but I’d argue that it would tel you nothing.

As we know, patient responses to meds are highly variable. I have patients that can’t tolerate Prozac 10mg, and I have patients functioning well on Zyprexa 20mg. My mother-in-law can’t take a child’s dose of Benadryl without sleeping 10 hours.

So regardless of your response to these medications, an N-1 shouldn’t change your prescribing.

 

[Celexa]

Let's make sure to clearly separate out the two questions here.

No, you should not ask the nurses to steal meds for you from the pyxis in the name of experimentation.

If you want to arrange to try non-controlled substances out of curiosity some other way, you do you I guess?

 

[TheRightMedication]

Asking a nurse to break the rules to accomplish your goal is very wrong on many levels. Boundaries, use of hospital property, and abuse of power in doctor-nurse relationship, to name a few.This is a bigger problem than I think you appreciate, OP, and I hope you consider talking that out with a mentor.

 

[docksan]

Is it immoral to ask ur inpatient nurses for low doses of commonly prescribed second generations and first generation antipsychotics like haldol or abilify 5 in order to understand what exactly I'm giving my patients . There's something icky about the idea of being given meds that aren't prescribed but my intention isn't abuse either obviously , I just feel llke I want to know what it is I'm giving , like truly .

When you finish residency prescribe them to yourself and face the music.

This is a very, very bad idea, even if it's coming from good intent. If you want to see the effects the medicine has on your patient, listen to them or watch them get a shot.

 

[Bartelby]

As others have said, involving a nurse to divert meds from the cart is a hard no. That nurse could get fired (and you could face repercussions as well).

I have heard of this practice, but I'm skeptical of its value. Imagine:

-Taking a large dose of insulin to see what it does for your diabetic patients.
-Taking some Reglan to find out what it does for your patients with nausea.
-Getting a epidural to see what it does for your patients in labor.

My point is obvious: in each case, you don't actually have the condition being treated. The experience of being floridly psychotic and taking Haldol is quite a bit different from the experience of being in your usual state of health and taking Haldol for the heck of it. As others have pointed out, taking a particular medication will tell you what side effects *you* get, but nothing else. For example, if you take Seroquel and find you barely notice it, would that change your mind about the patients who report severe sedation on it? There is a good reason no other field in medicine typically goes around taking the medications they prescribe, which is mainly that doing so poses risks for little benefit.

But if you do want to do this, your best bet is to pair up with another physician who also wants to do it. You could both prescribe each other the things you want to try. Then be present when the other person takes so that you can help out, for example, if there is an acute dystonic reaction.

 

[clozareal]

We did a tasting in residency hosted by the pharmacists (mostly licking it or putting it on our tongue and spitting it out immediately) of the commonly prescribed medication on inpatient: lithium, haldol, depakote, seroquel, risperdal, etc of course knowing fully not to take it if there were any issues with it.

You should not ask your nurses for medications. You don't need lived experience to treat patients. There would much less ethical issues and likely more benefit to asking patients about the experience of taking the medication since each patient will have a different reaction/experience. Even if you think it's icky or not, the patient may not have the same experience.

 

[tr]

Some of my older attendings in residency said this was actually a fairly common thing back in the day and several of them had taken low doses of meds like haldol, thorazine, and lithium in single doses to get a better understanding of what they were giving to patients. I realize that different patients will experience them differently, but I do think that for some people it can give a better appreciation of the effects of what we prescribe. Relevant non-psych side story from one of my old IM attendings:

When he was a resident in the 90's, an intern on his team gave an inpatient a dose of lasix by mistake and when called out by the attending said it was a low dose and that they didn't think it was a big deal. So the next day at the start of rounds, the attending pulls out a pill and tells the intern to take it. When the intern questioned it, the attending parroted the intern's response the day before that it was just a low dose of lasix and didn't know why it was a big deal. So the intern took it and the attending told them to use the bathroom if they had to, because no one would be allowed to until they finished rounds, which he then proceeded to drag out for an extra couple of hours. You all can imagine the results, but the intern supposedly learned a valuable lesson about not taking even low doses of medications for granted.

That's straight up abuse.

Short summary, I have done this and while it wasn't very pleasant, I think the insight was useful. I got a free sample of olanzapine from an attending who had some back when that was a thing. Here's my trip report

sampling antipsychotics

Has anyone here actually tried an antipsychotic? I've had several patients ask me if I've tried this stuff I want to give them, and it always feels a bit awkward to have to say no. I was thinking of trying a little olanzapine just to see what it feels like. I don't expect it to be...

forums.studentdoctor.net

If you are interested I agree with those above who suggested pairing up with a physician friend for mutual prescription and oversight.

I wouldn't recommend doing it more than once. Psychedelics are far and away more interesting than antipsychotics.

 

[shoomer]

You cannot replicate the effect of an antipsychotic on a person with psychosis by popping a Haldol for fun.

Unless this is the start of some disorganized behavior...

 

[smalltownpsych]

Antipsychotics are very sedating and appear to help with psychosis although that usually seems to take a while. I also hear that it is more sedating for non-psychotic individuals. If you don’t have psychosis then in theory, all you would experience is sedation. Non-psychotic but agitated patients in the ED I covered were given antipsychotics for this reason all the time. So I guess another strategy to try this is to go into the ED and start throwing chairs and threatening everyone.

 

[J ROD]

Asking someone else to risk their career, license, and job is poor taste.

 

[TheRightMedication]

Antipsychotics are very sedating and appear to help with psychosis although that usually seems to take a while. I also hear that it is more sedating for non-psychotic individuals. If you don’t have psychosis then in theory, all you would experience is sedation. Non-psychotic but agitated patients in the ED I covered were given antipsychotics for this reason all the time. So I guess another strategy to try this is to go into the ED and start throwing chairs and threatening everyone.

I believe this is the ethical solution.

 

[whopper]

Some of my older attendings in residency said this was actually a fairly common thing back in the day and several of them had taken low doses of meds like haldol, thorazine, and lithium in single doses to get a better understanding of what they were giving to patients. I realize that different patients will experience them differently, but I do think that for some people it can give a better appreciation of the effects of what we prescribe. Relevant non-psych side story from one of my old IM attendings:

Charles Nemeroff talked about this in a lecture. He said "back in they day" lots of doctors tried meds they gave their patients. While of course some of it was intent to abuse most of it was to feel as if they could understand the patient's experience better.

But getting to the point he said don't ever take a psych med expecting it's going to help you experience what the patient experiences. IF you don't have ADHD you're dopamine levels in your frontal cortex are likely fine while in the ADHD they are likely lower then what the patient needs, and in effect instead of stabilizing your levels you're making them abnormal.

He told the audience he's never seen residents who were foolish enough to try this have good experiences. "What benefit do you expect if you don't have psychosis if you take an antipsychotic? You're lowering dopamine's effects where they are where they should be."

Now all this said meds these days are different, and yes I still see this going on. Someone told me they tried a Vraylar and had an increase in energy and this person isn't depressed, manic, or psychotic, but Vraylar doesn't work the same way the older antipsyhotics work.

BTW, if you are curious, there is a medication out there you really need to try if you're male. It's called Leuoprolide. Mix that in with some estrogen. Then put some Nair into your shampoo. Then put on the high-heels, put on the electric-blue g-string, dance in front of a mirror. Trust me you'll be a brand-new person! (I got to add I'm joking cause the idiots won't be able to tell this is sarcasm).

 

[allantois]

Go for the fun stuff like ketamine lol

 

[Stagg737]

That's straight up abuse.

Yes, but this was also 30 years ago and probably would have barely registered compared to some of the crap that went on.

Charles Nemeroff talked about this in a lecture. He said "back in they day" lots of doctors tried meds they gave their patients. While of course some of it was intent to abuse most of it was to feel as if they could understand the patient's experience better.

But getting to the point he said don't ever take a psych med expecting it's going to help you experience what the patient experiences. IF you don't have ADHD you're dopamine levels in your frontal cortex are likely fine while in the ADHD they are likely lower then what the patient needs, and in effect instead of stabilizing your levels you're making them abnormal.

He told the audience he's never seen residents who were foolish enough to try this have good experiences. "What benefit do you expect if you don't have psychosis if you take an antipsychotic? You're lowering dopamine's effects where they are where they should be."

Now all this said meds these days are different, and yes I still see this going on. Someone told me they tried a Vraylar and had an increase in energy and this person isn't depressed, manic, or psychotic, but Vraylar doesn't work the same way the older antipsyhotics work.

BTW, if you are curious, there is a medication out there you really need to try if you're male. It's called Leuoprolide. Mix that in with some estrogen. Then put some Nair into your shampoo. Then put on the high-heels, put on the electric-blue g-string, dance in front of a mirror. Trust me you'll be a brand-new person! (I got to add I'm joking cause the idiots won't be able to tell this is sarcasm).

I think it is unethical to ask nurses to be involved in this as it is likely an offense worth terminating if admin finds out.

If you want to do this with an understanding colleague, it would probably be fine, but I’d argue that it would tel you nothing.

As we know, patient responses to meds are highly variable. I have patients that can’t tolerate Prozac 10mg, and I have patients functioning well on Zyprexa 20mg. My mother-in-law can’t take a child’s dose of Benadryl without sleeping 10 hours.

So regardless of your response to these medications, an N-1 shouldn’t change your prescribing.

I think it can hold value, though was probably much more relevant decades ago when docs were throwing patients on massive doses of antipsychotics left and right. Might make someone think twice about jumping straight to Haldol 40mg if they know what a 5mg dose can do.

 

[comp1]

Don't involve nurses. If you want to do something sketchy, that's up to you.

 

[ChudsMgee]

Is it immoral to ask ur inpatient nurses for low doses of commonly prescribed second generations and first generation antipsychotics like haldol or abilify 5 in order to understand what exactly I'm giving my patients . There's something icky about the idea of being given meds that aren't prescribed but my intention isn't abuse either obviously , I just feel llke I want to know what it is I'm giving , like truly .

I've seen this a few times with parents of my patients. I have had several parents openly admit to getting the same meds prescribed by their own psychiatrists/primary/prescriber family members etc prior to giving it to their own children. Their rationale was they want to know how it feels to take a medication before allowing their child to take it.

I am sure Hadol and Abilify aren't the only meds you order so are you really wanting to try a plenthora of psych meds? Sounds like a bad time

 

[G Sheb]

Not sure if OP is trolling but this is a terrible idea. Unless you want to risk a complaint against you and possibly losing your license.

This doesn't count, but I've only tried Benadryl and it was bad. Once on a plane, and I couldn't sleep. Just made me more tired, fidgety and miserable. When I did sleep, I was tired and useless the following day.
Melatonin all the way. It definitely cuts sleep latency time and I get deeper and more restful sleep even if total sleeping time remains the same.

This probably can help you get more empathy for your patients but it should not affect your prescribing habits.

 

[MacDonaldTriad]

I can verify that in the 70s some programs had residents take low dose Mellaril and Haldol. The residents complained of dragging their A**es all day. I think the original question about ethics is moot because this approach to trying drugs illegal.

 

[Crayola227]

I've had an attending that tried a little haldol, like 1mg and he told me he couldn't really move for a few hours after it. Another told me he took 12.5mg of Seroquel before a flight and had to be dragged off the plane! Always made me think that folks that need these meds likely have an over-reactivity of the receptors that are the target of them and that they get benefit rather than side effets.

This is precisely why arguably there is little value in taking a medication to "experience it" in the absence of any indication for it.

You will never "experience" say Seroquel like the say, florridly psychotic patient and I think it's silly to try and think by taking Seroquel you really learned anything about what Seroquel does to those patients.

That said, we should just take patient report of side effects that are commonly acknowledged as being from a drug, that much more seriously because we cannot fully know that experience.

 

[comp1]

I agree with the above poster. It's like taking 30 units of glargine and saying you experienced the side-effects of insulin in diabetes.

 

[Shikima]

All I can think of when I read this is - one for you, one for me.

 

[MedMan80]

Patient told me today that his CMH NP looks like she's "high on her own supply, which is fine by me, but I still don't trust her"