Is This Inmate Gaming Me?

Lanea runs the pharmacy at the Ada Co. Jail in Boise. Should I have her order in some oxybutynin?

I have seen several patients recently with an unusual complaint.

A typical presentation would be this:  a male in his early 30s and without medical history  complains of frequent urination: “I have to get up 10-12 times a night to pee.”  He reports no other symptoms, like dysuria or discharge or pain.  This reportedly has been going on for years, though he has never before sought medical attention for it.  He says it got worse once he arrived at his current jail around three months ago.

He says he ran across an ad for a medicine “that I think would help me, called oxy-something.”  He must be referring to oxybutynin (Ditropan).  This is an anticholinergic drug that is used to treat “hyperactive bladder syndrome” or “bladder instability.” I would not expect a healthy 30 year old male to suddenly have hyperactive bladder.

There are a couple of other problems with this history that made me suspicious, as well.  First, oxybutynin is generic and so is not being advertised.  Second, I asked the deputies to watch him one night and record how many times he got up to go to the bathroom.  He only went once.

I suspect that he is seeking this medication for secondary gain of some kind.

I have seen several patients in the medical clinic with similar requests recently.  I have also seen several young and healthy patients transferred to my jails from other correctional facilities with prescriptions for oxybutynin.  This seems to be a recent phenomenon.  I do not recall seeing such patients say five years ago.

Is oxybutynin a medication of abuse?  Can inmates get high on it?  I suspect that it is, because in is an anticholinergic drug.  The Prescriber’s Letter reports that oxybutynin can cause “hallucinations, agitation, confusion and sedation.”  Sounds like a great drug to get high on!  But I have not read or heard about oxybutynin being abused in correctional facilities before.

Of course, I practice in Idaho, which is 3-5 years behind the rest of the country!  I first heard about inmates snorting bupropion to get high when I visited the Maricopa County Jail in Phoenix a good two years before that problem cropped up in my Idaho institutions.

The “can be abused” problem drug list now contains trazodone, Seroquel, bupropion, amitriptyline, gabapentin, and several others.  These drugs have legitimate medical indications, but their potential for abuse must be considered when using them in correctional facilities. Should oxybutynin and the urologic anticholinergics be added to this list?

Have you had a problem with oxybutynin at your institution?  Please comment!

26 thoughts on “Is This Inmate Gaming Me?

  1. William Arsenault, PA-C

    Brilliant! Never thought of that. Makes sense though. Seems like a large dose would be needed for adequate induction of hallucinations. Treatment is supportive.

    Reply
  2. Roger S Buck MD

    The complaint of increased urinary frequency is not uncommon in the incarcerated male population over my 7+ years experience at this. But no specific requests for the Ditropan class of meds noted. I usually give a trial of Doxazosin, presuming BPOH related etiology. But your index of suspicion on this is appreciated, and I appreciate you bringing it up.

    Reply
  3. Julie

    You had us hold the med for one of our patients, and now we have had 1 or 2 kites asking for the medication (not by name.) So glad you are on top of these issues.

    Reply
  4. Jim K RPh-

    I have a patient at my pharmacy who purchases large amounts of oxybutynin every couple weeks. She goes through approximately 240tabs in a 2 week span and visits ERs to get RXs for oxybutynin. None of the other pharmacists could figure out what she was doing with it, but we figured something was up. Maybe large doses causes enough delirium that it is worth all the dry mouth.

    Reply
  5. Pingback: Interesting Study of the Week–”Overactive Bladder” | Jail Medicine

  6. Sue Burkhalter

    I am a NP practicing in corrections where I have been for 11 years, I thought I had seen it all until recently. I work in a Mississippi facility with an inmate population of 1,000. I do not have a single inmate on Ditropan. I have now started seeing Oklahoma inmates by tele-med and there is a huge population of young healthy men taking Ditropan, also Bentyl and many of the inmates are on both! They do often request it by name. I did not prescribe these medications for these inmates, most of them came to the facility already on them from other correctional facilities. When I explain that I am concerned why a 30 y/o healthy male would have such frequent urination (concerns of DM etc…) because it is not normal they become uncomfortable and a bit defensive, I then inform them we will be perfoming a DRE and suddenly their problems seem to get better 🙂 I definitely feel both Ditropan and Bentyl are being abused in the correctional setting. Prescribers beware!

    Reply
  7. Richard Alexander

    I was incarcerated at Idaho correctional center for 6 years and yes inmates do get very high off it as I have done my self it was given to us as a KOP. And 10 to 15 of the blue pills would get you high like on mushrooms.

    Reply
  8. Travis

    I have seen people injecting Oxybutynin. Appearently it feels like being sorta drunk/upper and downer combined !

    Reply
    1. jeffk2996 Post author

      Interesting. Hopefully, not too much injecting of oxybutynin or anything else will be going on in correctional facilities.

      Reply
      1. Travis

        Are you kidding, ” Hopefully, not too much injecting of oxybutynin or anything else will be going on in correctional facilities” ? No offence but I’ve been in jail and there is a a lot of injecting going on believe it or not ! Find inmates that will tell you all the little secret hiding areas not that the corrections staff don’t already know but if you’re in jail and want to get high you’ll find a way to hide things especially with all that time on your hand, LOL Cheers
        Travis

        Reply
  9. Sarah Kaczorowski

    I just ran across this bc I googled abuse of ditropan bc my boyfriend who is in a florida doc prison said a whole bunch of the inmates were taking like 8 of these at a time ro “trip” I was shocked bc I have been on this med for over 20 yrs due to a neurogenic bladder from having an autoimmine paralysis at age 14. So yes this med is DEFINITELY being abused….crazy!

    Reply
  10. sean o'shea

    I llive in Scotland where addicts on the streets take them for a drowsey~ trippy time,gabapentin abuse is rife along with diazepam,temazipan and many others. The people of Dundee,Scotland have again found a new drug that is very popular. But how long is the half life

    Reply
  11. Mary Fitzgerald

    I have heard of abuse of this drug at the prison where I volunteer. This was a woman who was taking 10-12 a day and buying them off others on the yard.

    Reply
  12. Denise D.

    Interesting!! I have worked in jails for quite a while as a pharmacist, and I’d wondered about all the Ditropan use in young men. I’m mentioning this to our physicians.

    Reply
  13. Dan Reed

    I just started working corrections 2 months ago in the medical clinic as a PA. Gabapentin use is diffuse for all kinds of pain. Also I am seeing 20 ad 30 year olds on oxybutynin (Ditropan) for frequency (self reported history) of urination. Some are even prescribed by the urologist in consult(apparently they are unaware of abuse potential). Sometimes I see the gabapentin, oxybutynin, bentyl combo, again more in young inmates. I have never heard of this on the outside. I work in the Department of Corrections in Colorado, USA. Any journal articles describing this in corrections? I did find one article , google, ” gabapentin abuse 2015″ which was recent and interesting.

    Reply
    1. Jeffrey Keller MD Post author

      Thanks for your comment Dan! Very little has been written about the abuse potential of these medications. It is not much of an issue outside of corrections, evidently.

      Reply
      1. Dan Reed, PA-C

        In Colorado Department of Corrections we will be making gabapentin non formulary in the first few months of the year, per our staff meeting last week. Our CMO said most state corrections facilities nationally are going that way. Not a day goes by at least one or more offenders asking me to start gabapentin to try it out, restart discontinued gabapentin, or increase gabapentin. For oxybutynin and bentyl probably once a week. Actually if you go to PubMed central, and put in gabapentin abuse or oxybutynin abuse there are a lot of articles, especially written in recent years.

        Reply
  14. Kim Jones

    I know Bentyl ( I hope I spelled that correct) Has been removed from the facility I work and Likely the entire department due to offenders scraping the drug and snorting it…….. apparently when snorted it has the effect of Heroin, I believe.

    Reply
      1. Dan Reed, PA-C

        Update from my last comment on abuse meds. We are moving to eliminate gabapentin use for chronic pain here in Colorado DOC. Offenders caught cheeking meds is a daily occurence. Also oxybutynin is off formulary now and Bentyl is next. Tricyclics, SSRIs, SNRIs, and occasiional anticonvulsants are the replacements. Now only psych is using gabapentin and welbutrin.

        Reply
  15. Alisa Williams MD

    Yes we do see this, and it is often snorted in combination with Wellbutrin to enhance benefits. We see offenders manipulating to get both prescribed.

    Reply
  16. Joe

    I did some time in prison and I can tell you personally that Wellbutrin is abused EXTREMELY bad. 90% of inmates that get prescribed Wellbutrin or “Wellies” or “purple powers” have contracts with someone that they give them to another inmate daily and in return get payed in commesary. Other drugs that are majorly abused are gabapentin , pamelara. Remeron. Seroquel. Effexor. It seems like the prison I was at they had damn near everyone on the same drugs. For depression wellbutrin. For sleep remeron. But neurontins were expensive because only the diabetics and people who got arrested who had private insurance and were on neurontins would be able to keep getting them

    Reply
  17. Kel

    Yes this inmate is trying to fool you.. I know oxybutrin. I myself inject it. It gets you really messed up.. it feels like my heart us goibg to stop beating sometimes and I crave the rush even tho it sounds scary.. and I never hulicated. I don’t inject more than 6 a shot.. most time I crush 4 and cook it and inject it. And within a minute iy messes me up. My mouth gets really dry and my vision gets blurry and black strings or dots floatys I see in my eyes. Its like a dry drunk. You get dizzy as well and have hard time focusing on typing textes and reading messages.. ur skin also drys up. And your head feels like it’s pumping and u can hear ringers in your head.. you can barely walk straight if your really high.. and ur body twitches.. when u inject it the medicine in the syringe looks like blue berry juice. Clear blue medicine.. I actually got then for my weak bladder and I never knew what they were ubtil my friend told me and she said I have a gold mine bc I had so many bottles filled. On the street they go a dollar to 2 dollars. Cheap drug and strong high.. doctors should look into this and take ppl drug trials to find out what could happen if injected.. I think this shit is gonna kill me soon.. and I’m a dumb ass addicted to keep doing it.. bc it’s FREE and I’m on the methadone and nothing else could give me a rush besides coke .. but i get drug tested and I don’t oxybutrins are prescripted to me and doesn’t show up on a drug test like cocaine..i get random drug tested so I don’t take the chances with cocaine. If you wanna know anything else about it. Ask me.

    Reply

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