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!