Vancouver doctors find vial of urine hidden in rectum of patient, The man eventually admitted that he had put a friend’s “clean” urine inside his rear end to try to fool a drug test at his methadone clinic, according to a just-published case study.
The idea was to keep the liquid at body temperature and avoid suspicions that the sample came from someone else.
It is the first published account of the innovative anal subterfuge, said Hin Hin Ko, the gastroenterologist called in by emergency doctors at St. Paul’s Hospital to extract the object.
“I think he had done it before – he’d just go and grab that bottle from his rectum and pretend it was his,” said Dr. Ko. “And I’m not sure he’s the only one — there might be many other people doing the same thing.”
Finding the concealed urine was unique, but it is not uncommon for hospitals to encounter patients with other articles lodged in their rectums, the specialist said. Though she is on call only about once every two months, Dr. Ko said she sees such patients two or three times a year.
They include one who had a “pretty decent-sized” carrot jammed inside. “He said he had accidentally slipped and fell on it,” the University of British Columbia professor recalled.
The objects can be inserted for sexual reasons or to hide drugs or as a result of psychiatric problems. The practice is potentially dangerous, though, with the risk of internal perforations leading to serious infection.
The case also shines a light on the culture around methadone, a substitute opioid drug used to treat addictions to heroin and, increasingly, prescription painkillers like oxycodone and hydromorphone.
Methadone users begin by visiting a drug store daily and drinking their dose in front of the pharmacist, but are typically allowed to take home several days of the medicine after they’ve shown some success. If one of the regular drug screens they undergo shows they are abusing a problem drug again, however, patients can lose the coveted carry-home privilege, said Mel Kahan, a University of Toronto addictions specialist.
“Cheating is, I think, pretty common, although usually not to that crazy extreme,” he said. “They may be embarrassed, they may be ashamed, but most of all they don’t want to lose their [take home doses].”
Patients will sometimes even pay other methadone patients for a sample of their urine, he said.
The Vancouver patient showed up at the St. Paul’s emergency department saying he had had difficulty passing stools and abdominal discomfort for a week. He neglected to mention any possible causes of the symptoms, said the British Medical Journal paper.
When an X-ray revealed a foreign object of some kind, Dr. Ko was called in to help.
Using an endoscope – the tiny camera and light-tube employed in colonoscopies – she found an object wrapped in a pink condom. Dr. Ko then inserted a “loop snare” – an instrument designed to cut off pre-cancerous polyps in the colon — to lasso the end of the tied-off condom and slide it out.
When doctors discovered the eye-dropper filled with urine inside the condom, the patient finally revealed the whole story, she said.
A 2012 paper by doctors at the University of Southern California in Los Angeles said hospitals find a wide array of foreign bodies in patients’ rectums, from bottles and other household objects to toothbrushes, knives, cell phones, sex toys and Christmas ornaments.
The authors urged physicians to maintain the “utmost degree of professionalism” and avoid being judgmental when dealing with the cases.