Off Label Rx and Mistaken Conclusions

How many times have you read, or seen, a fictional detective look at the prescription medications stored in a cabinet and draw specific conclusions about a crime victim, suspect, or missing person? This is a common clue to the physical, mental, or emotional status of a mysterious character. The detective may discover cancer medications and an excess of prescription painkillers—leading to one set of conclusions. If the detective finds a shelf in the kitchen devoted to over-the-counter allergy drugs and refills for a prescription inhaler, there’s another definitive conclusion. And when they find anxiety and depression meds, there’s an entirely different conclusion.

I’ve yet to read a mystery where the detective’s definitive conclusion turns out to be mistaken because of an off-label use of a commonly known Rx.

And yet in real life, off-label prescription drug use pops up all the time. Botox was developed to treat the eye disorder strabismus. “Treating” wrinkles with Botox is much more profitable and common, so most of us associate scary injections of a bacterial toxin with the expressionless foreheads of famous actresses and wrinkle free older people.

Drawing conclusions on the basis of an off-label Rx can be problematic. Imagine a snoopy new girlfriend checking the medicine cabinet the first time she’s in her new guy’s apartment. She might determine that he’s schizophrenic or bipolar because there’s a bottle of one of the older medications used to treat delusional psychiatric diagnoses (Haldol, Risperdal, etc.). She might go running from a perfectly nice guy taking low doses to lessen the symptoms of a neurological tic disorder and not for a psychiatric diagnosis. Some people with Tourette Syndrome are treated with high blood pressure meds as a side effect of these drugs diminishes TS-related tics.

I started to ponder the potential for misdirection in off-label prescriptions when my new doctor wrote and Rx for a sleep medication. I’ve never been a “good sleeper” and he suggested I try a particular drug. I didn’t realize—until I did my research—that it’s an anti-depressant that is commonly used as a sleep aid. Could a nosy visitor find the bottle and presume I’m being treated for depression? I guess so—although that’s not the case at all. (The Rx turned out to be no more effective than melatonin.)

However, right now I think I’m going to use the mistaken Rx conclusion gambit in a mystery. Now that’s a great misdirection! A red herring in the detective’s mind…

Sneaky peeks do not always reveal truths…


  1. lol – so this is how mysteries take shape? Interesting peek into a genre I know little about. One question though, what exactly is ‘Rx’?
    Okay, I tell a lie, two questions: if you use the off-label red herring, how will you allow the reader to at least wonder whether the conclusion is right or not? Or doesn’t that matter?

    • Candy Korman

      That’s an excellent question. I’m still in the pondering phase for a short story. One approach would be to have police partners. One detective is the dominant personality and he comes to rock solid conclusions. The rookie, or simply less stubborn, detective, might have his or her own secret and understand the secondary or off-label use for the prescription. Does detective number 2 need to reveal something personal in order to conflict with detective one about a possible alternative conclusion? That’s what I’m thinking about. Not there—yet—but… there’s a story in the making.

      (Rx is short for prescription medication as opposed to over-the-counter in the U.S.)