Phenergan Abuse?

[SoCal student]

It's been my understanding that many opiate (among other) addicts also abuse phenergan as it can potentiate the effects and can also be sedating. I work in detox/rehab and patients consistently request phenergan, specifically IM. Our docs have instructed nurses to only administer IM if it has been confirmed by staff that patient is actively vomiting. If only nauseous, we should give PO.

A couple of patients have been agitated with me recently for this reason as I've refused to provide the IM when they are solely nauseous.

I've read a couple articles that confirm a potential for abuse, but they stated that the actual reasons for abuse aren't completely understood. The potentiating effects as well as sedation were mentioned.

Anyone have insight into this? It appears the IM is strongly preferred over the PO in addicts. I assume this is because any desired effect comes on quicker/stronger?

[Sour Lemon]

IV is preferred over IM, too. It does seem to have a sedating effect, from what I’ve observed.

The past two hospitals I’ve worked at don’t use the stuff ...at least not routinely and never IV.

[Nurse SMS, MSN, RN]

Never known an opiate seeker who did not also want Phenergan.

[Jory, MSN, APRN, CNM]

The patient doesn't get to decide the most appropriate route. Just be careful on disclosing to too many patients that "we only give IM with active vomiting". Say instead, "The provider feels PO is appropriate". It won't take long before they put two and two together and then you have a floor of pukers.

But even the PO can be very sedating. I refuse to take either form if I get horribly ill if I can avoid it.

[hppygr8ful, ASN, RN, EMT-I]

We give Phenergan IM and PO during detox but how the patient gets it depends on their COWS or CIWA score which is an objective assessment. For non detox patients who may be seeking a high the nurse is expected to see the vomit before calling the physician for orders.

Hppy