street drugs vs. prescribed drugs

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Specializes in Er/ICU/Med-Surg/Home health.

Ive been a Nurse since 1992. Mainly in Er. Never ever ever give someone who is a crack addict - Ativan. There should be an official warning - it makes crack patients go into overdrive ( as if that were possible). Not sure why, but I have seen evidence over the years. Finally convinced my Docs that it is a BAD idea. Has anyone else experienced this?

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Specializes in Emergency & Trauma/Adult ICU.

I have to say, I have not experienced what you seem to have experienced ... and I've worked in 2 different hospitals located in an urban "crack alley" :rolleyes:.

Many of these patients, however, require what might otherwise be considered ungodly amounts of benzos ... just as those with alcohol withdrawal or those coming off of "bath salts" or other hallucinogens.

Intubation & vec work nicely too ... ;)

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Specializes in ER trauma, ICU - trauma, neuro surgical.

I miss the days when pts OD'ed on GHB, and all you had to do was intubate them for 4 hrs and then send them home. At least the weekend warriors knew that the fun stopped before work on monday.

To answer you question, I haven't seen crack addicts that get worse with ativan. Maybe they get more confused with it and go ape****. I have been seeing more use of antipsychotics. 10 years ago, it was all about ativan for people acting out. Now, antipsychotics are being used in place of that and more studies are showing the benefits of them in acute delerium. I would think a good percentage of crack abusers have a mental illness or are already on some type of psych meds. Antipsychotics could help with some underlying issues, but they can be risky. Haldol can lower seizure threshold or cause ectopy, so those meds have to be given with caution. But, ativan and haldol or geodon seems to calm them metabolically and behaviorally. But, if they use enough crack, it doesn't matter. When all else fails, intubation and propofol does wonders. Opiates on top of that can be a good option since they probably abuse narcotics as well. Crack overdose and withdraw is twice as bad.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think it has to do with a crack to ativan ratio...they need TONS of ativan to calm them

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Specializes in ED.

Geodon is the best ever

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Vec and roc are the best ever

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I think it has to do with a crack to ativan ratio...they need TONS of ativan to calm them

Could you imagine them teaching that in school? I'm picturing an instructor lecturing on proper crack to Ativan ratio.

Could your patients be "speedballing"? I've seen people on steer drugs who mixed their "uppers" and "downers" completely freak out.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Could you imagine them teaching that in school? I'm picturing an instructor lecturing on proper crack to Ativan ratio.

Could your patients be "speedballing"? I've seen people on steer drugs who mixed their "uppers" and "downers" completely freak out.

That is quite the visual! :roflmao:

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I concur with thelema13...Geodon and a nice nap should get them through my shift nicely.

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I concur with thelema13...Geodon and a nice nap should get them through my shift nicely.

Geodon = The savior of my sanity!

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That is quite the visual! :roflmao:

I would love to see that.

Seriously though, is Ativan a depressant? Because "speedballing" (is there a medical term for that?) would explain the craziness.

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Ativan is a benzo, so yes, it is in a downer in the same family as Xanax and Valium. Definitely a speedball.

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