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street drugs vs. prescribed drugs

Posted

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?

Altra, BSN, RN

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 ... ;)

hodgieRN

Specializes in ER trauma, ICU - trauma, neuro surgical. Has 10 years experience.

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.

Edited by hodgieRN

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

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

thelema13

Specializes in ED. Has 3 years experience.

Geodon is the best ever

VictoriaGayle

Has 1 years experience.

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.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

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:

ezgreazin

Has 2 years experience.

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

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

Geodon = The savior of my sanity!

VictoriaGayle

Has 1 years experience.

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.

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

NO50FRANNY

Specializes in Emergency, Haematology/Oncology. Has 14 years experience.

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 ... ;)

A couple of our more senior Docs will give propofol if we are chasing our tails with midazolam / benzos just seems to interrupt whatever is going on just long enough for the other stuff to settle and avoids heading down the tube road. We have also recently been trialling 10mg straight up of droperidol for rapid tranquilization which is also working well... But I too, firmly believe that a short acting paralytic never hurt anyone :smug:

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

A couple of our more senior Docs will give propofol if we are chasing our tails with midazolam / benzos just seems to interrupt whatever is going on just long enough for the other stuff to settle and avoids heading down the tube road. We have also recently been trialling 10mg straight up of droperidol for rapid tranquilization which is also working well... But I too, firmly believe that a short acting paralytic never hurt anyone :smug:

I miss Droperidol. I don't see it used anymore in my neck of the woods.

I've had a pt addicted to crack get uncontrollable with IM Ativan. We had difficulty getting an IV so we went with the quickest route at the time. The guy went from mildly annoying to being on all fours in the bed acting nuts. Once a line was started and about 35mg of Ativan later the guy was resting nicely. He earned himself a drip and a spot in the ICU for a couple days.

The issue is that crack is not purely cocaine. It can be mixed with God only knows what, so when the person smokes, all heck breaks loose. It can be ex-lax, to bath salts, meth, to asprin.....seems to be whatever it is that the dealer has on hand to make the stuff, increase their amount (ie: money) and to heck with anything else. I have seen acute pychosis from meth or salts, acute dehydration from the ex lax, to bleeds from the asprin. And as any crack addicted person will tell you, too much baking soda and it doesn't do what it is supposed to, so it is un-usable. Dealers caught on to the pretty quickly. Like little sadist scientists. In any event, crack addicted people get very little cocaine, but a "purer" cocaine because of the method of delivery, but all the other stuff mixed with it can and does cause all the psychotic behaviors. Oh, and there is not one "crackhead" on the planet. Addicts will get extremely agitated when one suggests they are addicted to crack. They are "freebasing cocaine" and we best not all forget it. PC amongst the addicted. Hence why in my neck of the woods, Vicodin and Oxy are the choice drugs....

Edited by jadelpn

SNB1014, RN

Specializes in Critical Care. Has 8 years experience.

The issue is that crack is not purely cocaine. ..

Lol @ " pure " cocaine

Lol @ " pure " cocaine

No, PURELY cocaine, meaning MAINLY cocaine which would have been a better descripritive word. Bottom line is that drug dealers could care less what they put in a drug, so addicts don't always get what they believe they are getting.

Addicts sadly get desperate quickly, Especially with a crack cocaine addiction. So that is the part that adds to an already difficult to stabilize situation.

So with all due respect, LOL'ing at any addicition is, in my world, inappropriate.