What is the drug of choice in your area?

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Where I live, the drug of choice is almost exclusively heroin. I am well versed in the treatment of heroin overdoses and the resources for those who use, as we have several per day on average. I've never dealt with a patient on bath salts, meth, crack, etc. , at least to my knowledge. I'm getting ready to relocate to a different region and i'm realizing I may have to educate myself on other presentations for other substances!

Meth, alcohol, antidepressant and anxiolytic abuse, opioid abuse. Midwest here, usually when they come in it's a combination of several of those.

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Meth & ETOH.

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Northern California here too - the real NorCal though. Sacramento and above. ;) We consider the Bay Area to be Central California.

I googled Flakka . . . never heard of it even when I read about what it is . . .

Flakka: Drug Side Effects, Complications, and Symptoms

Opana is a brand name probably not used around here much because I HAVE heard of oxymorphone.

I live in northern Sonoma county. Definitely NorCal :)

I've never heard of Flakka either.

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Specializes in ICU.
I know a doc who went to bat at their facility to refuse to carry Opana in the pharmacy. I was so proud.

That's awesome. Opana is such terrible stuff.

I had a patient recently who got up to Opana through her pain clinic, and the Opana extended release was the only thing that stopped her pain. Then she went into respiratory failure, got vented, and developed swallowing problems after extubation. NOTHING else worked. I mean dilaudid drips at 20mg/hr didn't touch her, and you can't go home on a dilaudid drip! She'd just scream all day every day.

We ended up giving her the ER Opana back - she was totally NPO except for 1 tbsp of pudding whenever her ER Opana was due. Even with those precautions, she'd get bad aspiration pneumonia, and she'd get put back on the ventilator. She'd get better, get extubated, scream all day long because nothing else worked, get her Opana back, and get septic from aspiration pneumonia again. The instant release Opana didn't even help because her body was used to that slow release dose - even a small immediate release dose knocked her out and she needed Narcan - and promptly went into withdrawals, of course, and getting her pain back under control was a nightmare.

She did rounds and rounds in my ICU vented, sometimes on the oscillator, on a crap ton of vasopressors - from aspiration pneumonia that came from taking her Opana. We thought she was going to die at least four times. This went on for MONTHS.

Her family finally withdrew care on her and let her die because she couldn't function without her Opana, and her swallowing it was incompatible with life.

The worst part was she was a responsible user. She never crushed it, injected it, or anything like that, she just took it exactly as prescribed by her pain clinic. I will never forget what happened to her because it was just awful. That stuff is the devil.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Flakka is horrible. I think it's mostly in Florida, not sure if it's made its way up to Georgia yet.

In my area of Georgia, it's meth, benzos & opiates (usually both), and alcohol (lots of MVC patients have ETOH and some kind of drug on board).

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Specializes in ER.

Rural Ohio is full of heroin & ETOH. Our ED averages about 130-145 volume a day a probably sees 5-6 overdoses a day.

Think we saw our first two cases of flakka about 2 weeks ago. The female half of the couple was fairly tame. But the male half pulled an IO out. We have him 20mg of Geodon, 10 of Haldol, 8mg Ativan and he was still agitated. Then they both got transferred out.

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Specializes in Emergency/Cath Lab.

Depends on the time of year. Summer months we see a huge spike in Molly. Winter it is meth. Also seen a huge increase in LSD lately.

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Specializes in Forensics or Psychiatric.

Heroin, there's teens dying from it now...

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Fargo ND: Heroin, straight fentanyl, fentanyl laced heroin and furanyl fentanyl

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I know a doc who went to bat at their facility to refuse to carry Opana in the pharmacy. I was so proud.

Good for him. Opana is from the devil!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Depends on the time of year. Summer months we see a huge spike in Molly. Winter it is meth. Also seen a huge increase in LSD lately.

I had to Google "Molly," I hadn't heard of that one.

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Specializes in Emergency & Trauma/Adult ICU.
I had a patient recently who got up to Opana through her pain clinic, and the Opana extended release was the only thing that stopped her pain. Then she went into respiratory failure, got vented, and developed swallowing problems after extubation. NOTHING else worked. I mean dilaudid drips at 20mg/hr didn't touch her, and you can't go home on a dilaudid drip! She'd just scream all day every day.

We ended up giving her the ER Opana back - she was totally NPO except for 1 tbsp of pudding whenever her ER Opana was due. Even with those precautions, she'd get bad aspiration pneumonia, and she'd get put back on the ventilator. She'd get better, get extubated, scream all day long because nothing else worked, get her Opana back, and get septic from aspiration pneumonia again. The instant release Opana didn't even help because her body was used to that slow release dose - even a small immediate release dose knocked her out and she needed Narcan - and promptly went into withdrawals, of course, and getting her pain back under control was a nightmare.

She did rounds and rounds in my ICU vented, sometimes on the oscillator, on a crap ton of vasopressors - from aspiration pneumonia that came from taking her Opana. We thought she was going to die at least four times. This went on for MONTHS.

Her family finally withdrew care on her and let her die because she couldn't function without her Opana, and her swallowing it was incompatible with life.

The worst part was she was a responsible user. She never crushed it, injected it, or anything like that, she just took it exactly as prescribed by her pain clinic. I will never forget what happened to her because it was just awful. That stuff is the devil.

You know that warning in many EHRs that must be acknowledged before ordering or administering Dilaudid - "1mg Dilaudid = 7mg Morphine" or something to that effect?

The entire text of this post should be a warning/advisory that pops up when prescribing Opana. The prescriber should have to initial every line.

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