Synergy Health and Wellness

Mind Body Soul

5 Drugs we’re seeing in ED & Psych right now and what you need to know.

Leave a comment

5 Drugs we’re seeing a lot of right now!  What you need to know!

Images of parents and grandparents passed out from Heroin overdoses and their child (grand child) in the back seat flooded Facebook and social media platforms in the past few weeks.  This drug epidemic is not isolated to the northeast, California or far removed areas – this drug epidemic is seen in all locales, countries and cities and is absolutely non-discriminatory affecting all races, religions, socio-economic backgrounds, ages and sexes.  The following is a list (in no order) of the 5 most common drugs we are currently seeing in Emergency Departments and Psychiatric facilities, especially here in Palm Beach County.

  1. Heroin – We have seen an explosion in the number of heroin addicts in recent months and years some of which can be attributed to the closure of pill mills but truly many of my patients were introduced to heroin through “friends” in school and college. Sadly, much heroin today is being “cut” with dangerous fillers such as Fentanyl, Dibutylone, Carfentanil and even Flakka which is why we are seeing so many overdoses.   These added substances directly affect the patients breathing so much that patients cannot support their own breath.
    1. Class Opioid
    2. How is it used: Snorted, Smoked, Injected, Inhaled?
    3. Signs/Symptoms: Overdose, “nodding” excessive sleepiness,
    4. Additional Problems: Hep C, HIV, Abscesses, Septicemia, Endocarditis, physical dependence – many of these life threatening.
    5. Treatment: Buprenorphine (now also implantable), Detox and Rehab, Methadone
  1. Cannabis – While medical marijuana can be extremely beneficial for certain conditions we are seeing a rise in patients being seen in psychiatric facilities more for the side effects of excessive use than sheer numbers of those addicted. For example, of all substances addicted to cannabis patients have the lowest level of encounters in Emergency Departments or Psychiatric facilities.
    1. Class: Cannabinoids
    2. How is it Used: Smoked, Dabbed, Inhaled (Vape), Ingest (edibles)?
    3. Signs/Symptoms: Extreme Paranoia, hallucinations, depression, Dry mouth, dizziness, coughing
    4. Additional Problems: Has been linked to increased schizophrenic breaks, Tachycardia (sustained heart rate at 120 beats per minute).
    5. Treatment: Abstinence! and treat the symptoms hydration, possible arrhythmic if elevated heart rate persists, watchful monitoring.  Patients can return to normal in most cases by refraining from use.
  1. Synthetics – Remember the face eating patient in Miami a couple of years ago and most recently the cannibal patient in Jupiter, both patients had apparently used “synthetic” drugs, drugs mostly manufactured in China, in large commercial factories. This is a really hard class of drugs to detect initially as drug developers stay one step ahead of drug tests. But the behavior we see is unforgettable. Patients often arrive combative, with superhuman strength, paranoid with dangerously elevated temperatures and its not unusual for them to remain in this state for 2-4 days and more. Unfortunately, some patients do not recover!
    1. Class: Synthetics
    2. Common Names: K2, Spice, Flakka, Gravel
    3. How is it Used: Smoked, Injected, Inhaled, Ingested, Snorted?
    4. Signs/Symptoms: Extreme Paranoia, hallucinations (visual and auditory), delusions, superhuman strength, elevated body temperature (remember the pictures of patients running in traffic and stripping off their clothing) aggression, violence, seizures, chest pain.
    5. Additional Problems: Rhabdomyolysis, a dangerous condition affecting the kidneys and often requiring the patient to have to undergo dialysis.  Chest pain leading to heart attack, self harm and suicide, Hyperthermia
    6. Treatment:  Initially our main concern is medical stabilization of the patient.  Treat the rhabdo, hyperthermia and other medical issues such as trauma and then treat the addiction with inpatient detox and rehabilitation
  1. Prescribed Medications This is a huge category and everyday we see patients addicted to prescription medications that include Opiates such as Percocet, OxyContin, Fentanyl, Dilaudid.  Benzos such as Valium, Klonopin, Ativan, Xanax.  Anti-Epileptics such as Gabapentin and Neurontin and while these medications are supposedly not “addictive” we do see misuse and signs of withdrawal with psychoactive effects.  Patients will increase dosages to get better effects, can seize if they miss a dose and will purchase medications on the street (Yes, Gabapentin does have a street value). Miscellaneous Analgesics – Tramadol (non narcotic with narcotic like properties) but now a scheduled drug.
    1. Class: Multiple Opiates, Benzodiazepine, Anti-Seizure, Analgesics
    2. Common Names: OxyContin, Klonopin, Gabapentin, Tramadol
    3. How is it Used: Oh yes we have seen Smoked, Injected, Inhaled, Ingested, Snorted, insertion (rectal and vaginal)
    4. Signs/Symptoms: Depending on drug type Opiates will mimic the signs and symptoms of heroin such as drowsiness, sleep, decreased respirations.  Benzos are much like opiates we also see slurred speech and lack of coordination.  Anti-Epileptics – weakness, loss of balance, headaches, slurred speech and seizures/   Analgesics – headache, nervousness, anxiety
    5. Additional Problems: Liver toxicity, Seizures, end organ damage.
    6. Treatment:  Our main concern is medical stabilization of the patient as there are so many side affects associated with withdrawal not least of which is seizures and falls.  We will treat all medical problems and in addition try and make the patient more comfortable throughout the detox process.  Nausea and vomiting will be treated with antiemetic’s such as Zofran.  Persistent Diarrhea with antidiarrheal such as Imodium and withdrawal symptoms with Librium and Clonidine, a blood pressure medication with anxiolytic properties.  In some cases, we will actually use a taper benzo schedule so that patients do not seize.  Following medical stabilization inpatient detox and rehabilitation programs guide the patient through out the rehab process but that is only if this is an option for the patient due to expense.  Outpatient programs are great options too, but again they can be costly and NA and AA are available free of charge and in my personal opinion offer great hope to all addicts.
  2. Alcohol Last, but by no means least, along with Heroin abuse this drug is one of the most abused on the planet. Many of the alcoholics we see in psych facilities are there because they have been Baker Acted in the ED.  Many of the patients we see in the ED are there due to traumatic injury, because they have been found passed out or because they are suicidal (therefore they are Baker Acted).
    1. Class: Alcohol
    2. Common Names: Beer, Liquor, Wine, Hand Sanitizer, Mouth Wash
    3. How is it Used: Ingested?
    4. Signs/Symptoms: Slurred Speech, lack of coordination, poor judgment, loss of memory, loss of consciousness
    5. Additional Problems: Liver toxicity, Seizures, end organ damage.
    6. Treatment:  Our main concern is medical stabilization of the patient.  As stated in the ED we see a lot of alcoholics as trauma patients who have been hit by a car while walking in traffic, head injuries, assaults on the street.  Also alcohol withdrawal related seizures are probably the most violent seizures I have ever had to treat, usually occurring 6-72 hours after drinking has stopped.  We will treat all medical problems and in addition try and make the patient more comfortable throughout the detox process.  Nausea and vomiting will be treated with anti-emetics such as Zofran.  Persistent Diarrhea with antidiarrheal such as Imodium and withdrawal symptoms with Librium and Clonidine, a blood pressure medication with anxiolytic properties.  In some cases, we will actually use a taper Librium schedule so that patients do not seize.  Following medical stabilization inpatient detox and rehabilitation programs guide the patient through out the rehab process but that is only if this is an option for the patient due to expense.  Outpatient programs are great options too, but again they can be costly and NA and AA are available free of charge and in my personal opinion offer great hope to all addicts.

Picture of a Drug Addict  This could be your brother, sister, mother, father, friend.  It’s the banker, the nurse, the student, the teacher, the rich socialite, the impoverished homeless person.

Treatment  

  1. Recognition
  2. Intervention
  3. Stabilization

Treatment facilities with Inpatient, PHP (Partial Hospitalization Program) or IOP (Intensive Outpatient Program), Half Way House.  The draw back with these programs, especially in the US is expense and in other areas of the world sheer lack of availability.

AA:  Alcoholics Anonymous – Free Program with like minded members addicted to Alcohol.  http://www.aa.org  find meetings here.

NA:  Narcotics Anonymous – Free Program with like minded members addicted to Narcotics.  https://www.na.org find meetings here.

Outlook:

From a personal stand point, we are losing the “war on drugs”.  Is our current strategy working? Are we seeing less patients?   With a continued lack of connection to each other this problem is only going to persist. For a different perspective on the war on drugs http://chasingthescream.com.

For more confidential help or if you have a topic you would like discussed – you can call me at 561-866-1211.  Thanks Dolores

Synergy Health and Wellness   Dolores@synergyhealthandwellness.net

http://www.synergyhealthandwellness.netUnknown-2.jpeg

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s