The aggressive methamphetamine patient

[BushyFromOz]

So after 3 years and no post, I've successfully resurrected 1 dead thread and started another....

 

Anyway, Methamphetamine has become a big story here over the last few years, (the jokers would say we don't have Methamphetamine problem because everybody has it)

. And unlike you Heroin epidemic of the late 90's, to late 2000's where they were nice and peacefully asleep and a little bit cyanosed and they would generally wake up with some oxygenation and some Narcan and be pretty OK with things, these mongrels are often wound up like spring, especially the polypharm OD's and sometimes even the synthetic Marijuana user. It became such a problem we are now giving high dose IM ketamine to knock them down as Midazolam was ineffective,

Just interested to hear whats happening in other places,  are you dealing with it, and are you seeing secondary problems such as serotonin syndrome/rhabdo/renal failure/MI often?

 

There.. my contribution for the next 3 years

[paramedicmike]

Meth isn't a big thing in my area.  I'm in heroin central.  Heroin, heroin and more heroin.  It's cheap, plentiful and potent.  At one of the ERs where I'm working we get pretty regular drive up for the unresponsive respiratory arrest from heroin OD.

The few meth patients we have seen can get pretty scary pretty quickly.  They'll flip like a switch and become wicked violent.  Ketamine has worked well as, similar to your experience, midaz wasn't doing much.

[BushyFromOz]

Heroin is making a bit of a comeback. With the State and  Feferal Police forces looking at amphetamines so kucg, good ole heroin is a cheaper low key option.

Its pretty amazing how many meth users i mett who were heroin users who changed drugs in the late 2000's when heroin was becoming more expensive.

[paramedicmike]

All of our folks used to be prescription opioid abusers.  We've been clamping down on prescription narcotics for a while now.  While we still get some folks who are angling for narcs from the ER it doesn't happen nearly as often as it used to.  When oxys and percocets became more expensive due to decreased supply they started going to heroin.  Or going back to heroin.

[BushyFromOz]

On 01/11/2017 at 12:34 AM, paramedicmike said:

All of our folks used to be prescription opioid abusers.  We've been clamping down on prescription narcotics for a while now.  While we still get some folks who are angling for narcs from the ER it doesn't happen nearly as often as it used to.  When oxys and percocets became more expensive due to decreased supply they started going to heroin.  Or going back to heroin.

Actually, thats a good point. You cant sill buy codeine based products over the counter here for a few more months. I wonder how much substitution will happen afterwards

[paramedicmike]

Codeine products OTC?  Interesting.  How does that work?  How's it regulated?  Sounds like it's going away from your statement.

Abuse issues with this kind of availability?

[BushyFromOz]

Not well regulated im afraid. A pharmacist can dispense it if you provide identification, but its open to and does get abused, which is why it's being closed. I'm not sure where that fits into the heroin trade, as the heroin epidemic was before my time in the job.

 

My gut feeling is Dr shopping tends to be people with chronic pain who have then become addicted, where the earlier heroin epidemic was more based in recreational drug use, but i have nothing to back that statement with.

Edited November 3, 2017 by BushyFromOz

[aussiephil]

The biggest problem was that the register for codeine based products was not compulsory. There is a good argument for some OTC Codeine to be available, either in conjunction with Paracetamol or ibuprofen. 

 

When it was initially approved for OTC sale there was supposed to be the implementation of an online register to control who, when & how much was bought. The pharmacists then lobbied through the big pharma companies to water this down & it became a voluntary register. This simply meant, like with anything, the honest people who use it for legitimate purposes, bought what they needed & when with advice from the pharmacist. Those who wanted to abuse the system simply found those pharmacies who did not participate in the register & went from shop to shop to purchase. 

 

In reality this has not really changed anything. If anything the supply & use of Codeine will actually decrease with an increase in other presciption meds such as Endone (oxycodone hydrochloride) & Tramal (Tramadol) increasing & becoming the drug of choice. They are easy to get & people will Dr shop & have other get scripts for them. 

Codein, in the OTC meds was safe & very low dose (15mg per tablet). The decision by our highly intelligent lawmakers to change this, while restricting the use of medical cannabis, is questionalble & could be easily resolved by reintroducing a compulsory online register. If, as a pharmacy you choose not to participate, then you are not licenced to sell it. Easy.

[Just Plain Ruff]

I remember being able to go to the local pharmacy, tell em you needed Novahistine with codeine and they would sell you a bottle.  I could do it on a daily basis if I watned to back when but I think the last time I was able to do that was in the early 1980's if not the 1970's.   My parents would tell me to go get a bottle of novahistine and bring it home.  

I also remember a pharmacist at the local Bruce Smith Drugs who gave me 90 days worth of all my medications instead of just the script amount.  To say it was not well regulated or watch-dogged is an understatement.  

[rock_shoes]

On 11/1/2017 at 3:44 AM, BushyFromOz said:

So after 3 years and no post, I've successfully resurrected 1 dead thread and started another....

 

Anyway, Methamphetamine has become a big story here over the last few years, (the jokers would say we don't have Methamphetamine problem because everybody has it)

. And unlike you Heroin epidemic of the late 90's, to late 2000's where they were nice and peacefully asleep and a little bit cyanosed and they would generally wake up with some oxygenation and some Narcan and be pretty OK with things, these mongrels are often wound up like spring, especially the polypharm OD's and sometimes even the synthetic Marijuana user. It became such a problem we are now giving high dose IM ketamine to knock them down as Midazolam was ineffective,

Just interested to hear whats happening in other places,  are you dealing with it, and are you seeing secondary problems such as serotonin syndrome/rhabdo/renal failure/MI often?

 

There.. my contribution for the next 3 years

We're essentially walking the Ketamine path right along with you. Big dose IM Ketamine for this indication is starting as a trial in one of our urban zones now and will likely be extended to the rest of the service by the end of the year. We've used Ketamine for all kinds of indications in air-evac for a long time. It's new to street level ALS practice in BC.