Acute meth / Stim psychosis - self-administering antipsychotics & other misc meds

[bad_kuchi_kopi]

Hi all,

I am a long-time lurker on this forum, but first time poster. Tried searching both here and among the scientific literature & could not find much conclusive regarding my specific question. I would greatly appreciate direction to relevant past threads if they exist.

I am a chronic methamphetamine (smoked primarily, IV'd occasionally) and heroin (IV'd primarily, smoked occasionally) addict. I'm talking "non-functional" addict: daily use with multiple failed attempts at professional treatment (including several hospitalizations).I am prefacing my question by saying I am aware that I am playing with fire while surrounded by barrels of gasoline and that this question can only be considered relevant to harm reduction within the context of someone whose disease is sufficiently advanced and who is choosing between "bad" and "very bad" decisions.

Recently, I have begun to develop pretty severe psych symptoms towards the end of each "day" (usually a 32 hour stretch followed by 12-16 hrs of sleep). Symptoms include: paranoia, auditory/visual hallucinations ("shadow people",flickering lights, coherent voices that range from low whispers to full volume speech sometimes resembling people I know, but often resembling strangers), intense anxiety / sudden feelings of panic and certain, imminent, though nebulous, doom, and just an all around feeling of severe dysphoria. Other symptoms are more "manic" and less "schizophrenic" feeling, like extreme locquacity, delusions of "profundity", etc. Noticeably absent are any symptoms of aggression or violent thoughts (towards self or others). Sleep can be very intense and is punctuated by powerful lucid dreams and nightmares that occur almost every time I sleep. Whether related to these symptoms or not, I also experience severe anxiety specifically about falling asleep. I typically nod off "against my will" after sufficient opiod doses, but the periods leading to sleep are usually quite terrifying.

I have self-administered a variety of benzodiazepenes to try to address these symptoms. I understand the dangers of co-administering these on top of my daily cocktail, but always stick to infrequent (max 3 times a week, rarely two nights consecutively) benzo doses at low-moderate doses (doses for the benzos used are at a max of: 0.5-1mg of clonazepam, 1mg alprazolam, 30mgs temazepam, 20mgs diazepam, or 2.5mgs lorazepam. NOTE: I do NOT co-administer benzos. These are all individual max doses). Benzos definitely help with taking the hardest edges off of the anxiety & feelings of dread, in particular, but do little to reduce any paranoia, hallucinations, nor do they reduce anxiety / dysphoria to tolerable levels.

I also have in my possession varying doses of several antipsychotics: haloperidol, quetiapine, aripiprozale, and olanzapine - all in tablet forms. I also have tablets of several "grab bag" anti-anxiety meds like mirtazipine, buspirone, gabapentin, hydroxyzine, as well as ready access to a couple of GABA(b) agonists (baclofen and GHB).

I am aware of the obvious answer to how to make these symptoms go away - immediately cease my stimulant abuse & seek psychiatric help. I also know that I can seek help at any emergency department. Having done so in the past, I know that they will respond to me with (in progression as I tell them nothing is working): 1) IV fluids, 2) IV lorazepam/diazepam, 3) IV haloperidol. They will repeat steps 2-3 until I pass out.

My question is basically is there any (comparatively) safe way for me to self-administer any of the meds that I have at my disposal in a situation where I am either unwilling or unable to go to the ER, but am lucid enough to understand that my symptoms are likely chemically-induced. I am curious to know if anyone else has had similar experiences with the sudden onset of regular stim psychosis and, if so, how have they addressed it. Are the antipsychotics the natural "escalation step" once benzos have failed to relieve symptoms adequately? If so, which antipsychotics are relevant for acute treatment? I am also curious to know, if, again, assuming that things are "really bad", it is "safe" to inject any of the antipsychotic tablets mentioned above (I understand that injecting any kind of tablet is inherently unsafe, but, again, I am talking about making a cost/benefit analysis in an already pretty awful situation). All research I could find suggested escalating doses of haloperidol and olanzapine were the most effective courses of action. However, I also have been on treatment regimens of anti-psychotics in the past and know that, both acutely and chronically, they can produce some pretty nasty symptoms.

Ultimately, the situation is getting severe enough that it is finally pushing me to accept the need to change. I have scheduled meetings with an addiction psychiatrist, but cannot meet with them right away. The terrifying, but honest, truth is that I do not have the will or courage to quit right away and likely will continue using until getting medical advice on the best course of action for quitting in a sustainable, holistic way. I am looking for input on how to manage this situation in the immediate term should I again find myself in potentially dangerously dysphoric/delusional states without access to professional care.

Any thoughts that are deeper than "damn, you crazy!" or "Hey man, quit smoking meth!" or "Get thee to a psych ward!" are truly appreciated. Other thoughts are likely to be ignored.

Thanks again to anyone willing to help.

 

[LordOfTabs]

First off, I had a horrible run with amphetamine psychosis, as a young adult. And have also had methamphetamine psychosis.
Benzodiazepines will almost seem to snap people. For me it completely snapped me out, and calmed about 95% of my psychotic symptoms.
Antipsychotic drugs, are very touchy. But do work if taken for a good amount of time (my experience was with geodon. 20mg taper to 40 mg 3 times daily) problem with anti psych meds.
Side effects. Stimulant psychosis can make you think your crazy. Psych meds can feed this. And also help symptoms. But for symptoms like visual disturbances and auditory hallucinations, your probably looking for a quick fix.
I'd recommend using benzodiazepines as short term relief, taper up slowly until your symptoms lower. When you feel the euphoric effects you've gone a bit close to the danger zone. As addictions happen easily in this case.
Say your using xanax .5 mgs when needed, then switch to clonazepam 1mg, then when you feel confident switch to .5 mgs of clonazepam. If your taking an anti psych and this is working, start coming off the benzodiazepines.
I used this method for about 6 months. The best way to beat it Is to live life happily as yourself, do not depend on drugs to fix other drugs problems. Hope I helped!

 

[d1nach]

What is this fear and loathing in los vegas when he pulls out his suitcase of uppers downs halidol and everything inbetween. Lol sorry I know this is serious but I just pictured that scene especially because of how clear and coherent you spoke like he does describing it all while seeing bats . Anyway I know you think you cant stop but what bout trying to lower the dose I mean like taking 5 % less see if you get any less high and see how much u can go down wifhout impacting your buzz. Euphoria is nonlinear so you probably can reduce it quite a bit and prob get more euphoria as you stay just as high but have less time scared to death

 

[bad_kuchi_kopi]

LordOfTabs,

Thank you for your reply. It is good to hear from someone else who has had a similar experience. I used to take low doses of antipsychotics regularly (alongside concurrent heavy meth abuse) under psychiatric supervision, for the anti-psychotics not the meth, and I definitely experienced these symptoms with FAR less frequency, but also did not experience any of the "classic" negative side effects of anti-psychotics while I was on them.

I appreciate regarding the benzos. I have so far been reluctant to titrate my dose too far upwards, both out of safety/tolerance concerns. You specifically mention alprazolam and clonazepam. Were these just examples or did you find them to have superior effects given their comparatively high potency, especially w/rt their anxiolytic effects relative to the other "benzo effects" (hypnotic, anti-convulsant, muscle relaxant) they exhibit? Again, one of my concerns is adding benzos into the opiate stew due to the exponentially higher risk of respiratory depression. Are certain benzos typically "less depressive" than others? I've only found "negative"/implied evidence to suggest that these two benzos might cause less depression. Some examples are the fact that Xanax, specifically, has been implicated in exacerbating manic symptoms in some with bipolar disorder (links on request), that clonaz is sometimes indicated for depression concurrent with anxiety, that neither alpraz nor clonaz are commonly prescribed/indicated for sedation/insomnia/anaesthesia (compared to others like lorazepam, diazepam, temazepam, or midazolam). I've also just noticed subjectively for me that, in terms of drowsiness/feelings of shallower breathing / lower vitals, the benzo hierarchy from least to greatest per equivalent dose goes: alprazolam, clonazepam, diazepam, lorazepam, temazepam, midazolam (have only had in anesthetic settings, so a little bit harder to judge). This could all be total BS, but I'm interested in hearing any input regarding "most anxiolytic to least sedating" benzos in this case. I feel a lot more comfortable, for example, popping 2mgs xanax than 80mgs temazepam or 40mgs diazepam after having shot a point or two of tar heroin, but this could be complete nonsese on my part. There is just something about the fact that I know people regularly prescribed 2mgs xanax every morning, but can't think of a single person scripted more than 30mgs temazepam for insomnia, that makes me think alpraz is likely to be "safer" to co-administer alongside already high opiate doses.

Yes, you are correct that I'm really thinking in terms of short-term fixes. I've found a study or two (one might just be a review of the other) suggesting that IV haloperidol can resolve psychotic symptoms within as little as 1 hour. I have also noticed that clinicians are quick to grab the syringe full of haloperidol, in particular, in my own experience when, say, my snarky comments and expressed annoyance begin to be "misinterpreted" as aggression of some sorts. I'm a big, expressive guy and I've found that, especially as soon as the tox screens come back showing what's in my system, I have to seriously tone down my personality in the exam room before I start getting threatened with the ol' "chemical lobotomy". In case it's not clear yet, I've had some negative experiences with psychiatric hospitalizations (ER doctors appear to be much worse than psychiatrists in this regard), which is why I am so keen to developing alternatives. My closest ER is surprisingly upscale and sleepy, even though it is in a neighborhood in the center of a major city with a large homeless/IVDU population. I have generally been made to feel "unwelcome" there and, as a norm, get thrown out the second I seem remotely stable (usually heavily sedated, with a pat on the back & an Ativan Rx short enough than I can count the tablets on my hands). From your experience, it seems like short-term anti-psychotics did little to help you. I'm curious to know if you, or if anyone else, have any experience in successfully (or unsuccessfully) using specific anti-psychotics to address acute symptoms, rather than just chronic ones.

I appreciate the final two sentences as well. Yes, I am aware that, roll their eyes though some may, I can have stability, freedom from these real and imagined demons, health, relationships, financial security, etc, or I can have drugs and live a reality that most people could only equate with Hell. How else can one seriously, with any speck of personal accountability and self-awareness, describe a life characterized by isolation and idleness punctuated only by its regular terrifying psychotic breaks and limited to the company of hallucinations, paranoia, delusions of persecution, and so on and so on and so on? I understand that, in the end, I cannot dope my emotions until they stop resisting. In my case, though, I fear that I may need the world to stop spinning long enough for me to at least have a chance to hold on. I am hoping to find a way to use these meds at my disposal to stabilize things long enough to get help rather than face the alternative of finding out how far down the next "floor" is in the event that I should again go into freefall.

 

[bad_kuchi_kopi]

d1nach,

Hah, I sometimes used to feel like a boring Hunter S. Thompson, so appreciate the analogy. It's not so far from the truth. I have a "First Aid Kit" that, in addition to the vanilla supplies like bandages & disinifectants, houses things better suited for a psychiatric ward - hypodermic needles, strong pain killers, stimulants, benzos, anti-psychotics, etc etc etc. I guess I used to find it funny, now I mostly find it sad. That's maturity, I guess?

I agree that I could likely reduce my dosage without losing much. Meth is particularly bad smoked for the "fiending" impulse it creates, its dosing imprecision (easy to keep adding and adding to the pipe rather than letting a bowl naturally fizzle out), its rapid onset, etc. Maybe I'll try switching ROAs and be more precise about how I dose. Then again, the list of "maybe I'll do's" is getting longer, not shorter.

 

[bad_kuchi_kopi]

On another note, I'm curious if the severe dysphoria might be a side effect of the heroin use. I spoke with one other friend who told me that, though she had had positive experiences with oxys and hydros, morphine and heroin gave her very intense nightmares and a strong dysphoria every bit as powerful as any positive feelings, usually about an hour or so after dosing. I find these dysphoric feelings to correspond very clearly with the "nod" phase of heroin. Whether smoked or IV'd, heroin tends to give me a delayed "rush" of euphoria and general well-being, followed by significant drowsiness and drifting in and out of consciousness that will last for hours. I typically "dislike" this second phase and will sometimes unsuccessfully try to stimulate myself out of it with clear.

I have not seen many other experiences mirroring my own or my friend's. Does anyone have similar accounts? I've had a severe habit for far too long to remember clearly if I get similar feelings from other opiates like oxy, though I can remember having a short, but finite, plug for lots and lots of cheap hydromorphone and noticed that this medication, in particular, whether shot or snorted, did not seem to produce quite as much fear and dysphoria as Queen Morphine or her even more sadistic, deceptive heir-apparent. I had a similar run with very potent fentanyl powder (or what I was told was fentanyl powder. It was highly active at what I estimated to be 0.5mg-1mg), however, and that produced virtually nothing euphoric, but left plenty of drowsiness, heavy respiratory depression, and dysphoria, that was intense and very short-lived.

 

[rainyday107]

See a doctor soon. Layperson opinion...take ONE-TWOmg of a benzo. Then take an antipsychotic med that is sedating. Small snack, relax and try and sleep.

Antipsychotic ... most important one. They work FAST.

Benzo...I'd take Xanax because it kicks in quickly.

No alcohol.

Its all good. Try not to stress. xo

 

[Em8753]

Xanax hs the quickest onset with the shortest half life making withdrawl more up front, k pins the half life is much much longer, but also making withdrawl more drawn out and longer imo. I personally would take xanax to to get off kpin. And temaz is what I used to be prescribed (highest dose is in fact 30mg) I have one of those left. I am today starting my w/d from 2months of meth.

I had psychosis although I don't know what drug it was from, I thought the cops were going to arrest me, I was going to go to hell, I was being taken over by the devil. And false confessions of things I didn't even do just what sounded like a voice in my head.

(I quit 3ozs of MJ a month, 300mg of zolpidem[ambien] in 3-4days after being on them over a month, I'd say 200mg of blue and peach adhd meds. And stopped abusing hydrocodone. I think it was a mixture of the MJ and Zolpidem. (Couldn't justify the amount of money I was spending on that much weed per month) and everytime I took 3 zolpidem 10mg my head would "clear" for an hour then go right back to impending doom. This made me wind up in a mental hospital for a week.

Didn't get better for 2-3months and all in all I was like that (before mental hospital, with the 2-3months after included) for 6-7 months.

 

[RonnieRayRodriguez]

I thought i had some problems. I too have been reading these forums for years and just registered. I recently tried m3th and tried in my ignorance to go hard like i always did my coke. Big mistake. Now my kidneys hurt, my urine looks like cola almost. I hallucinated a good bit also. I should have taken it easy and hydrated up. Electrolyte support as well. These muscle cramps.... I bet the people on here can help you. I hope so. Good luck.

 

[d1nach]

dark urine Rhabdomyosis A Side Effect Of Stimulant Overdose Where Urine Towns Brown Like Coca Cola

 

[Em8753]

D1 it's also a sign of extreme dehydration . I'd start to drink water and electrolyte drinks for a few days to see if it helps any, if at anytime your symtomps get worse I'd think about going to the doctor as what d1 said could be the cause.

 

[jimmy lynch]

I can only speak from the experience of an addict that has gone through similar situations.
for me Xanax - 1mg , maybe 2mg if I'm feeling a lot of panic (i have a high benzo tolerance). this is while I'm smoking. I'm very aware of my doses of both meth and benzos and try to keep it safe.
but for ending a bad trip, like paranoia. Seroquel has worked the best for me. almost completely shuts that part of my brain down. but i must say benzos help me alot with anxiety, panic and those two things can make paranoia and psychosis worse. so for me Xanax really does the trick. Seroquel is also a one way ticket to a great sleep ( well atleast for me )

p.s i dont recommend anything for you, but this is what has worked for me