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How do emergency rooms treat acute opiate w/d syndromes?

hello all im new on this forum been long time reader though first post :) i have experience with going to the ER for acute heroin withdrawal and was given methadone after a 3 hour wait. i was given 3 options clonidine methadone or a benzo it surprised me that some of you are saying the doc wouldnt give you methadone i thought it was a common thing guess not in some states
 
It absolutely sucks to go to ERs if you are in WD. If you are in NY they can legally only give you 10mg of methadone unless they can confirm you are in a program with a clinic or something. Most ERs aren't licensed to dispense bupeprenorphine either so if you are there with bupe withdrawal you're fucked. They basically give you some ativan or klonopin and ignore you for hours while you writhe in hell. You might get some clonidine if you're lucky but they make you pick and choose and won't just give you a benzo, clonidine, and the minuscule amount of methadone.
 
lol im in canada and i when i planned to detox i went to a walk-in and the doctor basically gave me all the clonazepam (40 x 2mg) and ativan (60 x 1mg) i wanted. wouldn't give me clonidine though. fucking weirdo.

edit: he was actually like "really, you want both? ok then".
 
Yeah, coming away with clonidine and benzos is better than usual.
Typically, IME, the opiate-dependent are considered the bane of the ER dr/nurse's existence.
IME, they immediately treat me like a junkscumbag and either toss me out or stick me in a bed and forget about me. I've had multiple experiences of going to the ER for real problems and told them upfront when they asked that I take buprenorphine and that I do NOT want any opioids. Once, the doc wouldn't even give me a script for lidocaine (as in Anbesol) eye drops when I got a burn on my cornea. (The pain was bad enough I was seriously considering robbing a pharmacy at knifepoint or killing myself. I settled for pounding a liter of vodka instead with antihistamines, willing to take the risk of death. A cornea burn! Luckily when I woke up it wasn't suicide-painful any more, just excruciating.)
Sometimes after overdoses I've gotten ativan, ambien, or clonazapam -- mainly because the nurses were getting annoyed that I wouldn't stop screaming. But on other occasions they've done some pretty messed up things after ODs (like naltrexone for hours at doses so high I was too incapacitated to yank out the IV, try as I did, approximating full ultra-rapid detox--without my consent--of course, I'm happy to take a reasonabl amount and suffer to live, but after 8 or 10 hours it seems like the dose could be turned down a bit; and they didn't need to use whatever weird little metal thing it was to insert that catheter--while I tried to fight in a stupor/semi-seizure, mind you--that caused visible bleeding; or, another time, trying to trick me into staying by saying I had life-threatening organ failure, which I believed until I found two other docs on the floor and asked them to explain it to me again, and they said you're fine).

Even though I now take opioids as prescribed, I avoid hospitals like jail. I would have to be gut-shot, and even then I'd probably try to take a bus to Mexico...
You could always deny that you have any opiate experience or say you're a benzo addict, I suppose...
 
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The last time I mistakenly took my suboxone after partying with about 280mg of oxycodone only maybey 8 hours before I immeditaly started to feell that something just wasn't right about 30s after I had dissolved it under my tongue and within 3 to 5 minutes I was in the absolute most intense pain/need/desperation I think I have been in since I was born. and quickly had my mom (who gave me about 80mg of her hydrocodone but unfortunately I didn't know buprenorphine is extremely competetive) who drove me what seemed like an eternity untill I reached the ER were after being processed I was given a 6mg dose of hydromorphone IV which at least might have given me the psychological calm I was needing while I was flailing around and cursing like a debauched sailor for the next 6h before I decided I was base-line enough to get myself checked out and hope to god I would never experience that kind of incident again.

Here I am though, about 2h after I took 4mg of suboxone even 48h after my last methadone dose and still have a mild withdrawal going on. Fortunately Im not 1/10th as bad off as I was that one night but that's is a good thing because no one deserves this agony.
 
I was given a 6mg dose of hydromorphone IV

Holy hydros! They gave you IV hm for w/d? Nice!
I had a pretty horrifying precipitated w/d one time and considered calling 911 (too messed up to do it though) but figured they'd just call the cops or something (I'd IVed the Suboxone, and it was a backward-ass small town). But after hearing that, sounds almost worth it, in a perverse kinda way... :!
 
cold turkey is bad for your system. I would stay on junk until you can get an appointment with a doctor that specializes in replacement therapy (suboxone/methadone). It's really the best way. Ive been off tar for 6 months thanks to methadone and can even go without methadone now if i need to. It's a long road, but it can be scenic.
 
I guess the one thing you can do is not disclose the fact that it is indeed opiate withdrawal and they may give you a shot or two of an opiate for excruciating stomach pain (which happens after pinwheel vomiting sessions). But then when you get home (they probably won't give you much to take home, if any), you'll have to deal with it once the dose of opiates leaves your system. The overall message in this thread is that you are better off riding this out at home. I've put myself into serious precip. wd from Suboxone (after removing a fent patch 26 hours before dosing) and it was indeed a living hell. That was the only time I considered getting help because I kept having these panic attacks (and rls, sweating, chills, pain, diarrhea, etc. etc.). It was a moment of serious weakness. But I didnt call (because noone could do a thing about it) and I just rode it out for a few days.
 
Just threaten to kill yourself or others and they'll throw you in the psych ward. Just go buck wild and hopefully they will sedate the fuck out of you.
 
^ lol

OP - they may not admit you at the hospial - and if they do - they wont make the detox as nice as you could ake it for yourself....

cant u get your General Practioner to help you ?
 
^ lol

OP - they may not admit you at the hospial - and if they do - they wont make the detox as nice as you could ake it for yourself....

cant u get your General Practioner to help you ?

You ever think that maybe his supplier IS his primary care physician? But besides that at least here in California we have laws that protect anybody that wishes to get help at the CDRP centers around here (chronic dependency recovery program) and I went there for a couple days until I decided it wasn't for me and my doctor is not allowed to access the records, or even to be given confirmation that I have/am being seen for dependency issues.
 
You ever think that maybe his supplier IS his primary care physician?

fair point

... i found that when i was honest with my GP that he was able to help me and he got me off opiates benzos alcohol and all other rec drugs - it did require brutal honesty tho .... i guess what works for some doesnt necessarily work for others -

i guess my real point is that conquering demons like addictons requires strength from within first and foremost - any thing else that follows this will be useless(or temporary at best) if the "ground work" hasnt been set in palce properly.....

good luck tho OP please keep us all posted.... if i can help at all PM me

FM

(former benzo , alcohol and opiate addict)
 
I went to the er during w/d's and all they did was give me a shot of torodol (not tramadol) right in the ass.. its only an nsaid but damn it helped with my knee pain.

I could actually walk outta the er without feeling crippled.
 
I went to the er during w/d's and all they did was give me a shot of torodol (not tramadol) right in the ass.. its only an nsaid but damn it helped with my knee pain.

I could actually walk outta the er without feeling crippled.

For real. If you're on Suboxone and you're in a pain situation, toradol will help you out a lot. I had to go back to the hospital the day after a surgery with major pain at the surgical site. They gave me 2 shots of Dilaudid. Even 72 hrs after 16mg doses of Suboxone, the D was still partially blocked. I didn't feel any euphoria or pain relief. When they refused to give me any more opoids (because I did tell them about the Sub, hoping they'd try to shoot through...yeah right) they gave me toradol. It worked better than 4mg Dilaudid.
 
1 st off- The ER is the last place to go to get treated for opiate withdrawl- although sick as a dog at 3:00 am before the methadone clinic opens it might sound like a good idea. Not only are they busy enough with unstable patients, of the many reasons the triage nurse would decide what priority you would be seen, WD is at or near the bottom of the list. Urgent care is also not a good option. This is all US of course. Kaiser and a few private practice physicians were trying outpatient detox in the late 90s. The Haight Ashbury free med clinic would scrip darvon. I had a doc in San Clemente scrip darvon, valium, clonidine, loperamide, and placidyl to sleep.

^what are you talking about? Heroin maintenance? From what I've read this is very small scale and only for addicts who have repeatedly failed every other treatment option. A junkie withdrawing is not going to get a shot of diacetylmorphine if they walk into an ER in ANY country.

Not true. The Swiss Rx Heroin extensively and have done pilot programs with Rx Cocaine- there system is extensive with safe injection/smoking rooms.

I started a thread on the evolution of the swiss harm reduction model-tons of info. Great thread on UK system. They need to expand.
 
Originally Posted by PLUR2000 said:
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I agree --- but if you feel like you need medical help... check out the local Methadone/ Bupe detox options (ER's can hold you in the psych ward if they think you might be a harm to yourself) apparently shooting up is a harm to yourself, cuz one time I got sent to rehab that way!(

It doesn't work that way. You can only be held on a psych hold if you are a dangerous to yourself or others. Using drugs is dangerous, but unless you are trying to harm yourself with the drug, they can't hold you legally. It is ALL about intent. I'm not saying that it didn't happen to you, Im just stating that it's not legal.

:\they said that
 
They Don't

If you live in the Us they will may monitor you but will not administer any drugs. Saline is the only thing going in your arm. They may have you talk to a social worker and will suggest detox.
 
I went in recently went in for a bad infection in my knee. Since I was hurt, I was also out of work so I had no money to buy my subs; therefor I was in w/d. Anyway, since I needed to stay in the hospital for 4 days, they gave me methadone on top of my morphine injections (2mg). I'm glad they did because suffering from the knee pain and w/d at the same time sucked. And the morphine did not much of anything, so the methadone helped a lot more with the pain. They way over-medicated me though. I told them I had a 2mg/ day habit of bup, and gave me as much as 70mg/day of methadone. They brought me down super quick though, so that sucked.
So, if you have another reason to be in the hospital, they'll give you methadone while you're in there.
 
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