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  • BDD Moderators: Keif’ Richards | negrogesic

What drugs are typically used to stop a drug overdose in the ER?

Lightning-Nl

Lightning-Nl

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Joined
Nov 11, 2012
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I'm asking this question because, until just now, I thought that for a very severe Meth overdose they would give the person an IV injection of Lorazepam every 15-minutes until the person has stabilized. But now that I think about it, Lorazepam is know to cause hallucinations at doses above 4 milligrams.

Maybe, where ever I read that from, said Diazepam instead of Lorazepam? If that's the case, however, why would the dose of Diazepam be so low to begin with, if the person is at risk of hemorraging, lesions, seizures, stroke, convulsions, and panic reactions? Would a high dose of Diazepam and then repeated lower doses if needed be way more effective (and life saving?)

What do you guys think?
 
In a stimulant overdose situation, typically patients are given benzos. I've read about Ativan being administered via iv, one mg. They might give some other benzo but I'm not sure. So I imagine if more is needed to stabilize the patient, the benefit would outweigh the possible risks involved.
 
I do not think it makes much of a difference whether diazepam or lorazepam are used to treat agitation associated with stimulant intoxication. But as far as why higher doses are not given, it is because some will respond to lower doses and high doses can be harmful to some if given right off the bat. Remember, they are already in a hospital, if agitation continues, the doctors will notice and readminister benzos if needed. If there are cardiac, cerebrovascular, or CNS issues, they will notice that too and start the protocols for whatever is needed.
 
I know Naloxone is injected IM to opiate overdoses, but that's at the scene/in the ambulance rather than at the ER
 
^Due to naloxone's short duration, it's commonly administered a few hours later, while OD-level opiates are still active in a person's bloodstream.



I have no idea how hospitals typically treat stimulant ODs, however.
 
for stimulant overdoses, i wouldn't imagine that any benzodiazepine is used. diazepam and lorazepam is what seems to be the most common ones used. it depends on what symptoms are present, diazepam and lorazepam have strong anticonvulsant properties that some benzodiazepines such as alprazolam, can't match. all benzodiazepines provide potent anxiolytic properties and have anticonvulsant properties, however different benzodiazepines have varying degrees of the anticonvulsant properties. so alprazolam wouldn't be the first choice in a stim OD situation in an ER because it has much weaker anticonvulsant properties. i've read that clonazepam functions as a good anticonvulsant as well but haven't read about its use in stimulant-related ER scenarios before. the onset and half-life would normally be taken into consideration but in an ER they're going to use IV with a specified frequency, so onset isn't as important as when you take them orally.
 
The doctor at the hospital here gave my sister a 3mg shot of lorazepam when she od'd on E and meth on her birthday.
 
I have heard of people being put into medically induced coma for stimulants OD's despite the fact that benzodiazepines reduce core body temperature as well. Seeing how these comas actually cause brain damage (many must learn to speak/walk again after due to atrophy) is there any real reason to put someone in a coma in this situation other than to create scare stories for propaganda?
 
If they are hyperthermic to the point of imminent death or in severe seizure what options are there? Cannot think of situations other than these that warrant medically induced coma.
 
Yes but not always effective. Doctors are trying to prevent a patient from dying or suffering. They do not care about pharmacology in the heat of an emergency.
 
You got it backwards DankOpiAmp, a real trauma induced coma can last so long as to cause atrophy of the muscles & such. But a drug induced coma can be stopped by the removal of the drug or addition of a reversal agent. Also typically drug induced comas are only maintained for short periods.
 
Rob27shred said:
You got it backwards DankOpiAmp, a real trauma induced coma can last so long as to cause atrophy of the muscles & such. But a drug induced coma can be stopped by the removal of the drug or addition of a reversal agent. Also typically drug induced comas are only maintained for short periods.
Click to expand...

I have a family member that had the atrophy I described from a medically induced coma for other reasons (I am assuming that is what you are referring to when you say drug induced) They can cause such things to occur within several days to a week or so. I am aware of a few example of people treated for a supposed ecstasy overdose that were put into comas as a treatment. Unless hyperthermic brain damage has similar symptoms to coma-induced atrophy it seems they damaged the patient unnecessarily.

My original question still hasn't been answered. A medically induced coma would require the use of drugs administered by the doctors to induce it. Pharmacology would certainly be relevant if that is supposed to lower core body temperature faster than a benzodiazepine, thus making it preferable.
 
they still use barbiturates in the result of benzos not slowing you down enough if you do too many uppers, i know that much :p
 
Just had an interesting run in at a hospital. I was unaware that they even did this.

Apparently, if someone comes in addicted to benzos and they need to be withdrawed from them, they will skip everything - clonazepam, diazepam and chlordiazepoxide. Instead they'll do a 'phenobarb rapid detox'. Something that I was completely unaware of until yesterday.

Apparently, you can stop and eliminate all benzodiazepine dependence if you do an ultra rapid taper with Phenobarbital. I have no idea how that works tbh. Maybe because the GABA subtypes they bind to are different? I know that Barbiturates mainly bind in the brain stem. While benzodiazepines mainly bind to the cerebellum and the part of the brain right above the brain stem (forgot what it's called).

Maybe it could also be due to the fact that benzodiazepines increase how often the GABAA Cl- channel opens, while Barbiturates just increase the duration of how long the channel stays open.

Anyways, this doctor told me that you can do an ultra rapid detox of benzos using Phenobarbital in only 1 week. I, personally, thought that takin barbs instead of benzos would be a step backwards, but it works apparently and he's been doing it for years. He also claimed that there was no risk of seizures, convulsions, or panic reactions and that 99% of withdrawal symptoms from benzos are eliminated within that one week. Not sure if I believe it, but apparently he's been doing it for over 15 years so it must work...

Anyways, I declined to do that because I'm not sure how else I would deal with my increasingly debilitating anxiety. Especially since I've literally been on every other alternative to benzos.
 
I believe the logic behind the phenobarb use is to prevent seizures, convulsions etc. as a patient withdraws from the benzos then a quick taper off the phenobarb.
 
Kittycat5 said:
I believe the logic behind the phenobarb use is to prevent seizures, convulsions etc. as a patient withdraws from the benzos then a quick taper off the phenobarb.
Click to expand...

True. However, considering that they're mechanisms of actions are so similar and the fact that the end result is exactly the same for both (more Cl- inside of the neuron) I was always under the impression that they were cross tolerant. That's what confuses me about the Phenobarb taper. It seems to me like it would just prolong withdrawals.

Also, there is evidence suggesting that Temazepam may work like a barbiturate rather than a typical Benzodiazepine (e.g it hold the chloride channel open longer rather than more frequently). How would this work if that was the case?
 
I too was wondering about the cross tolerance. I guess it is possible that the mechanisms for tolerance are different for benzos and barbituates but cannot find evidence supporting this. I imagine the kinetics of phenobarb, particularly its long half life that are useful in acute withdrawal.

Have no idea about temazepam, never heard of it acting like a barbiturate.
 
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