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The Opiate Epidemic is Real

I love that people on the West Coast don’t always understand or are offended by the Narcan joke on my clipboard. I've come to realize it’s because the opioid epidemic (especially Heroin) is not as dramatic here, and many haven’t faced the realities the sticker represents.

After working in the Midwest/East Coast I can tell you that the heroin, carfentanyl, spice and oxy epidemic is real, understated, and it’s insane. And the secondary traumas, injuries, medical conditions and psychiatric problems associated with the heavy narcotic use is exponential. A large amount of the traumas we would receive in the Midwest were because the patient was a heavy drug user and was high on Heroin. 30 year old patients often had severe endocarditis and were already in heart failure. Narcan drips were routinely used in the ER. 0.2mg/0.4mg was not the “go to” IV push dose, we went straight to 2 and 4mg and many times with no effect. At the moment I work in California and in over a year at multiple trauma centers, i have only cared for one heroin overdose. Methamphetamines & hallucinogens seem to be the drug of choice on the West Coast which has taught me new ways to care for OD patients With methamphetamines there is no specific antidote and so treatment is generally supportive, we are less worried about respiratory arrest and more with the stimulating effects such as increased anxiety, seizures and subsequent hyperthermia, cardiac abnormalities and kidney failure. For most cases, fluids and cardiac monitoring will be suffice until we can discharge safely. More complicated cases can involve benzodiazepines to mitigate the effects of psychosis, anxiety and seizures. Activated charcoal and/or a Nasogastic tube may be used if the patient ingested the drug orally. With hallucinogens, such as LSD, PCP, MDMA (ecstasy), Ketamine and Peyote, the treatment is almost all supportive. These drugs are either synthetic or derived from plants in nature and no antidotes exist. Maintaining an airway (like anything) is the priority but generally the treatment is to just wait it out. Placing the patient in a quiet room with little sensory stimulation is ideal but good luck with that in the ER! Benzos can also be given to chill the patient out and mitigate anxiety. Ketamine is even given in some cases if LSD/MDMA was used, fighting fire with fire!

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