Posts Tagged ‘Drug Abuse’

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Psychiatric Patients

February 19, 2013

Forensic nursing involves the application of science and nursing in legal situations. Psychiatric nurses care for patients with mental illnesses. Forensic psychiatric nurses are employed in institutions such as a juvenile homes or prisons where a majority of the residents require treatment for mental conditions. Many of theses patients also struggle with the dual problem of mental illness and drug abuse. Patients who abuse drugs present with the additional complications of addiction, dangerous behavior, withdrawal symptoms, etc. It is interesting to consider that people who abuse drugs frequently also have a mental disease, which may or may not be diagnosed. For this reason all healthcare providers should be at least basically prepared to identify and care for patients with such conditions as they may not always be found under the strict care of a mental health facility and could present for treatment in emergency rooms and doctors’ offices.

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Benadryl, comment

February 12, 2009
Benadryl is a medication that most people
would consider safe because it’s given over the counter on a regular
basis. All the comments made about this medication and the tragic
occurrences resulting from overdose is a very serious issue that needs
to be looked at. This is the first i’ve heard of adolescents smoking
benedryl to get high, because it is a cheap and easily accessible drug.
It becomes very scary when you hear of these things happening on a
regular basis. But really what is the answer? Parents need to be
educated, as well as elementary and highschool students about the
possible effects of experimenting with even over the counter
medication. I think more time needs to be spent with elementary and
highschool students, so that they are well aware of the possible
outcomes of consuming foreign substances, as well as ones they are
familiar with.

Original Post:
February 9, 2009
Benadryl, comment
Reading articles like the Benadryl article
scare me. Society appears to be very flippant about the use of
medications for other that what they are intended. Articles abound from
ISMP. One that comes to mind recently had to do with a Fentanyl patch.
The grandmother was watching a young girl who was complaining of pain.
Grandma had some “leftover” Fentanyl patches and placed one on the
granddaughter, subsequently leading to respiratory arrest and death.
Now I see commercials by lawyers, soliciting through the TV for people
who have had problems with Fentanyl patches and the potential for
overdose. Education about the proper use of and misuse of all drugs
should be paramount. If medication errors are one of the leading causes
of death IN the hospital, what are the numbers that are associated with
death OUT of the hospital. Action needs to be taken, not in the form of
litigation, but through vigorous education, with understanding by the
learner, so that these horrible incidents can be prevented.

Original Post:
December 29, 2008
Benadryl, comment

It is a tragedy when a child is injured or killed secondary to a
pharmaceutical drug. Children are given prescription and OTC
medications too often. There are many herbal and homeopathic remedies
available to treat everyday complaints. This tragedy not only impacted
the mother of the child, but the siblings as well. In the instance
presented here, perhaps the natural herb valerian would have been a
safer choice over benadryl.

Original Post:
December 1, 2008
Benadryl, comment
I
agree that Benadryl, an antihistamine often used for its sedation
effect in adults, can cause paradoxical central nervous stimulation in
children with effects ranging from excitation to seizures and death.
Many young parents have used Benadryl to give their children to calm
them down when they travel. I was working the emergency room one night
when a mother with 3 small children came running into the emergency
room with her youngest who was 12 months old. She said they were
traveling to Iowa and she stopped at a road side park to change the
baby’s diaper. She started screaming her baby was cold and not
breathing. She tried to do CPR and drive at the same time. She did not
have a cell phone and no other cars were at the park. We assessed the
baby and did a tox screen which also showed nothing. I asked the mother
if she ever gave her kids any over the counter medicine for colds or
coughs. She said sometimes. The 6 year old sister said, “mommy gave us
some pink medicine”. The mother then told us she gave them Benadryl
liquid. We tried to revive the baby, but after 45 minutes of CPR she
died. The death was ruled accidental and no charges were made. But I am
sure the mother was emotionally blaming herself for what she did and
will have to live with that the rest of her life. I think there needs
to be an education program for parents that over-the-counter
medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
How
do we combat the abuse of drugs that are unable to be detected through
any toxicology tests? The fact remains that people, especially young
teenagers, will try almost anything to attempt to get high. It becomes
almost impossible for law enforcement to prevent such actions and
therefore lies solely on the parents. It is definitely time to be
involved in the lives of your kids and know what they are doing.

Original
Post: November 12, 2008 Benadryl, comment I have a response for the
blog entry from November 10, 2008 entitled Benadryl. In the emergency
department I work in we had an adolescent arrive in a psychotic state.
He was hallucinating, was manic, combative and then would calm down and
become very docile. He was slightly tachycardic and at times tachapneic
and his blood pressure wavered between normo to slightly hypertensive.
He didn’t have a diagnosed mental disorder. Our toxicology screens all
came back negative and so we were getting ready to transfer him to an
inpatient mental hospital when one of his relatives came in with
Benadryl wrappers and opened capsules of Benadryl found in his waste
basket in his room (they think he may have smoked it on a cigarette or
joint). The kid overdosed on Benadryl. Not because he wanted to die,
because he wanted to get high. Benadryl doesn’t show up in a tox screen
and all his other labs were pretty normal. He ended up going to our ICU
for a day and was discharged.

Original Post November 10, 2008
Benadryl, an antihistamine often used for its sedation effect in
adults, can cause paradoxical central nervous stimulation in children
with effects ranging from excitation to seizures and death. Teenagers
have discovered Benadryl, an over-the-counter medication, which is
easily obtainable and affordable. The effects of Benadryl produce a
“High.” Benadryl in this population is also taken with alcohol and high
energy drinks. Parents also give their infants Benadryl to produce
sleep and the outcome has been fatal intoxication. I have been made
aware of Benadryl and its deadly side effects when a 10-year-old child
was told by his mom to take a Benadryl tablet for his allergies. The
child unfortunately took an overdose and was placed in the hospital for
2 days to withdraw from medication.

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Narcotic Abuse

February 11, 2009
At this time I own/operate a drug testing business and we currently have a program through the court system to prevent juveniles from serving “adult” sentences if there are drugs involved. I live in eastern KY and I’m sure if you watch the news you have seen we are the RX drug capital of the US. Anyway, these kids are stealing their parents narcotics and snorting them or selling them. The parents are doctor hopping and have not 2-3 bottles but 40-50 bottles of different narcotics. It sickens me to think about the life these kids are getting into. Sometimes I wonder if it wouldn’t just be better to let them serve some “real” time and see what “innocent” snorting will get you. As a nurse, this is a rampant problem even among professionals. I am shocked at the number of nurses, doctors and nursing students that we have positive drug tests on that are taking large volumes of narcotics with legal RX while treating patients. It makes me want to drug test all physicians or nurses before they touch me!!

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Benadryl, comment

February 9, 2009
Reading articles like the Benadryl article scare me. Society appears to be very flippant about the use of medications for other that what they are intended. Articles abound from ISMP. One that comes to mind recently had to do with a Fentanyl patch. The grandmother was watching a young girl who was complaining of pain. Grandma had some “leftover” Fentanyl patches and placed one on the granddaughter, subsequently leading to respiratory arrest and death. Now I see commercials by lawyers, soliciting through the TV for people who have had problems with Fentanyl patches and the potential for overdose. Education about the proper use of and misuse of all drugs should be paramount. If medication errors are one of the leading causes of death IN the hospital, what are the numbers that are associated with death OUT of the hospital. Action needs to be taken, not in the form of litigation, but through vigorous education, with understanding by the learner, so that these horrible incidents can be prevented.

Original Post:
December 29, 2008
Benadryl, comment

It is a tragedy when a child is injured or killed secondary to a pharmaceutical drug. Children are given prescription and OTC medications too often. There are many herbal and homeopathic remedies available to treat everyday complaints. This tragedy not only impacted the mother of the child, but the siblings as well. In the instance presented here, perhaps the natural herb valerian would have been a safer choice over benadryl.

Original Post:
December 1, 2008
Benadryl, comment
I agree that Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Many young parents have used Benadryl to give their children to calm them down when they travel. I was working the emergency room one night when a mother with 3 small children came running into the emergency room with her youngest who was 12 months old. She said they were traveling to Iowa and she stopped at a road side park to change the baby’s diaper. She started screaming her baby was cold and not breathing. She tried to do CPR and drive at the same time. She did not have a cell phone and no other cars were at the park. We assessed the baby and did a tox screen which also showed nothing. I asked the mother if she ever gave her kids any over the counter medicine for colds or coughs. She said sometimes. The 6 year old sister said, “mommy gave us some pink medicine”. The mother then told us she gave them Benadryl liquid. We tried to revive the baby, but after 45 minutes of CPR she died. The death was ruled accidental and no charges were made. But I am sure the mother was emotionally blaming herself for what she did and will have to live with that the rest of her life. I think there needs to be an education program for parents that over-the-counter medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post: November 12, 2008 Benadryl, comment I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn’t have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn’t show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post November 10, 2008 Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a “High.” Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Narcotic Abuse

February 6, 2009
An increase in potential narcotics diversions were occurring within our Emergency Department after an influx of Agency nurses. What was happening; pain meds were being administered without corresponding orders and single dose vials were being used as multidose vials. We discovered that orders were not being written when crucial conversations took place between practitioner and nurse. Nurses were adminstering meds based on verbal orders, not thinking to follow-up with the physician or even hand the chart to the physician so they could write the order “real time”. I had worked in the ER for many years prior to my current position and there was always a sense of trust between nurse and physician. You helped each other out by doing for the other or even prompting when necessary. I find it rather interesting that there seems to be a new culture within the department that seperates physician and nurse; a form of alientation that fosters distrust. You hear things like: “That’s not my job” by nurses when discussing giving meds without orders, or “I didn’t know he did not write the order” or “I can’t give these meds even though I had a verbal order?” The other issue of using single dose vials as multi-dose vials come from not wanting to waste resources and work-arounds. I can understand the issues presented here. It happens when the physician orders 1mg of Morphine that comes in a 2mg vial. The nurse withdraws the 1mg, administers it, then saves the other 1mg for later, knowing it will be used at some point in time. Unfortunatly, all these actions may and do cause suspicion. Narcotics diversion was becoming such an issue that we ended up contacting an agent from the NYS Health Department, Bureau of Narcotics Enforcement. Imagine my surprise when this gentleman showed up for his in-service sporting a utility belt complete with handcuffs and a lovely government-issue 9mm handgun. Needless to say, his in-service caught the attention of many staff members, not just our ER staff. His presentation was very inciteful, replete with numbers about jail time and fines. Some of the “simple” penalties exceeded $5,000, loss of license, etc. Our numbers regarding narcotics diversion did diminish after his visit, but time will tell if the department goes full circle right back were it started.

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Drug abuse co-occurring with chronic pain, comment

January 11, 2009

I do agree that physicians are obligated to try to relieve the pain to there fullest power, however, one person may continue to experience pain and the physician should not always be held liable. It is the responsibility of the physician to do all that is in their power, but sometimes despite attempts at pain relief, some patients who have been addicted to drugs in the past end up with chronic pain. I do not think that one should be judged by their past experiences with drugs nor do I think this is a reason to keep pain medications from them. They have the right to treatment. Sometimes one of the barriers is that when a person has done drugs in the past, they have a higher threshold, meaning that they may require more of a substance than the physician who is treating them is willing to prescribe. Some past drug addicts require mega doses of morphine for pain, and some doctors do not feel safe in prescribing this. As an overdose could end fatal. One of the things that Naturopaths can do is to help the patient focus on other things instead of the pain. Try relaxation techniques and try to help the patient focus on healing instead of feeling the pain. While this will not work for all patients, this will work for some.

Original Post:
October 16, 2008
Drug abuse co-occurring with chronic pain
Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

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Benadryl, comment

December 29, 2008

It is a tragedy when a child is injured or killed secondary to a pharmaceutical drug. Children are given prescription and OTC medications too often. There are many herbal and homeopathic remedies available to treat everyday complaints. This tragedy not only impacted the mother of the child, but the siblings as well. In the instance presented here, perhaps the natural herb valerian would have been a safer choice over benadryl.

Original Post:
December 1, 2008
Benadryl, comment
I agree that Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Many young parents have used Benadryl to give their children to calm them down when they travel. I was working the emergency room one night when a mother with 3 small children came running into the emergency room with her youngest who was 12 months old. She said they were traveling to Iowa and she stopped at a road side park to change the baby’s diaper. She started screaming her baby was cold and not breathing. She tried to do CPR and drive at the same time. She did not have a cell phone and no other cars were at the park. We assessed the baby and did a tox screen which also showed nothing. I asked the mother if she ever gave her kids any over the counter medicine for colds or coughs. She said sometimes. The 6 year old sister said, “mommy gave us some pink medicine”. The mother then told us she gave them Benadryl liquid. We tried to revive the baby, but after 45 minutes of CPR she died. The death was ruled accidental and no charges were made. But I am sure the mother was emotionally blaming herself for what she did and will have to live with that the rest of her life. I think there needs to be an education program for parents that over-the-counter medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post: November 12, 2008 Benadryl, comment I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn’t have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn’t show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post November 10, 2008 Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a “High.” Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Benadryl, Comment

December 1, 2008

I agree that Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Many young parents have used Benadryl to give their children to calm them down when they travel. I was working the emergency room one night when a mother with 3 small children came running into the emergency room with her youngest who was 12 months old. She said they were traveling to Iowa and she stopped at a road side park to change the baby’s diaper. She started screaming her baby was cold and not breathing. She tried to do CPR and drive at the same time. She did not have a cell phone and no other cars were at the park. We assessed the baby and did a tox screen which also showed nothing. I asked the mother if she ever gave her kids any over the counter medicine for colds or coughs. She said sometimes. The 6 year old sister said, “mommy gave us some pink medicine”. The mother then told us she gave them Benadryl liquid. We tried to revive the baby, but after 45 minutes of CPR she died. The death was ruled accidental and no charges were made. But I am sure the mother was emotionally blaming herself for what she did and will have to live with that the rest of her life. I think there needs to be an education program for parents that over-the-counter medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post: November 12, 2008 Benadryl, comment I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn’t have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn’t show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post November 10, 2008 Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a “High.” Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Benadryl, comment

November 21, 2008

How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post:
November 12, 2008
Benadryl, comment
I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn’t have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn’t show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post
November 10, 2008
Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a “High.” Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Drug abuse co-occurring with chronic pain, comment

November 12, 2008

I too believe that just giving these people pain meds is irresponsible. Giving them resources is all we can do in the emergency department setting. They get mad when they become a repeat customer and are finally refused pain meds. We give them alternatives and resources to providers who can get them help or long term treatment. The problem is these patients have to want the help. There are patients out there that work the system. They travel in an “ED circle” to get what drug it is they need. They might not even be the abuser of the drug. They may be looking for meds for their spouse or to sell, so they can get the drugs they do want. I offer resources to patients repeatedly. But, after numerous attempts I stop. Patients do need to take charge of their own health. And unfortunately, there are those people out there that just don’t want to and no matter what approach you use, you’re not going to change them. They have to change themselves.

Original Post:
November 10, 2008
This is an interesting post about physician’s obligation to “relieve chronic pain.” As the patient(s) may be coming in for treatment of pain with a concurrent drug abuse situation, the patient is the one who does the healing and the nature of the pain needs to be fully examined. Drug addiction can be recreational, prescribed meds, and common “foods” like sugar, alcohol, caffeine, nicotine, nutritional stimulants, etc. If a patient does not respond to pain meds, there could be many causes that warrant further investigation. If substance abuse is suspected, then blood testing and urinalysis may detect overuse, but how about in people that have been long-term users/abusers? I don’s believe that the solution is to simply use an “alternate drug.” A professionally supervised detox program will usually free up the liver detox pathways to allow the meds to work better – in the even of an emergency situation with debilitating pain. If the pain is chronic in nature than the origin must be detected and dealt with in order for the patient to regain health. In my experience most patients want help with their addictions usually come clean if they trust the practitioner. Our job as health care practitioners is to promote health – neglecting the patient’s habitual abuse and underlying causes for his/her chronic pain is just pain lazy and irresponsible. There is a person sitting in front of us who needs our immediate help and we must understand the situation in to the best of our ability. Giving the patient more meds is no solution, and you can’t promote health by loading people up on drugs -in fact you may kill him/her. They will need education and integrative therapies that will help them piece together their lives. The “chronic pain” is the body’s way of communicating a person that there is a problem or imbalance and using meds to shut off this alarm is not an effective long-term solution.

Original Post: October 16, 2008 Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

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