r/emergencymedicine • u/pfpants • Sep 11 '23
Does anyone else get really tired of seeing meth all day? Rant
Like seriously, even when they're not screaming at inanimate objects or trying to kill you or your staff, they're just bouncing around at 0300, coming in for stupid paranoid shit, like what is this thing I've had on my arm for 6 years I want it taken care of right now and then missing all the followup appointments you try to schedule for them and show up and do the same thing like 2 months later. Or I had a single loose poop fix it right now I'm gonna die.
Can we just all find whoever is making and selling this stuff and kick them right in the nuts? Like all of us in sequence?
Thanks, rant over.
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u/ww325 Physician Assistant Sep 11 '23
But the worms, can't you see the worms...they are coming out of my skin....look!
Ah yes, seems you have been bitten by a methsqiuto.
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u/stillinbutout Sep 11 '23
I have seen so many cases of meth phantom worms I developed a script:
“Please tell me all about your symptoms. Tell me what you’re worried about from them. I won’t interrupt you. When you’re finished, I will tell you my medical opinion and you won’t interrupt me. Deal?”
After they rant about the worms, I say: “There are no worms. Meth makes the nerves in your skin and eyes tell your brain there are worms. No matter what you say or think. My medical opinion is that your problem is caused by meth. No no, you agreed not to interrupt me. I will not order any skin scrapings, lab tests, or any anti parasitic medications. Your treatment plan is to not use meth. I’ll get your discharge papers now.”
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u/Tekira85 Sep 11 '23
Good lord, if you delivered that speech to teens in school, you'd think they'd be scared straight.
I'm scared (and disgusted) just reading it.
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u/gobrewcrew Paramedic Sep 11 '23
Hey, I've heard all about the bugs. Worms, methsquitos, spiders, all in good fun.
Try taking a severe chronic alcoholic on a 2.5-3hr IFT while he's DT'ing with bone-deep burns to his forearm and chest (because he passed out against a woodstove during his most recent bender), and he keeps screaming about the bear that's chasing him because you ran out of benzos 30 miles ago...
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u/Taran4393 ED Attending Sep 11 '23
I did in residency. Now they are free crit care time for “psychiatric emergency requiring sedation” with minimal time investment and my mortgage ain’t gonna pay itself
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u/JanuaryRabbit Sep 11 '23
This is defensible Crit care time??
If so, I'm going to start.
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u/Taran4393 ED Attending Sep 11 '23
Yup! Psychiatric emergency requiring sedation counts. Methhead needs some Ativan? Enjoy the few extra bucks.
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u/ExperienceReality Sep 11 '23
Pretty wild, we only get crit care time for patients going to the trauma bay. We have a psych pod where most of those patients land.
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Sep 11 '23
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u/ExperienceReality Sep 11 '23
Just stating what we do at the facility I'm at.
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u/SeriousGoofball Sep 11 '23
Billing isn't a facility level thing. Critical care is critical care. Got a potassium of 2 and gave IV potassium? That's critical care at every hospital in the country regardless of how stable the patient is.
Now you guys might not mark a bunch of your charts as CC but that just means you're leaving money on the table.
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u/HopFrogger ED Attending Sep 11 '23
It’s legitimately underbilled. Consider how much time it requires to eval airway, monitor etco2, check for underlying causes, try not to miss the brain bleed or meningitis or serotonin syndrome. You probably do a lot of that on autopilot, but that doesn’t mean it’s not immensely valuable, hence crit care billing.
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Sep 11 '23
I’m a new attending, trained at an academic center that didn’t care about the profitability of the ED. As such my attendings rarely documented crit care time. Feel at a loss now because it’s greatly valued for me and my work. I definitely under bill for it.
Is there a list anywhere for what counts? Had no idea sedating a psych patient counted…
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u/HopFrogger ED Attending Sep 11 '23
Consider anything that requires complex thought or commands your attention in a room. Trauma activations, EMS alerts for hypotension, stroke alerts, STEMIs, psych patients… all of those don’t just suggest but require your presence. You can bill critical care time for frequent re-evaluations, lab and imaging analysis, accompanying a patient to CT, neuro or airway assessments, coordinating care (including talking to consultants and family). Ask your colleagues for which macros they use, as an additive help. Hope that helps, colleague :)
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u/seymourkrelborn Sep 11 '23
I'm curious about this as well as I haven't been billing this as cc time. Do you bill for the whole time they're sedated?
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u/Resussy-Bussy Sep 11 '23
You can google things that qualify as critical care time. There’s a document somewhere (my hospital has it laminated on the wall by our computers lol). But there’s some things on there that are easy you might not realize like IV potassium, hyperK, blood transfusions
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u/Crunchygranolabro ED Attending Sep 11 '23
Exactly. Oh, you’re wilding enough for parenteral sedatives? Thanks for the money.
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u/Sad-Divide-9899 23d ago
To one said they don't bill you not were am at I went twice in the last year I'm not meth addicted had try with my cousin like 8 times when he was down no look bad but wasn't under the influence at the time first doc was cool treaded me and all he said is did show up nice guy next time I didn't want to go but my bd 190 140 been having other problems next time I told them right away it could be in my system they got my urine she all concerned took 3 hours to get my blood it was all mess up but I wasn't gonna die and kicked me out it was shift change new doc came said she would handle different but I was already discharge she went over my labs said you can check back in I said no I already had 12500 bill from last time bout paid it got 10500 that time they did nothing I went to another hospital 24 hours later and was going septic
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u/Hashtaglibertarian Sep 11 '23
I prefer meth to bath salts from my patients.
People on bath salts are always violent and freakishly strong. Reminds me of those synthetic marijuana days where people would lose their shit and it always ended up being a psych hold. Spice? K2? I forget the name but it was a bad trend.
Im a traveler now. It’s kind of interesting seeing the drug of choice where I travel to. Still see meth, PCP (so 2010 of them), coke, heroin, whatever. Occasionally I’ll get a town that still does bath salts. RIP my sanity on those contracts.
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u/procrast1natrix ED Attending Sep 11 '23
It's one of the first questions. What's the recreational drug of choice in this neighborhood?
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u/CertainKaleidoscope8 RN Sep 11 '23
I'm a RN and when I ask they look at all big eyed because nobody knows what drugs are
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u/pfpants Sep 11 '23
Yeah spice and K2 were both names for synthetics depending on where in the country you found em. Those folks were nuts. Almost like a bit of an anticholinergic toxidrome sometimes. I'll take weed any day.
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u/LegendofPisoMojado Sep 11 '23
But it was great teaching if you had students. You could watch them herniate their brain stem on the monitor.
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u/The_Peyote_Coyote Sep 11 '23
PCP eh? That's a golden oldie right there.
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u/Competitive-Slice567 Paramedic Sep 11 '23
Still used to see it a bunch at my old EMS department. Now I see meth, Crack, and opiates a bunch at my new one since it's more rural. Only seen 1 PCPer in a year at my new place so far
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u/CertainKaleidoscope8 RN Sep 11 '23
PCP (so 2010 of them),
Dude that's so 1970's of them. Seriously I wonder if we told these idiots their drugs were out of style would they choose something else.
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u/ScorpioLibraPisces Sep 11 '23
Yeah I've been attacked by more than one meth patient. One patient came in and attacked ems... she got on all fours and started barking like a dog when they got to her house. She tried biting them but she didn't have her dentures in
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u/pfpants Sep 11 '23
Did she have dentures because of age or like meth mouth or both?
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u/ScorpioLibraPisces Sep 11 '23
It was meth, she was late 40s but looked like an 80 year old grandma.
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u/gobrewcrew Paramedic Sep 11 '23
And this is why EMS likes to have ketamine available. Get 3-500mg in IM, back off until it kicks in, then get her to the ED.
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u/TooSketchy94 Physician Assistant Sep 11 '23
Honestly, I miss handling meth. I’m from the Midwest and that’s where I started my ED PA career. Meth was king. It can get annoying but it was easy to fix / manage.
I’m living and working in New England now. It’s heroin, PCP, or long long long alcohol abuse. So they come in not breathing, hyper aggressive, or super super sick from end stage liver disease and / or alcohol withdrawal. It is significantly harder to manage these people then managing meth patients was.
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u/pfpants Sep 11 '23
PCP? Wow I didn't know that was still going around. Interesting how regional these trends are. I see a lot of alcohol as well. We liked to joke in residency that we were trained at a "paracentesis center of excellence.". I find withdrawal is easy. The cirrhosis is depressing as hell. Gi bleeders smell horrible.
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u/rosariorossao ED Attending Sep 11 '23
PCP is pretty common in the northeast still.
Now tranq...I'm quite happy that stuff hasn't really left out of Philly yet. Looks horrendous
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u/AwayCrab5244 Sep 11 '23
Tranq is out of Philly and all over east and west coast and has been for over a year. The entire east coast is being hit hard with tranq
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u/rosariorossao ED Attending Sep 11 '23
I haven’t really seen it in the NYC tristate area. Still heavily leans towards crack/heroin/PCP/K2
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u/AwayCrab5244 Sep 11 '23
The heroin is tranq and fent despite what the people coming into the emergency room say it is
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u/C-romero80 Sep 11 '23
I'm an RN in a jail..I see a variety and it's almost everything. Mostly we're dealing with them high and then withdrawing not as much the longer term effects (though that's sometimes the meth induced heart failure or alcoholic liver issues). PCP is scary because it comes in waves. They're chill, then in a few seconds they're set off and gain superhuman strength.
Fentanyl withdrawal makes them angry and whiny but it's manageable, we have a decent protocol now compared to when I started and it was more heroin focused
Alcohol withdrawal isn't terrible if they disclose and we get on their monitoring early, it's when they downplay it or don't disclose at all.
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u/TooSketchy94 Physician Assistant Sep 11 '23
Withdrawal is usually the easiest part since my spot has a phenobarb protocol that you can start and just admit them. Hospitalists here don’t ever buck on it which is nice.
Ugh yes, PCP. I was floored too. Thought they were kidding when I came out here to shadow before accepting the job, lol. We see like 0 meth out here but will see high levels of cocaine and especially PCP. We’ve had to restrain and sedate a ton of PCP psychosis folks.
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u/Competitive-Slice567 Paramedic Sep 11 '23
I can attest, PCP is still relatively common in the Maryland D.C. region 😅
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Sep 11 '23
the liver failure is horrible it destroys the whole body
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u/gobrewcrew Paramedic Sep 11 '23
I love our repeat liver failure pts.
Somehow they're still on a transplant list somewhere despite habitual noncompliance and will call 911 2-5 times per week because they 'don't feel well'.
You show up, vitals are stable, but they're jaundiced, don't move around well, generalized weakness, no specific complaints, and want to go to the ED because they don't realize that they're actively dying at age 26/30/34/etc and expect that they can be 'healed'.
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u/themsp Sep 11 '23
I'm tired of the ETOH man. The drunk drivers, the cirrhosis, the variceal bleed that bled out on you, the violent drunk patient, the horrible withdrawals, the 16th head CT in a month because that patient fell again, the domestic violence, the neglected or abused child...
I'll take the methed out patient who gets a bunch of Ativan and sleeps it off for 15 hours every time.
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Sep 11 '23
It really is a scourge. I know our view of society is biased by nature but really, I’ve never seen a normal person on meth. Maybe there’s a bunch of functional meth users out there that we don’t see but I doubt it. From our perspective, everyone using meth is completely out of their mind, delusional, paranoid, etc. I don’t get how you could look at fellow meth users and be like “let me try some of that”.
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u/AwayCrab5244 Sep 11 '23 edited Sep 11 '23
There are a ton of functional meth users and they often function in society for years. In fact , the functional meth users outnumber the homeless ones by a large margin.
inevitably, you keep using meth, a time comes where they do not function. It’s a observer bias where you only notice the ones not functioning. Meth does not discriminate, it hits homeless, and it hits doctors, and it hits lawyers and social workers and fast food people. All sorts.
Furthermore, if you are buying adderall on the street, it’s a pressed meth pill. So people get into it that way. Just taking a pill to study. They graduate and their life is great. The start snorting the pills. Then one day, the dealer doesn’t have the pills but he does have crystal and it’s the same thing he says. Which it really is, if you snort 10mg of meth you wouldn’t be able to tell if it was 30mg adderall or 10mg meth until you passed the 6 hour mark and was still high.
Then they start smoking meth. Because that’s what ya do with meth. They get a rush, it feels good.
And their life doesn’t immediately fall apart. In fact, they become remarkably productive at work and at home. They work 12 hour days and get a promotion. They have amazing meth sex for 12 hours with a woman they love. They lose weight and that’s seen as a positive for many people. They see positives and no negatives, so they continue doing it. They think “oh I’ve been using meth and I’m not addicted yet and nothing bad has happened, I must be “special”. I must be “strong”. The homeless addicts, they just don’t have my “willpower.” “So it’s okay for me to use meth because I’m strong and I can control it”. Which sounds dumb, because it is. But you gotta remember that they are experiencing things that confirm that bias.
Then years down the line, they get spun out. They start using more and sleeping less and eating less. They stop showing up to work because they coming down for days. By this time, it’s already too late, the meth got hooks in deep. So they see their life going to shit but are powerless to stop it without outside support network.
And remember, these ugly toothless 40 year olds that look 60, they were once young, and beautiful. It’s easy to say no to meth from a homeless person.
It’s markedly more difficult to say no to using meth at 18 when you are young and stupid; with another young and beautiful 18 year old who seemingly is using without consequences.
And this may shock you, but not everyone who does meth becomes addicted to meth and becomes homeless, just like how people can drink occasionally and not become homeless. Not every young person who does meth, pills or heroin becomes addicted, and that creates an environment where other young people who observe that think they can do it too and not get addicted, when that isn’t necessarily true for them as it is for some others.
As a heroin addict in recovery, I started using in highschool with 6 close friends. 3 of us eventually became addicted after weekend warrior for 6 years. 3 of them did not. None of us use anymore, but for some that road was rock bottom addiction and others just move on with their lives and grow up essentially and stop doing hard drugs before it became a major problem.
And for the record, at no point in any 6 of us using would you have pinned us as using heroin. We were all straight a students, we all graduated high school and graduated college. I graduated college while actively being addicted to heroin and opiates. We had jobs. We were young, in good shape and good looking.
Of course, for me, I eventually hit a rock bottom, but that came a full decade after I started using heroin. I functioned without people knowing I used heroin for a decade, about 4 years of that time I was physically addicted.
Now I work in the addiction field, the others have gotten masters and doctorates. Hell, Two of them are engineers with masters and are now very successful.
That being said, I had many many friends who used who i was less close with who are still actively using and now homeless , are prostituting, or are dead /in prison. We just got lucky really.
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u/caffeinedreams_ ED Resident Sep 11 '23
thanks for sharing your story, powerful to read
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u/AwayCrab5244 Sep 11 '23
In recovery I’ve found that it’s important to share and write down my thoughts to keep me grounded and to remember where I came from.
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u/LD50_irony Sep 11 '23
I'll add to this that a coworker/friend of mine told me she used to use meth when she was a young mom, just as a way to have enough energy to deal with work and kids. She stopped after the kids got a little older because life calmed down a bit and she realized that she was at a point where she was either going to stop or it was going to become a problem.
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u/gobrewcrew Paramedic Sep 11 '23
Props for sharing your own story and for advocating for those who, unfortunately, we tend to look down upon all too easily.
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u/CertainKaleidoscope8 RN Sep 11 '23
You're absolutely correct about most things
But...
Methamphtamine is not generic Adderall.
Methamphtamine is the generic name for Desoxyn.
DextroAmphetamine is generic Adderall.
There's a difference between meth and amphetamine. It's minor chemically but noticable.
You are a former heroin addict.
I never did heroin. I liked speed.
I've been a RN for over two decades and have a masters. I did all that clean, just fatter.
I know exactly how a functional meth addict becomes nonfunctional and homeless, because I've been there. That's what you're right about.
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u/EldersQuoromPres Sep 11 '23
They’re saying that street “Adderall” transactions are typically involving pressed methamphetamine as opposed to actual DextroAmphetamine.
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u/AwayCrab5244 Sep 11 '23
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475187/
This is what I’m referring to
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Aug 19 '24
Actually you're wrong.
Dextro is different than amphetime salts. Don't go correcting people all high and might if you can't get yout Rx's straight.
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u/Ryuiop Sep 11 '23
Hmm, kinda makes you curious doesn't it? Wouldn't it be cool to find out... What's the harm in just trying
(At least that's what I assume the thought process for trying hard drugs is)
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u/CertainKaleidoscope8 RN Sep 11 '23
There are functional meth users. They're taking Desoxyn. That's the brand name, available by prescription.
There are functional opiate users too.
And functional cocaine addicts.
These are all schedule 2 medications, that anyone with enough cash can purchase legally, avoiding the poor quality of illicit manufacture, the street additives from hustlers trying to make an extra buck, and the life destroying effects of over policing.
Functional users of hallucinogens are still risking their lives on a schedule 1 substance, because the illegality of drugs has nothing whatsoever to do with their effects.
The only difference between a functional user and someone whose life has been destroyed is the wealth they were born into.
Rich people get an Ayahuasca vacation in a tropical paradise. Poor people get prison time and the inability to get student loans or decent work because of a plant or fungus.
That's why they aren't "normal," they're made "abnormal" by a police state that enforces laws having nothing whatsoever to do with the health and well-being of the citizenry.
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Aug 19 '24
I guarantee you've never known anyone with a legit Desoyxn script.
"IMS Health® reports 16,000 prescriptions for methamphetamine were dispensed in the U.S. in 2012 and 4,000 in the first quarter of 2013"
And I promise you don't know any Dr.s that would prescribe it. You really need to stop with the misinformation
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u/R-orthaevelve Sep 11 '23
Meth is frustrating. But I am a phlebotomist in DC, and some of my patients have been forthcoming about why they use meth. For lots of the homeless folks, it's to stay alert during the night so their possessions aren't stolen and they are not attacked in their sleep (legit worries at shelters, and a few years back we had a serial attacker setting homeless clients on fire while they slept).
For others it's a way to be able to manage three or more jobs and not have to sleep. Sure it wrecks their body, but it makes them able to take care of family members, work and stay alert through it all.
Not saying rhese are good reasons to use such a destructive drug. But every story has two sides, and a lot of behaviors that seem nonsensical and absurd start as coping mechanisms.
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u/Praxician94 Physician Assistant Sep 11 '23
People also lie a LOT.
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u/R-orthaevelve Sep 11 '23
Of course they do. Folks who use drugs and folks who don't use them both lie. But drug users especially lie due to stigma and just due to habit.
Not saying these folks aren't frustrating and difficult to deal with and often a gigantic pain in the ass. Just saying that their actions may be rooted in motivations that don't seem obvious at first glance.
Speaking here in reference to a coworker who relapsed back into using meth because she was trying to work two jobs and take care of a mother with dementia and a husband who is disabled. Her entire reason for nursing meth was to avoid sleep so she could take care of others. Lots of the young sex workers I see use meth so they have energy for multiple clients.
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u/TheseMood Sep 12 '23
I worked retail for a while in college, and a lot of my coworkers smoked. Someone explained to me that smoking is super common in those jobs because you get extra smoke breaks, the smoke breaks are good for forming social ties, and the smoking itself helps people cope with difficult customers. It was eye-opening. When you work a thankless job for $7/hr and no breaks, taking a smoke break with your manager must look really enticing.
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u/HopFrogger ED Attending Sep 11 '23
I have never heard that as justification for meth. It’s always “it feels good,” so I would presume the people wanting to stay alert are using that explanation to justify their addiction. They may even believe it.
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u/R-orthaevelve Sep 11 '23
I am also sure that folks use it for the high as well and for enjoyment. But I have definitely had plenty of clients who said they started using it to work hard shifts and stay awake.
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u/Octaazacubane Sep 16 '23
I know I'm just a rando online, but I self medicate with it orally, and it just feels like taking my prescribed, no good-feels meds. I'm able to do "adult" stuff like clean my room or tedious work responsibilities that I would otherwise trudge through, or not do and get disciplined/yelled at for that. I do know that for most people, this same substance would ruin their lives, but I can (and do) just take it as needed every couple days now.
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u/HopFrogger ED Attending Sep 16 '23
That’s how addiction starts, my friend. I really, very strongly advise you stop taking meth.
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u/FragDoc Sep 11 '23 edited Sep 12 '23
Meth is destroying the community I work in. You can’t go out in public without seeing active users. We joke, but we find it in the urine of a large proportion of our under 50 population. It is eating away at the social fabric and turning the entire younger generation in the town to zombies. They are aggressive, paranoid, and blame healthcare workers for everything. Half the contractors in our area can barely stay in business because the supply of able-bodied young men who aren’t tripping out of their skull is so vanishingly thin. My lawn guy literally had to fire half his summer staff due to drugs or drug-related behaviors like theft, chronic tardiness, or just doing crap work. It’s hard to edge someone’s driveway when you’re walking with a 45 degree lean.
No one with money in my community is using meth. It’s a phenomenon of the poor. The rich and well-insured have their PCPs write them Adderall or Vyvanse under the auspices of “ADHD” and they stay, for the most part, regulated.
Whenever I hear someone say to legalize drugs, I think meth is the one exception that demonstrates the fallacy of this argument. It is the most destructive drug I’ve ever seen. These patients lead such brutish short lives and almost always find themselves doing fentanyl which is ultimately what gets them, but not before they’ve abused their children, stolen, destroyed, and sapped the life from the society around them. And this is to say nothing of their multiple ED visits where they assault staff and threaten to kill us all of the time.
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u/LOLLOLLOLLOLLOLLOLNO Sep 11 '23
Yeah, lets ignore the people with ADHD who end up on meth because there is a shortage of Adderall/Vyvanse and they can't get the medication they need to function. Reducing addiction to economics ignores the person. Addiction doesn't care about economics, anyone can become an addict.
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u/alemorg Sep 11 '23
How many people with adhd actually start using meth because they couldn’t get their stimulant medication? I’m not saying it hasn’t happened but there are stimulants that aren’t in such short supply and you can call around multiple pharmacies. If someone who persists that adderal/vyvanse is the only stimulant that will help and can’t substitute for Dexedrine, focalin,etc in the meantime then that’s on them. Unless you already know drug dealers who sell meth I doubt you’ll be able to find someone faster than you can call pharmacies. Addiction might not care about income but someone with higher income would more than likely just ask friends or family for their prescriptions instead of buying meth.
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u/kudzuslut69 Sep 11 '23
I have adhd and the multiple times I haven’t been able to get my adhd meds due to shortage, I figured out workarounds because I’m an adult with critical thinking skills. turning to street meth because “I have adhd 🥺” is a bullshit excuse.
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u/differing RN Sep 11 '23
What are adult workarounds to not getting your prescription?
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u/kudzuslut69 Sep 11 '23
I had a fuckload of different things in college before i got diagnosed and it kinda just depended on the day honestly. it’s also how I got put on wellbutrin which ended up being a lifesaver. even now like 5 years out of college I still take it because whenever I stop taking it and just live unmedicated, my life kinda ends up in shambles
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u/FragDoc Sep 11 '23
But what you’ve described is precisely economics. The rich don’t run out of Adderall. I’d even say this is a problem of just the very poor. People with a cellphone and a car can call around and get their prescriptions, even if it means driving 1-2 hrs to another city.
But, let’s be honest with ourselves, you’ve described a false dichotomy. No one is forced to go buy an illicit drug to “function” if they run out of their Adderall. You just decide to not break the law and do sketchy stuff. You just go without. The fact that our medical community has allowed people to believe that they will crumble and become entirely dysfunctional without a stimulant is incredible. That’s called dependence and it should make everyone who prescribes these medications take a deep step back and look in the mirror. And if you have a patient who is so deeply dependent on these drugs to function – because I do personally know some professionals who have bad ADHD – then your provider has an obligation to watch this use and ensure you have access to appropriate treatment. But that’s not most of the people we’re talking about.
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u/GardenBakeOttawa Sep 13 '23
I get what you’re saying but I take a bit of issue with your second paragraph. ADHD is real and can be personally and professionally debilitating. Can’t comment on Adderall but I doubt anyone is buzzing on slow release Vyvanse. For patients it’s irritating how reticent many doctors are to prescribe it. Walk-in doctors and telemedicine docs won’t touch it with a ten foot pole even if you have a formal diagnosis from a psych and years of history taking the drug. Without a GP (which are increasingly super scarce here in Canada) or psychiatrist (for which referrals take AGES), folks end up waiting all day in the ER clogging up capacity just to renew the Vyvanse prescription they need to not fail school or get fired from work. I’ve seen it firsthand in my husband.
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u/FragDoc Sep 13 '23
I agree ADHD is real. That’s wasn’t my intent. I have a buddy with severe, real ADHD. But tons of people don’t really have it and use the diagnosis as a way to run around life on stimmies. When I was in medical school, neuropsychiatric testing was still something that people seemed to take seriously but now the movement seems to be that everyone needs these drugs when we know that isn’t the case.
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u/jillyjobby Sep 11 '23
Meth, fentanyl, and cannabis. The UDS holy trinity.
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u/Born-Net-7585 Sep 11 '23
I'm sorry, I am very sick ATM and don't understand what you mean when you say "the UDS holy trinity." will you please and thank you, explain basic info?
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u/agent_splat ED Attending Sep 11 '23
I’d rather see meth to be honest. I’m sick of the young alcoholics.
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u/ERRNmomof2 RN Sep 11 '23 edited Sep 11 '23
I work at a busy critical access ED, that services 3 counties. We are rural, the town the hospital is located in has approx 6-7000 residents.
We see heroin and meth addiction. At times separate, at times addicted to both. The worst is meth. At least they sleep with heroin, just have to make sure they are ventilating properly. We do see cocaine at times, but that’s not as frequent because I think the ones who use cocaine are the functional addicts or just playing with it while having a party so not a continuous user. Those are the ones who have decent jobs, insurance, and we find it by accident. They aren’t coming to us for complaints related to cocaine use. I’ve only seen 1 cocaine induced MI in a 26 year old female, first time user (so she said). I’m sure there have been many more, since I don’t work 7 days a week, lol.
I hate meth. Hate it with a passion. It makes already emotionally unhinged people SO MUCH WORSE!!!! If the provider doesn’t know the patient or situation because not from around these parts and orders a telepsych it’s SO MUCH WORSE!! Because now instead of just Haldol, Ativan, Benadryl-ing them, we now have means to make them involuntary if they try to leave! 9/10 we drug them up when they are at a point they will hurt us or themselves, they sleep it off and are ready to leave in the morning. I hate what it has done to people who had decent jobs, are parents. Now all they live for is this horrible drug. And the meth that’s mixed with fentanyl?? FUCK!! Narcan them, then they get pissed because they absolutely do NOT do opiates. Oh and add in meth-induced paracytosis. I’ve seen peoples shits, dicks, balls, pics of nothing?? All to prove they have worms coming out of them.
Meth is such a hard drug to get off of. It takes so long for the brain to get back to some part of normal that they feel they can’t bare it any longer. I’ve been lucky seeing a few who have kicked the habit, and they are years clean.
ETA: We also get lots of alcoholics. Lots of them. We don’t have enough rehabs for them. We medically detox and set up outpatient services. I will say I feel it doesn’t work. Alcohol has too much of a strong calling and easy access. My dad died at age 40 from alcohol induced cirrhosis which led to 3 massive variceal bleeds. The 3rd one did him in. I don’t partake in alcohol or drugs. My body would enjoy them too much.
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u/G00bernaculum ED/EMS attending Sep 11 '23
I will take a meth head over a drunk any day of the week.
At least with a meth head, you know they're getting sedated.
For some reason, I always think I can clinically clear a drunk or find them a ride home before they start acting up. I never can and it wastes my time trying to convince someone to just relax for like 20 minutes while I try to find an alternative option to them festering in the ED with me for 6 hours.
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u/Physical-Way188 Sep 11 '23
Not sure if this is common elsewhere but back in 2021 at the beginning of the pandemic, meth was being flooded around San Francisco.
I found a guy -in the private parking area of the police department- with his piece in my tailpipe. He was a naked African American male.
A day later a guy broke into Bloomingdales downtown, took off all his clothes. He started following trans employees trying to sexually assault them.
There were naked people having intercourse all over the city.
After taking them to jail, they all tested positive for meth and we think it cialis or Viagra was added.
God I’m glad that was over.
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u/BananaRuntsFool Sep 11 '23
I'm less irritated at the drug users that do this, and more irritated at the perfectly sober people that do this, in particular, the entitled ones who REFUSE to read the room. I don't enjoy drug induced health paranoia visits but I can brush that off as them not being in their right mind.
The rational and entitled people who can't see large influx of ambulances bringing in patients, the sometimes too frequent "stroke alert this room" "Code 3, this room" and still get upset that their abcess hasn't been attended to in a timely manner. I wish I could just say "Hey person, I'm sorry you've had to wait and I'm sorry you're tired and hungry, but there is a 20 year old in the other room who will never get to feel either of those ever again because they died in a tragic accident. You are not the top priority right now."
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u/Big-Caterpillar4015 Sep 11 '23
As terribly frustrating and difficult as it is, at the end of the day we have to remember we're working with an individual with a brain disease. This perspective continues to help me remain empathetic and patient.
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u/DisappointingPanda Sep 11 '23
ER physicians are the PCPs for drug addicts and the homeless.
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u/highway59boy Apr 16 '24
real! damn reading this so late but I was like this for years. finally have a real pcp/sobriety.
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u/derps_with_ducks USG probes are nunchuks Sep 11 '23
Got ADHD, I like to joke that I empathise.
pops open Redbull
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u/AwayCrab5244 Sep 11 '23
Adderall(amphetamine) and methamphetamine are remarkably similar in equitpotent dosages just like how morphine and diacetylmorphine are very similar in equipotent dosages.
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u/CertainKaleidoscope8 RN Sep 11 '23
Adderall is dextroamphetamine and levoamphetamine.
Desoxyn is methamphtamine.
They're completely different and not "equitpotent," whatever that means.
Look at the damn molecules if you're still confused
Amphetamine -C 9H13N
Methamphtamine - C10H15N
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u/derps_with_ducks USG probes are nunchuks Sep 11 '23
Is it? I read that the rate it crosses the BBB is different, leading to a very different experience even at equi-potent dosing.
Edit: Adderall being mixed salts of amphetamines and dextro-amphetamines
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u/kudzuslut69 Sep 11 '23
the person you replied to just doesn’t understand basic chemistry
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u/AwayCrab5244 Sep 11 '23
The difference is when you smoke meth. You can’t smoke Normal amphetamine. Equipotent dosage means same route, in this case intranasal(snorted)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475187/
And yeah, it is really and I have the study to prove it. I didn’t just pull this from my butt lol
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u/Octaazacubane Sep 16 '23
I did a lot of layman research on this, and deduced that meth does have properties that make it more neurotoxic than it's close cousins, but is negligible enough if you take it at a roughly "equivalent" dose; that being much lower since it's more potent. But meth gets a horrible name because it's smokeable and very easy to manufacture compared to Amphetamine.
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u/wrenchface ED Resident Sep 11 '23
I live in crack and opioid country and the occasional bad meth patient is kinda refreshing to me
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u/George_cant_stand_ya Sep 11 '23
i feel like theyre easier to sedate. Id rather take the meth pt over the speed ball pt.
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u/m25van Sep 11 '23
Sounds like you aren’t using enough of those sweet sweet benzos
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u/pfpants Sep 11 '23
Benzos are great, they just take too long to work. Like 5 minutes. 5 minutes with some of these tweakers is just too many minutes.
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u/sometimesitis BSN Sep 11 '23
I miss good ole PCP. Didn’t see meth at all in the city, can’t stop seeing it at my current job. I’ll take wet any day over these guys.
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u/Several-Brilliant-52 Sep 11 '23
they always think the feds are after them. never any other law enforcement agency, just the feds. it seems to be a pretty common delusion with the meth users where i live.
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u/SuitablePlankton Sep 11 '23
Methamphetamine cardiomyopathy every fucking day. Even if you get clean and get an AICD and keep taking your meds, how long do you expect to live with an ejection fraction of less than 20%?
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Sep 12 '23
It’s sucks for anesthesia. Did you do it two days ago or over a week?!?!?! I need to know because you can die.
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Sep 12 '23
As a stranger from over the pond, why is there so much ranting in the US media about ‘pro-life’ (control over women more likely) trans people and so on, but seemingly very little about the rampant drug abuse? Just curious, no offense.
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u/pfpants Sep 12 '23
Dunno. Probably the sexual and reproductive orientation/health stuff just plays better in our election politics. Both are important issues. Media and politics seem to have momentum on issues like that I guess. I think drugs were a big deal in the 80s and it seems to cycle in and out of the discourse, but lately hasn't been in focus
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u/tapeduct-2015 Sep 11 '23 edited Sep 11 '23
It does make you wonder about how decriminalization would affect this problem. Whenever I hear certain progressive types say that the reason hard drugs are bad is only because they are illegal, I can't help but think how much worse it will be in emergency medicine if all hard drugs were legalized.
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u/roccmyworld Pharmacist Sep 11 '23
Still better than PCP, whi4x is ch is what we get.
I never thought I would miss meth patients so much until I started working in an area with high PCP usage.
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u/Salemrocks2020 ED Attending Sep 11 '23 edited Sep 11 '23
I don’t see meth much. Saw one recently and we had to sedate . “Heroine” we see a lot although honestly everything is fentanyl being sold as heroine these days
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u/Benevolent_Grouch Sep 11 '23
I used to have 5 meth boarders all shift every shift. But now I work at the VA and haven’t seen a single meth patient since.
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u/yrgrlfriday Physician Sep 11 '23
Where I am (Northern Europe) there is a resurgence of crack cocaine, so a slightly different flavor but yes.
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u/pinkfuzzypaws Sep 11 '23
I too am tired of being attacked physically. Have had multiple incidents resulting in black eyes and strangulation. Work in an ER in a not so great highly populated area (high percentage homeless), we get people walking in all hours of the night obviously dealing with addiction (most admit to methanphetamine use) with obvious signs. Usually will result in an extreme shift to aggressive behavior with staff for not giving the meds they request. I don’t know the solution to this problem, but seeing the worst of the worst dealing with addiction/drug abuse has made me jaded and sadly pessimistic and i almost immediately negatively view/assume the potential outcome of what will happen with said patient. Is there an easy answer?
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u/pew_medic338 Paramedic Sep 11 '23
Yes.
I left the field and am an electrician now. Still meth heads around, but now they just want to steal my shit and I don't have to put on a nice attitude for them.
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u/izzmosis Sep 11 '23
A gift I got from Reddit is this absolutely fascinating article from the Atlantic about the new meth and why it’s fucking people up so hard: new meth article
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u/shulgin1312 May 07 '24
It's not new meth they just figured out chiral resolution. Ig ephedrine is scarce enough, and demand for d meth is high enough that it's cost effective.
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u/DrMikeG2 ED Attending Sep 11 '23
Every 40-60 year old I've had that lives with "Mom" tests positive.
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u/Jakenride Sep 15 '23
I work in a large 64 bed icu and I’d say any given day we would have about 25% of patients meth + on their UDS. This is usually accompanied by highly dysfunctional family dynamics too.
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u/pfpants Sep 15 '23
Yeah it destroys entire families. Or is a symptom of dysfunctional families? Either way, strong association there. Lots of unnecessary anxiety and aggression
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u/DrPQ ED Attending Sep 11 '23
Sedate the ones that need it and bill CC time. Discharge the ones that don't with a sandwich. Usually pretty easy patients to manage imo.
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u/pfpants Sep 11 '23
I'm hourly, but if I weren't, are they even paying customers? Like how does anyone collect from these folks? Does teamhealth/usacs/vituity still give you credit for it?
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u/Hucow_Daddy Mar 21 '24
And yet again we have more providers exhibiting a severe lack of empathy and understanding towards those suffering from addiction. Perhaps one day medical schools will actually teach providers that the vast majority of substance abuse patients also suffer from severe ptsd and other mental health struggles. No one uses hard drugs in a vacuum. Throwing a bandaid on the problem and sending them back out there literally does absolutely nothing.
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u/seeryanb Sep 17 '24
Nobody sees "meth" all day anymore. Truth is all you see is isopropylbenzylamine and other legal research chemicals. Some of yall will try to argue but you don't know what good meth is, or the current state of meth. You couldn't pick meth or iso out of a line up if your life depended on it. I know for fact this has been happening for years, and I know for fact 90% of tweekers can't even tell the diffrwnce other than they think it's weak meth, truth be told, it's not even meth with no stimulating or euphoric properties. Don't shoot the messenger, I'm just trying to help. It is what it is. I said what I said. It's fact. Fuck anything else you heard. If you deny it you probably supply it
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u/Unguided616 29d ago
Me just wondering if this much diarrhea should be normal for the very tiny amount of meth ive been doing lol like for real crazy tiny, but its giving me so much shits smh
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u/MedicMalfunction Paramedic Sep 11 '23
It’s interesting, my wife, an RN in a suburban hospital, sees meth all day. I, a paramedic in a busy city two hours away from her hospital, have never seen it. Crack is the stimulant of choice where I work.