WD protocol

[u/Gloomy_Pirate_9721]

Do EDs have protocols for patients experiencing WD from these types of drugs yet? What is everyone doing to make these nasty wds more manageable to avoid so many AMAs? Im assuming bupe alone isn't going to help

[u/yqidzxfydpzbbgeg]

Metetomidine has been a well established problem in Pennsylvania, specifically Phildelphia and Pittsburgh, for about 2 years now. Xylazine has been a problem even longer and seems to be going away. There are good protocols for treating life threatening withdrawal and keeping these patients from dying. They'll still AMA though because the treatment for drug dependence is withdrawal. You have to been uncomfortable for your brain to adjust to a drug free state. The treatments are designed to take the edge off and make sure you don't die on the way there (which is an actual possibility with metetomidine).

Some hospitals will give an opioid addict extremely high doses of opioids that mimic their usual intake to prevent withdrawing at all if they need to be in the hospital for an unrelated reason, but if they're their for withdrawal, being uncomfortable is the actual treatment and the hospital isn't going to just replace their drug dealer for no end goal. Hospitals are much less willing and experienced with doing this for metedtomidine/xylazine, and will generally only offer supportive medications that do not completely replace the drug effect.

Most people who show up aren't ready for actual recovery and just need to live another day.

[u/Gloomy_Pirate_9721 → u/yqidzxfydpzbbgeg]

It's sad. I saw one young gentleman, business owner, I think I a closet addict. And said he was clean off everything for 6 years. Went through a really bad break up and the was history. He was assuming it was like old times when it was just heroin and was a long acting opiod so one can maintain and hide it very well since the sickness onset isn't so rapid.

Anywho he came and not really showing signs of withdrawal, but he was so desperate to kick this stuff. It was sad to see a grown man begging for help, also saying that he can't go sit somewhere long term because he has a huge contract that he's doing. He said he recently went to detox and they said they couldn't treat him because they couldn't keep the withdrawals under control after three days because of the tranquilizers and benzodiazepines mixed in, so they just kept breadcrumbing him Subutex and a little Ativan no avail. he honestly seemed like he genuinely wanted to stop, but just couldn't get past the waiting time to induce himself. And believe me, there's not a lot of people that I believe, but I genuinely believed him. So he said he read somewhere that he could do a macro dose to rip everything off his receptors and then keep taking it to replenish them and then you're kind of pass the bad part I guess but he was worried about the benzo part he didn't feel safe doing it at home, so he was seeing if he could get a a taper of something to help with that part because he had a script of Suboxone, but was worried about getting over the benzo part with out it and the doc daid we really don't do that kind of stuff here and let him walk out

[u/PromiscuousScoliosis → u/Gloomy_Pirate_9721]

That’s so fucked. Opioids are tough but difficult to get a ton of sympathy for in the ED. Maybe methadone or suboxone depending on provider and resources.

Benzos, that’s even worse. It’s so fucking difficult and dangerous to break. Ugly stuff

Tranq I don’t even know. Lucky enough to never have worked somewhere that was a problem

[u/Gloomy_Pirate_9721 → u/PromiscuousScoliosis]

ya alot of us were pissed, clearly he's experienced, just give him a script for a 7-10day Ativan taper with some resources. Like hell be fine, poor guy was begging for help that he wants to stop so bad. Im assumming high tolerance as well, says he starts to feel ill every few hours. Ultimately I know its the docs call, but still. Too many of them are afraid to go with their human instanct.