Opiates (Opioids, Narcotics)
S/S: Central nervous system and respiratory depression, miosis, pulmonary edema, apnea, coma.
TX: Assist breathing, Naloxone (Narcan) IM, IM, SQ, or IN, in 0.2 mg increments to improve respiration only, repeating as needed every 20-60 minutes (short half-life) or titrate a continuous infusion.
Full and sudden awakening with 2 to 4 mgs is dangerous for everyone.
Heroin withdrawal causes restlessness, insomnia, vomiting, diarrhea, abdominal pain.
TX: Methadone, buprenorphine, or naltrexone.
Sedative-Hypnotics (Benzodiazepines) and Barbiturates
Often co-ingestion with alcohol.
S/S: Central nervous system and respiratory depression, slurred speech, incoordination, drowsiness.
TX: Assist breathing, Flumazenil (Romazicon) competes with benzodiazepines at the receptor sites so can induce seizures so consider the benefit versus the risk.
Rohypnol (flunitrazepam) Benzodiazepine
S/S: drowsiness, amnesia, blackout, impaired motor coordination, bradycardia.
Gamma-hydroxybutyrate (GHB, “date-rape” drug)
Odorless with salty taste so typically added to alcoholic beverages.
S/S: Drowsiness, confusion, and amnesia last 3-6 hours.