Sedatives and Opioids

· Sedative-Hypnotics (Benzodiazepines) and Barbiturates

o Often co-ingestion with alcohol.

o S/S: Central nervous system and respiratory depression, slurred speech, incoordination, drowsiness.

o TX: Assist breathing, Flumazenil (Romazicon) competes with benzodiazepines at the receptor sites but can induce seizures so consider the benefit versus the risk.

· Gamma-hydroxybutyrate (GHB, “date-rape” drug)

o Odorless with salty taste so typically added to alcoholic beverages.

o S/S: Drowsiness, confusion, and amnesia last 3-6 hours.

· Rohypnol (flunitrazepam) Benzodiazepine

o S/S: drowsiness, amnesia, blackout, impaired motor coordination, bradycardia.

· Opiates (Opioids, Narcotics)

o S/S: Central nervous system and respiratory depression, miosis, pulmonary edema, apnea, coma.

o 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.

o Heroin withdrawal causes restlessness, insomnia, vomiting, diarrhea, abdominal pain. TX: Methadone, buprenorphine, or naltrexone.

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