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  1. xanadu

    xanadu Contributor Contributor

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    Opioid Overdose / Mixing Pills

    Discussion in 'Research' started by xanadu, Aug 31, 2019.

    Hey all, been away working on my current project. I'm at the climax and want to make sure I'm portraying the events accurately. Here's the situation:

    1. My main character is a pill addict.
    2. In the climax scene, she takes a couple pills for a headache while trying to finish a ton of work. I don't specify what the pills are, but they're basically oxy/vicodin level.
    3. The headache isn't going away, she's getting close to finishing the work, but finishing the work means the job is over and the income with it, so she begins to panic. That sets her into an anxiety spiral.
    4. Without thinking, she takes some anxiety meds (again unspecified, but the xanax/valium level).

    The idea is that she starts puking, falls out of her chair, and loses consciousness. She's at home and her parents find her and get her to a hospital and the plot goes from there, but my biggest concern is the timeline. I've been able to get good info about the symptoms and effects of overdose, but unable to find information on how quickly the effects of mixing these pills would hit and whether two of each pill would be enough to be a serious threat (seems like it would be).

    Obviously things like this are going to depend on the person, but are there any general guidelines that would apply here? She's 26, fairly average young woman with no specified medical conditions.

    Any advice would be greatly appreciated. Thanks!
     
  2. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    I can't say about mixing it with anxiety meds, but anyone I've seen overdose on opioids generally just slides into a super chill state, and keeps going. They don't want to be disturbed, don't really respond to anything, breathing gets super shallow, laboured and raspy, and they take on a grey complexion and their lips turn bluish. No real struggle, no sudden collapse or vomiting. If you weren't around those kinds of of drugs you'd probably assume they weren't feeling well and let them sleep it off. How much they need to OD depends on the person. Their size, resistance, use history, how much they've eaten, and other substances in their body. If someone gets to the point where they're gurgling, they've probably got about 5-20 minutes left without intervention. The best thing to do if you find them in that state is to give them an opioid blocker. The only one I have experience with is Naloxone. It usually comes in a kit of two needles with around 15 cc each. Inject one needle into a muscle and wait 5 minutes, if nothing happens, jab them with the other and make sure they get proper medical attention. When they come around, they'll usually be seriously disoriented and frequently violent. Naloxone is a broad band opioid blocker, so it will sober a person up, but doesn't flush the drug from their system, so when the Naloxone wears off in around 20 minutes, they still may not make it if they haven't gotten proper treatment.

    Question I do have, though, is if she's fairly young with no medical conditions, why would she have high level pain killers and anti-anxiety meds floating around? I'm not sure where the story's taking place, but most of the doctors I know keep a pretty tight reign on those types of drugs.
     
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  3. Cdn Writer

    Cdn Writer Contributor Contributor

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    I worked for 25 years with people who had developmental disabilities and took oral medications. We were told that pills taken orally took 30 minutes to get into the individual's body. It came up in a discussion about whether or not an individual who took pills and then vomitted an hour later would still have drugs in their body. I believe the answer was "yes" because it was after 30 mins. Take it with a grain of salt because it does depend on weight, whether there's food in the stomach (slows digestion I guess?), the dose, and whether there is already a therapeutic level of medication in the individual's system or not.
     
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  4. matwoolf

    matwoolf Banned Contributor

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    Lips turned blue, with a greyish complexion

    'He doesn't look right, he doesn't sound right...'

    'Probably he will sleep it off..huh. Let's just go to bed.'

    'No, our little prick has taken, and overdosed, on heroin. If we don't call the ambulance he will be dead in half an hour.'

    ...

    Am I wrong?
     
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  5. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    'I mean, we could call an ambulance, but then people will know he does heroin, and I don't know if that's something we can handle right now. Besides, you can't say I didn't look worse than that the one time I ate those corner store burritos. Look, I know you're worried, so why don't you go get the wheel barrow, we can take him down the road and dump him on the Pulaski kids front door, we can call a cab and then it'll be in gods hands. Atta girl. And this way we don't have to worry about a bunch of cops crawling all over the house and judging the way we live, especially with the state of the meth lab right now. Just don't even get me started.'
     
  6. matwoolf

    matwoolf Banned Contributor

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    Brilliant write.
     
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  7. xanadu

    xanadu Contributor Contributor

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    Thanks everyone. I think, based on the responses, I know how I want the scene to go--it'll change a little but I know how I can use that for some character development.

    She very definitely did not get them from a doctor :). This is taking place in suburban Philadelphia, Pennsylvania in the midst of the opioid epidemic. A very brief explanation is that in the 90s and 00s big pharma pushed the opioids *hard* and doctors vastly overprescribed them, flooding the streets. Eventually the regulations tightened but not until millions and millions of people were hooked on them. The result was that drugs like heroin became cheaper and more available to fill the gap, but also that the unused pharmaceuticals were all over the black market (and in parents' medicine cabinets), especially in suburban and middle- to lower-class neighborhoods. Between high healthcare costs, bored kids, stressed young adults... getting pills on the street or stealing from parents and self-medicating was (is) a lot cheaper than going to a doctor or a therapist. She gets her pills from the known hookup in the area.

    I'll have her quietly slip into that super chill state until her stepdad comes up (after falling asleep in front of the TV) and finds her at about 2 in the morning with her light still on. My original plan was for her mother to wake up from the noise when she hits the floor, but having her stepdad find her is actually a lot better since he's the quasi-antagonist and this will turn their conflict with each other on its head.

    Appreciate the responses, it really helped!
     
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  8. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    If you're looking for something a little more showy, era appropriate, and you don't have to worry about her getting them legally, Quaaludes are easy to overdose on and one of the symptoms of overdose is convulsions. Though I have no idea how to treat that kind of OD. Also, as a drug, it's just way more preferable to opiates.
     
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  9. xanadu

    xanadu Contributor Contributor

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    Good to know. I'll play around with it a bit.

    Appreciate the input!
     
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  10. Rzero

    Rzero Reluctant voice of his generation Contributor

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    Sorry. You're probably already on top of this, but it's worth mentioning. Remember to have characters call them "opiates" if it takes place in the 90's (probably the 00's too.) "Opioids" wasn't a word people used then, at least not that I ever knew of, and even then, a character would only use terminology like that when speaking of the entire category of opium derivatives. Usually they would specifically reference codeine (or later, oxy,) morphine or any of a hundred slang terms for heroine, and on rare occasion, actual opium.
     
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  11. xanadu

    xanadu Contributor Contributor

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    Good call. The story takes place in summer of 2018, but that’s still important for characters who were around then and still might use those terms.
     
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  12. newjerseyrunner

    newjerseyrunner Contributor Contributor

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    2 pills of each is not going to do much to an addict. If YOU took two of each pills, it'd make you very sick, but an addict will have tolerance for that. I take xanax for anxiety, and 2 will just make you tired. It also doesn't really affect oxy much, which I've also taken from time to time for injuries. My wife has chronic pain from an injury, and on rainy days, she sometimes takes up to 120mg of oxy in a day (4 of the most powerful pills.) I've never seen her take two at once, but I've seen her take 1.5. Make her stupid and sluggish, but still very functional.

    Puking and falling sounds about right, too much of the oxy will give you terrible vertigo, but passing out doesn't seem right. Oxy gives you energy (a lot of it.) I think if your character was to pass out, it'd actually happen on the way down, not up. Extra dopamine wouldn't knock you out, but a lack of it would. Xanax also takes a lot to knock someone out. I went through a bad part of my life and took an entire bottle of it to end it. I wasn't totally aware after about ten minutes, but I was conscious for a good half hour. I'm not even sure I even lost consciousness until my heart stopped. Once they got me breathing again though, I didn't wake up for a day or so.

    Drug addicts also tend not to have the money for the powerful pills. I would think the most common form of street oxy is 5mg or 10mg, but they go all the way up to 30. Even prescriptions don't usually go that high though, 15 is a very high dose and 30 is reserved for situations like my wife.
     
  13. Shenanigator

    Shenanigator Has the Vocabulary of a Well-Educated Sailor. Contributor

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    The cue to call the ambulance for the last person I know who OD'ed on painkillers was, in addition to the chill state, his words started slurring. That's when people started freaking out and asking how many he took and went on a mad search for the prescription bottle while someone called 911.

    I don't remember which painkiller he was on, but fortunately he made it.
     
  14. Mary Elise

    Mary Elise Senior Member

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    Opiates are a respiratory depressant that slows the autonomic nerves responsible for the diaphragm and chest wall. Basically one dies of asphyxiation with no sense of panic.

    I'd love to know that too. A friend's son got access to some prescription pain meds but quickly moved to street heroin because it's so much easier to get.

    You wouldn't believe the crap I go through every single freaking month.
     
  15. Shenanigator

    Shenanigator Has the Vocabulary of a Well-Educated Sailor. Contributor

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    Dental work, broken bone, or minor surgery for the pain killer question. Several addicts I've known got started because of one of those three, and it happened extremely quickly.

    As for the anxiety med, Adderall is used off-label by a lot of young women as a diet pill. There are entire communities on Reddit devoted to the Adderall Diet.

    Some college students also use Adderall as a "study drug" while cramming for exams, based on some of their peers' claims of it improving test scores by improving focus.

    Neither of those is recommended, though. Adderall is pretty damn addictive.
     
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  16. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    I honestly have no idea why Adderall is a perfectly legitimate drug while Meth is so vilified when they're nearly identical.
     
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  17. Mary Elise

    Mary Elise Senior Member

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    One is used to force young males to be docile and is a favorite of teachers. The other. ...
     
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  18. Shenanigator

    Shenanigator Has the Vocabulary of a Well-Educated Sailor. Contributor

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    I never thought about it before, but I wonder if the fact that Meth is snorted while Adderall is swallowed in tablet form has anything to do with it. :rolleyes: Because, you know...tablets are ever so much less addictive than something one snorts (!) :rolleyes:
     
  19. Mary Elise

    Mary Elise Senior Member

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    There you go applying science (chemistry) to a social hysteria. [​IMG]
     
  20. deadrats

    deadrats Contributor Contributor

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    These strong pain killers don't work for headaches and can actually cause really bad headaches. Vicodin, for sure, does this. They're not just stronger versions of Tylenol. They work quite differently. And anyone who takes these kind of pills probably knows or has experienced that. Also, I don't think you would get much work done on these pills. It would be more believable if she was sort of craving these pills while trying to get work done, but then gives into the urge to take some. The headache thing just doesn't work with these level of painkillers.

    Some anxiety medicine can take a good hour to kick in. Ativan would be an exception. That one is pretty quick. They make some of these meds in forms that dissolve under your tongue to act faster.

    I think the main problem is that you wouldn't really take high doses of these pills if you had to get anything done. And an addict would know that. But the headache thing is sort of a red flag if you want this scene to be realistic.
     
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  21. KiraAnn

    KiraAnn Active Member

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    Methamphetimine is a prescription drug and comes as pills or time released capsules. It is considered more addictive than other amphetamines.

    Street meth is usually not pure and contains god knows what.
     
  22. Mary Elise

    Mary Elise Senior Member

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    According to PubChem there is no difference in the structure of the molecule.

    The street version also contains contaminants that may or may not have biochemical impacts but the primary molecule that impacts the CNS is identical.

    [​IMG]
     
  23. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    Crystal meth is actually really hard to cut. I'm not saying there can't be impurities, but small amounts of almost anything will keep crystals from forming during manufacture and very obviously change its properties when partaking. It's also really easy to clean.
     
  24. KiraAnn

    KiraAnn Active Member

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    I’ll have to take your word as I have zero direct knowledge. :D
     
  25. The Dapper Hooligan

    The Dapper Hooligan (V) ( ;,,;) (v) Contributor

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    It is an experience that is not for everyone!
     

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