In the second half of a two-part column, Sullivan Smith, MD, Medical Director of the Cookeville (Tennessee) Regional Medical Center, talks to health care professionals about how to treat “bath salts” patients, and what you can do to help address the growing problem of abuse.
Because bath salts are relatively new in the United States, many health care professionals are grappling with how to treat these acutely intoxicated patients.
There are a few basic principles. First, provide for your own safety. These patients can become explosively violent, phenomenally strong and do not feel pain. The potential for serious bodily injury to you or your staff is very real. Always deal with these patients in groups and in the calmest and quietest environment possible.
Treatment consists of intravenous fluids and sedation. It will often take very large amounts of both in order to stabilize these patients. IV fluid volumes on the order of those used to treat sepsis are a good idea. That’s a lot of fluid, but these patients are usually significantly volume depleted.
Even more startling is the amount of sedation required to control these patients. A benzodiazepine such as midazolam (Versed) is an excellent choice. Very large amounts are often required, to the point that many practitioners are very uncomfortable with the doses required.
On several occasions in our Center, doses of more than 100 mg of intravenous midazolam have been required in order to resuscitate and control these patients. This high-dose benzodiazepine and intravenous fluid therapy not only controls the delirium, it also corrects the high body temperatures, high blood pressures, fast heart rates and seizures. Some patients will require chemical paralysis and mechanical ventilation because of persistent violence or in order to protect their airway because of very high-dose sedation. All of these patients will require admission to an intensive care unit, sometimes for several days.
This is clearly a national problem. It is growing rapidly. It is costing our health care system significant dollars. It is killing people. These designer drugs we call bath salts and plant food are truly a health care crisis.
Currently, there are a couple of plans to address the bath salts problem. First, there is legislation in Congress to address the rapidly growing abuse of these drugs. The House bill, HR 1254 (the Synthetic Drug Control Act of 2011, sponsored by Representative Dent of Pennsylvania), passed out of the House last month and has now moved into the Senate, where the companion bill is currently stalled in the Senate Judiciary Committee.
There are also three Senate bills that have passed and are now winding their way through the House: SB 409 (the Combating Dangerous Synthetic Stimulants Act of 2011, sponsored by Senator Schumer of New York), SB 605 (the Dangerous Synthetic Drug Act of 2011, sponsored by Senator Grassley of Iowa) and SB 839 (the Combating Designer Drugs Act of 2011, sponsored by Senator Klobuchar of Minnesota).
I encourage you to contact your representative and senators and tell them to support this very important legislation.
Sullivan Smith, MD, FACEP, is Medical Director of the Cookeville (Tennessee) Regional Medical Center; the Medical Director of Putnam County EMS and Clay County EMS; Chairman of the Tennessee Emergency Medical Services Board and Lieutenant of the Cookeville Police Department SWAT.
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