What Kids are Doing to Get High: Part 3

In this series, we review several of the most popular substances being used specifically by teens today because they are easily accessible. Keep in mind that the availability of a few of the substances that will be mentioned varies based on state law. However, regardless of where you live or work, you should be aware of what kids are doing these days to get high.

In researching this series of articles, I found several other options for getting high that don’t appear to be as popular as inhalants, dextromethorphan and others, but do warrant mentioning. These include:

Smoking Nutmeg: While cinnamon and oregano have been mentioned occasionally, it seem nutmeg is the spice that is most popular among adolescents for developing a euphoric state. The Utah Poison Control Center reports nutmeg is making a comeback and can be very dangerous. While the official reports of just what nutmeg can do—other than creating euphoria—aren’t plentiful, the problems the Utah Poison Control Center are consistently seeing include vomiting, seizures, an alteration in blood pressure, and heart rate with dysrhythmias.

Salvia: Salvia divinorum is a member of the mint family and originates in Mexico. It has been transported across the U.S. border and has been successfully cultivated in the States, especially in humid semitropical climates. Also called Maria Pastora, Magic Mint or Sally-D, this drug can be chewed, smoked or vaporized, and acts as a hallucinogenic similar to LSD. The effects of the drug include perceptions of bright lights, vivid distortion of movement, paranoia, uncontrollable laughter and a condition called synesthesia, which is an effect that causes abusers’ senses to become confused. Users may describe smelling colors or tasting sounds.¹

While this drug is legal to purchase in the United States and there is no age limit, the Drug Enforcement Agency considers it a “drug of concern.”¹

In order to avoid confrontation and possible harm to you and your partner, it is best to first offer verbal reassurance to the person whom you suspect might be under the influence of drugs and/or alcohol. Moods and perceptions are highly altered and can change with little warning. The sooner you can develop a good rapport with the patient, the better. Using a calm voice, avoiding bright lights or strobes, and using open body language will go a long way in defusing the situation when someone is sensitive to verbal and auditory stimulation. Standing above someone while having your arms crossed is universally regarded as confrontational. Whenever possible try to remain at eye level, and keep your arms and hands where the patient can see them.

When considering interventions, it is important to weigh the risks versus benefits. While oxygen is one of the first things we think of when we begin treating any patient, applying even a nasal cannula to someone who is paranoid may lead to a confrontation, as the patient may fear you may be trying to “gas them.” Attaching a cardiac monitor is standard intervention and performing a 12-lead EKG can be helpful in ruling out dangerous rhythms. An IV may be beneficial, especially if the patient is unstable and you anticipate needing access during transport. If the patient is hyperthermic, try to cool them down with cool washcloths or by turning on the air conditioner during transport. Pilot programs are being evaluated on the success rate of EMTs giving intranasal Narcan to reverse the effects of a narcotic overdose.² Narcan should be considered, especially when you are unsure of what was taken or if the patient is unresponsive, but you must weigh the benefits versus risks. Factors to consider before administering Narcan are if your patient is maintaining their own airway and ventilatory status, and if the patient has a history of long-term narcotic dependence. In patients with chronic narcotic usage, administration of Narcan can produce symptoms of withdrawal within minutes and last for up to two hours.³ It is advised if you do have a patient who is known to be chronically narcotic dependent to start with a small dose of Narcan (0.4 mg) to restore their respiratory status while reducing the potential of inducing withdrawal symptoms with a complete reversal.⁴ Keep in mind that Narcan takes 2–3 minutes to begin taking effect no matter which route you choose to administer.

Depending on the severity of the condition of the patient and your agency’s protocols, considering a sedative or hypnotic such as Haldol may be beneficial for transport; however, even if you have standing protocols for such medications, it would be best if medical control was contacted since the effects of mixing such medications with some of these substances is unknown. Discussing with medical control the patient’s current condition, suspected substances and transport time are key factors in deciding what is best for both the patient and the crew responsible for transport.

References

1. Salvia Divinorum Drug Fact Sheet. U.S. Drug Enforcement Agency, www.dea.gov.
2. Lopez T. Study: New York EMTs Giving Intranasal Narcan Doses. EMS World, www.emsworld.com/10782632.
3. Narcan. Food and Drug Administration Fact Sheet, www.drugs.com.
4. Stephens E. Opioid Toxicity Treatment and Management. Medscape, https://emedicine.medscape.com/article/815784-treatment?.

Janet Taylor has been a nurse for over 17 years. She began her career working on a medical-surgical unit and floating to various other departments, gaining knowledge and experience along the way. After working for 7 years in the ICU, obstetrics, outpatient and ER,  Janet began working as a flight nurse for Mercy Life Line in 2004 and helping in EMS education as an Instructor for all levels of classes including basic, advanced and critical care.

Janet serves as the site coordinator for International Trauma Life Support at Citizens Memorial Hospital and also serves as support staff as a Pediatric Advanced Life Support Instructor. She completed her Bachelors Degree in Science and Nursing in May of 2013. Visit her website at www.emsteacher.com.