Overdose - Methadone and Cocaine?

[inozip]

I'm doing research for a client whose daughter snorted an unknown combination of Methadone and Cocaine. At least this is what showed positive in the drug screen.

She went into respiratory arrest and ended up on a Narcon drip in the hospital for 2 days. She was labeled a possible suicide attempt and overdose.

My questions are this: Is this common to snort this combo? How much would normally be insuflatted? Would vomiting be a side effect? Why would anybody do this? She has a history of headaches and pain...

As you can guess, I don't do any drugs so I am not familiar with this at all.

Thank you for any information

[purplehaze]

Some people like to do whats called speedballing. This is taking uppers and downers at the same time, which was probably the intention at the time. It is very dangerous.

I would start looking here.
http://en.wikipedia.org/wiki/Speedball_(drug)

Speedball (drug)
From Wikipedia, the free encyclopedia
For other uses, see Speedball (disambiguation).

Speedballing (alternatively known as snowballing) is a term commonly referring to the intravenous use of heroin or morphine and cocaine together in the same needle. This is a potentially lethal concoction: the cocaine acts as a stimulant, raising the pulse, but its effects wear off more quickly than those of either heroin or morphine, which in turn slow the heart down. As a result, it is possible to experience a delayed "overdose" (technically, severe respiratory depression) when the stimulant wears off and the full effects of the morphine are felt in isolation.

The invention of the speedball is variously attributed to Harry K. Thaw circa 1900, followers of Sigmund Freud in the late 19th Century, Beatniks in the 1950s, an obscure and long-forgotten pharmacist or battlefield medic as long as 150 years ago, or American soldiers returning from the Vietnam War.

Stimulants are used clinically to combat somnolence created by large and/or rapidly increasing doses of opioid analgesics and/or potentiate the effect of the opioid, with Methylphenidate being the most commonly used. In the past, pharmaceuticals containing both cocaine and morphine or heroin were on the market, such as Trivalin, specifically the product distributed under that name up until the 1930s or shortly thereafter which contained the valerate salts of morphine, cocaine, and caffeine.

Sometimes, other combinations of stimulants and depressants are referred to as speedballs, such as the use of amphetamines in conjunction with other opiates like hydromorphone, dihydrocodeine, oxycodone and others, benzodiazepines or barbiturates. Methylphenidate and hydrocodone is known as "kiddy speedball". Vodka Red Bull is sometimes referred to as a "speedball cocktail" since it contains the alcohol depressant and the caffeine stimulant. An oral or insufflated combination of depressants or opiates and stimulants is more properly called a "set up."

Reputation Comments on this post:

well researched

[inozip]

I need an opinion... Would someone do this having NEVER done drugs before or would this activity be more typical of a drug abuser or chronic user?

The family is adamant that she never had any drugs up until this incident.

[purplehaze]

I'll go ahead and answer your other questions while I'm at it.

Originally Posted by inozip

My questions are this: Is this common to snort this combo?

Yes

Originally Posted by inozip

How much would normally be insuflatted?

Impossible to tell, your asking did she take enough to overdose, since methadone tolerance varies greatly, from 5mg to 80mg and above etc, it is impossible to tell if she took enough to kill herself or was trying to dose, because it all depends on her tolerance.

Originally Posted by inozip

Would vomiting be a side effect?

Greatly, possibly even so much she fell out and choked on her own vomit.

Originally Posted by inozip

Why would anybody do this?

Polysubstance abuse, drug abuse, who knows...

Originally Posted by inozip

She has a history of headaches and pain...

Don't we all, especially opiate abusers...

purplehaze added 1 Minutes and 38 Seconds later...

Originally Posted by inozip

I need an opinion... Would someone do this having NEVER done drugs before or would this activity be more typical of a drug abuser or chronic user?

The family is adamant that she never had any drugs up until this incident.

Unable to tell that either, but if I had my guess, if she was snorting this combo she had a history of drug abuse. Stemming from use of uppers and downers and then combinations. But like I said, you never know, someone might have offered it or etc. Always account for variables.

[inozip]

Would this combo leave one
Passed out for 2-3 hours? She was found , unresponsive, not breathing, blue, then
EMS was called.... So many questions were not answered at the time this happened and the daughter of course is denying any drug use at all and claims to have been poisened. I've actually never heard of anyone being forced to snort.... seems like this would be self inflicted...

[Coconut]

Originally Posted by inozip

Would this combo leave one
Passed out for 2-3 hours?

I would say it could do. As purplehaze has already explained, speedballing is extremely dangerous - if the cocaine wore off, the methadone (depending on dosage) could have rendered her unconscious and depressed her respiratory system, leading to hypoxia and bluing of the skin.

[purplehaze]

Absolutely, she could have actually entered a coma.

Edit:

Or died.

[drug-bot]

never heard of someone snorting methadone its usually taken orally because of is large bioavailability taken in this method. powder cocain is usually snorted althother it can be injected.
the person most likely has some history of drug use, its not common for a person with out one to use methadone and coke, even for the simple reason they'd need some sort of 'connection' to obtain these substances.

[inozip]

Just read the EMS report. Pt admitted to taking 10 Methadone and Street
Stratera. What is Stratera? Would you usually mix this with Methadone?

Report reads she was alert and talking upon arrival to the hospital. She
extubated herself in the ambulance.

Thanks for any info...

[purplehaze]

Strattera is a new nonstimulant medication that has been approved for the treatment of ADHD in children and adults.

[inozip]

Would you take it for a high?

[purplehaze]

Do you know how many mg the methadone were?

[drug-bot]

Originally Posted by inozip

Would you take it for a high?

short answer, no.
long answer, its used to treat add and adhd, its not a stimulat like ritilan or adderal so has no real recreational effects, plus the fact that it doesnt reach its full action for about 2 weeks of daily theraputic use.
it could have been used by someone seeking a 'high' from it (although most likely didnt get one), people do dumb things and sometimes eat random shit trying to get high (mostly people ignorant about drugs).

[purplehaze]

Strattera is "Atomoxetine" Please use chemical names when posting on this forum.

Usually with the treatment of adhd stimulants are used such as ritilan or adderal (amphetamine). These are considered uppers.

I personally have never heard of anyone abusing Atomoxetine.

Here is the wikilink for further info. http://en.wikipedia.org/wiki/Atomoxetine


Edit:

Potential for abuse

To date, the potential for abuse of Strattera has not been exhaustively researched. The two studies that have been performed suggest that atomoxetine has a low to moderate risk for abuse, since it has a long titration time (meaning that it may have no effect on the user unless they've been taking it regularly for days) and does not produce strong stimulating effects like most other ADHD medications (which are usually dopamine reuptake inhibitors). Monkeys will not self-administer atomoxetine at the doses tested (Gasior et al, Neuropharm 30:758, 2005; Wee & Woolverton, Drug Alcohol Depend 75:271, 2004). However, rats, pigeons and monkeys trained to distinguish cocaine or methamphetamine from saline indicate that atomoxetine produces effects indistinguishable from low doses of cocaine or methamphetamine, but not at all like high doses of cocaine (Spealman, JPET 271:53, 1995; Sasaki et al., Psychopharm 120:303, 1995). No place preference studies have been conducted with atomoxetine. It may be abused if taken in larger amounts than the daily dosage, the effects may be compared to those experienced on amphetamines that are also used for ADHD medication.

[inozip]

This is why they hired me to investigate this incident. There are just too many questions some lead to more questions, and some just don't make sense. They state this girl never used any drugs, yet she was at work, passed out for hours, then "woke up" in the ambulance , extubabed herself , then was alert and awake. But in the hospital, condition listed as sleeping, awakens to verbal, then back to sleep. They diagnosed her as a drug addict, suicidal, and depressive. Her parents and she
deny all of this *of course..... I'm just puzzled why the EMS would assume this combo unless she told them straight out... and why would the ER doc "assume" she
snorted Methadone:??? unless she really did it.

[purplehaze]

So, did she snort methadone and Atomoxetine? Or methadone and Cocaine?

[inozip]

Thats the question: Her drug screen was positive for Methadone and Cocaine, but EMS stated in their report she took
street stratera. Er physician stated in his report, polypharmolgical drug use...

[purplehaze]

Hmm, cocaine stays in the system for around 3-5 days. Usually 3, It's a mystery how nobody is sure what she took, but regardless poly would just mean she took a combination of drugs. Methadone alone could have caused it, in combination with cocaine would definitely be a mixture for disaster.

Not really sure how else i can help, if you have any more questions, please be detailed on exactly what you need to know otherwise my guess is as good as yours.

[frankz81]

i bet she is playing dumb, probably has a history and doesnt want her parents to know..
i was on pethidine,the methadone tabs,the oxy's then daily methdone pickup b4 my p's new anything...
methadone tabs are usually 10mg's each, if she had no tolerance and took 100mgs ,that would certainly result in an od.
typically around 30mgs is enough to od sum1 without a tolerance...
and i have neva heard of methadone being snorted??
also if u have no drug use issues, why would u start on methadone?? the only good thing about it is that its sedating and can cause a bit of relaxation but nothing like the highs from morphine etc etc
also why dont u find where she sourced it and speak to them for more answers

[beena]

The only person who really can tell you what happened is the girl herself of course.....whether she has (long-term) issues with drug abuse or it was a one-off/first time it is understandable that she might not want to discuss it/admit her actions.....if she took methadone with atomexetine (2 drugs that aren't really taken to "get high" as such), it may be that she is a novice drug-user with not much experience/sense who was trying to get high and that's why she took these substances as supposed to something else.....on the other hand first-time users usually tend to be more cautious in regard to what they take and how much just because it is new to them: most overdoses actually happen to experienced users who get careless thinking they know exactly what they're doing (or because they've taken a break from drug-use and then go and use the same dose they used to take even though their tolerance has decreased because of the break).

[Benga]

a thread that might be worth looking into on cocaine + opiates /opiod combinations

http://www.drugs-forum.com/forum/showthread.php?t=7957

the nature / motive behind the OP's questions ( "Is this common to snort this combo? How much would normally be insuflatted? Would vomiting be a side effect? Why would anybody do this? She has a history of headaches and pain..." ) are not crystal clear imo. Is it just a "first time" experiment gone wrong or the sign of some experience in substance use ? not much use looking for such answers on an internet forum, especially if legal implications are involved...
let's just say that such a combination, methadone and cocaine is not that common for a first experiment with psychoactives, which would probably be alcohol, medications or cannabis. methadone isn't the most common substance on the illegal market. and it also implies knowing people which would have had access to such substances, which is in this case worth looking into. the situation we're looking at here is pretty different from a "keg party" with a pile of cocaine and methadone vials and crowds cheering "chug it ! chug it !"... but then again, as stated before, ill-informed people also due stupid things / stupid situations happen, ie it could also have been a first experience...

b