Headlines abound about the psych pills taken by the Las Vegas killer. Fifty Diazepam, aka Valium, at the highest end strength of 10 mg was picked up by Mr. Evil in June. Unless further evidence comes out that there weren’t refills, but that’s a big unknown.
Diazepam is an older person’s request. Younger people ask for Xanax. In older times I might write for bigger numbers and higher doses but I’m far, far more cautious in my old age, using lower doses and fewer pills. There’s a war on pills, and with good reason; they cause bad problems.
Diazepam has a long half-life and plenty of drug interactions. Mixing it with other central nervous system acting substances can produce problems, like lack of breathing. It is a benzodiazepine used commonly for anxiety, often with 2-5 mg doing the trick. Sometimes I use it for insomnia but there’s better meds in its class and even better outside its class. I use it for veritigo and sometimes muscle spasms.
I have plenty of experience with this drug, even taking it preoperatively twice for eye surgeries. No wonder I don’t perform eye surgeries anymore. (OK, it was for LASIK I had done. It was a mellow jello sort of feeling.)
Once there was a drug addict paramedic who had a cocaine OD and kept calling me Doogie. I hit him with IV diazepam in 10 mg increments, ending up with nearly 400 mg, because I just kept dosing this obnoxious jerk every time he called me Doogie. I did have the luxury of an ICU setting.
I remember someone getting diazepam in the hospital when I was an intern, and having a paradoxical reaction of increased agitation. We gave her more diazepam and she got worse. An older attending doc figured it out fast. Don’t ever knock experience.
I’ve seen gambling addicts, often doing cocaine, get diazepam from casino sources. Pills are harder to get these days but not that hard. Higher money players can often find someone willing to make a buck.
Heavy use of diazepam would be 30 mg a day or more but a psychological dependency could exist at 5-10 mg a day. Yes, I’ve seen this drug, combined with multiple other medications, cause death.
So Mr. Evil got 50 pills in June. Not so uncommon for a 60-something gambling addict. Speaking of which, an addict with bad losses would not do something like this horror over losses if he had money left. Where there’s money, there’s hope in that twisted world. Pro gamblers are usually jerks, annoying to interact with.
It would be extraordinary rare for this drug to change the man. It’s possible its use made horrible ideas seem OK to him. Lots of psych meds can make the abhorrent somehow tolerable. It is almost certain he had experience with this medication prior to this.
Like many I’m interested to find out if this guy was bat-guano crazy or had a motive and performed evil in some greater name. We shall find out soon, I expect. The worst I see the drug doing in this case is lessening whatever internal revulsion he had regarding his thoughts. I’m not sure this man had a conscience though, damn him.Published in