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50 Valium Since June Is Not a Lot of Drug

 

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.

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There are 69 comments.

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  1. Thatcher

    The whole situation with that guy is unbelievably bizarre.

    • #1
    • October 4, 2017 at 11:48 pm
    • 14 likes
  2. Member
    DocJay Post author

    Mike LaRoche (View Comment):
    The whole situation with that guy is unbelievably bizarre.

    Evil is bizarre. It helps to put a face on it , like Nazi or AntiFa or Islamist. We can understand the dedicated fanatic better than the sociopath. Even this guy’s brother can’t sort it out.

    • #2
    • October 4, 2017 at 11:54 pm
    • 17 likes
  3. Member

    Although I can see there isn’t in this most recent case–thank you for writing this out for us–I believe there’s something to the connection between psych meds and mass shooters. Drugs often have completely unexpected impacts on patients. The 2002 Tampa air crash is my favorite example of this. The parents sued the maker of the anti-acne drug the boy was taking, and the parents won the case.

    Mind-altering drugs of one kind or another keep showing up in bizarre nightmarish crimes where people are acting out some weird thing or another.

    I read a great book called Social on the nervous system. I’m hoping research on the nervous system will find some answers to drug reaction aberrations.

    • #3
    • October 5, 2017 at 12:19 am
    • 5 likes
  4. Member

    DocJay: 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 shouldn’t have laughed, but I did.

    • #4
    • October 5, 2017 at 12:31 am
    • 21 likes
  5. Thatcher

    Arahant (View Comment):

    DocJay: 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 shouldn’t have laughed, but I did.

    If you hadn’t picked that one out, I would have. And I don’t mind laughing.

    • #5
    • October 5, 2017 at 4:05 am
    • 8 likes
  6. Member

    DocJay: Mixing it with other central nervous system acting substances can produce problems, like lack of breathing.

    Details, Doc, details.

    • #6
    • October 5, 2017 at 5:34 am
    • 5 likes
  7. Member

    Thanks, Doc. “Diazepam” is just a word to me – I have no experience of what it actually does. Good to hear from someone with expertise.

    • #7
    • October 5, 2017 at 5:56 am
    • 2 likes
  8. Inactive
    MLH

    Mother’s Little Helper!

    • #8
    • October 5, 2017 at 5:58 am
    • 12 likes
  9. Member

    Again, too early to say what influenced this guy and we don’t have all the facts yet about his recent past or his medical history but Glenn Reynolds posted this piece from writer John Ringo that discusses some of the personal family experience he had with bizarre psychotic reactions to Cymbalta and also discusses other psychotropic drugs as it might relate to the Vegas shooter.

    Again, let me stress, I’m not advocating or pushing this line of inquiry as definitive or close to the truth by any means because no one knows at this point the specifics of the shooter’s recent history. I just find it interesting. The statement from the shooter’s Filipino girlfriend seems to suggest that she is a relatively normal and sincere person and it appears she is being very cooperative with the authorities, so hopefully more specific information will come to light about what set this guy off.

    • #9
    • October 5, 2017 at 7:19 am
    • 7 likes
  10. Member
    DocJay Post author

    Isaac Smith (View Comment):

    DocJay: Mixing it with other central nervous system acting substances can produce problems, like lack of breathing.

    Details, Doc, details.

    Adding CNS depressansants together, like booze, narcotics, and muscle relaxers is far worse than lots of just one substance. Some people stop breathing.

    • #10
    • October 5, 2017 at 7:40 am
    • 5 likes
  11. Member
    DocJay Post author

    Brian Watt (View Comment):
    Again, too early to say what influenced this guy and we don’t have all the facts yet about his recent past or his medical history but Glenn Reynolds posted this piece from writer John Ringo that discusses some of the personal family experience he had with bizarre psychotic reactions to Cymbalta and also discusses other psychotropic drugs as it might relate to the Vegas shooter.

    Again, let me stress, I’m not advocating or pushing this line of inquiry as definitive or close to the truth by any means because no one knows at this point the specifics of the shooter’s recent history. I just find it interesting. The statement from the shooter’s Filipino girlfriend seems to suggest that she is a relatively normal and sincere person and it appears she is being very cooperative with the authorities, so hopefully more specific information will come to light about what set this guy off.

    I’m sure the FBI has been looking hard. Since I’ve treated thousands with mood pills I’ve seen them go wrong too.

    This man prepared for a long long time. 33 guns since October 2016.

    • #11
    • October 5, 2017 at 7:44 am
    • 8 likes
  12. Member
    DocJay Post author

    MarciN (View Comment):
    Although I can see there isn’t in this most case–thank you for writing this out for us–I believe there’s something to the connection between psych meds and mass shooters. Drugs often have completely unexpected impacts on patients. The 2002 Tampa air crash is my favorite example of this. The parents sued the maker of the anti-acne drug the boy was taking, and the parents won the case.

    Mind-altering drugs of one kind or another keep showing up in bizarre nightmarish crimes where people are acting out some weird thing or another.

    I read a great book called Social on the nervous system. I’m hoping research on the nervous system will find some answers to drug reaction aberrations.

    Yes there’s a connection. I wonder how much are people with bad psyche issues not being medicated right OR people with bad psyche issues being medicated wrongly.

    I’ve dealt with hundreds of people off the deep end mentally. We used to institutionalize them. Now it’s pricey pharma and a prayer that they have family.

    • #12
    • October 5, 2017 at 7:48 am
    • 12 likes
  13. Member
    DocJay Post author

    MLH (View Comment):
    Mother’s Little Helper!

    5 mg yellow Valium.

    What a drag it is getting old. Life’s just much to hard today, I hear every mother say…..

    • #13
    • October 5, 2017 at 7:50 am
    • 13 likes
  14. Member

    DocJay (View Comment):
    This man prepared for a long long time. 33 guns since October 2016.

    It sounds as if he were very methodical and not just “going off” from a bad drug reaction. I have seen other posts that imply he was a Democrat (ex-IRS? No, couldn’t be!) who may have been upset about Trump’s victory, but don’t know the veracity of their sources. Still, this is not something that started when he got a prescription in June.

    • #14
    • October 5, 2017 at 7:50 am
    • 7 likes
  15. Member

    Arahant (View Comment):

    DocJay (View Comment):
    This man prepared for a long long time. 33 guns since October 2016.

    It sounds as if he were very methodical and not just “going off” from a bad drug reaction. I have seen other posts that imply he was a Democrat (ex-IRS? No, couldn’t be!) who may have been upset about Trump’s victory, but don’t know the veracity of their sources. Still, this is not something that started when he got a prescription in June.

    That’s true. And we don’t even know since he was not being supervised–that is, no one was seeing that he took prescribed medications.

    However, psych meds can come back and bite the patient later, even if they haven’t taken them for a while. That much we do know.

    We need researchers working on this aspect of human behavior.

    • #15
    • October 5, 2017 at 9:01 am
    • 4 likes
  16. Member

    I tried to write this out last night, but I couldn’t frame it coherently. I’m going to try again.

    The reason the drug companies and others push off this issue of the psych meds as a cause in the mass shooter crimes is because there is no curve.

    In other words, there’s a cluster of events at one extreme end of the continuum of side effects for psych meds and then no similar but less dramatic events on that continuum. These then look like statistical outliers to scientists, and they are not worth studying.

    If I were king of the country, I would pour a lot of resources and money into research on this group of outliers.

    :)

    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon it about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    • #16
    • October 5, 2017 at 9:09 am
    • 7 likes
  17. Member

    MarciN (View Comment):

    Arahant (View Comment):

    DocJay (View Comment):
    This man prepared for a long long time. 33 guns since October 2016.

    It sounds as if he were very methodical and not just “going off” from a bad drug reaction. I have seen other posts that imply he was a Democrat (ex-IRS? No, couldn’t be!) who may have been upset about Trump’s victory, but don’t know the veracity of their sources. Still, this is not something that started when he got a prescription in June.

    That’s true. And we don’t even know since he was not being supervised–that is, someone seeing that he took certain medications–what he took or when.

    However, psych meds can come back and bite the patient later, even if they haven’t taken them for a while. That much we do know.

    We need researchers working on this aspect of human behavior.

    Well, longer term obsessive/compulsive psychotic behavior isn’t that unusual and may not just be exhibited in an instant ‘snap’ of hyper rampage. If you read the article I referenced, the man’s wife was stockpiling containers of bleach to presumably carry out the killings she had planned to commit for quite some time.

    • #17
    • October 5, 2017 at 9:11 am
    • 5 likes
  18. Member

    The other thing I’d study, if I could, is desensitization (or as the scientists call it, neuroadaptation). It seems to me, just from walking through rooms in which my family members and their friends are watching movies or television shows or playing video games that these AK-47 spraying bullets at enemies happens a lot. I remember reading years ago an essay by a former military guy who was concerned about the level of violence kids were being exposed to because he said the military had used similar materials for training purposes, and they found over time, that people became desensitized to them. A lot of people who watch a lot of the stuff in these movies are living in a war zone in their heads. It cannot be a complete coincidence that I see in television shows and movies so many scenes that look like what this Las Vegas shooter just did. These scenes are so common in the media that the general public thinks that AK-47s are in every gun owner’s home. The NRA knows that’s not true, but if I didn’t know anything about guns (and I don’t), I’d think of these scenes in the movies when someone brought up gun control.

    I just read an interesting book a month ago (it’s not out yet) about how to work with your brain to help you achieve more. There was one section on something the author called “myelination.” The author talked about how the brain forms habits–the more you repeat something, the more myelin layers form around the axons. The more layers, the more easily and faster the brain can repeat the action or thought sequence. So there are changes in the physical structures of the brain that we cause to happen by our activities.

    So what if there is a toxic combination of elements that are causing an infinitesimal number of human beings to behave in ways that I see in movies and nightmares that is heightened by psych meds or activated by psych meds somehow. And last, what if the psych meds can cause a “bad spot” to develop–a term I have heard the computer IT guys use who have fixed my computers over the years–on the human hard drive. LSD was just such a drug. The effects could come back long after the person had had it, an effect that was much worse if the person did not know he or she had been given it in the first place.

    The mass shooters are black swan events, I think. We need to look at them differently than we have been.

    • #18
    • October 5, 2017 at 9:50 am
    • 8 likes
  19. Contributor

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    • #19
    • October 5, 2017 at 11:18 am
    • 14 likes
  20. Member

    James Lileks (View Comment):

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    Oh. Good to know. I did not know that. :) Thank you. :)

    • #20
    • October 5, 2017 at 11:45 am
    • 1 like
  21. Member

    Isaac Smith (View Comment):

    DocJay: Mixing it with other central nervous system acting substances can produce problems, like lack of breathing.

    Details, Doc, details.

    There, you find the Devil ?

    • #21
    • October 5, 2017 at 11:54 am
    • 4 likes
  22. Member

    James Lileks (View Comment):

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    Xenu is watching you, James and he’s not happy.

    • #22
    • October 5, 2017 at 11:58 am
    • 11 likes
  23. Member
    DocJay Post author

    Brian Watt (View Comment):

    James Lileks (View Comment):

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    Xenu is watching you, James and he’s not happy.

    Lileks thetan levels are off the charts. I felt them once and it it was glorious.

    • #23
    • October 5, 2017 at 12:08 pm
    • 10 likes
  24. Member

    DocJay:Headlines abound about the psyche pills. 50 Diazepam, aka Valium, at the highest end strength of 10 mg was picked up by Mr Evil in June. Unless further evidence comes out 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

    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.
    My mother had that same reaction when in a nursing home. I asked that she not be given that again. The doctor over ruled my request and she had the same reaction. I spoke to him and he said since I was not a doctor he knew better than I . I then asked him if he could write a script with two broken arms. He got the hint but it took a stare down first.BTW he was a young buck.

    • #24
    • October 5, 2017 at 12:55 pm
    • 11 likes
  25. Member

    James Lileks (View Comment):

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    There’s a chicken and the egg thing with psych meds and shootings. Yeah lots of the shooters are on psych meds. Because a lot of them are crazy. With nearly half of the US population taking some form of psychotropic drug, why are we surprised when the most disturbed among us are on them?

    • #25
    • October 5, 2017 at 1:11 pm
    • 12 likes
  26. Member

    @docjay, can you use diazepam to commit suicide? Though the Sheriff said today that he thinks the guy planned to escape, if suicide was his fall-back position, there are plenty of suicides who decide to double-up on methods, to ensure success. I responded a couple of weeks ago to a suicide in which the subject took pills and then, when the police showed up, shot himself.

    And/or he just planned to steady his nerves, or make sure he slept well the night before his big battle, or whatever the hell he had in his wormy mind…?

    • #26
    • October 5, 2017 at 1:39 pm
    • 4 likes
  27. Member
    DocJay Post author

    Kozak (View Comment):

    James Lileks (View Comment):

    MarciN (View Comment):
    PS: Don’t everyone yell at me at the same time because I don’t know much about the people who run this organization and website, but I stumbled upon about ten years ago, and it peaked my interest in this subject. Here is the link for what’s it is worth or not worth. :)

    I’m not a fanatic about this. I just wish we would look at it with a fresh pair of eyes.

    I’ve been interested in the link between those drugs and mass shootings for a while now; I think there’s something there. As for the people who run that organization and website, they’re Scientologists. Doesn’t mean they’re wrong about a link, but I wouldn’t trust anything they say.

    There’s a chicken and the egg thing with psych meds and shootings. Yeah lots of the shooters are on psych meds. Because a lot of them are crazy. With nearly half of the US population taking some form of psychotropic drug, why are we surprised when the most disturbed among us are on them?

    I’m never surprised but then again, we see boatloads of psychiatric folks.

    • #27
    • October 5, 2017 at 1:49 pm
    • 3 likes
  28. Member
    DocJay Post author

    Kate Braestrup (View Comment):
    @docjay, can you use diazepam to commit suicide? Though the Sheriff said today that he thinks the guy planned to escape, if suicide was his fall-back position, there are plenty of suicides who decide to double-up on methods, to ensure success. I responded a couple of weeks ago to a suicide in which the subject took pills and then, when the police showed up, shot himself.

    And/or he just planned to steady his nerves, or make sure he slept well the night before his big battle, or whatever the hell he had in his wormy mind…?

    20-50 pills and a quart of vodka would do it.

    Tough scene to respond to. God bless you dear.

    I doubt we will find much on this shooter’s tox screen or autopsy though. We shall see.

    • #28
    • October 5, 2017 at 2:52 pm
    • 1 like
  29. Inactive

    The mention of drugs – some citing “studies” is for one purpose only: to lay the groundwork for finding out from electronic medical record databases who is on any psychotropic drug and erasing their Second Amendment rights. They would become de jure dangerous. Recall that the failed Toomey Manchin bill specifically exempted NICS from HIPAA privacy protections. This will be the next big push, since probably half the population has at some time been prescribed some psychoactive drug. Think Bendaryl, which has sedative properties. Ask your local police friends how many of their colleagues would have to be disarmed under this regimen.

    • #29
    • October 5, 2017 at 2:58 pm
    • 9 likes
  30. Member

    DocJay (View Comment):

    Kate Braestrup (View Comment):
    @docjay, can you use diazepam to commit suicide? Though the Sheriff said today that he thinks the guy planned to escape, if suicide was his fall-back position, there are plenty of suicides who decide to double-up on methods, to ensure success. I responded a couple of weeks ago to a suicide in which the subject took pills and then, when the police showed up, shot himself.

    And/or he just planned to steady his nerves, or make sure he slept well the night before his big battle, or whatever the hell he had in his wormy mind…?

    20-50 pills and a quart of vodka would do it.

    Tough scene to respond to. God bless you dear.

    I doubt we will find much on this shooter’s tox screen or autopsy though. We shall see.

    Much tougher for the LEO than for me. And of course, it’s Maine, so everyone knows everyone…

    • #30
    • October 5, 2017 at 3:39 pm
    • 1 like
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