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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.
Published in General
It’s closer to 20% of the population on these drugs. Maybe a tad more. And when you subtract mass killers who are motivated by political or personal grievance, the number of those who remain who are on these drugs is probably about 90% from what I’ve been able to discern. So a much larger percentage than the general population. Whether that is significant depends on what percentage of mentally ill people are on these drugs. If most are, then it may not indicate causation. If most aren’t, then it well may. Not sure of the answer to that.
But we do know that these drugs carry a risk for suicide. It’s on the warning. I have taken a benzo myself. It didn’t make me feel suicidal, but it did make me feel depressed at all but the smallest dose. I also felt that someone could have put a gun to my head and I wouldn’t have cared. Not good if you have underlying violent or suicidal tendencies.
There’s another suicide phenomenon in some cases as well: the patient has been thinking suicidal thoughts but has lacked the energy, for lack of a better word, to act on them. Suddenly the medication makes them feel better and more active. Now they can actually do the stuff they have been dreaming about.
Again, it’s not enough to give out these potent medications. We need to keep in touch daily with patients and really get to know them to get a good idea of how they are feeling and thinking.
Nevertheless, some people are good at hiding their actual feelings and intentions. Deceiving the people around them is part of the plan.
There’s no easy fix here.
But we have to figure this out because psych meds are helping millions of people to live in their community independently and productively. We would miss them.
I agree. I think these meds treat symptoms and not causes for the most part. But sometimes that’s all you can do. And it seems to work for most people. But I think most people who get these meds are never really briefed on the fact that they can backfire on you. It’s in the small print you get in the pharmacy bag.
And sometimes the facts can be stranger than what we perceive as a delusion.
My best friend’s father had a nervous breakdown in the late 70s – he was convinced the FBI was following him, listening to his telephone conversations and that the new family across the street were spying on him on the FBIs behalf.
Lots of drugs and an institutionalization later he lived for another 20 or so years as a somewhat stable alcoholic. He was just a step up from homeless but had regular contact with some of his children.
And then out of nowhere he hanged himself. After the funeral and the dust settled my best friend returned to work to find several messages from the FBI. Seems her father had missed a couple of meetings and the agent was concerned.
The last person to see him alive was an FBI agent.
To my chagrin, I didn’t even think of this wrinkle on the problem of mental illness:”Amber is six months pregnant when she assaults a female nurse and punches me in the head. She is a schizophrenic and drug addict who earns money prostituting on the street. This is her third child. She rejects any form of birth control because she wants a baby. After the state took custody of her last two children she is obsessed with having a baby, but is not equipped mentally or physically to care for one.”
But…duuuhhh. Of course.
Good Lord. What on earth are we doing?!?
I posted the following comment on Mona Charen’s thread, but it fits better here, so I’ll put here too:
There is one thing that I read that makes me think the Las Vegas shooter was truly and deeply mentally ill. According to the woman at the coffee shop he often went to:
Sleeplessness is the most common symptom of mental illness. It makes sense to me that that may have been what the doctor was treating who originally prescribed the Valium for him.
And not sleeping is one thing that a daily visit from a trained caregiver could pick up on.
I was a guardian for a friend for thirty years. She was a paranoid schizophrenic, and as part of the guardianship, I had to give her the antipsychotic every day. It was a small maintenance dose because with all of the other emotional supports we built into her life, she did pretty well for many years.
She decompensated at one point when she had had a heart attack in her sleep, and we didn’t know it. The police called me one day to say that she had thrown out of her apartment everything she owned. Ugh. But when the brain isn’t getting the oxygen it needs to function, depression often sets in, and after that, extreme irritability. I always tell people, please, start with a complete cardio workup! Back to my point:
Her doctors instructed me to watch first for sleep changes and then eating changes. Which I did. I went over every morning to visit and called her every night. I did many other things, of course, but those two things were my “wellness checks.”
So I know the psychiatrists know this about mental illness and sleep. In fact, when Cape Cod Hospital opened a psych ward for teenagers at one point, I found out that the first step in treatment was to get these kids on a normal sleep-wake schedule. They would wake up the kids in the morning to make sure they were up and active.
What I’m saying is that successful community care is possible. We just have to do it correctly and know what we are looking for.
My mom was taking Ultram and Lexapro. That is when I found out about synergtic effects of those drugs leading to seratonin syndrome.
I guess I hope he was mentally ill. But I have concerns with that, too. While I understand everybody wanting to know why, most of the search for answers starts with something like, “it wasn’t his fault. He was _______ (fill in the blank). That’s pure Freud, and purely debunked. Evil exists, period. Our culture’s attempts to hide from it by finding an excuse for evil behavior is an an attempt to run from this awful truth.
But wait: There was a report posted here a day or two ago that alleged that he was a liberal Democrat, heavily involved in “Never Trump” and other anti – Republican activities. This would place him in the same corner as the two previous mass murderers. This also puts him in the same camp with people who are, in some cases, advocating violence, even killing, of “the other side” – us. So what if he isn’t crazy at all? What if his philosophy permits him to see himself as a soldier, firing opening shots in this perceived war against those evil Republicans? It has been said that we are essentially engaged in a “political cold war.” There is some merit to that view. What happened last Sunday, though, isn’t so “cold” after all.
I must add hastily that the allegations of his political leanings are, as far as I know, not adequately sourced. It did strike me even the day after, that nobody was reporting on his voter registration, indications of political leanings, etc. The MSM typically comes up with that information very quickly, and had he been in any way associated with the “Right,” it would have been part of every headline.
This is one of many fallacies regarding behavior, mental illness and the unscientific near-religious belief in the effect of psychotropic drugs on suicide and violence. I have pretty impressive bags under my eyes. They are worse every morning after a very good night’s sleep (and I do not use drugs for that good sleep). They definitively do not imply lack of sleep. There are no credible studies showing dangerousness as a result of psychotropic drugs. Anyone can make an unblinded observational study “show” any conclusion they like