How many hits of this acid should I eat? August 11, 2010 8:42 PM   Subscribe

Seriously, we're going to tell somebody how much ativan to take?

I know medical questions have been cleared as acceptable, and so has amateur advice. But, we're going to tell this person how much of a potent psychoactive compound to take?
posted by Netzapper to Etiquette/Policy at 8:42 PM (101 comments total) 2 users marked this as a favorite

Ativan is not acid and this call out is pretty flimsy.
posted by kate blank at 8:46 PM on August 11, 2010 [6 favorites]


Two tabs if it's blotter.
For liquid, two drops from a medicine dropper.

And I should warn you... a Wendy's straw does not make a reliable substitute for a medicine dropper.
posted by Babblesort at 8:53 PM on August 11, 2010 [16 favorites]


All of the advice in that thread seems reasonable.

Also, four.
posted by zinfandel at 8:55 PM on August 11, 2010 [2 favorites]


Does anyone know where I can score some?
posted by cjorgensen at 9:01 PM on August 11, 2010


Two tabs if it's blotter. For liquid, two drops from a medicine dropper.

Is it mystery meat street stuff or of known concentration? A, er, friend had an experience with liquid that was half as dilute as it ought to have been. Which can be rather more than one bargained for. Also, planned consumption of additional substances may favor a more conservative approach.
posted by juv3nal at 9:04 PM on August 11, 2010


Didn't your concern get covered in the thread though? You'll never stop people from chiming in on what they think about how to treat medical issues. It's been going on since people could talk to each other. But you can warn people to take it with a grain of salt and consult a professional. That's about it.
posted by SpacemanStix at 9:06 PM on August 11, 2010 [1 favorite]


But you can warn people to take it with a grain of salt
Seriously, we're going to tell somebody how much salt to take?
sorry
posted by juv3nal at 9:08 PM on August 11, 2010 [33 favorites]


I agree, this is a horrible question. How do we know she doesn't have some other condition/medication that would contraindicate a higher dose than she'd been prescribed? I'm on two medications that make me drowsy - should I double up on the dose of one of them? How the fuck would you know?
posted by desjardins at 9:12 PM on August 11, 2010 [11 favorites]


This isn't just a generic medical question, though. It's a specific, pharmaceutical question.

I tend to agree with the callout. This question strikes me as falling squarely within some of the problems that have been articulated in former conversations, particularly by one former member who was critical of medical AskMe. But, I'm not a doctor or a pharmacist. I'd be more interested to hear the opinions of someone who is.
posted by cribcage at 9:14 PM on August 11, 2010 [6 favorites]


To answer your question, I would say 1 the first time, 2 the second , and 4 the third. Acid's like that, in that you're never going to regain your earlier ground. Everything ain't for everyb
ody.
posted by BeerFilter at 9:32 PM on August 11, 2010


One if by land, two if by sea.
posted by 1000monkeys at 9:35 PM on August 11, 2010


Netzapper, I think you have a valid concern, and it's great that you raised it in the original AskMe thread where the OP can see it. But what is the solution to this callout? Should all questions about prescription drug usage be banned? That seems like overkill. Should mods make a case-by-case decision based on the potency of the drug? That's asking a lot from the mods, since they are not doctors.

Personally, I would like AskMe to err on the side of allowing a question like this, and raising concerns like yours in-thread. Lots of people don't have good access to formal medical advice; IMO it's better for those people to submit an AskMe and get a range of responses, rather than merely asking their friends or family (populations which are much less broad than the MeFi membership) and getting more biased, less informed responses as a result.
posted by twirlip at 10:03 PM on August 11, 2010 [2 favorites]


Normally, I would totally agree with the concern here but I think we're forgetting that this medication has already been prescribed by a doctor. I think it would be a completely different scenario if the OP didn't have a Rx and wasn't under a doctor's care (and judging by the phrasing of the question, it seems pretty safe to me that the OP was prescribed the meds).

I've been on ativan before, and there generally isn't a "set" dosage per sé; the doctor usually says take one or two and wait half an hour to an hour and then take another one if needed and so on. Two .5 pills under the tongue, in my experience, isn't enough to have any major effects. It's not like the OP will be driving or operating heavy machinery, and people don't OD on 2 or 3 .5 tabs. spread over a few hours (or even at once). I know several people personally who were on 2 mgs at one time and were barely drowsy. It's Ativan, not Ambien or Valium.
posted by 1000monkeys at 10:21 PM on August 11, 2010 [2 favorites]


The only real solution is for all of us to take at least 1 mg of ativan and report back. Netzapper, slug those down with a nice glass of malbec and see if you don't feel less stressed about what we're telling or not telling people to do.
posted by clockzero at 10:31 PM on August 11, 2010 [1 favorite]


My advice for airplanes ranges from hash brownies to a bump of xanax and some red wine, and my advice for airports is get high before you go, then play the moving-sidewalk-high-five-game (which surely needs a name that's a little briefer but still as descriptive). My advice for driving is T. Rex, my advice for boats is canned beer, my advice for horseback is that you can't ride horses drunk, dumbass. My advice for acid is take one to start and redose before you peak, my advice for mushrooms is eat 'em dry, and my advice for mescaline is that San Pedro cactus is a pain in the ass.
posted by klangklangston at 10:34 PM on August 11, 2010 [43 favorites]


There's plenty more acid where that came from, so eat as much of it as you want.
posted by fuq at 10:39 PM on August 11, 2010


It's still not as awesome as the AskMe thread where someone found a baggie of white powder in the parking lot of a school, and everyone was all "You should lick some to find out what it is."
posted by ErikaB at 10:41 PM on August 11, 2010 [15 favorites]


All of the advice in that thread seems reasonable.

It is not reasonable to believe that one can give adequate medical or pharmacological advice knowing only the prescribed dose of a drug and nothing else about the patient taking it.
posted by toomuchpete at 10:41 PM on August 11, 2010 [5 favorites]


my advice for airports is get high before you go

Worst trip ever, for multiple values of "trip."
posted by twirlip at 10:42 PM on August 11, 2010


"Worst trip ever, for multiple values of "trip.""

Nah. Nothin' on ya, they can't touch ya. Just be cool, man, and we'll all get through this.
posted by klangklangston at 10:51 PM on August 11, 2010 [1 favorite]


Yeah usually I'm all about giving half-ass advice about benzos but...if their doctor didn't tell them how much to take then maybe they should just not take.

(Don't controlled scrips have "maximum daily dose" on them? WTF does that mean? Maximum dose before you die? Maximum dose before you'll see shit and walk into walls?)
posted by internet fraud detective squad, station number 9 at 10:59 PM on August 11, 2010 [1 favorite]


Klang .... can I ...fly with you?
posted by The Whelk at 10:59 PM on August 11, 2010


Klang .... can I ...fly with you?

Can we make this a meet-up? Fly with Klang! Experience new highs!
posted by grapesaresour at 11:09 PM on August 11, 2010 [3 favorites]


Astral Plane Meetup. BYOB.
posted by The Whelk at 11:11 PM on August 11, 2010 [2 favorites]


I am cranked full of lorazepam on a regular basis...thank you emergency departments. I also am aware that, usually, the benzodiazepine class of drugs is most likely to do damage in conjunction with other CNS depressants. Usually, on their own, they don't kill people, as long as you're just taking a nap or something and not trying to drive or something. Usually. And 1mg...yeah, in my experience that's pretty low for most people.

Still, I'm really not ecstatic about dosing directions in thread, either. Here are two things to note: I have heard no one bring up rate of hepatic metabolism--not just body size, weight, medication conflicts, and sex. Most physicians guesstimate on this, but they're trained to do it, even though usually they guess to the average. However the average is not the reality for many people: I'm sure I've mentioned this on other threads, but I have a liver that is practically a magical dimension of its own: I take doses of pharmaceuticals that would knock most men twice my size out for days. There are plenty of people without actual liver problems who are slow metabolizers.

Secondly, I'm already seeing misinformation here. Not to pick on 1000monkeys, but let's dispel the idea that 'it's Ativan, not Ambien or Valium.' Both Ambien and Valium are less potent drugs and act differently on the brain from each other. Diazepam is much closer to lorazepam than it is to Ambien.

I used to keep a chart of benzo/benzo-type drug dose conversions and which can be used for which purposes in case of emergency so people would know how much and which one to administer if they couldn't find the Diastat when I was on a trip or camping or something. For example, sometimes I have Xanax on hand for anxiety (rare, because I hate the way I can't think on that stuff, but sometimes)....and you can't swap Xanax for an anticonvulsant benzo. It's just not as effective. I can't find the chart just now, but the reason I had it is because in that case it's coming down to life-or-death and yeah, at that point I'm cool with other laypeople just throwing the kitchen sink, without any guarantee that they understand all of the pharmacology, and getting a bit cavalier.

Other than situations that are going that south that quickly, well, individual dosing questions are why Nurselines exist. Really.
posted by Uniformitarianism Now! at 11:24 PM on August 11, 2010 [8 favorites]


Fair enough, but it's not like the OP is habitually using them, they just want a one-time dosage for a flight and I highly doubt there would be any adverse reactions at all to 2 or 3 .5 tabs, especially given that they have had no allergic reactions at all. Of course IANAD and this is purely based on my own experience and that of friends/family members, under a doctor's care and advice. I certainly wouldn't recommend abusing Ativan as it can be highly addictive and dangerous in high amounts, but I am assuming based on the AskMe that the OP has been prescribed the medication.
posted by 1000monkeys at 11:31 PM on August 11, 2010


(Don't controlled scrips have "maximum daily dose" on them? WTF does that mean? Maximum dose before you die? Maximum dose before you'll see shit and walk into walls?)

I have a friend who's a medical student who explained this to me once: every drug has a toxicity limit (or whatever they call it) and if you take enough to hit that limit you'll need hospitalisation, but the "maximum daily dose" on medical packaging is usually like a third of that for safety reasons. So for example the "maximum daily dose" of Panadol is 8 tablets per day, but an average adult would need to take, say, over 20 before their life would truly be in danger.

It's probably also to account for people who mix medication, or are tiny, or have preexisting conditions or whatever.
posted by Xany at 11:39 PM on August 11, 2010


But, we're going to tell this person how much of a potent psychoactive compound to take?

Seriously? The mob around here tells people to go on their meds. Ativan is child's play.
posted by Blazecock Pileon at 11:41 PM on August 11, 2010 [3 favorites]


"Can we make this a meet-up? Fly with Klang! Experience new highs!"

I've got a lot of snacks and some albums you've just got to hear.
posted by klangklangston at 11:57 PM on August 11, 2010 [2 favorites]


To answer your question, I would say 1 the first time, 2 the second , and 4 the third. Acid's like that, in that you're never going to regain your earlier ground.

This is false. And terrible advice.
posted by BitterOldPunk at 12:00 AM on August 12, 2010 [2 favorites]


Is this where we give drug related advice? I got a few chestnuts myself.

1. In a day, 8 gallons of water is too much for anybody.
2. Don't soak bread in anything alkaline. It just is bad luck, and you won't hallucinate.
3. Aspirin is really bitter. Swallow it whole, don't chew it. Boy, did I ever learn that lesson!
4. Whatever you do, never mix hard alcohol and cider vinegar after having a few glasses of wine.
5. No matter where you go you'll have a hangover in Australia, but they'll call them verandas.
7. Wear matching colored clothes while huffing paint otherwise you'll just be conspicuous. Gold polyester overalls would be my recommendation. A shirt is optional.
8. When driving down a street, try not to drive too hard only soft enough otherwise you may alert authorities.
9. Walmart has a corner in the store that is more of a corner than that other corner but I don't trust it.
9. I think I took too many of these.
posted by TwelveTwo at 12:16 AM on August 12, 2010 [30 favorites]


To answer your question, I would say 1 the first time, 2 the second , and 4 the third. Acid's like that, in that you're never going to regain your earlier ground.

This is false. And terrible advice.


My aforementioned friend tells me that while tolerance diminishes pretty rapidly so "you're never going to regain your earlier ground" is manifestly false, if you're going on a multi-day bender and waiting for the comedown before re-upping, doubling up is sound advice for maintaining an even keel. Well, as even a keel as you can get with a multi-day acid bender.
posted by juv3nal at 1:48 AM on August 12, 2010 [1 favorite]


Sadly, the "buy all you want, we'll make more" drug maxim does not seem to apply to LSD.

Dudes, email is in my profile don't be shy know what I mean?
posted by Meatbomb at 2:39 AM on August 12, 2010 [5 favorites]


Oh man, Ativan for me has a total reverse effect. It makes me insane. Completely off the wall bonkers. Ativan is the go-to benzo for emergency use with seizures and I've made sure that there are huge notes in my chart that say "VALIUM, NOT ATIVAN." We're talking "I had to have my arms pinned down I was so nuts" insane on IV Ativan.

Wait, what were talking about? Oh yeah. The AskMe. I guess the only real answer would be "Some and if that doesn't work, try more." Not really very scientific or helpful - definitely not a very good use of AskMe, but then again, most of my questions are about poop so I'm not throwing stones here.
posted by grapefruitmoon at 5:32 AM on August 12, 2010 [1 favorite]


Remember kids, AskMeFi doesn't advocate drugs, we merely prescribe them.

This is the rock n' roll doctor. Hi, who's on the line ...
posted by octobersurprise at 6:23 AM on August 12, 2010 [1 favorite]


One of the reasons I've mostly stopped answering medical questions.
posted by gramcracker at 6:25 AM on August 12, 2010


my advice for airports is get high before you go

Absolutely the best way to deal with them.

Once on the plane, .5mg of Ativan should do the trick.

Seriously, I'm in with the callout, I hate AskMe playdoctor sessions. Just going on the record again.
posted by fourcheesemac at 6:44 AM on August 12, 2010


I hate AskMe playdoctor sessions.

askme has my permission to playdocter with me whenever it wishes. I'll be in the treehouse...
posted by Potomac Avenue at 6:57 AM on August 12, 2010 [3 favorites]


A close relative is hypersensitive to ativan. When she went in for surgery, it caused her to stop breathing, and she had to be put on a ventilator. We had no idea that was a possibility; she had never taken any before.
posted by boo_radley at 7:13 AM on August 12, 2010


Oh, God, octobersurprise, thank you! I had totally forgotten.

Caller: Hello-llo-llo?
Dr.: Yeah, turn your radio down please?
Caller: Hello-llo-llo?
Dr.: You want to turn you radio DOWN please?
Caller: Oh. Yeah.
Dr.:Right. OK. That's better. You have a question sir?
OK. Yeah, I'm -- I'm goin' to the Nugent concert . . .
Dr: Kinda figured.
Caller: I'm takin' some put, and uh, uh, some acid, and I'm gonna be takin' some coke, and I'm gonna be takin' a couple quarts of rum. I was wonderin' if there was anything else I should take.
Dr.: Yah. An ambulance.

posted by The Bellman at 7:19 AM on August 12, 2010 [1 favorite]


Registering agreement with this callout-- experience taking a medicine does not qualify you to give advice to others about how to take it.
posted by vincele at 7:33 AM on August 12, 2010


Maybe people should start appending their comments with "I Am Your Anonymous Internet Idiot." (Not saying that anyone is actually an idiot, just that being self-deprecating would be great CYA.)
posted by XMLicious at 7:49 AM on August 12, 2010


Also - since someone in the AskMe thread said "1mg of lorazepam won't do anything bad" (I assume that's the generic name) maybe some of the people who have commented here about extremely bad reactions should make the same comments in the AskMe, for posterity's sake.
posted by XMLicious at 7:54 AM on August 12, 2010 [1 favorite]


We're all going to be really embarrassed when we find out that the asker was actually the pilot on that flight he was talking about...
posted by quin at 8:04 AM on August 12, 2010 [6 favorites]


Fair enough, but it's not like the OP is habitually using them, they just want a one-time dosage for a flight and I highly doubt there would be any adverse reactions at all to 2 or 3 .5 tabs, especially given that they have had no allergic reactions at all. Of course IANAD and this is purely based on my own experience and that of friends/family members, under a doctor's care and advice. I certainly wouldn't recommend abusing Ativan as it can be highly addictive and dangerous in high amounts, but I am assuming based on the AskMe that the OP has been prescribed the medication.

This, right here? The kind of advice give in response to medical questions in AskMe, where people are all like "Here's this specific set of recommendations that I and everyone I know have found useful, but LOL don't take MY advice for I am not a doctor nude-nudge-wink-wink," where the advice is couched as being strongly normative, and listening to it could be really fucking dangerous? It's a bad thing, and you're a bad person for doing it, and it's really incredibly bad policy that it's allowed here.

We clamp down on people dispensing legal advice, but this kind of shit is on AskMe all. the. fucking. time. Stop it. Just stop it. There is a world of damage you can do, and no possible benefit to be had from you flinging shit when you obviously have no idea what you're talking about. No, really. You don't. You don't know if they're allergic to this class of medicine. You don't know what else they're taking. You don't know how Ativan reacts with other CNS depressants, even though you read about it on fucking Wikipedia. You don't know these things because you don't have an MD, or any sort of advanced pharmaceutical degree, and you don't have the OP's list of medications and their chart in front of you. What exactly do you think pharmacists do for the years and years they're in school? They're not playing tiddlywinks. They're learning how to dispense extremely powerful drugs, that interact with other drugs in sometimes-hazily-understood ways, in a way that isn't likely to kill or maim their patients.

Yes I know this answer was over here and not in the original thread, and it's not fair to direct this at 1000monkeys, but goddamnit, there are 20 answers just like this in the original thread, including furiousxgeorge's bon mot about how awesome it is to get pleasantly high by intentionally ODing. Christing shit, people.
posted by Mayor West at 8:29 AM on August 12, 2010 [11 favorites]


ErikaB writes "It's still not as awesome as the AskMe thread where someone found a baggie of white powder in the parking lot of a school, and everyone was all 'You should lick some to find out what it is.'"

I want it on the record that while not stridently so I was (and am) opposed to random taste testing of white substances found in a baggy in a parking lot.
posted by Mitheral at 8:36 AM on August 12, 2010 [1 favorite]


You don't know if they're allergic to this class of medicine.

It was occurring to me that the same could be true of eating peanuts or shellfish et cetera, so I was wondering, seriously, if we should resist certain types of answers in cooking threads in the same way.
posted by XMLicious at 8:43 AM on August 12, 2010 [2 favorites]


We clamp down on people dispensing legal advice, but this kind of shit is on AskMe all. the. fucking. time.

I agree with your point, but: While I cannot speak with authority about medical or pharmacological questions, I can absolutely tell you with authority that bad, just-plain-wrong legal advice appears on AskMe "all. the. fucking. time." There is no "clamping down." It's rampant. I think it's somewhat less critical than advising people about dosages, but it happens often. The worst "ChatFilter" problem on AskMe is not unsolvable questions, but a general attitude among answerers that they should pop into any ol' thread with, "Hey, here's what I think!"
posted by cribcage at 8:51 AM on August 12, 2010 [2 favorites]


We clamp down on people dispensing legal advice

What? No we don't. I'd prefer people didn't ask questions about prescriptions as well. We generally don't approve anonymous questions about prescriptions [especially lately]. People should be calling their doctors, but for whatever reason, they don't. However, they'd be asking their friends if they weren't asking here and our general feeling is they're likely to get better advice here.

So the open question is this: people should be asking their doctors and they're not. Then what?
posted by jessamyn (staff) at 8:55 AM on August 12, 2010 [6 favorites]


I want it on the record that while not stridently so I was (and am) opposed to random taste testing of white substances found in a baggy in a parking lot.

That one really pissed me off, as this non-help finger-wagging comment stayed:

and, for all the people saying taste it.... Seriously?? Is that what you do? Find stuff on the street and randomly stick it in your mouth?

...whereas my answer to that got deleted, despite it being earnest, straightforward, and informative:

Yes.
posted by Greg Nog at 9:14 AM on August 12, 2010


All of the advice in that thread seems reasonable.

that your professional opinion?
posted by shmegegge at 9:14 AM on August 12, 2010


The only acceptable answer to "how much drugs should I take" is "more."
posted by Cool Papa Bell at 9:46 AM on August 12, 2010 [2 favorites]


However, they'd be asking their friends if they weren't asking here and our general feeling is they're likely to get better advice here.

I'm not sure that's true. I ask (and see asked) questions here that I wouldn't ask my friends, because I don't always assume my friends have the expertise needed to answer a given question. On the other hand, when I post something to AskMe, I'm essentially lobbing it up into the air for tens of thousands of pairs of eyes to see, and assuming that people will self-select and answer things in which they have relevant domain knowledge. The bar for 'having relevant domain knowledge' varies by question: most people probably can't (and won't try to) help with my pointer-arithmetic problems, but everyone can chime in on what to name my cat.

So the open question is this: people should be asking their doctors and they're not. Then what?

I'm not sure if this is addressed specifically to me, but:

You make it against the guidelines to dispense {legal | medical | bridge-building | discipline-where-failure-has-a-prohibitively-high-cost} advice without credentials, then you remove such posts when they're flagged as breaking the guidelines. Since no one with said credentials ever actually posts advice other than to say "I am a {lawyer | doctor | aerospace engineer}, please consult a professional in your area who can thoroughly consider your unique situation immediately," it should be pretty easy to pick out the imposters.
posted by Mayor West at 9:51 AM on August 12, 2010 [1 favorite]


You don't know if they're allergic to this class of medicine.

Mayor West for all we know neither does the doctor who prescribed the medication. Patient could have withheld pertinent information intentionally (or, didn't know what medical information was valuable) in order to get the drug or, like me couldn't know (its not like I was born with a warning label stuck to my butt may adversely react to these substances: ... :p).

I will always maintain that the reality is no matter how long those disclaimers are for the latest wonder drug we're all guinea pigs for big pharma despite their studies that n = [number who took part in clinical trials] responded x way. There is no just way to know how YOU will respond unless you swallow/rub/inhale/etc despite all their studies and, what the package insert says. All doctors can do is evaluate risk vs benefit then try to minimize the risk, but they can't avoid it entirely when they prescribe you something. So says the person who broke out in hives and, stopped breathing after one doctor prescribed dose of Imitrex. it's not the only time I've had a bad reaction, but that by far was the worst and, because of it leaves me feeling like I'm playing Russian Roulette with a pill bottle every time I take something new.
posted by squeak at 10:15 AM on August 12, 2010


So the open question is this: people should be asking their doctors and they're not. Then what?

Then they ask anonymous internet strangers who give them bad advice.
posted by fixedgear at 10:32 AM on August 12, 2010


Seriously, we're going to tell somebody how much ativan to take?

No, because then we'd have to stop allowing people to tell askers that they should totally ignore the law and just split that inheritance up equally and not report the estate to the authorities.

Once that door's open, you can advise people on self-surgery.
posted by Ironmouth at 10:32 AM on August 12, 2010


So the open question is this: people should be asking their doctors and they're not. Then what?

Then, that's a decision that you either decide to participate in and enable, or not. You might be right that people will get better advice here from their friends. (I don't think so, actually. Filling in blanks about strangers is a major problem on AskMe, in any context, and can be key here. Moreover on the flip side, you're equally likely to get bad advice, and since you don't know these people like you know your friends, you're less able to discern which is which.) But that's an after-the-fact point. The issue is participating in the first part.
posted by cribcage at 10:40 AM on August 12, 2010


Oh man, Ativan for me has a total reverse effect. It makes me insane. Completely off the wall bonkers

Finally! Someone like me! Taking ativan is like taking a shitload of amphetamines! (And taking amphetamines is like taking a shitload of ativan).
posted by Cat Pie Hurts at 10:46 AM on August 12, 2010


Wait, is he taking ativan while riding a bike? If so, not cool man, not cool.
posted by spikeleemajortomdickandharryconnickjrmints at 11:24 AM on August 12, 2010


Mayor West: Fair enough for the callout, that's your (valid) opinion and I have no beef with you. I gently disagree, but I do agree with the general idea of your post. I took the question as the OP requesting general anecdotes given people's own experiences (after all, that's all they CAN expect from AskMe), and they even ended up posting as much in response to their question. Obviously, there are the previously posted and ever-perpetual IANAD IANAL IANYD etc. warnings, and common sense would hopefully dictate to ANY person asking a question on AskMe that, unless it's an extremely specific and answerable question ("What is 1 plus 1?"), then they are going to get a bunch of non-professional OPINIONS rather than hard and fast, factual responses. That's just the nature of AskMe and the internet, and if asking these types of questions (including ALL of the RelationshipFilter questions) makes us nervous/upset/whatever, then perhaps we just can't deal with having an AskMe section and we cannot give people enough credit, and faith in them, for having basic common sense.

In this case, the poster had already taken some Ativan and had zero effects. I had to assume, based on the question and in good faith, that the OP had a prescription for the medication in the first place. Anybody asking a question on the internet has to know that they run a huge risk of getting answers that are vague, potentially harmful, or just plain wrong. It's up to the asker to sort out the wheat from the chaff and decide if they trust in the advice of strangers on the internet rather than just calling their doctor's office. That's where personal responsibility comes in. And at least people have a second place to come and ask a question, gauge the responses, and decide whether or not to take them into consideration when making their decision.
posted by 1000monkeys at 12:31 PM on August 12, 2010


Also, in general: people asking questions need to realize that THE MORE INFO THEY GIVE US (succinctly, so it doesn't get lost in the tl;dr noise), the better chance of having a clearer answer.
posted by 1000monkeys at 12:33 PM on August 12, 2010


One more thing (sorry!): I had to take the question at face value in good faith. The OP was asking how much ativan they can take for a flight/to get to sleep and not asking how much they can take to get really really high. If they were looking to trip out on ativan, then they probably would be posting elsewhere.

I don't do drugs personally, and I don't advocate recreational drug use (to each her own), but if I had the sense that the OP was looking to get high and not for legitimate experiences with a dosage level, then I wouldn't have answered the question myself. Again, IANAD or a pharmacist, but in my (limited and personal, therefore purely anecdotal) experience, the Rx that comes on the bottle usually says something like : dissolve 1-2 pills under the tongue as needed, maximum 3 times per day. I believe, but am not 100% sure, that is a standard dosage.
posted by 1000monkeys at 12:44 PM on August 12, 2010


1000monkeys: Thanks, and I apologize for the "you're a bad person" quip--honestly didn't mean to direct that at you, I was just a little hypoglycemic and generally irritated at the state of medical advice being dispensed 'round these parts.

Here's the thing. Lots of seemingly-innocuous advice can cause horrible complications. Let's take Tylenol. They sell it in giant bottles over the counter, so it must be a generally safe thing to consume in reasonable quantities, right? Absolutely. Unless you're one of the people who react poorly to any sort of anti-inflammatory. Or if you decide to take it when you're drinking. Or if you mix it with other anti-inflammatories, which you probably didn't know were anti-inflammatories because the bottle didn't say it in huge angry letters, and who reads those little inserts anyway? Or if you decide that your headache is particularly nasty, and you double the recommended dose and your liver fails. I have known people to whom two of the preceding things have happened. And you, as J. Random Internet Guy, would have absolutely no knowledge of the possibility of any of those things happening, unless you had seen it happen, or had spent a lot of time studying pharmacology. Drug dispensation (in the narrow case) and medicine (in the broader case) is a vast minefield, to which we erect massive barriers to entry, and viciously prosecute those who try to navigate it without proper licensure.

So I guess my point is, yes, everyone should know to take Serious Internet Advice with a grain of salt. But everyone should also know not to dispense advice about things of which they are manifestly ignorant. And the latter transgression is by far the more serious one. If you were to tell a friend of yours that it was OK to mix two random prescriptions together, and he followed your advice and ended up blowing out his liver, you would be responsible for it, and could probably be found liable for practicing medicine without a license. Those insanely high barriers to entry are there for a reason. And, more to the point, I'm having a hard time seeing the value (either to the person dispensing the terrible advice, or to the community in which such dispensation is condoned) in sanctioning questions like this, or of leaving up answers which are very obviously unqualified advice.

In other words: what do you, the hypothetical person who just spouted advice about which you acknowledge that you know nothing, hope to gain from this transaction? Your wild-assed guessing is no more or less useful to the OP than the OP's own uninformed speculation, since neither of you really understand the full picture, so you haven't helped him with his problem. At the same time, what does AskMe gain from it? It isn't a better place for having the bits of wisdom that you have dispensed. In the best case, it now contains bad advice, stored for Google to index for the rest of time. In the worst case (and I admit there's no precedence for this, but it is not outside the realm of possibility), a zealous enough prosecutor could probably come after its admins or the responder himself for doing something that is widely acknowledged to be illegal.
posted by Mayor West at 1:19 PM on August 12, 2010 [3 favorites]


I would like to share a story of taking terrible prescription pharmaceutical advice from lay people…one that didn’t even require the internet. In this case, there are no excuses for not knowing the person well enough or filling in the unknown history blanks with assumptions, because the information was all there. You see, I took this advice directly from myself. Because I am that awesome. Here's the thing: I’m about as steeped in basic medical information as a lay person can be. However, none of this basic knowledge translates directly into ‘board certification’ in anything except ‘yo, here is a cool thing I teach in theory.’ My smart is all books/studies, professional/personal hearsay and "personal anecdata." I try to be upfront about this, and make sure my disclaimers aren't 'wink-wink-nudge-nudge.' This story--and the other anecdote of mistaking myself for a person with a genuine clue that I've related in AskMe--is one reason why my disclaimers absolutely need to be there. I am just smart and informed enough to get into real trouble when left unsupervised.

Last summer I felt what seemed like early signs of a UTI. I've had these, I figured I knew what was going on. A couple of days and two gallons of pure, unsweetened cranberry juice and lots of water later, nothing had changed. For various reasons, I didn’t think I had time to be sick. Haha, how quickly life will correct you on that.

Over the years I've amassed a catalog of various medications, and although I try to pitch everything that expires, it still leaves me with a lot of extra bottles of unexpired scripts. One of these bottles was minocycline I’d taken for acne, but had stopped because long-term a/b use isn’t great if you don’t need it, and the point had come in the last year where I didn’t need it. I’d forgotten to pitch it before the move, or I read the expiration date incorrectly. (If you know pharmacology, this is the part of the story where you get a little antsy.) Anyway, that bottle survived the move.

Now, I am well aware of the problem of antibiotic misuse and that it’s a poor plan on the individual AND group scale. I even know that the tetracyclines are usually bacteriostatic and not bacteriocidal, and that they have limited-if-any efficacy against E. coli and the other common culprits in UTIs. But, hey, I was in a decision-makin’ kind of mood, I'm just one person, it's just this once, I've used it before regularly, I didn’t “have time” to go see anyone about it, and I really hate UTIs. So, 300mg of minocycline to load things up it was. Then I'd drop the dose--no, I had a whole plan here, I swear. It couldn’t hurt anything to try—the most it would do is not work or upset my stomach/screw up my gut flora a bit….right? It's not like I hadn't been on minocycline before, so I was familiar with its effects. And if it did nothing then I’d go in later on in the week.

Fast-forward to 30 minutes later. I am covered in hives and experiencing the most hideous ‘ants are eating my skin’ full-body sensation I’ve felt since I was four and did in fact sit in an hill of army ants. As I learned at the urgent care facility—which I somehow found time for--the next time I take a tetracycline it may well kill me. I had probably been slightly sensitized to the low-dose I’d been on months ago, and when I reintroduced a higher dose, my body decided I should update the ol' medical alert bracelet.
Clinician: And why were you on minocycline anyway? It’s not exactly the first line for UTIs. It’s generally one of the least useful, to be honest.

Me: (considers lying and saying 'acne')...um, because I’m an idiot. I knew this wasn't the best way to go, and did it anyway.

Clinician: Okay, well, at least you admit it. Don’t ever do that again.

Me:(meekly) No, sir.
I went home, took more Benadryl according to the clinician's instructions, and went to sleep. I didn't see the expiration date on the minocycline until I disposed of it--properly--a few days later, and the pharmacy commented on it, and there was the walking-on-my-grave shiver for the week. Expired tetracyclines occasionally destroy your kidneys. I have a close relative who treats many patients with Fanconi syndrome. It's not fun. I lucked out just developing an allergy. That was the good outcome, if for no other reason than it kept me from taking a second, third or fourth dose.

Yes, everyone: I'm here making the really stupid, arrogant, reckless choices so other people don't have to. Don't let my astoundingly short-sighted decisions be in vain.

oh, and, ftr, it turned out not to be a UTI anyway. It was a 'lookalike' condition easily confused for one. Get a culture!
posted by Uniformitarianism Now! at 1:21 PM on August 12, 2010 [5 favorites]


Bad Idea Jeans
posted by Blazecock Pileon at 1:43 PM on August 12, 2010 [1 favorite]


Finally! Someone like me! Taking ativan is like taking a shitload of amphetamines! (And taking amphetamines is like taking a shitload of ativan).

So... you're taking a shitload of a shitload of a shitload of a shitload...

Sounds like a load of shit to me.
posted by thesmophoron at 1:48 PM on August 12, 2010


I don't get how this isn't practicing medicine without a license, which I'm pretty sure is illegal in most parts of the US.
posted by Big_B at 2:20 PM on August 12, 2010


I don't get how this isn't practicing medicine without a license, which I'm pretty sure is illegal in most parts of the US.

I was Googling some case law to explain to you exactly why this is not practicing medicine without a license and then I said "oh, wait...." and stopped.
posted by jessamyn (staff) at 2:26 PM on August 12, 2010 [13 favorites]


If people ask me about taking meds or whatever, my usual advice is tell them to start with the lime wedge, THEN pop the pills and last shoot the Petrone. Well, actually, last is the blunt hit but who would be stupid enough to try to pound a shot after hitting the reefer? Amiriteorwut?

So should I not be suggesting that in AskMe?
posted by P.o.B. at 2:43 PM on August 12, 2010




Oh, and 'learned profession'. Remember folks, no matter how much time you spend on Metafilter at work -- it's not a profession.
posted by A Terrible Llama at 2:56 PM on August 12, 2010


Casual medical advice doesn't bother me particular.

If I were to be concerned that the Metafilter community was not qualified to dispense medical advice, I think I'd reflect on the many life or death discussions that parade through AskMe on a regular basis: My boyfriend slapped me three times-is this domestic abuse? Should I leave my girlfriend? I think I was raped - was I? I'm terribly depressed. I haven't gotten out of bed in three weeks. Am I depressed? Should I eat this?

To my mind, focusing on whether or not someone should take an extra of a commonly used medication is a bit of a red herring when you consider how much knowledge and variables you'd have to consider with regard to advising someone whether or not you could die from botulism from eating a two-week-old mushroom pate.

So I think that AskMe is a world that sometimes has some heavy responsibilities that we should all probably bear in mind when posting, whether or not we're talking about whether or not to take an extra Xanax or whatever was going on in that thread, and that when people make a big deal out of medical advice it makes it seem as if those other life- altering bits of advice aren't so important.

(Please note I am not talking about telling someone with a pounding headache and blood coming from their ears to go to the emergency room. There are limits.)

Just my opinion.
posted by A Terrible Llama at 3:15 PM on August 12, 2010 [3 favorites]


Three posts in a row. God, I'm sorry.
posted by A Terrible Llama at 3:16 PM on August 12, 2010


People always looked down their nose at Donovan but he convinced hippies all over the world they could get high from smoking banana peel. He must still be laughing.
posted by jfuller at 3:27 PM on August 12, 2010


Stroboscopic dosage calculation.

Been smoking pot all day every day for months. Lets perform an experiment, half a gram of dried P. cubensis every 4 hours for a week, then a party on Saturday.

It is a 16 kilometer walk to the party, only three mescaline, chili powder and clay beads left on my walking necklace, dissolved between molar and cheek, I love the gritty feeling in my mouth. Better to stop at the drugstore for some water, nothing else open for the next 2 hours. It was there on the shelf, looking at me, two 120ml of generic Dextromethorphan, washed down with half a gallon of orange juice. What a beautiful summer evening, walking by the lake.

Arrived at the party, already peaking on the DXM. Better swallow the last 8 grams of mushrooms before going through the pat down. My flake of a friend inside only has half an E pill for me, crappy counterfeit orange triforce pill. It will have to do.

Am I peaking on the shrooms, the E, or is it still the DXM? It is only eleven p.m., I better find something to last me all night. The dude with the white top hat is selling drops. I know him, I gave him a couple of spore prints before. Two drops for a hundred pesos? Give me four for one fifty and I will owe you. Just put them on the back of my hand, I'll lick them up.

Strobes are back on, I can see the first drop falling down in slow motion, so clear, so pure, so shiny. Gravity is fucked, the music is so good. The second, third and fourth floating drops hit my skin. I see four, I count four, I feel on my skin drip drip drip drip drip drip drip drip drip drip.

.........................

That night was the first time ever I was brave enough to talk to my future wife. I don't remember, but she does, and my next birthday she gets me a small portable strobe light. Never buy drop without a strobe light again.
posted by dirty lies at 4:01 PM on August 12, 2010 [3 favorites]


tl;dr question: anyone know if the OP lived?
posted by cjorgensen at 4:32 PM on August 12, 2010 [1 favorite]


Yes, at the bottom of the AskMe the OP replied and said that he or she took the second dose, got some sleep, and got up in time for the flight.
posted by XMLicious at 5:07 PM on August 12, 2010 [1 favorite]


Finally! Someone like me! Taking ativan is like taking a shitload of amphetamines!

Um. Have you ever taken a shitload of amphetamines? Because while it's true that a few people can have paradoxical reactions to benzodiazepines I've never heard of one so severe that it was equivalent to taking a shitload of amphetamines!
posted by Justinian at 5:18 PM on August 12, 2010


Please pass the benzodiazepines. Thx!
posted by 1000monkeys at 7:10 PM on August 12, 2010


Strobes are back on, I can see the first drop falling down in slow motion, so clear, so pure, so shiny. Gravity is fucked, the music is so good. The second, third and fourth floating drops hit my skin. I see four, I count four, I feel on my skin drip drip drip drip drip drip drip drip drip drip.

Using a strobe light while counting drops of anything seems like a bad idea. Or I guess a good idea, if you're the one buying.

Btw, in case any psychonauts read this post and decide to get adventurous, mixing DXM and Ecstasy is a terrible idea. I did it accidentally one night and it was among the worst drug experiences of my life.
posted by empath at 8:05 PM on August 12, 2010


If you were to tell a friend of yours that it was OK to mix two random prescriptions together, and he followed your advice and ended up blowing out his liver, you would be responsible for it, and could probably be found liable for practicing medicine without a license.

IANAL, but I'm fairly certain this is bullshit. I believe that in most states you have to both represent that you are a doctor and accept some kind of compensation.
posted by empath at 8:14 PM on August 12, 2010 [4 favorites]


I believe that in most states you have to both represent that you are a doctor and accept some kind of compensation.

Exactly, the person taking your advice would have to prove that they had a reason to believe the person dispensing the medical advice was qualified to do so (i.e. representing themselves as a doctor or medical professional when they are not). I highly doubt they could make a (successful) claim in court by arguing, "Well, this random dude on the internet named sparklesmcgee said it would be safe". I'm pretty sure that case would be thrown out of court. Well, in Canada, anyways. Americans apparently aren't expected to use any common sense or reasonable judgment, it seems.
posted by 1000monkeys at 8:20 PM on August 12, 2010 [3 favorites]


Did you just link to the McDonalds coffee case? O NO YOU DIN'T
posted by Justinian at 8:41 PM on August 12, 2010 [2 favorites]


mwahaahah That, I believe, is what the lawyers call: McPrecedent. "I'm lovin' it"
posted by 1000monkeys at 8:49 PM on August 12, 2010 [3 favorites]


So, yeah, apparently McDonald's served coffee hot enough to cause third degree burns requiring skin grafts in seconds.

The one had 3rd degree burns covering 6% of her body and second degree burns covering 16%, and she was hospitalized for eight days.

Anybody can spill a cup of coffee on themselves. Doing so shouldn't cause one to be hospitalized.
posted by empath at 8:54 PM on August 12, 2010 [3 favorites]


*sigh* You can't win--even when you're agreeing with people here, they'll argue with ya.
posted by 1000monkeys at 8:58 PM on August 12, 2010


empath:

I have to agree. A full dose of MDMA with a full dose of DXM is bad news.

Half a pill of crap Ecstasy that you know is mostly caffeine with a little amphetamine can take the sluggishness out of a DXM come down.

The protagonist of that story almost died when he got a common liver infection and his liver was too fucked up from bad drug cocktails to function properly.

It is surprising how many common legal OTC drugs can really mess you liver or kidneys up when you combine them. Do your research.
posted by dirty lies at 9:19 PM on August 12, 2010


My advice for subways is rye whiskey. It let me make friends with a guy named Jupiter and a girl name Katrina and now I'm invited to his birthday party.
posted by klangklangston at 1:16 AM on August 13, 2010


my advice for mescaline is that San Pedro cactus is a pain in the ass

Yeah, um, I'm pretty sure you're not supposed to put the cactus in your ass.

*checks erowid*

Well, I'll be.

It'll be the next smoking banana peels myth, just you wait!
posted by Sys Rq at 1:32 PM on August 13, 2010


1000monkeys: "Mayor West:I took the question as the OP requesting general anecdotes given people's own experiences"

That's what Erowid is for.
posted by meehawl at 1:58 PM on August 13, 2010


As an anecdote, I'll say that although I try really hard to listen to my doctor when he gives instructions, I still google for other people's reactions with medications.

I understand that all people are not alike, and that effects and doses may vary wildly, but having a wide variety of literate people's first hand experiences on hand is really really useful. I don't take their responses as gospel as much use them to build an idea of what stuff can do, and I can take that idea back to my doctor and ask follow-up questions about reactions and dosing and what's normal and what's not.
posted by redsparkler at 2:04 PM on August 13, 2010 [1 favorite]


That's what Erowid is for.

Well, I did already link to them (sneakily) :)
posted by 1000monkeys at 3:08 PM on August 13, 2010


It is a 16 kilometer walk to the party, only three mescaline, chili powder and clay beads left on my walking necklace, dissolved between molar and cheek, I love the gritty feeling in my mouth. Better to stop at the drugstore for some water, nothing else open for the next 2 hours. It was there on the shelf, looking at me, two 120ml of generic Dextromethorphan, washed down with half a gallon of orange juice.

God, I hate story problems. Which direction were the nuns headed, and what was the wind speed, again?

For the record, I absolutely and categorically state that klang did not ever get any of that knowledge from me. Well, I'm pretty sure. I was a pretty good example by the time he came along, except for the occasional tobacco use. Should I not have told him stories of my misspent youth? I thought they'd be instructional!
posted by beelzbubba at 2:49 PM on August 14, 2010


Apparently they were.
posted by Mitheral at 4:27 PM on August 14, 2010


1000monkeys: "That's what Erowid is for.
Well, I did already link to them (sneakily) :
"

Well, I guess my point would be that Erowid is precisely *for* anecdotes about people tripping balls while yoked out of their gourd on semi-random substances. Whereas AskMe is, well, not entirely for that (or maybe I have been misled). At least, for medical-related issues like this question, it should aspire to something more authoritative than mere anecdote. The range of response to benzos is so broad -- there are so many varied polymorphisms of GABAergic receptors and their yang-ish NMDA counterparts, individual tolerances vary dramatically depending to recent use/habituation and potentiation due to concommitant use of alcohol and other sedative-hypnotics -- that any "answer" has very little useful applicability to the questioner in terms of benefit but the potential for harm is high. I've seen people barely affected by daily dosages of benzos that would put naive users unconscious and I've seen people emergently in the ER for adverse reactions to tiny dosages, or for allergic reactions involving anaphylaxis or skin eruptions. That's why it's dangerous to advise someone to take the same dosage as you... unless they are a close relative you have no guarantee their experience will have a high probability of similarity.
posted by meehawl at 10:07 AM on August 15, 2010


But if she had already been prescribed Ativan, that doesn't magically make her not allergic to them. If she was going to have a reaction to it, she would have had it regardless--it's not like the doctor makes you take your first dose in front of him and wait half an hour to see if you have any adverse reactions, right? I think everybody is seriously over-analyzing this (I mean, do we really need to discuss polymorphic GABA alternators or whatever?).

She took a pill that many hundreds of thousands of people take every day; she just wanted to know if she could take another one. The standard Rx on the bottle says it's okay. Anyways, it's all irrelevant now: she had a nice sleep and went on her merry way the next day. If she would have had a reaction to it, she would have had a reaction to it--that's what happens, that's life. Just like she could have had a reaction to penicillin; just because the doctor prescribes it, doesn't make you immune to any reactions. I don't get the logic here.
posted by 1000monkeys at 10:17 AM on August 15, 2010


And again, it appears that the Ativan was prescribed to the asker by a doctor (maybe she can confirm that for us, if she ever reads this thread).
posted by 1000monkeys at 10:19 AM on August 15, 2010


One more thing (sorry for 3 posts in a row, again!), here is the standard dosage for Ativan from Drugs.com which reflects my own experiences (and with that of family/friends) on the Rx amount:
Recommended dosage for Ativan

ADULTS

The usual recommended dosage is a total of 2 to 6 milligrams per day divided into smaller doses. The largest dose should be taken at bedtime. The daily dose may vary from 1 to 10 milligrams.

Anxiety

The usual starting dose is a total of 2 to 3 milligrams per day taken in 2 or 3 smaller doses.

Insomnia Due to Anxiety

A single daily dose of 2 to 4 milligrams may be taken, usually at bedtime.


Read more: http://www.drugs.com/pdr/ativan.html#ixzz0whEgC0O8
posted by 1000monkeys at 10:25 AM on August 15, 2010


So... you're taking a shitload of a shitload of a shitload of a shitload...

I also favour this reverse-homeopathic approach to drug consumption.
posted by PeterMcDermott at 11:00 AM on August 15, 2010 [1 favorite]


1000monkeys: "Here is the standard dosage for Ativan from Drugs.com... Read more: http://www.drugs.com/pdr/ativan.html#ixzz0whEgC0O"

This response is over 9,000 times better than pretty much all the anecdotal responses in the original question, is safer, is backed up by evidence and is exactly the best and safest way to answer a question like that. See, it's not that difficult!
posted by meehawl at 8:47 PM on August 15, 2010


Yay, me. I guess I should've posted that in the actual question then...
posted by 1000monkeys at 10:39 PM on August 15, 2010


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