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Extreme Agitation After Stimulants

When When someone becomes extremely restless, paranoid or aggressive after cocaine, amphetamine, methamphetamine or cathinones, cannot be calmed down and physical exhaustion is imminent.

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Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. Reduce stimuli — quiet room, dimmed light, few people.
  2. 2. Speak calmly, do not contradict, do not restrain. Communicate safety.
  3. 3. In case of danger to self or others, persistent tachycardia, chest pain or clouded consciousness: 112.

Don't do

  • Do not try to 'bring them down' with alcohol or sedatives without medical instruction — mixed-use risks.
  • Do not argue or debate — this intensifies agitation.
  • Do not leave the person alone, but also do not crowd them. Keep your distance.

Stimulant-induced agitation can range from “nervous and irritable” to “acute psychotic episode with danger to self.” The transition is gradual.

It becomes clinically relevant with:

  • Persistent tachycardia above 130–140/min
  • Pre-seizure signs (twitching, stiffness)
  • Hyperthermia above 39 °C
  • Chest pain or shortness of breath
  • Clear danger to self or others

In low-threshold situations, trip-sitting helps: calm company, reminding them of the substance (“this will pass”), no discussion about the content of their perceptions. SONAR awareness teams and similar structures are trained for exactly this.

In acute stimulant toxicity, benzodiazepines are usually administered clinically — by emergency physicians, not by laypeople.