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Archive: January, 2013

POSTED: Monday, January 14, 2013, 9:54 AM
Filed Under: Michael Cohen
Teen prescription drug abuse: A mother's story.

Is your medicine cabinet a source for a teen’s legal “high?” Because a doctor’s prescription is not needed, many mistakenly believe that over-the-counter (OTC) medicines are safer than prescription medicines and illegal street drugs. They are in fact safe and effective when taken as directed, but even OTC medicines—including herbals—can cause serious and potentially fatal side effects when abused.  

Abuse of OTC medicines is most common among teens between the ages of 13 and 16. They know they might find a cheap high right in their family’s medicine cabinet, often without being caught. But young adults have also abused OTC medicines, particularly in combination with other medicines, alcohol, and illegal drugs, which increases the risks. The list that follows includes the top 10 medicines currently abused by teens and adults.

  1. Dextromethorphan: This is the active ingredient in more than 100 OTC cough and cold medicines such as Robitussin and NyQuil. One teen in every 10 has reported abuse of cough medicine to get high. Large doses can cause euphoria, distortions of color and sound, and “out of body” hallucinations that last up to 6 hours. Other dangerous side effects including impaired judgment, vomiting, loss of muscle movement, seizures, blurred vision, drowsiness, shallow breathing, and a fast heart rate. When combined with alcohol or other drugs, a large dose can lead to death. For example, Coricidin HBP Cough and Cold includes both dextromethorphan to treat a cough and chlorpheniramine to treat a runny nose. But chlorpheniramine alone abuse by itself has led to numerous deaths and hospitalizations. Dextromethorphan is also addictive and can cause withdrawal symptoms, including depression and difficulty processing thoughts, when the abuse stops. Not much is known about long-term abuse, but cases of bone marrow and nerve cell damage, high blood pressure, heart damage, and permanent brain damage have been reported. 
  2. Pain relievers: Adults and teens have taken pain relievers like acetaminophen and ibuprofen in doses higher then recommended because they want the medicine to work faster.  They don’t think of the side effects. They don’t know that liver failure can happen with large doses of acetaminophen, and that stomach bleeding, kidney failure, and cardiac risks are heightened when taking large doses of ibuprofen.
  3. Caffeine medicines and energy drinks: OTC caffeine pills like NoDoz or energy drinks like “5 Hour Energy,” or pain relievers with caffeine have all been abused for the buzz or “jolt of energy” they seem to impart. Large doses of caffeine can cause serious dehydration, gastric reflux, panic attacks, and heart irregularities that have occasionally been linked to accidental deaths, particularly in those with an underlying heart condition. Taking too much of a pain reliever can also cause serious side effects as noted above.
  4. Diet pills: In large doses, diet pills can create a mild buzz. But misuse of diet pills can also signal a serious eating disorder. Abuse of diet pills often starts with trying just a few in order to lose weight. But these OTC medicines can be highly addictive.  Although the US Food and Drug Administration (FDA) has banned several of the most dangerous stimulants commonly found in OTC diet pills—phenylpropanolamine, ephedrine, and ephedra—other ingredients in these OTC products can be dangerous. To cite an example, bitter orange is a common ingredient that acts much like ephedrine in the body.  It can cause nervousness and tremor, rapid and irregular heartbeat, high blood pressure, stroke, heart failure, and death. Many other diet pill ingredients cause digestive problems, hair loss, insomnia, anxiety, irritability, extreme paranoia, blurred vision, kidney problems, and dehydration. Furthermore, even the most “natural” diet preparations can have serious side effects when misused, particularly those containing ma huang (ephedra). An earlier FDA ban on ephedra pertained only to diet pills considered dietary supplements, not herbal remedies such as teas and Chinese preparations. 
  5. Laxatives and herbal diuretics: Like diet pills, some teens and young adults also abuse OTC laxatives and herbal diuretics (water pills), including uva-ursa, golden seal, dandelion root, rose hips, and others, to lose weight. Laxatives and herbal diuretics can cause serious dehydration and life-threatening loss of important minerals and salts that regulate the amount of water in the body, acidity of the blood, and muscle function. 
  6. Motion sickness pills: Motion sickness pills that contain dimenhydrinate (Dramamine) or diphenhydramine (Benadryl) taken in large doses can cause one to feel high and have hallucinations similar to street drugs. The dose needed to cause these symptoms varies widely according to body weight and tolerance. Some teens and adults may take as many as 40 pills of Dramamine, for example, to experience the desired high. Extremely high doses of Dramamine have caused dangerous irregular heartbeats, coma, heart attacks, and death. Long-term abuse can cause depression, liver and kidney damage, memory loss, eye pain, itchy skin, urine retention, and abdominal pain.
  7. Sexual performance medicines: OTC sexual performance medicines, often purchased via the Internet, are sometimes abused by teens and adults who are drinking to counteract the negative effects of alcohol on sexual performance.  These medicines can cause heart problems, especially when combined with alcohol or when taken in large doses.
  8. Pseudoephedrine: This nasal decongestant and stimulant is found in many cold medicines. Its similarity to amphetamines has made it sought out to make the illegal drug methamphetamine. The medicine has also been taken as a stimulant to cause an excitable, hyperactive feeling. Abuse may be less common with pseudoephedrine than with other OTC medicines due to a federal law requiring it to be kept behind the pharmacy counter, limiting the purchase quantity, and requiring photo identification prior to purchase. However, people have taken pseudoephedrine to lose weight, and athletes have misused the medicine to increase their state of awareness and to get them “pumped up” before a competition. Dangerous side effects include heart palpitations, irregular heartbeats, and heart attacks. When combined with other drugs, such as narcotics, pseudoephedrine may trigger episodes of paranoid psychosis.
  9. Herbal ecstasy: This is a combination of inexpensive herbs that are legally sold in pill form and swallowed, snorted, or smoked to produce euphoria, increased awareness, and enhanced sexual sensations. Marketed as a “natural” high, the main ingredient is ma huang (ephedra), an herb banned in the US but only in dietary supplements. The product can be purchased in gas stations, health food stores, drug stores, music stores, nightclubs, and online. It is easy to overdose on the product because the dose needed for desirable effects varies widely. The adverse effects can be severe, including muscle spasms, increased blood pressure, seizures, heart attacks, strokes, and death.
  10. Other herbals: Other herbal products are increasingly being abused for their stimulant, hallucinogenic, and euphoric effects. Besides being legal, another draw is that many herbals are not detected during routine urine drug screens. One example is salvia, which is ingested or smoked to experience a short-lived distortion of reality and profound hallucinations. Users can experience severe anxiety, loss of body control, extreme psychosis, and violent behavior. They are also at risk for accidents and injuries that may result from an altered mental state. Some states have regulated the sale of salvia. Another example is nutmeg, which is eaten as a paste to experience giddiness, euphoria, and hallucinations.  Nausea and vomiting set in within an hour and hallucinations begin within 3 hours and can last for 24 hours or more. Effects such as blurred vision, dizziness, numbness, palpitations, low blood pressure, and rapid heartbeat may occur.

One of the greatest difficulties with preventing OTC drug use is that few teens and adults realize the danger. Unlike the risks associated with illegal street drugs like cocaine and heroin, the risks associated with OTC drug abuse are given little thought and attention. Teens and young adults who learn about the risks of drugs at home are up to 50% less likely to abuse drugs.

POSTED: Thursday, January 10, 2013, 12:43 PM
Filed Under: T.J. Sharpe

Yea cancer pretty much sucks, but there are small benefits here and there if you know how to find them:

10. Facial hair freedom – First it was the playoff beard, now we’re rocking the Fu Man Chu (poorly I may add), who knows what is next. 

9. Mid-day naps – I average two. Per day. And they are fantastic. Somehow, this will continue after all is said and done. Siestas are way better than trying to plow through the afternoon on 5 Hour Energy.  Josie and Tommy are the perfect cuddle buddies for one of the aforementioned naps, as long as they don’t kick too much.

8. Baby weight loss – Granted, this wasn’t the ideal way to drop the sympathy pounds I put on while Jen was pregnant, but I do not have to worry about counting calories anytime soon.

POSTED: Tuesday, January 8, 2013, 9:29 AM

When you think of chemotherapy, images of suffering patients, clad in hospital gowns and bandanas, pop into mind.  Hours into my first chemo dose, I'm still waiting for our night to tailspin into the medical nightmares you read about.

Instead, it has been surprisingly good hospital food, surprisingly bad college football, and lots of sitting around in t-shirts and sweats talking to nurses and each other.  The toughest thing so far was choosing what color Gatorade to have (green over orange, no brainer). I know the next two weeks will give plenty of challenges, so I am grateful this start has gone rather smoothly. 

In serious situations, I lean on humor to lighten the mood. My nurse said I was the funniest chemo patient she has ever had, although I'm pretty sure she was pacifying me in hopes I would quiet down. When she set up the IV for the Cytoxin, she wore two sets of rubber gloves and a full smock-type thing, which led to this exchange:

POSTED: Tuesday, January 8, 2013, 9:00 AM
Filed Under: Daniel Hoffman

Last October we reviewed some KMR data, combined it with our own findings (see here) and concluded that while the industry's overall productivity at developing new drugs has not substantially changed during the past decade, the period between starting a compound's clinical trials and its registration filing has increased by more than a year during this time.  The single biggest reason why clinical development takes longer is that it simply requires more time to enroll enough patients in drug trials.  Over a decade or more that contributes to the growing costs of running trials, even as it increases the time required for each compound to start generating sales.

While several factors can plausibly contribute to longer patient recruitment times, a largely overlooked reason stems from the fact that pharma has never given it the sort of attention and resources commonly devoted to other aspects of drug development.  This presents an interesting bit of irony, if only because 85 percent of the entire cost for developing a compound occurs during the middle and late clinical stages.

Our assessments of the reasons for delayed patient recruitment have shown that clinical trial sites are organized into social networks with defined statuses, roles and norms.  Program teams charged with successfully managing a compound's clinical development within their pharma companies are only vaguely aware of these social networks, if at all.  Yet social network behavior is the efficient factor controlling the pace at which their sites screen and recruit patients.

POSTED: Monday, January 7, 2013, 1:52 PM
Filed Under: Michael Cohen

Look-alike and sound-alike similarity between the names of two different medications used in epilepsy might be putting children in jeopardy of getting the wrong medication. The drugs are clobazam and clonazepam.

Children with a rare and severe form of childhood onset epilepsy known as Lennox-Gastaut Syndrome (LGS) are most vulnerable to this error. Clobazam was approved by FDA in October 2011, specifically for this condition. LGS is characterized by frequent seizures and different seizure types, often accompanied by developmental delay and psychological and behavioral problems. Its onset is generally between the ages of 4 to 6.

Mix-ups between these two medications have been reported to us, both by hospitals and community pharmacies, and the potential for confusion is unmistakable.

POSTED: Monday, January 7, 2013, 9:00 AM
Filed Under: Embarrassing Questions

I've noticed a tiny bit of white discharge from my nipples, but I don't have a baby. Does this mean I'm pregnant?

John Missanelli, DO, is a gynecologist at Lourdes Health System.

Discharge from the breast of any color and consistency is normal.

POSTED: Sunday, January 6, 2013, 4:00 AM
Filed Under: T.J. Sharpe

167 days.  That’s how long it will be fromfirst checking into the hospitalwith flu-like symptoms and when I start the most intense, and important, treatment for Stage 4 Melanoma.  For you moms out there, I am almost in the third trimester – many surely remember the feelings of anxiety mixed with excitement as “the date” got closer.  So, yes, getting the green light this past week was an exhale moment.  It is go time.

This year has already been about go-go-go, less than a week in.  I experienced the life of a sports reporter for a few hours at the Outback Bowl in Tampa on January 1st.   Knights Sports Productions, a radio and television sports production company based in Tampa, brought me to Raymond James Stadium to shoot a segment prior to the game. Our team watched the game in the press box and, for the final five minutes, from the field.   If you saw the game highlights (a last-second South Carolina win over Michigan), you saw us standing under the goalpost as the Gamecocks scored the winning touchdown.  Pretty cool! And anote to the Eagles front office- you want to finish 0-16 next year and draft Jadeveon Clowney. Trust me on this one.

Alas, all good things come to an end, so the following day I got a port placed in me.  It is a “permanent” IV; inserted for the next month so they don’t need to keep sticking me with needles.  Presented as a small procedure, it wiped me out for nearly a full day, and certainly was not pain-free.I don’t know what I was expecting, but placing a tube into your chest vein the size of a Big Gulp straw is not the same as a routine blood draw.

POSTED: Saturday, January 5, 2013, 10:00 AM
Filed Under: Daniel Hoffman

Editor’s Note: All this week Check Up will be sharing one new Pharma fact a day that was an important breakthrough in the world of pharmaceuticals in 2012. Today, Check Up delves into health care changes.

One of this year's memorable expressions came from a wise fellow at a major software company. He was developing cost-effective treatment guidelines for medical practices, based on electronic medical databases, when he said, "Pharma is not just in the caboose on this, they don't even know the train has left the station."

Pharma's entire customer base, their needs and what they expect from drug makers are changing enormously.  The customers will no longer be individual physicians, isolated in their offices and too busy to maintain state of the art knowledge about therapeutics.  Increasingly those physicians will be working for large groups that are part of integrated delivery networks.  In the future these larger corporate entities must share in the risk of patient outcomes and they will be pharma's customers.  In this capacity the large practice groups and networks will decide which drugs to use and when.  Individual physicians will be free to deviate from their network's preferred formularies, but they will seldom choose to do so.

About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Michael Cohen id the president of the Institute for Safe Medication Practices in Horsham.

Daniel Hoffman is the president of Pharmaceutical Business Research Associates (PBRA) in Glenmoore, Pennsylvania, a healthcare research and consulting company specializing in key account positioning and messaging.

Michael Cohen
Daniel Hoffman
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