EMERGENCY ROOM VISITS – ILLICIT DRUG ABUSE TOP TEN

poppy.gifAccording to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

meth-1.pngMETHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300

HALLUCINOGENS……………….OVER 3700

LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers. ecg_evol1.gif

This data is from the 2004 National Center for Health Statistics, the latest full database.  Prevention is the key in almost all of these killers.  With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top.  For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%

CANCER…………………………………………………………………………………23.1

CEREBROVASCULAR DISEASES…………………………..6.3%

CHRONIC LOWER RESPIRATORY DISEASES…………5.1%

UNINTENTIONAL INJURY…………………………..4.7%

DIABETES MELLITUS……………………………..3.1%

ALZHEIMER’S DISEASE………………………2.8%

INFLUENZA AND PNEUMONIA……2.5%

KIDNEY DISEASES……………….1.8%

SEPTIC CONDITIONS……….1.4%

CHEESE – MARKETING HEROIN FOR YOUR KIDS “SAY CHEESE”

cheese-drug.jpgAs part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

paremsan
(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.

cheese-drug.jpgSAY “CHEESE” MAY BE THE LAST PICTURE TAKEN……..

HUG YOUR KIDS TODAY!

AARP article misses the boat – DRUG SAMPLES AND DRUG REPS – MAYBE NOT SO BAD – BUT LIMIT THE DIRECT-TO-CONSUMER ADS and LAWSUITS

A recent article in the AARP Bulletin highlighted an email of a drug company's inside commentary on drug representatives and their impact on physicians' practices.  Congress was on this subject of how doctors obtain information years ago, and rather than mandating legislation, the Pharma Industry limited themselves.  Now the irony here is that, all the Pharma Industry now advertises the millions and millions of dollars for their new drugs on television, cable and non-cable, radio, and the print media.  How many ads of erectile dysfunction have you seen or watched in the last few years?  What about allergy drugs?  Those ads seem to be everywhere also.

Meanwhile, most doctors get some of their information from drug company representatives.  The doctors of yesteryear were wined and dined – alot.  But all that has changed.  Company meetings for continuing medical information and education are sponsored for cost.  However, the rules are tight.  No trips to Hawaii have ever been offered to me, in 25 years or so.

Now the medical appliance industry, like the artificial hips, pacemakers, etc., are not included in the Pharma SELF-imposed rules.  This industry works like many others.  Recently my awareness was stretched when a person told me ALL hundreds of employees of a beer industry were wined and dined, golfed, and brought to a city with alot of casinos!  All on the company.  And recently a marketing company took hundreds of employees to another city for 3-4 days, for their needs.

Now, most doctors do like to see drug representatives.  We do get good and current information from the reps.  If the doctor has a brain, he or she will and can challenge the drug rep with his product, his information, and his competition.  This is good information.

Literally, thousands of patients through the years have asked for "Any free samples?" Many times we can accomodate some starter paks of medicines that have been given to us by the pharmaceutical representatives.  Most clinics get some samples for patients.  According to a recent study over 75% of clinics get free samples.  Many times the reps will sponsor quick to the point luncheons.  Some doctors join company panels to discuss the highlights and controversies of new therapy.  So, what is the big deal?

Most pharmaceutical reps are good people.  Most earn their living by providing information currently and timely.  Most doctors are good people.  Most earn their living by providing good patient care.  Most patients are good people.  Most enjoy and sincerely appreciate a "few samples" to start their drug regimen.

Now, with the costs of drugs so high, and the pressure on the drug companies to limit free samples or starter paks, it would seem to be soon – a policy that will be forced out.  This will be a loss for the underinsured, uninsured, family of four parents, and others that look at the costs in general of healthcare and delay or eliminate their prescription all together.

The billions of dollars spent on "direct-consumer-advertising" that is endorsed by the FDA and other federal, state, and societal organizations is the first place to cut drug costs.  Those ads drive the physician by patient requests.  Get rid of direct to consumer advertising.  Next, get rid of the massive class action suits against all the companies.  The U.S. has driven the vaccine industry out of the U.S. and the drug making is not far behind.  If the vaccine shortage concerns did not awaken some fear in you, this should.

So, soon, patients will say good bye to free samples, free starter cost reduction cards, and reduced up to date physician information.

As for me, trips, rock n' roll collections, and tennis racquets have not crossed my desk….And to say they do is just crazy by a biased author.  And some of the doctors will stay "chummy" with professional colleagues in the pharmaceutical representative business.  Some might call that professional interaction and ethical education…

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

Stroke and other cardiovascular diseases are linked closely to high blood pressure.  In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked.  Most of these studies have been a type of case control showing high probable causal relationship.  Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue.  In the study, persons were given about 2.6 gms or 2.0 gms of salt daily.   Another group of placebo was a control also.  The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period.  This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group. 

We have long known this concern of salt and high blood pressure and other cardiovascular diseases.  Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day. 

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %.  In many developing countries however, the personal use is the burden of salt.  Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation.  More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it.  Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products?  Dear ol' Mom probably had it right when she said, "Not so much salt!" 

So next time you pick up the product, do a salt survey.  Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk.  The debate appears to be over.  Salt can take a toll.  Be a wise shopper and a wiser eater. 

Salty popcorn with butter anyone?  Remember, more fiber, less salt, less trans-fats….Yuk!

ER – CRITICAL ENCOUNTER OR DEATH IN FRONT OF YOUR EYES

After yesterday, castMD must speak out again.

The Emergency Departments are at a break point. A year or so ago, almost 3/4 of all medical directors said their ER has inadequate specialist on-call backup! There are fewer specialists in general surgery being trained, and neurosurgeons are at a standstill in training numbers. Many of the ortho, neuro, and plastic surgeons are older and not being replaced in numbers.

Yet the numbers of ER patients is exploding in numbers. Many patients are uninsured, underinsured, and have serious illnesses and injuries. ERs must see, triage, treat, and plan for each one without asking for a dime upfront. Declining reimbursement with increasing costs is a martial arts contest in the ERs. EMTALA dictates ERs must see everyone! The on-call specialist to the emergency doctors have high liability with these patients. Some specialty groups have stated one third of their groups have been sued by patients that they have responded to in the ER patient's time of greatest need.

Many ERs have closed, and more will. Many hospitals cannot continue to absorb the see all and sue all patients under the mandated-free care system. It is broken, and yesterdays marches reminded me. No one should be turned away in a critical time of health-need, but the system is critical now.

Washington State did not pass tort reform. Why work there? Why be on call to an ER that will lead the doctor to critical patients with high malpractice risk? You wonder why doctors quit being "on-call" to trial attorneys. Oh, did the drycleaners mistake settle for the 60+ million yet?

DRUG ERROR – COLCHICINE – POSSIBLY LINKED TO FATALITIES

THIS IS IMPORTANT INFORMATION FOR THOSE PERSONS SEEKING MEDICAL AIDES AND MEDICAL CURES.  (REFERENCE CITED.)  
 
 
 
 
(generic photos from tufts.edu and generic medicines)
 
 
HeraldNet
The Herald – Everett, Wash. – www.HeraldNet.com

Published: Saturday, April 28, 2007

Toxic drug at Portland clinic causes three deaths

Associated Press

 


PORTLAND, Ore. – Three people in the Pacific Northwest have died after receiving a drug that was erroneously made 10 times more potent than intended, the Oregon State Medical Examiner’s Office said Friday.

ApotheCure Inc., a drug-compounding pharmacy company in Texas, said an employee made a weighing error in the creation of the drug colchicine, which lead to the deaths. Colchicine is commonly used to treat gout, but in these cases it was being given intravenously to treat back pain.

The drug was sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch of the drug this spring. All three people, two from Portland and one from Yakima, died between the end of March and beginning of April from the toxic levels of the drug.

The defective doses were sent only to the Portland clinic, ApotheCure said.

The Food and Drug Administration said it is investigating the case but believes the problem has been contained.

The Center for Integrative Medicine has since closed, and representatives from the organization could not be reached.

Colchicine works by stopping cells from dividing, which reduces inflammation in conditions such as gout, said Dr. Rob Hendrickson, associate medical director for the Oregon Poison Center. But in excess doses, the drug stops all cells from dividing – eventually leading to organ failure and death.

The medication is not commonly used anymore and the use as a back pain treatment is less common than for gout.

Gary Osborn, a pharmacist and certified clinical nutritionist for ApotheCure, said the situation could have been contained earlier, but the clinic did not contact ApotheCure until nearly two weeks after the first death. He said the second death occurred before the company was able to complete recalling the batch and sending them a new lot. He said this is ApotheCure’s first incident of this sort.

“We are kind of the leaders in the industry,” Osborn said. “But you know what people say, stuff happens.

 

Copyright ©1996-2007.
The Daily Herald Co.
ALL RIGHTS RESERVED.

 
 

POISON CENTERS AND TOXINS AND POISONINGS METH to METHANOL to MUSHROOMS – One Call 1-800-222-1222

This is the time of year when lawn chemicals, yard cleanups, and neighborhood events start to be exposed and available to little hands.  Certainly many chemicals, including pesticides, herbicides, fuels, and cleaning agents are ubiquitous in homes and garages.  But beware.  Many of these chemicals are poisonous and dangerous with regard to flammability, explosiveness, and chemical burns.

Each dollar invested in poison centers saves about seven dollars in expenses not needed if the patients go into their doctor, their clinics, or their hospitals.  This is a great public health service.

Over the years since the early 60's, the poison centers have become an integral part of the healthcare network.  Now with the terrorism issues, the poison centers have become an integral monitoring source of information, as many times calls come to the poison centers early and often, thereby making a grid of what is happening and where it is happening.

For instance, when the bad botulism toxin product that was being used by spas and clinics that were trying to save money by not buying and using the approved botulinum toxin brand, the poison centers were seeing a problem early.  Patients across the country, in pockets, were being paralyzed – not just the muscles of the eyebrow, forehead, and other smaller muscles.

The poison centers across the USA now have a single number.  Depending on your area code, your call will be forwarded to the center in your area, or the one contracted by your state officials.  For instance, Idaho calls go to Denver's poison center.  Alaska's poison calls go to Oregon.  Washington's poison center gets all of Washington State's calls.  This year that number will be around 150,000 calls!   Poison calls are answered by an expert group of pharmacists, nurses, Pharm Ds and have backup by physicians specializing in toxicology and poisonings.  It is the number that the experts in all fields, from dermatologists to kidney specialists, call when the patient has been poisoned, or is toxic from unknown sources, or when the patient doesn't act or change based upon "normal" disease states.

The goal of Poison Prevention Week is to reduce illnesses, injuries, and deaths due to poisonings; build safer communities; and reduce unnecessary health care costs for everyone.

 

Here are some ways to be poison cautious:

Obtain syrup of ipecac and keep it in your home – but use it ONLY if instructed to do so by a poison center or physician

Use child-resistant containers and remember, they are not childproof

Keep products in their original containers

Never call medicine candy or take it in the dark

Return products to storage areas immediately after use

Teach children about Mr. Yuk

Put Mr. Yuk stickers on all poisonous products  

Call the Poison Center for a free information packet and Mr. Yuk stickers  

Keep emergency numbers next to your phone:

1-800-222-1222

 

What is National Poison Prevention Week?

Public Law 87-319 authorizes the President to designate annually the third week in March as National Poison Prevention Week. This act of Congress was signed into law on September 16, 1961, by President Kennedy, after which the Poison Prevention Week Council was organized to coordinate this annual event. Congress intended this event as a means for local communities to raise awareness of the dangers of unintentional poisonings and to take such preventive measures as the dangers warrant.

(PC week and listing adapted from WAPC.org website with commentary from castMD.com)

The Cost of Cremated Ashes: Dad Nose Best A New Cocaine Substitute – Keith Richard’s Marketing Expertise’ – a parody of abuse

THE ROLLING STONE'S KEITH RICHARDS MAYBE SNORTED HIS DAD THE TABLOIDS HAVE COMMENTED AND THERE SEEMS TO BE CONTROVERSY REGARDING WHETHER IT WAS TRUE OR NOT.  CastMD CONTINUES TO DIG INTO THIS ISSUE WITH CLARITY AND REASON.  BUT INQUIRING BRAINIACS WANT TO KNOW THE NUMBERS……..SO HERE THEY ARE ! 

Theory:

Average cremation remains = 3700 grams

Crackdowns on producers and smugglers of cocaine in Colombia and the United States have caused the wholesale price of the drug to rise sharply, according to officials of the Federal Drug Enforcement Agency. A kilogram, 2.2 pounds, of cocaine that cost a dealer $15,000 six months ago now costs $25,000 to $30,000, Frank Chellino, a spokesman for the agency's Miami office, said. (NYT 4-5-07)

 

The common street selling price of cocaine hydrochloride powder is $80-$100 per gram. The purity of the drug is TYPICALLY diluted by dealers wanting to increase the volume of the cocaine to multiply profits. Popular "cutting" agents include lactose, inositol, mannitol, lidocaine, and even cornstarch, talcum powder, or sugar.  NOW YOU CAN CUT WITH DAD'S ASHES !!!

 

 

 

 

 Freebase cocaine is cocaine without its water-soluble component, or "base." It is prepared by prepping cocaine hcl with an alkali, and separating the cocaine from its impurities. The preparation of freebase cocaine involves the use of highly flammable solvents such as ether. "Crack" or "rock" cocaine is the street name given to freebase cocaine processed from cocaine hydrochloride to a base, then using a base and heating it to remove the hydrochloride. The resulting mixture is allowed to harden, then broken into small pieces or rocks, which can be easily smoked in a pipe. The term "crack" refers to the crackling sound made when the mixture is smoked.

Therefore:

30,000 dollars divided by 1000 grams is 30 dollars a gm wholesale.  Yet the retail prices vary, but about the 100 dollars a gram retail street value.

3700 grams of cremation remains is 370,000 dollars of cocaine equivalency in weight. 

The most popular method of use is to separate the powder into fine "lines" of approximately 1/4 gram, 4-6 inches long. A small straw is then used to "snort" the cocaine into the nose.

3700 divided by 1/4 gm per line is:

14,800 lines of cremation-dad cocaine-substitute ! 

Now, a direct cremation cost noted on the web was:

Direct Cremation Service : $625.00*

Therefore:

Cost of cremation divided by 3700 grams of cocaine substitute is 625 / 3700 = 0.1689 dollar/gram

SUMMARY:

IF YOU BUY COCAINE YOU WILL BE PAYING 80-100 DOLLARS RETAIL FOR ONE GRAM

USE CREMATION-DAD COCAINE-SUBSTITUTE  AND YOU WILL PAY ONLY 17 CENTS PER GRAM

IF YOU DO DRUGS, YOU DO THE MATH…BUT DON'T SNORT DAD-SNOW. 

 

 

 

GOING GREEN – AN ESSAY – THE WASTE BY THE PHARMA INDUSTRY AND ADVERTISING COMPANIES – WHERE IS AL GORE ON THIS?

Did you ever get a sample or starter pak of medicine from your doctor?  Usually, the pak will have one or two pills in a blister, nuclearbomb proof wrap, and then boxed with some expensive advertising.  When is enough, enough !  To top it off, the little pill in the blister pak in the little box is one of five or six other little highly advertised little boxes in a yet bigger box.  Then comes the literature that is mandated by the FDA to be put in each box or on the blister pak itself.  Then, with the leaving of the little boxes in the bigger boxes, pages and pages of highly detailed literature is presented and left with the doctor.  Only God or Buddha would actually know how much of this stuff ends up in the garbage.

 

And now, with the internet, WebMD, CastMD, Mayo Clinic, and other portals of Net-formation, why is all this waste appealing to the advertisers, the pharma companies, and the FDA subcommittees? 

If the waste would stop, more medicines could be used by clinics to help offset the high costs to patients for starter paks, courses of medicines, or to give to those without drug benefits…a rising number !  How about just a 5-10 point update on the med instead of pages of infitessimal fine print squished on multi-folded paper…What do you think FDA? 

Well, I hope Al and his Green friends read my essay today.  Maybe he could trade some of those "Green CO2 impression stamps" he bought to offset his private jet and give them to the FDA and the Pharma companies.  That way, the universe would be in drug balance, and we don't have to worry about trees, water, air, and the uninsured and underinsured.  ZZZZOOOOOOOMMMMMM, I hear his jet now………

BIOPHARMACEUTICALS AND GENERIC DRUG POLICY – GENERIC SAFETY EFFICACY PURITY – LEGISLATING WHEN A GENERIC IS A GENERIC?

 

Biopharmaceutical “generics” controversy continues on Capitol Hill.  Manufacturers say that the biopharmaceuticals cannot be guaranteed of safety, potency, and purity in the generic sense, since they are proteins and other biological type medications.  This is quite different from the many generic forms of other drugs, such as aspirin, penicillin, and other chemical drugs. 

Why is this such a big deal? 

Biopharm prices are considerable higher than chemical drugs.  Of the $252 billion dollars spent on prescription medicines in 2005, $33 billion was biotech-biopharm types of medicines. All med sales grow about 5-6 % per year, whereas the biopharm group grows about 3 times that rate. The top three selling biopharm meds were neupogen, epogen, and intron A – with costs at about 15, 20, and 22 thousand dollars per patient per year. Imiglucerase, an enzyme drug, will cost about 200,000 dollars per patient per year.  

Large carriers such as Kaiser and others are seeing astronomical increases in these drug costs.    Medicare estimates for drug plans estimated at 395 billion, now is over 650 billion over the ten years initial estimates. 

 In the generic marketplace, drug costs have been reduced about 50-70 percent in general.  However, this truly sensical process may be difficult to add to generic follow-through biotech group of biopharmaceuticals. How will the abbreviated new drug application be changed to allow “generic” or “follow-through” biotech biopharmaceuticals to progress faster to FDA approval?  Certainly, the savings for guaranteeing the purity, safety, and efficacy of the biopharmaceuticals may not be as great.  The big issue still remains whether the profits from “open season” on the off patent biopharmaceuticals will allow for continued research and development for newer and unique and orphan type biotech drugs that will save patients and save money.   

The baby boomers are passing through the biopharmaceutical turnstile now, and with growing numbers. 

How the 1984 Hatch-Waxman Act (Drug Competition and Patent Term Restoration Act) will change and what effect any change will have is to be determined as of yet.  This law allowed rapid development and approval of chemical drugs for generic distribution after patents expired on known brand name drugs. 

 

(Commentary by castMD with adaptation from:  Fuhr & Blackstone's article in Biotechnology Healthcare)