Tag Archives: drugs

Careful Steps Need to be Implemented to Avoid Drug Poisoning in Young Children

A recent study published in The Journal of Pediatrics blames greater availability of prescription medications in the household for the rise of accidental drug poisonings in children.

'My Medicine Cabinet' photo (c) 2008, Mr. T in DC - license: http://creativecommons.org/licenses/by-nd/2.0/

The large majority of these accidents, which lead to serious poisonings, hospitalizations and even death, are from young children finding and ingesting drugs by themselves. Failure to poison-proof a household may play a role.

However, the larger problem is simply the increased use and availability of prescription medications, including pain medications, narcotics, sedatives for sleep, muscle relaxants for injury, and cardiovascular prescriptions. Dosing mistakes for pediatric patients account for only a very small portion of the problem.

Past emphasis by FDA and other professionals has minimized therapeutic mistakes and does not account for the rise of serious drug poisoning in children. The offending medications are often not even drugs that are commonly used for children.

The most recent surveys show that 55 percent of adults have taken a prescription medication within the last week and 11 percent have taken five or more prescription drugs within the preceding week. The use of over-the-counter medications such as common anti-inflammatory products and acetaminophen has increased and created more prevalence in the home.

But the largest increase in poisonings remains from prescription medications, resulting in more adult medications around that are toxic to both toddlers and young children. Medications for seniors and grandparents are estimated to be involved in these accidents only 10 to 20 percent of the time. These products are often stored in containers or pill reminders that are not child resistant. The rise of more serious admissions for accidental poisonings and the types of drugs ingested, point to the greater availability of medications in a child’s environment without adequate precautions for protected access.

Some experts believe there are limitations to education about prevention and poison-proofing the home for children. The consensus among behavioral experts is that the best efforts in child proofing will result in prevention 90 percent of the time. Even that would be an improvement over the status quo.

The typical pattern for accidental ingestion is during the period of time that the medications are in use by an adult. They are typically left out for convenience without recognizing the hazard they present to a curious young child. Medication in locked cabinets is generally considered inconvenient, which limits the accessibility, especially when needed two or three times a day.

The recent information sheds light on the prevalence of prescription medications in a household and the serious risks of ingestion by children. Some experts have suggested new types of packaging that would restrict the access to medication by limiting the amount. This means adding flow restrictors for liquid medications and containers that would dispense only one tablet at a time. Such changes would have to be applied to both adult and pediatric products to have any beneficial effect.

Renewed education for all consumers about where the overlooked risks lie is an important first step. More thoughtful storage and access to prescription medications is necessary to restrict access for young children.

In general, the situation should give everyone reason to pause and consider society’s overall increased use of powerful medications such as opiates and sedatives that have clearly been on the rise. In turn, it has indirectly increased the risks to our children.

Preventative measures need to be taken to decrease the immediate risks. The larger picture is evaluating a society that relies too heavily on the use of therapeutic prescription drugs.

Dr. Bruce Kaler, U.S. HealthWorks Medical Group

Dangerous Bath Salts All the Rage and We’re Not Talking “Mr. Bubble”

On the heels of synthetic marijuana (K2/Spice), the basement chemists are already at it again. This time they are passing something off as a bath product when it is a designer drug based on amphetamine.

Designer drugs are actually an offshoot of a legitimate search for better medications. Whenever we, the medical community, find a medication that works, we try to improve it. I would like to tell you that the entire medical/pharmaceutical industry has nothing but the noblest of intentions, but a great deal of money is made on a “new” medication.

A pharmaceutical research team will try dozens of small modifications on a particular medication. Some won’t work, some might be toxic, and occasionally one is a better medication. Maybe it lasts longer so it doesn’t have to be taken as frequently. This also, not coincidentally, happens to get around the patent. Change one atom in the drug molecule and you have a new patentable drug to compete with the original. It also won’t test like the original.

Designer drugs are just variations of illegal drugs, attempting to get a stronger effect, or at least to change it enough, to get around drug laws. Ecstasy is a minor variation on Dextro-amphetamine.

Bath Salts are another variation of an amphetamine. The chemical name for so-called “bath salts” is MDPV (Methylenedioxypyrovalerone). MDPV shares a lot of the properties of its parent drug, Dextro-amphetamine. It is a stimulant and an appetite suppressant, but in some cases acts like a hallucinogen. It is believed to be roughly four times stronger than its parent drug, and that is problematic because people dose the drug in similar quantities as amphetamine.

The stimulant effects are physical as well as psychological. The extra alertness comes at the expense of an elevated heart rate, hypertension and physical alertness similar to the uncomfortable effects of adrenalin fight-or-flight response. Not exactly the clearheaded intense focus that its users are seeking.

Some rather nasty things are occurring with higher frequency than amphetamines or Ecstasy, its closest relatives. Psychologically, MDPV can cause hallucinations, delusional thinking and severe paranoia. Physically, we have seen a rapid breakdown of muscle, usually resulting in kidney failure and death.

MDPV is illegal in only a handful of states and the federal government has not yet acted on this new drug. There are emergency scheduling laws that allow the DEA/federal government to expedite a ruling on this drug. It will likely be illegal under federal law very soon.

These days the drug screen laboratories can come up with a test for these drugs faster than they can be made illegal. Testing for MDPV is available now and is a straightforward urine drug screen. It can be added to any non-DOT urine drug screen for a modest charge. The detection window for MDPV is about three days; which is longer than the 24 hours that Dextro-amphetamine is present.

We offer full MDPV testing at U.S. HealthWorks.

Take care.

Dr. Don Bucklin, MD
National Medical Review Officer

Answers to Common Questions About K2/Spice

As a follow up to our recent posting about K2/Spice, below is a Q&A on the drug and issues related to testing.

Q: What is K2/Spice?
A: This is a synthetic chemical that is slightly different from THC, the active ingredient in marijuana.

Q: Is K2/ Spice illegal?
A: The Federal Government, through the DEA, made K2/Spice a Schedule 1 Drug, the most restrictive category, identifying the substances as unsafe, highly abused substances with no medical usage. That action placed K2/Spice on par with marijuana, cocaine and heroin. It is illegal to sell, possess or use these drugs.

Q: Is K2/Spice legal under the medical marijuana laws?
A: Spice is a synthetic chemical that is sprayed on a dried plant. There is no marijuana plant in K2/Spice. The synthetic marijuana chemical is different from THC. K2/Spice is not legal under any present medical marijuana law.

Q: How does K2/Spice affect someone?
A: The effects are similar to being intoxicated on marijuana. Because this is a new designer drug, risks from short or long term use are not yet known. Previous designer drugs like Ecstasy have proven to have dangerous medical consequences that were unknown in the early years of use.

Q; Will someone who smokes K2/Spice test positive on a drug screen for marijuana?
A: No. The active chemical in K2/Spice is slightly different from THC. It is different enough that it won’t test positive on a marijuana drug screen. That is why K2/Spice was invented – to avoid detection but still get the same effects as smoking marijuana.

Q: Is there a drug screen for K2/Spice?
A: Yes. CRL has created a test that will detect K2/Spice. CRL is the largest lab in the country and is federally licensed. The K2/Spice test is of the same high and accurate standards as present drug screens for marijuana. U.S. HealthWorks recommends MRO review of any positive drug screen. Each positive urine test will be confirmed by a second GC/MS test, as is the current standard practice on all drug screens.

Q: Is the collection procedure any different for K2/Spice?
A: No. Normal drug screen collection procedures are followed. No additional urine is needed. The test for K2/Spice can be administered by itself (separately) or added to any non-DOT drug screen panel.

Q: Can K2/Spice be done on a DOT test?
A: No. DOT Part 40 specifies the exact drugs to be tested in federal DOT testing. K2/Spice is not currently permitted on a DOT test.

Q: Why is there an additional charge to test for K2/Spice?
A: It is an additional and separate test from marijuana and, therefore, an additional cost is applied.

Dr. B

Urine Drug Screening 101

Pre–employment drug testingphoto © 2011 Francis Storr | more info (via: Wylio)I see a lot of drug screens. As the National Medical Review Officer for 36,000 companies, I spend a lot of time answering questions about them. The most frequent category of question involves the numbers seen on positive urine drug screens results. I will review what these numbers mean and what they can and cannot tell you. I will try to clear up the cloudy urine, so to speak.

We’ll start with cut off levels. There is a simple concentration level that determines the “line drawn in the sand.” Any value equal or above the limit is positive, and those below the limit are negative, kind of like Black Jack.

Now to complicate matters, every positive drug screen goes through two different testing procedures. The first is called an immunoassay – this test is highly sensitive and not very specific. They can detect several variations of a drug (drugs break down into several parts in the body). In the case of marijuana, the cut off of the immunoassay is 50 ng/ml. Either the test is positive (above 50 ng/ml) and goes on to further testing, or it’s below 50 ng and is reported as negative. There is never an immunoassay numeric result.

Any positive initial test (immunoassay) will undergo a second testing of a different type-GCMS confirmation. This stands for Gas Chromatography Mass Spectrogram (don’t worry – there won’t be a test later). This is an extremely specific test that identifies one single drug variant in the urine. Because it identifies a single molecule type, the cut off level is low, 15 ng/ml in the case of marijuana. The GCMS result is the only number reported. The lab reports the test as negative if it is below 15 ng/ml. If it is above 15 ng, a quantitative number is given, like 38 or 300.

That is a lot to write down, but we are just talking a cut off level. We see cut off levels everywhere in life – 90% in school gets you an “A,” 89% a “B.” Driving 75 mph on the highway gets you there, while 80 mph gets you a ticket.

So, let’s say we have a drug screen that is positive for cocaine at 300 ng/ml (the cut off cocaine is 100 ng/ml on GCMS). Every day a company wants to know if the donor was under the influence at the time of the drug screen. The simple answer is: “I have no idea.”

That information isn’t available with a urine drug screen. The reasons are several. The most important is the concentration of drug in the urine is not the same as the concentration of drugs in the brain. Drugs in the urine don’t affect you; drugs in the brain do. The other reason a drug screen won’t reveal impairment is there are too many variables (unknowns). Among these are the donor’s dose, timing, body weight, food and drink intake, kidney and liver function. All affect the level of the drug in the system. So for a given value in urine, the donor could have arrived at that by taking hundreds of different combinations of drug amount and timing before the drug screen. So we can say the cocaine was definitely present in the urine, and it was a positive drug screen. The positive result cannot tell you if the donor is a long-term cocaine user or used it once in his life right before the drug screen. And it can’t tell you whether he was impaired (high) at the time of the drug screen.

So a urine drug screen only places the person into a user or a non-user group. We unfortunately don’t have chronic users groups and tried-it-only-once user groups to pick from.

– Dr. B