Pharma

Tom Petty’s COD Lesson for Underwriters

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Good article from The Dose Makes the Poison blog.  You can read the entire article here.

I found the following excerpt fascinating.  The bold lines are my highlights.

From a general forensic toxicology standpoint, the real takeaway is that this is a dangerous combination of substances to use concurrently. He was consuming two powerful opioid and two potent benzodiazepines which when used together can create synergistic effects and exaggerated central nervous system depression. Add that situation to an already compromised cardiovascular and respiratory system, and it’s a recipe for disaster.  For my own information, I would love to see the full toxicology report with quantitative measures of drug, etc. How much fentanyl was present? How much temazepam and alprazolam were detected? Not that any of that really matters though.

With the detection of acetylfentanyl and despropionylfentanyl, it seems as if Tom Petty was supplementing his pharmaceutical medications with illicitly manufactured substances. Acetylfentanyl is not a pharmaceutical medication anywhere in the world and is only found as a designer opioid/analog meant to skirt the controlled substances act in the USA. Fentanyl does not metabolize to acetylfentanyl. As despropionylfentanyl is a precursor/intermediate used in the illicit (non-pharmaceutical) synthesis of fentanyl, it generally used as a marker for exposure to illicitly manufactured fentanyl. The presence of this substance has also been associated with the use of various fentanyl analogs including acetylfentanyl, acrylfentanyl, and furanylfentanyl. No one knows if the use of illicit opioid was intentional or not. Remember the situation surrounding Prince’s death. Multiple pills were found in his residence that looked like pharmaceutical hydrocodone/acetaminophen but turned out to be counterfeit tablets containing fentanyl and the opioid research chemical U-47700.

As a conclusion, I’ll say, please do not mix depressant drugs. Do not mix opioids with benzodiazepines. Do not mix either of them with ethanol. Stay safe, folks.

Pay attention to those medications.

Didn’t I mention this previously when writing about Heath Ledger’s death?

PulmCrit- Phenobarbital monotherapy for alcohol withdrawal: Reloaded

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It has been said that alcoholics exist to teach physicians humility. These patients are quite complicated, often suffering from several problems simultaneously (e.g., withdrawal, nutritional deficiencies, trauma, infection, psychiatric problems). Arguably the most important task when treating alcohol withdrawal is exclusion of alternative or superimposed problems. Phenobarbital obviously cannot be expected to solve every problem that may exist in an alcoholic patient.

Phenobarbital does, however, appear to be a uniquely effective and safe treatment for alcohol withdrawal (including withdrawal seizures and delirium tremens). Several reasons for the superiority of phenobarbital are listed above. Preliminary evidence suggests that these do indeed translate into meaningful clinical benefit (e.g. faster recovery, fewer complications).

Read the entire post here.

The Battleground of Prime Time Media, Disease, and Death

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I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and non-healing wounds, as well as other dire medical complications.

Read the full article here.

 

Gastric Cancer Risk Doubled With Long-term PPI Use

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Source: Gastric Cancer Risk Doubled With Long-term PPI Use

The study was published online October 31 in Gut.

The researchers point out, however, that this was an observational study, which can’t prove cause and effect.

A strength of the study is its use of data from a large population-based database with complete information on subsequent diagnoses and drug prescriptions, which minimizes selection, information, and recall biases, the researchers say. Use of strict exclusion criteria as well as propensity score adjustment to control for potential confounders and restricting the sample to patients with successful H pylori eradication are other strengths.

In terms of study weaknesses, the researchers  lacked information on some risk factors, such as diet, family history, and socioeconomic status.  And despite the large sample of more than 63,000 H pylori–infected patients, the small number of gastric cancer cases did not allow for any “meaningful evaluation of the dosage effect and role of different PPIs,” the researchers say.

Benzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management – emDOCs.net – Emergency Medicine Education

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Prescription benzodiazepines continue to be commonly prescribed drugs for treatment of mood and anxiety disorders. In 2015, more than 32 million people over the age of 12 reported use of benzodiazepines in the previous year. Of these, nearly 20% used benzodiazepines in a pattern of misuse (Figure 1).1 Benzodiazepines also ranked second among misused/abused drug related visits to the ED by patients aged 65 and older in 2011.2 The rates of long term benzodiazepine use have steadily increased over time. A retrospective study showed an age-related increase in the percentage of benzodiazepine use with higher rates of any benzodiazepine use in women at any age.3 Most of the patients with long term benzodiazepine use received their prescriptions from prescribers who were not psychiatrists.4 Benzodiazepine dependence can be seen within just 3-6 weeks of regular use at therapeutic doses.3

Source: emDOCs.net – Emergency Medicine EducationBenzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management – emDOCs.net – Emergency Medicine Education

Physicians are being murdered for not prescribing opioids

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I would like to suggest that the root of this opioid epidemic lies far deeper than “physicians overprescribing.” The problem is that we are now a society of adults who have no coping skills. No ability to deal with the curves that life throws us. Everyone is looking for a quick fix. We have taught our children that they should never have to feel any sort of discomfort whether emotional or physical.

Source: Physicians are being murdered for not prescribing opioids

I’ve been concerned about the lack of coping skills for quite some time.

Then I read this:

The number of Americans who say they’ve taken an antidepressant over the past month rose by 65 percent between 1999 and 2014, a new government survey finds.

Source: Antidepressant Use Jumps 65 Percent in 15 Years

This is depressing.