“Krokodil” Hype: In a piece posted at Slate, Justin Peters cuts through the nonsense regarding just how fast use of “krokodil” is spreading in the U.S., and concludes there are much more important threats to worry about.
Dangerous Bali High: The Irish Mirror reports that in the months of August and September of this year, 52 people have died of methanol poisoning after drinking tainted Arak — a local spirit — in Bali. This is an ongoing problem — TPR has reported on it before.
The Power of Poison: In the New York Times, Edward Rothstein reviews the just-opened blockbuster show “The Power of Poison” at the American Museum of Natural History in New York City.
Dietary Supplement Recall: The FDA announced today that USPlabs in Dallas is voluntarily recalling OxyElite Pro dietary supplement products that contain Aegeline, a compound derived from the bael tree (Aegle marmelos.) Aegeline has been associated with hepatic injury. Further studies are underway in an attempt to determine whether the connection is causative. This week, the FDA also banned the hallucinogenic stimulants 25I-MBOMe, 25C-NBOMe, and 25B-NBOMe, making them schedule I, illegal drugs for the net 2 years under the Controlled Substances Act. The FDA announcement notes that “these compounds have been linked to the deaths of at least 19 Americans aged 15 to 29 between March of 2012 and August of 2013.”
WSJ on Laundry Pods: The Wall Street Journal ran a front page story today about the danger that single-dose detergent capsules (“laundry pods’) pose to toddlers. These capsules were designed to by colorful and eye-catching, and ended up looking quite like candy and being attractive to young children. Although about 10,000 pediatric exposures were reported to poison control centers over the past year, there has been only one reported death, that in a 7-year-old Florida boy last August. The pods have been redesigned to be opaque and less attractive. The old product is being phased out. (H/T @AAPCC)
More “Krokodil”: The November issue of the Maryland Poison Center’s “toxtidbits” gives a brief discussion of “krokodil”, the homemade opiate that has been getting much press in the last month or two. Although the discussion claims that “to date, no cases have been confirmed in the United States,” it doesn’t delve into exactly what “confirmation” would consist of. (Not an easy question when it comes to “krokodil”!) It also apparently was written before the recent case report from St. Louis, which appeared to be a confirmed “krokodil” exposure on the basis of history and soft tissue injury.
Benzodiazepines and Liver Disease: Over at Academic Life in Emergency Medicine, Bryan Hayes (@PharmERToxGuy) points out that all benzodiazepines are metabolized by the liver, but through different pathways. The “LOT” drugs — lorazepam, oxazepam, and temazepam — are metabolized by conjugation, and do not have active metabolites. Therefore, their half-lives are relatively unaffected by hepatic disease. Other common benzos — such as diazepam, clonazepam, and midazolam — are handled by the CYP450 system and have active metabolites. Their durations of action can be radically prolonged by cirrhosis or severe hepatic failure. There is expert peer review commentary by David Juurlink (@DavidJuurlink).