More on e-cigarette nicotine liquid: On KSTP-TV news in Minneapolis/St. Paul, medical toxicologist Dr. Ben Orozco discusses the hazards of e-cigarette refill liquid, and the signs and symptoms of nicotine toxicity.
Suicide by hydrogen sulfide: The St. Charles (LA) Herald-Guide reported the tragic story about a 32-year-old research scientist who killed herself by releasing hydrogen sulfide in her car. She had posted hazmat warnings in the windows to protect first responders. TPR has written previously about these s0-called “chemical suicides,” a phenomenon that started in Japan and often takes place in the victim’s automobile. HT @NaturesPoisons
Risks of fluoroquinolones: At Academic Life in Emergency Medicine, Matthew DeLaney discusses the clinical and medical-legal risks of fluoroquinolones, including tendinopathy and peripheral neuropathy.
Use of opiates to treat headache increasing in U.S. emergency departments: HealthDay reports that recently there has been a large increase in the number of prescriptions for opioid analgesics written to treat headache, according to a presentation at the March 2014 American College of Medical Toxicology conference in Phoenix:
The researchers analyzed national data from 2001 to 2010 and found a 65 percent increase in emergency department use of narcotic prescriptions for headaches during that period. The largest rise (450 percent) was in the use of hydromorphone, and there was also a significant increase in the use of oxycodone.
As the report notes, both the American College of Emergency Physicians and the American Academy of Neurology recommend that opioids not be first-line drugs for treating headache. (HT @LNelsonMD)
A related story in the Boston Globe describes how an effort by Blue Cross Blue Shield in Massachusetts to place restrictions on physicians’ ability to prescribe large amounts of opiate analgesics reduced scripts written for such agents by 20-50%. (HT @DavidJuurlink)
Fentanyl-laced heroin – a deadly combination: In Emergency Medicine News, Jim Roberts makes recommendations for treating heroin overdose in 2014, at a time when the number of cases are skyrocketing and drugs used to adulterate the supply on the street are becoming more varied.
Does legalizing weed make the roads safer?: In Forbes magazine, Jacob Sullum makes the counter-intuitive argument that loosening restrictions on the medical and recreational use of marijuana leads to decreased numbers of motor vehicle collisions and traffic fatalities. The argument rests on the notion — which is controversial but backed by some evidence — that increased use of marijuana results in decreased consumption of alcohol. (HT @NaturesPoisons)
Death after use of recreational marijuana: BBC News reports that in Denver a 19-year-old exchange student from the Republic of Congo died after falling from a hotel balcony. The accident occurred after the man ate a cannabis cookie, and after the autopsy the medical examiner listed marijuana intoxication as a factor in the death. although in Colorado use of recreational marijuana is not legal for anyone under the age of 21, the cookie had been purchased by another individual. (HT @Rx_Ed)
It’s 10 am. Do you know where your medical school Dean is?: The Wall Street Journal reports on the disturbing trend in which leaders of academic medical centers also serve on the boards of pharmaceutical companies:
The dual roles may create conflicts because these individuals “wield considerable influence over research, clinical and educational missions” at the same time they are chartered with promoting the fortunes of a drug maker, according to the paper in the Journal of the American Medical Association, or JAMA. The board members, by the way, were compensated an average of $312,564 in 2012 by the drug makers.
A recent survey of 17 U.S. drug makers found that 16 of them had at least one academic leader on its board. These included deans, university presidents, executive officers, and clinical department chairs. The conflict of interest created by this type of relationship should be obvious. The Milwaukee Journal-Sentinel has a related story. HT @pharmalot.
Magic mushroom intoxication: In a very amusing read, erowid.com reprints a 1914 first-hand account of mushroom intoxication from the journal Science. A man and his niece feasted on a large amount of the little brown mushroom Panaeolus papilionaceus. This species is generally considered non-intoxicating, but can contain psilocybin. In this instance, it apparently did:
Next, say about half an hour after eating, both of us had an irresistible impulse to run and jump, which we did freely. I did not stagger, but all my motions seemed to be mechanical or automatic, and my muscles did not properly nor fully obey my will. Soon both of us became very hilarious, with an irresistible impulse to laugh and joke immoderately, and almost hysterically at times. The laughing could be controlled only with great difficulty; at the same time we were indulging extravagantly in joking and what seemed to us funny or witty remarks. Mr. Y., who was with us, said that some of the jokes were successful; others not so, but I can not remember what they were about.
Short and highly recommended.
“Leaves of three, let it be.”: The excellent “Nature’s Poisons” blog this week features uroshiol, the toxin behind the nasty effects of poison ivy and poison oak. In another post, Justin from the blog writes about solanine and chaconine, the toxic glycoalkaloids found in green tomatoes.
Long-read of the week: In Esquire magazine, Ryan D’Agostino goes deep into the problem of proliferating ADHD drugs in with his piece “The Drugging of the American Boy.” A must-read. HT @DavidJuurlink
Podcast of the week: At the Journal of Medical Toxicology Podcast, Howard Greller and Dan Rusyniak discuss that publication’s March 2014 issue, including articles about complications of antidotal intravenous lipid emulsion therapy, toxicology of HIV medications, and problems with declaring brain death in overdose cases.