Creative Ways Drug Companies are Changing Drugs of Abuse

The FDA has taken a stance on decreasing drug abuse and pushing for drug companies to find ways to deter people from abusing prescribed medications (crushing, snorting or injecting tablets) or using medications the way they were not intended to be used.

Some of the novel drugs that have been created include:

• Hysingla is a harder to abuse hydrocodone that deters crushing, dissolving and injection because the contents turn into a thick gel when attempting to dissolve.
• Targiniq, when crushed and snorted or crushed, dissolved, and injected, the naloxone blocks the euporic effects of oxycodone making it less liked by abusers than oxycodone alone.
• Embeda is an agonist/antagonist combination of an extended release morphine with naltrexone. Naltrexone is not an active component unless the tablet is chewed, crushed, or dissolved.

Unfortunately, the most common route of abuse of these types of medications is the oral route. This cannot be addressed through the physical component of the tablets on the market but has been combated with changes such as state databases showing trends of prescription opioid fills and refills and also changing hydrocodone from a CIII to a CII causing more regulation and different rules for the pharmacist and prescriber to follow.

When People Fail

I am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.

Guest Post: Pain Management - A Way Out of Addiction To Pain-Killers and Opiates

Pain is a natural process we all have to go through in life, physical pain being the most common type. Whether it be from the prick of a needle or the debilitating pain of rheumatism, such circumstances require appropriate management, otherwise it can critically affect one's lifestyle. The use of painkillers and opiates are typical in the medical field. Ranging from Hydrocodone to Morphine, these valuable tools are used to treat many different diseases and injuries, including ankle sprains, headaches, animal bites, etc. Though they are safe to use in controlled frequencies and amounts within the care and observation of medical institutions, things can go out of hand when measures proper care isn't taken. If this sound all too familiar to you, here's what you should know.

What is Addiction? To work your way out of painkiller and opiate addiction, you must first understand when you're in that actual state. There are many symptoms of addiction that anyone can recognize. They are somewhat of a gray matter, however, mainly because pain is a subjective experience. Since different patients have different thresholds for pain, it becomes complicated to know whether the drugs have failed to manage the patient's pain or whether the patient is lying in order to be administered more painkillers. Common signs of addiction include running out of a prescription early, telling your physician the prescription is lost, using multiple doctors to get pain medication, and borrowing pain medication from friends.

The Best Solution Withdrawing from painkillers and opiates may just be as difficult and consequential as withdrawing from stronger illegal drugs. For this reason, it is recommended that one enter an inpatient facility in order to take on this challenging process right. An inpatient detox facility can help you through the initial pains of detox. The first few days are usually the hardest and most demanding, as it causes chills, fever, muscle pain, nausea and vomiting, due to spontaneous withdrawal. The staff in this facility also will also help one to understand why they began using in the first place and how to avoid making the same mistakes again.

Other Options? If inpatient care is not an option, the next best way to withdraw safely and effectively from painkillers and opiates is to slowly but surely stop taking the substance. For many, stopping spontaneously only makes the process of withdrawal more complicated and escalates the chances of a relapse before one even has the opportunity to orient themselves.

Natural Pre-Emption One of the best ways to avoid addiction to dangerous substances is to head off the reasons for taking them in the first place. For instance, headaches are currently the most common form of pain in today's fast-paced lifestyle. Many factors lead to headaches, and they can commonly be dealt with by tuning in to what your body naturally requires (rest, reduction of stress, etc), instead of simply reaching for drugs.

Painkillers and opiates do have advantageous effects. However, make sure you practice only the pain management techniques prescribed by a doctor. Even if you think something's not working or not strong enough, never make an adjustment to your dosage without consulting a professional - and never, ever try any medication without a prescription. Not only is it illegal, it could have very dangerous side effects.

Mya Gilmore is a nurse who writes about health, nutrition and more at the Bow Creek & Bella Vista Recovery Centers.

Guest Post: Depression And Addiction - How Are They Related?

Both addiction and depression are two serious health concerns that plague millions of people around the world. Dealing with addiction or depression on their own can be hard enough, but what happens when the two combine ? Studies have shown that there is a definite correlation between depression and addiction, and the two often go hand in hand. Here are some examples of how addiction and depression are related.

Depression Can Cause Addiction/Addiction Can Cause Depression

Depression can cause a person to turn to illegal drugs and alcohol to help mask the sadness and despair. Unfortunately, drugs and alcohol can cause an even deeper depression when a person realizes these substances only disguise problems for a short time. Because addiction and depression often occur simultaneously, they are closely related.

Psychological Problems

One way that depression and addiction are related is that they both stem from psychological problems. Chemical imbalances in an addicted or depressed person's brain cause him or her to suffer from these crippling mental illnesses.

Changes In Behavior

Both addiction and depression cause changes in a person's behavior. Both of these mental illnesses cause a person to become withdrawn, irritable and angry. These mental illnesses can also cause negative changes in the depressed or addicted person's relationships with others.

Medical Attention

In order to begin the long journey to recovery from depression or addiction, a person must seek medical attention. It is only with the help of ongoing therapy and/or medication that a depressed or addicted individual can have the tools needed to combat these horrible mental diseases.

Suicidal Thoughts

Depression and addiction can cause any person to have suicidal thoughts. In some cases, a person may even make suicide attempts. This is because both addiction and depression can completely diminish a person's will to live.. This hopelessness can cause suicidal thoughts and attempts.

Weight

A person who is suffering from addiction or depression usually experiences drastic weight gain or loss. This is because both of these mental illnesses cause disruptions with a person's appetite.

Appearances

When a person is depressed or addicted to illegal drugs or alcohol, he or she will eventually begin to acquire a disheveled appearance. Addiction and Depression often cause a person to give up caring about personal hygiene and cleanliness.

Depression and addiction to illegal drugs or alcohol are crippling conditions that can cause a variety of issues in a person's life. While depression and addiction are different mental health issues, they are related in many ways. In fact, in many cases addiction and depression occur at the same time. From a disheveled appearance to angry outbursts, addiction and depression can cause a variety of related problems. While they do have many similarities, both addiction and depression need to be treated individually by a medical professional. It is only through treating each issue individually that a person can begin to heal from addiction or depression.

Marcia Timm is a substance abuse counselor who who writes about health, nutrition and more. Her most recent work focuses on the Top 10 TED Talks on Psychology.

Diprivan and the Death of Michael Jackson

Milk of amnesia, propofol, diprivan, whatever you want to label it, diprivan has always been a medication that I put in the category of a medication that definitely needs hospital or long-term care support when administrating. Now because of the latest error a physician made in the case of Michael Jackson, the drug is propelled into the spotlight. Just recently:

Propofol: Limited Recall Due to Elevated Endotoxin Levels − July 2009

Teva Pharmaceuticals USA has announced a voluntary recall of certain lots of propofol injectable emulsion 10 mg/mL 100 mL vials. The lots identified are being recalled due to elevated endotoxin levels in some of the vials. Teva has received reports of 41 propofol treated patients experiencing postoperative fever, chills, and other flu-like symptoms; most cases reported appeared to be self-limiting. Possible adverse effects associated with elevated endotoxin exposure include fever, chills, and rigors. High endotoxin level exposure may be associated with more serious adverse effects including disseminated intravascular coagulopathy, acute respiratory distress syndrome, and death.

But, that only included certain lots. Sounds scary, huh?

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Um, no brainer. It's a medication that is an intravenous infusion and has several pharmacological purposes includng induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age; in adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients.

And straight from the books:

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: May rarely cause hypersensitivity, anaphylaxis, anaphylactoid reactions, angioedema, bronchospasm, and erythema; medications for the treatment of hypersensitivity reactions should be available for immediate use.

• Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Patients who develop hypertriglyceridemia (eg, >500 mg/dL) are at risk of developing pancreatitis. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3-7 days thereafter. Monitoring of serum triglycerides should especially be considered with therapy >48 hours with doses exceeding 50 mcg/kg/minute (Devlin, 2005). An alternative sedative agent should be employed if significant hypertriglyceridemia occurs. Use with caution in patients with preexisting hyperlipidemia as evidenced by increased serum triglyceride levels or serum turbidity.

• Hypotension: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Use with caution in patients who are hemodynamically unstable, hypovolemic, or have abnormally low vascular tone (eg, sepsis).

• Injection-site reaction: Transient local pain may occur during I.V. injection; lidocaine 1% solution may be administered prior to administration or may be added to propofol immediately prior to administration to reduce pain associated with injection (see Administration).

• Myoclonus: Perioperative myoclonus (eg, convulsions and opisthotonos) has occurred with administration.

• Propofol-related infusion syndrome (PRIS): PRIS is a serious side effect with a high mortality rate characterized by dysrhythmia (eg, bradycardia or tachycardia), heart failure, hyperkalemia, lipemia, metabolic acidosis, and/or rhabdomyolysis or myoglobinuria with subsequent renal failure. Risk factors include poor oxygen delivery, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses >83 mcg/kg/minute or >5 mg/kg/hour for >48 hours), but has also been reported following large dose, short-term infusions during surgical anesthesia. The onset of the syndrome is rapid, occurring within 4 days of initiation. The mechanism of the syndrome has yet to be determined. Alternate sedative therapy should be considered for patients with escalating doses of vasopressors or inotropes, when cardiac failure occurs during high-dose propofol infusion, when metabolic acidosis is observed, or in whom lengthy and/or high-dose sedation is needed (Jacobi, 2002; Corbett, 2008).

Sound familiar???