Showing posts with label drugs. Show all posts
Showing posts with label drugs. Show all posts

Tuesday, September 8, 2015

Vaporizing Cannabis Using E-Cigarette Equipment—It’s Happening in High School




          We and other journals have been publishing articles on the increasing prevalence of electronic cigarette (e-cigarette) use among teenagers despite their not being approved for use before age 18.  But what happens when the equipment for vaporizing nicotine and other chemicals that make up the contents of an e-cigarette is used by teens for vaporizing cannabis?  So how prevalent is this practice among adolescents?  Can you predict what subtypes of e-cigarette users will do this?  What forms of cannabis are being used for vaporization?  
       Morean et al. ( (doi: 10.1542/peds.2015-1727) ) share the results of responses from more than 3800 Connecticut high school students who completed an anonymous survey with some dramatic results that you will want to know about.  The fact that those 18% of those who regularly use e-cigarettes will vaporize cannabis was surprising to us.  Link to this study and learn a great deal more from the results of this survey than you may have imagined, enabling you to then introduce this subject into conversations with adolescents in your practice.   
      Were you aware of this practice?  Is it happening in your community?  Please share your experience with vaporizing cannabis by responding to this blog, sending us an e-letter, or posting your comments on our Facebook or Twitter sites.

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Monday, August 31, 2015

Use of Marijuana and Alcohol among Youth with Chronic Illness, Especially Those Non-Adherent to Treatment

By: Lewis First, MD, MS; Editor-in-Chief 

          Adolescent risk-taking is something we all work hard to talk about and prevent with our teen patients during routine health maintenance visits.  But how often do we focus on risk-taking prevention in our teens with chronic illness such as cystic fibrosis, diabetes, inflammatory bowel disease and others? 
      Weitzman et al. (doi: 10.1542/peds.2015-0722) share with us the results of a cross-sectional study of more than 400 chronically ill preteens and teens ranging from 9 to 18 years who completed a self-administered survey that enabled correlation of risk-taking behaviors with disease knowledge and treatment adherence behaviors while controlling for possible confounders like mental health co-morbidities.  
      The results are concerning and show high school aged teens with chronic illness demonstrating more usage of alcohol and binge drinking as well as marijuana use than you might expect and things get even worse in those teens who forget or skip their routine medications.  There’s lots more to be learned and then shared with your patients with chronic illness with the hope of curbing their risk-taking so at no risk—read this article and learn more.   
     Are you finding your non-adherent teen patients with chronic illness are similar to those in this study when it comes to risk-taking behaviors?  Share your thoughts with us by responding to this blog, sending us an e-letter or posting on our Facebook site or Twitter.

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Tuesday, February 3, 2015

Tobacco Product Use by Teens: Concerning Information


By: Lewis First, MD, MS; Editor-in-Chief  



          Despite the efforts being made to curb conventional cigarette smoking in teens, it seems that more and more tobacco options are being marketed to teens and young adults—and one wonders what it is doing to smoking patterns practice by adolescents today. 
Well wonder no more. Based on a study being released this week by Lee et al. (doi: 10.1542/peds.2014-3202) that used data from the National Youth Tobacco Survey involving almost 25,000 teens in grades 6-12.  The bottom line may surprise you in that nowadays, teens who smoke are twice as likely to use at least two or more different tobacco products as those who smoke tobacco cigarettes alone. 
What is contributing to the uptick in poly-tobacco use makes for an interesting read as the authors discuss the importance of flavored products, e-cigarettes, and media marketing of such products as contributing to the increasing prevalence of tobacco usage.
There is much to be learned in this study regarding the smoking habits of our teen patients—information that we should share with our patients as well.  If you want to smoke out why teens are continuing to smoke and what risk factors may be enhancing their desire to do so, read this study to learn more.

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Friday, December 19, 2014

Preventing Hazardous Drug-Drug Interactions in Children



Photo Courtesy of Kathea Pinto
Editorial Board Member Joann Schulte, DO, MPH

Drug-Drug interactions remind me of Haiti.  Specifically I think of the bokor (folk medicine healer vs. witch doctor) who used to sit under the flambeau trees at an outdoor market at Deschappelles, near the compound of Albert Schweitzer Hospital. He would set out a lazy susan swirl tray of capsules and tablets arranged by color. Patients would spin it like like a Vegas roulette wheel, picking a pink one and a turquoise one or some other mixture for malaria or hypertension. The hospital staff was persistent in telling patients that you couldn't take medicine that way. But the bokor always had supplies and customers, some of whom ended up admitted to the hospital.

I think about that roulette twirl these days as I’m learning more about Drug-Drug interactions in the US in a medical toxicology fellowship at the North Texas Poison Control Center in Dallas Parkland Hospital. Bad pharmaceutical consumption out of home medicine cabinets is a common history I hear. Every week or so I see patients who jiggered up their personal suicide attempts with a combination of benzodiazepines, street drugs, opioids and alcohol. Other patients are toddlers who went candy hunting in grandmother’s purse. 

Another category of drug interactions –unintended and often undetected– occurs in US hospitals. Those Drug-Drug interactions are the focus of a study published in Pediatrics this month.

Dr. Feinstein et al. (doi: 10.1542/peds.20142015) investigated potential Drug-Drug interactions (PDDI) among almost half a million hospitalizations in 2011 in forty-three pediatric hospitals.   They classified PDDI as contraindicated (shouldn’t be used together), major (life-threatening or medical intervention needed), moderate (may change the patient’s condition or require medical intervention) and minor (limited clinical effect).  They used an administrative database to calculate the potential interactions in a retrospective cohort study.

The researchers from Colorado and Philadelphia founded that 49% of the admitted children (approximately 245,000) had one or more PDDI. A contradicted PDDI occurred in 1% of admissions.  Opioids were were involved in 25% of of all PDDI, followed by anti-infective agents (17%), neurologic agents (15%), neurological agents (15%), gastrointestinal agents (13%) and cardiovascular agents (13%).

The likelihood of PDDI exposures increased with length of hospital stay. Among infants, 21.8% were exposed to a PDDI on the first day.

The authors have done a study showing potential PDDI, not actual data and have done it using an administrative database. But their work is important because it suggests how frequent Drug-Drug interactions might be. The numbers of reported adverse drug events are much lower. In 2003, 10% of pediatric hospitalizations were reported to have included an adverse drug effect.  

In short, the work done by the Colorado and Philadelphia researchers suggests that actual prevalence of Drug-Drug interactions might be under reported. More work is needed to verify how often such Drug-Drug interactions happen. There’s a big gap between the potential 49% reported here and the actual reported 10%.