To Flush or Not To Flush

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FDA lists meds for trash or toilet.

A recent post here on the subject of illegal bong water in Minnesota—coupled with a perceptive comment by a reader about drugs in the water supply—got me thinking again about what gets thrown in the sink or flushed down the toilet.

I was surprised to discover that, according to the Food and Drug Administration (FDA), consumers are better served by flushing some drugs down the toilet. The FDA has put up a web site dedicated to the proposition that flushing drugs is the preferred method for certain kinds of drugs—but not for every kind of drug.

While noting that “flushing is not recommended for the vast majority of medicines,” the FDA asserts at druginfo@fda.hhs.gov that “certain medicines may be especially harmful and, in some cases, fatal in a single dose...” To dangerous, in other words, to leave around the house or in the trash.

The potential for fatal overdose, particularly with prescription morphine and its derivatives, suggests that flushing will be the preferred method of disposal unless or until communities and pharmaceutical companies get serious about take-back programs and other medicine disposal services.

Specifically, drugs recommended for flushing include:

--Morphine Sulfate (Morphine, Avinza, Embeda, Kadian, MS Contin, and Oramorph).

--Fentanyl Citrate (Actiq, Duragesic, Fentora, Onsolis).

--Meperidine Hydrochloride (Demerol).

--Methylphenidate (Daytrana).

--Hydromorphone Hydrochloride (Dilaudid).

--Methadone Hydrochloride (Methadone, Methadose, Dolophine).

--Oxymorphone Hydrochloride (Opana).

--Oxycodone Hydrochloride (Oxycontin, Percocet, Percodan).

-- Sodium Oxybate (Xyrem).

The FDA says that the disposal of “these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”

The preferred disposal method for all other drugs, says the FDA, is to mix them with kitty litter or coffee grounds, place the mixture in a sealed plastic bag, and throw the container in your household trash.

Photo Credit: www.pri.org

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Alcohol and In Vitro Fertilization

Do drinking women face tougher odds?

Everybody knows by now that it’s not safe to drink while pregnant. However, a new study of more than 2,500 couples enrolled in a course of in vitro fertilization (IVF) treatment at a fertility clinic found that women who drank more than a single drink per day significantly reduced their likelihood of pregnancy, according to a report by doctors at the Harvard Medical School in Boston.

Now, it may not even be a good idea for women to drink while trying to get pregnant. And that includes you men out there as well.

Dr. Brooke Rossi presented the findings last week to a meeting of the American Society of Reproductive Medicine. In the study cohort, half the women and a third of the men had less than one drink per week, while about 5% of men and women had at least one drink per day. According to Dr. Rossi, women were 18% less likely to have a successful IVF baby if they drank at the higher level. Men who had more than six drinks per week reduced the rate of successful in-vitro fertilization by 14 %.

The average age of women taking part in the study was 34, and for men, the average age was 37. Tony Rutherford, chairman of the British Fertility Society, told the UK Guardian that “this is further evidence to suggest that alcohol does have an impact.” Rutherford agreed with the study authors at Harvard that women who wish to become pregnant should stop drinking.

In 1998, the British Medical Journal published a Danish study of more than 400 couples that concluded: “A woman's alcohol intake is associated with decreased fecundability even among women with a weekly alcohol intake corresponding to five or fewer drinks.” The authors conceded, however, that other studies have found little evidence of an alcohol effect on conception rates.

“It may well be that couples who are already subfertile are more affected by alcohol than those who are perfectly fertile,” Rutherford speculated. “Eggs and sperm take at least three months to develop so women have got to stop smoking, reduce alcohol consumption, or, if you are overweight, correct that weight, that far ahead if you want to maximize your chances of conception.”

Photo Credit: www.babble.com


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Bong Water Illegal in Minnesota

State Supreme Court calls it a “drug mixture.”

(See Update HERE)

The lesson is clear: If you live in Minnesota, and you happen to own a bong, be sure to pour out the water after each use.

Bong water is now officially a controlled substance in Minnesota, according to a state Supreme Court ruling last week. An Associated Press report by Steve Karnowski in the Minneapolis Star Tribune said the decision “raises the threat of longer sentences for drug smokers who fail to dump the water out of their pipes.”

The decision (PDF HERE) reverses two lower court rulings, which dropped charges in a case where a search of a Minnesota home included the discovery of a glass bong with 37 grams of liquid that tested positive for methamphetamine. Rice County authorities charged the homeowner with a first-degree drug offense for possession of a “drug mixture.”

The Minnesota Supreme Court ordered the case back to Rice County District Court prosecutors. The 4-3 decision, authored by Justice G. Barry Anderson, said that the bong water was clearly a drug “mixture” and therefore subject to state drug statutes. Anderson also wrote that a narcotics officer had alleged that drug users sometimes drink or inject bong water.

Justice Paul Anderson, writing in dissent, claimed the majority decision “borders on the absurd.” Bong water as a drug mixture carries a penalty of up to seven years in prison. However, when defined as drug paraphernalia, which is conventionally the case, the offense is a misdemeanor carrying a $300 fine and no jail time.

An attorney for the woman arrested and charged in the case said that officials were treating his client, “who had two tablespoons of bong water, as if she were a major drug wholesaler.”

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How Pure Is Ecstasy?

Dutch study of street MDMA.

For 16 years, the Drugs Information Monitoring System (DIMS) in The Netherlands has gathered and analyzed tablets of purported MDMA sold on the street as Ecstasy. In a research report published in Addiction, Neeltje Vogels and others at the Netherlands Institute for Mental Health and Addiction in Utrecht found that between 70 to 90 % of the samples submitted as MDMA were pure. The most common non-MDMA adulterant was found to be caffeine.

The study covered the years from 1993 to 2008. In the mid to late 1990s, researchers saw an increase in ephedra and methamphetamine in the samples, and sample purity hit an all-time low of 60% in 1997. The years from 2000 to 2004 were the golden era, so to speak, for MDMA purity. “After 2004,” the study authors write, “the purity of ecstasy tables decreased again, caused mainly by a growing proportion of tablets containing meta-chlorophenylpiperazine (mCPP).” mCPP belongs to a class of stimulants, the so-called piperazines, that have been banned in several countries (See my post).

As noted on the DrugMonkey science blog, a lack of consistent published data has hampered efforts at studying street MDMA. Tablets for analysis are obtained either from law enforcement—which seizes drugs that may or may not be for sale at the club level--or drug analysis and harm reduction sites. The problem, DrugMonkey writes, is that “perhaps Ecstasy found to result in suspicious subjective effects on the user are submitted to harm reduction sites preferentially.” In other words, people only submit the brown acid.

The Dutch study, on the other hand, obtained samples for testing from capsules seized by club owners and given to the police, who then passed them on to DIMS for analysis. This system helped eliminate the possible bias effect of voluntary submissions.

The study also found that larger tablets, containing 100 mgs or more of MDMA, became increasingly popular starting in 2001.

DrugMonkey, an anonymous NIH-funded biomedical researcher, calls the study “an impressive longitudinal dataset.” The data, he wrote, give us “a good picture of the percentages of MDMA-only across time (higher than certain MDMA fans seem to acknowledge when it comes time to assess medical emergency cases) and the relative proportions of specific contaminants (certain baddies are quite rare.)”

Specifically missing in action most years is the baddy known as PMA, or para-methoxy-amphetamine, which has been implicated in many of the alleged Ecstasy deaths by overheating--a condition known as hyperthermia.

Graphics Credit: National Institute on Drug Abuse


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Moderate Drinking: The Debate Continues

New study says it’s the lifestyle, not the alcohol.

Ever since the first studies showed modest statistical health benefits for people who drank a light to moderate amount of alcohol, the debate has bounced back and forth among researchers. Now an Italian study of more than 3,000 older adults, published in the Journal of the American Geriatrics Society, claims that it is the moderate lifestyle of drinkers, and not the alcohol itself, which helps prevent functional decline as we age.

After controlling for body weight, level of physical activity, education, and income, Cinzia Maraldi and coworkers in the Department of Clinical and Experimental Internal Medicine at the University of Ferrara pointed the finger at lifestyle characteristics—primarily weight control and exercise.

The researchers did not dispute the finding that moderate levels of alcohol intake can lower the risk of cardiovascular disease--but lead author Maraldi said in a press release that “the benefit of alcohol intake on other health-related outcomes is less convincing.”

Maraldi said the positive effects of moderate alcohol on physical aging and cognitive impairment in the elderly may be only apparent, “because life-style related characteristics seem to be the real determinant of the reported association.”

The research follows earlier U.S. studies suggesting much the same thing. A finding that had become common folk wisdom—with perhaps a little nudge from the alcoholic beverage industry--is now openly disputed by scientists.

“The moderate drinkers tend to do everything right,” said sociologist Kaye Middleton Fillmore, in a New York Times article by Roni Caryn Rabin. “They exercise, they don’t smoke, they eat right and they drink moderately.” In the same article, an Oakland cardiologist said: “It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative.”

In the New York Times article, Dr. Tim Naimi of the Centers for Disease Control and Prevention said: “The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study—the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country.”

Photo Credit: Rhodes University


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Another Round of Trials for Vigabatrin

Firm secures funding for anti-craving tests.

A Florida pharmaceutical company has secured financing for additional testing of the anti-addiction drug vigabatrin, despite the drug’s poor performance in earlier trials. Patrick J. McEnany, chairman and CEO of Catalyst Pharmaceuticals (CPRX) in Coral Gables, said the company would continue developing CPP-109 , its version of vigabatrin, for the treatment of cocaine and methamphetamine addiction.

Vigabatrin garnered early publicity on the basis of early trials suggesting it might be effective against stimulant addiction. Unlike alcohol and heroin, cocaine and speed have proven particularly resistant to treatment with other drugs designed to diminish craving. A drug that effectively reduced craving in abstinent cocaine and methamphetamine addicts would open up a potentially large and lucrative market.

Catalyst said it raised $3.97 million in a recent common stock offering from a group of investors including Federated Kaufmann Funds. Catalyst owns exclusive licensing rights to several patents related to vigabatrin from Brookhaven National Laboratory, reports Genetic Engineering and Biotechnology News. The company also owns patents or patent applications in more than 30 countries. Catalyst recently acquired worldwide rights to a related patent held by Northwestern University.

Earlier, the U.S. Food and Drug Administration (FDA) had given Fast Track designation to vigabatrin. The drug increases brain levels of GABA, an inhibitory transmitter. However, CPP-109 failed in a mid-stage treatment for cocaine addiction. Brian Bandell of the South Florida Business Journal reported that during the 12-week study, the drug did not help addicts stay cocaine-free, compared to a placebo group. In July, the company’s stock was trading at a 52-week low of 39 cents.

Last week, Catalyst said its decision to renew testing and development efforts with vigabatrin was due to a reanalysis of data from the earlier test. The company said the review showed that overall test subject compliance rates during the clinical trial may have been as low as 40 %. The company also said that early results with methamphetamine addiction were promising, but not statistically significant due to the small number of test subjects.

Last year, there was also a flurry of interest in vigabatrin as a weight loss drug. (See my earlier post). The FDA has yet to approve the drug for use in the U.S., citing concerns about reports of retinal damage in patients overseas. Catalyst said it had not uncovered any clinically significant visual abnormalities in its CPP-109 testing programs.

Vigabatrin, or gamma vinyl-GABA, is marketed in Europe as Sabril, and has existing clinical uses for the treatment of specific types of epilepsy and infant spasms.

Graphics Credit: www.dosewatch.com


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Top 50 Smoking Awareness Blogs

Addiction Inbox makes the cut.

Addiction Inbox is pleased to find itself listed among the "Top 50 Smoking Health Awareness Blogs" by the Pharmacy Technician Certification web site.

Here is the description included in the listing:

"An exhaustive, comprehensive, and stimulating catalogue of information pertaining to the science of substance abuse, the Addiction Inbox counts nicotine amongst its list of dangers. Expect to see articles regarding tobacco control alongside psychological studies on the physical, emotional, and mental elements of addiction."

Thanks go to Ashley M. Jones for the listing, and for bringing it to my attention.

The latest numbers on cigarette smoking from the American Heart Association show that 23.5 % of white males are smokers, with female smokers having closed the gap considerably with a smoking rate of 18.8 %.

26.1 % of black men are smokers, compared to 20.1 % of Hispanic males, and 16.8 % of Asian men. For women, blacks smoke at a rate of 18.5 %, followed by Hispanic women at 10.1 %, and non-Hispanic Asians at 4.6 %.

The tragic winners, and thus the losers, of the smoking sweepstakes are Native Americans, who show smoking rates of 35.6 % for men and 29.0 % for women.

Graphics Credit: www.chantixhome.com

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