Tag: drugs

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Synthetic Hallucinating Designer Drugs are Not Synthetic Marijuana

A lake in Kananaskis to relax and unwind. Better than smoking weed.
A lake in Kananaskis to relax and unwind. Better than smoking weed.

Naturally growing cannabis (marijuana) is a popular psychoactive plant that is often used recreationally. Use of marijuana is in the news almost every day. Not to mention the recent death of a very accomplished actor. Cannabis is also unique in that it contains a psychoactive substance, THC. In some jurisdictions, it is legal to use medical cannabis to treat pain, insomnia, and stimulate appetite.

Then there is “synthetic” cannabis, a psychoactive designer drug created by spraying natural herbs with synthetic chemicals that, when consumed, produce psychoactive effects similar to the effects of cannabis. According to Wikipedia, synthetic cannabis are often known by the brand names K2 and Spice. “Synthetic” is considered a misnomer, because the ingredients contained in these products are mimics, not copies.

An article in the Canadian Medical Association Journal (Five things to know about synthetic cannabinoids, February 18, 2014) says, “Synthetic cannabinoids are not synthetic marijuana.” They are a large family of chemically unrelated compounds functionally similar to delta-9-tetrahydrocannabinol (THC), the active component of Cannabis sativa. It is important to remember, synthetic cannabinoids are NOT derived from cannabis.

The article says the use of synthetic cannabinoids is increasing, quoting statistics from the American Association of Poison Control Centers. The typical users are adolescent males and young men in their early to mid-20s, with the most commonly stated reasons for use being curiosity, relaxation and attaining the desired effects of THC while avoiding toxicological detection. Synthetic cannabinoids cannot be legally sold in Canada.

Use of synthetic cannabinoid can cause psychosis, agitation, seizures, acute kidney injury, low potassium level, high blood pressure, increased heart rate, heart attack and death. Clinical diagnosis of synthetic cannabinoids overdose is difficult to make in a patient presenting with acute psychosis unless there is a high index of suspicion.

There is no specific antidote.

So, it boils down to the same old adage, “Prevention is better than cure.” There are so many wonderful things to do in life that one wonders what drives people to drugs, smoking and drinking. I guess we are all not made of the same outlook in life. People in the same family, carrying similar genes, sometimes end up in different directions. There are so many genetic and environmental factors over which we have no control. That does not mean we should not try and be healthy and make the best of what we have been given and improve on it.

You can be what you want to be. Keep smiling. Talk to you again soon.

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Widely Admired Actor Dies from Apparent Heroin Overdose

The world's tallest teepee on a snow-free morning. (Dr. Noorali Bharwani)
The world's tallest teepee on a snow-free morning. (Dr. Noorali Bharwani)

By the time this column is published, we may know the exact cause of death of Philip Seymour Hoffman, perhaps the most widely admired American actor of his generation. He was 46. How sad. He left behind three young children, their mother and millions of admiring grieving moviegoers.

The death is believed to be from an apparent drug overdose. Investigators found a syringe in his arm and, nearby, an envelope containing what appeared to be heroin. Heroin is highly addictive painkiller.

Charles Romley Alder Wright (1844 – 1894) was an English chemistry and physics researcher at St. Mary’s Hospital Medical School in London. He was the first person to synthesize heroin, in 1874. Heroin itself is an active drug, but it is also converted into morphine in the body.

Opium is obtained from the opium poppy. Opium contains approximately 12 per cent morphine, which is frequently processed chemically to produce heroin for the illegal drug trade and for legal medicinal use.

Heroin, when used in a medical environment, is referred to as diamorphine. It is highly addictive drug. According to the National Institute on Drug Abuse, heroin is both the most abused and the most rapidly acting of the opiates.

It is estimated Afghanistan, in 2004, produced roughly 87 per cent of the world supply in illicit raw opium. However, the production rate in Mexico has risen six-fold from 2007 to 2011, placing Mexico as the second largest opium producer in the world. Reports indicate Mexican cartels are also known to produce another type of illicit heroin, commonly called black tar.

A UN report last year put the problems in stark perspective. “The number of people who die of heroin overdoses in NATO countries per year (above 10,000) is five times higher than the total number of NATO troops killed in Afghanistan in the past eight years,” it said. “We need to go back to the dramatic opium addiction in China a century ago to find comparable statistics.”

Canadian police seized 92 kilograms of heroin in 2008, up from 67 kilograms in 2001 – a 38 per cent increase, according to Health Canada, which tests seized drugs for police forces. They also seized 67 per cent more raw opium. In Alberta, the police have seized 42 times more heroin and opium each year on average between 2002 and 2008 than in the 1995-2001 period.

Is there a solution to the problem?

It is almost impossible to get hold of the drug dealers at the “factory” level. The problem is almost worldwide. It is an epidemic, which cannot be controlled by vaccination. The best thing we can do is educating the public, especially our children, of the dangers of using drugs and the consequences of addiction. Prevention is better than cure. Pursuing healthy lifestyle includes avoiding drugs, no smoking, don’t drink and drive, exercise regularly, meditate and laugh a lot. A good family environment and good friends are the pillars of good health.

That’s it for this week. Talk to you again soon. Take care.

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The Good and Ugly Sides of Grapefruit and Grapefruit Juice

Cross section of a grapefruit.
Cross section of a grapefruit.

There are many good things about grapefruit. According to the USDA, 100 grams of grapefruit contains 32 calories. Most of those calories come from carbohydrates and very few are from fat or protein. Micronutrients include vitamin C and potassium.

According to proponents of the “grapefruit diet”, grapefruit’s low glycemic index promotes fat burning. There are many other myths about the health benefits of grapefruit. How many of these are true remains to be seen.

Grapefruit is the bitter hybrid fruit of pomelo and sweet orange. It was first bred in Barbados in the 18th century and called the “forbidden fruit.” I could not find out why. However, there is new evidence to suggest it could be a “forbidden fruit.”

For years it has been shown that grapefruit interferes with absorption of medications, many of which are commonly used by people with serious health conditions. One-third of prescribed drugs in the US are taken by the elderly. Ambulatory and nursing home patients take an average of nine to 13 pills a day. This certainly increases their risk of adverse reactions. This can be from drug-drug interactions or caused by food.

A group of researchers have been tracking adverse reactions between medication and grapefruit for 20 years. The article was recently published in the Canadian Medical Association Journal. A disturbing trend was found between 2008 to 2012. The number of medications with the potential to interact with grapefruit, and cause serious adverse effects, increased from 17 to 43. This represents an average increase of more than six drugs per year. A portion of the new drugs entering the market each year.

It’s possible to die from an adverse reaction. Other complications range from kidney failure, respiratory failure, gastrointestinal bleeding, and bone marrow suppression in immunocompromised people.

The chemical compounds in grapefruit which cause these dangerous interactions are furanocoumarins. When we take a pill the whole amount is not absorbed from our intestine. An enzyme in the intestine destroys a portion of some drugs, thus reducing the amount entering the bloodstream. Furanocoumarins irreversibly inhibits the enzyme that normally inactivates an estimated 50 per cent of all medication. This allows more of the drug to enter the bloodstream and may cause damage to organs in the body.

Other citrus fruits like Seville oranges, used in marmalade, limes, and pomelos also contain this active ingredient. Drugs that undergo metabolism in the gastrointestinal tract by the enzyme CYP3A4 are affected. These drugs have to be taken orally and it does not matter when and how much grapefruit you have consumed before taking the pills.

Here are some examples of the pills you should avoid if you cannot do without grapefruit: statin drugs to lower cholesterol, blood pressure-lowering drugs, organ transplant rejection drugs, anti-anxiety drugs, antiarrhythmic drugs, and antihistamines. Visit Health Canada’s website for a complete list.

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Four Most Dangerous Groups of Drugs for Seniors

Pharmacist and a senior. (Jupiterimages)
Pharmacist and a senior. (Jupiterimages)

As we get older, our health tends to deteriorate. We need medications to control these adverse changes. Also there is a price to pay in old age if we did not take care of ourselves when we were younger.

A recent study published in the New England Journal of Medicine says that 40 percent of people over 65 take five to nine medications every day. What this means is that hospitalizations for accidental overdoses and adverse side effects are likely to increase among this group.

The study found that every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. Most of the patients are there because of accidental overdoses. Sometimes the amount of medication prescribed for them had a more powerful effect than intended.

The four most common groups of medications putting seniors in hospitals are: warfarin, insulin injections, antiplatelet drugs to thin the blood and oral diabetes drugs.

Warfarin accounts for the most visits due to adverse drug reaction. It accounted for 33 percent of emergency hospital visits. Warfarin (Coumadin) is an anticoagulant – popularly referred to as a “blood thinner.” In reality, it does not make the viscosity of the blood thin. What it does is that it acts on the liver to decrease the quantity of a few key proteins in blood that allow blood to clot.

It was initially marketed as a pesticide against rats and mice. Later it was found to be effective and relatively safe for preventing blood clots in humans. It was approved for use as a medication in the early 1950s and now it is the most widely prescribed oral “blood thinner” drug in North America.

Insulin injections were next on the list, accounting for 14 percent of emergency visits. Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body.

Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetes mellitus will result. Patients with type 1 diabetes depend on insulin injections.

Antiplatelet drugs like aspirin, clopidogrel (Plavix) and others that help prevent blood clotting were involved in 13 percent of emergency visits. An antiplatelet drug is a member of a class of pharmaceuticals that decrease platelet aggregations and inhibit clot formation. They are effective in the arterial circulation, where “blood thinners” have little effect.

Lastly, diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Why do these four groups of medications cause problems?
-the line between an effective dose and a hazardous one is thin.
-they can be difficult to use.
-some require blood testing to adjust their doses.
-blood sugar can be notoriously hard to control.
-warfarin can interact with many other drugs and foods.

The authors of the article say that in order to reduce the number of emergency hospitalizations in older adults we should focus on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group. And patients should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.

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