Tox Tunes #104: Oxycontin Blues (Steve Earle)
This is from Steve Earle’s 2007 CD Washington Square Serenade. The lyrics are simple and stark:
Well my daddy worked in the coal mine
Till the company shut it down
Then he sat around and drank his self blind
Till we put him back underground
Now nothing grows on this mountain
And what’s a poor boy to do
Except to wander these hills forgotten
With the oxycontin blues
Of course, in the nearly decade since this song came out, we’ve become all too aware that the “oxycontin blues” is an problem that has spread far beyond the coal region and Appalachia.
Thanks to reader @kimvie for suggesting this ...
Source: The Poison Review - January 11, 2016 Category: Toxicology Authors: Leon Tags: Medical oxycontin blues Steve Earle tox tunes Source Type: news
Saturday with SMACC: Tox Dogmalysis
The 4th annual Social Media and Critical Care (SMACC) conference will take place in Dublin (Ireland, not California) later this year from June 13 through June 16. I’m really looking forward to it, both because last year’s meeting in Chicago was so much fun, and because the last day of the Dublin conference — June 16 —coincides with Bloomsday, the day James Joyce’s novel Ulysses takes place and the occasion every year for a huge festival in Dublin.
The first two releases of tickets to SMACC Dublin sold out quickly. The third and last batch of tickets will be available in early February and are expecte...
Source: The Poison Review - January 10, 2016 Category: Toxicology Authors: Leon Tags: Medical benzodiazepine poisoning beta blocker Bryan Hayes calcium cocaine chest pain digoxin poisoning flumazenil hyperkalemia SMACC SMACC Chicago tox dogmalysis Source Type: news
ACMT position statement on prescribing opioids: a missed opportunity
3 out of 5 stars
Safety Issues Regarding Prescription Opioids. American College of Medical Toxicology J Med Toxicol 2016 Jan 5 [Epub ahead of print]
No abstract available
This “Position Statement” from the American College of Medical Toxicology (ACMT) covers 3 topics related to safety issues associated with use of prescription opioids. Unfortunately, some of the positions taken by the College are, to say the least, wishy-washy, and represent a missed opportunity to make some important points forcefully.
The first topic addressed in this statement involves the use of medications that combine acetaminophen with a...
Source: The Poison Review - January 7, 2016 Category: Toxicology Authors: Leon Tags: Medical american college of medical toxicology opiates opioids position statement prescribing Source Type: news
The 6th Annual Alexander Awards: The Best Tox Reading of 2015
Alexander Gettler
At the end of every year, TPR bestows the coveted Alexander Awards on the best long-form writing on toxicology topics that have appeared in the popular press during the preceding 12 months. To be eligible, an article must be open-access and freely available, not locked behind some paywall. The awards were named for Alexander Gettler (1883-1968,) the head of toxicology for the Office of the Chief Medical Examiner on the City of New York during the first half of the 20th century. Gettler has been called the “father of forensic toxicology in America.” His work was vividly described in Deborah Blu...
Source: The Poison Review - December 31, 2015 Category: Toxicology Authors: Leon Tags: Medical Alexander awards arsenic earth and fire erowid erowid.org marsh test opiates opioids spice spike synthetic cannabinoids Source Type: news
Carbon monoxide “myths”
2.5 out of 5 stars
Myth busting in carbon monoxide poisoning. Hampson NB. Am J Emerg Med 2015 Nov 3 [Epub ahead of print]
Abstract
This short review, by the former medical director for the Virginia Mason Center for Hyperbaric Medicine in Seattle, sets out to debunk four “myths” associated with carbon monoxide (CO) exposure. Although nothing here will surprise most emergency physicians, the paper may be worth a quick look.
The “myths” discussed are:
The caboxyhemoglobin (COHb) level correlates with symptoms in acute CO poisoning: What really matters is CO in the cells and central nervous system, no...
Source: The Poison Review - December 24, 2015 Category: Toxicology Authors: Leon Tags: Medical carbon monoxide toxicity myths Source Type: news
TPR Podcast Episode #10: Synthetic cannabinoids, “Crazy Monkey,” and a man and his dog
Episode #10: The Rise of Synthetic Cannabinoids…and Crazy Monkeys
Written by Theresa Kim, M.D.
Highlights
According to reports from the CDC, an increasing number of calls to poison centers for synthetic cannabinoid exposure has been noted on a local as well as national level
A report in the Morbidity and Morality Weekly (MMWR) published June 2015 cites a 330% increase monthly incidence nationwide from January 2015 to April 2015
A report in the MMWR published April 2015 cites 721 suspected cases including 9 deaths at the Mississippi Control Center from April 2 to May 3
Most commonly reported adverse effects
T...
Source: The Poison Review - December 17, 2015 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
TPR Podcast Episode #10: Synthetic cannabdinois, “Crazy Monkey,” and a man and his dog
Episode #10: The Rise of Synthetic Cannabinoids…and Crazy Monkeys
Written by Theresa Kim, M.D.
Highlights
According to reports from the CDC, an increasing number of calls to poison centers for synthetic cannabinoid exposure has been noted on a local as well as national level
A report in the Morbidity and Morality Weekly (MMWR) published June 2015 cites a 330% increase monthly incidence nationwide from January 2015 to April 2015
A report in the MMWR published April 2015 cites 721 suspected cases including 9 deaths at the Mississippi Control Center from April 2 to May 3
Most commonly reported adverse effects
T...
Source: The Poison Review - December 17, 2015 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
Tox Tunes # 103: I’ll Never Smoke Weed with Willie Again (Toby Keith & Scott Emerick)
Yesterday we linked to a New York Magazine piece about Willie Nelson and his relationship with marijuana. As described in the article:
. . . Nelson’s tolerance is supernatural. He can easily smoke 30 or 40 hits in a session and then play a flawless two-hour show. He does not always deploy this talent toward noble ends. He is famous for smoking new friends to oblivion and then challenging them to a few hands of high-stakes poker. Willie’s game is cash-only, and all debts must be settled at the table.
Toby Keith’s song “I’ll Never Smoke Weed with Willie Again” apparently was written after one suc...
Source: The Poison Review - December 13, 2015 Category: Toxicology Authors: Leon Tags: Medical i'll never smoke weed with willie again toby keith tox tunes willie nelson Source Type: news
Tox on the Web: doomsday scams and more!
Apocalyptic Con Games: An article in The New York Times Magazine by C. J. Chivers sets out to find whether the purportedly extremely toxic and explosive compound “red mercury” actually exists. According to some reports, the Islamic State of Iraq and the Levant (ISIL or ISIS) has been trying to acquire samples in order to build a neutron bomb or other doomsday weapon. The author finds that “red mercury” is an urban myth, likely perpetuated by arms merchants in attempts to scam terrorists and other gullible potential customers to pay large amounts of money for a chimera. In the following interview o...
Source: The Poison Review - December 12, 2015 Category: Toxicology Authors: Leon Tags: Medical Alcohol driving marijuana opioid toxicity red mercury weapon of mass destruction weed willie nelson Source Type: news
Case series: agitation and hallucinations after exposure to 25B-NBOMe (“N-bomb”)
25B-NBOMe
3.5 out of 5 stars
Case series: toxicity from 25B-NBOMe — a cluster of N-bomb cases. Gee P et al. Clin Toxicol 2015 Dec 1 [Epub ahead of print]
Abstract
The NBOMe series of drugs are substituted phenethylamines. They act as agonists at both the 5-HT2A serotonin receptors and the α-receptors. Because of these actions they can cause both hallucinations (5-HT2A effects) and the sympathomimetic toxidrome (α effects.) Since these drugs are so potent, they are often sold in the form of impregnated blotter paper and misrepresented as LSD. Street names include N-Bomb, Wizard, Smiles, and Blue Batman. “N-bom...
Source: The Poison Review - December 8, 2015 Category: Toxicology Authors: Leon Tags: Medical @%B-NBOMe case series hallucinogenic stimulant n-bomb phenethylamine psychedlic Source Type: news
Effect of lipid rescue therapy on laboratory tests
3 out of 5 stars
Review of the effect of intravenous lipid emulsion on laboratory analyses. Grunbaum AM et al. Clin Toxicol 2015 Dec 1 [Epub ahead of print]
Abstract
Lipemic serum can interfere with laboratory measurements because of a number of factors: sample turbidity, partitioning, and cross-reactivity. Clinicians who are not aware of these effects can be misled by erroneous lab results in ways that may affect patient management.
The Lipid Emulsion Therapy in Clinical Toxicology Workgroup was established by the American Academy of Clinical Toxicology to “review all appropriate evidence pertaining to the use o...
Source: The Poison Review - December 3, 2015 Category: Toxicology Authors: Leon Tags: Medical intralipid laboratory interference lipid emulsion lipid rescue therapy Source Type: news
Do labels accurately reflect THC content of medical marijuana edibles?
Atomazul/shutterstock.com
3.5 out of 5 stars
Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products. Vantrey R et al. JAMA 2015 Jun 23/30:2491-2493.
Reference
Titrating the dose of edible marijuana is difficult for a number of reasons, including differing rates of absorption and unpredictable metabolism involving active metabolites.
In addition, some states that have legalized medical marijuana have not instituted stringent monitoring and regulation to assure that the dose listed on the package is consistent with the actual amount of THC and other cannabinoids in the product. The authors of this interesti...
Source: The Poison Review - December 3, 2015 Category: Toxicology Authors: Leon Tags: Medical cannabidiol cannabis marijuana edibles medical marijuana THC Source Type: news
Chronic pain is not acute pain: forget the numerical pain scale
4 out of 5 stars
Intensity of Chronic Pain — The Wrong Metric? Ballantyne JC, Sullivan MD. N Engl J Med 2015 Nov 26;373:2098-9.
Full Text
This short but very important “Perspective” article argues that numerical pain scales are absolutely the wrong way to evaluate and monitor chronic pain. The authors point out that:
Opioids . . . have good short-term efficacy, but there is little evidence supporting their long-term benefit.
They note that the “titrate to effect” method that can be successful in treating acute or end-of-life (e.g., cancer) pain may not be appropriate or effective in cases of c...
Source: The Poison Review - November 27, 2015 Category: Toxicology Authors: Leon Tags: Medical acute chronic pain pain scale Source Type: news
Kitchen Tox: beware of the durian
ThamKC/shutterstock.com
3 out of 5 stars
Durian Induced Hyperkalaemia. Leo CLB et al. Med J Malaysia 2011 Mar;66:66-67.
Full Text
Durian, a spiky, coconut-sized fruit native to Malaysia and grown throughout southeast Asia, is known for its distinctive aroma that some have compared to ripe Limburger cheese. The Oxford Companion to Food notes that others have compared the smell of durian to “the civet cat, sewage, stale vomit, onions, and cheese; while one disaffected visitor to Indonesia declared that the eating of the flesh was not much different from having to consume used surgical swabs.”
Anthony Bourdain...
Source: The Poison Review - November 18, 2015 Category: Toxicology Authors: Leon Tags: Medical durian hyperkalemia kitchen toxicology potassium Source Type: news
Must-read: review of single-dose activated charcoal
wikipedia.org
4 out of 5 stars
Activated charcoal for acute overdose: a reappraisal. Juurlink D. Br J Clin Pharmacol 2015 Sep 26 [Epub ahead of print]
Abstract
The British Journal of Clinical Pharmacology seems to be publishing a series of articles on basic management of the poisoned patient. Several weeks ago we reviewed (and highly recommended) Marco Sivilotti’s excellent discussion of flumazenil, naloxone and the coma cocktail. This current article looking at single-dose activated charcoal (SDAC) is similarly well done, and essential reading.
The author points out that although most poisons bind to activated c...
Source: The Poison Review - November 17, 2015 Category: Toxicology Authors: Leon Tags: Best of TPR Medical gastric emptying management of poisoned patient Review single dose activated charcoal Source Type: news
