Booster Shots

Oddities, musings and news from the health world

Category: addiction

Cigarettes in a yummy lozenge: Parents of toddlers, beware

April 19, 2010 |  9:16 am

A candy-like lozenge designed to satisfy a smoker's nicotine craving could prove dangerously tempting to little ones and lead to nicotine poisonings, a new study warns.

Cinnamon- and mint-flavored Camel Orbs were launched on the U.S. market last year -- aimed at smokers needing a nicotine fix at moments when they can't light up. But the product's "candy-like appearance and added flavorings" -- the orbs are about the size of a TicTac, though not as colorful -- are virtually certain to tempt children to sneak one -- or a few -- with potentially disastrous effects, an article published in advance of May's issue of the journal Pediatrics concludes. 

The product is sold in several forms -- orbs, strips and sticks -- with increasing nicotine potency. The products' maker, R.J. Reynolds, notes that they are sold in "child resistant" packaging. But researchers conjecture that some adult users of the products are likely to leave them out in the open, where little ones will gain access to them.

A 4-year-old child could suffer potentially fatal poisoning with the ingestion of 13 to 21 orbs or four sticks, and a 1-year-old could succumb to the effects of as few as eight orbs or three sticks. Smaller doses could lead to nausea and vomiting.

Beyond the prospect of unintentional poisoning, researchers flagged the attraction of the flavored cigarette-replacement product to teens, who could then become addicted to nicotine.

"Nicotine is a highly addictive drug, and to make it look like a piece of candy is recklessly playing with the health of children," said the article's lead author, Gregory Connolly, in a press release.

The study underscores that there's plenty of reason to believe a child as young as a year old will pop a few of these made-for-adult treats if he or she comes upon them. Researchers from the Harvard School of Public Health combed through all of the reports of unintentional child poisonings involving tobacco products and found 13,705 of them, 70% of which were among children under a year old. While cigarettes themselves were the most common form in which a child ingested tobacco, smokeless tobacco products were second.

One report from Portland, Ore., where the orbs product was test-marketed, involved a child ingesting one of the pellets.

The "novelty and possible harm" posed by these new dissolvable orbs, strips and sticks should prompt the Food and Drug Administration, which now is regulating tobacco as a drug, to have a look at this new product.

-- Melissa Healy


OxyContin gets a safety makeover

April 7, 2010 |  9:42 am

Oxycontin The painkiller OxyContin can be plenty dangerous if you knowingly abuse it; but it has long posed real dangers of overdose, as well, to those who had little thought of getting high. Cutting a pill in half may sound like a swell way to get just a little relief on a day when that chronic pain problem isn't so bad. But oxycodone, the chemical name of this often-prescribed opioid painkiller, has traditionally been packaged in high doses meant to release slowly over time so they can be taken once or twice daily. Cutting such pills can release of a high dose of opioid medication into the system very fast, risking overdose.

With both sets of risk -- accidental overdose and abuse -- in mind, the Food and Drug Administration this week approved a new formulation for OxyContin. In its new form, OxyContin will be much harder to crush, cut, ground, chew or dissolve in liquid. It's hardly the answer to opioid addiction and abuse. But, said the physician in charge of the FDA's division of anesthesia and analgesic drugs, Dr. Bob Rappaport, "it is still a step in the right direction." 

OxyContin, introduced to the U.S. market in 1996, quickly became a drug of choice for abusers, and, along with related drugs such as Percocet, Vicodin and methadone, has dramatically driven up overdose rates in the United States. (Between 2004 and 2005 alone, there was a 17% increase in emergency department visits attributable to oxycodone abuse.) A recent report by the Substance Abuse and Mental Health Service Administration found that more than a half-million Americans began abusing OxyContin each year for the last several years. 

In approving the new formulation, the FDA has ordered the maker of OxyContin, Purdue Pharma, to conduct a post-marketing study  aimed at determining whether and by how much the new formulation reduces abuse and overdoses.

-- Melissa Healy

Photo: Painkiller OxyContin, shown at a drugstore in 2001; in its new form, it will be much harder to crush, cut or dissolve in liquid. Credit: Darren McCollester / Getty Images


Smoke menthols? You'll want to tune in to FDA's inaugural tobacco meeting

March 29, 2010 |  4:32 pm

Lots of smokers, lots of racial overtones, lots of interest. There's so much interest in menthol cigarettes and their regulation, in fact, that the Food and Drug Administration's newly created scientific advisory committee on tobacco products will be webcasting its inaugural meeting -- focusing entirely on menthol in tobacco -- on Tuesday and Wednesday, March 30 and 31. The panel is expected to tackle the question of whether and how mentholation of cigarettes should be regulated by the FDA. You can check the meeting out here.

First, a few facts from a comprehensive collection of research on menthol and tobacco produced by the National Cancer Institute: Menthol cigarettes account for 26% of all cigarettes sold in the United States. Among adult African Americans who smoke, nearly 7 in 10 smoke menthols. Smoking menthols is biggest among black women and 18- to 30-year-olds. Latinos also appear to be drawn to the frosty taste and sensation of menthols: Among Latinos who smoke almost 3 in 10 smoke menthols, compared with about 22% of non-Latino whites.

Those facts mean that any regulation of menthol in cigarettes will weigh more heavily in minority communities -- a sensitive subject for public policy. African Americans have the highest rates of lung cancer of any racial or ethnic group, and black men are far more likely than males of any other ethnic group to die of it. 

Beyond those glaring demographic facts, there's a lot of uncertainty about the role of menthol in cigarettes. Does menthol induce young people, and especially young African Americans, to take up the habit? Does it make it harder for those who smoke them to quit? Does the frosty flavoring prompt those who smoke menthols to drag harder or inhale more deeply? And are menthols any more cancer-causing than unmentholated cigarettes? These questions -- to which research has provided contradictory and incomplete answers -- will be discussed by the FDA's advisory committee, the membership of which is listed here.

Menthol is derived from the oil of peppermint, and it's also known as mint camphor. As luck would have it, it's a compound that in used in embalming, and in masking the smell of decomposition. The first brand of menthol cigarettes, Salem, was introduced by R.J. Reynolds Tobacco Co. on the American market in 1956, just as researchers outside the tobacco industry were beginning to collect evidence of cigarettes' dangers. (Newport is now the nation's biggest-selling brand of menthol cigarettes.)

--Melissa Healy


A child's sweet tooth could mean more than just liking sugar

February 12, 2010 |  5:23 pm

Most kids like sweets, but for some children there may be an underlying cause for that affinity.

Kwyr59nc A new study finds there may be a link between sweet preference in children and a family history of alcoholism, plus the child's feelings of depression.

Researchers from Monell Chemical Senses Center in Philadelphia studied 300 children ages 5 to 12. They were placed into groups according to a family history of alcoholism (based on a parent, sibling, aunt, uncle or grandparent who had a diagnosis of alcoholism) and depression symptoms, determined by a series of questions. About half of the children had a family history of alcoholism, and about 25% had symptoms of depression. All of the children were asked to taste five samples of table sugar in water to see which level of sweetness they liked best.

Those who liked the most intense sweetness -- 24% sucrose -- were 37 children who had both a family history of alcoholism and depression symptoms. That concentration of sugar is about the same as 14 teaspoons in an 8-ounce cup of water, far sweeter than the average cola. The other children preferred water with 18% sucrose.

The study shows correlation, not causation, and the researchers also note that this penchant for sweetness doesn't necessarily mean the children who preferred the sweeter taste will eventually become alcoholics. "At this point, we don't know whether this higher 'bliss point' for sweets is a marker for later alcohol use," said Julie Mennella, the study's lead author and developmental psychobiologist at the center, which does interdisciplinary research on taste and smell.

The study appears online in the journal Addiction.

-Jeannine Stein

Photo credit: Larry Crowe / Associated Press


Internet browsing: Searching for happiness?

February 3, 2010 | 10:21 am

Internet People who are addictive Internet searchers should probably browse for a phone number to the nearest therapist. Though almost everyone uses the Internet to conduct business, connect with people, pay bills or find information, the people who spend hours each day aimlessly surfing the net are more likely to be depressed, according to a new study.

Psychologists at the University of Leeds in Britain evaluated the Internet use and depression levels of 1,319 people ages 16 to 51. Of this group, 18 people (1.2%) were classified as Internet-addicted. When these 18 people were compared with 18 similar people who were not Internet-addicted, the researchers saw striking differences in depression. The 18 non-addicted people were not depressed while the 18 Internet-addicted people were classified, as a group, as moderately to severely depressed.

The addicted people tended to use the Internet more for sexual gratification, gaming and chat rooms, compared with the non-addicts. The authors of the paper, published in the journal Psychopathology, concluded that these people are replacing real-life socializing with Internet surfing. 

They say, however, that it's not clear which comes first: the Internet addiction followed by depression or depression followed by Internet addiction. Regardless of the answer to that question, depression and heavy Internet use appear to be a bad mix.

Here's a link to The Center for Internet Addiction.

-- Shari Roan

Photo credit: Greg Baker / Associated Press


Rodent of the Week: Why cocaine becomes addictive

January 8, 2010 | 12:13 pm

Rodent_of_the_week A clue to explain how cocaine becomes addictive has emerged and may lead to new ways to treat the addiction.

Research funded by the National Institute on Drug Abuse shows that an epigenetic mechanism in the brain helps explain cocaine's addictiveness. Epigenetics is a hot, new branch of science that focuses on changes to gene expression even though a gene's sequence remains unchanged. Epigenetic changes are thought to be largely triggered by environmental factors, such as diet, substance abuse and toxic exposures.

In a study using mice, researchers led by Dr. Eric J. Nestler of Mount Sinai School of Medicine gave one group of mice repeated doses of cocaine and another group repeated doses of saline with a final dose of cocaine to determine how the effects of repeated cocaine exposure differ from one-time exposure. They found that one mechanism by which cocaine alters the pleasure circuits in the brain is by repressing an enzyme called G9A that plays an important role in epigenetic control of gene expression. When the researchers reversed the cocaine-induce repression of G9A, they found they could block changes in gene expression and prevent the preference for cocaine.

"This fundamental discovery advances our understanding of how cocaine addiction works," Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said in a news release. "Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications."

The study was published this month in the journal Science.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.


Trying to quit smoking? Encouragement works better

January 7, 2010 |  4:00 pm

In the same week that would-be quitters got the depressing news that they're at higher risk of developing diabetes for roughly a decade after stopping smoking, a study published Thursday in the Journal of the National Cancer Institute has made a remarkable discovery:

Positive messages are a better way to help you quit!

It turns out that phone counselors staffing Quitlines, which are an increasingly popular and effective way to support smokers in kicking the habit, might be more effective if they reframed their comments to be positive, a study conducted by Yale University researchers found.

So instead of telling a smoker in the grips of nicotine withdrawal, "you gotta resist the urge to light up, or else you'll be more likely to die an early and painful death," the counselor might say, "if you resist the urge to light up, you're very likely to live a longer life!"

Whodathunkit?

Actually, the effectiveness of scary versus positive messages in discouraging people from smoking is very much an active subject of research right now. With its new regulatory powers over tobacco, the Food and Drug Administration is empowered to dictate that cigarette packaging has prominent warnings about the dangers of smoking or the importance of quitting. Amid growing evidence that scary, graphic images of blackened lungs and death actually backfire, the agency is deliberating just what kinds of messages will sway consumers best from buying cigarettes. 

The Yale study found that the consistent delivery of such "gain-framed" exhortations to quit made smokers using the quit-lines more likely to attempt a program of smoking cessation and more likely to have continued abstaining from cigarettes when they were contacted two weeks later. At the three-month mark, alas, the difference between the two disappeared--a testament, perhaps, more to the addictive powers of nicotine than to the weakness of positive thinking.

Even more remarkable, perhaps, is that these were would-be quitters who were taking antidepressants to aid in their effort. That may have made them more amenable to hopeful, positive messages encouraging them to stay the abstinence course.

Nevertheless, the authors of the study argued that positive messages of encouragement--which are neither more expensive nor more intrusive to deliver than messages that are scary or more neutral--are worth trying for states and institutions running quit lines. And their study showed that it's possible to get operators to deliver "gain-framed" messages consistently, with just a little training.

So, let's go back to that diabetes/quitting study published Monday in the Annals of Internal Medicine, and think how to "gain-frame" that message.

Old: "Hey, while you're jones-ing for that cigarette, you want to be careful not gain too much weight, because for the next three years, you're at much higher risk of developing Type 2 diabetes."

New: "You know, if you can just quit smoking now, you're going to lower your risk of developing diabetes to that of someone who never smoked in about 12 years!"

See? It's that easy! 

Is giving up cigarettes your New Year's resolution, or have you done so in recent years? Here's the National Cancer Institute's guide to all things quitting, and here's the American Cancer Society's guide, also available in Spanish. And here's a guide to all the research that says you should do so. And if you think that packing on the pounds is an inevitable effect of quitting, check out this authoritative website.

-- Melissa Healy


New York City criticized for its heroin how-to guide

January 4, 2010 |  3:14 pm

Oh, New York City -- your heart may have been in the right place when you published a handy step-by-step safety booklet for drug users. But you might want to rethink your tactics. (Another recent case in point: those “drinking fat” ads.)

The Department of Health and Mental Hygiene’s 70,000-copy effort to educate heroin users on reducing infection and risk of overdose is coming under fire from federal drug enforcement agents in New York, according to an Associated Press story.

The state's top official with the Drug Enforcement Administration calls the "Take Charge Take Care" guide a "step-by-step instruction on how to inject a poison." DEA special agent-in-charge John Gilbride says the handout is disturbing. 

The nonjudgmental writing style and yellow cover is indeed reminiscent of the "For Dummies" how-to book series.  

But think of the new guide as a verbal version of by-now-commonplace needle-exchange programs, which recently received symbolic White House support with the removal of a federal ban on funding: If people are going to use drugs, no matter how hard you try to stop them, you may as well make sure they do so safely. It ultimately saves on risks and costs to them and others.

Still, I have to wonder about the city's priorities. The 16-page booklet starts out with 10 tips for safer use. Here's a sampling:

No. 1: Prevent overdose.

No. 4: Use new syringes.

Further down, No. 9: Get help for depression.

And finally -- at the bottom of the list -- No. 10: Ask for help to stop using.

Might have been a good idea, if only for appearances' sake, to switch those around a little.

-- Amina Khan


A stimulating suggestion for treating cocaine addiction

December 28, 2009 |  4:41 pm

With apologies to the Partnership for a Drug-Free America, if this is your brain …

Egg

… and this is your brain on drugs …

Fried

… then perhaps this is what your drug-addicted brain would look like after being treated with deep brain stimulation:

Benedict

To hear a team of French researchers tell it, electrical stimulation of the subthalamic nucleus -- or STN -- is a promising treatment for cocaine addiction that ought to be tried in people.

Cocaine use floods the brain with dopamine, a neurotransmitter that makes you feel really good. Previous strategies to break cocaine addiction relied on messing with the dopamine system, but that had the unwelcome side effect of damping one’s motivation to do healthy things as well, such as eating.

DBSBut the STN can distinguish between healthy behaviors that merit a dopamine reward and drug abuse, which doesn’t. The French scientists had previously shown that inducing a lesion in the STN of rats damped their desire for cocaine but kept their appetites intact.

In their latest study, they demonstrate that deep brain stimulation produces the same results without causing permanent damage.

Cocaine-addicted rats treated with deep brain stimulation were about half as willing as their untreated counterparts to press a lever over and over again to get a hit of the drug. When the researchers switched the two groups and began stimulating the brains of the “control” rats, they were the ones who lost some interest in pressing the lever, according to a study published online today in the Proceedings of the National Academy of Sciences.

The scientists also found that untreated rats preferred to hang out in the place where they had previously gotten cocaine but had no particular preference to the area where they received food. In contrast, the rats who got deep brain stimulation were indifferent to the area associated with cocaine and instead hung around the place where they expected to be fed.

Deep brain stimulation is already used to treat movement disorders such as Parkinson’s disease and is being tested for an array of problems, including traumatic brain injury, obesity, Alzheimer’s and chronic pain, according to this Times' Health section article. Perhaps cocaine addiction will soon join that list.

-- Karen Kaplan

Egg photo credits (from top): Glenn Koenig / Los Angeles Times, Wally Skalij / Los Angeles Times and Mel Melcon / Los Angeles Times

Photo: Devices surgically implanted in the brain may someday help cocaine addicts kick the habit. Credit: David M. Grossman / Associated Press

 


Count to 5--it's the holidays!

December 22, 2009 |  6:00 am

Something about the holidays compels people to write lists. Maybe that's why we've been bombarded lately with "five things" pitches that consist of five tips and tricks to get or stay healthy through the holidays--you know, de-stress, avoid the 5-pound weight gain, etc. To say most of these reek of common sense and redundancy is being kind, but maybe there are one or two pointers that will help make your holidays a happier, healthier time (Note: Some tips have been edited, but we retained the key elements):

Ktn4cjnc From ChicagoHealers.com, a site dedicated to natural medicine and a holistic lifestyle, "Tips for Healthy Digestion after Holiday Eating." We’re pretty much down with everything except the one about drinking apple cider vinegar diluted in water first thing in the morning. Not. Going. To happen.

1. Walk it off: Walking helps food move along the digestive tract, improving digestion and absorption. For added benefits, walk while massaging your abdomen with your palms, in a circle around your belly button.

2. Drink herbal tea: Relieve that feeling of fullness with herbal teas that target your digestion. Steep one teaspoon each of mint, rosemary, oregano, cilantro, sage and basil and in a cup of hot water. Drink after each meal to soothe and prevent bloating.

3. The next morning drink apple cider: Apple cider vinegar is traditionally used to remedy digestive distress, support liver detoxification, normalize digestive juices, and reduce intestinal bloating. Mix one tablespoon of organic apple cider vinegar with 12 ounces of warm water, and drink in the morning on empty stomach. Feel free to add a little honey or maple syrup.

4. Eat right: After overdoing it, make sure to eat meals with fiber and protein to help your body recover from the overindulgence.

5. Drink Water: Though this is hardly a secret remedy for combating a hangover, it bears repeating. Alcohol dehydrates your system, so drinking plenty of water will help combat some of your unpleasant hangover symptoms, rehydrate your body and flush out toxins.

If you need to fight stress, take the advice from the online gaming and entertainment website GR88.com. Because no one understands the pressures of the holiday like people who run an online poker and gaming website.

1. Music: According to Forbes, this was the No. 1 way Americans relieved stress in the tumultuous year of 2009. Numerous studies have demonstrated the role of music in relieving stress and it has been discovered that the rhythm or the beat of the music relieves stress.

2. Online gaming: With new online forms of entertainment and gaming emerging, researchers are beginning to find evidence that a wide variety of games can be relaxing.

3. Exercise: The therapeutic benefits of regular exercise are well documented. Study after study has shown that it increases health and general well being. It's been said that if exercise were a drug, it would be the most powerful medication on earth.

4. Mix up your daily routine: Mixing it up, whether by altering your routine or trying something new--like changing your hairstyle--can improve your outlook and mood.

5. Write it out: The physical process of writing, in combination with taking the time to focus on the things that are bothering you, can be very cathartic. What you write is not important; it is the process and the frequency that counts.

The University of Missouridevised some holiday survival strategies based on research studies conducted throughout the year. Not to knock these health and fitness smarties who no doubt have advanced degrees, but we can't get past the clock thing in the first tip. Because once we spot the brie, we're loading up (They also sneaked in a sixth tip which is not cool, Mizzou. You know the rules.):

1. "Try eating around the clock at parties--grab the smallest plate available and look at the plate as though it was a clock face," said Ann Cohen, associate state nutrition specialist for the College of Human Environmental Sciences and MU Extension. "From the noon to 6:00 position, fill it with lots of fruits and vegetables. At the 6 to 7:00 position, fill it with dip or salsa. From the 7 to 8:00 position, add some nuts. From 8 to 10:00, place crackers and cheese. The 10 to midnight position is the space for a sweet treat. Then, have a good time at the party 'eating around the clock,' starting at noon and ending at midnight."

2. "It is helpful to focus on behavioral strategies for exercise during the holiday season," said Vicki Conn, associate dean in the Sinclair School of Nursing. "Effective strategies include setting specific behavioral goals, providing reminders or cues to exercise, rewarding yourself for exercising and self-monitoring your exercise by recording all exercise sessions."

3. "Be realistic--don't focus on losing weight during the holidays. Focus on maintaining your current weight," said Susan Mills-Gray, nutrition specialist with MU extension and HES.

4. "Make sure whatever you're offered is splurge-worthy," Mills-Gray said. "Why waste calories on foods you can have anytime?"

5. "While holiday shopping, the coffee drink you choose many have more calories than you realize," said Tammy Roberts, nutrition specialist for extension and HES.

6. "Relationship conflicts can increase during busy holiday times," said Constance Brooks, nursing professor and instructor in the Master of Public Health Program. "To reduce stress, be clear in explaining to others what you want and need, instead of telling them what you want them to do."

If quitting smoking is on your to-do list for the New Year, the American Lung Assn. has some recommendations for getting through the toughest days (they tried to sneak by seven tips, but we've condensed them to five because this is just getting out of hand now):

1. Talk to your doctor or pharmacist about the different over-the-counter and prescription medications to help you quit smoking.

2. Look into the different options available to help smokers quit. Visit www.lungusa.org or call (800) 548-8252 for suggestions.

3. Take time to plan. Pick your quit date a few weeks ahead of time and mark it on the calendar. If you can, pick a day when life's extra stresses are not at their peak, such as after the holidays. Mark a day on the calendar and stick to it.

4. Get some exercise every day. Walking is a great way to reduce the stress of quitting. Exercise is proven to not only combat weight gain but also to improve mood and energy levels. Eat a balanced diet, drink lots of water and get plenty of sleep.

5. Ask family, friends and co-workers for their help and support. Having someone to take a walk with or just listen can give a needed boost. You don't have to quit alone. Help is available online and in your community. Consider joining a stop-smoking program like Freedom From Smoking from the American Lung Assn.

So there you have it. Count to five and the holidays will be breeze.

-- Jeannine Stein

Photo credit: Anne Cusack / Los Angeles Times



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