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Your Child

FDA Warning: Don’t Give Kids Codeine, Tramadol

1:45

The U.S. Food and Drug Administration (FDA) recently issued a warning about the dangers of two popular painkillers and the effects they can have on children. The government agency said that Codeine and Tramadol should not be given to kids under the age of 12 because they can cause life-threatening breathing problems.

Nursing mothers should also avoid using these drugs, since they can pass unsafe levels of opioids to their babies through their breast milk, the agency said.

Some children and adults are genetically predisposed to process opioid drugs more quickly, the FDA said. That can cause the level of narcotics in the bloodstream to rise too high and too quickly, risking overdose in children, due to their smaller size.

"It's very hard to determine which child or mother has this risk, so that's why we've taken this action today," Dr. Douglas Throckmorton, deputy center director for regulatory programs at the FDA's Center for Drug Evaluation and Research, said in a media briefing.

Codeine is often combined with acetaminophen in prescription pain medicines and cough syrups, while Tramadol is only approved to treat pain in adults, the agency said.

The FDA is now warning against children under 12 years old taking either codeine or tramadol.

Kids under 18 also should not be given tramadol to treat pain following surgery to remove the tonsils or adenoids, the agency noted. Codeine labeling already warns against post-surgical use for kids.

In particular, children with sleep apnea, are obese or who have a weakened respiratory system are at a higher risk for dangerous breathing problems from these two drugs.

"Today's actions build on a better understanding of this very serious safety issue, based on the latest evidence," Throckmorton said.

Both of these medications are often prescribed and are in households.  Nearly 1.9 million kids aged 18 or younger received a prescription for a codeine-containing medication in 2014, and nearly 167,000 were prescribed a medication containing tramadol, the FDA said.

Parents should carefully read drug labels to make sure medications don't contain either opioid, the agency stressed. They also can ask their doctor or pharmacist if a specific medication contains codeine or tramadol.

"We understand there are limited options when it comes to treating pain and cough in children," Throckmorton said. "However, after careful review our decision to require these labeling updates was taken because we believe it is a way we can protect children."

The FDA plans to hold a public advisory committee meeting later this year to discuss the broader use of prescription opioid cough and cold medicine in children, he said.

Story source: Dennis Thompson, http://www.webmd.com/children/news/20170420/dont-give-kids-medicines-with-codeine-tramadol-fda#1

Daily Dose

Marijuana Use

1:30 to read

The legalization of marijuana in a majority of states for both medical or recreational use is making marijuana use more and more prevalent. It  has also made it incumbent for pediatricians to have conversations with teenage patients (and parents) about the harmful effects of marijuana use. 

 

We are now in the in the era of legalization of marijuana, and I find myself having more and more conversations with teenage patients who “think that weed is acceptable and safer than alcohol”.  That statement alone is worrisome. In fact, I “hear” that many teens are using marijuana on a daily basis, and do not realize or are in denial about any long term deleterious effects of daily marijuana use.

 

“Marijuana is not a benign drug, especially for teens. Their brains are still developing and marijuana can cause abnormal and unhealthy changes” according to a just published clinical report from the American Academy of Pediatrics (AAP).

 

Studies have shown that teens who use marijuana on a regular basis may develop serious mental health disorders including addiction and depression. (Some teens are wrongly trying to  self-medicate their own anxiety and depression with a depressant).  Marijuana may also decrease memory and concentration, as well as causing attentional and problem solving issues.  Going to school “high” is just not conducive to academic success.

 

There are also studies that have shown that addiction may be related to daily marijuana use.  17% of people who use marijuana in adolescence may become addicted and that number may increase to 50% for teen who smoke marijuana daily. Daily alcohol use and marijuana use are both harmful but do effect the brain in different ways.  

 

But even knowing those statistics, teen surveys done by the U.S. Dept. of Health and Human Services found that there is decreasing concern for the risk of using marijuana once or twice a week among 12-17 year olds.

 

Parental use of marijuana is equally concerning. Parents not only expose their child to second hand smoke, but seeing parents using marijuana recreationally makes a child more likely to use marijuana themselves. Just like alcohol, being “high” on marijuana makes it difficult to parent and to provide a healthy home environment for a child.

 

Lastly, in my own years of practicing pediatrics I have seen more than a handful of teens who have had serious drug problems….they will all tell you their drug use did not begin with cocaine or meth or even heroin…..they all say it was marijuana that started them down the terrible path of drug addiction.

 

While there is a place for marijuana use in medicine for those with certain chronic conditions or for the management of reducing the side effects chemotherapy, marijuana use is not harmless and will never be.

 

Talk to your teens about drug use and specifically marijuana use…legalization does not make it safe. It is a slippery slope for sure.

Daily Dose

Prescription Drug Abuse

1.30 to read

Several weeks ago, 23 students at Texas Christian University in Ft. Worth Texas were busted for drug use and solicitation.  The newspaper and TV shows have been covering this story with great detail.  While making my morning coffee, a recent update stopped me dead in my tracks. 

I had just been talking with several parents, as well as adolescent patients, about the escalating use of prescription drugs in our community, especially among high school students, and TCU is in our “backyard”. 

This is another “wake up” call! While teens and college students across the country may not be using as many illicit drugs, their new “drugs of choice” are prescription drugs. They deem these drugs to be legal, “safer” as well as easier to obtain. This is alarming on so many different fronts. 

A CDC report in 2009 found that 20% of teens had admitted to having taken a prescription medication, without a prescription. 

In 2010 the Monitoring the Future survey found that prescription drugs were the most commonly used drugs after alcohol, marijuana and tobacco. Lastly, another study among adolescents reported that 7.7% of 12-17 year olds reported misuse of prescription drugs!  Teens unfortunately believe that prescription drugs are “safer” to use than illicit drugs.  Unfortunately, they are dead wrong. 

Looking at another recent headline, the reality of prescription drug abuse continues.  Whitney Houston’s untimely death looks to be most likely secondary to some mixture of prescription drugs. 

The story of Demi Moore’s seizure and hospitalization has rumors swirling of prescription drug abuse (along with “something” else). 

The most commonly abused prescription drugs fall into several categories which include:  painkillers (Vicodan, Percocet, oxycontin), stimulants (used for ADHD such as Adderall, Ritalin), or depressants (used for anxiety and sleep, such as xanax, valium, klonopin). While all of these classes of drugs are safe when used appropriately, when taken illegally and in combination, the side effects can kill you.  Mix any of these with alcohol, as so many teens and young adults are doing, and you may have respiratory depression and then your heart can stop!  A quiet death. 

I hear reports of teens taking pills which were typically obtained from a “friend’s” parents medicine cabinet. Several students in my area have been hospitalized due to the combination of prescription drugs and alcohol.  It is amazing to me how many households have many of the drugs mentioned above just hanging around in their medicine cabinets.  

I have also seen college students who have come home due to a viral illness, such as mono, and they have come in to see me for follow up.  They have brought along narcotics that the student health center had given them for their painful sore throat, or pills to help them sleep while they are sick.  Unbelievably there were a lot of pills prescribed for a fairly short illness and several bottles even had refills!! What are doctors thinking?   

Parents need to LOCK up medications just like the liquor cabinet. When teens come to hang out and they used to “steal” beer from the refrigerator, they are now heading to bathrooms to pocket a bottle of Xanax from a parental medicine cabinet. Scary stuff. 

Talk to your tweens/teens/young adults about the risks surrounding the use of prescription medications when they have not been prescribed. Discuss alcohol and drugs in combination. Show them the headlines in the news. The problem is real.       

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

College Students & Drugs

1:30 to read

It is the end of the school year and therefore there seems to be a great deal of stress among students of all ages. I am especially seeing this in some of my college students…..who seem to be making some rather dangerous choices in order to “help them cram for finals” and “stay awake”.

In the past few weeks I have had several students who have purchased or somehow procured a variety of drugs that were “purported” to aid in their studying for finals.  While there has been a great deal in the news about opiod addiction in young adult males, some of my patients have preferred other drugs that are seemingly available and acquiring them illegally.  

The on line drug scene, as well as the drug dealing among students, seems to be a growing problem among some college students.  While I have known that there was a great deal of alcohol and weed being used and abused, I suddenly feel as if I am getting more calls about patients, typically male, being taken to the ER after trying a combination of drugs, which were purportedly being taken to help them study, stay awake, curb anxiety and “succeed in school”.

So, what to do when you realize you have a test in a few days, or a paper that is due and you are “freaking out” as you are not prepared?!?!  Your roommate, or friend in the dorm, or even a complete stranger on line offers you an option - why not take a “stimulant”,  the preferred drug seems to be Adderall  (which was not prescribed for you) and chase it with an anti-anxiety drug   (Xanax, Valium or Ativan) then add in some alcohol when you need to chill or get some sleep. Some have even bought an unknown drug that is also supposed to curb anxiety and relax you (on line fake quaaludes)? This same scenario may occur over a few days or even weeks. While these patients thought they were “fine” and ready for class the next morning they were not!  In several cases these “crazy, stupid boys” suffered a grand mal seizure..never making it to class. Truly they are lucky to be alive the way they combined all of these medications.

Neither of my patients had ever had a history of seizures and were otherwise healthy.  Thankfully, they both recovered without problems.  But, they both admitted to me that they were just one of many who were doing the same thing.  Why they asked, did they have “adverse effects” from this lifestyle, when lots of their friends seemed to be fine….really??? I don’t even have words to try and answer this.

When I probed about how they “acquired” these drugs they said they are for sale in the dorms or on line and basically all over their campuses…..and these students attended what would be called “good” colleges. I have asked several kids who were already home from school about this and they too had heard some similar stories….and were aware of drugs being readily available, but had not partaken.

So, when your college student gets home you might take the opportunity to ask some questions about their college experience and if they are aware of these drugs …and remind them of the fact that taking ANY drug which is not prescribed for them is dangerous.  I have discussed binge drinking before and warn all of my student/patients that drinking excessive alcohol to “get drunk and pass out” can kill you from alcohol poisoning. But after hearing these stories and dealing with my own patients and their visits to the ER I am adding more information to my check ups with college students.  Mixing alcohol  and drugs has always been risky….but now the availability of these drugs is nothing but scary…..BE WARNED.  

Your Teen

Teen Drug Use On The Rise, Again

Teen drug use is on the rise and parents need to take note.After nearly 10 years of declining numbers, teen drug use has reversed course and is rising among 9th-12th graders.

A  joint study published by the Partnership for a Drug Free America and the MetLife Foundation revealed the following: *teen alcohol use grew to 39% from 28% in 2008 * yearly and monthly marijuana us increased to 38% and 25%, respectively *75% of teenagers say they have friends who get high at parties, a 9% increase from 2008 The study revealed several reasons for the increase including less federal funding for drug-prevention programs in schools and the media. Inhalants like glue, nails polish remover, spray paints, and cleaning fluids pose a growing risk among teens.  These items are cheap readily available in a home and are used by younger teens to get a “quick high”. Over the past several years, studies have revealed that teen access to drugs, especially prescription medicines, is easier than ever. So what can parents do?  Be aware of any mood swings or behavior changes in your teen.  Make an effort to get know your child’s friends.  Eat dinner as a family.  Studies continue to prove that children who sit down to a family dinner do better in school and are less likely to get involved with risky behaviors.

Daily Dose

College Drug Overdose

1:30 to read

Colleges are gearing up for a new school year and already there has just been a death reported at a fraternity house at Texas A&M University.  This news hit close to home as the adolescent who died was from a Dallas suburb and several of my patients attend Texas A&M and were even in the same fraternity.  

The misuse of opioid medications is a national epidemic and the drug scene on college campuses seems to be increasing. The misuse of opioid medications includes drugs which have been obtained both legally (by prescription for pain management) and illegally. Many of the college students that I take care of have recently told me that these drugs which include oxycodone, hydrocodone, codeine, morphine and fentanyl are relatively easy to obtain in dorms, frat houses, classrooms, and on line via social media sites.  All of these opioids are chemically related and interact with opioid receptors in the brain to produce pleasurable effects and relieve pain. Some students reported that friends often offered to “share” their unused pain relievers and would even offer them for free! Unfortunately, unintentional drug overdoses due to opioids also continues to rise and has more than quadrupled since 1999. Adolescents just don’t seem to realize the power of these drugs!

In the case of the recent death in our area, the teen was found unresponsive and not breathing in the early morning hours after a fraternity party. It was thought that he had combined alcohol (probably excessive) with an opioid. The toxicology reports are pending….but the police reported they found marijuana (which seems to be almost everywhere) and other drugs including not only opioids but also MDMA (Ecstasy), LSD and other drug paraphernalia. 

Just like alcohol poisoning following binge drinking, opioids also cause respiratory depression and loss of consciousness   The combination of the two may be even more deadly, which could occur even if this was the first time the teen had used opioids. There is an antidote to opioid overdose, Naloxone (Narcan) which may be injected (or given intranasally) to counter the effects of an opioid drug overdose.  It is now available over the counter and my be life saving if given soon enough, by helping to reverse the respiratory depression and allow the person to be transported to a hospital for life saving care.

If you are just sending your child off to college or back to college PLEASE talk to them about alcohol and drugs and reiterate that the combination may be even be more deadly!!  Even one time use could be the last time….so tragic.

 

 

 

 

 

Your Teen

Kids Using Inhalants To Get High

More kids are using household products to get high.Take a look around your house. Do you have hairspray, furniture polish or air freshener?  Lock it up!  A recent study reveals children as young as 12 years old are more likely to use these products to get high than marijuana or alcohol.

The National Inhalant Prevention Coalition  released new findings showing kids are experimenting with everyday products and inhaling them to get high. Many of these products are accessible in a child’s home providing easy access to a quick buzz. Parents:  be aware of what common household products are in your home.  Talk with your children and explain to them just how dangerous inhaling these liquids and sprays can be. If you don’t think it can happen in your home, take note.  The National Institute on Drug Abuse says one in five 8th graders have tried inhalants.

Your Teen

Teens Are Taking Risks "Just For Fun"

News study says teens are engaging in risky behavior just for the thrill of it.Every parent of a teen knows, the teen years can be a rollercoaster ride. Parents find themselves telling their teens to slow down while driving, don’t engage in risky behaviors, and stay away from alcohol and drugs.  But why do teens engage in this behavior? A new study says:  it’s for the thrill of it.

A study published in the journal Cognitive Development found that teens, especially 14 year olds were the most likely to take risks because it is an escape. "The reason that teenagers take risks is not a problem with foreseeing the consequences. It was more because they chose to take those risks," Stephanie Burnett, of the University College London's Institute of Cognitive Neuroscience, explained in a university news release. This is the first evidence from lab-based study that adolescents are risk takers. Advice to parents?  Begin the dialogue early, when your child is in elementary school.  Clearly discuss your expectations and lay out the consequences of engaging in any risky behaviors.  The sooner you begin having these age-based conversations the better.

Daily Dose

Heroin Use Rising

1.15 to read

I continue to be alarmed with the news that heroin is becoming a more prevalent drug in our society. I was reminded of the reality of this just the other day when I saw a young adult (20 year old) patient of mine that I had not seen for awhile.  I remembered that during the end of his high school years his mother had called me about some issues he was having....but I never heard more and had not seen him for quite some time.

He came into the office as he was having cough and cold symptoms. While I was taking the history of his illness, I also started asking him how he had been and what he was doing now. He told me that he had just recently gotten out of rehab and was working part time and planning to start taking some college classes.  While he certainly was not the first patient of mine who had been to rehab, he was the first to tell me that he had been a heroin addict. I was “shocked” to say the least....heroin? One of my patients?

He was quite open as he told me he had started smoking marijuana in high school and then had gone on to experiment with other drugs including prescription narcotics, mushrooms and even meth. He was then introduced to heroin and as he told me , “it is readily available around here and in almost any high school in the Dallas/Ft. Worth area”. He also told me that heroin is cheaper than many other drugs, so may be a go to drug.  What really struck me was when he said “I cannot tell you the rush and euphoria you get with heroin.....you are addicted the first time!”. That statement turned out to be true for him.

At some time in the last 2 years he had also been arrested and sent to jail, but once out he continued to use heroin until he finally accepted help and went to rehab.  He had been clean for months and was continuing to work on staying that way.  I was so proud of him as well as his honesty in discussing his addictions. I pray that he may stay clean and sober, although he is smoking now...but as he said to me, “that discussion is for another appointment”. Agreed.

The face of heroin addiction is not like I had thought. It is now affecting a lot of this country and in suburban neighborhoods and schools. This is not only an inner city problem. If his statement, “I was addicted the first time” is true...then this is yet another discussion to have with our teens. 

While some teens “experiment” with alcohol and marijuana, there is no experimenting with heroin.  

 

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