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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 in Teens

1.15 to read

While tobacco use is at an all time low among teenagers the use of marijuana is on the rise.  According to the annual 2012 Monitoring the Future Survey (which is administered annually to over 45,000 students grades 8-2 in both public and private schools) marijuana is the number 1 drug used by students in 8-12th grades.   

The 2012 survey showed that about 35% of high school seniors said they had smoked marijuana (pot, weed) in the past year, with daily use among seniors of about 7%.  Of some concern is the declining numbers of teens who view marijuana use as “risky”.  Only 20% of seniors thought that occasional uses was harmful and while more younger teens viewed marijuana smoking as risky, those numbers are also declining. 

While I have always talked to my adolescent patients about smoking I am now making sure that I am asking not only about cigarette use (which is almost gone in my practice) but specifically marijuana use as well, and anecdotally I can say that the numbers of older teens using “weed” is on the rise for sure. 

One of the concerns is that teens perception of marijuana use and harmful effects may be “squelched” due to the ongoing debate and legalization of medical marijuana in some states.  For many teens, “legal drugs” such as prescription painkillers and ADHD meds, even when used recreationally and inappropriately, are not as harmful.  Their perceptions are NOT accurate, and teen painkiller abuse is one the rise as well. 

Ongoing studies about daily marijuana use in teenage years has shown that marijuana contributed to lower IQ scores and impaired mental abilities.  There is growing concern that regular or daily use of marijuana may affect a teens ability to “achieve and/or excel” in school or jobs.   

Obviously, more data is needed, but among my teen patients with drug abuse issues, they will all admit to the fact that they started out “using” marijuana. I don’t have any patients that I can recall who started using meth or cocaine prior to having used marijuana (most fairly regularly). I still have concerns that for some people marijuanas seems to be a “gateway drug”.   

As the debate about legalizing marijuana continues it is becoming more important to discuss marijuana use with your teen and stay tuned for more studies on its effects (beneficial/detrimental).  Like so many issues, it doesn’t seem to be black and white.

Daily Dose

Fake Pot is Dangerous!

1.15 to read

It seems that “fake marijuana” continues to be a problem with adolescents. In March of 2011 the DEA took emergency action to control five chemicals used to make so-called “fake pot”.  This action made possessing and/or selling these products illegal in the U.S.  These chemicals are now designated as Schedule 1 substances, which is the most restrictive category under the controlled substances act.  

But a recent online article in Pediatrics reported several case studies of adolescents presenting to ER’s with various unexplained and disturbing symptoms. In each of the cases the teens had a history of smoking “fake pot” sometimes alone, and sometimes with marijuana as well.  This fake pot often goes by the name, Spice, K-2, Aroma, Blaze, and Dream. The fake cannabinoids are not detectable on a routine drug screen. This makes it even more confusing and difficult for ER doctors to determine the cause of some of the behaviors being seen after smoking or ingesting “fake pot”. 

The American Association of Poison Control Centers has reported over 4500 calls involving synthetic cannabinoids (marijuana) since 2010. These “fake pot” products are often a blend of plant and herbal materials that are then sprayed with one of the active chemicals (that were outlawed last year) which results in the marijuana like high as well as other symptoms as well. Reports of high blood pressure, high heart rates, seizures and catatonic like states are now in the medical literature. There have even been adolescent deaths reported after the use of these “fake marijuana” substances. There is still speculation that Demi Moore was using some sort of “fake pot” prior to her seizure and call to 911. 

Unfortunately, despite the DEA’s attempts at controlling the chemicals used to make “fake pot” the makers of these drugs are “crafty and clever” about getting around the law. They may change the chemicals used to stay ahead of the DEA’s restrictions, or market them as incense which is not for human consumption. In either case, the makers of the drug are staying one step ahead of the DEA and the synthetic “fake pot” is still widely available, and may even be as close as your neighborhood convenience store! These products may easily be ordered on line. 

Younger tweens and teens are also hearing that these “fake marijuana” products are safer and cannot be detected if used.  It is incumbent that parents continue to discuss drug use as well as the dangers of “fake pot”. A young unsuspecting teen may not even understand what is in these products and that even if “not illegal” smoking or ingesting them may lead to serious and possibly life threatening side effects. 

Parents, talk to your kids about this…it can be a matter of life or death.  

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

Daily Dose

Teen Drug Abuse Declines But Abuse Continues

There is good news to report from a national survey of teens on drug use. The survey conducted from 2001 to 2005 indicated that there was a 20 percent decline in illicit drug use. The bad new is that teens are abusing different drugs than in previous years.

 Over 3 million adolescents each year begin using either over-the-counter (OTC) or prescription drugs inappropriately, and pain relievers are quickly becoming a "gateway" drug similar to marijuana. The other alarming statistic is that these drugs account for up to 22 percent of new substance abuse, and many teens report that these "prescription" drugs are readily available in their homes. During the last five years the parental medicine cabinet has become the easiest place to get "high" just like the liquor cabinet of old. Parents need to be as aware, if not more so, of locking up their medications as well as the liquor. Teens these days would prefer to abscond with their parent’s vicodin rather than a bottle of vodka. With so many adults now on multiple medications including medications for sleep, anxiety, pain relief, mood disturbances and even attentional issues the family medicine cabinet has a plethora of choices. Opiods are becoming a drug of choice and about 5 percent of high school seniors reported initiating Oxycontin use in the last year, while 10 percent report having tried Vicodin. I went to my own medicine cabinet and looked to see what we had available. There was left over pain medication from one son's wisdom teeth extraction, and another bottle from a different son's shoulder injury secondary to football. There were also several tablets of sleep medication that is sometimes used for travel and a half used bottle of cough syrup with codeine. Beyond that not much interesting; just vitamins and a few random bottles of Tylenol and Advil. I must admit, I would not know if any of the pain pills went missing, as I really had no idea they were even there. Many adolescents view the "miss-use" of prescription medications as being "safer" than illicit drugs. The misconception that prescription drugs cannot become addictive or lead to the use of other illicit medications is a common problem with teens. It is almost as if their immature brains do not process that these drugs, which were not prescribed for them, can be just as addictive and even deadly as illegal drugs. Many of my adolescent patients will report "borrowing" a friend or roommate’s stimulant like Ritalin or adderall to pull an "all nighter" and think nothing of this. They also have often reported using narcotics in combination with alcohol, without realizing that this could be deadly. They often don't even know what they took, as they will just say, "it was the blue pill a friend gave me, and they told me it would help me relax". As illicit drug use declines, the discussion with teens regarding abuse of OTC or prescription medications is a reality. Telling our teens about the inappropriate use of pain medications is as important as the discussions regarding marijuana and cocaine. As parents we must take inventory of our medicine cabinets, keep medications locked up, not just to prevent poisoning in younger children, but also to prevent potential drug abuse among teens. I know of several instances where adult friends have reported medications missing from their bathroom cabinets after their teens had friends over for an evening. I am heading to my own cabinet to do a little New Years throw away (remember to dispose of medications properly too!) That’s your daily dose, we’ll chat again tomorrow.

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.

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.

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.

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