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Your Child

FDA Bans Certain Cough Medicines for Kids

2:30

 

The U.S. Food and Drug Administration (FDA,) has added strict restrictions to the use of children’s cough medicines that contain opioids, such as codeine or oxycodone.

"After safety labeling changes are made, these products will no longer be indicated for use to treat cough in any pediatric population and will be labeled for use only in adults aged 18 years and older," the FDA said in a news release.

The country is in the middle of an opioid abuse epidemic that is devastating families in just about every state. An updated Boxed Warning label will also warn adult users "about the risks of misuse, abuse, addiction, overdose and death, and slowed or difficult breathing that can result from exposure to codeine or hydrocodone," the agency added.

FDA Commissioner Dr. Scott Gottlieb said the agency is concerned about exposing children to opioids unnecessarily.

“We know that any exposure to opioid drugs can lead to future addiction. It's become clear that the use of prescription, opioid-containing medicines to treat cough and cold in children comes with serious risks that don't justify their use in this vulnerable population,” Gottlieb said in the press release.

The new rules announced Thursday were "based on an extensive review of available data and expert advice," the agency said.

They go much further than the 2017 labeling rules -- restricting use of codeine-containing products to everyone under the age of 18, and including cough-and-cold products that contain a second drug, the opioid oxycodone.

In any case, there's little that can or should be done to ease most children's cough and colds, the FDA said.

"Experts indicated that although some pediatric cough symptoms do require treatment, cough due to a cold or upper respiratory infection typically does not require treatment," the agency said. "Moreover, the risks of using prescription opioid cough products in children of all ages generally outweigh the potential benefits."

The press release also pointed to known side effects of opioid medications, "drowsiness, dizziness, nausea, vomiting, constipation, shortness of breath and headache."

The FDA recommends that parents currently using these medications for their child should speak with their child’s doctor about alternative therapies

It's always important to read medicine labeling, too -- even if it's not obtained by prescription.

"Caregivers should also read labels on non-prescription cough and cold products," the FDA said, because "some products sold over-the-counter in a few states may contain codeine or may not be appropriate for young children."

Story source: EJ Mundell, Health Day Reporter, https://www.webmd.com/drug-medication/news/20180111/fda-bans-opioid-containing-cough-meds-for-kids#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.

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

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.  

 

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.

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Teens & Substance Use

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

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

K2: New Legal "Drug" For Teens?

1.30 to read

I was seeing patients the other day when I saw a teenage boy that I have taken care of since he was born (one of the perks of being a pediatrician).  He came in over lunch with his mother, as she had called me earlier that morning, and she wanted him to have a drug screen. She had found a “pipe” in some pants of his and she was concerned that he was smoking marijuana.  I am often asked to perform drug screens on kids, and I really think it is important to sit down with the child and parents to discuss their concern, rather than ruin the trust of the teen, and blindside them with the results of a drug screen obtained under false pretenses. So…the point of this is that the adolescent told me that he had been smoking K2.  He told me that it was a “legal” substance that you could buy over the internet or in smoke shops. K2 is a mixture of herbal and spice products that are then sprayed with a psychotropic drug.  When asked why he would smoke it, he told me that it had similar effects as marijuana with an overall feeling of feeling good, sleepy, and relaxed.   Seeing that I did not know anything about this new substance, I got my computer, brought it into the exam room and “googled” K2, only to see many different articles. The most interesting was an article in LiveScience written earlier this year, that explained how K2 had been developed by a research scientist who was studying cannabinoid receptors in the brain.  He had published articles about this substance (which when first discovered went by his initials, JWH-018),  and had found that that K2 binds to the same receptors in the brain as marijuana, and that it is actually much more potent than marijuana. K2 may be 10 times more active than THC (marijuana) and while it may have many of the same effects as the high with marijuana, it  has also been found to cause hallucinations, and seizures. Upon further investigation, I found that it is becoming a problem in many states with plenty of information on the internet. K2 has already been declared illegal in the state of Kansas.  There are concerns that this drug has caused adverse effects and ER visits due to hallucinations, vomiting, elevated blood pressure and heart rate, which are not typical symptoms seen with marijuana.  K2 does not show up on routine drug screens.  There is a researcher in St. Louis who is studying K2 and is seeking urine samples obtained from teens who have used the substance.  I called several private labs in my area and they did not have the capability of testing for it. The good news in my patient’s case is that he told me about K2, had not smoked it in the last several weeks, and his urine drug screen was negative for marijuana and other drugs. Oh the things we must learn to keep up with adolescents! How someone discovered the article written in scientific journals in the late 1990’s and extrapolated that this compound, which binds to the same receptors in the brain as marijuana, could be used “legally” for a high similar to “weed”  is beyond me.  But kids are really “smart and clever” and will do almost anything for a “high” especially in this case with a product that is easily obtained and is legal.  After a lengthy discussion with this boy and his mother I understand that K2 use is quite prevalent in his high school, even among the “non-drug” crowd. I am going to continue researching this topic and will keep you posted. But if you have an adolescent who you think exhibits odd behavior and may even require a visit to the ER for a suspected overdose, and the drug screen turns out to be negative, be aware of K2. Lastly, talk to your teens, they are probably already in the know. That's your daily dose.  We'll chat again tomorrow.

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