Pharma: February 2007 Archives


February 22, 2007

The title of this Reuters article on an NIDA report about changes in smoker's brains is "Smoking Changes Brain the Same Way as Drugs: Study". Here's the result:
Feb 20, 2007 -- WASHINGTON (Reuters) - Smoking causes long-lasting changes in the brain similar to changes seen in animals when they are given cocaine, heroin and other addictive drugs, U.S. researchers said on Tuesday.

A study of the brain tissue of smokers and nonsmokers who had died showed that smokers had the changes, even if they had quit years before, the team at the National Institute on Drug Abuse reported.

"The data show that there are long-lasting chemical changes in the brains of humans," said Michael Kuhar of Emory University in Atlanta, who was not involved in the study.


Hope said other studies had seen the same thing in animals given cocaine and heroin \u2014 and it was clear that the drugs were causing the effects.

What a shock to discover that nicotine is a drug! Before this new result I was under the impression that smoking was totally innocuous and that that the gum smokers chewed while trying to quit was just some singularly foul breath mint. Do you think maybe it was intended to help them withdraw from something they were addicted to?


February 19, 2007

The Amgen Tour of California started yesterday. Am I the only one who finds it a bit ironic that the name sponsor of the race is the company that makes EPO?.

February 13, 2007

Most of the common asthma medications (albuterol, Flovent, ...) are packaged in aerosol inhalers for delivery right to the lungs. Like any other aerosol, there's a medication suspended in a compressed gas propellant. As one of the last steps in the great CFC phaseout, these inhalers are being reformulated with hydrofluoroalkanes (HFA).1 In general, this is a pretty transparent process for consumers (except for the patent extensions being granted to the manufacturers for the propellant transition) but GSK actually decided to add some value here.

Asthma inhalers are what's called a metered dose inhaler, which is designed to emit a constant amount of medication per puff. Each inhaler is rated for a certain number of doses, but it can be pretty hard to determine when you've used up the rated capacity of the inhaler, especially since there's still propellant and drug in the inhaler afterward. Unfortunately, once you've used up the rated capacity you start to get inconsistent doses with each press and unlike aerosol deodorant it's kind of important to get the right amount of drug and it's not just a simple matter of holding the button down longer.

In what is no doubt the result of decades of research, GSK added one of those gizmos that conductors use to count the number of people on the train to their new Ventolin HFA inhaler, letting you know how many doses you have left. Pretty snazzy, huh?

1. So, what's the total amount of CFC emitted? Your typical inhaler is about 15 grams, so if you go through one inhaler a month, which is pretty typical for a moderate asthmatic, you're looking at 200g of CFC/person-year. Asthma incidence in the industrialized world is aroung 5%, so assume we're looking at something around 108 inhaler users, or about 20 million kg (20 kilotons) of CFC emitted. For comparison, the 2000 emissions of CFC-11 (the propellant used in albuterol) were order 75 kt. So, we're looking at a significant fraction of current emissions.


February 10, 2007

If you want to have an opinion about capital punishment in this country you need to read this NYT article about the sorry state of the procedures used for administering lethal injections:
Over the course of Doerhoff's testimony, Anders uncovered many significant details similar to those uncovered in other states. For instance, Doerhoff testified that executions in Missouri have taken place in the dark, an execution team working by flashlight, and that the execution team routinely consists of "nonmedical people." For most, the day of the execution is "the first time probably in their life they have picked up a syringe . . . so it's a little stressful for them to be doing this." Doerhoff stated that he determined if an inmate being executed had been adequately anesthetized by observing the condemned's face through a window, which others noted was obscured by partly opened blinds. He also told the court that he reduced by half the five grams of anesthetic he had been using after the pharmaceutical company supplying it started packaging it in smaller bottles, which made it tricky to get the five grams in a single syringe. When Anders asked if he used calculations to determine the quantities of drugs to administer, he replied, "Heavens, no."

Later Anders asked, "Is any part of the execution procedure written down?"

"I've never seen it."

"There's no guide that you follow as you're doing it?"

"Absolutely not."

As background, the procedure involves three drugs:

  • Sodium pentothol to sedate the prisoner.
  • Pancuronium bromide (Pavulon) to paralyze him.
  • Potassium chloride to stop his heart.

These are all delivered through an IV. Unfortunately, if you screw up the IV, you might not get some or all of the meds. So, for instance you might be paralyzed but not sedated, which is no doubt terrifying and then quite painful when the KCl is injected. Now, you may be of the opinion that it's a good thing for those who are being executed to be in pain and terrified (I'm not) but surely that should be done intentionally, not just because we don't have competent procedures. However, in practice the procedures seem to be almost entirely ad hoc. Here's Chapman, who designed the Texas procedure:

It never occurred to me when we set this up that we'd have complete idiots administering the drugs.
The rest of the article is equally disturbing.

February 4, 2007

Back in '04, EG covered the use of mouthwash as an intoxicant. The advantage of mouthwash is that it's cheap and available even to minors and when liquor stores are closed. The disadvantage is that it's, well, gross and doesn't have a particularly high alcohol content (15-25% ethanol.) According to this article, the rise of ethanol-based hand sanitizer has provided an alternative:
WASHINGTON -- The 49-year-old Maryland inmate seemed seriously sick after he drank from a gallon container of hand sanitizer. Described as "loony," "red-eyed" and "combative," officials whisked him to a nearby hospital for treatment.

But they quickly discovered he wasn't ill -- just very, very drunk on Purell. The October incident, detailed this past week in the New England Journal of Medicine as one of the first documented cases of its kind, has raised questions about the potential abuse of alcohol-based hand sanitizers.

"The widespread use of hand sanitizer is fraught with a great deal of danger," said Suzanne Doyon, medical director of the Maryland Poison Center, who co-authored a letter in the journal about the case. "From an infection control perspective, they are excellent. But there is this risk involved."

Purell, which is 70 percent alcohol, is far more potent than beer (5 percent), wine (10 percent) or hard liquor (40 percent). Doyon said the nonalcohol ingredients in hand sanitizer don't pose a health risk if ingested.

So, the good news is that the alcohol concentration is pretty high so it's a convenient form factor, and it apparently won't kill you much faster than ordinary booze. The bad news is that it tastes bad. As one of my friends put it "here i was expecting minty freshness, and instead it tastes like fermented ass." While writing this article, I had an opportunity to taste sanitizer and I can vouch for this description.


February 1, 2007

Mark Kleiman has a generally sensible article on improved drug policy. One of the recommendations strikes me as a bit off, though:
Full commercial legalization of cannabis, on the model now applied to alcohol, would vastly increase the cannabis-abuse problem by giving the marketing geniuses who have done such a fine job persuading children to smoke tobacco, drink to excess and supersize themselves with junk food another vice to foster. However, if current laws were changed to make it illegal to sell cannabis or to exchange it for anything of value, but not to grow it, possess it, use it or give it away, the costs of the current control regime could be sharply reduced without greatly increasing the size of the marijuana consumption problem. Such a law could not effectively prevent private sales any more than a ban on gambling can prevent private poker games. Its goal would be to prevent mass marketing.

In the short-to-medium term such a policy would have only a slight impact on use. The biggest effect would be on those who now cease marijuana use as they enter the workforce but might instead keep using the drug. In the long term, there would probably be modest growth in cannabis use due to decreased social stigma and employment risk; how much of that growth in use would be among people who subsequently got into trouble with the drug is harder to guess.

I suppose it depends on what you mean by "medium term", but I'm not sure that this is right. Most of what keeps cannabis illegal is its general social unacceptability; if you go to a party at someone's house they're quite likely to offer you a drink. Indeed, a party where no alcohol is being served is considered kind of odd. This is true of cannabis in some circles but not most. As a consequence, as was true for many years with gays, many people don't know (or rather don't know that they know) anyone who uses cannabis and so rather than having the correct issue which is that it's fairly harmless—and almost certainly less harmful than alcohol—think of it as drugs. This thinking is of course encouraged by the way that drug education and propaganda in this country treats all drugs as more or less the same.

So, What if home cannabis production and use was legal? Well, I would foresee two effects. First, cannabis would get a lot more available. Cannabis production is basically gardening and fairly low-volume gardening at that. A single cannabis plant yields around .75-1.25 pounds of usable product. A casual daily user might go through an ounce of marijuana in a year. A very heavy user might go through an ounce of marijuana a month. Given that gardeners typically grow a lot more than one of any kind of plant, it would be easy for any grower to produce plenty to supply most of their friends full-time. My point here isn't that everyone would but simply that there wouldn't be any logistical barrier to doing so and so as a practical matter anyone who wanted to get marijuana would be able to.

The second effect is that you would would expect semi-public marijuana use to become a lot more common, even if the total amount of marijuana use went down, since people would not feel the need to hide from their friends. I have friends who don't drink but they know I do and I don't feel uncomfortable cracking open a beer when they're in the room. If marijuana use were legal, one would expect to see people behave similarly (with the current social disapproval of smoking applying counterpressure here.)

Those are short to short-medium term effects. In the longer term, frequent contact between users and non-users is likely to lead them to the the non-users drawing the (proper) conclusion that it's quite possible to use marijuana without being an unemployed Phish-listening deadbeat who lives in your parents' basement. Doesn't it seem likely that this will produce a ratchet effect whereby marijuana laws get progressively looser and use gets a lot more common? I'm not saying that that's a bad thing, but it seems like a likely result of what Kleiman proposes.