January 2, 2015

Adolescents Abuse Fewer Substances … Except for E-Cigs

A national survey of U.S. middle- and high-school students painted a mostly positive portrait regarding substance abuse. But one area — smoking e-cigarettes — yielded troubling results.

The University of Michigan’s Monitoring the Future study showed that both alcohol and cigarette use in 2014 were at their lowest points since the study began in 1975. And use of several illicit drugs also notched declines.

But in 2014, more teens used electronic cigarettes (“e-cigs,” or “vaping,” so-called for the vapors that are emitted instead of smoke) than traditional tobacco cigarettes or any other tobacco product. It’s the first U.S. national study to show that teen use of e-cigs surpasses use of tobacco cigarettes.

The Monitoring the Future study tracks trends in substance use among students in 8th, 10th and 12th grades. It’s an annual survey now in its 40th year of 40,000 to 50,000 students in about 400 secondary schools throughout the U.S.

Here’s a breakdown of substances and survey results:

Alcohol use declined among all three grade levels. Students reporting any alcohol use in the 12 months before to the survey in the three grades combined dropped from 43 in 100 to 41 in 100, a statistically significant change. The peak year was 1997, when more than 6 in 10 respondents reported using alcohol.

And the proportion of teens who reported "binge drinking" — that is, consuming five or more drinks in a row at least once in the two weeks preceding the survey — fell significantly again this year to 12 in 100 for the three grades combined, down from a high point of 22 in 100 in 1997. But the researchers said that about 1 in 5 12th-graders still reported binge drinking at least once in the last two weeks, and some drink even more heavily.

Cigarette smoking reached historical lows among teens in 2014 for all three grades. In 1997, for the three grades combined, 28 in 100 reported smoking in the last month; in 2014, the rate was 8 in 100.

Synthetic marijuana ( also called K-2 or "Spice") is sold over the counter in many states, particularly in gas stations, convenience stores and head shops. Its synthetic chemical components of marijuana are sprayed onto shredded plant material that’s smoked. It’s an unregulated product and often is imported. It can be very potent and unpredictable in its side effects, which can be as severe as acute psychosis and heart attacks.

In 2011, 11 in 100 survey respondents reported using it, and in 2014 it was 6 in 100.

"Bath Salts," another class of synthetic drugs sold over the counter, also have declined in use, with fewer than 1 in 100 students in all three grades using them. It’s a dangerous synthetic stimulant, and apparently the substantial efforts to make them illegal are showing results.

Marijuana, after five years of increasing use among teens, declined slightly in 2014, down from 26 to 24 users per 100 teens for the three grades combined.

Daily or near-daily marijuana use also declined a bit, but it’s still high (no pun intended). About 1 in 17 high school seniors is a current daily or near-daily marijuana user, down from 6.5 in 100 in 2013.

Ecstasy (MDMA) use declined significantly in 2014. For the three grades combined use in the last 12 months dropped from 2.8 in 100 in 2013 to 2.2 in 100 in 2014. Used peaked in 2001, at 6 in 100.

Salvia, another drug used for its hallucinogenic properties, fell significantly, as it has in recent surveys. In 2009 nearly 6 in 100 12th-graders had used it in the last month; in 2014 it was fewer than 2 in 100.

Hallucinogens other than LSD, such as mushrooms (Psilocybin or "shrooms"), continues a long-term decline.

Prescription drug misuse (narcotics, sedatives, tranquilizers and/or amphetamines without medical supervision) is of considerable public health concern especially because its use increased substantially in the 1990s, then began to decline in the 2000s.

Only 12th-graders reported on their use of all of these drugs, and it declined between 2013 and 2014, from 16 in 100 to 14 in 100. In 2005, 17 in 100 indicated misuse of any of these drugs.

Narcotic drugs other than heroin, which are among the most dangerous of the prescription drugs, have been declining in use by 12th-graders since 2009, when 9 in 100 teens said they had used them in the last 12 months without medical supervision. In 2013, there were 7 in 100 users, and 6 in 100 in 2014.

Cough and cold medicines available over the counter usually contain the drug dextromethorphan. To get high, teens sometimes take it in large quantities, which is dangerous. But among all grades, its use declined significantly in 2014, to 3.2 in 100 kids.

Use of several other illicit drugs remained essentially unchanged between 2013 and 2014, including some particularly dangerous ones — heroin, crack, methamphetamine and crystal methamphetamine. Other drugs whose use remained unchanged in 2014 include Ritalin and Adderall, stimulants used to treat ADHD, as well as LSD, inhalants, powder cocaine, tranquilizers, sedative and anabolic steroids. But the use of most of these drugs is well below their peak levels.

E-Cigarettes are battery-powered devices with a heating element that produces an aerosol, or vapor, that users inhale. Usually the vapor contains nicotine, but specific contents are proprietary and not regulated. The liquid that is vaporized in e-cigarettes comes in a variety of flavors that appeal to youngsters.

In the last 30 days before the survey in 2014, the number of all-grade users of e-cigs who had never smoked tobacco ranged from 4 in 100 to 7 in 100.

“Whether youth who use e-cigarettes exclusively later go on to become tobacco cigarette smokers is yet to be determined by this study,” researchers reported, “and is of substantial concern to the public health community.”

For more information on drug, alcohol, tobacco and e-cigarette use by children, see our blogs here.

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October 17, 2014

Marijuana: Sometimes It’s Legal, but Always Dangerous for Children

With the increasingly relaxed laws on the use of marijuana, more youngsters are sampling weed with the idea that it’s safe. It’s not.

Dr. Garry Sigman, director of the Adolescent Medicine division at Loyola University Health System and professor in the Department of Pediatrics at Loyola University Chicago, said marijuana is an addictive substance and, compared with adult users, adolescents are as many as four times more likely to become dependent on the drug within two years after first using it.

As more adults legally are allowed to smoke dope, and as more states refrain from imposing many of their marijuana laws, teenagers particularly perceive marijuana as a safe substance. But, as Sigman noted in a news release, “[I]ts effects on the adolescent brain can be dangerous, especially if there is heavy use. As the stigma of marijuana use decreases, the number of teens using the drug has increased. More U.S. high school students now smoke marijuana than they do cigarettes.”

Loyola Medicine referred to a recent study showing that more than 1 in 3 high school seniors and 7 in 100 eighth-graders reported using marijuana in the last month. A report in the October issue of the Journal of Leukocyte Biology indicates that using marijuana in adolescence might damage the immune system in the long term.

Some teens use marijuana only occasionally, mostly the result of peer pressure in a social setting, but others self-medicate to cope with stress and emotional issues.

“Marijuana is the most common substance addiction being treated in adolescents in rehabilitation centers across the country,” Sigman said. But because it’s perceived as a “softer” kind of drug, because it moderates anxiety and depression, many people don’t realize that its addictive quality can come with the cost of dependence, and the problems associated with withdrawal.

According to Loyola Medicine, heavy use of marijuana by adolescents can lead to:

  • impaired thinking;

  • poor educational outcomes and perhaps a lower IQ;

  • increased likelihood of dropping out of school;

  • symptoms of chronic bronchitis; and

  • increased risk of psychotic disorders for people who are predisposed.

Parents, Sigman advised, need to know that today’s “joint” is as many as four times as potent as the stuff they might have smoked in their youth. “Parents should inform themselves about the scientific facts relating to marijuana and the developing brain and be able to discuss the topic calmly and rationally,” Sigman advised. “Also, if the parents occasionally used marijuana during their lives, they should now know that there’s a risk if used before adulthood.”

To learn more about the addictive qualities of marijuana, how to recognize if your child is smoking it and what to do about it, consult the website of Choose Help, a resource for information about addiction and access to treatment.

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March 28, 2014

E-Cigarettes Pose Long-Term Addiction Threat to Teens, and Short-Term Risk of Poisoning

Electronic cigarettes are increasingly popular as substitutes for tobacco cigarettes, but as we wrote last year, it’s not clear if they are an acceptable alternative to the more traditional nicotine delivery systems. It’s also not clear if they might help smokers quit tobacco. And if smoking e-cigarettes has risks, it’s not clear exactly what they are, and how harmful.

But according to a recent study published in JAMA Pediatrics, e-cigarettes might very well serve as gateway devices for adolescents to begin cultivating a nicotine addiction. And that's not good.

E-cigarettes are battery powered devices that look like fat pens. They have a reservoir for liquid nicotine that, when heated, becomes vapor that users inhale, just like a tobacco cigarette. They’re available in multiple colors and often are flavored with a wide range of options, including bubble gum and peanut butter.

As explained on AboutLawsuits.com, the JAMA study was conducted by researchers from the University of California, San Francisco Center for Tobacco Control Research and Education. They surveyed more than 40,000 middle and high school students across the United States.

Another new report on the "e-liquids" that supply the nicotine in e-cigarettes has disturbing information for any concerned parent. As the New York Times reported last week:

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

And get this quote from a toxicologist in the Times article:

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

In the JAMA Pediatrics study, use of e-cigarettes among kids doubled from 2011 to 2012, from about 3 in 100 to 6.5 in 100. The teens who used e-cigarettes were less likely to abstain from smoking tobacco cigarettes a month, six months and a year later.

About 1 in 5 middle schoolers and 7 in 100 high schoolers who used e-cigarettes had never smoked regular cigarettes. So some teens are introduced to nicotine addiction through e-cigarettes, the researchers concluded, and are on the road to long-term addiction.

The teens who smoked tobacco and who also used e-cigarettes were more likely to intend to quit smoking within the next year, but they actually were less likely to do so. Experimental cigarette smokers also were less likely to abstain from smoking tobacco if they tried e-cigarettes.

As we noted in our blog, manufacturers of e-cigarettes market them specifically to the teenage demographic — it’s a rich new market!

As AboutLawsuits notes, e-cigarettes are not regulated by the FDA, and more than 40 state attorneys general have appealed to the agency to do so. More than 20 states ban the sale of e-cigarettes to minors, and many ban them in certain areas, as they do tobacco cigarettes.

A report released last autumn by the Centers for Disease Control and Prevention (CDC) found that regular use of e-cigarettes among middle and high school students has more than doubled over the past few years.

A study last year in Nicotine & Tobacco Research concluded that e-cigarettes might expose nonusers involuntarily to nicotine but not to toxic tobacco-specific combustion products. It also said that more research is needed to evaluate the health consequences of secondhand exposure to nicotine, especially among children, pregnant women and people with cardiovascular conditions.

And although it lacks regulatory muscle, the FDA did issue a health warning about the devices nearly five years ago, warning consumers of potentially toxic chemicals in the solution.

So no matter how you slice it, adults should be cautious about taking up electronic cigarettes, and they should be “never” events for kids.

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February 14, 2014

Youthful Binge Drinking: Spotting It and Getting Help

Sometimes children experiment with alcohol. Some of them will become binge drinkers. Knowing the signs is the first stop in arresting this harmful behavior before it ruins someone’s life or academic career. And knowing where to get help can prevent a long-term problem.

Drinking too much, according to the National Institute on Alcohol Abuse and Alcoholism, either on a single occasion or over time, can harm health in many ways. It interferes with brain, heart, liver and pancreas function. It can increase the risk of developing certain cancers. It can weaken the immune system and leave the drinker more vulnerable to disease and infection.

Alcohol abuse can be disproportionately dangerous for young, “social” binge drinkers, according to the health resources page on InsuranceQuotes.org. If binge drinking becomes a habit, it can cause emotional and physical health problems that can undermine success in school, work or relationships. If a child’s grades and friendships slide, alcohol can seem like a good way to escape.

Binge drinking isn’t only a threat to one’s health, it’s expensive. According to InsuranceQuotes, in California, for example, the cost of a first time DUI for a teenage driver is at least $45,435. Most of that cost is about increased car insurance rates for years after the infraction. If someone’s injured during a DUI, it’s even more costly.

If your child exhibits any of these signs, he or she might have a drinking problem requiring your intervention:

  • mental confusion or stupor;

  • vomiting;

  • seizures;

  • slow (fewer than eight breaths per minute) or irregular (10 seconds or more between breaths) breathing

  • hypothermia (cool to the touch, pale or bluish skin color).

Because blood alcohol levels can continue to rise even when someone stops drinking or is passed out, don’t wait to seek medical help.

There are many resources to get help for your young drinker. Colleges and universities recognize the appeal of drinking to some students, and policies exist on many campuses to facilitate the reporting of alcohol or drug abuse without fear of punishment. Find out what your child’s school does in these instances from Students for Sensible Drug Policy (SSDP). Other resources include:

Because drinking affects everyone in the family and circle of friends, you might want the support and guidance offered by these organizations:

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April 12, 2013

Boom in ADHD Diagnoses Can Lead to Overmedicating and Drug Abuse

The news last month from the Centers for Disease Control and Prevention (CDC) was widely reported: Nearly 1 in 5 high-school age U.S. boys and more than 1 in 10 of all school-age children have been diagnosed with attention deficit hyperactivity disorder (ADHD).

ADHD generally is thought to result from abnormal chemical levels in the brain that impair the ability to pay attention and compromise impulse control.

The New York Times was among the media outlets that reported the significant increase of the diagnosis, and the concern about overprescribing the drugs used to treat it. We, too, have questioned the practice.

More than 6 million children 4 to 17 have been diagnosed with ADHD; their numbers have increased 16 percent since 2007, and more than doubled in a decade. More than 2 in 3 currently diagnosed take Ritalin or Adderall, stimulants that certainly help the afflicted, but, according to the The Times, also can cause addiction, anxiety and even psychosis.

Sales of stimulants to treat ADHD, The Times says, have more than doubled to $9 billion in 2012 from $4 billion in 2007.

Some people legitimately need these drugs, but experts estimate that only 3 to 7 in 100 children suffer from ADHD, and that the meds are being given to people with mild symptoms who shouldn’t be taking them.

As The Times puts it, “While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school.”

Kids often share or sell their meds to classmates, so the boom in ADHD opens the door to drug abuse and its consequent health risks. CDC Director Thomas R. Frieden compared the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.

One heartbreaking illustration of this scenario was presented last week in a commentary in the New York Times. The writer, Ted Gup, told the story of his son David, who was diagnosed with ADHD as a first-grader and told by one psychiatrist that he wouldn’t even see the child until he was medicated.

Gup resisted, but after a year of David’s “rambunctious” behavior, he started taking Ritalin, then Adderall.

As a 21-year-old college senior, he was found on the floor of his room, dead from a fatal mix of alcohol and drugs. The date was Oct. 18, 2011.

No one made him take the heroin and alcohol, and yet I cannot help but hold myself and others to account. I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable.

My son … was known to trade in Adderall, to create a submarket in the drug among his classmates who were themselves all too eager to get their hands on it. What he did cannot be excused, but it should be understood. What he did was to create a market that perfectly mirrored the society in which he grew up, a culture where Big Pharma itself prospers from the off-label uses of drugs, often not tested in children and not approved for the many uses to which they are put.

Stories like David’s are likely to repeat. As The Times points out, the American Psychiatric Association is planning to broaden the definition of ADHD in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (see our blog, “Controversy Swirls as Psychiatry Manual Gets an Update.”)

That invites more people to be diagnosed and be medicated, possibly many for whom other treatments are more appropriate.

Pharmaceutical company marketing enables any parent seeking to help a kid who’s misbehaving and whose grades are falling. The Times noted that the brochure for Vyvanse, an ADHD drug, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”

Dr. Jerome Groopman, professor of medicine at Harvard Medical School, told The Times, “There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood.”

Diagnosing ADHD is a difficult judgment call. As The Times notes, there’s no definitive test for it—it’s determined only by extensive communication with patients, parents and teachers, and by ruling out other possible causes for its behavioral symptoms. The process is subjective and made more difficult when parents pressure doctors for a diagnosis. ADHD is a chronic condition that often endures in adulthood.

More than twice as many boys as girls have been diagnosed with ADHD—15 in 100 versus 7 in 100. The rates were highest among high-schoolers—1 in 10 girls, and nearly twice as many boys. About 1 in 10 high-school boys takes ADHD medication.

Before yours becomes one of them, find out if your kid truly is suffering from a mental disorder. Explore other treatment options, such as counseling, and causes for unacceptable behavior that might be social (bullying?) instead of chemical. Drugs can be lifesavers, but they also can harm.

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January 2, 2013

Energy Drinks Entice Teens with Mumbo Jumbo

You can take your caffeine straight, or mixed with a large dose of b.s. If sales trends are any judge, many teens take their caffeine with the b.s., and they pay a lot more than if they took it straight with a cup of coffee or a NoDoz tablet.

We're talking about energy drinks, which are marketed with lots of scientific sounding ingredients, proprietary mixtures of this and that, but it all boils down to one and only one ingredient that's been proven to do anything: caffeine.

This conclusion was repeated again today in a takeout by Barry Meier, a top New York Times investigative business reporter. Energy drinks simply have no scientific basis to claim that they do anything for you that you wouldn't get from regular old caffeine alone.

To sell these products, Meier documents how the manufacturers mix in large amounts of obscure, little tested ingredients with mega-doses of well known stuff like various of the B vitamins. But it all adds up to the same thing: no real proof, unless you're a believer in marketing jingles, that they do anything beyond a cup of coffee's worth of caffeine.

To get the same caffeine boost that a 16-ounce energy drink will give you for $2.99, you could spend less on a Starbucks coffee, or even less on a NoDoz tablet: about 30 cents.

It's your choice, kids.

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September 21, 2012

Does Your Kid Really Need Antipsychotic Drugs?

Whether it’s a marker of our “take a pill, solve a problem” mentality or a genuine effort to address a medical diagnosis with less than laserlike precision, a whole lot of kids are taking a whole lot of seriously psychotropic drugs for problems that don’t necessarily require them.

Psychotropic drugs alter perception, emotion and/or behavior. We’ve covered their misuse in general, but this study focused on children at doctors' offices. It followed a similar study last year that surmised that the increase of these powerful agents for youngsters was probably due to inpatient use.

As reported last month by Reuters, antipsychotic drugs are prescribed in nearly 1 in 3 of all visits by children and teens to psychiatrists in the U.S. That’s a significant increase from the 1990s, when it was about 1 in 11 such visits.

The study of this practice was published in the Archives of General Psychiatry. It concludes that the increase is the result of doctors prescribing the drugs for disruptive behaviors, such as attention deficit/hyperactivity disorder (ADHD), never mind that the FDA does not approve antipsychotics to treat those disorders in kids.

They are approved to treat schizophrenia, bipolar disorder and irritability with autism.

Use of them for other purposes is deemed “off-label,” which isn’t illegal, provided the drug manufacturers don’t promote them for such uses.

The study couldn’t say whether the prescriptions were unnecessary, but their effectiveness for disorders such as ADHD is uncertain. And, like all drugs, they carry the potential for side effects. Antipsychotic drugs can promote weight gain and have been linked to diabetes.

Last year, according to Reuters, a large study of children found that kids who took antipsychotic drugs were four times more likely to develop diabetes than their peers who weren’t taking them.

In September, an FDA advisory panel expressed concern about the drugs’ appropriateness for children, and urged the agency to monitor weight gain and metabolic diseases (diabetes) in children who take them.

Antipsychotic drug use is increasing across all demographic groups, but it’s most accelerated for children and teens. It’s difficult to cite exact numbers because the research concerns only prescriptions written during doctor office visits—clinics, community health centers or other facilities weren’t included. Another complication to being exact about antipsychotic drug use in children is that researchers don’t know how long each patient took the drug or if any prescription was written at a repeat visit by the same patient.

The new study’s lead author has his own prescription for parents whose children might be given an antipsychotic drug prescription at a doctor’s appointment. He advises them to ask more questions about the drugs—why is it being prescribed, what are the intended effects, how soon are they expected to appear, what are the side effects (see our blog, “Questions Patients Should Always Ask”)—and also if there are any alternative treatments.

He said psychosocial interventions (training for parents to manage the behavior from certain disorders) can reduce aggressive and disruptive behaviors in kids. But they take time, and they’re more expensive.

"Perhaps if they were more available, we wouldn't have as much use of these antipsychotic medications," he told Reuters.

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June 26, 2012

Poll Sends Clear Message to Presidential Candidates about Child Health Issues

It’s election season, and there is no shortage of either polls or opinions. A recent national survey by the University of Michigan’s National Poll on Children’s Health found that a majority of adults agree on four major issues they want the presidential candidates to address.

More than 2,100 adults were surveyed, and were asked to select the single most important child health issue from 24 common health concerns. These priorities represented more than half of all responses, and crossed party and ethnic lines:

Because many adult health problems often are seeded in childhood—obesity, heart disease, diabetes, depression—the need for early intervention is acute, and is a matter of public policy.
To see the full report, link here.

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May 17, 2012

Drug Labels Still Leave Pediatricians Playing a Guessing Game

Nearly 50 years ago, Dr. Harry Shirkey coined the phrase "therapeutic orphan" to describe children who took prescription medicine. Because drug studies among a pediatric population were complicated and offered little financial return for pharmaceutical companies, no one really knew how drugs developed for adults would affect children who took them. Providers prescribed them based on their best guess about how to tailor an adult dose to a child.

In 1997, Congress passed the Food and Drug Administration Modernization Act (FDAMA). It offered incentives for pediatric drug development in the form of additional marketing exclusivity. Progress has been made in drug research among children, and drug labeling for these patients has improved.

But not enough.

According to a recent study published in the Journal of the American Medical Association, (JAMA) not even half of drug labels have information on safety and proper dosing for kids. More than 500 drug labels were evaluated.

According a Reuters story about the new study, drugs still pass the FDA approval process and make it to market without much research on how they should be given to children for the best treatment and least harm.

Pediatric research remains difficult—the number of children with a given disease usually is lower than that of adults, and the ethical concerns are thornier because minors can’t provide informed consent.

The JAMA study looked at hundreds of drugs that treated a range of problems from high blood pressure to allergies.

Labels were deemed “adequate” to use in children if they included how effective the drug is, if it’s safe in younger children and teens and enumerated doses of children of different ages.

Two hundred thirty-one drugs were adequately labeled and 29 others carried dosing for some younger age groups, but not all. Still, slightly more than half of all labels lacked useful pediatric information. Even after tossing the results of drugs that were irrelevant to kids (prostate cancer treatments, for example), 44 in 100 labels offered no information for young patients.

Some newer drugs, those approved by the FDA between 2002 and 2008, also lacked safety and dosing information for kids. But the good news is that drugs commonly prescribed for children—asthma meds and vaccines, for example—often undergo rigorous testing.

Still, kids get cancer, arthritis, and they suffer lung and heart disease; studies on how drugs to treat them react in children often fall by the wayside. And the “how much and at what cost” treatment guessing game continues.

Prescribing medications to children that have not been labeled for them is an off-label use (doctors are allowed to prescribe them, but drug companies may not market them for an unapproved use). That might result in benefit, no therapeutic effect or harm (adverse reactions). (To learn more about medication errors, link here.)

Doctors uncertain about a drug’s effect in a kid might be reluctant to prescribe it off-label, and that could deprive the patient of a real benefit.

If a child receiving an unlabeled drug therapy doesn’t respond well, is that because the drug just didn’t work? Was the dosing incorrect? If there are side effects, do they denote a marker of the drug itself, or of an incorrect dose?

The researchers concluded, “Labeling with pediatric information in only 46 percent of products is still insufficient. Legislation to increase pediatric clinical trials and require the resulting information be added to labeling is necessary. The current legislation expires in 2012 without reauthorization.”

That lapse is not acceptable. Contact your congressional representatives to appeal for completion of a process that has shown benefit but is not finished.

And if your child is prescribed a drug lacking information about appropriate doses for certain age groups, and possible side effects, ask your doctor and pharmacist for more information. If they’re uncertain, because there’s no science to inform them, ask if there are alternative therapies.

Children should not be guinea pigs.

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April 4, 2012

Common Products That Can Poison Children

According to the American Association of Poison Control Centers, approximately half of all poison exposures involve children younger than 6.

Most parents are pretty good at identifying and keeping their children safe from obvious toxins, from cleaning fluid to blood thinners. But many common household items, not to mention the contents of mom’s purse, are attractive and potentially lethal.

In his job as director of the Toxics Epidemiology Program for the Los Angeles County Department of Public Health, Dr. Cyrus Rangan tracks and responds to toxic exposures and consults with patients exposed to toxins. Following is his list of common products that pose a poison threat, and why.

  • Button batteries (for hearing aids, watches, etc.) can get lodged in the airway or the esophagus, causing third degree burns and bleeding. Note that these potentially lethal button batteries can even be found in toys.

  • Chewing gum is generally safe, but a young child can choke on pieces of gum. Nicotine gum is very poisonous to young children.

  • Cough drops taste sweet and might seem like candy to young children. But some contain medications like destromethorphan, which can cause gastrointestinal and vision problems, among others. Also, kids can choke on cough drops.

  • Sanitary gel can be 60 percent alcohol (120 proof). If ingested, a small bottle is like giving a kid a couple small shots of hard liquor.

  • Cigarettes carry a unique smell and taste that is attractive to some young children. Acute nicotine poisoning can result if they ingest a cigarette.

  • Nail polish remover can cause gastrointestinal distress, and can be even more harmful if vomited and inhaled into the airways. These products seldom come in child-resistant containers.

  • Pepper spray can be extremely irritating to the eyes, mouth, throat and lungs of anyone, but it’s worse for children, and such devices are easily deployed by accidental.

  • "Gummy" vitamins look and taste like candy. Although toxicity is likely to be low, there’s a larger issue here of referring to medicine as candy. Children should learn that medicine is medicine, candy is candy and confusing them is dangerous.
  • Over-the-counter medications, like cough drops and gummy vitamins, are often colorful, coated with sweetener and mistaken for candy. Some can be just as dangerous to a young child as prescription medications. We’ve tracked the checkered history of one such notable example, acetaminophen.

  • Prescription medications that aren’t stored safely away from youngsters are hazardous. We’ve addressed this hazard, and the fact that many can kill a 2-year-old in a single dose. Never store them in a container other than what they came in.

If your child has ingested a toxic product or substance, or has a reaction to something he or she has touched, contact the National Capital Poison Center at (800) 222-1222. If you think your child might have swallowed a button battery, go to the nearest emergency room.

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March 12, 2012

Good News for Kids About the Orphan Drug Act

Few medical scenarios are more heartbreaking than a child with a dread rare disease who might be able to be treated if only drugs were available.

“Orphan drugs,” as we recently described, treat extremely rare disorders, generally afflicting 6,000 or fewer patients. Because the consumer market for them is so small, there’s little incentive for manufacturers to conduct the R&D necessary to develop them, or to spend the money marketing them.

Legislative efforts are underway to deliver orphan drugs faster to the people who need them. An article published recently in the journal Pediatrics, “What the Orphan Drug Act Has Done Lately for Children With Rare Diseases: A 10-Year Analysis,” reviewed progress for victimized youngsters.

It looked at orphan drug designations and approvals from Jan. 1, 2000, to Dec. 31, 2009, and determined that the Act “led to increased product availability for [rare diseases] overall, with an increasing number of marketing approvals for children this past decade.”

During that time period:

  • 1,138 drugs were designated as “orphan,” of which 148 received marketing approval;
  • 38 (more than 1 in 4) addressed pediatric diseases;
  • the proportion of approvals for pediatric products increased from fewer than 1 in 5 in the first half of the decade to slightly fewer than 1 in 3 in the second half.
This is good news, as is the fact that approval for “orphan” designation and marketing for pediatric diseases with fewer than 20 000 patients grew more than for any other group.

Anyone interested in knowing more about the FDA’s Office of Orphan Products Development may link here.

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December 26, 2011

Another Warning on Baby Acetaminophen (Tylenol)

If you give your baby acetaminophen to reduce fever and pain, pay close attention to the packaging.

Several months ago, we reported about the FDA’s interest in more accurate dosing information for children’s Tylenol . It’s still a hot topic. Last week, the feds issued a warning about the potential for dosing errors with liquid acetaminophen for infants. As explained on MedPage Today, in 2009 the FDA recommended introducing a new, single strength version of the drug. Adverse event reports from babies given the drug indicated that the problem was dosing errors.

Many manufacturers who made liquid acetaminophen in different strengths agreed to produce only a single concentration—160 mg/5 mL. The quantities refer to how much of the active ingredient (160 mg) is in each dose (5 mL). But the effort to simplify appears to have complicated things.

The recommendation to produce only a single dose was voluntary, and not every manufacturer followed it. Acetaminophen strengths of 80 mg/mL and 80 mg/0.8mL are still available for purchase. Some consumers have both versions of the drug, and some of the newer packaging is similar to the old. For the Little Fevers brand, the FDA noted, “both boxes … say ‘New’ on the front, but only one of the contains the new concentration of liquid acetaminophen.”

Parental tip: If your package of liquid acetaminophen includes a dropper, that’s the older version. The 160 mg/5 mL products include an oral syringe that is supposed to make dosing more precise. To eliminate the risk of giving the wrong dose, use only products with the syringe, and dispose of any other liquid acetaminophen. If you’re uncertain how to measure, contact a pharmacy or your doctor’s office.

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December 15, 2011

The No. 1 Cause of Kids' Visits to Emergency Rooms, and What Parents Can Do

What sort of misadventure do you think brings most young children into the emergency room? Most people would guess car accidents. Most people would be wrong.

It’s poisoning by drugs. According to the National Capital Poison Center, this stark reality is the result of more children having access to and swallowing prescription drugs at home.

More adults are using prescription medication, especially of the pain-killing variety such as oxycodone, hydromorphone, morphine, methadone and fentanyl. And older children with chronic conditions are adding to the prescription drug bottom line with meds to treat their attention deficit disorders and, increasingly, Type 2 diabetes.

The danger to the wee ones simply reflects the law of averages: The more medicines present in young children’s homes, the greater the likelihood they will find and swallow them.

The most dangerous prescription medicines for children are those that treat:

  • diabetes;

  • pain (opioids, or narcotics);

  • anxiety, muscle spasms and sleep problems;

  • heart disease and high blood pressure.

Medicines should be locked up, but that can be tough if the rightful patient requires frequent dosing. Travel also complicates safe storage. And even the most vigilant parent gets interrupted and distracted while taking medicines.

To minimize the incidence of childhood poisoning, researchers such as those involved in a Journal of Pediatrics study propose that packaging limit the amount of drug available (children can’t open many child-resistant blister packs at one time). Liquid medicines as well could be dispensed in single-dose containers.

Other poison-prevention measure suggested by the Poison Center:

  • Use child-resistant packaging. Replace caps tightly after use.

  • Lock all medicines up high, out of sight and reach of children.

  • Take medicines when children aren’t looking—children imitate adults.

  • When traveling, ensure that medicines are locked away from children.

If you think a child may have swallowed too much medicine or someone else’s medicine, call the poison center immediately at 800-222-1222.

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July 20, 2011

Secondhand Smoke Poses Yet More Risks to Children

Because nicotine is possibly the most difficult addiction to kick, because inhaling smoke carries so much destructive potential, you can never try too hard or too often to quit. Now another study shows why smoking around children is a terrible idea.

“Not only are children who are surrounded by secondhand smoke at greater risk for asthma and other health problems,” says the Los Angeles Times, “but they may be more likely to have attention-deficit/hyperactivity disorder or learning disabilities too.”

Researchers at the Harvard School of Public Health found that children who lived with smokers were 50% more likely to suffer from a learning disability, a behavioral or conduct problem or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

Although the study was less than scientifically ideal—it was a phone survey of parents—and some variables were not considered, such as whether the mothers smoked during pregnancy, this is not the first study to connect mental health problems and secondhand smoke.

Another study published in Archives of Otolaryngology–Head and Neck Surgery concludes that exposure to secondhand smoke is associated with increased risk of hearing loss among adolescents.

Fetuses and young children exposed to secondhand smoke are vulnerable to an array of possible problems, including low birth weight, respiratory and ear infections and behavioral problems. Now evidence suggests that adolescents are at risk of compromised hearing.

In the new study, adolescents who were exposed to secondhand smoke showed higher rates of hearing loss than teens who weren’t exposed.

If your teens have been exposed to secondhand smoke, the researchers suggest they be closely monitored for hearing loss, and informed that noise from recreational or occupational endeavors can further impair hearing, even if the kids aren’t aware of it.

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February 3, 2011

Caffeine-laced energy drinks worry researchers

A review of studies about the contents of energy beverages has raised serious questions about their efficacy and safety. The review, published in the November issue of the Mayo Clinic Proceedings, noted that the drinks contain high levels of caffeine and could pose dangerous, even life-threatening effects on blood pressure, heart rate and brain function to some susceptible individuals.

The study found four documented cases of caffeine-associated death and five separate cases of seizures associated with consumption of energy/power drinks. Other reports included: (1) an otherwise healthy 28-year-old man who suffered a cardiac arrest after a day of motocross racing; (2) a healthy 18-year-old man who died playing basketball after drinking two cans of Red Bull; and (3) four cases of mania experienced by individuals known to have bipolar disorder.

Noting that teens and young adults are consuming energy drinks “at an alarming rate,” the study authors said it was important to determine whether long-term use of these beverages “will translate into deleterious effects later,” such as liver and cardiovascular disease, insulin resistance and diabetes.

Currently, the drinks are labeled as “dietary supplements,” which exempts them from regulations governing sodas and juices and allows manufacturers to make “ “structure and function” claims, like “enhances athletic performance” and “increases caloric burn and mental sharpness.”

The American Beverage Association says most mainstream energy drink brands voluntarily put statements on their containers, including advisories about use by people sensitive to caffeine, and many also list the amount of caffeine on their product labels or have provided caffeine content information through their Web sites and consumer hot lines.

But the study authors worry that some athletes who exercise intensively are substituting energy drinks for sport drinks (which only contain sugar and electrolytes). They say the high doses of sugar in energy drinks can impair absorption of fluids and result in dehydration, noting that a 16-ounce can of an energy drink may contain 13 teaspoons of sugar and the amount of caffeine found in four or more colas.

Source: The New York Times

You can view an abstract of the study published in the Mayo Clinic Proceedings here.

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May 1, 2010

"Tic Tacs" Packed with Nicotine Appeal to Teens

In response to the increase of smoke-free air laws, one of the nation’s biggest cigarette makers started test marketing flavored tobacco pellets in parts of the country. Although the new product by R.J. Reynolds Tobacco, called Camel Orbs, is marketed for adults and packaged in child-resistant containers, critics think it “closely resembles Tic Tac breath mints,” and creates appeal for teenagers, reports Duff Wilson of the New York Times.

According to Wilson, in a study published in the April issue of the Pediatrics journal, researchers say that Camel Orbs and other dissolvable tobacco products are “packed with nicotine and can poison children and lure young people to start using tobacco.” These smokeless products are appealing to teenagers because of their “candy-like appearance, added flavors, and easily concealable size,” says Dr. Laurence Deyton of the FDA in a commentary in the same issue of the Journal. In fact, a group of teenagers were seen sharing Camel Orbs.

Not only do these pellets increase the likelihood of more teenagers becoming addicted to tobacco, their dissolvability and high level of absorbable nicotine also pose health hazards to younger children: children who ingest tobacco products suffer nausea and vomiting.

To combat the emergence of these new products, Congress passed legislation last year to require Reynolds to produce research results and other materials about the dissolvable tobacco products. The FDA is also required under the legislation to study the products within two years; and “depending on the outcome of that review, the agency could ban them or require product changes,” writes Duff Wilson.

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October 2, 2008

Experts at Hopkins in Baltimore Recommend Labels for Energy Drinks for Kids

Caffeine is technically a drug, although it's hard to think of it like that.

But some experts are saying that, because caffeinated energy drinks promise some of the same effects as prescription drugs, they should be labeled so kids know that anything that produces those effects has to be treated with caution:

Because energy drinks are touted as performance enhancers and stimulants, Dr. Roland R. Griffiths explained in an interview with Reuters Health, kids who use them for these reasons will likely be more open to trying prescription drugs that promise the same effects.

"It seems like it's a pretty easy threshold to step over, but as a society we want to make this a bright line," Griffiths said in an interview.

In their report on the marketing, regulation and health effects of caffeinated energy drinks published this month in the journal Drug and Alcohol Dependence, Griffiths and his colleagues at The Johns Hopkins University School of Medicine call for regulations requiring energy drink makers to list the caffeine content of their products on their labels, and warn of the potential for caffeine intoxication.

The whole article merits reading as it contains a lot of little-known information about energy drinks and how they are manufactured and what they contain.

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July 16, 2008

Menthol: A Hook for Young Smokers

New research from the Harvard School of Public Health shows that tobacco companies have been deliberately varying levels of menthol in their cigarettes, marketing cigarettes with lower levels of menthol to younger smokers and then increasing the level of menthol with the age of the target demographic. From the article:

One document from R.J. Reynolds noted that all three major menthol brands "built their franchise with YAS (younger adult smokers) ... using a low-menthol product strategy. However, as smokers acclimate to menthol, their demand for menthol increases over time."

In 1987, R.J. Reynolds marketed low-level menthol varieties to persuade consumers to switch from regular brands and to recruit new, young smokers, noting: "First-time smoker reaction is generally negative. ... Initial negatives can be alleviated with a low level of menthol."

This new research serves as a reminder that, despite famous regulations about where and how Joe Camel can be displayed, tobacco companies continue to market deadly products to very young people.

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July 15, 2008

Cholesterol Pills for Kids?

Recently, there was an outcry about new recommendations from the American Academy of Pediatrics that suggest giving kids as young as 8 years old cholesterol-reducing statin drugs.

Tara Parker-Pope discusses the controversy in a recent column. Those who object to the new recommendations worry about the drugs' long-term consequences, the AAP's financial relationships with drug companies and the possibility that the new guidelines will lead to overuse of the drugs. The defenders argue that the guidelines specify that only a very small group of children--those with strong genetic and lifestyle risk factors--would even be considered for statin therapy. Parker-Pope's whole article is worth reading, as it discusses both the financial and the medical aspects to this debate.

One problem here is widespread throughout medicine: what some have called "indication sprawl." Once a drug or treatment is recommended for one narrow category of patients, it tends to get indicated for more and more categories with less and less testing and justification for the new categories. But more profit for the drug makers.

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March 21, 2008

Study: Computerized Program Helps Teens Quit Smoking

A smoking cessation program involving four computerized sessions is effective for teens, new research indicates. From the article:

Fritz studied 128 teenagers, 14-19 years old, divided in half for control and experimental groups. The experimental group completed four CASCP computer sessions as well as questionnaires and post-intervention testing. Not only did the experimental group report more quit attempts than the control group subjects, who did not participate in the computer sessions, but 23% of the teens actually quit smoking.

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