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Archive for the ‘inhalant huffing’ Category.

Mint, menthol e-cigarette liquids high in cancer-causing compound: study


A cancer-causing compound banned by U.S. regulators last year as a food additive has been found at potentially dangerous levels in mint and menthol flavored e-cigarette liquids and smokeless tobacco products, researchers said on Monday.

The findings, published in the journal JAMA Internal Medicine, provided the latest evidence about health concerns related to e-cigarettes. Federal health officials are investigating lung illnesses linked to e-cigarettes and vaping products tied to six U.S. deaths.

The levels of pulegone, a carginogenic constituent of mint plant oil, that are inhaled by e-cigarette users are as much as 1,000 times higher than those taken in by smokers of menthol cigarettes, Duke University School of Medicine researchers said. The study involved six types of pulegone-containing smokeless tobaccos and e-cigarette liquids used for vaping.

The Food and Drug Administration barred the use of pulegone as a food additive after receiving petitions from health and environmental groups.

“The FDA regulatory regimen for food is much more strict than what is required for e-cigarettes,” said study co-author Sven-Eric Jordt of the University Program in Environmental Health at the Duke University School of Medicine. “In the ‘70s, the tobacco industry already knew that pulegone was undesirable and moved to synthetic flavorings.”

To calculate acceptable levels of carcinogens in food, the FDA takes the highest amount animals can consume without developing tumors and divides it by the estimated amount consumed per day. The resulting number – called the “margin of exposure,” or MOE – needs to be above 10,000 for the food to be deemed safe by regulators. Lower MOEs are a cause for concern. And the lower the number, the less safe the food.

“The FDA decided that the intake of a carcinogen from food must be at least 10,000-fold less than the maximal dose that doesn’t cause cancer in an animal,” Jordt said. “Meaning, the product is 10,000-fold safer.”

Of the six types of pulegone-containing smokeless tobaccos and e-cigarette liquids examined, all came out with MOEs below 10,000, the researchers said.

Depending on consumption rates, MOEs for the e-liquids ranged between 325 and 6,012, and for a pulegone-containing smokeless tobacco they ranged between 549 and 1,646.

The researchers determined that the MOE for one e-cigarette liquid, V2 Menthol, ranged from 3,084 to 325, depending on how much was consumed. For that example, daily exposure to pulegone was 86 to 1,608 times higher with e-cigarette use than with a menthol combustible cigarette.

Dr. Panagis Galiatsatos, director of the Tobacco Treatment Clinic at the Johns Hopkins Medical School, called the findings “highly concerning.”

This is yet another example of something that has been looked at by the FDA only as a food and not as an inhalant, Galiatsatos said. Galiatsatos, who was not involved in the research, added that the study “tells us how willing e-cigarette makers are to create an enhanced experience at the cost of health ramifications.”

The researchers noted that the tobacco industry has minimized pulegone levels in cigarette flavorings because of toxicity concerns.

“Our findings appear to establish health risks associated with pulegone intake and concerns that the FDA should address before suggesting mint- and menthol-flavored e-cigarettes and smokeless tobacco products as alternatives for people who use combustible tobacco products,” the researchers wrote.

President Donald Trump’s administration last week announced plans to remove all flavored e-cigarettes from store shelves in a widening crackdown on vaping, as officials warned that sweet flavors have drawn millions of children into nicotine addiction.

SOURCE: bit.ly/32DHan8

JAMA Intern Med 2019.



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Autopsy: Prominent attorney Fred Leonhardt died of huffing


“Medically we just don’t see death from huffing ethyl chloride much, and when we do its from much younger people,” said Timothy Huckaby, medical director of the Orlando Recovery Center, in response to a reporter’s questions about the autopsy. “One of the real dangers of huffing it is that it makes you more prone to heart arrhythmia.”



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Miami Valley Young Marines win national award


WASHINGTON, D.C. — The National Department of Defense selected the Miami Valley Young Marines from Huber Heights as this year’s winner of the Fulcrum Shield. The award was presented Thursday, Oct. 17, at a special ceremony in the Hall of Heroes at the Pentagon, Arlington, Va.

The award is given annually by the Department of Defense and recognizes military-affiliated youth organizations around the world that have made intensive efforts at spreading anti-drug messages in local communities.

This is the second time Miami Valley Young Marines has won this prestigious award and the 10th win for the Young Marines program.

“It has been a busy yet rewarding year for our Young Marines,” said J. Keagan Miller, unit commander of the Miami Valley Young Marines. “It is exciting to see them interact with all of the local law enforcement and other drug prevention organizations throughout the Miami Valley.

“We are thankful for all of the community support we have garnered over the past few years which, without their assistance, none of this would be possible,” he said.

In 2014, the Young Marines unveiled “Closing the Gate on Drugs” on a national scale. It consists of lessons that help young people learn and practice new skills and strategies for resisting the gateway drugs. These “gateway drugs” include tobacco, alcohol, inhalant abuse, marijuana and over the counter or prescription medication.

“We are extremely proud of Miami Valley Young Marines for their remarkable efforts in educating the local community the dangers of drugs,” said Col. William P. Davis USMC (Ret), national executive director and CEO of the Young Marines. “Their message reached thousands of adults and youth and made a real impact that extends beyond just our members. The engagement by the Young Marines and the interaction with so many community element and leaders really was fantastic.”

The Miami Valley Young Marines was founded in 1998 as the Dayton Young Marines. The name was changed in 2003 to encompass communities in all 13 counties in the Miami Valley area. The unit has 30 youth members and 12 registered adult leaders.

Recent awards received by the Miami Valley Young Marines:

• Fulcrum Shield Award by the DoD (2017)

• Division Unit of the Year (2006, 2018, 2019)

• Division Enrique “Kiki” Camarena Award (2017, 2019)

• Distinguished Unit Citation (2005, 2015, 2018, 2019)

• Marine Corps League Unit Commendation (2006, 2017)

• Regimental Unit of the Year (2017)

The Young Marines is a national non-profit 501c (3) youth education and service program for boys and girls, age eight through the completion of high school. The Young Marines promotes the mental, moral and physical development of its members. The program focuses on teaching the values of leadership, teamwork and self-discipline, so its members can live and promote a healthy, drug-free lifestyle.

Since the Young Marines’ humble beginnings in 1959 with one unit and a handful of boys, the organization has grown to over 264 units with 8,500 youth and 2,500 adult volunteers in 40 states, the District of Columbia, Japan and affiliates in a host of other countries.

For more information, visit the official website at: https://www.YoungMarines.com or the Miami Valley Young Marines at https://miamivalleyyoungmarines.com/.

Provided photo Col. William P. Davis USMC (Ret.), national executive director and CEO of the Young Marines; Tina Miller, of Troy, recruiting and retention officer with the Miami Valley Young Marines; YM/GySgt Jordyn Webb, 17, of Dayton, with the Miami Valley Young Marines; and James N. Stewart, performing the duties of the Under Secretary of Defense for Personnel and Readiness, U.S. Department of Defense.

Honored by Dept. of Defense for anti-drug education





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Teens ‘huffing’ Freon from air conditioning units, experts say 


Freon inhalation killed at least two teenagers in 2009, KABC reported, and led to the hospitalization of more than 2,000 others. In 2010 more than 7,000 people reported exposure to Freon and other propellants, according to the American Association of Poison Control Centers, and nine people died as a result.



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Is laughing gas harmless fun or a serious drug problem?


Walking in central London recently, I noticed a group of teenagers inhaling the contents of balloons in an alleyway. There was a lot of giggling and high spirits and my initial reaction was that they were inhaling helium from the balloons in order to induce Donald Duck-like speech.

However, I now realise they were inhaling nitrous oxide (N2O) or laughing gas in pursuit of a so-called legal high.

With professional soccer players such as Liverpool’s 20-year-old Raheem Sterling filmed allegedly inhaling laughing gas before briefly losing consciousness, it’s no surprise to read that nitrous oxide abuse is growing in popularity. Research suggests laughing gas was the second most popular drug among young British adults in 2013/14 after cannabis.

A 2006/2007 Irish survey found some 2 per cent of the adult population reported using a solvent or volatile inhalant in the past. Lifetime use was highest among adults aged 15-24 years, at 4.2 per cent.

The drug is used legitimately in the catering industry as a whipping agent, leading to one of its street names – “whippet”.

It is also used in medicine as an anaesthetic and as an anxiolytic during labour, and for dental procedures. A colourless and non-flammable gas, with a slightly sweet taste and smell, nitrous oxide for recreational use is usually bought in pressurised canisters before being used to inflate balloons to facilitate inhalation.

Carnivals

The principal “hit” from laughing gas is a short period of euphoria. It can also cause dizziness and may precipitate disordered thinking in the short term.

Concerns around its use include the fact that it displaces oxygen in the bloodstream, leading to hypoxia and a risk of asphyxiation. However, there is little research to indicate how frequent use of nitrous oxide affects the habitual user.

At the annual Euroanaesthesia meeting in Berlin recently, the pros and cons of using nitrous oxide as an anaesthetic agent were debated.

Over the past 15 years, with the advent of new options, there has been a shift away from N2O as an adjuvant to general anaesthetic during surgery.

Tingling and numbness

In its favour, N2O was deemed by the taskforce to have a “faster and smoother induction with improved oxygenation”, and its use allows for lower doses of other drugs, “which, in turn, may result in faster recovery at the end of the procedure”.

Noting the anaesthetic agent’s use in about two billion patients to date, it concluded that there is no data to suggest that N2O in clinically relevant settings would pose a health risk to patients.

Meanwhile, back on the streets, how worried should we be about the rising use of laughing gas as a drug of abuse? The Advisory Council on the Misuse of Drugs (ACMD) said that there were five deaths in the UK in 2010 and one in 2011 related to its use. These deaths were due to asphyxiation resulting from hypoxia, and most involved the use of nitrous oxide in an enclosed space, it noted.

Deaths may be rare but they are random – and clearly no laughing matter. mhouston@irishtimes.com muirishouston.com



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Young Marines Wins Award From Department Of Defense


The U.S. Department of Defense selected the Miami Valley Young Marines from Huber Heights, Ohio, as this year’s winner of the Fulcrum Shield. The award was presented Thursday, October 17, 2019, at a special ceremony in the Hall of Heroes at the Pentagon, Army Navy Drive and Fern Street, Arlington, Virginia.

The award is given annually by the Department of Defense and recognizes military-affiliated youth organizations around the world that have made intensive efforts at spreading anti-drug messages in local communities.

This is the second time Miami Valley Young Marines has won this prestigious award and the 10th win for the Young Marines program.

“It has been a busy yet rewarding year for our Young Marines,” said J. Keagan Miller, unit commander of the Miami Valley Young Marines. “It is exciting to see them interact with all of the local law enforcement and other drug prevention organizations throughout the Miami Valley.

“We are thankful for all of the community support we have garnered over the past few years which, without their assistance, none of this would be possible.”

In 2014, the Young Marines unveiled “Closing the Gate on Drugs” on a national scale. It consists of lessons that help young people learn and practice new skills and strategies for resisting the gateway drugs. These “gateway drugs” include tobacco, alcohol, inhalant abuse, marijuana and over the counter or prescription medication.

“We are extremely proud of Miami Valley Young Marines for their remarkable efforts in educating the local community the dangers of drugs,” said Col. William P. Davis USMC (Ret), national executive director and CEO of the Young Marines. “Their message reached thousands of adults and youth and made a real impact that extends beyond just our members. The engagement by the Young Marines and the interaction with so many community element and leaders really was fantastic.”

The Miami Valley Young Marines was founded in 1998 as the Dayton Young Marines. The name was changed in 2003 to encompass communities in all 13 counties in the Miami Valley area. The unit has 30 youth members and 12 registered adult leaders.

Recent awards received by the Miami Valley Young Marines:

  • Fulcrum Shield Award by the DoD (2017)
  • Division Unit of the Year (2006, 2018, 2019)
  • Division Enrique “Kiki” Camarena Award (2017, 2019)
  • Distinguished Unit Citation (2005, 2015, 2018, 2019)
  • Marine Corps League Unit Commendation (2006, 2017)
  • Regimental Unit of the Year (2017)

About the Young Marines

The Young Marines is a national non-profit 501c (3) youth education and service program for boys and girls, age eight through the completion of high school. The Young Marines promotes the mental, moral and physical development of its members. The program focuses on teaching the values of leadership, teamwork and self-discipline, so its members can live and promote a healthy, drug-free lifestyle.

Since the Young Marines’ humble beginnings in 1959 with one unit and a handful of boys, the organization has grown to over 264 units with 8,500 youth and 2,500 adult volunteers in 40 states, the District of Columbia, Japan and affiliates in a host of other countries.

For more information, visit the official website at: https://www.YoungMarines.com or the Miami Valley Young Marines at https://miamivalleyyoungmarines.com/.





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Health education at New Canaan High School gets an F


Published


Editor, Advertiser:

I was so happy to see the excellent and riveting op−ed, “An Open Letter to the NCHS Administration: Sex Ed Sucks” by Helen Culpepper in last week’s Advertiser.

I totally agree with her viewpoint. I would like to broaden that title to include all health care.

I am a nurse midwife in private practice and have focused a large part of my practice in adolescent health. Health education begins at home and should be reinforced and supported by health educators, starting in early elementary school. This begins with healthy eating, exercise, anti-bullying, and sharing the dangers of smoking (including vaping). As the child becomes older (middle school), the health discussion broadens to introduce body and psychological changes, menses, drug awareness, and inhalant abuse.


Twenty years ago, when my older children were attending Saxe, I became aware that there was no health education offered. I brought this up at a PTC meeting and was asked to teach health education for grades 6-8. I said yes and provided an outline of what needed to be covered to properly educate our students. I was informed that I would be teaching the girls only, because the boys were going to be taught by a male teacher. It would be only two classes, which was a total of 90 minutes of health education. Total.

If it wasn’t for New Canaan CARES offering students information and education, they would have only had those 90 minutes to learn at least two years worth of information. This program was at NCHS until the renovation in 2007 and was removed due to “lack of space.” This choice severely limited students’ access to information.

The health education program at NCHS must include vetted information about nutrition, sexual health, psychological health, and the dangers of drug abuse.

Knowledge is power. When students are not educated about their bodies, they make poor decisions because they are not equipped with the knowledge to choose well. In the long run, a lack of health education hurts our kids the most.

Christine Dombrowski, MS, CNM



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Young Marines Wins National Award From Department Of Defense


The U.S. Department of Defense selected the Miami Valley Young Marines from Huber Heights, Ohio, as this year’s winner of the Fulcrum Shield. The award was presented Thursday, October 17, 2019, at a special ceremony in the Hall of Heroes at the Pentagon, Army Navy Drive and Fern Street, Arlington, Virginia.

The award is given annually by the Department of Defense and recognizes military-affiliated youth organizations around the world that have made intensive efforts at spreading anti-drug messages in local communities.

This is the second time Miami Valley Young Marines has won this prestigious award and the 10th win for the Young Marines program.

“It has been a busy yet rewarding year for our Young Marines,” said J. Keagan Miller, unit commander of the Miami Valley Young Marines. “It is exciting to see them interact with all of the local law enforcement and other drug prevention organizations throughout the Miami Valley.

“We are thankful for all of the community support we have garnered over the past few years which, without their assistance, none of this would be possible.”

In 2014, the Young Marines unveiled “Closing the Gate on Drugs” on a national scale. It consists of lessons that help young people learn and practice new skills and strategies for resisting the gateway drugs. These “gateway drugs” include tobacco, alcohol, inhalant abuse, marijuana and over the counter or prescription medication.

“We are extremely proud of Miami Valley Young Marines for their remarkable efforts in educating the local community the dangers of drugs,” said Col. William P. Davis USMC (Ret), national executive director and CEO of the Young Marines. “Their message reached thousands of adults and youth and made a real impact that extends beyond just our members. The engagement by the Young Marines and the interaction with so many community element and leaders really was fantastic.”

The Miami Valley Young Marines was founded in 1998 as the Dayton Young Marines. The name was changed in 2003 to encompass communities in all 13 counties in the Miami Valley area. The unit has 30 youth members and 12 registered adult leaders.

Recent awards received by the Miami Valley Young Marines:

  • Fulcrum Shield Award by the DoD (2017)
  • Division Unit of the Year (2006, 2018, 2019)
  • Division Enrique “Kiki” Camarena Award (2017, 2019)
  • Distinguished Unit Citation (2005, 2015, 2018, 2019)
  • Marine Corps League Unit Commendation (2006, 2017)
  • Regimental Unit of the Year (2017)

About the Young Marines

The Young Marines is a national non-profit 501c (3) youth education and service program for boys and girls, age eight through the completion of high school. The Young Marines promotes the mental, moral and physical development of its members. The program focuses on teaching the values of leadership, teamwork and self-discipline, so its members can live and promote a healthy, drug-free lifestyle.

Since the Young Marines’ humble beginnings in 1959 with one unit and a handful of boys, the organization has grown to over 264 units with 8,500 youth and 2,500 adult volunteers in 40 states, the District of Columbia, Japan and affiliates in a host of other countries.

For more information, visit the official website at: https://www.YoungMarines.com or the Miami Valley Young Marines at https://miamivalleyyoungmarines.com/.





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The Myth of Drug Expiration Dates — ProPublica


This story was co-published with NPR’s Shots blog.

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

What if the system is destroying drugs that are technically “expired” but could still be safely used?

In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.  

“Refining our prescription drug dating process could save billions,” he says. 

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.


For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

Maintaining these stockpiles is expensive. The drugs have to be kept secure and at the proper humidity and temperature so they don’t degrade. Luckily, the country has rarely needed to tap into many of the drugs, but this means they often reach their expiration dates. Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality.

The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. The time limits allow the agency to ensure medications work safely and effectively for patients. To determine a new drug’s shelf life, its maker zaps it with intense heat and soaks it with moisture to see how it degrades under stress. It also checks how it breaks down over time. The drug company then proposes an expiration date to the FDA, which reviews the data to ensure it supports the date and approves it. Despite the difference in drugs’ makeup, most “expire” after two or three years.

Cantrell keeps a collection of old bottles of chemicals and medicines. He’s tested some of them and found that they’re still potent.
(Sandy Huffaker for ProPublica)

Once a drug is launched, the makers run tests to ensure it continues to be effective up to its labeled expiration date. Since they are not required to check beyond it, most don’t, largely because regulations make it expensive and time-consuming for manufacturers to extend expiration dates, says Yan Wu, an analytical chemist who is part of a focus group at the American Association of Pharmaceutical Scientists that looks at the long-term stability of drugs. Most companies, she says, would rather sell new drugs and develop additional products.

Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

Industry officials say patient safety is their highest priority. Olivia Shopshear, director of science and regulatory advocacy for the drug industry trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, says expiration dates are chosen “based on the period of time when any given lot will maintain its identity, potency and purity, which translates into safety for the patient.”

That being said, it’s an open secret among medical professionals that many drugs maintain their ability to combat ailments well after their labels say they don’t. One pharmacist says he sometimes takes home expired over-the-counter medicine from his pharmacy so he and his family can use it.

The federal agencies that stockpile drugs — including the military, the Centers for Disease Control and Prevention and the Department of Veterans Affairs — have long realized the savings in revisiting expiration dates.

In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program.

Each year, drugs from the stockpiles are selected based on their value and pending expiration and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.

Marc Young, a pharmacist who helped run the extension program from 2006 to 2009, says it has had a “ridiculous” return on investment. Each year the federal government saved $600 million to $800 million because it did not have to replace expired medication, he says.

An official with the Department of Defense, which maintains about $13.6 billion worth of drugs in its stockpile, says that in 2016 it cost $3.1 million to run the extension program, but it saved the department from replacing $2.1 billion in expired drugs. To put the magnitude of that return on investment into everyday terms: It’s like spending a dollar to save $677.

“We didn’t have any idea that some of the products would be so damn stable — so robustly stable beyond the shelf life,” says Ajaz Hussain, one of the scientists who formerly helped oversee the extension program.

Hussain is now president of the National Institute for Pharmaceutical Technology and Education, an organization of 17 universities that’s working to reduce the cost of pharmaceutical development. He says the high price of drugs and shortages make it time to reexamine drug expiration dates in the commercial market.

“It’s a shame to throw away good drugs,” Hussain says.


The drugs kept in emergency crash carts at Newton-Wellesley Hospital, outside Boston, Massachusetts, often expire before they can be used and must be thrown away.
(Erik Jacobs for ProPublica)

Some medical providers have pushed for a changed approach to drug expiration dates — with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

Citing the federal government’s extension program, the AMA sent letters to the FDA, the U.S. Pharmacopeial Convention, which sets standards for drugs, and PhRMA asking for a re-examination of expiration dates.

No one remembers the details — just that the effort fell flat.

“Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report. “I’m glad the subject is being brought up again. I think there’s considerable waste.”

At Newton-Wellesley Hospital, outside Boston, pharmacist David Berkowitz yearns for something to change.

On a recent weekday, Berkowitz sorted through bins and boxes of medication in a back hallway of the hospital’s pharmacy, peering at expiration dates. As the pharmacy’s assistant director, he carefully manages how the facility orders and dispenses drugs to patients. Running a pharmacy is like working in a restaurant because everything is perishable, he says, “but without the free food.”

Federal and state laws prohibit pharmacists from dispensing expired drugs and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. So at Newton-Wellesley, outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

“I question the expiration dates on most of these drugs,” Berkowitz says.

One of the plastic boxes is piled with EpiPens — devices that automatically inject epinephrine to treat severe allergic reactions. They run almost $300 each. These are from emergency kits that are rarely used, which means they often expire. Berkowitz counts them, tossing each one with a clatter into a separate container, “… that’s 45, 46, 47 …” He finishes at 50. That’s almost $15,000 in wasted EpiPens alone.

Newton-Wellesley Hospital throws away about $200,000 in expired drugs each year. Studies have shown that many expired drugs are still potent and usable.
(Erik Jacobs for ProPublica)

In May, Cantrell and Gerona published a study that examined 40 EpiPens and EpiPen Jrs., a smaller version, that had been expired for between one and 50 months. The devices had been donated by consumers, which meant they could have been stored in conditions that would cause them to break down, like a car’s glove box or a steamy bathroom. The EpiPens also contain liquid medicine, which tends to be less stable than solid medications.

Testing showed 24 of the 40 expired devices contained at least 90 percent of their stated amount of epinephrine, enough to be considered as potent as when they were made. All of them contained at least 80 percent of their labeled concentration of medication. The takeaway? Even EpiPens stored in less than ideal conditions may last longer than their labels say they do, and if there’s no other option, an expired EpiPen may be better than nothing, Cantrell says.

At Newton-Wellesley, Berkowitz keeps a spreadsheet of every outdated drug he throws away. The pharmacy sends what it can back for credit, but it doesn’t come close to replacing what the hospital paid.

Then there’s the added angst of tossing drugs that are in short supply. Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available. He holds up a purple box of atropine, which gives patients a boost when they have low heart rates. It’s also in short supply. In the federal government’s stockpile, the expiration dates of both drugs have been extended, but they have to be thrown away by Berkowitz and other hospital pharmacists.

The 2006 FDA study of the extension program also said it pushed back the expiration date on lots of mannitol, a diuretic, for an average of five years. Berkowitz has to toss his out. Expired naloxone? The drug reverses narcotic overdoses in an emergency and is currently in wide use in the opioid epidemic. The FDA extended its use-by date for the stockpiled drugs, but Berkowitz has to trash it.

On rare occasions, a pharmaceutical company will extend the expiration dates of its own products because of shortages. That’s what happened in June, when the FDA posted extended expiration dates from Pfizer for batches of its injectable atropine, dextrose, epinephrine and sodium bicarbonate. The agency notice included the lot numbers of the batches being extended and added six months to a year to their expiration dates.

David Berkowitz, assistant director of the pharmacy at Newton-Wellesley Hospital, said he questions the validity of many drug expiration dates.
(Erik Jacobs for ProPublica)

The news sent Berkowitz running to his expired drugs to see if any could be put back into his supply. His team rescued four boxes of the syringes from destruction, including 75 atropine, 15 dextrose, 164 epinephrine and 22 sodium bicarbonate. Total value: $7,500. In a blink, “expired” drugs that were in the trash heap were put back into the pharmacy supply.

Berkowitz says he appreciated Pfizer’s action, but feels it should be standard to make sure drugs that are still effective aren’t thrown away.

“The question is: Should the FDA be doing more stability testing?” Berkowitz says. “Could they come up with a safe and systematic way to cut down on the drugs being wasted in hospitals?”

Four scientists who worked on the FDA extension program told ProPublica something like that could work for drugs stored in hospital pharmacies, where conditions are carefully controlled.

Greg Burel, director of the CDC’s stockpile, says he worries that if drugmakers were forced to extend their expiration dates it could backfire, making it unprofitable to produce certain drugs and thereby reducing access or increasing prices.

The 2015 commentary in Mayo Clinic Proceedings, called “Extending Shelf Life Just Makes Sense,” also suggested that drugmakers could be required to set a preliminary expiration date and then update it after long-term testing. An independent organization could also do testing similar to that done by the FDA extension program, or data from the extension program could be applied to properly stored medications.

ProPublica asked the FDA whether it could expand its extension program, or something like it, to hospital pharmacies, where drugs are stored in stable conditions similar to the national stockpile.

“The Agency does not have a position on the concept you have proposed,” an official wrote back in an email.

Whatever the solution, the drug industry will need to be spurred in order to change, says Hussain, the former FDA scientist. “The FDA will have to take the lead for a solution to emerge,” he says. “We are throwing away products that are certainly stable, and we need to do something about it.”

Help us investigate wasted health care dollars: Experts say the United States might be squandering a quarter of the money spent on health care. That’s an estimated $765 billion a year. Do you believe you’ve encountered this waste? Tell us.





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Lane County Teens Vape At Alarming Rate, State Report Reveals


Over a four year timespan, Lane County saw a 250% increase in teenage use of E-cigarettes. Public Health officials say many young people and their parents are misinformed about the dangers of vaping and they want to change that.

The kids know these inhalant devices by many names: hookahs, MODS, vape pens, and Juul—the new E-cigarette that looks like a USB flash drive. They come in enticing flavors like bubble gum and tooty fruity.

Christy Inskip is the Tobacco Prevention Coordinator at Lane County Public Health. She says the unregulated E-cigarette industry markets their products as safe.

“We have been hearing that even parents have been providing them to their children because they don’t know that they’re harmful.”

Inskip says these products contain heavy metals and other carcinogens. She says the plumes exhaled from these devices is not a vapor at all, but aerosol. And they almost always contain nicotine, Inskip says.

“When our youth start using these products, they sometimes will vomit profusely,” says Inskip, “which is actually their body overdosing and rejecting that nicotine.”

Prevention specialists are taking their anti-vaping campaign to public schools and the community at large.



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