NH Governor Declares State Of Emergency Over `Spice’ Overdoses

 

# 8955

 

For a state with a pastoral reputation and a population of just over 1.3 million, reports of more than 40 serious overdoses on `spice’ (an illegal synthetic cannabinoid) over a span of just 72 hours isn’t just unsettling, it has prompted their Governor to declare a 21-day state of emergency in order to identify and quarantine the product.

 

While sold as herbal `incense’ or `bath salts’ and labeled `not for human consumption’, people buy these products because they know its dirty little secret – they are laced with a powerful synthetic cannabinoid  that can produce effects ranging from mild euphoria to severe illness, stroke, or psychosis.

 

First the Governor’s declaration, then I’ll be back with more on `Spice’.

 

For Immediate Release
August 14, 2014

Contact:
Communications Office
(603)271-2121

Governor Hassan Declares State of Emergency as a Result of Overdoses from Synthetic Cannabinoid

State of Emergency Triggers HHS Public Health Powers to Quarantine Commodity Identified as Smacked!

CONCORD – In order to protect public health and well-being, Governor Maggie Hassan today declared a State of Emergency in the State of New Hampshire as a result of recent overdoses in Manchester and Concord as a result of the use or misuse of the synthetic cannabinoid identified as "Smacked!".

The declaration of a State of Emergency triggers the Department of Health and Human Services public health powers under RSA 21-P:53 or any other applicable statute to investigate, isolate or quarantine and require the destruction of the commodity in question. The department will work closely with local police departments to quarantine the "Bubblegum Flavor" of "Smacked!".

Since August 11, 2014, the Manchester Police Department and local health authorities reported at least 41 people in the Manchester area have experienced serious medical reactions to the synthetic cannabinoid and at least 20 were taken by ambulance to Manchester hospitals for treatment. In addition, the Concord Police Department has reported at least three cases in the last 24 hours.

"These products pose a serious threat to public health, especially to young people, and it is our responsibility to do whatever we can to combat the recent rash of overdoses," Governor Hassan said. "In consultation with the New Hampshire Department of Homeland Security and Emergency Management, public health officials in the New Hampshire Department of Health and Human Services and the Attorney General's office, I have declared a State of Emergency so that we can move quickly to stop the sale of this dangerous substance that has caused an outbreak of serious overdoses."

While not related to overdoses at this time, samples of at least two other brands of synthetic cannabinoids, "Crazy Monkey" and "Green Giant," have tested positive for controlled substances. Store owners are reminded that it is illegal to sell or consume these controlled substances under New Hampshire law.

Other brands of synthetic cannabinoids may also pose dangers for substance abuse and public health. Stores are encouraged to voluntarily remove all synthetic cannabinoids from their shelves.

Generally referred to as "spice," synthetic cannabinoids are chemically engineered substances similar to tetrahydrocannabinol (THC), the active ingredient in marijuana. While they are labeled as not for human consumption, "herbal incense" products of this type are known to be ingested by smoking or brewing into a tea because they contain synthetic cannabinoids.

"It's very important that individuals be made aware that use of this product poses serious and immediate danger to their personal health," Department of Health and Human Services Commissioner Nicholas Toumpas said. "We strongly recommend the public avoid any use of this product, and we will work with local police departments as quickly as possible to put the quarantine into effect."

Attorney General Joseph Foster said, "As we have seen in recent days in Manchester and Concord, the misuse of products like 'Smacked!' can cause significant and adverse health risks. Therefore, we are strongly recommending that merchants who have similar products remove them from their shelves and destroy their current inventory. Retailers that continue to knowingly sell these dangerous or illegal products are placed on notice that they could be held responsible for harm caused to a user of the product."

The Governor's declaration will last 21 days unless terminated earlier or extended by further order.

 (Continue . . . )

 

 

Cheap, usually sold online or from less than discerning convenience stores – and labeled as "herbal incense" or sometimes as  "herbal smoking blends" - these synthetics have a growing reputation among ER doctors, and mental health professionals, as extremely dangerous drugs.

 

Last summer, authorities in Denver reported at least 75 people treated in local emergency rooms due to bad reactions to `spice’, as reported in this CNN article 3 deaths may be tied to synthetic marijuana in Colorado.

 

Last November we looked at three reports on the dangers of `spice’ in Synthetic Cannabinoids Associated With Severe Illness, Stroke & Psychosis.

 

• An MMWR report entitled Notes from the Field: Severe Illness Associated with Synthetic Cannabinoid Use — Brunswick, Georgia, 2013
• A case study by USF researchers on Ischemic stroke after use of the synthetic marijuana “spice,”
• And a Medscape report from 2011 called Synthetic Cannabis May Pose an Even Greater Psychosis Risk

 

A more recent Medscape article - Synthetic Cannabis Triggers 'Spiceophrenia' – looks the psychosis-inducing effects of these drugs, and describes the presentation of 50 cases in NYC.

 

Nearly all of the patients presented with severe agitation, disorganized thoughts, paranoid delusions, and assaultive behavior. Other common symptoms included suicidal ideation (30%), anxiety (28%), depression (20%), and catatonia (0.05%).

 

In addition to the psychiatric symptoms, ingestion of `spice’ can induce serious – sometimes lethal – physical reactions that include tachycardia, cardiac arrhythmias, chest pain, nausea, vomiting, and even heart attacks and strokes.

 

To learn more about this dangerous class of drugs, the AAPCC (American Association of Poison Control Centers) maintains this fact sheet.

The Perils Of Not Knowing Your Dose

Photo Credit – Wikipedia

 

 

# 7837

 

Twice last year (see The Narrow Margin & Too Much Of A Good Thing ) we looked at the dangers of accidental (& intentional) overdoses of acetaminophen (Tylenol ®).  

 

The first blog looked at a national campaign called KNOW YOUR DOSE launched by the AAC  (Acetaminophen Awareness Coalition), while the second looked at Supratherapeutic Dosing of Acetaminophen Among Hospitalized Patients – where a study found doctors were sometimes prescribing more than the recommended daily dose of acetaminophen for their patients.

 

Doctors will typically prescribe  hydrocodone/APAP 5 mg/500 mg 1 to 2 tablets every 4 to 6 hours to give patients some latitude in pain control. If a patient takes the full prescribed dose (12 pills in 24 hours) they will ingest 6 g of acetaminophen, or 50% more than the maximum daily recommendation.

 

In 2011 the FDA announced their intention to limit the amount of acetaminophen in opioid/APAP prescriptions like Vicodin and Lorcet to 325mg in order to reduce the risk of liver damage in patients taking these meds for chronic pain. But those regulations won’t come into effect until January of 2014, and for now, 500 mg & 600 mg APAP/opioid analgesics are still available.

 

But it isn’t just misuse of prescription medicines containing acetaminophen, as there are more than 600 over-the-counter medications containing the drug, and people who take two or more of these cold/pain remedies are often unaware of how much of the drug they are ingesting.

 

A study published in 2011 in the American Journal of Preventive Medicine (see Emergency Department Visits for Overdoses of Acetaminophen-Containing Products) found that - in the United States alone – there are an estimated 78,414 ER visits each year due to acetaminophen (aka Tylenol, paracetamol, APAP) poisoning.

 

Although most of these were intentional overdoses (69.8%), more than 13,000 ER visits were described as due to `therapeutic misadventures’  . . . or accidental overdoses.

The problem with acetaminophen is that there is a narrow margin between the maximum therapeutic dose and a potentially toxic (and sometimes fatal) overdose. 

 

While well tolerated when taken as directed, APAP in larger doses is a hepatotoxin; it overwhelms and destroys the liver. In fact, APAP poisoning is the biggest cause of acute liver failure in the United States (cite).

Which is why Johnson & Johnson – the makers of Extra-Strength Tylenol ® – has announced that they will take the unusual step of printing (In bright red letters) a warning on the bottle caps of their product.

More information on the safe  use of acetaminophen appears on the Johnson & Johnson website: 

 

Acetaminophen —the active ingredient in TYLENOL^® — is an effective pain reliever and fever reducer. It works quickly and safely when used as directed.

Here is some information on the appropriate use of TYLENOL^®:

• Always read and follow the label
• Don't take TYLENOL^® with other products containing acetaminophen
• Don't exceed the recommended dosage
• Don't take TYLENOL^® if you drink 3 or more alcoholic beverages a day
• Talk to your doctor if you are taking the blood-thinning drug, warfarin

 

 

With cold and flu season upon us, the consumption of over the counter (OTC) remedies will most certainly go up considerably over the next few months, so it seems a good time to repeat the warning from the ACC  KNOW YOUR DOSE campaign.

 

And finally, we’ve these videos from the FDA’s  Youtube channel on the dangers of misusing acetaminophen.

 

 

 

The Narrow Margin

Photo Credit – Wikipedia

 

# 6649

 

 

Cold and flu season is upon us, and that means the consumption of over the counter (OTC) remedies will go up considerably over the next few months. So each fall I try to do a piece on some of the hidden dangers of these commonly used medications.  

 

• Last year, in Kids, Colds, And OTC Meds we looked at the continuing trend of parents – against the advice of the CDC  – to use OTC medications to treat cold and flu symptoms in toddlers under the age of four.

 

• And the year before, we looked at inconsistent and confusing dosing instructions provided by many manufacturers of OTC medications (see JAMA: Inconsistent Dosing Instructions For OTC Meds).

 

• Another study in 2010 (see Inappropriate Use Of OTC Medicines In Children) reported that inappropriate use, and incorrect dosing of OTC meds lead to a large number of accidental drug poisonings each year.

 

 

The plain truth is, accidental and intentional poisonings from OTC medications are very common.

 

A study published last year in the American Journal of Preventive Medicine (see Emergency Department Visits for Overdoses of Acetaminophen-Containing Products) found that - in the United States alone – there are an estimated 78,414 ER visits each year due to acetaminophen (aka Tylenol, paracetamol, APAP) poisoning.

 

While most of these were intentional overdoses (69.8%), more than 13,000 ER visits were described as due to `therapeutic misadventures’  . . . or accidental overdoses.

 

The problem with acetaminophen is that there is a narrow margin between the maximum therapeutic dose and a potentially toxic (and sometimes fatal) overdose. 

 

While well tolerated when taken as directed, APAP in larger doses is a hepatotoxin; it overwhelms and destroys the liver. In fact, APAP poisoning is the biggest cause of acute liver failure in the United States (cite).

 

Since more than 600 products (OTC and Rx) contain acetaminophen, many consumers may be unaware that they could be `doubling up’ their dose when they take two or more of them. 

 

All of which leads me to a press release issued earlier this week by the AAC  (Acetaminophen Awareness Coalition)  who have launched a Know Your Dose campaign to help educate consumers about the safe use of acetaminophen. 

 

Excerpts below, but follow the links to read them in their entirety.

 

Credit – Acetaminophen Awareness Coalition

 

 

U.S. Health Coalition Reminds Consumers: Double Check, Don't Double Up

As Cold and Flu Season Nears, Consumers Are Urged to Double Check Their Medicine Labels to Avoid Doubling Up on Acetaminophen

WASHINGTON, Oct. 17, 2012 /PRNewswire-USNewswire/ --

The Acetaminophen Awareness Coalition is launching a nationwide initiative today calling on consumers to double check their medicine labels so they don't double up on medicines that contain acetaminophen during the cold and flu season. Acetaminophen is the most common drug ingredient in America. It is found in more than 600 different medicines, including prescription (Rx) and over-the-counter (OTC) pain relievers, fever reducers, sleep aids and numerous cough, cold and flu medicines. It is safe and effective when used as directed, but there is a limit to how much can be taken in one day. Taking more than directed is an overdose and can lead to liver damage.

 

Each year, Americans catch an estimated one billion colds, and as many as 20 percent get the flu. Seven in 10 consumers use over-the-counter medicines, many of which contain acetaminophen, to treat their symptoms. The Coalition is targeting its "Double Check, Don't Double Up" message to the more than 50 million Americans who use acetaminophen weekly for conditions such as headache and chronic pain, and directing them to double check their medicine labels before taking a cold or flu medicine that also contains acetaminophen.

 

<SNIP>

When taking medicines for cough, cold or flu this coming season, consumers should follow these four simple acetaminophen safety steps:

1. Know if medicines contain acetaminophen, which is in bold type or highlighted in the "active ingredients" section of over-the-counter medicine labels and sometimes listed as "APAP" or "acetam" on prescription labels.
2. Never take two medicines that contain acetaminophen at the same time.
3. Always read and follow the medicine label.
4. Ask your healthcare provider or a pharmacist if you have questions about dosing instructions or medicines that contain acetaminophen.

(Continue . . . )

 

For more on this issue, we turn to the FDA’s  Youtube channel for the following videos.

 

 

 

 

 

 

While drugs like acetaminophen are extremely useful and safe when taken as directed, the number of ER visits each year testify to the harm they can do when taken inappropriately.