Male readers, would you risk your life for an erection?
It seems like a bizarre (and personal) question, but there are patients that are more than willing to do it. They are so willing, in fact, that they will lie to both doctors and pharmacists to get their hands on little blue pills when it's the little white ones that are keeping their heart supplied with oxygen.
Viagra, Cialis, and Levitra belong to a class of drugs called PDE-5 inhibitors. PDE-5, otherwise known as phosphodiesterase isoform 5, is an enzyme indirectly responsible for maintaining the amount of free nitric oxide, or NO, in certain parts of the body. PDE-5's claim to fame is that it decreases the amount of NO in the vasculature of the penis in an area called the corpus cavernosum. NO causes blood vessels to expand, which in turn causes an erection. By blocking PDE-5, the overall concentration of NO goes up, making it easier to achieve erection--but not in the absence of sexual stimulus (typically, anyway). If you want some good anatomical diagrams, try this link, which coincidentally explains more or less exactly how these drugs work in more detail.
Nitroglycerin and other nitrates work on the NO system, too. All of these drugs either directly degrade into NO or indirectly release NO via metabolism in the bloodstream. Angina pectoris (chest pain) is caused by the heart receiving insufficient oxygen. In the treatment of angina, NO causing expansion of blood vessels allows more blood to flow to the heart. It also decreases the pressure in other vessels, making it easier for the heart to pump blood; because the heart is not working as hard, it needs less oxygen. The result is a reduction in angina symptoms.
Both of these drugs increase NO levels. NO dilates blood vessels. Can you see where this is going?
Yes, combining nitrates with PDE-5 inhibitors can result in so much dilation of blood vessels that blood pressure drops to dangerous levels. If pressure drops too low, vital organs (such as the brain) can become starved of blood--which means that they are also starved of oxygen.
This drug combination is therefore contraindicated, i.e., a totally bad idea--and the kind of thing that a doctor (or more likely a pharmacist) could get sued for prescribing/dispensing. Giving a patient on nitrates a drug for ED is putting the patient at serious risk. But I've encountered patients who were willing to lie to everyone within a five-mile radius--doctors, nurses, technicians, pharmacists--to get their hands on the blue pills (or yellow ones, depending on their preferred drug).
The whole scenario raises some interesting questions. Why are male patients willing to lie to their healthcare providers? Perhaps they don't really understand the risk. Perhaps they think they understand the risk, but they don't care. Perhaps they're being fed all kinds of mass-marketing and commercial nonsense about how they'll never be able to satisfy their lovers without Big Pharma's magic erection pills. ED is a serious quality of life issue for a lot of patients--those with diabetes are among the most commonly affected. But when we as a society are putting pressure on men to the point where they are willing to risk their lives to get a hard-on, something is wrong. And this pressure isn't new--the search for aphrodisiacs has been on ever since the start of recorded history. A biological imperative? A product of culture? Who can say for sure?
Showing posts with label recreational drug use. Show all posts
Showing posts with label recreational drug use. Show all posts
Monday, May 12, 2008
Monday, April 7, 2008
At Least He Didn't Need any Narcan
This is what happens when I get too busy to catch up on blogs for a few days--I miss gems like this post on the Bad Idea Blog.
"Zero tolerance" policies in schools have always been taken to positively baffling conclusions. However, they certainly fulfill their function--allowing school teachers and administrators to resolve every problem that might come up via knee-jerk reactions without having to think or reason. Some of the policies occasionally make sense at the most fundamental level, but they inevitably get stretched way beyond reasonable limits:
Student expelled for bringing a butter knife to school.
Another student expelled for possessing Tylenol. Tylenol!
Boy expelled for having two soft pellet guns in his car. What were "school authorities" doing searching his car in the first place?
It's no wonder schools have so much trouble imparting the merits of critical thinking to their students--their administrators don't seem to get it, either.
Zero Tolerance has struck again: eight-year-old Eathan Harris was recently suspended for the dastardly crime of realizing that Sharpie markers smelled sort of neat.
"Zero tolerance" policies in schools have always been taken to positively baffling conclusions. However, they certainly fulfill their function--allowing school teachers and administrators to resolve every problem that might come up via knee-jerk reactions without having to think or reason. Some of the policies occasionally make sense at the most fundamental level, but they inevitably get stretched way beyond reasonable limits:
Student expelled for bringing a butter knife to school.
Another student expelled for possessing Tylenol. Tylenol!
Boy expelled for having two soft pellet guns in his car. What were "school authorities" doing searching his car in the first place?
It's no wonder schools have so much trouble imparting the merits of critical thinking to their students--their administrators don't seem to get it, either.
Monday, February 11, 2008
Optimizing Your Caffeine Intake
This article by Chris Chatham of Scienceblogs' Developing Intelligence is worth a look. It's a fascinating read, and if you're a caffeine enthusiast like I am, it might even be practical knowledge!
I predict my intake of the world's favorite stimulant will increase significantly over the course of the week--with five exams coming up between Tuesday and Thursday, there're going to be a lot of cups of coffee and cans of No Fear finding their way down my gullet.
I predict my intake of the world's favorite stimulant will increase significantly over the course of the week--with five exams coming up between Tuesday and Thursday, there're going to be a lot of cups of coffee and cans of No Fear finding their way down my gullet.
Wednesday, January 30, 2008
A (Sterile) Needle in a Haystack
As much as I hate to flagellate a deceased equine, I really don't think my last entry drove home the point about why we need to provide clean syringes and needles to injectable drug abusers.
There are numerous arguments made by those opposed to selling (or even giving) syringes and needles to drug users. It "doesn't work; addicts will use dirty needles anyway." It "sends the wrong moral message about drug use," which we all know is of primary concern to good, patriotic citizens. And, my personal favorite, it encourages drug abuse by making it "safer."
The first argument can be refuted with science. The second can't be strictly refuted because it relies entirely on subjective opinion; despite what some people seem to think, morals are cultural values, and they vary from person to person instead of being absolute or inherent.
The last argument annoys me more than the others because it blatantly ignores reality. IV drug users may be concerned with their safety, but what constitutes "acceptable risk" for abusers of illegal drugs is not the same as it is for you and I. In clinical practice, we never have patients self-administer IV injections, partly because it is considerably more difficult than giving a subcutaneous or intramuscular injection. Not only is the technique more complicated, but the risks are considerably greater. Forget about dirty needles for a moment; let's look at all the other "safety" issues being bypassed.
1: No way to verify purity of product. You don't know how much heroin you actually have and how much of that product is fillers--many of which do not belong in your veins. Even seemingly innocuous fillers such as talc or cellulose can cause tissue death.
2: Product concentration considerations. Injectable products have to be carefully balanced so that their osmolarity does not disrupt existing tissues. A solute (drug + additives) concentration that is too high will cause cells to shrink as water is sucked out of them to equalize the concentration gradient. A concentration that is too low will result in water rushing into cells and bursting their membranes.
3: Product and injection prep environment sterility. Even if you're using a clean needle, I doubt most IV drug users prepare their doses in a laminar flow hood. When pharmacists or technicians prepare injectable drug products they must meet many standards. You can potentially contaminate your product by touching any one of various critical needle/syringe areas, failing to wipe injection ports with alcohol, cleaning the hood improperly before use, taking your hands out of the sterile environment, leaning too far into the hood...the list goes on.
A "clean" needle is just the first step to sterility. You don't buy heroin in multidose glass vials that meet USP standards for purity and stability, buffered to appropriate pH and preserved with appropriate IV-safe additives. You buy heroin from a shady drug dealer in a back alley somewhere. You have no idea where he got it. There's no one you can complain to about manufacturing standards or product flaws. The fact is that drug users are willing to introduce a substance they bought in a back alley directly into their veins, bypassing all the body's barriers against infection and introducing contaminants or particles that can directly damage blood vessels.
It is so risky to abuse IV drugs that denying addicts access to clean needles is not going to be the straw that breaks the camel's back and turns them away from their dangerous habits forever. It is going to be added to the laundry list of hazards that addicts have already classified as "acceptable risks." And it isn't just addicts; new users aren't really concerned about their safety, either, and if they tell you that they are, they're lying, whether they realize it or not. There's a serious contradiction between "I prioritize being safe" and "I'm willing to inject substances of indeterminate origin and quality directly into my veins."
So we can ignore the reality that hard-core addicts are going to shoot up whether we give them clean needles or not and live in a political fantasyland where people don't do dangerous things. Or we can face the facts.
The fact is that IV drug users don't tend to pay their medical bills when they OD or contract hepatitis. They wind up in the ER, where they cannot be legally denied care, and everyone else absorbs the shock through increased healthcare costs. When addicts end up on Medicaid, you are paying for their AZT. You are paying for their hospital stays when they're suffering from liver failure. Your healthcare costs more when you deny clean syringes to drug users and more of them become seriously ill. I'm not saying you have to approve of their habits. I'm saying that you have to consider the economic ramifications of disease control. More sick people who can't pay their hospital bills means higher hospital fees for everyone so that hospitals can recoup their losses.
The fact is that the moral paternalists who oppose needle programs--and Narcan--don't care about the lives of drug addicts. They cloak their lack of empathy with layers of political doubletalk. But even if you can't bring yourself to have basic human empathy--or honesty--look at the situation from a pragmatic perspective. You are increasing costs for the entire healthcare system every time you deny that syringe sale because Johnny the addict doesn't have an insulin prescription.
There are numerous arguments made by those opposed to selling (or even giving) syringes and needles to drug users. It "doesn't work; addicts will use dirty needles anyway." It "sends the wrong moral message about drug use," which we all know is of primary concern to good, patriotic citizens. And, my personal favorite, it encourages drug abuse by making it "safer."
The first argument can be refuted with science. The second can't be strictly refuted because it relies entirely on subjective opinion; despite what some people seem to think, morals are cultural values, and they vary from person to person instead of being absolute or inherent.
The last argument annoys me more than the others because it blatantly ignores reality. IV drug users may be concerned with their safety, but what constitutes "acceptable risk" for abusers of illegal drugs is not the same as it is for you and I. In clinical practice, we never have patients self-administer IV injections, partly because it is considerably more difficult than giving a subcutaneous or intramuscular injection. Not only is the technique more complicated, but the risks are considerably greater. Forget about dirty needles for a moment; let's look at all the other "safety" issues being bypassed.
1: No way to verify purity of product. You don't know how much heroin you actually have and how much of that product is fillers--many of which do not belong in your veins. Even seemingly innocuous fillers such as talc or cellulose can cause tissue death.
2: Product concentration considerations. Injectable products have to be carefully balanced so that their osmolarity does not disrupt existing tissues. A solute (drug + additives) concentration that is too high will cause cells to shrink as water is sucked out of them to equalize the concentration gradient. A concentration that is too low will result in water rushing into cells and bursting their membranes.
3: Product and injection prep environment sterility. Even if you're using a clean needle, I doubt most IV drug users prepare their doses in a laminar flow hood. When pharmacists or technicians prepare injectable drug products they must meet many standards. You can potentially contaminate your product by touching any one of various critical needle/syringe areas, failing to wipe injection ports with alcohol, cleaning the hood improperly before use, taking your hands out of the sterile environment, leaning too far into the hood...the list goes on.
A "clean" needle is just the first step to sterility. You don't buy heroin in multidose glass vials that meet USP standards for purity and stability, buffered to appropriate pH and preserved with appropriate IV-safe additives. You buy heroin from a shady drug dealer in a back alley somewhere. You have no idea where he got it. There's no one you can complain to about manufacturing standards or product flaws. The fact is that drug users are willing to introduce a substance they bought in a back alley directly into their veins, bypassing all the body's barriers against infection and introducing contaminants or particles that can directly damage blood vessels.
It is so risky to abuse IV drugs that denying addicts access to clean needles is not going to be the straw that breaks the camel's back and turns them away from their dangerous habits forever. It is going to be added to the laundry list of hazards that addicts have already classified as "acceptable risks." And it isn't just addicts; new users aren't really concerned about their safety, either, and if they tell you that they are, they're lying, whether they realize it or not. There's a serious contradiction between "I prioritize being safe" and "I'm willing to inject substances of indeterminate origin and quality directly into my veins."
So we can ignore the reality that hard-core addicts are going to shoot up whether we give them clean needles or not and live in a political fantasyland where people don't do dangerous things. Or we can face the facts.
The fact is that IV drug users don't tend to pay their medical bills when they OD or contract hepatitis. They wind up in the ER, where they cannot be legally denied care, and everyone else absorbs the shock through increased healthcare costs. When addicts end up on Medicaid, you are paying for their AZT. You are paying for their hospital stays when they're suffering from liver failure. Your healthcare costs more when you deny clean syringes to drug users and more of them become seriously ill. I'm not saying you have to approve of their habits. I'm saying that you have to consider the economic ramifications of disease control. More sick people who can't pay their hospital bills means higher hospital fees for everyone so that hospitals can recoup their losses.
The fact is that the moral paternalists who oppose needle programs--and Narcan--don't care about the lives of drug addicts. They cloak their lack of empathy with layers of political doubletalk. But even if you can't bring yourself to have basic human empathy--or honesty--look at the situation from a pragmatic perspective. You are increasing costs for the entire healthcare system every time you deny that syringe sale because Johnny the addict doesn't have an insulin prescription.
Tuesday, January 29, 2008
Narcan, or: Why You Deserve to OD and Die
Pharmacy colleague (and I hope he doesn't mind my calling him that) and fellow blogger Abel Pharmboy provides a most excellent summary of the current buzz in the blogosphere about statements made by Dr. Bertha Madras. Dr. Madras, in the event that you were unaware, is a head member of the White House Office on National Drug Control Policy. And Dr. Madras would rather see opioid abusers die than distribute rescue kits that "encourage" opioid use.
I'm sorry, I thought we lived in a country that gave a damn about whether or not its citizens lived or died. Apparently, moral paternalism trumps compassion, which should be no surprise considering the government's track record with the "war on drugs."
This provides me with a handy segue into a topic that bothers me immensely: Pharmacists who refuse to dispense needles and syringes without a prescription, even in states that have laws that protect them from liability. Dispensing syringes without a prescription is clearly legal in 26 states, and most states that permit dispensing without a prescription absolve pharmacists (and technicians) of all responsibility.
The risk of contracting AIDS, hepatitis, or other blood-borne illnesses is not an effective deterrent for IV drug-users. Thinking otherwise is just flat-out delusional. If you believe that denying clean needles to drug users is going to make the give up their habit, you are way off. Drug use, especially injectable drug abuse, is a risky behavior, and it is an all-consuming urge. The fear of withdrawal symptoms is often considerably more powerful than the fear of contracting an illness. Many AIDS or hepatitis patients have no symptoms; they don't even know they carry the disease. They can and will pass that disease to others. It isn't that they don't know that sharing needles is dangerous. Using heroin is dangerous, too. The issue is that the risk is acceptable, given the information that they have. And if you don't know you're a carrier for a disease, you don't have all the information, which means that you're going to incorrectly evaluate the odds.
What denying needles (and Narcan) to addicts does do is send a powerful message. It says "society doesn't care about you, and we're secretly hoping you die so that we don't have to deal with the problem anymore." These are the same people who think you deserve to be punished for unintentionally getting pregnant. They don't care about outcomes. They don't care any more about addicts than they care about single mothers. They can all die, and decrease the surplus population.
They just want you to shut up and pay your taxes.
I'm sorry, I thought we lived in a country that gave a damn about whether or not its citizens lived or died. Apparently, moral paternalism trumps compassion, which should be no surprise considering the government's track record with the "war on drugs."
This provides me with a handy segue into a topic that bothers me immensely: Pharmacists who refuse to dispense needles and syringes without a prescription, even in states that have laws that protect them from liability. Dispensing syringes without a prescription is clearly legal in 26 states, and most states that permit dispensing without a prescription absolve pharmacists (and technicians) of all responsibility.
The risk of contracting AIDS, hepatitis, or other blood-borne illnesses is not an effective deterrent for IV drug-users. Thinking otherwise is just flat-out delusional. If you believe that denying clean needles to drug users is going to make the give up their habit, you are way off. Drug use, especially injectable drug abuse, is a risky behavior, and it is an all-consuming urge. The fear of withdrawal symptoms is often considerably more powerful than the fear of contracting an illness. Many AIDS or hepatitis patients have no symptoms; they don't even know they carry the disease. They can and will pass that disease to others. It isn't that they don't know that sharing needles is dangerous. Using heroin is dangerous, too. The issue is that the risk is acceptable, given the information that they have. And if you don't know you're a carrier for a disease, you don't have all the information, which means that you're going to incorrectly evaluate the odds.
What denying needles (and Narcan) to addicts does do is send a powerful message. It says "society doesn't care about you, and we're secretly hoping you die so that we don't have to deal with the problem anymore." These are the same people who think you deserve to be punished for unintentionally getting pregnant. They don't care about outcomes. They don't care any more about addicts than they care about single mothers. They can all die, and decrease the surplus population.
They just want you to shut up and pay your taxes.
Subscribe to:
Posts (Atom)
