Abuse of OTC drugs

The abuse of prescription medications, especially those in the opioid class of drugs (e.g. Vicodin, Lorcet, Oxycontin, others), has reached epidemic proportions in the U.S.  It is estimated that more than 2 million Americans suffer from substance use disorders related to these medications that are typically prescribed for pain relief. 

Inappropriate use of medications, however, is not confined to prescription drugs.  A recent report in the Annals of Emergency Medicine describes two cases of abuse of a popular over-the-counter (OTC) anti-diarrhea medication, both resulting in death.  The active ingredient in this medication is loperamide, marketed as Imodium or as the generic, "Anti-Diarrheal Loperamide".  Loperamide is a very mild opioid, however, taken in high quantities it also has mind-altering properties similar to prescription opioids or heroin.  Unfortunately, at these doses, loperamide is also capable of causing serious side effects, including mental slowing, breathing problems, and heart rhythm irregularities.

But loperamide is not the only OTC drug with abuse potential.  Today's Health Tip discusses some of the more commonly abused medications that don't require a prescription for
purchase.

Decongestants--- Pseudoephedrine is a decongestant that is used to relieve nasal congestion caused by colds, allergies and hay fever.  It can also be used to manufacture illegal methamphetamine ("meth").  Prior to 2006, pseudoephedrine was an active ingredient in many OTC cold medicines.  Following passage of the "Combat Methamphetamine Epidemic Act", the sale of pseudoephedrine became more restricted.  Currently it is available "behind the counter" requiring a photo ID for purchase with a limit on the amount that an individual can buy each month. The same restrictions apply to phenylpropanolamine, which had also been included in many OTC decongestants.

Cough suppressants---Dextromethorphan is a cough suppressant present in many OTC cough and cold remedies.  The letters "DM" attached to the names of many of these medications denotes that it contains dextromethorphan.  Its street names include DXM and "robo".  Large doses produce a high and can cause hallucinations. Toxic symptoms include anxiety, confusion, rapid heart rate and respiratory depression.

Antihistamines---Dimenhydrinate, marketed as Dramamine in the United States is an OTC antihistamine used primarily for the prevention of motion sickness.  Ingesting high doses can alter one's mental state producing euphoria and hallucinations.  Diphenhydramine, the active ingredient in Bendaryl, is taken therapeutically for several reasons including producing sedation and for allergy symptoms.  OTC medications that include the letters "PM" most likely include diphenhydramine for its sedative properties. In some people, taking high doses of diphenhydramine can produce hallucinations. Toxic symptoms include agitation, confusion, tremor, convulsions, delirium, and coma.

In addition to these OTC medications, certain plant and herbal supplements also have abuse potential.  Included in this group are salvia, a hallucinogenic herb related to the mint family, and Ma Huang, a traditional Chinese medicine with the stimulant ephedra as its active ingredient.

In general, OTC drugs, taken at the labeled dosages are safe.  When misused (taken at higher dosages or at more frequent intervals than recommended) or abused (taken for a non-therapeutic effect) they can be as dangerous as any other type of medication or drug.

Sources for article:
Loperamide Abuse Associated With Cardiac Dysrhythmia and Death from the Annals of Emergency Medicine  

Over-the-counter medicine abuse – a review of the literature from the National Library of Medicine

Should I be Concerned about Radon in the Home?

What is radon and where does it come from?  Radon gas is formed by the natural radioactive decay of uranium in rock, soil, and water. It is colorless, odorless, and tasteless. Unless you tested for it, you would have no idea of its presence or its amount.  It is found in all 50 states, although it is more prevalent in certain parts of the country, particularly the central and mountain states of the U.S.

How do we become exposed to radon?  Most radon exposure occurs from radon gas that moves up through the ground and into the home through cracks and other holes in the foundation.  The amount of radon in the soil depends on soil chemistry, which varies widely from one location to the next.  Houses trap radon gas inside where it can build up to dangerous levels.  Once  inhaled into the lungs, the radon gas decays into radioactive particles.  The energy released by these particles is capable of damaging the lungs and in some instances has been linked to the development of lung cancer.

What are the health risks associated with radon exposure? Breathing radon has no apparent short-term effects on the lungs such as causing shortness of breath, wheezing or coughing. The U.S. Environmental Protection Agency (EPA) and the Surgeon General's office, however, estimate radon is responsible for around 21,000 lung cancer deaths each year. Only cigarette smoking is more closely tied to the development of lung cancer. The risk of developing lung cancer is particularly high in those cigarette smokers who have significant radon exposure.

How is radon detected in the home?  The average radon concentration in the indoor air of America's homes is about 1.3 picocuries per liter (pCi/L).  Although there is no safe level of radon exposure, the EPA recommends addressing radon if you have a radon level of 4 pCi/L or more in the home. The amount of radon in the home can be determined with the use of in-home testing devices. The most commonly used consumer testing devices are short-term passive devices in which the homeowner collects a sample and sends it in for analysis. There are also long-term testing devices available that are often used to confirm a positive short-term test.    Free test kits are sometimes available from local or county health departments or from the American Lung Association.

 What should be done if the radon level is too high?  If radon levels are found to be unhealthy, measures to mitigate the problem may be necessary.  Usually, this means calling in a professional radon contractor. In addition to sealing cracks and other openings in the floors and walls that allow radon gas to seep into the home, the contractor may recommend the use of underground pipes and exhaust fans to reduce the radon level in the home.  Retesting should then be done to assure that the radon level in the home has been reduced to acceptable levels.

Sources for article:
A Citizen's Guide to Radon from the U.S. Environmental Protection Agency
Radon and Cancer from the American Cancer Society

Content last reviewed by Medical Director on 5-18-2016

Coffee's "Perks"

Search the National Library of Medicine's database, PubMed, and you will find hundreds of studies that have examined coffee's impact on health.  Not only does this research overwhelmingly suggest that moderate coffee consumption doesn't cause harm, it appears that drinking coffee may even offer some health benefits.  Moderate coffee consumption, defined as three or four cups a day, provides around 300 to 500 milligrams of caffeine. While it's a stretch to consider coffee as a "health food", the following health benefits have been found to be associated with coffee consumption:

• Moderate caffeine consumption appears to offer a protective effect against the development of Parkinson's disease.
   
• Drinking at least 2 cups of coffee a day appears to reduce the risk of developing colon cancer by up to 25%.
   
• The risk for type 2 diabetes is significantly lower among regular coffee drinkers than among those who don't drink it.
   
• Regular coffee drinkers are less likely to develop symptomatic gallstones.

Additionally, there is some evidence that coffee may benefit asthma, improve memory, decrease fatigue, improve mental functioning, and stop a headache, as well as improve endurance performance in long-duration physical activities.

Now for the bad news---for some, drinking coffee can cause a number of untoward effects.  Caffeine, coffee's active ingredient, is a mildly addictive stimulant which can make a person jittery and uncomfortable.  Certain heart conditions are affected by caffeine, causing rapid or irregular heart rhythms. Coffee drinking is associated with small increases in blood pressure, and, in some people, may play a role in the development of hypertension.  Pregnant women are advised to limit coffee consumption because of the potential for spontaneous abortion or impaired fetal growth.  Furthermore, caffeine abuse, particularly in association with the so-called "energy drinks," commonly seen at the neighborhood convenience store, is becoming an emerging problem.  While a cup of regular coffee contains approximately 100 mg of caffeine, a 16 ounce can of Original Rockstar contains 160 milligrams and Rockstar Punched energy drink contains 360 mg of caffeine per 24 ounce can. Also one needs to consider the "hidden" calories that can be found in some coffee drinks. A cup of black coffee contains only around 2 calories, but a small McDonald's Chocolate Chip Frappe is reported to contain a whopping 500 calories!

Perhaps the inscription "Nothing in Excess" at the Oracle's temple at Delphi was referring to coffee consumption.  Maintaining a moderate level of coffee consumption of 3 to 4 cups per day, however, appears to be safe for most and may even provide some health benefits.

Article Sources:
Coffee Consumption and the Risk of Colorectal Cancer, Cancer Epidemiology, Biomarkers & Prevention, 2016

Coffee, the Good News, Harvard T.H. Chan School of Public Health News

Kent Davidson MD - Health Tip Content Editor
Content last reviewed by Medical Director on 5-11-2016

Elevated Blood Pressure----How High is Too High?

What is blood pressure?  Blood pressure is the force of blood against the walls of arteries as it leaves the heart.  Sufficient pressure is necessary within the circulatory system to move blood throughout the body.  If blood pressure gets too high, however, a number of adverse health effects can develop.

Why are two numbers given in a blood pressure reading?  A blood pressure reading consists of two readings, the systolic blood pressure (the "top" number) and the diastolic blood pressure (the "bottom" number). The systolic reading is the pressure in the arteries when the heart beats. Diastolic pressure is the pressure reading in the arteries as the heart relaxes between beats.

What is considered to be normal blood pressure?  A reading of 120/80 millimeters of mercury (mmHg) is generally considered to be "normal" blood pressure.  Hypotension (when blood pressure is too low) occurs when the pressure in the arteries is insufficient to adequately supply the heart, brain, and other parts of the body.  A systolic blood pressure reading of 90 mmHg or less or a diastolic reading of 60 mmHg is generally considered to be in the hypotensive range.

What is hypertension and why is it dangerous?  The medical term for sustained high blood pressure is hypertension. High blood pressure increases the work load on the heart and contributes to atherosclerosis (hardening of the arteries). Hypertension is a major risk factor for the development
of heart disease and stroke, respectively the first- and fifth-leading causes of death among Americans today. It is especially troublesome because it often has no warning signs or symptoms. High blood pressure also can lead to other conditions, such as congestive heart failure, kidney disease, and blindness.

What level of elevated blood pressure signifies that someone has hypertension? As defined by the American Heart Association, hypertension is present when the systolic reading is in the range of 140-159 or the diastolic reading is 90-99.  Blood pressure in this range is considered to be Stage 1 hypertension, the lowest category of high blood pressure. The AHA classification goes from Stage 1 to the highest category, Hypertensive Crisis, in which blood pressure is higher than 180 over 110.
 
What if only one of the readings is high?  If the systolic or diastolic blood pressure is elevated alone, it is called "isolated hypertension".  Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over. A great deal of evidence has accumulated over the last few years to warrant greater attention to the importance of isolated systolic hypertension, since treatment will significantly decrease deaths from heart-related events and stroke.

What about readings between "normal" and those that are considered hypertensive?  The most recent classification of blood pressure includes a new category called "prehypertension".  This category includes people whose blood pressure is in the range of 120-139 mmHg systolic and/or 80-89 mmHg diastolic.  Prehypertension is not considered to be a disease. Instead, it designates those individuals who are at high risk of developing hypertension.  Anyone with prehypertension should institute intensive lifestyle measures in an attempt to avoid developing hypertension. These measures include getting regular exercise, eating a diet low in sodium, limiting alcohol intake, reducing to an ideal weight, and stopping smoking.
 
Does having high blood pressure mean that treatment with a medication is necessary?  Unless the blood pressure is extremely high, adopting healthy lifestyle habits, rather than medications, is the first step in controlling high blood pressure. If lifestyle changes alone are not effective in bringing the blood pressure down to 140/90 or lower, it may be necessary to add blood pressure medications. For people with chronic kidney disease, diabetes, or coronary artery disease the target blood pressure should be 130/80 or lower.

Article Sources:
American Heart Association: Understanding Blood Pressure Readings
High Blood Pressure:  National Heart, Lung, and Blood Institute

Content reviewed by our Medical Director on 5-4-2016