'Poor man's methadone': Imodium is a potentially fatal high

A popular drug that promises rapid relief from diarrhea is worrying doctors and emergency room staff because of the dangerous high it gives opioid abusers.

The over-the-counter medication Imodium, whose main ingredient, loperamide, is an opioid, is cheap and easy to buy at a drugstore. It's available in bulk at Walmart and Costco.

"Drug users, opioid seekers, they are desperate," says Nardine Nakhla, a lecturer at the faculty of pharmacy at the University of Toronto.

"They need this medication to help with the withdrawal, or to achieve that euphoric state. So they disregard the warning and still use the drug if it means they get their fix."

Imodium is safe when taken as directed. The maximum recommended daily dose is 16 milligrams, or eight tablets.

"It's been likened to a poor man's methadone", says Dr. David Juurlink, a drug safety researcher at Sunnybrook Hospital. "At high doses, it will cause effects like methadone or oxycontin. The problem is the doses you need to achieve that is really, really dangerous."

Juurlink says its not uncommon for drug abusers to take up to 200 tablets a day to get high.

"It can cause your heart to stop. It's the sort of thing people can do for weeks or months at a time, with no symptoms at all, then suddenly they just drop dead," says Juurlink.

He says people abusing this drug will put a few hundred pills in a blender, make a smoothie and drink it. "That's especially dangerous because you absorb the drug very quickly."

At Vancouver's St. Paul's Hospital, Dr. Chris DeWitt calls an Imodium overdose a "double whammy."

"It can cause slow breathing or even stopping breathing, similar to other opioids. But it can also cause direct effects on the heart."

On web forums, drug abusers have been talking about the "lope cocktail" for several years. One writes that Imodium may be his "new best friend." Another says his loperamide high "almost killed me a couple times with crazy pressure in my head."

In the U.S, the number of calls to poison centres have doubled between 2010 and 2015. Several people have died of loperamide overdoses. The alarming trend prompted the Food and Drug Administration to issue a safety alert last year warning that higher than recommended doses of Imodium can cause serious heart problems that can lead to death.

The Ontario Poison Centre reports only a "couple of cases" of Imodium poisoning, but its medical director, Dr. Margaret Thompson, can't say whether those involved an overdose or a death because of patient confidentiality.

Juurlink says the small number of cases doesn't tell the whole story.

"We are starting to see more and more people coming to hospital or just dying suddenly at home courtesy of this drug that most of us perceive as pretty innocuous."

A soon to be released review co-authored by Juurlink warns Canada's emergency room physicians to watch for increasing misuse and abuse of loperamide, with patients suffering from "loperamide-induced cardiac toxicity."

It's a challenge for doctors because the go-to antidote Naloxone works to reverse an opiod overdose but can't fix heart problems caused by this medication. Juurlink says doctors sometimes have to resort to "Hail Mary therapies."

Affected people have "grossly abnormal" electrocardiograms, he says. "When a person has that sort of ECG, we don't have a magic drug that we can just give to reverse it."

Imodium is widely available and cheap in drugstores and grocery stores. (Kas Roussy/CBC)

Health Canada says it's aware of health warnings for Imodium in the U.S. The agency says it has conducted a preliminary review of the issue and has not found evidence of a similar problem here, but it will monitor the safety of the drug.

In a Toronto drugstore, Nakhla says she believes more needs to be done to prevent Imodium abuse.

"I think pharmacists need to be adequately monitoring patients who are coming in requesting this type of medication," she said. "They need to think about further restricting the sale of this by placing it behind the counter where they will be in contact with the individual who will be purchasing it."

Juurlink agreed.

"If you couldn't just walk in a drugstore and for $20 walk out with enough of the tablets to get high and possibly kill you, I think that would be a good thing," he said.

By Kas Roussy, CBC News

DOH says 6M Filipinos ‘walking time bombs’

About 12 million Filipinos are hypertensive and half of them are “walking time bombs” who could succumb to a heart attack or stroke because they are unaware of their condition. To raise greater awareness of hypertension, the Department of Health (DOH) on Thursday launched a monthlong campaign to screen Filipinos for abnormal high blood pressure.
Called the May Measurement Month 2017 (MMM17), the campaign aims to screen at least 1.7 million Filipinos for hypertension as part of a global screening effort targeting 25 million people, the DOH said.
“Some of these unsuspecting hypertensive individuals are extremely at risk and can be considered ‘walking time bombs’ because anytime they can figuratively ‘explode’ to develop complications like massive stroke, heart attack, heart failure and kidney failure,” said Health Secretary Paulyn Ubial.
“Health awareness offers tremendous advantages,” she added, referring to screening to detect the illness.
Premature death
Hypertension is a primary contributor to premature death in the country, with 200,000 deaths every year due directly or indirectly to high blood pressure, according to the DOH.
A department report said hypertension was the third leading cause of morbidity in 2014, behind topnotcher acute respiratory infection and pneumonia.
Ubial said screening would be a cost-effective way to identify at-risk individuals early enough to reduce their healthcare costs, increase their productivity and prevent a rise in the overall disease rates.
She urged Filipinos to support the campaign by getting screened this month for hypertension and other noncommunicable diseases like diabetes at local health centers, rural health units or hospitals.
Health workers would need to take a person’s blood pressure several times to establish whether that individual has hypertension. Those diagnosed with hypertension would be encouraged to enroll in the DOH Hypertension and Diabetes Registry and Club for regular checkups and maintenance medicines.
Healthy lifestyle
“We advise the public to know their blood pressure and adopt a healthy lifestyle because your health is in your hands,” Ubial said.
She suggested regular exercise, a diet that is low in fat, sugar, salt and high in fiber, and avoiding tobacco and alcohol consumption to lower the risk of hypertension.
The screening project is a DOH initiative in cooperation with the International Society of Hypertension and the World Hypertension League, the Philippine Society of Hypertension and the Philippine Heart Association.
The DOH chose Manila as the pilot site for MMM17 because of Mayor Joseph Estrada’s focused health-care programs and policies, including the citywide smoking ban and free maintenance medicines for the city’s senior citizens.




968 new HIV-AIDS cases in March, highest in a month since 1984 – DOH

MANILA — March was a record month for reported new cases of the human immunodeficiency virus (HIV) with 968, the highest number recorded in a month since 1984, the Department of Health (DOH) said Wednesday.
Based on the HIV/AIDS Registry of the Philippines, the latest figure was 32 percent higher compared to 735 recorded cases in the same period in 2016.
This meant that an average of 30 cases were being reported everyday in March.

HIV is a virus that attacks the immune system, the body’s natural defense system. Over time it leads to acquired immunodeficiency syndrome (AIDS).
Of the 968 new cases, 108 had developed into full-blown AIDS.
There were 27 deaths from HIV/AIDS in March.
The regions with the highest number of cases reported in March were the National Capital Region with 309 cases (32 percent); Calabarzon, 135 cases (14 percent); Central Luzon, with 107 (11 percent); Central Visayas, 76 cases (8 percent); and Davao region, 52 cases (5 percent).
Sexual contact remains to be the main mode of transmission with 942, most of which are from the male-having-sex-with-male (MSM) population with 820.
Homosexual contact had the highest number with 560, followed by the bisexual contact with 260, while heterosexual contact led to 122 cases.
Injecting drug use accounted for 22 new cases, while the remaining four cases involved mother-to-child transmission.
A total of 59 overseas Filipino workers (OFWs) were also found to have acquired HIV/AIDS, all of whom were infected through sexual contact.

The latest figures brought to 2,661 the total number of HIV cases reported in the country from January to March this year, which included 292 AIDS cases, and 155 deaths.
Since 1984, a total of 42,283 HIV cases, including 3,957 AIDS cases, and 2,124 deaths, have been recorded in the Philippines. SFM

By: Tina G. Santos - Reporter / @santostinaINQPhilippine Daily Inquirer

Poll shows fewer Pinoy smokers due to higher cigarette prices

High tobacco excise taxes helped cut smoking prevalence among Filipino adults by 5.9 percent in 2015, according to the results of the Global Adult Tobacco Survey (GATS) released Friday.
Dr. Encarnita Blanco-Limpin, Framework Convention on Tobacco Control (FCTC) executive director, said at press briefing that high taxes have been a "great discouragement" to consumers surveyed for the second GATS.
"The price, actually, even in other countries, it has been shown that really tax measure is the most effective measure that we can implement to reduce tobacco use," Limpin said.
"Sa mga mahihirap, if they don't have enough money to spend, then they would rather na they placed the money to the more important needs of the family: food, education, children, yung clothing, instead of buying cigarettes."
Tobacco use dropped from 29.7 percent in 2009, the first time GATS was conducted, to 23.8 percent in 2015.
About 55.5 percent of current (daily and less than daily) smokers attempted to quit smoking in the past 12 months because of the cost of cigarettes, which can run them P678.4 a month, the survey also said.
Of those who smoked in the past 12 months, four percent managed to successfully quit; 76.7 percent planned to or were thinking about quitting; and 56.5 percent who visited a healthcare provider were advised to quit.
Higher taxes, no public smoking
Among the policies that helped reduce tobacco use is the Sin Tax Reform Law of 2012, which restructured the excise tax on alcohol and tobacco products and marked up their retail prices.
"Because of the sin taxes, since it has really provided much impact on how much money will be consumed just to buy for the cigarettes," Health Assistant Secretary Dr. Maria Francia Laxamana said.
The strict implementation of the policy prohibiting smoking in government buildings except for designated smoking areas and public places were also given significant heft.
"Let us not also remove the impact of the efforts on the drive against smoking in public places because we have actually shown in this particular study, in this survey, that there was significant reduction also in exposure to second-hand smoke which means to say that the drive against smoking in public place is also working very well," Limpin stressed.
More investment into counter advertising such as warning labels on cigarette packages, anti-cigarette smoking commercials, and posters also encouraged smokers to quit tobacco.
The number of adults who noticed anti-smoking information on any media is up 83.2 percent; those who noticed posters are up 57.9 percent; and those who heard radio counter commercials go up to 39.1 percent.
While the full effects of cigarette warning labels could not yet be ascertained, as it was only put into full effect in November 2016, 44.6 percent current smokers thought about quitting because of warning labels on cigarette packages.
"The fear factor was there when we showed the messages to the communities, to our areas here in the different regions of the country, even in our airports, seaports, we have a lot of messages there that conveys the fear factor of continuing smoking," Laxamana said.
"It has provided the greatest impact of change in the behavior."
Secondhand smoke, advertising still high
While smoking rates have dropped, a large number of adults remain exposed to secondhand smoke and advertising by the tobacco industry.
Secondhand smoke exposure is greatest at home at 34 percent (39 percent men and 30.3 percent women) and at work at 21.5 percent (26.4 percent men and 16.4 women), the report said.
Bars and nightclubs remain the biggest culprit of secondhand smoke exposure in public at 86.3 percent, followed by public transportation at 37.6 percent, and restaurants at 21.9 percent.
Meanwhile, 58.6 percent of adults noticed sponsorship or promotion of cigarettes, with 44 percent spotting them in stores and 9.6 percent seeing them on clothing or other items with cigarette brand names or logos.
Comprehensive ban should be next
While the reduction has been significant, Limpin said a comprehensive ban in tobacco advertising should be the next step in reducing the public's exposure to tobacco.
"We have to push for maybe a comprehensive ban on tobacco advertising, promotion, and sponsorship because right now, we can still see a lot of advertisement, particularly in the stores and this is clearly shown in the data," Limpin said.
Health Secretary Paulyn Jean Rosell-Ubial said they will also push for plain packaging and banning of "tingi" or selling of individual cigarette sticks to secure 100 percent smoke-free public spaces.
"Right now, it's not total, there is still some advertisement at the point of sale. Also, we're moving for plain packaging of the cigarette or tobacco products. I hope that would also further reduce the consumption of tobacco," Ubial said.
Ubial and World Health Organization Technical Officer Dr. Benjamin Lane are also pushing for a unitary tax instead of the tiered tax system envisioned for tobacco and alcohol to protect Filipinos.
"The WHO does not support a two-tier, we do not think it is a good idea. A single tier tax, as planned by the government of the Philippines, as was supposed to take effect in January of this year, that is the way to go," Lane said.
"It's actually very fair on poor people because it protects them more. It needs to be a single tier in order that people do not substitute away to local, cheaper brands and smoke the same amount or even more; and in order that the people who are poor are given the same level of protection as everybody else," he continued.
Lastly, Limpin campaigned for a national smoking cessation program to give current smokers the means to completely cease their consumption of tobacco.
"From the data we have seen that there is a very high number of smokers who are interested in quitting; many of them started to quit but a majority of them were not able to successfully quit," Limpin said.
"We need to have a more comprehensive smoking cessation program, not just a brief tobacco intervention but we need to really have the intensive smoking cessation program which, I believe, the Department of Health is already going to start with within the year," she continued.
GATS 2015 had a sample size of 13,963 households and had a 95.6 percent household response rate while 11,644 individuals surveyed had a 96.3 percent response rate, amounting to an overall response rate of 92.1 percent.
Persons aged 15 and above were surveyed by the Philippine Statistics Authority in coordination with the DOH. —KBK, GMA News

Rattlesnake Safety in the Regional Parks

A reminder from the East Bay Regional Park District that Spring and Summer are active snake seasons in parks and open spaces.    Park District staff advises that as the weather heats up, rattlesnakes especially become more active. They, like humans, like to explore when the weather gets warm.  Snakes are able to regulate their body temperature by moving in and out of shade. A warmer body allows a snake to move faster when trying to catch prey. Depending upon the kind of snake, they eat insects, slugs, frogs, birds, bird eggs, small mammals, and other reptiles.

Several kinds of snakes live in the Bay Area. Most snakes are harmless to humans and pets, but any snake will bite in self-defense. Because a rattlesnake bite is poisonous, it is considered a medical emergency: call 9-1-1.

Within the past week, the Park District staff has received six reports of rattlesnake sightings, including today when a 47 year old male who was bitten by a rattlesnake this afternoon near the top of Mission Peak Regional Preserve in Fremont.  The victim was taken by helicopter to the hospital and is recovering.  Over the weekend a pet dog was bitten by a rattlesnake at Del Valle Regional Park in Livermore on the Arroyo side along the trail.  A park ranger assisted the owner to his car so the dog could be taken to his vet.   Additional rattlesnake sightings were reported at Castlerock Regional Recreation Area in Walnut Creek in a picnic area, on the Delta DeAnza Regional Trail in Pittsburg as well as in the parking lot outside of EBRPD Police Headquarters at Lake Chabot Regional Park.   No snake bites were  reported with those incidents.

Park staff urges taking snake safety precautions when visiting regional parks especially at this time of year.   A Common Snakes brochure is available and may be downloaded from the Park District’s website,  Search for “common snakes.”

Some safety tips when visiting Regional Parks:
Always hike with a friend so you can help each other in case of emergency.
Look at the ground ahead of you as you are walking. 
Look carefully around and under logs and rocks before sitting down.
Avoid placing your hands or feet where you can’t see clearly. 
Check the immediate area around picnic tables, campsites, and barbecues before using them or camp area.  If you encounter a rattlesnake in these areas, notify park staff.  Do not disturb it. Stay calm.  Give it plenty of room and leave it alone.
Also bring plenty of water for yourself and your pets as many parks do not have direct water supply.  
Keep pets on the designated trails and away from snakes if they see one.  

Learn to recognize a rattlesnake.
Rattlesnakes have a triangular head, much wider than the neck, thick body with dull skin, black and white bands on tail, blunt rattle at tip. May or may not shake rattle in warning. Rattle sounds like bacon sizzling.
Contrast to a gopher snake, which is not venomous.  A gopher snake’s head is narrow, and only slightly larger than the head. The body is slender and usually shiny. The tail is pointed.

If you see a rattlesnake on a trail:
Leave it alone. Do not try to capture or harm it. All park wildlife is protected by law.  Wait for it to cross and do not approach.  Then move carefully and slowly away.

What to Do if Bitten by a Snake:
If bitten by a rattlesnake, stay calm and send someone to Call 911. The victim should remain calm by lying down with the affected limb lower than the heart. Do not waste precious time on tourniquets, “cutting and sucking,” or snake bite kits. If you are by yourself, walk calmly to the nearest source of help: another person, a park employee, or a phone to Dial 911. Do Not Run. 

If bitten by any other kind of snake, leave the snake alone. Wash the wound with soap and water or an antiseptic and seek medical attention.

 If you are not sure what kind of snake bit you, check the bite for two puncture marks (in rare cases one puncture mark) associated with intense, burning pain. This is typical of a rattle snake bite. Other snakebites may leave multiple teeth marks without associated burning pain.
While snake sightings are common in the regional parks, it is generally a rare occurrence to be bitten by one.  But it does happen, so please be aware of your surroundings while enjoying the parks.  

Snakes are an important resource in the natural environment. They are prime controlling agents of rodent, insect, and other reptile populations. They must be enjoyed from afar and left where they are found. It is illegal to collect, kill, or remove any plants or animals from the East Bay Regional Park District.   Please help us to protect wildlife and their environment for present and future generations.

One third of U.S. millennials live with and rely on parents: survey

WASHINGTON –Around one third of all U.S. millennials live with and rely financially on their parents, putting off adulthood milestones like marriage, having a child and home-buying, according to a new report from U.S. Census Bureau on Monday.
That's a shift from four decades ago, when more Americans viewed marriage and child-rearing as gateways to adulthood, U.S. Census Bureau demographer Jonathan Vespa says.
Among younger Americans, women are much more likely to attain a college degree and a full-time job nowadays than they were in 1976.
Meanwhile, young men are only slightly more likely to have attained a higher education and slightly less likely to be employed, the report says.
The number of young Americans living independently of their parents stands at 40.7 percent, down more than 10 percentage points from a decade ago, according to the report
Today, more people between the ages of 18 and 34 live with their parents, 22.9 million, than live with a spouse, 19.9 million. In 1975, more than twice as many people in the same age group lived with a spouse (31.9 million) than with their parents (14.7 million).
Home ownership rates have plummeted, too: In 1975, almost 52 percent of those between 25 and 34 owned their own home. Today, just 28.8 percent do.
The percentage of both men and women who marry at a young age has fallen precipitously in recent years: In 1976, 85 percent of women and 75 percent of men had been married by age 29. Today, only 46 percent of women and 32 percent of men said they were married before they turned 30.
Overall, the number of men and women marrying by older ages has remained virtually unchanged. That shows the average American's chances of getting married remain almost the same, though their chances of marrying while young are dramatically smaller.
"Young adults are not necessarily giving up on marriage. They are waiting longer," Vespa wrote.
Data from the 2012 General Social Survey shows 62 percent of Americans believe completing formal schooling is an extremely important experience necessary to become an adult, and 50 percent say the same about landing a full-time job.
Only 12 percent say getting married is an extremely important step toward becoming an adult, and 10 percent say that about having a child, according to the report. (PNA-Xinhua)

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