- Written by Ethan Abbott
Toxicology Literature of Note
In NY and NJ, anyone is able to walk into a retail pharmacy and obtain naloxone without a prescription, but it appears that not all retail stores stock this life-saving drug. The following paper surveyed all retain pharmacies within 10 NJ cities to assess their availability of naloxone. They then looked at the cities population and socioeconomic demographics to assess any differences. They concluded that “naloxone deserts” do exist in select NJ cities, which are high risk. The pharmacy naloxone availability may be positively related to medical household income, and negatively related to population size. There was no relationship found between opioid-related hospital visits and naloxone availability. This is a study I would like to replicate in NY, and more specifically in the Bronx. Does anyone want to help?
Higenamine is a compound found in plants with stimulant properties. In animal studies, it is demonstrated to be a beta-2 adrenergic agonist. The following study analyzed dietary supplements available in the US for the presence and quantity of higenamine. 24 products were analyzed, with most marketed for weight loss or as sports/energy supplements. None of the products were accurately labeled, and the quantity of higenamine in the products contained from <0.01% to 200% of the quantity listed on the label. The FDA does not have the ability to regulate the supplement industry, and this paper shows that what is on the label may not be accurate. Other studies have had similar findings, even with different pills from the same bottle containing different concentrations of reported supplement. Keep this in mind the next time you are discussing supplements with your patients. You are asking about supplements, right . . . ?
Toxicology in the News
Fugu, better known as the Blowfish, is a Japanese delicacy with a deadly twist. If not prepared properly, there is the potential for it to be your last meal. Tetrodotoxin is found in high concentrations in the liver, ovary, eyes, and skin is a potent neurotoxin, which can paralyze you while you are still conscious! An amazing episode of The Simpson follows Homer as he believes that he only has 24 hours left to live after consumption of the fish. Now it looks like the toxin has been modified out, leading to diners to enjoy safely. But yet . . . I think the fish now loses some of its awe, as the idea of cheating death is why some decide to pay the expensive price tag for this formerly potentially deadly dinner.
Australia has some beautiful beaches, expansive countryside, Hobbits and someone of the most venomous animals on Earth! The Eastern brown snake considered one of the most deadly snakes in the world was overpowered, killed and eaten by a Redback spider, all caught on camera!
How do our individualized and specific genes affect the way our bodies handle a medication or overdose? The field of toxicogenomics looks at this specific question. An example is how codeine, which is metabolized to morphine by CYP2D6 does not provide any pain relief to those who do not have any active CYP2D6 (which is 5% of the Caucasian population). Another recently discovered example is how those with a variant of the CYP3A7 may quickly metabolize birth control pills, leading to them being ineffective and unintended pregnancy.
Toxicology Toxin of the Month
Everyone knows what an EpiPen is and what it is used for, but did you know that there is a naloxone autoinjector as well, EvzioTM The above blog post, by Dr. Andrew Stolbach, is a short and funny “interview” with the product. It explains how naloxone can be obtained without a prescription and without being seen by a doctor. But, although we are within a public health crisis, a simple autoinjector that could save lives is costing people between $400-$4100. Finally, it gives some examples of patients who are at risk of overdose and provides links to where you can learn more about naloxone laws by state.