Energy drinks are the fastest-growing beverage product in the United States. In fact, spending on energy drinks is up 700 percent from 2000, when these drinks were just hitting the market. Aggressive marketing has helped to create this $3.5 billion industry where teens and young adults are estimated to account for $2.3 billion of drink sales. According to self-reported surveys, 30-50 percent of adolescents and young adults consume energy drinks.

Whitney Houston’s tragic and untimely death surprised much of the nation. She has been honored and remembered during the last week, with special tributes at the Grammy Awards and thousands of status updates blanketing social media to praise her incredible talent. Such a shocking death certainly has not escaped the gossip of the mainstream media. Though the results from her autopsy will not be available for some time, the singer, who has dealt with drug and alcohol addictions in the past, was reportedly abusing a deadly combination of alcohol and Xanax around the time of her death. No one can say as of now what ultimately caused Houston’s death. It is important, however, to realize how dangerous the combination of alcohol and drugs like Xanax can be, especially around Mardi Gras.

Xanax, also known by the generic name alprazolam, is in a class of drugs called benzodiazepines. Klonipin (clonazepam), Valium (diazepam) and Ativan (lorazepam) are included in the same drug class. Similar to alcohol, benzodiazepines work as a depressant in the body’s central nervous system. Specifically, they enhance the effect of an inhibitory neurotransmitter in the body called GABA. Enhancing these inhibitory effects in the body can cause sedation, muscle relaxation, sleep-induction, anti-anxiety and amnesic effects.

To put into context for the non-New Orleanian readers, Frenchmen Street Halloween in New Orleans is huge. Think crazy and crowded Mardi Gras with a Halloween twist where both locals and tourists fill the streets. The fact that whippits were noticeably and openly being used at this Halloween hot spot indicates the popularity of the drug.

“Whippits” are actually an inhalant drug consisting of nitrous oxide, commonly referred to as laughing gas. It is the same anesthetic agent that is used in many dental practices for minor oral surgery and dental work to relieve anxiety and pain. When used in the dentist’s office, the drug is strictly monitored while recreational users are usually inhaling the drug at much higher dosages.

Recreational users usually fill a balloon with nitrous oxide and then inhale the gas straight from the balloon in order to get a high. Interestingly, the reason the drug is called a “whippit” is because small nitrous oxide gas cartridges can be found inside food preparation cans such as whipped cream. Users can simply order the individual cartridges online, place the cartridge in a device called a “cracker” (often sold with the cartridges), and place a balloon on the other end of the cracker in order to fill the balloon with the gas. Alternatively, large nitrous oxide gas tanks can also be used to fill balloons or people sometimes take the drug straight from the whipped cream can.

Inhaling the nitrous oxide from the balloon can cause a high within a few seconds, causing dizziness, a floating sensation, giddiness, disorientation, and occasionally visual hallucinations. The effect of the drug is very temporary with the high usually lasting two to three minutes. However, users often take several hits of nitrous oxide balloons in order to prolong their high for hours. With each inhalation, users feel more and more out of control and unconsciousness often results. Unconsciousness from the drug, or any drug for that matter, is a medical emergency and the person should be brought to the emergency department immediately.

Although the high may be fleeting, there is a risk of death associated with the drug. At high doses, nitrous oxide can replace oxygen in the bloodstream depressing the central nervous system and halting breathing. Since the drug is often used repetitively, it is important to realize that long-term abuse can permanently damage the central nervous system and nerve fibers. Long term users often suffer from a neuropathy, including a loss of balance and dexterity, weakness, numbness, and tingling in their extremities.

Also, nitrous oxide straight from a pressurized tank is actually very cold, which is why people usually take hits from balloons. When the drug is taken straight from a tank, the gas can cause frostbite of the nose, lips, and possibly the vocal cords.

To make a long story short, is it safe? Absolutely not.

If you want more info, check out this video from college.healthguru.com. If you can get past the one minute advertisement at the beginning, it’s actually pretty good!

Recently, Jackson’s personal physician, cardiologist Dr. Conrad Murray, began his trial facing a charge of involuntary manslaughter. As week two of the trial wraps up, I would like to clear up some confusion about the agent that ultimately led to Jackson’s demise: the anesthetic drug propofol.

As a medical student working in various hospitals and clinics in New Orleans, I have heard many patients refer to propofol as “that Michael Jackson drug.” In fact, an anesthesiologist once told me that he has spent a lot of time since Jackson’s death reassuring patients who need to be administered the drug that it is generally safe when used correctly. The buzz surrounding the Murray trial has not only spurred conspiracy theories around Jackson’s death, but also fueled unsubstantiated fear surrounding a drug that is generally approved to be safe if administered correctly.

Murray is accused of administering the drug propofol as a sleep aid to Jackson, who suffered from insomnia and who supposedly wanted help with sleep and anxiety problems leading up to his comeback tour. Propofol, however, is not approved as a sleep aide.

According to the coroner’s report, Jackson died of “acute propofol intoxication.” Jackson also had significant levels of other sedative drugs in his system, including benzodiazepines such as Ativan, Versed and Valium. The coroner ultimately determined that the manner of death was homicide.

Propofol is an intravenous anesthetic used for induction and maintenance of general anesthesia for surgery. It is also used in the ICU setting for sedation of critically ill patients who are usually intubated and closely monitored. The drug has many favorable properties that make it useful in a surgical setting, including a rapid onset of sedation, a generally predictable duration of action, and rapid return to consciousness post-anesthesia. The drug, however, also has the potential to cause respiratory and cardiovascular depression, which may be aggravated by other drugs, such as the benzodiazepines found in Jackson’s body.

Additionally, propofol has a very narrow safety margin between mere sedation and general anesthesia. It can lead to a situation that can lead to a loss of a patient’s ability to breathe alone without intubation and ventilation. For this reason, propofol should be administered with an infusion pump that can provide close dose control, and doctors should continuously monitor the patient with proper equipment.

The American Society of Anesthesiologists has stated that “non-anesthesia personnel who administer propofol should be qualified to rescue patients whose level of sedation becomes deeper than initially intended and who enter a state of general anesthesia.” Rescue, in this case, means the medical personnel should be qualified to correct physiological consequences such as hypoventilation, hypoxia and hypotension. Since propofol does not currently have an appropriate reversal agent, as do benzodiazepines and other sedatives, it is of the utmost importance that the person administering the drug monitors the patient appropriately and be appropriately trained in advanced life support.

In the coroner’s report, an anesthesiologist confirmed that “the standard of care for administering propofol was not met” in Jackson’s case. According to the consulting anesthesiologist, there was no evidence of an infusion pump to control the IV administration and no appropriate monitoring equipment was found at the scene. Furthermore, the amount of propofol found in Jackson’s body was equivalent to that found during general anesthesia in an intra-abdominal surgery where a patient would be intubated and ventilated and cardiovascular depression would be expected to occur and be treated.

The circumstances that caused Jackson’s death because of inappropriate propofol administration were ultimately dangerous and irresponsible. If you or a family member ever needs surgery and your anesthesiologist brings up propofol in the discussion, don’t let it alarm you. The drug is not just “that Michael Jackson drug.” Remember that if it used in the right way, correctly monitored and supervised by trained medical personnel, the drug will most likely not cause any harm.

Because of the water-filtering mechanism in hookah pipes, many people believe that smoking hookah is a fun and safe way to socialize with friends and to enjoy the flavorful and relaxing sensations of exotic tobaccos without detrimental health effects.

Hookah involves burning flavored tobacco on coals. The smoke from the tobacco then passes through the water of a pipe so it cools and “purifies” before a person inhales. The smoke is inhaled through long hoses that are attached to the pipe and are often passed around and shared among users. The tobacco comes in many exotic flavors, from the fruity to the savory. They are given provocative names that resemble cocktails such as Sex on the Beach or Kama Sutra to appeal to a young and trendy clientele.

Many people who may otherwise not smoke cigarettes are willing to partake in hookah because of the perceived harmlessness. Recent studies show, however, that smoking hookah pipes may be as dangerous and detrimental to a person’s health as smoking cigarettes. State legislators, college officials and health advocates across the nation have begun to shift the war on tobacco to the hookah front by introducing bills that would ban or limit hookah bars and also expand indoor smoking laws to include hookah pipes.

The cool, sweet and aromatic hookah smoke seems harmless compared to the hot, pungent smoke from cigarettes. The sweetness, however, is dangerously misleading. According to the World Health Organization, a hookah smoking session may expose the smoker to more smoke during a longer period of time than when smoking a cigarette. In fact, studies have said that the smoke inhaled from a typical hookah session is equivalent to smoking anywhere from 20-100 cigarettes.

The belief that the water in a hookah pipe purifies the smoke that is inhaled is a misconception. Researchers have found hookah smoke to contain tar, heavy metals and other carcinogens. Though most research regarding hookah smoke is relatively new and evolving, preliminary reports have found evidence linking hookah smoke to the similar detrimental health effects of smoking cigarettes, such as pulmonary disease, coronary heart disease and complications during pregnancy.

Because the tobacco in hookah is heated on charcoal, smokers also expose themselves to dangerous levels of carbon monoxide. One study found that patrons leaving hookah lounges had carbon monoxide levels more than three times higher than patrons exiting traditional bars and significantly higher carbon monoxide levels than an average cigarette smoker. Even hookah lounge patrons who did not partake in the pipe still had significantly elevated carbon monoxide levels that were equivalent to that of cigarette smokers, compelling evidence of the dangerous impact of second hand smoke from hookah pipes.

Smokers often use hookah pipes communally, with the hoses attached to the pipe passed from one smoker to the next. The sharing of hookah pipes has been linked with the spread of herpes, tuberculosis and other infections.

Though the cool and exotic vibe of hookah smoking may have great social appeal, it is important to keep in mind that behind the sweet aromatic smoke lays health risks in disguise. Just as the popularity of cigarette smoking met opposition in the 1960s by evidence of detrimental health effects, we should expect even more evidence linking hookah to similar effects in the near future.

Story appears in the 9/16/2011 edition of The Hullabaloo, http://www.thehullabaloo.com/views/columns/article_6abf1518-e09f-11e0-b122-001a4bcf6878.html

New drug trend comes in form of bath salts

Dickie Sanders, a twenty-one-year-old from Covington, La. snorted a packet of Cloud 9 “bath salts” in November 2010. After several days of hallucinations and paranoia, Sanders killed himself.

Sanders’ story made national news and brought attention to a new drug problem that has emerged in the United States, particularly in Louisiana. With names like Cloud 9, Ivory Snow, Red Dove and Vanilla Sky, one would never know that these “bath salts,” often found on convenience store shelves, are some of the most dangerous drugs on the market. Though labeled and sold as bath salts, these substances are nothing like what you find at the spa.

James Moises, an emergency room doctor at Tulane Hospital, has seen several cases of bath salt intoxications.

“They are pretty bizarre,” Moises said. “You know these people are on something way different than what we’ve seen before. The psychosis and delusions are just huge.”

The bath salts are highly addictive, even after one use. The cravings for the drug are so intense that users binge on the drug for several days before arriving at the hospital. After being released from the hospital, some immediately start using again.

The bath salt problem in Louisiana began when the state poison control office received their first call in September 2010. The calls began to escalate, with four calls in October, 21 calls in November and 109 calls in December.

“In November we started to question how widespread this actually was,” Louisiana Poison Control Director Mark Ryan said. “We started to look nationally and realized it was mainly us.”

In fact, last year 135 of the 237 total national calls to poison control centers came from Louisiana. Investigations suggest that there were large distributing operations in Louisiana. The drugs arrived from China in large quantities and were repackaged and sold as phony bath salts.

When ingested, these faux bath salts can have intense effects, even to the most experienced drug abusers. Hallucinations, paranoia and suicidal thoughts are some of the most common experiences. Ryan describes bath salts as one of the worst drugs he has seen.

“If you combine the worst adverse effects from several drugs — the hallucinations of LSD, the combativeness of PCP, the delusions of ecstasy, the severe anxiety and stimulation of crystal meth and cocaine — this is what you see with bath salts,” Ryan said. “It’s like being hit by a Mack truck. This stuff hits people hard.”

Though the documented ages of users have ranged from 14 to 64, a majority of users have been between 20 and 25, making it an issue for college students.

Governor Bobby Jindal issued an emergency rule Jan. 6 to outlaw six chemical compounds known to be components of bath salts. This type of emergency ruling for the ban of a drug is the first of its kind in Louisiana. Following Louisiana’s lead, other states have issued similar bans. Bath salts continue to be an escalating problem, however. Poison control centers across the nation received 237 calls in 2010, but in January 2011 there were a total of 283 calls.

James Guidry, state health officer and medical director of the Louisiana Department of Health and Hospitals, said he is concerned about the impact such bans may have on the allure of bath salts, especially to young college-aged adults.

“Sometimes banning something makes people want to try to get it, and many times it’s replaced by something worse,” Guidry said. “For us to ban this, it’s because we felt like it doesn’t get much worse. Our message is we don’t want you to go try to find this stuff, this is much worse than chemicals you may have tried in the past. It is serious stuff.”