Multiple forms of drugs causing errors
PHILADELPHIA - Dr. James Kmetzo knows that Diltiazem is usually the drug of choice for high blood pressure.
But then his choices explode. Cardizem, Dilacor and Tiazac are all brand names for Diltiazem. But should he prescribe Cardizem CD, Cardizem SR, Cardizem LA, Dilacor XR or Tiazac? All four come in varying doses, some taken once a day, some twice, some crushable, others not.
Most of the time, it's the insurance coverage and pharmacist that decide. "I know that it's Diltiazem and I can write any two letters after it and it gets filled correctly," said Kmetzo, a cardiologist.
Not always. Last month, the Food and Drug Administration called a closed-door meeting with pharmaceutical companies and watchdog groups to address the issue. They agreed to study the problem, but the solution remains elusive.
Many of the CD, XL and SR medications are designed to treat heart disease or mental illness, such as depression or anxiety. Most are higher-dose forms meant to be released slowly. Doctors say taking a more potent form incorrectly can result in seizures or a sudden drop in blood pressure, leading to fainting, falls and even death.
In 1996, an 83-year-old woman died after mistakenly being switched from immediate-release medication for her high-blood pressure to a time-release formula. By chewing the Cardizem CD tablets instead of swallowing them, she released the drug more quickly into her bloodstream, according to the Institute for Safe Medication Practices, an industry watchdog group.
Experts say the problem worsened as more drugs in multiple forms came on the market. Several pharmacists said they typically saw incorrect prescriptions two or three times a shift.
In an ongoing study at the Albany Medical Center, the director of pharmacy found that more than 600 errors annually were the result of those two letters at the end of a drug's name.
Patients often aren't paying attention. Consumers read their medication labels less than half the time, according to a 2005 study by the American Pharmacists Association.
"There are a lot of errors, and some have had a significant impact on patients, causing permanent impairment and death," said Linda Hanold, chairwoman of the National Coordinating Council for Medication Error Reporting and Prevention, which coordinated the conference.
"It's not an epidemic, but as more and more drugs enter the market, there's more confusion, and we need to address the issue now when it's still early."
The suffix issue started about 20 years ago when drug companies began developing new versions of medication. The original goal had good intentions -- to develop slower-releasing pills to be taken once or twice a day instead of multiple times.
Because it was the same medication, the drug companies had to find a way to distinguish the new time-release forms from the earlier pills. They started adding two letters at the end of the name: XL, CD, SR and LA.
The letters have no standard meaning. The letters "SR" on one drug, such as the blood pressure medicine Verapamil SR, means it is given once a day. On another drug, Wellbutrin SR, it's twice a day. Sometimes generic version letters do not match the brand name.
There are no FDA regulations on suffixes, said Michael Cohen, president of the Institute for Safe Medication Practices, which wants the names to be standardized. When the letters started appearing, he said, mistakes started happening almost immediately. In the last decade, his group received hundreds of medication mix-up reports due to suffix mistakes.
"Walk into any pharmacy and ask about this problem -- everyone is talking about it," said Cohen, a pharmacist himself. "There's no directory of these suffixes, and we don't know what they mean; the letters are just meaningless."
FDA officials say they take suffixes into consideration when approving a drug name and have changed some names. One problem with regulating names is how to address those already on the market.
"That's our dilemma, because the last thing we want to do is cause more confusion," said Carol Holquist, director for the division of medication errors in the FDA's office of drug safety. "What was promising about the meeting was that everyone recognized it was a problem.
For Kmetzo, the best solution is to streamline drug production.
"We don't need that many different Cardizem drugs, so the industry is bringing it on themselves," Kmetzo said. "Go work on other drugs instead that we can use."
Marijuana on the road
Marijuana on the road: Real but rare risks
Study from France finds nearly 9% of at-fault drivers with detectable cannabis levels in fatal crashes.
Nearly 1 in 10 drivers in France involved in fatal crashes had detectable cannabis levels, according to a study released early by BMJ (formerly the British Medical Journal), but the proportion of fatalities attributed to marijuana was dwarfed by those caused by alcohol-intoxicated drivers.
Looking at the October 2001 through September 2003 time period, Bernard Laumon of the French National Institute for Transport and Safety Research and colleagues identified 10,748 drivers with known drug and alcohol concentrations who were involved in fatal crashes. The 6,766 drivers who were considered at fault were compared with 3,006 of the other drivers in a population case–control design.
While 8.8% of cases were positive for cannabis, only 2.8% of control drivers had detectable marijuana levels. The odds ratio increased from 2.18 at low THC levels to 4.72 among those with high levels of this active ingredient of marijuana. But overall, only 2.5% of fatal crashes were attributable to cannabis, compared with 26.8% where alcohol was the likely cause.
How long a drug stays?
Drugs affect every person differently, and so drugs will be metabolised by every person differently. Drug testing results are always unique to the individual. This means that there are certain factors about you and your drug use that can affect these results. These include:
- strength of the drug
- how much you use
- how you use it
- how often you use it
- what other drugs you use
Results are also affected by your unique body, such as:
- your tolerance
- your sex and age
- your overall health and wellbeing
- your metabolism
- your mood and the environment you are in
Hair tests
Traces of drugs may accumulate in your hair after use. Hair testing can provide a history of your drug use because these traces may be present in your hair follicles. The length of your hair will determine how far back drugs might be traced (hair grows at approximately 1 centimetre per month). Hair testing is the only reliable method used at the moment that can detect drug use beyond a couple of days or weeks. Not many countries use this method, however, because of the cost and technology involved.
What is drug testing?
Drug testing is used to find out whether you use or have used drugs. Urine testing is the most popular form of drug testing. Urine testing detects leftover traces of drugs, called metabolites, long after the psychoactive effects (being stoned/ bombed/peaking) of the drug, and the drug itself, may have left your body. Passing a drug test means that either all traces of the drug have been metabolised (processed) by your body or that the testing procedure isn’t complex enough to detect these traces.
False Positive Results!
Are there legal drugs that I could list as taken which would cause a false positive?
There are more than 250 over-the-counter medications and prescription drugs that could cause a False Positive.
Filling out the lab test form to include over the counter medications that cause the same positive results as the illegal drug that might be consumed would be a good idea. If a positive result occurs on the test, a basis will have been laid for an appeal. Remember that the negative error rate is just as large or larger than the positive error rate. Many people using drugs escape detection.
Pain relievers such as Advil, Nuprin, Motrin, Midol, Trendar and Ibuprofen are known to cause false positives for Marijuana use. Second hand smoke inhalation from a rock concert or from being with someone who is smoking marijuana could also cause a false positive for THC. Hemp seed products, such as hemp burgers or food products containing hemp oil will also cause false positives for THC. Twelve ounces of hemp seed products ingested before a test will cause you to fail your test and has held up as a defense in at least two federal court cases.
Dristan Nasal Spray, Neosynephren, Vicks Nasal Spray, Sudafed and other medications containing ephedrine or phenypropanolamine could cause a false positive reading for Amphetamines.
Vicks Formula 44M containing Dextromethorphan, and Primatene-M containing perylamine as well as the pain reliever Demerol, Quinine water, poppy seeds and prescription anti-depressant Elavil will cause a false positive for opiates.
Nyquil Nighttime Cold Medicine will cause a false positive for Methadone.
Antibiotics such as Ampicillin and Amoxicillin will cause a false positive for cocaine.
Diasepam as well as Dextromethorophan (an ingredient in some cough medicines) will cause a false positive for PCP.
Drug Testing Information
This blog was created to help you pass your drug test. If you have an upcoming test, then you will need this information. This blog is set up to easily guide you into a detoxification solution for your specific drug screening.
Like most people, you probably are overwhelmed with the amount of products on the internet that promise to "help you pass your drug test". The fact is that most of these sites are "quick buck" artists, selling only false promises and low grade detoxification products.
Beware Of The Low Grade, Low Priced Detoxification Products!
Pass Drug Test
Hi and welcome. If you are there your are most likely getting a new job, being promoted, have a court mandate or you could be getting tested for your health insurance policy. You are not alone! New applicants for many of the top1000 corporations and now even small businesses are being forced to take a drug test. In fact, more than 25 million people in USA will be tested this year. Using recreationally or even very rarely (once a month) typically means you will fail your drug test miserably. Even the smallest amount of toxins can be detected in urine, blood, saliva, hair, external residue, and even perspiration!
