Courtesy of Medscape Today:
Deborah Brauser
Posted: 01/19/2012
January 19, 2012 — Intramuscular injection of the street drug known as "bath salts" may cause necrotizing fasciitis, a rare, flesh-eating bacteria syndrome that affects muscle and subcutaneous tissue, new research suggests.
In a case report published in the January issue of Orthopedics, investigators write that 2 days after injecting "bath salts," a young adult patient came to an emergency department with extensive cellulitis/infection of her upper arm.
"The cellulitis initially responded to broad-spectrum intravenous antibiotics but rapidly deteriorated 48 hours later, leading to a forequarter amputation with radical mastectomy and chest wall debridement to obtain healthy tissue margins and control the disease," write Russell Russo, MD, from the Department of Orthopedics at Louisiana State University Health Sciences Center in New Orleans, and colleagues.
The patient made a full recovery after "further minor debridements, negative pressure dressings, directed antibiotic therapy, and skin grafting."
The investigators note that the current popularity of "bath salts" may lead to an increase in cases of these flesh-eating infections. Necrotizing fasciitis can spread quickly through the body, threatening loss of limbs and even loss of life.
"Orthopedic surgeons should be vigilant in diagnosing this process early and should perform an extensive debridement," they write. In addition, "medical centers of all disciplines must be prepared to identify the signs of intoxication while treating the potential side effects" of this illicit drug.
Rapid Timeline
According to the researchers, necrotizing fasciitis was known as "hospital gangrene" during the American Civil War and as "streptococcal gangrene" in the 1940s. "The pathogenesis of the disease has remained constant over time," they write.
As reported by Medscape Medical News, the US Drug Enforcement Administration (DEA) temporarily banned synthetic stimulants marketed as "bath salts" in the fall of 2011.
Nevertheless, the substance remains popular in the United States among teenagers and young adults. The crystals can be swallowed, sniffed, injected, or smoked. In 2011, calls to poison control centers and reports of emergency department visits rose dramatically as a result of ingestion of these so-called "bath salts."
"Unlike common illicit drugs such as cocaine, heroin, lysergic acid diethylamide, phencyclidine, and ecstasy, the dangers of baths salts are unknown and only beginning to emerge," write the investigators.
The female patient in this report was aged 34 years and reported having pain and redness in her forearm after injecting intramuscular "bath salts" at a party. She did not have a fever at the time she presented. She also reported recent use of cocaine, opiates, and benzodiazepines.
This last factor is troubling to at least one commentator who posted on the journal's Web site. She asked whether there was any toxicological evidence to definitively explain the cause of the patient's condition.
"How can we be sure that the infection was a result of her bath salt injection and not from administering any of the [other substances] she took? There have been previous outbreaks of opiates leading to similar problems, e.g. anthrax epidemic in 2010 in Glasgow."
Nevertheless, the researchers note that the best way to treat necrotizing fasciitis includes early recognition, immediate surgical debridement, and treatment with penicillin G and clindamycin antibiotics.
"Necrotizing fasciitis has a rapid timeline to tissue destruction and loss of life."
A past study found that the average time to surgical debridement for surviving this rapidly spreading infection was just 25 hours. Another study found that overall survival from a diagnosis of the infection was as low as 50%.
"These infections are usually associated with crush traumas and farm injuries, but now one must also be prepared and vigilant when presented with a cellulitic patient who has a history of needle use," write the researchers.
"However, the best treatment is prevention with public, street-based education," they write.
The study authors have disclosed no relevant financial relationships.
Orthopedics. 2012;35:124-127. Full article
Wednesday, January 25, 2012
Thursday, January 19, 2012
Monday, January 9, 2012
Attention Parents and Educators: Health Concern Over "Lazy Larry's"
Public health officials are concerned about the sale of ―relaxation brownies laced with the sleep aid melatonin called "Lazy Larry's" (also known as "Lazy Cakes").
The brownies, intended for adults, are causing concern because they are marketed towards children and teens with its colorful and flashy packaging. The cartoon of 'Lazy Larry' also appears to be drug induced and relaxed on the cover of the product which attracts the attention of teens who think they will get a quick high after eating the brownies. The brownie manufacturers direct consumers to ―take half a brownie, twice a day -to relieve stress and combat sleeplessness. The product is sold at head shops, convenience stores, and major retailers across the country. They are also sold online. The cakes retail for $2.50 to $4 — a high price, considering that a 60-count bottle of 8-mg melatonin tablets costs $11.
Due to the 8 grams of melatonin in the product, the brownies were first marketed as a dietary supplement in mid 2011 to avoid mandatory approval from the Food and Drug Administration (FDA). The safety of a dietary supplement is, by law, the manufacturer‘s responsibility. In August of 2011 the FDA cited the Memphis-based company HBB LLC, the makers of the ―'Lazy Larry' product, stating that they do not consider melatonin to be a harmless food additive and the brownies are "adulterated" because they contain them. The FDA also cited ―medical research that has shown concerns about potential reproductive, cardiovascular, ocular and neurological issues as side effects of using the drug (melatonin). (FDA). A teen could be having a physical reaction to a Lazy Larry, so it is important adults are aware of this new product and the potential harm it can cause on children and teens.
Kush Cakes or Lulla Pies are also popular "lazy cakes", however they have not been cited by the FDA.
Members of the Putnam CTC Coalition are available if you have any questions or would like for us to do a presentation to your organization on this or any other substance abuse trends that affect our children. Please visit and join us on Facebook by searching "Putnam County Communities That Care – NY" or on Twitter at http://twitter.com/#!/PutnamCTCNY or call 845-225-4646.
The Truth About Energy Drinks
Energy drinks are beverages that are specifically marketed to young people, with names like Red Bull, Venom, Monster, Adrenaline Rush, 180, ISO, and Sprint. These drinks contain large doses of caffeine (as much as 80 mg), sugar and other legal stimulants like guarana and ginseng. When compared to the 37mg of caffeine in a Mountain Dew or the 23mg in a Coca-Cola Classic, it is clear that energy drinks pack a big punch.
There are also alcoholic energy drinks that are in the market that children are getting their hands on that look similar to the non alcoholic energy drinks. Examples of these dangerous drinks are Four Loko, Joose and Sparks. The marketing on the television and on the internet use fun or dramatic names, messages and colorful graphics that attract young people.
In the short-term, consumption of energy drinks can boost the heart rate and blood pressure (sometimes causing palpitations), dehydrate the body and, like other stimulants, prevent sleep. Energy drinks should not be used while exercising or to enhance athletic performance, as the combination of fluid loss from sweating and the diuretic quality of the caffeine can leave the user severely dehydrated. Additional health risks include increased anxiety, panic attacks, headaches, sleep deprivation, and stomach aches. (Martine Institute, 2007)
According to the NCAA Banned-Drug Classes, use of caffeine (guarana) is prohibited, as it is considered to be a stimulant. Any individual with a urine concentration that exceeds 15 micrograms/ml is considered to be ‘positive’. It is worthy to note that “the U.S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore purity and safety of nutritional dietary supplements cannot be guaranteed. Impure supplements may lead to a positive NCAA drug test”.
Members of CTC are available if you have any questions or would like for us to do a presentation to your organization on this or any other substance abuse trends that affect our children. Please call the Putnam County Youth Bureau at 845-808-1600 Ext. 46117 or the National Council on Alcoholism/Putnam at 845-225-4646, Ext. 13 if you have any questions. Please visit and join the Putnam CTC Coalition on Facebook by searching “Putnam County Communities That Care – NY” or on Twitter at http://twitter.com/#!/PutnamCTCNY or call 845-225-4646.
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