Her name was Gabi. She died after taking a drug “cocktail,” which calls into question the specificity of what killed her (“doing lots of drugs” is frequently a culprit in this situation). But it’s the exciting new powder in the mix that warrants some good old fashioned lock-the-kids-in-the-basement fear.

It’s called mephedrone, 4-methylmethcathinone to the pedantic, 4-MCAT to the hipper of organic chemists; the street name is “meow meow” which is presumably the kind of pun on the abbreviated moniker that, when one is actually on the drug, becomes by turns hilarious, trenchantly insightful, then horrifyingly vapid. It’s a stimulant of the phenethylamine class, meaning it shares a certain kinship with methamphetamine and methylenedioxymethamphetamine (MDMA). Unlike those drugs, however, it’s legal.

And not just legal, convenient. The Daily Mail‘s Paul Bracchi even had some delivered to his home, presumably to prove a point (later, he traced the courier back to an apartment where he observed men “of Middle Eastern appearance” and “with an East European accent,” presumably to prove a completely different point. Stay classy, London!). To avoid regulatory interference from the British FDA, it’s sold as plant food, but this doesn’t fool anyone. Mephedrone is very much a psychoactive compound, and its on-label use would end up creating very perky rhododendrons indeed.

Like its chemical brethren, mephedrone has a strong stimulant effect, though the nuances (as reported by the renowned Burners-pretending-to-be-scientists at Erowid), pleasurability, and levels of MDMA-like hallucinogenic and empathogenic activity varied by user; Vice‘s correspondent totally hated it, and those people are professionals. It clearly has a bit more of a kick than plain amphetamines, and indeed, it belongs to a family not seen all too frequently in the Western world: the cathinones.

Unlike amphetamine, the basic cathinone (called “cathinone,” cleverly enough) is found naturally in the East African khat shrub. An integral part of the nonstop party that is Somalian militia life (it’s like Burning Man, only with more men actually being set on fire), khat carries all the well-documented paranoiac and exhaustive dangers of all stimulants. Like amphetamines, cathinone’s effects gain subtler psychoactive properties when the substance is methylated, ethylated, and otherwise tricked out chemistry style. Thus, meow meow, your feline friend who kills perky blond teenagers.

This has lead some countries to ban the drug, though not Great Britain and not, to date, the United States. Indeed, the DEA only has one public record of mephedrone on U.S. soil. the closest relative to mephedrone that you can get your hands on, and the only cathinone with any pentration in the U.S. market, is also legal. It’s bupropion, also called Wellbutrin and Zyban. Which may not be plant food, but, as the fourth most frequently prescribed antidepressant, certainly has its adherents.

Who’dve thought it was such a small step from antidepressants to panic?

(Photo by Tambako the Jaguar)

Nah, it’s cool to freak people out; by doing that, we’re driving the cost of Chalupacream down. It’ll be affordable to everyone now.

So goes the pharma and device industry’s rationale with regards to direct-to-consumer (DTC) advertising. But a new study shows that this may be a complete fiction. According to University of British Columbia-based researchers publishing in the Archives of Internal Medicine, a DTC campaign made no difference in the number of prescriptions filled for the anticoagulant Plavix, but the initiation of the campaign was associated with a rise in drug price.

“Overall,” the authors write, “this change resulted in an additional $207 million in total pharmacy expenditures.”

According to Reuter’s, this shouldn’t be the case; “[I]ndustry analysts suggest that because direct-to-consumer advertising increases sales, it allows companies to spread out their costs, making them more affordable for everyone,” Julie Steenhuysen writes.

But DTC strategies, target… wait for it… consumers. Who are not actually able, by and large, to provide themselves with prescriptions (Levi Johnston’s mom notwithstanding). So physicians continue, by and large, to do what they do best, which is to ignore the potent mix of hypochondria and compulsive drug-seeking that pulses through the veins of the American patient. This goes double for a drug such as the one studied here; Plavix prevents blood clotting, so while it can promote heart attack prevention and recovery, it comes with some pretty gnarly will-kill-you caveats. Basically no lay person has any idea whether or not they should be on it. So all mass-audience advertising does is cost the pharmaceutical companies money, money which has to be recouped somehow. That somehow ends up being increased drug costs.

So it could stand to reason that another drug, one more elective—and there’s always the fear that certain drugs could be prescribed to otherwise healthy people who wanted to live more forever-y, c.f. Crestor (rosuvastatin)—and safe, would have prescription use driven by DTC advertising. That kind of more benign drug bears a similar investigation, but in the case of many powerful drugs, it would seem the only real reason to maintain DTC campaigns is to continue the diversion of cashflow to America’s most precious natural resource: ad flacks.

(image via)

See, most liquid drugs are prescribed in milliliter (mL) doses; liquid Tamiflu, however, is dispensed in milligram (mg) doses. Since no one can be arsed to read in America anymore [Editors: please illustrate this with the universal symbol for "a pig stabbing you in the face"; it's somewhere in the dingbats font set, I'm sure of it], folks are at risk for being misdosed. And an overdose of Tamiflu causes nausea and vomiting, though at least it’s not pig barf, so there’s that.

Not like it matters anyway; remember the bird flu? Us neither! But still, apparently, it mutated to become resistant to Tamiflu. Influenza is super mutate-y, which is why it jumped from swine to humans in the first place; it’s not unreasonable to think the swine kind, too, might become drug-resistant, especially if everyone freaks out (they will) and pill pops at the first sign of snot. And at that point, all we’ll be able to do is put our affairs in order and fall to our feeble, barfy knees before the almighty Pig Shiva.

Photo by be_khe

For one, things were just getting fun; a quick Google search for “Accutane” and “lawsuit” reveals a cottage industry of mesothelioma-esque proportions. According to Lawyers.com, “[i]f you have suffered a Accutane®-related injury, or if you are a close family member of someone who died as a result of taking Accutane®, you may be able to file an Accutane® lawsuit.” Yeah, the stuff was that toxic; in addition, it may be linked to depression (not only ironic in general, but extra funny considering the fact that an alternate formulation sells under the brand name Amnesteem, no kidding). But most fun are the birth defects.

The risk of birth defects is so severe that the FDA has, since 2006, made women being prescribed isotretinoin participate in iPledge. iPledge is essentially a cross-my-heart-hope-to-die-no-wait contract stating that the participant will use at least two kinds of birth control (classified primary and secondary by the FDA in what could in other contexts might serve as the I9 ID list for a bar bathroom liaison), and requiring various kinds of checking in by the dermatologist, pharmacist, and the woman’s endometrium itself (“ALL CLEAR!!”). Of course, this turns out to be problematic for a number of reasons, not the least being that it constantly refers back to the outcry over the Bush-era CDC’s “pre-pregnant” guidelines, which stated essentially that any woman who can have a baby just might at any moment, because women are capricious and their ovaries are just sending eggs flying down the tubes like a paintball gun of babies.

Of course, iPledge undoubtedly benefitted Hoffman-La Roche as well. The registry allowed the company to throw up its hands and saying, “Hey not our fault, you iPledged. Or uPledged. Or something,” when confronted by the enraged mom of a flipper baby. But damn if that flipper baby wouldn’t have perfect pores. Alabaster, even.

Photo by Ë�Cаvin ã��

So the news is out, the bell has sounded: Vicodin and Percocet may soon vanish, no longer to aid wisdom-detoothed adolescents in finally really getting Nirvana. A panel of grave-faced doctors with expertise, wisdom, and beards decreed it so.

But the pill-pulling isn’t even due to the addictive aspects of the drugs,  which stem from the inclusion of synthetic opiates; it’s the fact that the medications also incorporate acetaminophen, better known under its ubiquitous brand name, Tylenol. (In fact, the pill-pulling isn’t even as guaranteed as it seems; although the New York Times expansively asserted that the FDA “is not required to follow the recommendations of its advisory panels, but it usually does,” the 20-17 voting margin hardly rings of consensus, and the Faster Times spoke with a panelist who voiced some reservations about the way the vote was conducted. Hopefully more on this later. Journalisticness!) Tylenol can cause acute liver failure in doses over 4,000 mg/day, a dose that is fairly easy to reach with prescription opiates in cases of chronic pain management or addiction.

And so with classic media panache, the fact that the something in your medicine cabinet will kill you! was eagerly explored in myriad outlets, and immediately followed by measured reassurances that it’ll all be OK that we would’ve taken to heart if we weren’t already in the hospital dying from NyQuil and a lifelong Smartie-smoking habit. But all of this begged the question: why are hydrocodone (Vicodin) and oxycodone (Percocet) packaged with acetaminophen in the first place?

The first and most simplest reason is that acetaminophen has what Dr. Fancywords calls an “opioid sparing effect.” That is to say, Tylenol in the system causes opiates to exert a stronger influence, i.e. do more pain killin’. This means lower doses of the opiate are needed, and, natch, too much opiate-eating can make you really really want even more opiates (and also stop pooping, which can be more or less important, depending on how much you like pooping). So this would make the Tylenol seem like it should make Vicodin or Percocet safer – but this is only true if the doses remained as effective day after day, and this isn’t always the case.

The process of tolerance, even if slowed by this opioid sparing effect, often does still build at standard medical doses. With typical acetaminophen content being around 500mg per Vicodin or Percocet pill, a mere 8 pills exceeds the toxicity threshold. Munching them two at a time, all it takes is one insomniac night for you to put yourself in danger. Yes, this would mean violating your physician’s instructions, but find me a person who has always obeyed physician instructions to the letter on every drug they’ve ever taken, and I’ll show you someone who alphabetizes their underwear drawer.

So then why not separate the two drugs? This would probably be the short term effect of the FDA panel’s recommendation, if it’s put into full effect. Pain patients could receive one prescription for hydrocodone/oxycodone, plus a good old Tylenol bottle. However, we’re confronted with another intrinsic human weakness: following the fucking directions.

Entire studies are conducted devoted to the issue of drug regimen adherence, i.e. how reliably people take the drugs they’re told to take, and if they take them the way they’re supposed to. Although it seems less so every year, popping a pill doesn’t have the sense of biological urgency attached to it that things like eating, boinking, and watching “Lost”do (the luckiest among us eat, boink, and watch ”Lost” all at the same time, and we will crush them when the revolution comes). A basic message from almost all of these studies is that adherence, already a dodgy thing, drops off precipitously the more different pills are involved. Which eliminates any benefit from an opioid sparing effect — making addiction more likely and increasing tolerance at an even faster rate than would occur with good old “Vike” (that’s a street name!).

But there’s another reason to keep acetaminophen around. The universe of U.S. government pharmaceutical oversight is, like a Philip K. Dick theology, ruled over by a generally benign, protective force known as the FDA, and a largely dark, insane deity known as the DEA. The ease by which a drug can be prescribed by a physician and picked up by a patient is determined by its placement on the Drug Enforcement Agency’s drug schedules. Schedule IV drugs are the least regulated; Schedule I the most.

When combined with Tylenol, hydrocodone is a Schedule III drug (the same thing goes for codeine, but not, oddly, for oxycodone, which is Schedule II whether or not it comes with Tylenol. That phrasing, with the comma-oddly-comma, tends to apply to a great number of things the DEA does. We hope to go into this in more detail soon. Journalisticness-ier!). Schedule III drugs just need a prescription and can be refilled by mail, in three-month quantities, all that good stuff. Hydrocodone alone, however, is a Schedule II drug, meaning prescriptions can’t be for more than a month, all prescriptions must be written and verified, and the physician must be registered with the DEA and file reports and generally do a lot of things that involve suspecting the patient instead of treating them. For patients with chronic pain (not to mention chronic pain that varies in intensity, requiring different doses day to day) and limited physician access, a lower-scheduled drug can spell the difference between misery and an almost normal life.

(Now is the time when we would normally rant about how a better health care system with lessened paperwork loads, better physician reimbursement, and easier patient access to physicians would allow more personalized and flexible treatment regimens. This would solve a lot of problems and make drug schedules so much less important. But America is in a crisis and every blogger must do her or his share, and therefore we would ask you to forgive the glaring omission and maybe provide your own rant. If only there were some field below this one for a reader to go off about whatever shiny thing is in front of them at the moment.)

So this raises another question: why would the DEA loosen regulations on a variety of opiate pill that could be more dangerous? Although there’s some merit to the idea that the lower doses of hydrocodone required when accompanied by acetaminophen making the whole pill less pop-worthy, the fact that tolerance still develops clearly indicates the processes that lead to addiction are underway, mixed formula or no. And anyway, if Tylenol had any effect on reducing abuse, why would the DEA dedicate whole webpages to wigging out about recreational Vicodin use?

Is it possible, then, that the DEA is banking on the threat of liver failure to dissuade users? We hope not, although we’ve spoken with physicians who suspect that this is what’s going on (and graciously offered to share their tinfoil hats with us); if that is the reasoning behind the Vicodin being less regulated than pure hydrocodone, then the end effect is punitive – if you’re a user, you deserve it. At the very least, there’s a cruel double standard across government agencies, since the threatened elimination of the cocktail is a paternalistic response to non-abusers inability to use Tylenol-containing products safely. And users aren’t known for their diligent pre-use research. So the FDA ends up saying, “We don’t trust you not to die,” while the DEA’s message is, “We don’t trust you. Die.”

But regardless of the philosophical intention, the end result of the scheduling is that either way someone gets hurt; either Vicodin is eliminated and pain patients experience a decrease in quality of life, or the FDA takes no regulatory action both patients and abusers experience a decrease in, um, life. Both of which are what drugs are supposed to enhance in the first place.

Photo by Conanil

Like Gardasil, the tween-girl-sluttifying HPV vaccine already on the market, Cervarix protects against the major cancer-causing strains (that’s HPV 16 and HPV 18). Unlike Gardasil, Cervarix also protects against strains not specifically used in the design of the therapy, including HPV 31, HPV 33, HPV 45—hang on… BINGO!!—and as many as 12 others.

Unlike Gardasil, it does not, however, protect against HPV 6 or 11, which cause the creepy but probably harmless little white bumps. This is an excellent argument for getting in some quality face-to-, um…face? with any new partner’s fun bits during sexytimes. Not kidding.

Cervarix is already available in Europe. So is HPV.

Photo by amy_b

Also, everyone in D.C. who isn’t cheating on their spouse is being good ’cause they’re on too much coke to want to get any. Dr. Government says so!

In fact, going over the source report, it’s a little hard to draw useful generalizations. SAMHSA themselves essentially concluded, “every state is similar, yet different.” The scientific takeaway seems to be that the epidemiology of substance abuse has to be approached state by state. The snark takeaway is that the joke, “Because there’s nothing else better to do!” works for 48 states (Illinois is apparently incontrovertibly awesome, and the Chinese just bought California).

And now your meds may give you cancer.

According to a statement from the European journal Diabetologia (we’re pretty sure it’s concerned with either insulin levels or loge levels), three out of four studies charting the well-being of patients on the extended-release insulin therapy Lantus found a link between use of the drug and incidences of cancer.

Based on these findings, the U.S. Food and Drug Administration (FDA) recommends those taking Lantu…do nothing. There are some blips in the studies’ findings that call into question the strength of the association; among other things, the cancer-developing population were “generally older, higher blood pressure, more overweight,” all risk factors for many kinds of exciting death beyond tumor and insulin coma. The FDA is pushing for more studies before it makes any official decision regarding changes in treatment protocols.

Nonetheless, it should be pointed out that all cancer-developing individuals had diabetes, clearly demonstrating that God was determined to be a dick to them in the first place.

Photo by kirinqueen