Addiction is a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following: • Impaired control over drug use • Compulsive use • Continued use despite harm • Cravings
1 • 2 • 3 • Sobriety • Death • Jails / Institutions
Rates of Prescription Painkiller Sales, Deaths and Substance Abuse Treatment Admissions (1999-2010) SOURCES: National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 1999-2010; Treatment Episode Data Set, 1999-2009
Prescription Drug Overdose Death Rates By State per 100,000 People (2008) SOURCE: National Vital Statistics System, 2008
Delivery of glucocorticoids by jet nebulization: Aerosol characteristics and output Jeffrey Leflein, MD, a Eleanor Brown, MT(ASCP), a Malcolm Hill, PharmD, a H. William Kelly, PharmD, b David Todd Loffert, BS, a Harold S. Nelson, MD," and Stanley J. Szefler, MD ~ Denver, Colo., and Albuquerque, N.M. Background: Since inflammation has been identified as a critical factor in the pathogenesis of asthma, use of inhaled glucocorticoids has increased. Because young children are often unable to coordinate properly the use of metered-dose inhalers and no glucocorticoids preparations for nebulization have been approved in the United States, parenteraI and intranasal glucocorticoids preparations are occasionally administered by nebulization. Methods:We examined whether a parenteral preparation (triamcinolone acetonide [TAA]; Kenalog) could be delivered by nebulization. TAA, 1000 txg (0.1 ml), was placed in the nebulizer bowl (MB5 [MeFar, Brescia, Italy] or Pari-Jet [Dura Pharmaceuticals, San Diego, Calif.]), then diluted with 2. 9 ml normal saline solution for a total volume fill of 3 ml. Using a laser panicle analyzer, high-performance liquid chromatography, and cascade impactor, we examined the percentage of aerosol volume produced with panicles in the respirable range of 1 to 5 lazn in diameter, actual TAA output (in micrograms) and concentration of TAA contained in the panicles within the respirable range. Results: Laser particle analysis indicated that 34% +- 3% (mean +- SEM) (MB5) and 47 +- 3% (Pari-Jet) of the total aerosol volume produced were within the respirable range of I to 5 txm in diameter, and this remained consistent throughout nebulization. The nebulizer was stopped serially for determination of TAil output with high-performance liquid chromatography. TAA output (1000 tzg less the amount in micrograms remaining after nebulization) was essentially complete after 2 minutes with the Pari-Jet and within 4 minutes with the MB5 and totaled 352 +- 19 ixg and 367 +-- 9 Ixg, respectively. Finally, cascade impactor studies confirmed that 33.4% of the TAil aerosol generated by the MB5 nebulizer was contained in panicles in the respirable range. Conclusion: Approximately 35% (Pari-Jet) and 37% (MB5) of the initial 1000 lag of TAA was delivered with the two nebulizers tested. The panicles generated within the respirable range were limited to 34% (MB5) and 47% (Pari-Jet) of the amount delivered. TAA was equally distributed in the particles generated. The theoretic amount delivered in the respirable range was approximately 12.5% for the MB5 nebulizer on the basis of the cascade impactor and 16.5% for the Pari-Jet (assuming TAA distribution equivalence) of the TAA placed in each of the nebulizers. Additional clinical studies are needed to define efficacy and safety in view of the excipients used in preparing the parenteral preparation. (J ALLERGY CLIN IMMUNOL 1995;95:944-9.) Key words: Triamcinolone acetonide, glucocorticoids, laser panicle analyzer, high-performance liquid chromatography, cascade impactor.
COMPARISON OF DISPOSABLE JET NEBULIZERS, A METHOD FOR DETERMINING WHICH BRAND TO USE. D. Todd Loffert, PARI Respiratory Equipment, 7493 Whitepine Road, Richmond, Virginia, 23237. Four commercially available nebulizers from 4 sources were studied (Misty-Neb/Baxter, PARI LC-D/PARI, Updraft II/Hudson RCI, and Whisper Jet/Marquest medical). The nebulizers were operated using an PARI Master compressor and reanalyzed with an DevilbissPulmo-Aide compressor. Delivery rate(Ml/Min), percent Particles in the Respirable Range(PRR), Respirable Particle Delivery Rate(RPDR), and standard deviation of all parameters were compared. All nebulizers were filled with 2.5 ml of saline. PRR was measured by continuous sampling by Laser Particle Analyzer, Malvern Mastersizer X. The nebulizers were sampled at a simulated flow rate of 20 liters per minute. PARI MASTER COMPRESSOR Ml/Min varied from 0.23 to 0.56 ml/min. The Whisper Jet (0.23) had the lowest ml/min while the PARI LC-D (0.56) had the highest. PRR varied 22.74 to 59.89%. The Misty-Neb (22.74%) had the lowest PRR while the PARI LC-D (59.89%) had the highest. To combine the previous variables RPDR was calculated, = Ml/Min multiplied by PRR. The Misty-Neb (0.06) had the lowest RPDR while the PARI LC-D (0.34) had the highest RPDR (means significantly different at p<0.0001). PULMO-AIDE COMPRESSOR Ml/Min varied from 0.14 to 0.48 ml/min. The Whisper Jet (0.14) had the lowest ml/min while the PARI LC-D (0.48) had the highest. PRR varied 25.00 to 51.92%. The Misty-Neb (25.00%) had the lowest PRR while the PARI LC-D (51.92%) had the highest. To combine the previous variables RPDR was calculated, = Ml/Min multiplied by PRR. The Misty-Neb (0.04) had the lowest RPDR while the PARI LC-D (0.25) had the highest RPDR (means significantly different at p<0.0001). The Ml/Min, PRR, and RPDR of the commercially available nebulizers varies greatly with each compressor used. Consideration must be given to these efficiency parameters when deciding which nebulizer brand to use.
Comparison of the bronchodilator response to albuterol administered by the OptiHaler, the AeroChamber, or by metered dose inhaler alone. Nelson HS, Loffert DT. National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206. Eighteen subjects with moderate asthma participated in this double-blind study comparing the bronchodilator response to albuterol or placebo used in conjunction with three inhalation devices; the metered dose inhaler (MDI) actuator alone, the AeroChamber, and the OptiHaler. The principal comparison was the increase in FEV1 over 30 minutes. Also recorded were heart rate, time required to use each device, and patient acceptance of each device. There was a large bronchodilator response with albuterol with each of the devices, but there was no difference in the promptness or the magnitude of the bronchodilator response among the three devices. There was a small but statistically significant increase in heart rate which did not differ among devices. Subject ratings of acceptability were MDI alone best, followed by OptiHaler, then AeroChamber. We conclude (1) the bronchodilator response obtained with use of the MDI alone, the AeroChamber and OptiHaler were not significantly different; (2) patients, as a group, found the MDI required less time to use and they favored it over either spacer; (3) while in subjects employing good MDI technique, the addition of either an AeroChamber or an OptiHaler did not improve bronchodilator response. Spacers may have a role in those with poor inhaler technique or in conjunction with inhaled corticosteroids.
“If you were stranded on a desert island, what pain medicine would you want to have with you”
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THROUGHOUT MY 9 YEARS OF ADDICTION THE FOLLOWING EVENTS HAD A SIGNIFICANT DETRIMENTAL EFFECT IN MY LIFE 1) 67,457 controlled substance pills ingested 9) Fired from 5 prominent scientist positions 2) 45 grand mal seizures 10) 19 prescription related arrests 3) 323 narcotic related hospital visits 11) 180 forged prescriptions 4) 9 in-patient rehabilitation programs 12) 2 suicide attempts 5) Homeless 3 different times 13) 167 bad checks for prescriptions/Dr. visits 6) 35 hospitalizations from drug overdoses 14) 1,434 medical visits to obtain narcotics 7) Total medical debt over 9 years = $310,650.00 8) Dropped out of my Ph.D. due to addiction issues