ASK DR. BAUGHAN
January 19, 2001
ASK DR. BAUGHAN
January 19, 2001
TRANSFORMING GOOD DRUGS TO BAD
My son used to play with toys that with twisting and turning a few parts would change from one thing into another, such as a car into a robot warrior. These were called, aptly enough, Transformers. Young people are doing the same with medications that may be legally available, but in combination with other things or by manipulating certain ways, may take on entirely different qualities. A segment on the Dateline television show reviewed how commonly Ritalin is being abused in this way. The most incredible part of the show to me was how many seemingly intelligent college students would say, “I thought it was a safe drug. People take it all the time. No one told me there were any risks.” I would like to do my bit to ensure that anyone who reads (or hears their parents read) this column, will never be able to say, “I didn’t know.”
One of the first lessons in medical school is, “All drugs are potentially toxic. You have to know the risks of anything you prescribe.” Ritalin has an excellent safety record as a pill for people with attention deficit disorder. It is carefully manufactured in pills to dissolve at a predictable rate in the stomach to be absorbed at a safe rate to give a desired therapeutic effect. If it is taken some other way, unpredictable and therefore unsafe results can happen. If it is crushed and snorted, it is rapidly absorbed through the lining of the nose into the circulation that goes directly to the brain. The brain level is much higher than intended, and the effect on the brain receptors much more assaultive. Sudden unexpected reactions such as psychotic reactions or dangerous heart rhythms or effects on breathing can happen. How likely is this? The people who developed Ritalin and similar medicines spent a lot of money, time and effort to answer that question for the proper use of it. Those who encourage the improper use of it don’t spend a dime trying to monitor the safety of it. The risks are not just with the medicinal ingredient of the pills. The other chemicals that give the pills the shape, color and consistency were tested to be safe in the digestive tract. When they are rapidly absorbed into the blood stream, all bets are off. Allergic reactions may be the least of the problems to mention. Finally, the sudden effect on the brain when snorted has very similar addictive properties as cocaine and crack.
Similar ignorance and misinformation may surround other legally available drugs. Certainly, alcohol is still the most commonly misused drug that causes acute toxic reactions. “It’s only beer,” is one of those myths. “You will vomit or pass out before you can hurt yourself.” That’s a lie. The rapid absorption of alcohol into the brain can cause disruption of the breathing center, seizures or other brain catastrophes before it causes sleep. Combining other non-prescription medicines with alcohol “to prolong the high” seems to be in fashion. How do these other medicines do this? They delay the breakdown of alcohol in the liver. So the liver must work longer and harder to break it down? Does this sound good for the liver? The alcohol has a longer time to have a toxic effect on the brain cells. Does this sound good for the brain? The alcohol may delay the breakdown of the companion drug, resulting in the same effect as an overdose of that drug.
Even taking granules out of a capsule can dramatically change how a drug works in the body. A dramatic effect is what the person is seeking, but they do not know the risks of an exciting high versus a tragic death or brain damage. Taking anti-depressant capsules apart can cause a set of symptoms called “serotonin syndrome,” which includes marked agitation, restlessness, hallucinations, nightmares, high blood pressure, nausea and vomiting.
Finally, in our “more is better” culture, non-prescription pain medicines can be very dangerous if misused. More than 4000mg of acetomenaphen (Tylenol) in a day may cause liver failure. More than 2400mg of ibuprofen a day may cause kidney damage. It is crucial to know the appropriate uses of drugs and take them the way they were designed. It is a shame with much of the world not having access to basic health care, we have to worry about misusing the blessings we have.