DRUG & POISON INFORMATION CENTER | |
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Ohio Poison Centers Website - Now Available!
We are happy to share that information on potential poison hazards is now available at your fingertips! Visit us online at www.ohiopoisoncenters.org for information on poison hazards, printable materials, educational resources, materials requests, live chat, and assistance with education and outreach in your community!
Remember – if you ever have a question or concern about a substance, product, or medication – experts at the Drug and Poison Information Center (DPIC) are available 24/7/365 at 1-800-222-1222 to provide you with free, confidential assistance. Your call will automatically be routed to your local poison center!
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National Poison Prevention Week (NPPW) Recap
National Poison Prevention Week (NPPW) 2024 took place March 17-23, 2024. NPPW occurs the third full week of March each year and is dedicated to raising awareness of poison safety and prevention and the toll-free national Poison Help line: 1-800-222-1222.
DPIC and CCHMC partnered to highlight NPPW by sharing a blog dedicated to safe medication disposal: Medication Disposal: What is the Safest Way to Get rid of Unused and Expired Medicine?
Dr. Shan Yin, DPIC Medical Director, shared some information on the CCHMC Young and Healthy Podcast about keeping kids safe with the new recreational marijuana laws in Ohio. You can visit the following link to download or listen to the podcast: Marijuana Edibles and Drug Disposal: How to Keep Kids Safe, which is also available at www.ohiopoisoncenters.org.
Don't wait - save the Poison Help line: 1-800-222-1222 in your contacts today! #NPPW24
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Getting the Facts on CBD: Questions & Answers on CBD products
Q: We see CBD being advertised all over the city, what exactly is CBD and what is it used for?
A: Cannabis plants contain many chemical compounds including flavonoids, terpenes, and cannabinoids (Goertemoeller, 2021). One such cannabinoid is cannabidiol abbreviated CBD. Tetrahydrocannabinol, abbreviated THC is psychoactive whereas pure CBD is not. CBD is available in consumer products including foods, oils, lotions, capsules, cosmetics, etc. with claims of treating a wide variety of health conditions. Epidiolex is currently the only federally approved CBD product. It is a prescription medicine that has been approved for treating seizures and is only available at a pharmacy with a valid prescription from a medical provider.
Q: Is CBD addictive?
A: Current research indicates that CBD is not addictive in its pure form; however, lack of federal regulations may lead to contamination of CBD with other compounds from the cannabis plant including the psychoactive THC, or other contaminants.
Q: What can happen to someone who doesn't have a "condition" that CBD is known to treat, but takes CBD anyway?
A: The use of CBD is not without risks. Hospitalizations related to adulteration (contamination) of CBD products with psychoactive ingredients or other illicit drugs have been reported. Many places that sell CBD also sell products containing THC, which can easily be mistaken or confused with CBD or hemp. Products that contain THC can cause psychoactive effects and/or adverse events. Because most CBD products are not regulated by the United States Food & Drug Administration (FDA), they can potentially contain other unwanted ingredients such as THC, other drugs, pesticides, or heavy metals (lead, arsenic, etc.). Manufacturers may not be able to guarantee that products will contain the same ingredients, or the amount of CBD be consistent among products. While CBD oil alone may be safe to use, if adulteration has occurred, then the safety of these products is questionable. The need for regulation and standardization is clear and until that regulation occurs, the risks of using these products outweigh the potential benefits.
Q: Are there any long-term effects of using CBD?
A: There has not been enough research to fully understand the long-term effects of CBD use, however potential side effects and risks can include liver damage, interaction with other medications, fatigue, nausea/diarrhea, irritability, changes in alertness, and may harm to the reproductive system (CDC, 2022, SAMHSA, 2023). It’s important to note that it is difficult to know the extent of potential adverse effects from products like CBD that are not regulated by the FDA and there is limited data on their safety and effectiveness. Factors that may influence adverse effects include the strength and purity of the product, the amount that is used, how it is used (i.e.: vaping can cause additional adverse effects) and if it is used with other drugs or medications.
Q: Are you concerned about teens who use or misuse CBD? Do you think the use of CBD leads teens to use marijuana?
A: Cannabis plants and their products are divided into two categories based on the amount of THC that they contain. Any plant that contains more than 0.3 percent delta-9 THC on a dry weight basis is considered marijuana, and less than 0.3 percent is considered hemp (SAMHSA, 2023). CBD is typically produced from hemp and does not cause a “high” or psychoactive effect. THC is typically produced from marijuana plants and causes a “high” or psychoactive effect that is often associated with cannabis misuse. Because the FDA does not regulate CBD, it could contain THC and therefore could have psychoactive properties.
In addition, there is some research that suggests young people may use CBD to attempt to self-treat a variety of medical conditions including pain and psychological concerns. There have also been some reports of an association between CBD use and illicit drug use (Fedorova, Wong, Ataiants, Iverson, Conn and Lankenau, 2021). It is not known if CBD use leads to use of other substances, however, people who try to self-treat medical and psychological conditions may experiment with multiple substances. Research has shown that delaying the start of any substance use among young people can decrease substance use for the rest of their lives (National Institute on Drug Abuse, 2023). It is best to avoid using any substance that is not regulated by the FDA and if serious medical or psychological concerns are present, to discuss appropriate treatment with a medical provider.
Q: What message would you give to high school students and their parents about CBD?
A: It is important to be aware of the misconceptions associated with CBD products and the potential risks of using CBD that could be contaminated with THC. These products are unregulated and risks and precautions for use are not included on the product label. It is important to talk with your health care provider if you are considering using CBD.
Remember – if you ever have a question or concern about CBD or any other substance, product, or medication – experts at the Drug and Poison Information Center are available 24/7/365 at 1-800-222-1222 to provide confidential assistance at no charge to you.
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References
Centers for Disease Control (CDC). (2022, August 8). CBD: What you need to know. Retrieved from https://www.cdc.gov/marijuana/featured-topics/CBD.html
Fedorova, E. V., Wong, C. F., Ataiants, J., Iverson, E., Conn, B. M., & Lankenau, S. E. (2021). Cannabidiol (CBD) and other drug use among young adults who use cannabis in Los Angeles. Drug and Alcohol Dependence, 221, Article 108648. DOI: https://doi.org/10.1016/j.drugalcdep.2021.108648
Goertemoeller, S. (2021, May 14). Weeding out the toxicity of marijuana edibles in pediatrics. Retrieved from https://scienceblog.cincinnatichildrens.org/weeding-out-the-toxicity-of-marijuana-edibles-in-pediatrics/
National Institute on Drug Abuse (NIDA). (2023). Reported drug use among adolescents continued to hold below pre-pandemic levels in 2023. Retrieved from https://nida.nih.gov/news-events/news-releases/2023/12/reported-drug-use-among-adolescents-continued-to-hold-below-pre-pandemic-levels-in-2023
Savage, S. (2023, January 17). Getting the facts on CBD’s (S2: E7) In Now, That’s Good Chemistry. Indian Hill High School. https://open.spotify.com/episode/5RD28IZGYZ27q6ceolNXfG
Substance Abuse and Mental Health Services Administration (SAMHSA). (2023, February). SAMHSA Advisory: Cannabidiol (CBD) – Potential harms, side effects, and unknowns. Retrieved from https://store.samhsa.gov/sites/default/files/pep22-06-04-003.pdf
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DEA ALERT: Nitazines: New Dangerous Synthetic Opioids | |
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A variety of agencies monitor the emergence of novel psychoactive substances (NPS) appearing on the illicit drug market in the United States through testing of drugs that are seized as well as through medical laboratory data from patients. The term “novel” does not mean the drug is new or never-before-seen, but rather a substance that is newly available in the drug market.
In 2019, nitazenes began emerging in the US illicit drug supply. While nitazenes have been found more recently in the US drug supply, they were first developed in the 1950s. But because of safety concerns, they were never approved for human or veterinary use. There are more than 20 different nitazene compounds. Substances within the nitazene class include butonitazene, etodesnitazine, flunitazene, isotonitazene (Iso), metonitazene, and N-pyrrolidino etonitazene (Pyro).
Nitazenes are available in powders, counterfeit tablets, or liquids and are often found mixed with other substances. Nitazenes are increasingly being recorded in toxicology reports and between 2019 and November 2022, approximately 2,400 cases of nitazene identification were reported to the National Forensic Laboratory Information System (NFLIS).
Nitazenes bind opioid receptors in the brain and body which results in euphoria that can lead to repeated use and addiction. Some nitazene compounds are more potent and last longer than some fentanyl derivatives, while others are less potent than fentanyl. Because nitazenes are not approved for use, there are many unknowns about how long they work and how long the effects last.
It is impossible to differentiate what ingredients are in an illicit drug just by looking at them and nitazenes in a drug is not detectable through drug detection methods such as fentanyl test strips. As a result, many of those who overdose do not know what is in the drug they’ve purchased and whether it contains ingredients like nitazenes.
A nitazene overdose looks like overdosing on other opioids (i.e. fentanyl). Nitazenes can cause coma and decreased breathing. The antidote naloxone may be given for nitazene overdose; however, it is unknown how well someone may respond to naloxone or how long the effects of the nitazenes will last in the body.
Given their potency, raising awareness about nitazenes, and implementing strategies to reduce harm through increased testing, surveillance, and referral to treatment for substance use disorders are of vital importance.
If someone takes a nitazene it is important to get immediate medical attention by calling 911. If the person is not breathing, bystander naloxone can be given if it’s available.
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References
Drug Enforcement Administration (DEA). (2024). Benzimidazole-opioids other name: Nitazenes. Retrieved from: Benzimidazole-Opioids (usdoj.gov)
Drug Enforcement Administration (DEA). (2022). New, dangerous synthetic opioid in D.C., emerging in tri-state area. Retrieved from: New, Dangerous Synthetic Opioid in D.C., Emerging in Tri-State Area (dea.gov)
Legislative Analysis and Public Policy Association (LAPPA). (2023). Novel psychoactive substances: Nitazenes. Retrieved from: Nitazenes Fact Sheet (legislativeanalysis.org)
US Department of Health and Human Services, Centers for Disease Control and Prevention. (2022). Nitazene related deaths Tennessee 2019-2021. Morbidity and Mortality Weekly Report: Notes from the field, 71(37).
US Department of Justice Drug Enforcement Administration Diversion Control Division. (2024). National Forensic Laboratory Information System (NFLIS). Retrieved from: Home: NFLIS (usdoj.gov)
WebPoisonControl. (2024). Nitazenes: The new fentanyl? Retrieved from: Nitazenes: The New Fentanyl? | Poison Control (webpoisoncontrol.org)
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Reference
U.S Food & Drug Administration (FDA). (2020, October 1). Disposal of unused medicines :What you should know. Retreived on 5.16.24 from https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know
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Medication Disposal: What is the Safest Way to Get Rid of Unused and Expired Medicine?
It’s the time of year when many people like to clean and organize their homes. This often involves throwing out unwanted items, including prescription medications. It is important to dispose of unused and expired medicines safely to help avoid accidental exposures and to prevent teen drug abuse.
Aim to go through your medicine cabinet regularly to clear out expired medications and those that are no longer needed. Here are some options for disposing of your drugs safely. Note that different medications may need different disposal procedures.
4 WAYS TO SAFELY DISPOSE OF UNUSED AND EXPIRED MEDICATIONS
1. DRUG TAKE BACK EVENTS
The United States Drug Enforcement Administration (DEA) hosts National Prescription Drug Take Back Days a couple of times a year. The next one will happen later this year. You can take medications that you no longer need — both prescription and over-the-counter — to these locations for proper disposal. Check the DEA Take Back Day website for more information.
2. DEA AUTHORIZED COLLECTION SITES
The DEA is now encouraging the public to make Every Day Take Back Day by using year-round collection sites to dispose of unneeded and unwanted medications. Visit their locator site to find a pharmacy, hospital, or business with a DEA-registered year-round collection near you. Many local police departments also provide year-round drug disposal boxes.
3. FDA FLUSH LIST
It’s best to avoid flushing any medication — whether it’s prescription or over-the-counter — unless it’s on the FDA flush list. Flushing medications down the toilet is only recommended for specific drugs that primarily include strong pain medications. These medications should not be placed in a trash can because there is a potential risk of serious harm if someone accidentally swallows them. Here is a list of medications on the FDA flush list.
4. HOUSEHOLD TRASH
If you do not have a drug take back option and you have medications that are not on the FDA flush list, you may dispose of the medications in the household trash. It is recommended to remove your unwanted medications from their original containers, mix them with an undesirable substance such as kitty litter or coffee grounds, and put them in a sealed plastic container or bag. Then put the mixture in the trash for pick up. Be sure to remove any personal identifying information before throwing away the empty prescription bottles.
Together, we can keep our homes and communities safer by disposing of unused medications properly. Please call the Drug and Poison Information Center at 1-800-222-1222 with any questions on safe medication disposal.
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Preventing Accidental Overdose: How to Safely Administer Medications to Kids
As many parents can probably attest, giving medications to kids can be challenging.
For some kids, the medication tastes yucky to them and they refuse to take it. From the parent perspective, giving the proper dose can be tricky, especially when it’s 2 a.m. and 0.5 mL looks like 5 mL (1 teaspoon) in the dark.
BE SURE TO MEASURE MEDICATIONS PROPERLY
Turning on the lights and taking a moment to accurately measure the proper amount of medication for your child in the appropriate dosage device could prevent a potential overdose. In one study, the American Academy of Pediatrics found that 41% of parents made a dosage error when administering medications to their children.
At the Drug and Poison Information Center, we receive many calls about drug overdose related to improper measuring every day. It typically happens when caregivers don’t read the directions before giving the dose, or when an improper dosing device is used. Sometimes parents leave the medicine within reach of the child after giving a dose and the child can get into it, or two different caregivers both give a dose within minutes of each other. Here are some medication safety tips to help prevent accidental drug overdose in kids.
TIPS TO SAFELY ADMINISTER MEDICINE TO CHILDREN
1. USE THE MEASURING DEVICE (I.E. SYRINGES AND CUPS) THAT CAME WITH THE MEDICATION.
Always keep the original box that the medication came in with the original measuring device provided. If the medication did not come with a measuring device, ask your pharmacist for one. Do not use household spoons, as they come in many different sizes and it is too easy to measure inaccurately.
2. RE-READ THE LABEL EACH TIME.
It’s important to re-read the label each time so that you dispense the medication as instructed. This may sound obvious, but in the middle of the night it can be tempting to go by memory to save time. Be sure to turn your lights on, too.
3. KNOW THE ACTIVE INGREDIENTS.
Many over-the-counter products contain multiple active ingredients. Do not give more than one medication with the same active ingredient.
4. BE AWARE OF THE TYPE OR FORMULATION OF MEDICINE.
There are many infant and children’s medications available on store shelves. Infant medications are generally more concentrated than children’s formulations. Double check to make sure you are giving the correct formulation for your child.
5. WRITE DOWN THE TIME YOU GAVE YOUR CHILD THEIR MEDICATION.
Life is busy, especially with a sick child or children. Writing down the time you gave the dose of medication will help keep you on track and avoid too much or too little medication being given.
Keep track of the doses with a marker directly on the bottle. Or try an app such as Pill Monitor, Dosecast and Pill Alert Pro.
6. DON’T ALLOW YOUR CHILD TO DRINK DIRECTLY FROM THE BOTTLE.
Even if it is an over-the-counter medication or a natural remedy, it is still important to measure accurately.
7. USE CAUTION WITH FLAVORED MEDICATIONS.
Some manufacturers offer a variety of tasty flavors of medication, including chocolate. While this may be helpful for those times when you want your child to take medication, children may be tempted to get into those medications on their own and an accidental overdose could occur.
8. DO NOT CALL MEDICINE “CANDY.”
It can be tempting to make the medicine sound appealing to your child, but at the same time, you don’t want them to be eager to take an extra dose when they’re not supposed to.
If your child needs to take a medication in pill form and they’re having a hard time, read this blog post for advice: Tips for Teaching Kids How to Swallow Pills.
9. KEEP ALL DRUGS OUT OF THE REACH OF CHILDREN, OR BETTER YET, LOCKED.
Parents are busy and it can be difficult to remember to give your child their medication when you have a lot of other things going on. I recommend setting an alarm on your phone, rather than leaving it on the counter in plain sight (or your child’s reach) so that you’ll remember it.
10. KNOW YOUR CHILD’S WEIGHT.
Pediatric medications are typically dosed based on your child’s weight. It is important for you to know exactly how much your child weighs, especially if you are figuring out the dose of an over-the-counter medication. If you are not sure how much your child weighs, be sure to put them on an accurate scale prior to giving them medication. Remember, the dosage may be different for each child, depending on their weight.
Save the Drug and Poison Information Center number 1-800-222-1222 in your cell phone for emergency situations. If you think you might have given your child an improper dose of a medication or even if you are confused about how to measure or give your child’s dose, give us a call. We are here 24 hours a day, 7 days a week, to answer your drug dosage questions.
See also: Video – How to Give your Child Liquid Medication
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© 2024 By the Cincinnati Drug & Poison Information Center (DPIC)
Editors: Alysha Behrman RN, MSN, CSPI, OCPC, ICPS; Sheila Goertemoeller PharmD, DABAT, OCPC, ICPS ; Julia Conroy; Jewel Sisk; Jonathan Colvin, RN, MS; Shan Yin, MD, MPH
The opinions expressed herein are those of the contributing authors and do not necessarily reflect the views of the editor, publisher or supporting institutions. DPIC is a service of the Cincinnati Children’s Hospital Medical Center and Children’s Hospital Research Foundation. Services are also supported by: the US Department of Health and Human Services (HRSA), the Ohio Department of Health, Hamilton County Mental Health and Recovery Services Board, and the Ohio Department of Alcohol and Drug Addiction Services (ODADAS). Additional support for DPIC services is provided by Cuyahoga Department of Health and Human Services and additional member hospitals.
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