Published online today in the journal Biological Psychiatry, researchers also found that those who drank a large amount of alcohol before a traumatic event did not report an increase in the number of flashbacks.

"Many people who experience a personally traumatic event such as rape or a road traffic accident have consumed alcohol beforehand. For the first time, this research gives us an idea of how being under the influence of alcohol might contribute to our wellbeing later on," said James Bisby, from UCL’s Department of Clinical, Educational & Health Psychology, who led the research.

Scientists believe that the findings can be attributed to how alcohol affects two types of memory: one that is egocentric, providing a visual ’snapshot’ of an event, and another that stores a mental representation of the context of the event, which is independent of the person’s viewpoint.

The authors of the study suggest that contextual memory is reduced in those who experience high levels of stress and this reduction may be exaggerated in those who have had a couple of glasses of wine (around three units). This allows egocentric memories to be involuntarily re-experienced—resulting in more flashbacks. In those that have drunk seven or more units of alcohol both types of memory are disrupted leading to fewer flashbacks and an overall reduction in memory for the event.

During the study, nearly 50 participants consumed either alcohol or a placebo drink and then performed a virtual reality task designed to examine how an experienced event is stored within memory. They were then shown a video of serious road traffic accidents and recorded the number of times they spontaneously re-experienced any of the footage, i.e. had a flashback, over the following 7 days.

"People who had been given a small amount of alcohol showed reductions in memory that relies on contextual aspects of an event, whereas memory based on an egocentric representation was intact. However, those individuals given a higher dose of alcohol showed a global reduction in memory with decreases in both types of memory," explained James Bisby.

Although the findings suggest that drinking a large amount of alcohol might result in less involuntary re-experiencing of the event due to an overall reduction in memory, the researchers are cautious in drawing this conclusion.

"When people have no memory of the traumatic event, as can happen if they consumed a large amount of alcohol beforehand, they are more likely to imagine a ‘worse case scenario.’ This alone can prove to be extremely distressing and debilitating for the individual involved. We are currently extending our findings to try and provide a clearer picture of alcohol’s ability to affect memory during trauma," explained Professor Valerie Curran, also from the UCL Department of Clinical, Educational & Health Psychology, and a co-author of the research.

The research was funded by the Economic and Social Research Council.

Reuters reports that the findings add weight to previous research which linked psychosis with the drug (particularly in its most potent form as "skunk") and will feed the debate about the level of controls over its use.

Despite laws against it, up to 190 million people around the world use cannabis, according to United Nations estimates, equating to about 4 percent of the adult population.

John McGrath of the Queensland Brain Institute in Australia studied more than 3,801 men and women born between 1981 and 1984 and followed up with them after 21 years to ask about their cannabis use and assess them for psychotic episodes. Around 18 percent reported using cannabis for three or fewer years, 16 percent for four to five years, and 14 percent for six or more years.

"Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis were twice as likely to develop a non-affective psychosis (such as schizophrenia)," McGrath wrote in a study published in the Archives of General Psychiatry journal.

They were also four times as likely to have high scores in clinical tests of delusion, he wrote, and a so-called "dose-response" relationship showed that the longer the duration since first cannabis use, the higher the risk of psychosis-related symptoms.

A study by British scientists last year suggested that people who smoke “skunk,” a potent form of cannabis, are almost seven times more likely to develop psychotic illnesses such as schizophrenia than those who smoke "hash" or cannabis resin.

Previous studies had also suggested smoking cannabis can double the risk of psychosis, but the British study was the first to look specifically at skunk. Skunk has higher amounts of the psychoactive ingredient THC which can produce psychotic symptoms such as hallucinations, delusions and paranoia.

McGrath said, however, that "the nature of the relationship between psychosis and cannabis use is by no means simple," and that more research was needed to examine the mechanisms at work.

As part of his study, McGrath and his team looked at links between cannabis use and psychotic symptoms among a group of 228 sibling pairs and found the association still held. This suggests that other influences like genes or the environment were less likely to be responsible for the psychosis, they said.

An international group of drug policy experts published a book earlier this year arguing that laws against cannabis have failed to cut its use but instead led to vast numbers of arrests for drug possession in countries like Britain, Switzerland, and the United States, which cause social division and pointless government expense.

Why the Appeal?

Clearly there’s a somewhat compelling reason why anyone would mix energy drinks with alcohol. So, what is it? Ask any semi-sober college student – or high school student, for that matter – and they’ll tell you it’s so they can drink longer and avoid nasty hangovers in the morning. But, as already stated, that doesn’t hold true.

One of the reasons why people get hangovers is dehydration. Alcohol causes dehydration. Caffeine, the principle ingredient in most energy drinks, is a diuretic, which further increases water loss. Mixing alcohol and energy drinks makes dehydration worse.

While drinking the combo, the individual experiences the feeling that he or she can, indeed, party all night long and sustain energy levels. The reality is that the hangover will just be worse in the morning.

What’s So Dangerous?

Okay, so you have a little hangover. No big deal, most would say. Hold on. It goes far beyond just a hangover.

High levels of caffeine can speed up heart rate and increase blood pressure. This can cause palpitations, according to the National Institute on Drug Abuse. When energy drinks are mixed with alcohol, it further increases the risk of problems with heart rhythm – a potentially fatal condition.

Other ingredients in energy drinks besides caffeine include one or more stimulants such as ginseng and taurine. It bears repeating that alcohol is a depressant. By mixing depressants and stimulants, you’re sending mixed signals to the body’s nervous system. All of this may lead to cardiac-related problems.

Alcohol also reduces reaction time and interferes with judgment. Caffeine creates a false sense of confidence and energy. Teens who drink alcohol and energy drinks together may think they’re capable of driving or performing other acts – which they cannot do safely.

There’s also the risk of a bad reaction when alcohol and energy drinks are used in combination. A person may have a pre-existing medical condition or have an allergic or adverse reaction to one (or more) of the stimulants in the energy drinks. Who reads labels when everyone says how great this or that energy drink is, anyway? The desire to go along with the crowd and get high and party often takes precedence over such due diligence.

It shouldn’t. Beyond issues of underage drinking, binge drinking, and what’s right and wrong, counselors who interact with college students caution that they only take one – not both – types of beverage. If they are of legal drinking age, only consume one or the other. Or, alternate them so as to minimize the damage of combining the substances.

Why would they recommend this? Why not say you shouldn’t drink either one, but especially not together? The simple fact is that the message to curb usage of the potentially deadly combo is more likely to register than a flat-out plea to stop it altogether.

Warnings about Energy Drinks

In October 2008, the National Federation of High School Federations (NFHS) Sports Medicine Advisory Committee (SMAC) issued an alert regarding athletes’ use of energy drinks. Their position included recommendations that:

1. Water and appropriate sports drinks should be used for rehydration as outlined in the NFHS document “Position Statement and Recommendations for Hydration to Minimize the Risk for Dehydration and Heat Illness.”

2. Energy drinks should not be used for hydration.

3. Information about the absence of benefit and the presence of potential risks associated with energy drinks should be widely shared among all individuals who interact with young athletes.

4. Energy drinks should not be consumed by athletes who are dehydrated.

5. Energy drinks should not be consumed without prior medical approval, by athletes taking over the counter or prescription medications.

Popular Energy Drinks

Where there’s a target market, you can bet companies will seek to capitalize on it. In the case of energy drinks, there’s no shortage of candidate beverages to entice the party-hearty crowd. A report by the Marin Institute, based in Marin, California found that 500 new energy drinks were introduced worldwide in 2007. According to EnergyFiend, the top 15 energy drinks and percent of market share in 2008 included:

• Red Bull – 40%
• Monster – 23%
• Rockstar – 12.3%
• AMP – 8%
• Full Throttle – 4%
• Doubleshot – 2%
• NOS – 1.5%
• No Fear – 1.4%
• Private Label – 1%
• SOBE Adrenaline – 0.7%
• Vitamin Energy – 0.5%
• SOBE Lean – 0.5%
• Venom – 0.44%
• Jolt – 0.4%
• Go Girl – 0.4%

Here is more detailed information a few of the major players, along with their list of contents, health risks and some other useful facts.

Red Bull

Hugely popular, Red Bull captivated the college crowd early and often with clever marketing campaigns and free samples at events ranging from extreme sports such as windsurfing, skateboarding, cliff diving, freestyle motocross and snowboarding, to break dancing, art shows, music, beach volleyball and spring breaks. Its marketing slogan is “Red Bull gives you wiings.” The product is aggressively marketed through advertising, sports team ownerships, tournament sponsorship (Red Bull Air Race), and celebrity endorsements. As a result, the energy drink, by manufacturer Red Bull GmbH, of Austria, has the largest market share of all energy drinks, and is touted as the most popular energy drink in the world. Red Bull was originally an energy drink from Thailand. In fact, its name Krating Daeng, literally translated, means Red Bull.

The energy drink entered its first foreign market, Hungary, in 1992 and later was introduced to the United States in 1997. Ingredients include B vitamins, caffeine, glucose and sucrose, glucuronolactone and taurine. In 2009, a small amount of cocaine was discovered in Red Bull imported from Austria and sold in Taiwan, prompting a recall of those products in several states. Subsequently, six German states banned Red Bull and considered banning it nationwide. After testing various versions of Red Bull it was determined that a person with a low tolerance for cocaine would have to drink an impossible two million cans in a single setting in order to become critically ill.

Health effects include commonly reported adverse reactions to caffeine, including insomnia, nervousness, headache, and tachycardia (a faster than normal heart rate).

Monster – Introduced by Hansen Natural Corporation of Corona, California in 2002 and marketed as Monster Energy, the energy drink is not widely advertised but relies instead on the recognition it gets from its sports event sponsorships. Coca-Cola took over distribution of Monster Energy in 2008 and expansion into other worldwide markets is planned or underway.

The amount of caffeine in Monster Energy is 10 mg per ounce, or 160 mg per 16-oz. can. Packaging does carry a warning to consumers to not consume more than three 16-oz. cans per day, and that it is not recommended for pregnant women, children under 10, and those who are sensitive to caffeine. Among the other ingredients are taurine, panax ginseng root extract, glucuronolactone, and guarana seed extract.

While Monster Energy is the original, there are other flavors, including Monster Low Carb, Assault, Khaos, M-80, MIXXD, Import, Heavy Metal and DUB Edition. A new brand, recently introduced, is Nitrous Monster, containing carbonated and nitrogenated water, available as Nitrous Monster Anti-Gravity, Super Dry and Killer-B. Other products include 3-oz. energy shots called Monster Hitman Energy Shooters, available as Monster Hitman, Hitman Lobo and Hitman Sniper. Not to neglect the coffee and tea market, there are also Java Monster Chai hai, Lo-Ball 15, Irish Blend, Russian 15, Nut Up 15, Originale, Loca Moca, Lean Mean, and Big Black. X-Presso Monster Hammer, a coffee brand containing nitrogenated water, is the most recent entry.
Rockstar – Created in 2001 and manufactured by Rockstar, Inc. in Las Vegas, Nevada, Rockstar energy drink is available in 14 different flavors in more than 20 countries, including the United States. Seeking to differentiate itself from competitor, and market leader, Red Bull, Rockstar comes in standard 16-oz. cans – twice the size of the 8-oz. Red Bull. In fact, Rockstar’s marketing campaigns includes the phrase, “twice the size of Red Bull for the same price.”

Rockstar Energy Drink flavors include Original, Sugar Free, Zero Carb, Juiced Guava, Juiced Pomegranate, Punched Tropical, Punched Citrus Acai Berry, Roasted Mocha, Roasted Latte, and Roasted Vanilla Light. Newest flavors include Rockstar Energy Cola, Rockstar Recovery lemonade flavor, and Rockstar Roasted Espresso (now only available in an 8-oz. can). Rockstar Energy Shots come in two flavors. Rockstar energy GUM was introduced in 2010. Available in two flavors, iced mint and iced mint orange, the pack of 10 pieces contains as much caffeine as an 8-oz. can of the Rockstar Energy Drink.

Rockstar Energy Shots contain 200 mg of caffeine in a 2.5-oz. can, compared to the 150 mg in Rockstar Energy Drink in the original 16-oz. can. Besides caffeine (and sugar), other Rockstar Energy Drink ingredients include the herbs panax ginseng, gingko biloba, milk thistle extract, and guarana seed. After health concerns about guarana, the amount in the product was reduced. Rockstar Energy Drink also contains 1000 mg of taurine. The product fluoresces when exposed to ultra-violet light.
Health effects and complications include anxiety, jitteriness, and high blood sugar levels. Mixing Rockstar Energy Drinks with alcohol can lead to heart failure as well as hide the level of alcohol intoxication. It also makes dehydration worse. Although alcohol was originally included as an ingredient in one version, and still is in products sold in Canada, it was discontinued in all U.S. products in 2007. This was perhaps in response to criticism that young people were confusing it with the non-alcoholic regular version.

Rockstar, true to its name, sponsors a variety of musical events. These include the Mayhem Festival, a metal and rock festival that tours the U.S. in July and August each year, the Alternative Press Tour (tours U.S. and Canada annually), and the hardcore tour called Winter Warped Tour (originally known as Taste of Chaos).
Energy Drinks Containing Alcohol

Several energy drinks contain alcohol. Basically, they’re alcoholic energy drinks.

Tilt – Anheuser-Busch markets Tilt as a premium malt beverage. An energy drink containing alcohol, its other active ingredients originally included guarana, ginseng and caffeine. Alcoholic content by volume varies by flavor, with 6.6 percent alcohol in the berry version and 8.0 percent in the lemon-lime flavor. That’s higher than most American beers (ranging from 3 to 6 percent), and higher than competitor Sparks (7 percent maximum). Tilt’s formula was recently changed to eliminate taurine and guarana. In December 2008, Anheuser-Busch agreed to stop selling caffeinated alcoholic drinks.

Sparks – Originally created by San Francisco-based beverage marketing firm McKenzie-River Corporation, Sparks was purchased by Miller Brewing Company and is manufactured under the label of Steel Brewing Company of Milwaukee, Wisconsin. Sparks is a malt beverage energy drink. It contains caffeine, taurine, ginseng and guarana – all typical of energy drinks, with the exception of the alcoholic content. Sparks is 12 proof, and there are several types. Sold in 16 oz. silver cans with bright orange tops, the design features a “+” near the top of the can and a “-“ near the bottom. This gives the can the appearance of a battery. (Get it? Battery equals energy.) Packaging states 6 percent alcoholic content by volume.

Some say the flavor is similar to other popular energy drinks such as Red Bull, Rockstar and Monster Energy – sugary and tart. There’s also Sparks Light, a sugar-free version with a bright blue top, and higher alcoholic content Sparks Plus (7 percent alcohol, black top), and Sparks Red (8 percent alcohol, red top). The latter two are available in both 16 oz. and 24 oz. cans.
Sparks was introduced by word of mouth, since large quantities of the beverage were simply given away. It was very popular initially with the gay hipster crowd in San Francisco. Temporary discoloration of the teeth and mouth after consuming the drinks, known as “Sparks Mouth,” is due to the yellow food coloring used in the beverage. In December 2008, following the request of San Francisco and 13 states, distributor Miller Coors LLC agreed to take out the caffeine in Sparks drinks and to change its marketing campaign.

Alcohol and Energy Drink Combos

Drinking sites tout combinations of energy drinks and alcohol such as Red Bull and Tuaca, a 70 proof Italian liqueur. The combo is known as a “Tuaca Blaster.”

Other popular combos include the old standby, vodka, mixing Red Bull and vodka, as well as “Rockstar 21,” a combo of Rockstar and vodka, or the alternative, Rockstar plus pomegranate juice and vodka.

Basically, any type of generally flavorless alcohol mixed with energy drinks is latched onto by those seeking to get the rush and sustain energy. The variations are limitless, and someone is always coming up with the latest twist on the old favorites.

Just Say No to Combos

Bottom line, mixing energy drinks with other alcoholic beverages should send up a red flag reading, “Warning: do not consume.” Why mess with your body and mind and create more problems than you need?

It’s better to stick with non-alcoholic energy drinks – in moderation – if that is your thing. You can indulge in a single can of one of the more popular energy drinks to be like the rest of the crowd. Just don’t mix with beer, wine or spirits in an effort to keep up. Don’t become a statistic or part of a headline in the local news. Mixing energy drinks and alcohol is dangerous and may land you in more trouble than you bargained for.

CNN.com reports that a criminal complaint filed earlier Monday alleged that Murray "did unlawfully, and without malice, kill Michael Joseph Jackson."

Murray turned himself in shortly before 4 p.m. at a branch courthouse near Los Angeles International Airport.

Members of Jackson’s family, including his parents, Joe and Katherine and three of his brothers, had already arrived at the courthouse when Murray turned himself in.Asked for his reaction to the charge, brother Jermaine Jackson said, "Not enough."

The involuntary manslaughter charge means that Murray caused Jackson’s death by acting "without due caution and circumspection." If convicted, Murray would face a maximum four-year prison sentence, according to prosecutors. Deputy District Attorney David Walgren will lead the prosecution.

Murray traveled to Los Angeles at the end of January from his home in Houston, Texas, in expectation of possible charges, his lawyer said. He used part of his time last week to visit the pop star’s resting place in the Forest Lawn Memorial Park in Glendale, California.

Murray, a cardiologist, was hired as Jackson’s personal physician last spring as the singer prepared for comeback concerts in London, England.

The doctor told Los Angeles police that he was with Jackson at his $100,000-a-month rented Holmby Hills mansion through the early morning hours of June 25, 2009, in an effort to help the pop star fall asleep, according to a police affidavit.

He administered sleep aids, and after Jackson finally began sleeping in the late morning hours, Murray said, he left the bedroom for "about two minutes maximum," the affidavit says. "Upon his return, Murray noticed that Jackson was no longer breathing," it says.

The doctor stayed with Jackson as an ambulance rushed him to UCLA Medical Center.
Efforts at CPR proved fruitless, and Jackson was pronounced dead at 2:26 p.m.
The Los Angeles County coroner ruled Jackson’s death a homicide, resulting from a combination of drugs, primarily propofol and lorazepam.

The coroner’s statement said Jackson died from "acute propofol intoxication," but there were "other conditions contributing to death: benzodiazepine effect." Lorazepam and two other drugs Murray said he used are benzodiazepines.

The doctor told investigators he had given Jackson three anti-anxiety drugs to help him sleep in the hours before he stopped breathing, a police affidavit said.
Murray had been treating Jackson for insomnia for six weeks at the time of the singer’s death. The doctor told investigators he gave Jackson 50 milligrams of propofol, the generic name for Diprivan, diluted with the anesthetic lidocaine every night via an intravenous drip.

The doctor told police he was worried that Jackson was becoming addicted to the drug and tried to wean him off it.

During the two nights before Jackson’s death, Murray said, he put together combinations of other drugs that succeeded in helping Jackson sleep.

Lead author on this paper is Professor Fabrizio Schifano at the University’s School of Pharmacy. Schifano and his colleagues reviewed stimulant-related deaths from the np-SAD database and from the British Crime Survey 2001-2007 results. In this review, the researchers found 832 amphetamine and methylamphetamine-related deaths and 605 ecstasy-related deaths.

The element of higher concern identified the fact that the fatalities from ecstasy during that period

were typically identified in victims who appeared to be young and healthy.

The report findings included an 11-year, UK-wide analysis of mortality from these drugs. The deaths reported seemed to have dropped in 2000, only to peak again over the years since that time. Another drop occurred in 2003, only to once again increase consistently over time.

Commenting on the findings, Professor Schifano said: “These data seem to support the hypothesis that young individuals seem to suffer extreme consequences after excessive intake of ecstasy. This is an issue of public health concern which deserves further studies.”

It is unclear as to what is driving additional use of ecstasy and the overuse of the drug. Other industry studies have examined the use and its causes, but in this particular study, researchers only identified trends.

It does also highlight an area of concern for the young and healthy. It is likely that education and prevention measures have missed the boat on dangers associated with these drugs and proper measures must be taken to reverse the trend.

The BBC reports that cocaine swab kits have previously been used at venues in the town to detect if patrons have been using drugs.

Strathclyde Police will be issuing the torches to club and pub stewards and some of its officers as part of Renfrewshire’s festive safety campaign, which is run with the local council and businesses.

Sgt. Greg Dinnie, who is a violence reduction coordinator with the force, said: "Over the past couple of years the police have introduced a new tactic of using specially-designed swabs to detect the presence of cocaine within licensed premises. This has frequently identified suspected illegal drug abuse within toilet and wash room areas.”

"The introduction of a number of cocaine torches will provide licensed stewards, operating at the busier entertainment establishments, and police officers, with the ability to identify persons entering these premises who have been recently abusing controlled drugs,” he continued.

Sgt Dinnie said the torches were "intended as a non-intrusive preventative tool".

If anyone tests positive, officers will have the power to search them. Stewards will also be able to refuse entry.

The Food and Drug Administration (FDA) is the governmental agency in the United States that decides whether a medicine is safe enough to be sold over the counter. The FDA has a handy checklist that’s downloadable for choosing OTC medications for adults. But taking OTC medications, warns the FDA, still has risks.

According to Harmful Interactions: Mixing Alcohol with Medicines, a publication from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), “some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased over the counter.”

The NIAAA publication cautions that medicines, including popular remedies for cough, colds and allergies, may have many ingredients that interact with alcohol. Some OTC medicines for coughs contain up to 10 percent alcohol. Women are more susceptible to alcohol-related liver damage than men. Older individuals are at greater risk than younger ones for medication-alcohol interactions. In addition, millions of older Americans take more than one such medication at the same time.

Most Dangerous Drug/OTC Drug Interactions

Think of what’s currently in your medicine cabinet. If your household is like most families, you’ve probably got a mixture of prescription and nonprescription drugs. Some of these could prove fatal when used in combination, or in the wrong dosages.
Never combine blood thinners, such as warfarin (Coumadin), with aspirin. This may lead to excessive bleeding. If you take certain antacids, they may interfere with the ability of heart medicines, antibiotics and blood thinners to be absorbed into the blood. The result may be that the drugs either don’t work at all or are less effective. Cold remedies often contain decongestants, which may cause harmful increases in blood pressure with people taking MAO-inhibitors (a type of antidepressant) or medications for hypertension.

Food Interactions with OTC Drugs

Many medications, OTC and prescription, are intended to be taken with food or beverages (such as water or juice). But this is not always the case, and there are also instances where food or beverages negatively interact with the OTC medication.
The American Pharmacists Association (formerly known as the American Pharmaceutical Association) cautions that calcium-rich dairy products (including milk, cheese, and ice cream), vitamins containing iron, and antacids can lessen the effectiveness of antibiotics. This is particularly true with tetracycline. If you mix the foods mentioned with an antibiotic, it can cause a much slower rate of absorption into the body, and decrease the effect of the antibiotic.

Grapefruit juice is another example. Since it blocks enzymes that metabolize certain drugs, grapefruit juice should never be taken with medications to lower blood pressure, or with terfenadine, an antihistamine, or cyclosporine, a drug used to prevent transplant rejection.

Dangers of Common OTC Drugs

Millions of Americans take daily doses of acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve) or aspirin to relieve aches and pains, stiffness in muscles and joints, fevers and inflammation. Because they do not require prescriptions, and are touted by “experts” and advertisements as safe and effective, these OTC drugs are considered okay to use. Many Americans believe they can take them indefinitely, and they don’t even consider the potential negative side effects.
While OTC drugs are safe when taken only as directed, they are only meant to be taken for a short duration. Any symptom or condition that persists for longer than 10 days requires medical attention. Stop taking the OTC medication and see your doctor.

Let’s take several of these OTC drugs and look at the warnings and potential side effects listed on the labels.

• Aleve – This naproxen NSAID pain reliever is for temporary relief of minor aches, pains and temporary reduction of fever. Several warnings are listed on the packaging and container labels including:

o Allergy alert – Naproxen sodium may cause a severe allergic reaction, especially in people allergic to aspirin. Symptoms may include asthma (wheezing), blisters, facial swelling, hives, rash, shock, or skin reddening. If an allergic reaction occurs, stop use and seek medical help right away.

o Stomach bleeding – Naproxen sodium may cause stomach bleeding. Do not use if you have ever had an allergic reaction to any other pain reliever/fever reducer or right before or after heart surgery. Ask a doctor or pharmacist before use if you are taking any other drug. Stop use and ask a doctor if you have any signs of stomach bleeding (faintness, vomiting blood, or bloody/black stools), or if pain or fever gets worse.

o If pregnant or breast-feeding – Ask a health professional before use.

o Keep out of reach of children.

o In case of overdose – Get medical help or contact a Poison Control Center right away.

• Aspirin-Free Excedrin PM – This OTC contains acetaminophen and diphenhydramine citrate. Uses include temporary relief of occasional headaches and minor aches and pains with accompanying sleeplessness. Warnings include:

o Do not take this product, unless directed by a doctor, if you have a breathing problem such as emphysema or chronic bronchitis, or if you have glaucoma or difficulty in urination due to enlargement of the prostate gland.

o Avoid alcoholic beverages while taking this product.

o Do not take this product if you are taking sedatives or tranquilizers, without first consulting your doctor.

• Low-Dose Bayer 81 Aspirin – This low-dose (81 milligram) pain reliever for temporary relief of minor aches and pains carries numerous warnings on the packaging and label.

o Because of its delayed action, this product will not provide fast relief of headaches or other symptoms needing immediate relief.

o Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen.

o Reye’s syndrome – Children and teenagers should not use this medicine for chicken pox or flu symptoms before a doctor is consulted about Reye’s syndrome, a rare but serious illness reported to be associated with aspirin.

o Allergy alert – Aspirin may cause a severe allergic reaction which may include hives, asthma (wheezing), facial swelling, or shock.

o Alcohol warning – If you consume three or more alcoholic drinks every day, ask your doctor whether you should take aspirin or other pain relievers/fever reducers. Aspirin may cause stomach bleeding.

o Do not use if you are allergic to aspirin or any other pain reliever/fever reducer.

o Ask your doctor before use if you have stomach problems (such as heartburn, stomach pain, or stomach upset) that last or come back, asthma, bleeding problems, or ulcers.

o Ask a doctor or pharmacist before use if you are taking a prescription drug for anticoagulation (blood thinning), arthritis, diabetes, or gout.

o Stop use and ask a doctor:

- If an allergic reaction occurs – seek medical help right away
- Pain gets worse or lasts longer than 10 days
- Redness or swelling is present
- New symptoms occur
- Ringing in the ears or loss of hearing occurs

o If pregnant or breast-feeding, ask a health professional before use. It is especially important not to use aspirin during the last three months of pregnancy unless definitely directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery.

o Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

Tips on Correct Use of OTC Drugs

Of course, there are times when OTC drugs are safe and effective to use. But do keep in mind the following tips:

• Read labels – Thoroughly read the labels and all information, including warnings and side-effects.

• Risks/benefits – Understand the potential risks as well as the benefits of taking the OTC drug.

• Dosage directions – Pay attention to how much and how often to take the OTC medication. Do not use more than directed.

• Restrict access – Keep all medications, prescription and OTC, out of reach of children.

• Limit use – Do not use OTC medicines for longer than 10 days. They are meant for only short-term use.

• Don’t get lazy – Just because you’ve used the OTC drug in the past with no adverse reactions, don’t think that this will always be the case. Similarly, if you don’t see immediate results, don’t think that more is better. Overdose and potentially harmful side effects may result.

• If symptoms worsen – Consult your doctor if symptoms persist or get worse.

• Talk with your doctor – Before taking any new medications, prescription and/or OTC drugs, talk with your doctor. Ask if it’s safe to take this new medication, alone or with other prescription or OTC drugs, as well as herbal products or vitamins.

• Keep a drug list – Maintain a current listing of all drugs (prescription and OTC), vitamins, herbal products you take and provide it to your doctor.

• Use a single pharmacy – To avoid potential drug interactions and other problems, use a single pharmacy for all your prescription and OTC medications.

• Never give or take medicines in the dark – Turn on the lights so that you can see what you are taking or administering. Also, never give medication to a child who is not fully awake.

• Don’t use household utensils to dispense medicine – Household spoons or utensils are not accurate enough to dispense OTC medications. Ask your doctor or pharmacist about the correct dispensing mechanism. This may be an oral syringe or medication dosing spoon.
• Check for signs of tampering – Make sure the safety seal is intact on any OTC medicines. Do not use the product if there appear to be any signs of tampering.

• Be on the lookout for duplicate ingredients – Make sure to double-check all ingredients of any other medications taken at the same time as the OTC medicine to avoid duplicate ingredients.

• Discard expired OTC drugs – Never keep OTC medications (or any prescription medicines) past their expiration date. Discard them, but do not flush them. Contact your local pharmacy, recycling coordinator, or municipality to see if there’s a hazardous waste collection center near you.

When In Doubt

It’s always better to err on the side of caution. When in doubt, ask your doctor or pharmacist about any potential drug interactions, the advisability of taking OTC and/or prescription drugs, how long to take and what other remedies may be available.

Keep phone numbers handy for use in medical emergencies, including your doctor, hospital, Poison Control Center, and emergency medical personnel.

Remember, just because it’s available at the drug or grocery store counter doesn’t mean that an OTC drug is safe to take in all circumstances. Use caution, thoroughly read all labels, and take only according to directions and dosing instructions. Do not mix alcohol and OTC or other prescription drugs. Watch out for any drug interactions. And stop taking and seek medical attention if symptoms get worse or last longer than 10 days.

The best advice is to think twice before taking any OTC medication. If you don’t really need it, or your doctor doesn’t advise it, don’t take it. Your health may be at stake.

For further information and links to other resources on OTC medicines, visit Medline Plus.

"This is new and important information," said K. Michael Gibson, professor and chair of biological sciences at Michigan Technological University and a member of the research team. "It may provide new clues on how to counteract the drug’s effects, or to enhance its metabolism and decrease toxicity for chronic abusers or victims of sexual assault."

Gibson co-wrote the paper with Guo-Fang Zhang and others in the laboratory of Prof. Henri Brunengraber from the Department of Nutrition at Case Western Reserve University School of Medicine. The study was published online by the Journal of Biological Chemistry, and their findings will appear in the print edition on Nov. 27, 2009.

4-HB is a derivative of a major brain neurotransmitter in humans and other species. It occurs naturally in small amounts in the brains of most animals and humans. In a rare genetic metabolic disorder, 4-HB accumulates in extremely high levels, causing significant developmental delays and seizures.

But 4-HB is best known and most feared when it is taken orally, because it impairs the capacity to exercise judgment, like rohypnol and ketamine hydrochloride. For that reason, it can be used as a date-rape drug.

Analyzing the chemicals produced by the breakdown of 4-HB in mice and rats, Zhang, Gibson, and colleagues used very sophisticated mass spectrometry approaches to identify previously unknown enzymes and pathways that appear to act on 4-HB and other similarly structured compounds. They discovered that 4-HB is metabolized by two different chemical mechanisms or pathways. Their discovery of those pathways should open the door for future studies that can identify the enzymes involved in the following steps of the breakdown of 4-HB.

"This work may help to develop new antidotes and treatments for people who have ingested 4-HB, as well as treatment for children with the rare genetic disorder that causes the compound to accumulate in high levels," Gibson said.

Other research has supported the idea that there is actually at times a reverse gateway effect, in which social or individual circumstances are the factors responsible for initiating illicit drug use (Lessem et al., 2006).

A study by Tarter, Vanyukov, Kirisci, Reynolds and Clark published in 2006 reviewed the gateway hypothesis and studied whether it exposed a pattern for the transition from licit to illicit drugs.

The study used 224 male participants aged between 10 and 12 years of age, and assessed them at the ages of 12 to 14, 16, 19 and at age 22. Each participant was the son of men who were participating in another study, which included subjects who had a history of illicit drug use.

During each administration of the questioning, researchers used the Structural Clinical Interview for DSM-III-R to assess whether the participants met criteria for substance abuse disorders. The participants also self-administered the Drug Use Screening Inventory and took drug tests (both urine tests and alcohol breath tests) to obtain evidence of recent activity. In addition to these drug-use related screenings, the researchers also questioned the participants about social, family, psychological and educational characteristics and measured them using 35 variables.

The participants were grouped according to three different sequences of drug and alcohol use. The first group was comprised of participants who used alcohol and/or tobacco at the baseline, but had not moved on to using marijuana by age 22. The second group used alcohol and/or tobacco and then used marijuana by the age of 22. The third group used marijuana and then later used alcohol and/or tobacco by the age of 22.

The researchers found that the participants did not necessarily follow the pattern proposed by the gateway hypothesis. Participants whose behavior supported the gateway hypothesis were also associated with other social and family circumstances such as deviant behavior, a deviant social network, were less involved at school, and more likely to discontinue substance abuse than their counterparts who used only licit drugs up to age 22.

The study has limitations, including that much of the information was obtained using self-report, which is subject to bias. Some participants may exaggerate use to dramatize their situation and others will under-report use because of fear of legal sanctions.

The study is helpful, however, in looking at the gateway hypothesis more clearly. The gateway hypothesis is not applicable in all circumstances, nor are drug behaviors consistent across users of a specific drug. This study suggests that instead the patterns of drug use are influenced by a group of general social risk factors, such as parental influence and involvement in school.
 

Science Daily reports that the findings were presented at Neuroscience 2009, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news about brain science and health.

"Our finding suggests a promising therapeutic strategy for cocaine addiction, for which there is no approved treatment," said lead author Khaled Moussawi of the Medical University of South Carolina in Charleston.

Cocaine is a highly addictive drug characterized by frequent cravings for the drug, which lead to relapses. Recent advances in brain imaging are helping scientists uncover what happens in the brain when an addicted person is exposed to the drug-associated "cues" that trigger craving and lead to relapse. They’ve found that repeated exposure to psychoactive drugs such as cocaine causes an imbalance in the brain circuits regulating reward and cognitive control.

One of these circuits is a pathway involving the neurotransmitter glutamate. In the current study, Moussawi and his colleagues found that NAC restored normal functioning to this circuit in rats that had been previously addicted to cocaine. In addition, after receiving NAC, the previously cocaine-addicted rats did not reengage in drug-seeking behavior, even in the presence of drug-associated cues.

"Clinical trials involving people addicted to cocaine and nicotine have already suggested that N-acetylcysteine may be useful in decreasing cravings for those drugs," said Moussawi. "Our research adds support to that suggestion." A phase III clinical trial using NAC to treat cocaine addiction is currently underway.

Research was supported by the National Institute of Drug Abuse.