drug abuse

Can I drink beer while on medication?

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OSU football is in full swing, and this may mean an increase in alcohol consumption during the months to come. There are many drugs that interact with alcohol to some extent. These interactions can either metabolize medications and decrease the medications effectiveness, or can have the opposite additive effect and increase the risk of toxicity.

Here is a limited chart of studied alcohol-drug interactions and the risk/warnings of combining the two, be sure to ask your pharmacist about any drug-drug interactions before taking your medication:

Common OTC/Prescribed Medications Clinical Effects Recommendations
Pain Medications:
Acetaminophen (can be found in multiple OTC/prescribed drugs) Acute alcohol use in large amounts can increase risk of liver toxicity Do not consume >3 alcoholic drinks/day while taking this medication
Aspirin (Excedrin), ibuprofen (Motrin) and naproxen (Aleve) Increased risk of gastrointestinal bleeding Do not consume >3 alcoholic drinks/day while taking this medication
Codeine, hydrocodone + acetaminophen (Norco, Lortab, Lorcet, Vicodin), oxycodone + acetaminophen (Percocet, Endocet) and tramadol (Ultram) Co-ingestion may lead to respiratory failure, increased dizziness, sedation and can potentially be fatal Avoid alcohol consumption while on these medications
Antidepressants/Seizure medications:
Amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil); and bupropion (Wellbutrin/Zyban); phenytoin, perampanel (Fycompa) Increased risk of sedation, dizziness, fainting; may also increase risk of seizures; may cause psychiatric effects Minimize or avoid alcohol use, speak to your doctor/pharmacist about alternatives
Diabetic medications:
Glyburide (Diabeta), metformin (Glucophage) and insulin therapies May cause vomiting, nausea, headache, muscle or stomach pain and visual disturbance. Unpredictable effects while on insulin may occur Avoid heavy alcohol consumption (>3 drinks/day)
Antihistamines:
Diphenhydramine (Benadryl, ZZZquil) and doxylamine (Sleep Aids) Increased risk of sedation and dizziness Advise against alcohol consumption, speak to your doctor/pharmacist about alternatives
Antihypertensives:
Amlodipine (Norvasc), nicardipine (Cardene), nifedipine (Procardia), atenolol (Tenormin), and metoprolol (Lopressor, Toprol XL) Increased risk of dizziness and fainting

 

 Advise against heavy alcohol consumption (>3 drinks/day)
Antimicrobials:
Doxycycline (Vibramycin), ketoconazole, metronidazole (Flagyl), and isoniazid May decrease effectiveness of medication, as well as increase risk of vomiting, nausea, stomach pain. Isoniazid and alcohol may cause liver damage Advise to avoid alcohol on all antimicrobial agents ask your pharmacist about interactions with your medications

 

Next time someone hands you an alcoholic drink and you are taking medication, ask yourself… is it worth the risk?

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Alcohol and Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. December 2015.

Medical Marijuana

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Cannabis is also called marijuana. Its psychoactive properties are primarily due to one cannabinoid: delta-9-tetrahydrocannabinol (THC) and THC concentration is commonly used as a measure of cannabis potency.

The legal status of cannabis use, for medical as well as recreational purposes, varies internationally as well as across the United States. In Ohio, House Bill 523, effective on September 8, 2016, legalizes medical marijuana. However the program will not be fully operational until September 8, 2018. The Ohio Medical Marijuana Control Program will allow people with certain medical conditions, to purchase and use medical marijuana. This is after the recommendation of an Ohio-licensed physician certified by the State Medical Board.

Patients will require an identification card. The only valid state ID cards will be issued by the State of Ohio Board of Pharmacy once the state’s patient registry becomes available no later than September 2018. Please note that no patient identification cards are being issued by the state of Ohio’s Medical Marijuana Control Program (MMCP) at this time.

Certified physicians may recommend medical marijuana only for the treatment of a qualifying medical condition. Under Ohio law, all of the following are qualifying medical conditions: AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.

Patients taking cannabis for medical treatment should consider:

  • Prior experience with cannabis – Patients with no prior experience with cannabis are more likely to experience the psychoactive effects as dysphoric rather than pleasurable. Patients who are regular cannabis users are more likely to be tolerant to some of the adverse effects, eg, cognitive and psychomotor impairment.
  • Cannabinoid content – “Dosing” of cannabis is determined by the means of administration, frequency, and amount used as well as the cannabinoid content of the recommended strain (especially in terms of THC and THC:cannabidiol ratio).
  • Route of administration:
  • Smoked and inhaled cannabis have a rapid onset of effect which is typically minutes and relatively short duration of action which is typically two to four hours. These routes are preferred by some patients because they allow frequent and precise titration of dose to effect (eg, analgesia).
  • Oral cannabis has a slow onset of effect (typically half to one hour) and long duration of action (typically 4 to 12 hours). This may lead to inadvertent overdosing; when patients don’t experience effects as soon as they expect, they may take another dose, resulting in a cumulative overdose. This is especially likely by patients familiar with the rapid onset of smoked or inhaled cannabis

At this time The Ohio State University Wilce Student Health Center is not participating in Ohio’s Medical Marijuana Program however you can find updates at : Ohio Medical Marijuana Control Program 
http://medicalmarijuana.ohio.gov

Annmarie DiMeo

Medical Marijuana and Student Life Student Health Services

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So marijuana is now legal in the state of Ohio….what does that mean for me as a student here at The Ohio State University?

Can I get marijuana prescribed by a provider at the Student Life Student Health Center (SLSHS)?

I haven’t heard of anyone who has been prescribed medical marijuana yet.

As of September 8, state licensure, registration, and certification are required for Ohio’s Medical Marijuana Control Program. Ohio law requires the Ohio Medical Marijuana Control Program to be fully operational by this date.

 

Can I get a prescription from any doctor?

“The federal government prohibits doctors from being able to prescribe marijuana. Instead, patients must have a recommendation from a certified physician. Physicians interested in recommending the use of medical marijuana for patients must apply for a certificate to recommend from the State Medical Board of Ohio.” The Ohio Medical Marijuana Control Program

Many students will not qualify by age alone, as one must be at least 21 years old.

Physicians at the Wilce Student Health Center will not be certified. They will not be prescribing medical marijuana. That being said, it is very important that patients always disclose all supplements or other medications they are prescribed when seeking medical care. Be sure to let your SLSHS provider know if you are taking medical marijuana (or using recreational marijuana).

 

What kind of medical problems can be treated with marijuana?

The State of Ohio Medical Board has a defined list of medical diagnoses that qualify for treatment with medical marijuana.

The most common use is for pain control, especially nerve pain. Medical marijuana can also be helpful with certain types of nausea, muscle spasticity (as with multiple sclerosis and Parkinson’s disease), and glaucoma.

There are some initial studies that indicate marijuana may have a place in treating post traumatic stress disorder.

 

Keep in mind…

Marijuana is still illegal per federal law. The Federal Drug Free Schools and Community Act of 1989 prohibits the use of drugs (including marijuana) on campus if the school is receiving any federal funds.

We are in need of more medical research in the benefits and side effects/complications of marijuana use.

Just like with alcohol, one should not drive while using marijuana (medical or recreational).

The smoke from marijuana has toxic chemicals just like tobacco smoking.

In a student population already struggling with anxiety, depression and attention deficit disorders, the use of marijuana is likely to compound the issues. There is also increased risk of psychosis and impairments in learning, perception and judgement.

Kathryn McKee, M.D.

What’s in your work out supplements?

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It’s the start of 2018, which means the “new year, new me” resolutions are picking up some good momentum by now. Hitting the gym more often is definitely one of my resolutions, and if our resolutions are on the same page, then this post can be of some help to you!

Work out supplements… we see them advertised all over our social media pages, and if you are walking into your local GNC, or Vitamin Shoppe the selection can be intimidating. What I’ve learned so far is that there are supplements that you take as a pre-workout, and supplements that do just as they are named, supplement.

Pre-workout Supplements:

What’s the scoop? Boosting your performance is all part of the plan. Growing bigger muscles, having quicker gains, and hoping for an easy solution is something we all strive for. Most of us understand that easy isn’t necessarily so, and may not entirely be the correct way in doing something. Unlike medications, workout supplements are not as strictly regulated by The Food and Drug Administration (FDA), which means dangerous ingredients may be incorporated without the knowledge of consumers. Some of the ingredients may actually have detrimental effects, and potentially cause death.

1, 3- dimethylamine, methylhexanamine or geranium extract—also known as DMAA is an ingredient that has been found illegally in some dietary supplements, where manufacturers mask the component as a “natural” stimulant. In 2013, a case report was published in the Clinical Journal of Sport Medicine, highlighting an incident where a 21- year old male suffered from cardiac arrest after ingesting a workout supplement containing DMAA. Structurally, DMAA is similarly related to amphetamine, methamphetamine, and MDMA. DMAA does not produce any type of stimulant similar to the mentioned substances, but if you are set to take a urine drug test for a new job, or professional program at The Ohio State University… heads up, you may fail.

Good news, DMAA has been banned by the FDA after the unfortunate incident that occurred in 2013, however, there are still some supplements through online purchase that may have the ingredient incorporated within the product, and I would recommend reading the back of the nutrition label before purchasing any type of supplement. The discontinued substance that contained DMAA was specifically the pre-workout supplement marketed as Jack3d made by USPLabs.

Regular Supplements:

“First off, let me drink some protein.” Protein supplements are frequently consumed by athletes, as well as those who work out recreationally. There is much debate on the theory of amount of protein per day a person should intake and the timing of supplementation, and if you have any questions towards these matters PubMed.gov is a good source for you to do some more research about the topic.

Protein powders come in three common forms, those being—whey, soy and casein. A study by Kanda, A. et al in 2016, looked at the co-ingestion of all three substances and their effects on muscle protein synthesis after exercise in rats. The results of the study demonstrated a difference in peak time according to the type of protein ingestion, the authors concluded that whey protein was quicker to initiate the process compared to casein and soy.

Branched chained amino acids (BCAAs) especially leucine have been shown to increase muscle synthesis after exercise. Leucine is another component to keep an eye out for. Kanda, A et al. also noted that leucine displays a specific saturation point. The threshold described was around 43 mg of leucine, which means anything above this dose resulted in no further increase in the muscles anabolic response.

This is just the tip of the iceberg when it comes to the types of supplements that are available commercially, the big take away from this blog is to get you use to looking at the nutrition label located on the back of the products up for purchase. Speaking to your healthcare providers about any of your concerns is a good thing to do, especially if some of the components of your supplements seem a bit off.

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Kanda, A. et al. Effects of whey, caseinate, or milk protein ingestion on muscle protein synthesis after exercise. Nutrients. 2016 Jun; 8(6): 339.
  2. Lioudmila, K et al. Cardiac arrest in a 21-year old man after ingestion of 1,3 dmaa—containing workout supplement. Clin J Sport Med. 2015 Jan; 25 (1): 23-25

Prescription Refills

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Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?

In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.

You don’t have time to come in for an appointment right now?

Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.

How to avoid running out of medications?

Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.

Don’t see an appointment on-line that fits your schedule?

All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.

Ryan Hanson, M.D.

Medication Disposal Day – Don’t rush to flush!

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The Student Health Services Pharmacy will be holding our 6th annual DEA-approved Medication Disposal Day Thursday, October 26th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication).

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets.

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health.
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America.
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet.

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 5th Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe!

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx.

Candace Haugtvedt, RPh, PhD
Student Health Services
The Ohio State University

My friend is hooked on painkillers, what should I do?

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Addiction is a devastating disease that can have life-threatening consequences if not treated. It is important to know where to go on campus in case you or a friend is ever in need of help.

Counseling and Consultation Services

  • Location: Younkin Success Center (4th Floor), 1640 Neil Avenue, Columbus, OH 43201
  • Phone: 614-292-5766
  • About: Provide individual and group counseling, suicide prevention, mental health screenings and a variety of other mental health services to meet your needs.

The Ohio State Collegiate Recovery Community

  • Location: 1230 Lincoln Tower
  • Phone: 614-292-2094
  • About: The Collegiate Recovery Community is a program for students in or seeking recovery from drug or alcohol addiction. They provide many resources for students in recovery including the following:
    • Recovery House at Penn Place
    • Peer to peer support
    • Devoted recovery staff
    • Advocacy, information and referrals
    • On campus support group meetings
    • Monthly wellness workshops
    • Social events
    • CRC Student Leadership Board
    • Service opportunities
    • Recovery Scholarships
    • Annual CRC Program Orientation
    • Graduation Dinner
    • Individualized Recovery Plans
    • Ohio State alumni in recovery mentor program
    • Leadership and professional development
    • Scarlet, Gray & Sober Tailgates
    • Monthly community lunch
    • Designated CRC lounge on campus, 1230 Lincoln Tower

The Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery

  • Location: 125 Stillman Hall, 1947 College Rd, Columbus, OH 43210
  • Phone: 614-292-5572
  • About: Can help students identify resources and answer their questions about drug and alcohol misuse. The center can also help identify the best way to talk to a friend who may be misusing drugs or alcohol.

Student Health Services

  • Location: 1875 Millikin Rd, Columbus, OH 43210
  • Phone: 614-292-4321
  • About: Student Health Services is dedicated to caring for students and families of those struggling with the disease of addiction. For those in long-term recovery, SHS can provide maintenance medication if certain expectations are met. Call a Care Manager at Counseling and Consultation Services to apply (614-292-5766). The SHS Pharmacy is also equipped to provide naloxone (Narcan), the overdose reversal medication, and overdose education. Call 614-292-0125 for more information.

It is important to speak up if you or a loved one is struggling with the disease of addiction. You could save a life! Be sure to check out my next post about naloxone, a drug that can reverse opioid overdose!

 

Kelsey Kresser Schmuhl, PharmD Candidate 2017

 

 

 

 

Got anything to help me stay awake to study?

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As a college instructor, I am always somewhat amused by the panic that finals week seems to cause.  Seriously, it’s not like finals week is a surprise.  And it’s not like the content of a final is unknown – it could be anything that was covered in class.  And yet, students panic when it comes to finals week and look for ways to stay alert as they study late into the night trying to finish papers and prepare for exams.  For some this involves huge quantities of caffeine.  For others – study drugs.

This isn’t something new.  In the 70’s Ohio State students asked Dr. Spencer Turner, Director of Student Health Services, if he could recommend anything to stay awake while preparing for finals.  The study drugs back then were known as bennies or speed.  Today they are prescription stimulants like Adderall and Ritalin, for both the common component is amphetamine.  Used without a prescription, these drugs can be dangerous – not to mention illegal.

Dr. Turner stated that “the use of an amphetamine without proper medical supervision is unwise for several reasons:

  1. Pre-existing medical condition(s)
  2. Risk of adverse reaction(s) to even a single dose, especially when already fatigued
  3. Masking physical fatigue when this is the body’s signal for needed rest
  4. Likelihood of crashing at an inopportune time such as in the middle of a final or while driving
  5. Temptation to continue the drug’s use

These reasons continue to be valid today.  When prescribed, proper dosage has been determined by a physician based upon the medical condition of the patient.  The physician then monitors the patient regularly to ensure there are no adverse effects.  These are two key components – proper dosage and monitoring.  A pill obtained without a prescription, such as from a roommate or friend has neither of these. 

Study drugs can improve focus and motivation to study, but the short-term benefits of these substances do not come without their fair share of risks.  According to the National Institute on Drug Abuse, Adderall can cause hallucinations, impulsive behavior, paranoia, and irritability. These are among a long list of dangerous side effects that probably won’t help with that final!

You can read Dr. Turner’s article “Sleep, finals week, ‘Bennies’ and you“ in the Lantern Online Archive, March 12, 1971

Submitted by Tina Comston, M.Ed.

Reviewed by Mary Lynn Kiacz, M.D.

Do you belong to Generation Rx?

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Are you concerned about the misuse and abuse of prescription drugs?  Are you trying to educate those around you to its dangers?  Are you concerned about the “other freshman 15”?  Then you may be part of Generation Rx.

Generation Rx began at The Ohio State University College of Pharmacy in 2007 in response to the rapid increase in accidental drug overdose deaths in Ohio.  Its purpose is to combat the misuse and abuse of prescription drugs through educational prevention.  One such component – the “other freshman 15”.  Fifteen facts about prescription drug abuse:

  1. Prescription medications are among the most abused substances in the US.
  2. The average age when prescription drug abuse starts is 21.
  3. Non-medical use of prescription drugs by college students has doubled since 1990.
  4. About half of all college students will have the opportunity to abuse a prescription drug by their sophomore year.
  5. A growing campus culture of self-diagnosis and self-prescribing has the potential to cause negative health effects and lead to the dangers of prescription drug abuse.
  6. Abusing prescription medications is not a safe alternative to using illicit “street” drugs.
  7. Using medications like Vicodin, Adderall, or Xanax that aren’t prescribed for you is against federal and state laws.
  8. Emergency department visits relating to prescription drug abuse now exceed those relating to illicit “street” drugs.
  9. Some prescription medications can be addicting.
  10. Unintentional drug overdose is leading the cause of accidental death in the US.
  11. Most people who abuse prescription medications get them from family members or friends.
  12. It is critical that we store prescription medications securely and properly dispose of them when they are no longer needed to prevent misuse or abuse by others.
  13. It is important to only use prescription medications as prescribed by a healthcare professional.
  14. When you share your prescription medications with others, you could be liable if that person is harmed.
  15. Prescription drugs can help us live longer and healthier lives – but only if they are used properly and under medical supervision.

Take some time and view the Interact play on prescription drug abuse.

If you have prescription medications that you no longer need or that have expired, bring them to the Wilce Student Health Center Pharmacy on April 17, 2014 8am – 2pm for safe disposal.  No cost, no questions.

Learn more about Generation Rx at http://drupalmod.pharmacy.ohio-state.edu/outreach/generation-rx-initiative.

Submitted by Candace Haugtvedt, R.Ph., Ph.D.

Reviewed by Tina Comston, M.Ed.

Few days left to make your choice,,,about smoking

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November 15 – the 37th Annual Great American Smokeout, sponsored by the American Cancer Society, is a day for smokers to take a day off from using tobacco, and for nonsmokers to encourage their friends to do the same.  Are you getting prepared?

If you do plan to quit, you should know that the days ahead are going to be tough, and most people make several attempts before they actually kick the habit for good. So, don’t be too discouraged if it takes a few tries to make it stick!

The great news is that there are a TON of resources out there to help you quit smoking.

One of my favorite programs is 1-800-QUIT-NOW (1-800-784-8669). You can call this free hotline and speak to a professional smoking cessation counselor. They can help you get over your fears about quitting, help you set your quit date, teach you coping strategies for cravings, etc. The really great thing about this service is that they can often help you get access to nicotine replacement therapy if you are qualified, whether or not you have insurance. Plus, people who use “quit lines” have been found to be more successful in their attempts to quit!

If you’re not into the idea of calling a quit line, this government website is another great resource. It offers tips for quitting, a savings calculator, a cravings journal and much more!  The CDC website also offers a list of resources to help you quit. 

Closer to home, the staff of Student Health Services is also here to help. In addition to advice and encouragement, we can offer several prescription medication options to help you quit.  All medications have side effects, so be sure to discuss them fully with your health care provider before taking them.  The main options are:

Varenicline (Chantix) works by blocking the effect of nicotine on your brain, so if you relapse and light up, that cigarette won’t give you the same pleasurable effect it used to.  It also helps to reduce withdrawal symptoms.  Varenicline is not covered by insurance and it ain’t cheap (about $120/month), but it does seem to be very effective. 

Buproprion (Wellbutrin) is a commonly prescribed antidepressant that has been found to decrease tobacco cravings and withdrawal symptoms.  Buproprion is much cheaper than Varenicline (it’s on many $4 prescription plans and is usually covered by health insurance) but doesn’t seem to be quite as effective. 

There are also a number of nicotine replacement products on the market these days. You can get anything from patches to gum to lozenges to inhalers. These are typically priced so that a month of treatment costs the same as a month of cigarettes (at about a pack per day). So really, while it seems pricey up front, in the long run you’ll be saving money.  Even though you can buy them without a prescription, it’s always a good idea to talk to your health care provider before starting one of these products.

Good luck!  Please post a comment and let us know how you’re doing!  Who knows, your experiences may help someone else kick the habit!

Angela Walker, MD (OSU COM Alum)

John A. Vaughn, MD (OSU Student Health Services)