More Kids Accidentally Ingesting Marijuana Following New Drug Policies.


1st US High Times Cannabis Cup

At least 18 states allow medical marijuana, and the likelihood that more kids will encounter it at home only increases with Colorado and Washington’s recent legalization of recreational marijuana.

Beginning nearly four years ago, the federal government decided not to investigate those involved in using and distributing medical marijuana who complied with state laws; the more lenient stand spurred a boom in dispensaries and requests for personal use in states where it was allowed.

But around that time, doctors at Children’s Hospital Colorado noticed kids were coming into the emergency room after accidentally ingesting marijuana. Were the cases directly due to the fact that young children were finding more marijuana at home, or were the doctors simply more aware of the exposures because of the more relaxed policies?

To find out, they analyzed emergency room visits for kids under 12 seen for poisonings and ingestions of any kind between 2005 to 2011, using the fall of 2009 — when new enforcement guidelines were issued — as a dividing line.

From Jan. 2005 through Sept. 2009, there were no marijuana-related visits among 790 patients, according to the research, which was published in JAMA Pediatrics. Between Oct. 2009 to Dec. 2011, however, 14 of 588 children were seen for marijuana exposure — eight involving medical marijuana and seven from food containing the drug.

The researchers say that homemade brownies speckled with pot may not pose a significant threat to kids, but commercial products formulated for medical use — as well as loose-leaf marijuana grown for medicinal purposes — could be more concerning, since they contain concentrated amounts of THC, the chemical that induces a high.

“They’re sold as edible products and soft drinks that kids will eat or drink because they don’t know it’s any different,” says Dr. George Wang, the study’s lead author and a medical toxicology fellow at the Rocky Mountain Poison and Drug Center. “If they’re going to eat a whole cookie with 300 mg of THC, they will get much more symptomatic and sick and have to be admitted to the hospital.”

Tracing the poisonings to marijuana, however, wasn’t always easy. In some cases, parents didn’t want to admit or didn’t know that their child had gotten into their marijuana stash; in several cases, the marijuana belonged to grandparents. Young children who are exposed to high levels of THC can hallucinate, be difficult to arouse and have trouble breathing — symptoms that can be hard to narrow down. At least one child had an unnecessary lumbar puncture and another underwent a CT scan while doctors tried to pinpoint the cause of the problems..

“We’re in this new age of allowing marijuana and we are seeing things we haven’t seen before,” says Wang, who is also a clinical instructor in the department of pediatrics at Children’s Hospital Colorado and the University of Colorado School of Medicine. “We need to educate families to keep it out of the reach of kids. Treat it like a drug because it is a drug.”

Parents aren’t the only ones who need to be more vigilant about the potential new risks of marijuana exposure, however. Researchers who wrote an editorial accompanying the study called for more training of pediatricians and emergency medicine physicians, who aren’t necessarily able to recognize toxic reactions to marijuana, particularly among young children, because they aren’t expecting high dose THC exposure in patients so young.

In Colorado, where voters recently legalized recreational marijuana use, Wang and a Poison Control colleague persuaded the legislature to include wording to require child-resistant packaging for edible marijuana products in a bill about marijuana regulation. If the bill passes, Wang believes Colorado would be the first state to require such measures, though a doctor from Boston Children’s Hospital recently testified to the Massachusetts legislature about the need for similar requirements. “It’s hard to argue with,” says Wang. “It’s common sense.”

More packaging could drive up costs, but Dixie Elixirs & Edibles, a Colorade-based medical marijuana purveyor, is on board with the proposal.

“As a parent and a businessperson, I wholeheartedly support the legislation,” says Christie Lunsford, who as Dixie’s marketing director is overseeing its plans for upgraded packaging. “We take this issue so seriously.”

In July, the state is expected to release its preliminary requirements for new packaging. But Dixie has already informed its packaging provider that it intends to place orders for child-proof containers so that no unsuspecting tots are tempted by its medicated chocolate truffles, which Dixie’s website describes as offering “sweet, creamy relief” or their crispy rice treats, in which the classic, nostalgic match of gooey marshmallow and crispy, puffed rice gets a euphoric lift.” With the range of tempting marijuana-laced foods likely to increase, such pre-emptive strategies for protecting young children from potentially dangerous exposures — just as they’re safeguarded from prescription and over-the-counter medications — seems to make sense.

Source: Time.com

ATA issues guidelines for anaplastic thyroid cancer management.


The American Thyroid Association has released the first set of comprehensive guidelines for the management of anaplastic thyroid cancer, a rare but lethal form of thyroid cancer.

Members of the American Thyroid Association (ATA) task force compiled a list of 65 recommendations based on relevant literature.

 

Bryan R. Haugen

“The American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer is a remarkable and comprehensive document that distills the literature and task force expertise into a useful guide for providers of patients with this aggressive cancer. The focused therapeutic approaches, as well as the inclusion of palliative care and ethical issues into this document, is a real advance for our field,” ATA president and professor of medicine and pathology; head of the division of endocrinology, metabolism and diabetes at the University of Colorado School of Medicine, Bryan R. Haugen, MD, said in a press release.

According to the guidelines published in Thyroid, the ATA task force sought to address the following: diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (i.e., surgery, radiotherapy, systemic therapy, and supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues regarding end-of-life.

For more information:

Smallridge RC. Thyroid. 2012; doi: 10.1089/thy.2012.0302.

Perspective

 

Richard T. Kloos

  • ATC is a rare, rapidly growing and [usually] fatal disease. Few physicians have personal expertise, and the published literature tends to be of low quality. Thus, when a patient presents at their doorstep, unfamiliar physicians are ill equipped to manage the disease.

The ATA brought together experts from a range of disciplines that synthesize the published literature and combine it with their clinical experience to thoughtfully guide physicians through the complexities of an ATC diagnosis, evaluation, staging and the establishment of treatment goals. This latest endeavor includes disclosing the patient’s status in a realistic way, including a discussion of treatment risks and benefits, the discussion of patient values and preferences, and the eventual making of an informed decision.

Unfortunately, physicians see patients in their best condition at the time of the first appointment, as most patients with ATC progressively decline in health and die from the disease in less than 6 months. Therefore, important decisions are needed quickly to address the remainder of their life. The document includes important sections of surrogate decision making, truth telling, advanced directives, airway management, maintenance of nutrition and palliative care/hospice.

This is the first set of comprehensive guidelines on this topic, and Dr. Smallridge and the ATA Task Force are to be congratulated for creating such a thoughtful and extensive document. Readers should quickly appreciate that to treat these patients they need to have an awaiting comprehensive multidisciplinary treatment team on-site to receive such patients, in addition to a group that can review this document to discuss their institutional approach moving forward. Conversely, physicians need to know how and where to rapidly transfer patients into the care of such a team.

Historically, guidelines have improved patient care in the short term by educating physicians and guiding patient care. In the long term, guidelines improve patient care by driving research. Gaps in the medical literature are identified and disagreements over strategies can be appropriately studied to strengthen the evidence base and to change patient care. We all hope that this is the case for ATC, and this document sets the benchmark for optimal care in 2012.

Source: Endocrine Today.