As you know, street drugs for injection may have fentanyl added to give a cheaper kick but might cause death since a tiny amount can be fatal. Fentanyl has been found in any injectable street drug. There is a $1 test for any drug you inject that may be contaminated with fentanyl. You can test the syringe it was in or the baggie the powder was stored in. Do a web search for California syringe exchange programs and you will find LA, Orange, and San Diego Counties have them. Sadly, Riverside and San Bernardino Counties do not have them. An Orange County program lost a court case recently. These programs can help you inject drugs in a safer manner. Of course it is best not to use drugs.
If you live in a county without the programs and you know someone who has died from heroin overdoses or has hepatitis C or HIV from a needle, please attend your county board of supervisors meeting and urge them to have syringe exchange programs to save lives, prevent suffering, and lower the cost of health care.
CORTISONE JOINT INJECTIONS HARMFUL?
For years we have given steroid injections into knees, shoulders, etc when the patient has pain unrelieved by pills. The relief can last days to weeks. A new study shows that these injections might be harmful. If you are thinking of having one of these injections, please ask your provider about this new information.
VAPING KILLING AND MAIMING…….EVALI
The CDC has coined a new term “EVALI” for e-cigarette, or vaping, product use associated lung injury illnesses. This is a hot topic on web searches and most young people feel vaping is harmless.
In early October, the number of confirmed and probable cases of EVALI crossed over 1000 in the US. Recent lung biopsies revealed that EVALI is probably a result of direct toxicity or tissue damage caused by noxious chemical fumes. Which brands or chemicals are causing the problem: nicotine, CBD, THC, the chemicals that make the “smoke?” Some of these chemicals come from China which has a poor record for quality control over medicines and chemicals.
The FDA has launched a criminal investigation into the possible causes of EVALI.
This problem reminds the FDA of when cigarettes were causing diseases so they are moving much faster. One of the reasons for this speedy attack is that the problems are occurring with less time vaping; cigarettes needed 10-30 years to cause the cancers, heart attacks, strokes, etc, making it difficult to see the association. The tobacco companies hid their information and lied about it.
Juul has stopped selling some products and the FDA has sent warnings to other companies.
FOR NOW, IF YOU VAPE:
- CANNABIS: I urge you to change to edibles, topicals, or buy a device that vaporizes the bud product and then cools it for inhaling — There is no added chemicals with this method.
- NICOTINE: I urge you to change Nicotine lozenges and patches. Many Medi-Cal insurances pay for these.
MAJOR DISRUPTION/PROTEST OF LECTURE ON ENDING AIDS
The Director of the CDC (Centers for Disease Control and Prevention) was giving a lecture to providers and clinic administrators and the HIV community about the plan to end HIV with testing and treating promptly, using Post Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP), when a group of protesters stormed the stage in Washington DC demanding a place at the table where decisions are made. Much of research and handing out funds is in collaboration with community advisory boards where the consumers and other stakeholders are present besides clinical personnel. Evidently this group felt that they were excluded from this current plan and they feel they have much to add to make it successful.
EXPRESS SEXUAL HEALTH CLINICS, SUPER QUICK AND EASY
There are clinics in London and certain US cities that are located in high traffic areas where you walk in and are handed the swab kits for gonorrhea and chlamydia, watch a video in the restroom on how to swab your throat and anus. Then you go to the lab for a syphilis, pregnancy, Hepatitis C test, and HIV test, etc. Instead of waiting up to 8 days for results at a regular clinic notification is much, much sooner by text. This will help tackle the syphilis, gonorrhea, and chlamydia epidemics rise.
YOU ARE OVER 50: PROSTATE BLOOD TEST (PSA) GOOD IDEA?
Years ago, providers were urged to test yearly those more than 50 without any evidence that it helped them suffer less or live longer. Then the concept of over-testing arrived and we backed off.
The Family Medicine group now recommends not discussing this unless the patient brings this up since it is generally unhelpful (over-testing). It may find a:
- rare bad cancer
- less rare cancer that won’t bother the person before death
- commonly find a “cancer” that really isn’t there, causing much worrying along with stressful procedures.
Other groups recommend discussing this in detail with the patients. But the commentator I am reading says that the patients still don’t know what to do.
I take the hint from the patient: if they are very aggressive and usually express the desire that any and all testing is a great idea no matter if the tests find things that aren’t really there, then I will order the test. If they are more relaxed, I test only if there is a large enough suspicion.
Keep those questions coming, Be safe!
Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto)
Member, Coachella Valley Clinical Research Initiative