Dangerous Imports and Drugs » AIDS deaths

DEA weighs new limits on drug eyed in Jackson case

Gordon Johnson — Wed, 15 Jul 2009 15:53:00 +0000

Sometimes, you just have to wonder. How did a drug like propofol, slip by the radar screen of the DEA? Are they too busy prosecuting the use of marijuana, fighting off Mexican bandits, or was this just a Bush administration decision to look the other way?

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Date: 7/15/2009 4:45 PM

DEVLIN BARRETT,Associated Press Writer

WASHINGTON (AP) — Federal authorities are considering making the potent anesthetic propofol — one of the drugs found in Michael Jackson’s home — a controlled substance, which would put new limits on its distribution.

The Drug Enforcement Administration was petitioned two years ago to make propofol a scheduled drug under the Controlled Substances Act. That designation is used to impose restrictions on distributing and prescribing certain drugs prone to abuse and addiction.

DEA spokesman Rusty Payne confirmed Wednesday that the agency is considering adding propofol to the list of controlled substances. The brand-name version of propofol is called Diprivan. A nurse who provided nutritional therapy for Jackson, Cherilynn Lee, has said he asked her for Diprivan to treat insomnia. Propofol is not recommended for such use and Lee said she refused the star’s request.

Until Jackson’s death, the main concern about propofol was its potential for abuse by medical staff, because it is usually administered intravenously in hospitals to patients who need to be unconscious for surgery or other procedures.

The Food and Drug Administration has received an increasing number of reports about fatalities linked to propofol in recent years: 43 in 2008 and 35 in 2007, up from an average of 22 per year over the decade before that, according to FDA data. The increase may be due to increasing use of propofol over older barbiturates.

A central question in the Jackson investigation is who provided that drug and other prescription medications found at his rented Beverly Hills mansion. Investigators are talking to doctors who treated Jackson.

Adding a drug to the federal list of controlled substances is a lengthy process. As part of its review, the DEA asks for a recommendation from officials at the Department of Health and Human Services. HHS experts can stop a drug from being added to the list if they recommend against doing so. Congress can also add specific drugs to the list through legislation.

The federal list of controlled substances is divided into five categories, ranging from some of the most potent, like heroin, to much milder products, like cough medicine with codeine.

Propofol is the country’s most widely used drug to induce general anesthesia, and also is used for other types of health provider-based sedation, said Dr. Stephen Parker, anesthesia chairman at Washington Hospital Center in the nation’s capital.

Hospitals and doctors’ offices must follow specific monitoring requirements for different levels of controlled substances, to track how much is bought and used, and who uses it.

Changing propofol to a controlled substance would require “accounting for every cc of the drug that was used,” Parker said, referring to the way the doses are measured. A teaspoon is about 5 cc’s.

“It would put up barriers for us to easily use the drug,” he said. “It’s a lot of bureaucracy and expense, frankly.”

For at least two years, the American Society of Anesthesiologists has had a committee looking into whether propofol should be made a controlled substance, but this has not been a high priority because abuse of propofol is “much, much less common” than of painkillers such as OxyContin, said Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill.

“It’s the drug you get when they say count back from 100 and you only make it to 97,” Zvara said. “It quickly and reliably puts people under — usually, very safely.”

At his university, it is used for about four out of every five procedures and is favored over older drugs like Pentothal and other barbiturates.

However, propofol depresses breathing and the heart rate and lowers blood pressure — risks that must be constantly monitored.

When it is abused, it’s usually by people seeking sleep, but even that is misguided, Zvara said.

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Associated Press Medical Writers Lauran Neergaard in Washington and Marilynn Marchione in Milwaukee and AP writer Justin Pritchard in Los Angeles contributed to this report.

Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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WHO: heart, infectious diseases, cancer kill most

Gordon Johnson — Mon, 27 Oct 2008 15:26:00 +0000

Date: 10/27/2008

By ELIANE ENGELER
Associated Press Writer

GENEVA (AP) _ Heart ailments, infectious diseases and cancer remain the world’s top three killers, the U.N. health agency said Monday.

Heart attacks and related problems are the top killer, claiming 29 percent of people who die each year, the World Health Organization said in a report on the global burden of disease. In second place, infectious diseases lead to 16.2 percent of worldwide deaths.

Cancer, in third, claims 12.6 percent of global deaths, said the 146-page report, which is based on death registration data from 112 countries and estimates where reporting is incomplete.

The figures are from 2004, the most recent records available on a wide scale, officials from WHO said. But the rankings are unchanged since 1990 when WHO first did a global check.

Colin Mathers, WHO expert and lead author of the report, said he believed infectious diseases used to be the leading killer 20 to 40 years ago, but that he did not have statistics to back it up.

Some 58.8 million people died worldwide in 2004, most of them over 60, the report said. Nearly one in five deaths was a child under 5.

The heart disease death rate was virtually unchanged from WHO’s previous study on death causes, based on 2002 figures.

The rate for infectious diseases dropped from 2002, when they accounted for 19.1 of the world’s deaths, partly because estimates for AIDS deaths were revised downward last year, said Mathers.

“Malaria deaths are also somewhat lower, and some of the other child causes have also come down a bit,” Mathers said, adding that the number of deaths from measles has dropped thanks to wider use of vaccination.

Women die more often from heart disease than men. The rate for females is 31.5 percent, and for males 26.8 percent, the report said.

Mathers said the percentage for women was higher because there were more women living at older ages than men.

But in general, men are more affected by heart diseases, he said.

“Men in many parts of the world have a higher risk,” he said, adding that they are more often overweight or obese, get insufficient physical activity and eat more fat and salt.

Filling out the top 12 causes of death are respiratory infections including pneumonia in fourth place, 7.2 percent; respiratory diseases, including asthma and allergies, 6.9 percent; accidental injuries and drownings, 6.6 percent; newborn health problems, 5.4 percent; digestive diseases, 3.5 percent; suicide, murder and conflict, 2.8 percent; neuropsychiatric disorders, 2.1 percent; diabetes, 1.9 percent; and maternal health problems related to pregnancy or birth 0.9 percent.

Dr. Ties Boerma, who heads the agency’s statistics department, said there is always a time delay in assembling such data from a number of countries.

“Countries have a backlog of two, three years in publicizing their own information,” he said.

In countries where no death registration data are available, the figures are taken from research studies, which take a few years to get published, Boerma said.

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On the Net:

http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html