06/8/15

Hype Over Powdered Alcohol

© damedeeso | 123RF.com

© damedeeso | 123RF.com

The Alcohol and Tobacco Tax and Trade Bureau (TTB) approved the sale of a brand of powdered alcohol named “Palcohol” on April 8, 2014 and then rescinded permission on April 21st. An article in Time said the approval for Palcohol was halted because of an error in its labels. The parent company for Palcohol, Lipsmark, said: “there seemed to be a discrepancy on our fill level, how much powder is in the bag.” So when Senator Chuck Schumer called upon the FDA to ban Palcohol, this kid named River Donaghey got the idea to try and make his own powdered alcohol and then document the aftermath for Vice in “Powdered Alcohol Got Me Drunk in the Worst Way.”

Donaghey took a recipe for powdered alcohol off the internet to mix his own, because “I didn’t want to make wimpy powdered booze like Palcohol, which you need half a pouch of to make a single drink. I wanted something strong.” Instead of mixing in 30 grams of alcohol, “which is hardly anything,” he poured in an entire fifth of 192-proof grain alcohol. He knew it was the right mixture when his eyes started to water from the fumes.

He began by ingesting “handfuls of the stuff,” then he got the idea to sprinkle it on pizza. After running into his roommate, Charlie, he gave him a pinch of the powder and they both set off for pizza. Donaghey said the powder drunk crept up on him and he went from mostly sober to buzzed to beyond. He said he thought the powdered booze blended well on pizza. He also kept getting weird looks from people with his Tupperware bowl full of powdered alcohol. They thought he was acting out a scene from the movie Scarface with a bowl full of cocaine.

After leaving the pizza shop, River and Charlie went down to the East River where they decided to set some on fire. “It turns out my homemade powdered alcohol burns like napalm.” When he tried to stamp out the fire he ended up spreading it all along the rocky bank of the river. Charlie’s shoe cut on fire. He offered some to a group of high school students, who wisely refused. But there was one more thing he had to try: snorting it. So he went back to the VICE office and “started racking lines.”

The powder turned to glue in his nose and he was immediately plugged up. The fumes burned for a few minutes and then his sinuses became numb. Charlie and he staggered home and went to their respective rooms, hoping that unconsciousness would dull the throbbing inside their heads. Charlie didn’t snort any.

I woke up at 4 AM, with my face caked with blood from my nose. At least I could breathe again. The headache had dulled to a manageable form. I went out into the living room and found Charlie sitting on the couch, sucking on a beer. He handed me one. I slumped down next to him and took a drink.

Given the above, it’s not surprising that as soon as the TBB finally approved the sale of Palcohol on March 10th, 2015, Senator Charles Schumer introduced legislation to ban the sale and distribution of Palcohol and other powdered alcohol products.

We simply can’t sit back and wait for powdered alcohol to hit store shelves across the country, potentially causing more alcohol-related hospitalizations and God forbid, deaths. This legislation will make illegal the production and sale of this Kool-Aid for underage drinking.

Reported in the Time article and on the blog, SB Nation, the original Palcohol website suggested football fans could “Bring Palcohol in and enjoy the game.” And, yes, like River Donaghey tried, they said you could snort Palcohol. “You’ll get drunk almost instantly because the alcohol will be absorbed so quickly in your nose. Good idea? No. It will mess you up. Use Palcohol responsibly.” The current Palcohol website has removed such remarks and hopes to be able to get their production facility up and running to make their product available this summer.

They argued that banning their product would only make people want it more. The ban will create a black market and lose significant tax revenue. They also said it was irresponsible to ban Palcohol, because it probably won’t work. “No one wants the government telling us what we can drink and not drink. We don’t need a nanny. The legislature exists to protect our rights to live how we choose, not to use coercive power to force their values on us.”

Lipsmark sees Palcohol as “a revolutionary new product that can help so many industries.” Airlines can reduce weight and save on fuel costs. Medical personnel want to use it as an antiseptic, especially in remote locations. It would be a “boon to outdoor enthusiasts” wanting to enjoy an adult beverage without having to carry heavy bottles of liquid. They said there has even been interest in using powdered alcohol as a fuel source. “There is talk of multiple military applications from transport fuel to fuel in a soldier’s backpack.”

McCarton Ackerman on The Fix said that the National Conference of State Legislatures reported that 47 bills in 28 states have been introduced to address powdered alcohol. Virginia, Alaska, Louisiana, South Carolina, Massachusetts and Vermont have already banned the distribution of Palcohol, “while others are also considering similar measures.”  Reported by MyFOXdc.com, Maryland announced a ban on the distribution and sale of powdered alcohol on March 25th, 2015. “The likelihood of widespread Palcohol abuse – particularly among underage consumers – carries a real possibility of tragic consequences.”

Of course, Colorado has reversed its initial move to ban it and could be the first to approve its use. It is up to the Colorado Liquor Enforcement Division to write the rules for powdered alcohol sales and distribution. It could be on store shelves in a few months. The video embedded in thedenverchannel.com article illustrates the small size and ease with which the packets could be hidden. “The biggest benefit of powdered alcohol, or Palcohol, is also its biggest danger. It’s convenient, it’s easy and it can be sneaky.”

There have been some limited reports of powdered alcohol being a fake or a hoax. However, it does seem to be a real product. The question seems to be whether or not it is being hyped into becoming a fad. For example, hoaxes.org posted in 2005 that it was possible in theory to create powdered alcohol. However, it also noted that the end product from a formula used would only be 4.8% ethanol by volume, and concluded by saying: “But even if this stuff is real, I can’t imagine powdered rum tastes anything like the real thing.”

In his blog, Tim Vandergrift reported that alcohol (ethanol) is a volatile liquid, meaning that it evaporates very quickly, far faster than water. At room temperature, pure alcohol will evaporate away. It can’t be directly turned into powder, so that is why you have to mix and stabilize it with another substance (like sugar or maltodextrin, as Rive Donaghey did), and then seal it in a vapor-proof package. He then calculated the reported bulk of maltodextrin-alcohol mixture and estimated that you would need 26 packets to make an entire vodka bottle’s worth of cocktails.

Assuming you do make this damp maltodextrin substrate-with-alcohol mix, where does that leave you? With a product that’s only 12% ABV, probably costs more, and bulks much larger than simple beverage alcohol, is tough to dissolve in cold liquid and doesn’t taste like anything without the addition of lots of extra additives. Additionally you’d be consuming some form of unidentified powder in vastly higher quantities than the alcohol you’re seeking. Peachy (Italics).

It’s hard to not see this as a product that is aimed directly at under aged drinkers. Dr. Scott Krakower said the flavored powders would appeal to young people. “Youths are going to be very vulnerable to this.” And even though the company advised against it, “people will snort it”—as we saw with River Donaghey, just to see what it’s like.

05/4/15

The Opioid-Heroin Cycle

© Ouroboros tattoo by Sahua | Stockfresh.com

© Ouroboros tattoo by Sahua | Stockfresh.com

Since the death of Philip Seymour Hoffman on February 2, 2014, there has been a series of calls for the distribution of naloxone or Narcan, which is a prescription medication that reverses an opioid overdose. But it seems that the price of Narcan has doubled over the past year. The Fix and others report that the price of naloxone has recently gone from $51.50 per kit, to nearly $100 per kit. These are the Luer-Jet™ kits sold by Amphastar Pharmaceuticals, the only US company currently selling nasal kits. There is a cheaper injectable form of narcan, but it is supposed to be less user friendly.

Within four days of Hoffman’s death, The New York Times published an article by an emergency physician, noting how greater availability of Naloxone could prevent deaths. He referred to a report in the Annals of Internal Medicine that suggested up to 85 percent of users overdose in the presence of others, providing the opportunity for others to intervene. In Forbes Magazine David Kroll said the CDC reported that naloxone was used in over 10,000 opioid-overdose reversals between 1996 and mid-2010. He also expressed his concerns over potential shortages of naloxone.

Victoria Kim for The Fix reported that Amphastar’s president blamed the price increase of their naloxone product on “steadily increasing” manufacturing costs. But Matt Curtis, the policy director for a New York advocacy group said there had been a fairly steady price for several years. “Then these big government programs come in and now all of a sudden we’re seeing a big price spike. . . . The timing is pretty noticeable.” The Hill reported that Senator Bernie Sanders and Representative Elijah Cummings sent a letter to Amphastar complaining about the price increase and how it is “an obstacle in efforts by police departments to equip officers with the drug.”

Areille Pardes of Vice said that after the CDC said there was an opioid epidemic in 2008, the manufacturer of naloxone, Hospira, increased the price of a dose of naloxone from $3 to a little more than $30. Pardes also reported that the supposed difficulty of a lay-friendly delivery system has also been used to justify the high costs of epipens (around $400) and the naloxone auto-injector, EVIZO (Over $600 for a kit of 2 auto-injectors at Walmart, Sams Club, Target and other retail outlets). However a study found few differences between trained and untrained overdose rescuers in their abilities to use the syringes in a naloxone rescue kit. “Anyone with common sense could figure it out, even without training.”

It does seem that the timing of the price increases for naloxone (a generic drug) and its delivery systems occurred just as the epidemic of overdoses took place. The CDC reported in a March 2015 NCHS Data Brief that from 2000 to 2013 the rate of drug overdoses quadrupled, from .7 deaths per 100,000 to 2.7 deaths per 100,000. Overdoses are now the number one cause of injury-related death in the US. While the overdose deaths involving (prescription) opioid analgesics have leveled off in recent years, those from heroin have almost tripled. See Figure 1 of the NCHS Data Brief. While the heroin overdose rates increased among all age brackets, the highest rate of increase was among 25-44 year olds. Geographically, while there were increases in all regions of the country, the greatest increase took place in the Northeast and the Midwest. See figure 5 of the NCHS Data Brief.

There is some sense that effort to curb problems with overprescribing pain medications has inadvertently led to a boom in the misuse of heroin. Richard Juman reported for The Fix that while some treatment providers suggest that is the case, others note that there is evidence that heroin use was increasing before any state or federal interventions with prescribed opioids were implemented. According to Andrew Kolodny, MD:

The idea that efforts to curb prescription drug misuse have led to a spike in heroin use or overdose has become a common media narrative, but the facts don’t support it. It is the overprescribing of opioids itself that has caused increases in opioid addiction of all kinds, not the efforts to control the prescribing. The transition from prescribed opioids to heroin has been happening since the beginning of the epidemic, and there is no evidence that the interventions brought forth to reduce the overprescribing have been fueling the increase in heroin use or overdoses. Because of the epidemic of opioid addiction, you now have markets for heroin that you didn’t have in the past. So there has been an increase in heroin overdose deaths, but that increase was prior to states’ implementation of Prescription Monitoring Programs or any of the changes from the FDA.

I tend to agree with Dr. Kolodny’s assessment. There is a price factor in the shift for many opioid users switching to heroin. And there has been a global market increase in heroin production that paralleled the rise of prescription opioid use. Increased heroin use in the US is market driven. What does seem to be related to increased heroin availability in the US is the diversification of Mexican drug cartels into growing opium poppies, as their market for marijuana dries up. See “The Economics of Heroin.”

There is something very wrong with the cycle of Pharma marketing for increased use of opioids, leading to overprescribing opioids, leading to increased heroin use and increased overdoses, leading to an increased need for narcan, leading back to increased profits with drug companies, where the cycle began. The ouroboros pictured above is a symbol in Greek mythology of a dragon eating its own tail. It symbolizes something that constantly re-creates itself, which seems to be happening here with the opioid-heroin cycle.