Germs in Tobacco

Bacteria found in major cigarette brands.

It’s not enough that smoking causes all manner of cardiopulmonary complications, or that more than 3,000 chemicals and heavy metals have been identified as additives. Now comes evidence that tobacco particles extracted from cigarettes contain markers for hundreds of known bacteria. Lung infections in some smokers may be caused by germs on shredded tobacco, rather than the act of smoking itself.

According to a report by Janet Raloff in Science News, Amy Sapkota and a team of researchers at the University of Maryland screened tobacco flakes from cigarettes for bacterial DNA using known markers. In an online paper for Environmental Health Perspectives, the scientists explored the bacterial metagenomics of cigarettes using standard cloning and sequencing processes. The team provided evidence for the presence of Campylobacter (a cause of food poisoning), E. coli, several Staphylococcus varieties, as well as a number of bacteria, such as Clostridium, which is directly associated with pneumonia and other infections. Fifteen different classes of bacteria in all, with no significant variation from one cigarette brand to another. 

The time has come, Sapkota and coworkers conclude, “ to further our understanding of the bacterial diversity of cigarettes,” given the more than 1 billion smokers worldwide.  Smoking is now recognized as a risk factor for a basketful of respiratory illnesses, including influenza, asthma, bacterial pneumonia, and interstitial lung disease. In light of this, the authors have advanced their study as solid evidence that “cigarettes themselves could be the direct source of exposure to a wide array of potentially pathogenic microbes among smokers and other people exposed to secondhand smoke.”

In 2008, researcher John Pauly and coworkers at the Roswell Park Cancer Institute in Buffalo, New York, helped provide early evidence by conducting a tobacco flake assay and publishing the results in the journal Tobacco Control. The scientists opened a package of cigarettes “within the sterile environment of a laminar flow hood. A single flake of tobacco was collected randomly and aseptically from the middle of the cigarette column and placed onto the surface of a blood agar plate. The test cigarettes included eight different popular brands, and these were from three different tobacco companies.”

And the results? “After 24 hours of incubation at 37 degrees C, the plates showed bacterial growth for tobacco from all brands of cigarettes. Further, more than 90% of the individual tobacco flakes of a given brand grew bacteria.” Pauly believes that “the results of these studies predict that diverse microbes and microbial toxins are carried by tobacco microparticulates that are released from the cigarette during smoking, and carried into mainstream smoke that is sucked deep into the lung.”

In a recent study published in Immunological Research , Pauly and others expanded on their findings, writing that “Cured tobacco in diverse types of cigarettes is known to harbor a plethora of bacteria (Gram-positive and Gram-negative), fungi (mold, yeast), spores, and is rich in endotoxin (lipopolysaccharide).” This time out, the researchers conclude that “lung inflammation of long-term smokers may be attributed in part to tobacco-associated bacterial and fungal components that have been identified in tobacco and tobacco smoke.”

Cigarette manufacturers already use antibacterial washes during the curing process in order to reduce infection by fungi and bacteria.

If the findings are sound, they could place the argument over secondhand smoke in a vastly different light—cigarettes smoke may be taking the rap for respiratory infections cause by extant bacteria. With smoking rates in the U.S. holding at a steady 21 percent of the population, the issue is not trivial.

Graphics Credit: http://commons.wikimedia.org/

Sapkota, A., Berger, S., & Vogel, T. (2009). Human Pathogens Abundant in the Bacterial Metagenome of Cigarettes Environmental Health Perspectives, 118 (3), 351-356 DOI: 10.1289/ehp.0901201

Pauly, J., Smith, L., Rickert, M., Hutson, A., & Paszkiewicz, G. (2009). Review: Is lung inflammation associated with microbes and microbial toxins in cigarette tobacco smoke? Immunologic Research, 46 (1-3), 127-136 DOI: 10.1007/s12026-009-8117-6

Marijuana Q & A

My interview with AllTreatment Blog.

Denny Chapin, Managing Editor of AllTreatment.com, was recently invited to participate in an extended debate over marijuana withdrawal at the Drug WarRant blog site. I followed that debate with interest, due to the unusually high volume of responses to my own post on that subject.

Now Denny has kindly provided me the opportunity to offer my own views on a set of questions about cannabis use and cannabis dependency. The complete interview can be read at the AllTreatment site HERE.

Photo credit: http://www.medicalmarijuana.co.cc

The Cocaine Conundrum

Effective treatment remains elusive.

For addiction to cocaine, amphetamine, and other stimulants, the treatment picture has been complicated by the lack of any truly significant anti-craving medications. (See post, “No Pill for Stimulant Addiction"). The National Institute on Drug Abuse (NIDA) has yet to approve any medications for the treatment of either cocaine or amphetamine addiction.

Take the case of cocaine. Partly the problem stems from the direct effect cocaine has on dopamine transmission.  The hunt for a pharmaceutical approach to blunt that effect is complicated by the problematic nature of dopamine receptors.  Dopamine antagonist drugs like the antipsychotic drug haloperidol do not always block the stimulant rush. And their side effects, such as lethargy, emotional blunting, and tardive dyskinesia, make them unsuitable for ongoing addiction therapy. Conversely, some drugs that act as dopamine agonists turn out to be addictive in their own right. Many designer drugs are like that.

Because of all this, different approaches may be needed. The direct ride to the pleasure pathway provided by stimulants makes it difficult to tamper selectively with their effects. An antibody that would reduce cocaine consumption and sop up cocaine molecules in the brain, a kind of vaccine against cocaine, is one approach being pursued (See post, “Cocaine Vaccine Hits Snag”).

But other avenues of attack are being exploited.  Scientists in NIDA’s Intramural Research Program are testing compounds that target certain proteins known as dopamine transporters. Transporters move dopamine molecules in and out of the synaptic gap between neurons in the brain. Interfering with that transportation system is another way of altering dopamine uptake, and it represents one active avenue of approach to the treatment of cocaine addiction.

The researchers tested Benztropine Mesylate (BZT), brand name Cogentin, one of a class of drugs known as anticholinergic suppressants commonly used in the management of Parkinson’s disease. What exactly does benztropine do? It possesses both anticholinergic (acetylcholine-blocking) and antihistaminic effects. It has chemical similarities to atropine, which is used for Parkinson’s and for heart disease.

To begin with, the researchers wanted to establish that benztropine itself is non-addictive. By substituting different BZT analogs for cocaine during self-administration testing on addicted rats, “two of the three BZT analogs that were tested significantly reduced drug self-administration… which indicates that those BZT analogs themselves have low potential for abuse.”

Next, the cocaine-addicted rats were given different BZT analogs before they got their cocaine. “When given before rats had access to cocaine in the self-administration chambers,” the researchers reported in the Journal of Pharmacology and Experimental Therapeutics, “two BZT analogs also significantly reduced the number of times the rats would press a lever to receive cocaine.” Monoamine uptake inhibitors were used as a control. The authors conclude that “these compounds are promising candidates for the development of medications for cocaine addiction.”

Hiranita, T., Soto, P., Newman, A., & Katz, J. (2009). Assessment of Reinforcing Effects of Benztropine Analogs and Their Effects on Cocaine Self-Administration in Rats: Comparisons with Monoamine Uptake Inhibitors Journal of Pharmacology and Experimental Therapeutics, 329 (2), 677-686 DOI: 10.1124/jpet.108.145813

Photo credit: http://www.drugabuse.gov

Just for Fun: Simple Science Facts

Back to basics.

[Guest post adapted from 50 Simple Science Facts Everyone Should Know (But Doesn’t), from the folks at X-Ray Technician Schools.]

While obviously not everyone remains ignorant of the realities behind the myths, it is the sad truth that many of the following facts remain entirely obscured in the common consciousness – victims of myth and misconception in spite of reliable evidence to the contrary:

--Eating poppy seeds will not always result in a failed drug test. : The common myth about eating poppy seeds can lead to failing a drug test has a solid foundation in reality, as heroin, morphine, codeine, and other opiates are created from the plants. But Indiana University sheds some light on the reality of the situation, pointing out that only the seeds of opiate poppies cause false positives. For those who have eaten the offending poppyseeds, however, there are ways to determine whether or not the opiate traces come from narcotics or a harmless bagel.

--Do not mix ammonia and bleach together. : While death does not generally factor into the equation, blending ammonia and bleach together releases extremely harmful chlorine and other noxious gases that can cause serious damages to the lungs and brain – if not outright kill, of course. The State of New Jersey provides more details on using these cleansers safely.

--Acid into water, never water into acid. : The reliable mnemonic relating the procedure to A&W Root Beer helps students and chemists alike remember that the opposite effect may result in painful or disfiguring chemical burns. University of Oregon has more information on this and other lab safety tips.

--What goes up, must come down. : Anyone shooting a bullet or other dangerous projectile straight into the air ought to think towards one major aspect of Newton’s Universal Law of Gravitation, as explained by the University of Tennessee at Knoxville.

--Lightning can actually strike the same place twice. : Information on lightning striking the same location multiple times abounds online, but no research acts as the most compelling evidence to the same extent as NASA’s exhaustive testing of the myth at hand. Not only can it hit a target more than once, but the likelihood of it happening ended up being 45% higher than anticipated.

--Shaving does not cause thicker, darker hair. : Mayo Clinic weighs in on the myth that shaving directly causes hair to grow back thicker and darker, providing a much-needed dose of reality to a concerned populace. Lawrence E. Gibson, M.D. sheds light on how genetics determine hair structure and the ways in which the perception of coarser, darker strands initially came into play.

--The “5 second rule” is a fallacy. : Popular schoolyard mantras dictate that any food dropped on the floor fails to pick up microbes within the first 5 seconds. Paul Dawson, a food scientist at Clemson University, discovered that bacteria climbs onto food particles immediately upon contact and thus dispelled this eerily common myth.

--There is actually gravity in space. : Northwestern University lays to rest the general claim of zero gravity in outer space by explaining how its influence relates to distance. Every entity in the universe is actually subjected to some degree of gravitational pull, no matter its location.

Photo Credit: www.worldsciencefestival.com

U.N. Drug Chief predicts 3rd World “Health Disaster.”

The neo-colonialism of drug dependence.

For the developed world, drug abuse is a plague, a law enforcement problem, a budget line item, a therapeutical industry.  But in the developing world, rampant drug use can be a health disaster of immense proportions. Heroin use is skyrocketing in East Africa, while cocaine abuse is increasing in West Africa. The underground synthetic drug market is booming in the Middle East and parts of Southeast Asia.

“The developing world lacks the treatment facilities and law enforcement to control drugs,” according to a recent address to the Commission on Narcotic Drugs by Antonio Maria Costa, the executive director of the United Nations Office on Drugs and Crime (UNODC). “Why condemn the Third World, already ravaged by so many tragedies, to the neo-colonialism of drug dependence?”

The Commission on Narcotic Drugs (CND) is the UN’s primary policymaking body for drug-related issues. Costa told the commission, which is meeting in Vienna this week, that inequality within and between states marginalizes poor people who lack access to treatment. Reminding the commission that “the medical use of narcotic drugs continues to be indispensible for the relief of pain and suffering,” the UNODC director said: “We must not only stop the harm caused by drugs: let’s unleash the capacity of drugs to do good.” He called on member nations to overcome the socioeconomic factors “that deny a Nigerian suffering from AIDS or a Mexican cancer patient the morphine offered to Italian or American counterparts.”

Costa’s UNODC also works with the World Health Organization (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) to pursue universal access to drug treatment and the reduction of disease transmission due to injectable drugs.

Costa said that drug penalties and addiction treatment in some countries amount to little more than cruel and unusual punishment. Noting the millions of people, including children, who are sent to jail for drug use, Costa said: “People who use drugs, or are behind bars, have not lost their humanity or their human rights.” The director cited the Balkans, Central and West Asia, and East and West Africa as regions requiring increased assistance in matters of security and justice related to drug use.

Costa said that the UN sees drug trafficking as a growing security threat, and noted that “few issues have received as much attention as drug trafficking in the Security Council over the past few months.”

Photo Credit: http://www.unodc.org/

The Perils of Fair-Weather Cocaine

The higher the temp, the higher the death rate.

As spring approaches, cocaine users might take note of further evidence of a connection between high ambient air temperatures and accidental overdoses.

A study published recently in the journal Addiction used mortality data from the Office of the Chief Medical Examiner in New York City from 1990 to 2006 to determine the frequency of cocaine-related overdoses (itself an enterprise fraught with uncertainty and argument over listed causes of death).  The researchers cross-referenced the mortality data with temperature records from the National Oceanic and Atmospheric Association (NOAA).  

As reported in Addiction Journal, “accidental overdose deaths that were wholly or partly attributable to cocaine use rose significantly as the weekly ambient temperature passed 24 degrees Celsius [75 degrees F].”

Previous research, the authors write, had indicated that significantly higher temperatures—in the high 80s F--were required before cocaine mortality rates showed an increase. The researchers said they did not detect a corresponding rise in other types of drug overdoses during days over 75 degrees.

What is the mechanism connecting temperature to cocaine overdose? Cocaine intoxication raises core body temperature. Overheated cocaine users risk overdosing on smaller doses of the drug because their bodies are already under the strain of mild hyperthermia, or increased body temperature.

Specifically, the researchers from the University of Michigan and elsewhere found that above 75 degrees, there were 0.25 more drug overdoses per 1,000,000 residents per week for every two-degree rise in temperature, according to Addiction Journal. Applied to New York City, these numbers suggest and additional two cocaine deaths per week for every two degrees increase in average temperature over 75.

Lead author Dr. Amy Bohnert of the University of Michigan Medical School said in a press release that cocaine users are already “at a high risk of negative health outcomes and need public health attention, particularly when the weather is warm.”  During the study period, New York City had average weekly temperatures in the >24 C range roughly seven weeks per year.

The idea is quite plausible, given that ambient air temperature can affect many other metabolic processes.  Earlier investigations led to the discovery of a fairly well established diurnal AND seasonal variation for measurements of blood pressure. Researchers at Emory University data-mined 2 million  electronic records of participating patients and discovered that the odds of having high blood pressure were lowest during the morning, and generally increased throughout the day. Seasonally, high blood pressure occurred more often in winter, and was at its lowest in the summer. 

Graphics Credit: http://flatbushgardener.blogspot.com/

Bohnert, A., Prescott, M., Vlahov, D., Tardiff, K., & Galea, S. (2010). Ambient temperature and risk of death from accidental drug overdose in New York City, 1990-2006 Addiction DOI: 10.1111/j.1360-0443.2009.02887.x

Drug Abuse Coverage Leaves Out the Science

How the media covers harm reduction.

Lewis Mehl-Madrona, a graduate of the Stanford University School of Medicine, recently wrote a piece for Futurehealth.org that zeroes in on a series of highly pertinent questions about the manner is which the America media tends to cover drug policy stories. Questions like: Why is the existence of credible scientific research rarely mentioned when drug controversies are in the headlines? Why does science not matter when it comes to the coverage of drug policy issues?

Mehl-Madrona cites the example of U.S. television coverage of Vancouver’s Insite project in Canada, which provides addicts with clean needles and a supervised injection room. Such “consumption rooms” are also available in Europe, and are being tried sporadically in the U.S. (See my earlier post on drug injection sites) Here is his reaction:

“The American TV was awash with criticisms of this policy, the primary one being that it promoted drug abuse and caused people to abuse drugs even more than they otherwise would. What amazed me was the complete lack of attention to data in the American media. Substantial research has been conducted on Insite and on harm reduction models. It is known that programs like Insite reduce the spread of HIV/AIDS and of hepatitis C and reduce drug overdose. No evidence exists to support its spreading drug abuse.”

One of the primary concerns raised by the media was whether the Insite facility would encourage addiction by making injections safer and easier. Yet a reliable study in the British Medical Journal showed no substantial increase in relapse or decrease in quit rates among a group of Insite users.

Another concern was that the Insite facility would discourage drug addicts from seeking treatment. However, a study published in the New England Journal of Medicine in 2006, involving more than 1,000 users of the facility, found that “individuals who used Insite at least weekly were 1.7 times more likely to enroll in a detox program than those who visited the centre less frequently,” according to Mehl-Madrona.

Moreover, the study confirmed that onsite addiction counselors were successfully increasing the number of addicts who signed up for detox. Rather than discouraging addicts from seeking treatment, the study confirmed that Insite was “facilitating entry into detoxification services among its clients.”

“I don't have an answer for why ideology trumps scientific evidence in the United States and its media” Mehl-Madrona writes. “Why are the opinions of ordinary people in cities across the United States considered more valid than three dozen rigorous scientific studies? Is this just the American way?”

Graphics Credit: http://abortmag.com