“Relief-oriented use of marijuana by teens”

That is the title of an article in last April’s Substance Abuse Treatment, Prevention and Policy.

While this study in has a very small sample size, it nonetheless presents an interesting point, and one that needs to be taken into account when attempting to limit the use of illicit drugs (and the illicit use of licit drugs) by teens.

…these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced…Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.

One of the common reasons for use of illicit drugs is self-medication. Certainly a completely different approach would be needed in these individuals than in recreational users. Likely these folks present a different set of challenges.

Driven to Distraction

Subject: Driven to Distraction video goes live; please share!

Good morning task force supporters,

Please take a few moments to watch our fantastic new YouTube video featuring Dr. Brian Johnston of Harborview.

Call to action: Watch this video and share it with as many friends, colleagues and groups as possible. To watch, please click on the front page of our web site, nodistractions.org" or go directly to the YouTube link which can be copied and pasted into your own e-mails:

http://www.youtube.com/watch?v=sjj2dLfeERE


Many wonderful people helped make this video possible, and we will be acknowledging each of them on our web site soon.


Thanks for spreading the word!

Lindsay Pease
Driven to Distraction Task Force of Washington State

Teen abuse of OTC and Rx meds

In the rush to worry about teen use of illicit drugs (not to belittle that action) we often lose sight of the fact that OTC and prescription drugs are used “nonmedically” more often than cocaine, heroin, ecstasy, and methamphetamines combined (SAMHSA data). Why?

Many teens think that these drugs are safe because they have legitimate uses and are often found at home in the medicine cabinet… Teenagers generally lack a sense that OTC and prescription medications can be dangerous or addictive… Some teenagers who abuse prescription medications and OTC preparations are sensation seekers, they "use" to get high, or are seeking to self-medicate. [from an article on Medscape, sorry no link]

Remember “Parents are the anti-drug”, but:

Parents may simply not be aware of the consequences of this type of abuse. Despite the increase in parent-teen discussions about the risks for drugs, many parents may not be discussing the risks of abusing prescription and OTC medicines with their children. Only 24% of teens have reported that their parents had talked with them about the dangers of abusing prescription drugs or the use of medications outside of a clinician's supervision, and just 18% of teens have indicated that their parents had discussed the risks of abusing OTC cough medicine [from an article on Medscape, sorry no link]

The key for parents:

The Partnership for a Drug-Free America recommends a 3-step approach: (1) educate [themselves about these and other teen “dangers”]; (2) communicate [with your preteen and teen, factually and repeatedly]; and (3) safeguard [limit access to what you must have in your home and get rid of the rest].

Shine a light on mental health needs

A while back I ran across an "article" by Glenn Close (sorry, lost the link) in which she wrote:

Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma of psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign.

And

What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well…

She wrote this in support of a new website: BringChange2Mind.org. Every effort in this regard deserves support.

Mental illness does indeed not only affect the individual, but in so many ways affects all those around them. It is not something to be feared or ignored, but something to be treated and cared for.

Survivors of Suicide

We helped sponsor/host an event last Saturday giving folks whose loved ones have died by suicide an opportunity to view a program put together by the American Foundation for Suicide Prevention (AFSP). This is the third year we have done that. It is a great program (it will be available online, the AFSP website, through the year), well worth looking at. The program as always was thought provoking and emotion provoking, as well as filled with great information and support for folks who have had loved ones die by suicide.

One item that jumped out for me this year was a recommendation on how to help with someone who is grieving. It was summed up as: Hug, Hush, and Hangout. Be there for the person you want to help through their grief, listen instead of offering your thoughts, and give them a hug. What an excellent way to really help them.

Someone else on the broadcast mentioned doing the dishes for them as well. Not a bad idea either.

More on the health food that tastes good

A study out of the Nestle Research Center in Switzerland (no chance of conflict of interest there) demonstrated that 1.4 ounces of dark chocolate a day lowered the amount of stress hormones in folks’ blood streams, presumably reflecting reduced body reaction to life stress. A good thing.

Previous studies have demonstrated that dark chocolate is cardioprotective and I have mentioned that research in previous blogs. So, finally a health food that tastes good and appeals to the masses. Eat (remember, all things in moderation) live long and be healthy.

Just saw this and thought I'd add it: How to pick healthy chocolate

Coroner Hauntings?

In case you missed it in the Tribune:

"Eerie events rattle those in the coroner's office"

Photo Post: Swine flu fears

Writing and Arithmetic

Last night I was invited to the ITT Technical Institute Program Advisory Committee meeting, sitting with advisors and the program chairman for their School of Criminal Justice. It was an interesting experience. There were representatives from the Department of Homeland Security, Cook County Probation, and a private security company at our table for the discussion.

While the chairperson did discuss the program as it is and what sets it apart from other criminal justice programs, the bulk of the information being sought may be surprising: stuff regarding writing and math skills. I have said it before (somewhere in this blog) and in response to questions of what an investigator needs to work in our field (the Coroner business), communication skills (written and verbal) and at least some basic math skills are of critical importance.

The chairperson was looking for ways to “test” writing skills and input into how math is used in our fields as a tool in teaching math skills. Hopefully we gave him at least some usable stuff to pass on to the instructors. It is great to see that that is a focus of his program. While it isn’t as glamorous as the stuff you see on TV, the ability to write (communicate) and do relatively common math “problems” is critical to working effectively in the Coroner’s business, criminal justice, and, quite frankly, just about any walk of life.

No colonics

Now here is something you don’t see talked about every day:

I had someone come to the office a while back seeking my advice. He had seen all the ads and products for colon cleansing (there are an amazing number) and someone told him that it was a great and health producing procedure and that it was necessary to get out all the stuff we carry inside all our lives. He asked if, indeed, people carried 15 to 25 pounds of meat or other food byproducts (s**t) in their colons.

NO

In all the autopsies I have observed, surgeries I have observed, and lessons I learned in Med School, there has never been “stuff” “stuck like spackle” on the inside of someone’s colon. While an enema may be occasionally needed for acute constipation there is no other health benefit or health need for colon cleansing. Don’t be duped into buying into that foolishness.

Coroner’s Suicide Thought Piece

One in 5 or 6 people are touched by or are close to someone who has died by suicide or will die by suicide. That is a huge number. As they say, a sobering thought.

I have been “touched” by suicide in the past and continue to be brushed. This Friday I will be attending a workshop for Counseling Professionals regarding suicide prevention. More personally, I have had even closer brushes recently.

I was recently in a conversation about someone we knew who was thinking of traveling to Switzerland, where suicide is legal, as a place to die by suicide. As a matter of fact, I had just run across an article on the internet, just that day, about that fact about Switzerland. Apparently, a fair number of folks travel there with suicide on their mind. More to the point of this post, should I intervene? The individual is elderly, feel that they have lived a full life and fear that they will become a burden as they age further and develop more severe medical problems. Beyond trying to keep them aware of all the reasons life is worth living and the distinct possibility that they won’t become a burden, do I force my value system on them? Are they wrong to chose an end with a view of the Alps?

“Brush” number two: A dear friend of mine has serious fears that a mutual friend is or has contemplated taking their own life. They feel that because of a hurricane of stress that will be a choice that that person will make. There are risk factors, but that person has shown resilience in the past. They have a support system readily available. I feel that in this case the positives outweigh the negatives. But who can really predict what will happen? Certainly we have seen a number of folks who have died by suicide who had friends and family who felt the same way about them. Of the future, we can see only the possibilities.

Another brush is a young person. The darkness always seems immense and seems as if it will last forever. It is critical to work to help, to get them help as is appropriate. Expand their knowledge of available options, watch for impulses. Teach them resilience, the ability to work through it. Teach them that the darkness will not last forever, that they can get through the darkness, that there are other possibilities. Life is worth living, there is so much potential in each and every life.

Anti-cocaine vaccine?

Interesting, but I’m not sure how much “promise” this experimental treatment really shows: Cocaine vaccine shows promise for recovering addicts

… a new cocaine vaccine… the vaccine reduces use of the drug by raising anti-cocaine antibody levels in the blood, thereby inactivating the cocaine before it enters the brain and gives the user a high

However, the article goes on to say that the antibodies reached effective levels in only 38% of folks treated and they are only present about 2 months after getting the shot. Multiple vaccinations would be required.

Certainly this kind of treatment needs to be investigated, but don’t expect to see it out as an effective treatment any time soon. Although, it would be great if it could be boosted for improved effectiveness and long-term studies show “promise” as well.

Grief normal or too much

Grief does have it purpose, adjusting to the change in your life and dealing with your loss. We deal with grieving folks all the time and not just at the time of the death of their loved one, but often for weeks (and occasionally longer) after that.

Each of the 2.5 million annual deaths in the United States directly affects four other people, on average. For most of these people, the suffering is finite — painful and lasting, of course, but not so disabling…
For some people, however — an estimated 15 percent of the bereaved population, or more than a million people a year — grieving becomes …“a loop of suffering.” … “It takes a person away from humanity,” she said of their suffering, “and has no redemptive value.”
This extreme form of grieving, called complicated grief or prolonged grief disorder…

Those that do become debilitated by their grief, locked into that loop, do need professional help. They need to develop the tools in their psyche, in their lives, to deal with something that will not go away, but that can be dealt with. They may need to be nudged or pushed in that direction.

Grief is normal. You don’t get over it. But you can not let it take over your life to the point there is nothing else.

Zombie warning

Got this on a listserv and I don't see a copyright mark

Bullet shortage

Do you realize that this is affecting law enforcement agencies?

Shooting ranges, gun dealers and bullet manufacturers say they have never seen such shortages. Bullets, especially for handguns, have been scarce for months because gun enthusiasts are stocking up on ammo…

We have seen it, too.

My deputies do carry handguns (Coroner’s deputies in this county have carried at least since 1991). We do respond to somewhat risky neighborhoods at risky times in the immediate aftermath of violence or when violence may erupt for other reasons. (Deputies also wear ballistic vests) This shortage results in increases in the cost of ammunition and makes finding available sources more difficult.

Just a note about something else folks may not think about when they are pondering what the Coroner’s Office does.

I agree with the author that this trend is scary and a sad commentary on our society, as well.

Interesting Week for Coroner, Never Routine

It was an interesting week of meetings.

Tuesday I presented my 2010 budget to the County Board committees that need to approve it before it goes to the full Board. To meet county targets set because of projected county income short-falls, I had to make some cuts. It was tough to do because we have been running a pretty lean budget since I set my first one after taking office. I am pretty sure we will accomplish this expense reduction without forcing my deputies to use only one glove per case. Actually, despite already submitting my budget I have some other cost saving ideas that I have mentioned to the county Finance folks. We will see how they pan out. Then there is also my reserve plan to sell Coroner Office T-shirts, etc as a revenue enhancement.

Yesterday I went to a meeting to discuss a way to expand access to healthcare for uninsured folks here in Lake County. It was an interesting discussion on trying to port/modify a system in DuPage County to ours (the discussion continues). This is important because, as I have mentioned before, folks are dying from lack of insurance. This is a project I helped explore a few years ago, I am glad it has come up again. Not that I don’t trust changes occurring on a national level, but I don’t trust changes occurring on a national level.

Today I spoke to a group of 80 senior men (one guy was celebrating his 91st birthday). Who would have guessed that they would love the story about a case we investigated complete with the discussion of decomp odor, skeletalization, maggots on crack, and a blender rendering of those maggots for toxicology testing. I know the teens I talk to enjoy it, so I thought I’d try it on this audience. It was fun for me and I hope informative for them.

Oh sure there were death investigations, discussions of death investigations, media calls, and other routine things happening as well, but it is always the other stuff that moves the week along.

Level I Challenge for Coroner’s Office

We were already on track for a significant increase in the number of deaths in Lake County that involve Coroner office investigation (approximately 15%) this year. Most deaths (about 80%) require little or no investigation, e.g. hospice deaths, natural deaths from normal disease processes.

Then came the news that a local hospital will begin operating as a Level I Trauma Center October 1st. We knew it was coming, but couldn’t get concrete numbers on how many individuals (victims of trauma) that are currently flown out of our county would now be staying for treatment and potentially dying in county. The folks that are flown out are the most severely injured and unfortunately many succumb to their injuries despite the best care possible.

Now we know that the hospital projects that about 300 folks currently flown out will be going to their hospital for care. It must be an incredible undertaking on their part to prepare for that caring and that rather precipitous jump in treatment volume. But no one consulted us on how that will impact our functioning; apparently they felt we would just take up the potential jump in case volume. I’ve already submitted my budget for 2010 and it includes cuts because of concern for Lake County’s limited resources projected by County administration, not service expansion possibly mandated by this change in the county milieu.

I don’t mean to sound cold about these individuals dying, but the reality is that these things must be thought about as well. These deaths will challenge our resources, staffing, autopsy services, and toxicology testing. Planning is difficult because we don’t know how many more deaths will need investigation or what will be necessary in our death investigations for these individuals. For example, will they have had enough testing (x-ray, CT, MRI, toxicology) during their in-hospital care to preclude the need for autopsy?

These are interesting times and our personnel will rise to the challenge, but a bit of number projection and information about possible cases would have been nice.

Food for Misdirection of Thought

(Note: I had thought of this post before I ran across the article that prompted the above post. It became an interesting juxtaposition.)

I often get asked what we in the Coroner’s office do to decompress, to get our minds off the death we deal with all the time.

One of the things we do is participate in what I jokingly refer to as “food porn”. Not “porn” in the usually thought-of context, but reveling in the earthly delight of food. If you have ever watched some of the photography of food shows (and even food ads), you can see the visual quality they often strive for. Actually some of that photography comes pretty close to a porn presentation. I am also not referring to gluttony either. I think of that more in the sense of mass quantity consumption with “vomitoriae” (or is it vomitorii?). Again, some of the shows on TV do seem to cross that line, but we prefer a less gross presentation (although we sometimes catch a bit of Andrew Zimmern for grossness). Also our tastes do not run toward haute cuisine, but more the burgers, BBQ, and bacon sort of food selections.

We enjoy watching Anthony Bourdain during lunch while making multiple comments about his food exploits and the attractiveness, to us, of the food he is sampling. We also trade stories and recommendations about local, and not so local, eateries and food options. We trade web-based food information, like the recently circulated “squeezable bacon” ad and a recent article about potentially deadly fast food.

It’s fun, it’s something else to think about and sometimes it’s a tip that leads to a nice night out with the family.

16 year-old's death with hot dog

Now this is a pretty unusual occurrence, but I thought it might be worth a caution. Kids do choke on food, as do folks on the other end of the age spectrum, with hot dogs being high on the list (I remember during my ER days, pulling a gumball out of a young child’s larynx just in time). But it is pretty unusual to see this in a healthy teen.

An autopsy report on a 16-year-old Spartanburg boy came with a warning from the Cherokee County coroner. "Hot dogs are a choking hazard and should be consumed carefully,” he said
… died as a result of a hot dog lodging in his throat.
Friends at a youth group pool party tried the Heimlich maneuver but it failed.

With all the foody shows on TV showing folks wolfing their food, it behooves us to remind young people that it is important, and potentially life saving, to chew well when eating.

Suicide Prevention Week

Next week is “National Suicide Prevention Week” so I thought I’d post the “Suicide Warning Signs” from SAMHSA.

Last year Lake County had 67 individuals die by suicide (up 46% from the year before) and this year looks to be in the same range as 2008.

For folks that you think might be at risk of taking their own life, talk to them, suggest help, push them to get help. That will not push them toward suicide, but may help them to see that there are other options. Empathy expressed can be a useful tool to prevent suicide.

Seek help as soon as possible by contacting a mental health professional or by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you or someone you know exhibits any of the following signs:

Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself

Looking for ways to kill oneself by seeking access to firearms, available pills, or other means

Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person

Feeling hopeless

Feeling rage or uncontrolled anger or seeking revenge

Acting reckless or engaging in risky activities—seemingly without thinking

Feeling trapped—like there’s no way out

Increasing alcohol or drug use

Withdrawing from friends, family, and society

Feeling anxious, agitated, or unable to sleep or sleeping all the time

Experiencing dramatic mood changes

Seeing no reason for living or having no sense of purpose in life