Joan A. Marshman

Effect of cannabis on pentobarbital-induced sleeping time and pentobarbital metabolism in the rat☆

Abstract The effects of two cannabis extracts with different cannabinoid compositions, as well of as pure Δ 1 -tetrahydrocannabinol (THC), cannabinol (CBN) and cannabidiol (CBD), on pentobarbital metabolism were studied in the rat. Extract I, with high proportions of CBN and CBD relative to THC, when given by gavage 21·5, 40 or 63 hr before pentobarbital (30 mg/kg, i.p.), prolonged the sleeping time by 53, 42 and 21 per cent respectively. This effect was paralleled by decreases in the rate of disappearance of [ 14 C]pentobarbital from the blood, and of pentobarbital metabolism by liver microsomal preparations in vitro . Extract II, with low relative proportions of CBN and CBD, did not have any significant effect on penobarbital metabolism or sleeping time. CBD alone, in the same dose as that given in Extract I, had very similar effects, while a dose of CBD equivalent to that given in Extract II had no effect. THC, CBN and CBD added to normal rat liver microsomes in vitro inhibited pentobarbital metabolism competitively, CBD being a much more potent inhibitor than THC and CBN. The CBD content may, therefore, be a significant factor in interactions between marijuana and other drugs.

Addictive behavior of older adults

Very little is known about addictive alcohol use by older people. In the present paper personal effects reasons for drinking (i.e. drinking for the effects of alcohol) and concerns about drinking were used as indicators of addictive drinking behavior among a sample of 826 people aged 65 and older who participated in survey interviews in their homes. The relationship of addictive drinking behavior to frequency of drinking, quantity of drinks per occasion, and depressant drug use was examined. Alcohol use was higher among males and young-old (aged 65-74), while depressant medication use was higher among females and old-old (aged 75+). However, with the exception of use of over-the-counter medications containing codeine (which was significantly higher among current drinkers), no relationship existed between alcohol use and use of depressant medications. Personal effects reasons for drinking and concerns about drinking were related both to alcohol and depressant medication use. Frequency of drinking was associated with higher endorsement of both personal effects and social reasons, whereas volume of alcohol consumption (drinks per drinking day) was associated only with personal effects drinking. In addition, use of depressant medications by drinkers was significantly related to consuming alcohol for personal effects reasons (but unrelated to consuming for social reasons) and with having concerns about ones own drinking. These results suggest that even within the generally low levels of alcohol consumption of older people, addictive-use patterns emerge. In addition, the results confirm the importance of including depressant medication use in evaluating the drinking behavior of older people.

Clinical pharmacy services in the home: Canadian case studies.

OBJECTIVES To describe clinical home care services provided by Canadian pharmacists and to identify facilitators of and barriers to the provision of these services. DESIGN Home care practices in Canada were identified using key informant and snowball sampling methods. Case descriptions of each pharmacy were composed using data obtained via a faxed questionnaire and a follow-up telephone interview. SETTING Community and institutional pharmacies across Canada. PARTICIPANTS Sixteen pharmacists with practices that met three criteria: at least one home visit conducted per week, visits conducted specifically for clinical purposes beyond routine prescription counseling, and documentation of home care services. INTERVENTION Faxed questionnaire and follow-up telephone interview. MAIN OUTCOME MEASURES Pharmacist characteristics, pharmacy characteristics, types of clinical home care services, home care-related products and dispensing services, referral system, reimbursement, barriers and facilitators, and evaluative strategies. RESULTS Twelve practices were in community pharmacies, nine of them independents. Home care services were provided primarily to address noncompliance and at the request of other health professionals. Elderly patients were the predominant service recipients. Services provided in most practices included compliance support, medication regimen review, monitoring of new medications, and patient education and training. Less than one-third of practices compiled evaluative data on these services. Most practices did not bill for services rendered. Lack of reimbursement was cited as the most important practice barrier, and having other sources of funding, such as high prescription revenues, was viewed as the major facilitator. CONCLUSION Clinical home care practice is rare in Canadian pharmacy; reimbursement is a major barrier. Practices described in these case studies were initiated to address a perceived important patient need. To enable further dissemination of clinical home care practice, pharmacists need to establish formal linkages with other home care providers, evaluate their services, and use the data obtained to develop marketing and reimbursement strategies.

Phencyclidine Ingestion: Drug Abuse and Psychosis

Phencyclidine (PCP) is a popular illicit drug often misrepresented as some other hallucinogenic substance and distributed in widely varying dosage forms and strengths. Users of hallucinogenic drugs may present with unintentional PCP overdoses. Toxicological laboratory analyses are essential to establish the diagnosis. In nine admitted overdose patients, the consciousness level ranged from alert to comatose on presentation, and all showed a prolonged recovery phase with agitation and toxic psychosis. Severe behavior disorder, paranoid ideation, and amnesia for the entire period of in-hospital stay are characteristic. In very high dose patients, shallow respiratory excursions and periods of apnoea and cyanosis coincided with generalized extensor spasm and spasm of neck muscles. Excessive bronchial secretions, gross ataxia, opisthotonic posturing, and grimacing occur. PCP toxic psychosis should be considered in drug-abusing patients presenting with schizophrenic-like symptoms, psychosis, or other bizarre behavior, whether or not they admit to taking PCP.

Depressant medication use by older persons in the broader social context relating to use of psychoactive substances

Although use of depressant medications is associated with a number of risks for older people (e.g. drug-drug and alcohol-drug interactions, dependence, falls), very little is known about the factors that lead to use of depressant medications, especially use of benzodiazepines. Physicians clearly play a role in prescribing these drugs, but there are likely to be other influences on use patterns, such as the social context that defines the appropriateness of use, the types of symptoms defined as needing depressant medications, and so on. The social context of use of depressant medications was examined using survey data from 826 persons aged 65 years and older. About 30% of respondents were using depressant medications, with most use to alleviate sleeplessness, stress or pain, and most regular users reporting considerable psychological dependence on continued use (especially for use of tranquillizing drugs). Overall, respondents who used depressant medications consumed about the same amount of alcohol as non...