Are ibuprofen plus acetaminophen as good as opioids in treating acute extremity pain

November 22, 2017, 3:19 pm


Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. Chang AK et al. JAMA 2017;318:1661-1667.


As Dr. Demetrios Kyriacou points out in a must-read editorial accompanying this paper, a growing body of evidence clearly indicates that even short-term opioid use for painful injuries or procedures …

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Absolute must-watch: 60 Minutes on how pharmaceutical distributors fueled the opioid crisis

October 16, 2017, 6:02 pm

In a blockbuster investigation carried out along with the Washington Post, 60 Minutes’ Bill Whitaker looks into allegations that powerful pharmaceutical distributors helped advance the current opioid crisis by fulfilling patently suspicious orders for prescription opioids. The piece cites one example where a pharmacy in a West Virginia town with a population of several hundred ordered and received millions …

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Tox Tunes #111: Girl on LSD (Tom Petty)

October 8, 2017, 11:26 pm

Although this Tom Petty song is somewhat obscure, I’m embarrassed to say I hadn’t know about it until an article in The Cannabist after the singer’s death last week brought it to my attention. The song appeared as the B-side to “You Don’t Know How It Feels” and was scheduled to be on Petty’s 1994 album Wildflowers, …

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ACMT Position Statement: Toxicology Issues in Determining Brain Death

September 26, 2017, 9:11 pm


ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose. Neavyn MJ et al. J Med Toxicol 2017;13:271-273.

Full Text

The American Academy of Neurology guidelines on determining brain death in adults states that the clinician can not make such a determination unless he or she can  “[e]xclude the presence of a CNS-depressant drug effect by history, drug screen, …

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Organic psychosis and nystagmus? consider dextromethorphan toxicity

September 25, 2017, 9:46 pm


Dextromethorphan in Cough Syrup: The Poor Man’s Psychosis. Martinak B et al. Psychopharmacol Bull 2017 Sep 15:47:59-63.

Full Text

Dextromethorphan (DXM) is found in many over-the-counter cough and cold medications. At recommended therapeutic dosage (up to 120 mg per day in divided doses) DXM is safe and has no psychiatric effects. However, DXM and its major metabolite —dextrorphan — act …

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Fentanyl, carfentanil and the opioid crisis: where do we stand now?

September 19, 2017, 9:50 am


Controversies and carfentanil: We have much to learn about the present state of opioid poisoning. Cole JB, Nelson LS. Am J Emerg Med 2017 Aug 24 [Epub ahead of print]


I have argued — both in a post on this blog and a column in Emergency Medicine News — that the idea of a “heroin overdose” is a completely …

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Great New Toxicology Podcast

June 16, 2017, 12:36 am

In the first episode of “The Dantastic Mr. Tox & Howard Show,” Drs. Dan Rusyniak and Howard Greller — formerly of the Journal of Medical Toxicology Podcast — have a superb discussion about the current expanding opioid crisis with Dr. David Juurlink from Sunnybrook Health Sciences Centre in Toronto. Topics covered include opioid-induced hyperalgesia, the key difference between relieving …

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Episode #15: How easy is it to get addicted to opioids?

June 10, 2017, 11:17 pm

A recent article in the New York Times reported that there were likely more than 59,000 deaths from opioid overdose in the United States during the year 2016, an increase of 19% over the number of such deaths in 2015. Many of these victims became addicted to narcotics after being prescribed opioid analgesics for episodes of acute pain. Previously, physicians were told that the incidence of addiction in this setting were virtually zero. It is now known that this is not true. But just how easy is it go get addicted to opioid medication used to treat pain? In this episode, Steve Aks and I will discuss.
Podcast Episode

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Lipid rescue therapy for local anesthetic toxicity: is less more

May 25, 2017, 5:09 pm


Adverse events associated with a large dose of intravenous lipid emulsion for suspected local anesthetic toxicity. Corwin DJ et al. Clin Toxicol 2017 Jul;55:603-7.


The key word in the title of this case report is “associated” — a.though the authors do not emphasize the point, it’s not at all clear that all of the adverse events described were actually …

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