Archive for August, 2014

When Caffeine Kills

6 am usually finds me in my kitchen in front of a rectangular appliance 14 inches high, blending hot milk and coffee to jump-start my brain. My brushed nickel Gaggio Classic espresso maker is my go-to kitchen appliance every morning, to help me create my favorite form of caffeine: a 16-ounce hazelnut flavored latte, extra hot.

I’m one of the 100 million Americans who drink coffee every day, and like 60% of them, I consider coffee a mandatory part of my morning routine. There’s even a celebration associated with our coffee habit: August is National Coffee Month.

Although Americans purchase a large proportion of the world’s supply of coffee beans and gave the world Starbucks®,  Seattle’s Best® and Dunkin’ Donuts®, we only rank 25th in the world in per capita coffee consumption. The top 5 include Finland, Norway, Iceland, Denmark and the Netherlands.

Coffee is popular worldwide. In fact, behind crude oil, green (unroasted) coffee beans are the second most traded and valued commodity in the world. Coffee is also called “java” because when coffee first became popular in the 19th century the highest quality of beans came from the Philippine island of Java.

Most people drink coffee for the lift it gives from its caffeine content. Found in over 60 different plants, caffeine’s stimulant effect on the brain can be detected in amounts as low as 10mg, a tenth of the 100mg dose found in an average 8-ounce cup of brewed coffee.

As the most common psychoactive compound ingested in the world, caffeine is present in coffee, tea, a South American drink called mate, and cola flavored sodas containing kola nut extract, although today’s manufacturers of carbonated beverages use synthetic sources of flavoring and caffeine instead of natural kola nut.

Enterprising manufacturers have added caffeine to other things besides carbonated soft drinks. Red Bull®, Monster® and 4-Hour Energy® are huge commercial successes, offering the rapid pick-me-up effect of caffeine without the taste of coffee. Stay Alert® chewing gum has 100mg of caffeine per stick, about the same amount of caffeine as a good ol’ cup of Joe. Not interested in drinking a beverage to get your day going? Wired Waffles®, made in Marysville, Washington, contain 200mg of caffeine each, the same as in 2 cups of brewed coffee. There’s even caffeinated pancake syrup, although its designed to be used over plain pancakes and waffles, not “wired” ones. You can check out caffeinated waffles and syrup at or on their Facebook page.

Although caffeine has been traditionally consumed in beverages, the Food and Drug Administration (FDA) is concerned about the practice of adding it to foods, particularly since waffles, pancake syrup, gum and candy are attractive to children.

The currently recommended limits of caffeine intake are 300mg per day in adults and 100mg daily in teens and young adults. The FDA is concerned about food products containing caffeine as an additive because little is known about the effects of caffeine in small children, young adults, or in pregnancy. In addition, most adolescents are not aware of the amount of caffeine they consume, especially in energy drinks.

People differ in how sensitive they are to the side effects of caffeine. Some adults can drink a pot of coffee and sleep like a baby, while others experience heart palpitations, tremor, anxiety and insomnia after only one cup. Because some heart arrhythmias are aggravated by caffeine, most cardiologists tell their patients with arrhythmias to avoid caffeinated beverages entirely.

Now there’s a new caffeine source: pure powdered caffeine. Sold as a food supplement and marketed to athletes to boost energy, increase endurance and burn fat, the FDA has no control over caffeine powder like it does foods with added caffeine unless it is found to be harmful.

Unfortunately, caffeine can kill, and an Ohio teenager died in May from an accidental overdose of caffeine powder. Pure caffeine powder sold in bulk is dangerous because it’s extremely concentrated. According to the FDA, one teaspoonful of powdered caffeine is roughly equivalent to the amount found in 25 cups of regular coffee, making it nearly impossible to accurately measure a single dose (100mg) with typical kitchen measuring spoons and all too easy to get a toxic dose, especially if you mistook its white powder for something else, like artificial sweetener.

The FDA has just issued a warning to consumers to avoid using pure powdered caffeine. More information is available at

Thanks, anyway… I’m sticking to my morning latte.



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Hydrocodone and The Hassle Factor

Do you prefer to use an ATM machine instead of parking your car, walking into the bank and standing in line to get cash? Would you rather push a couple buttons on your cell phone or go looking for a pay phone to put a couple of quarters into? Yeah, me too. These are examples of what I call the “hassle factor”: the extra time and effort it takes to do something compared with an easier, faster way. When you discover a quicker, more direct way to do something it becomes your preferred option unless you’re forced to change.
The hassle factor has a lot to do with what medicine a doctor chooses to prescribe. One blood thinner doesn’t need any specific attention while another requires regular blood tests and close monitoring. Medicines to treat pain range from over-the-counter remedies to highly controlled narcotics. The more restrictions to prescribing a medicine, the higher the hassle factor the doctor, the pharmacist and the patient.
The Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) together determine how restricted a medicine will be in the United States. If the DEA decides that a medicine could be misused or abused they restrict access to it by making it a controlled substance. Controlled substances must be prescribed, stored and dispensed differently than other prescription medicines, with the most restricted category Schedule II, abbreviated as CII or C-II (called “Cee-Two”) and lesser restrictions in Schedules III, IV and V.
Concerned about the widespread use and misuse of prescription pain medicines, the FDA and the DEA have decided to increase restrictions on all products containing hydrocodone such as Vicodin®, Norco®, Anexia® and their generic equivalents. Combinations of hydrocodone and acetaminophen (called hydrocodone combination products, or HCPs) have up to now been classified as C-III (called “Cee-Three”), but are changing to the more restrictive C-II Schedule on October 6, 2014.
There’s a big difference between prescribing and dispensing a C-III and a C-II medicine. A C-III medicine can be called or faxed to the pharmacy and may have up to 6 dispensings allowed for each prescription, the original plus 5 refills. All C-III prescriptions expire 6 months from the date they are written, with any refills left over at that time gone forever.
In contrast, to fill a prescription for a C-II medication the pharmacist must have a written or printed out prescription, called a “hard copy”. The only exception is an emergency prescription for a 72-hour supply, which must be followed up with a hard copy given to the pharmacist. Each prescription must be hand-signed by the prescribing doctor, called a “wet” signature. Compared to a refillable C-III prescription, each C-II prescription is a one-time deal requiring a new prescription every time. You must go to the doctor or have the prescription mailed to you or to the pharmacy every time you run out and need more because there are NO refills allowed, ever.
Each C-II prescription must be a hard copy with a wet signature, every time, no exceptions. This cranks the hassle factor for prescribing hydrocodone WAY up, which is exactly what the DEA and the FDA want. They’re counting on this increased hassle factor to discourage Vicodin® and hydrocodone use and slow the epidemic of prescription drug abuse. Changing This is going to be a HUGE change affecting most areas of our medical care system because Vicodin® and its generics have been the most prescribed medicine in the United States for the past 10 years.
While many pharmacists have doubts that restricting Vicodin® will reverse the epidemic of prescription drug abuse, what we can guarantee is that there will be a lot of confusion and delay in filling prescriptions for hydrocodone combination products (HCPs), especially at first. Some predict that Tylenol with Codeine (Tylenol #3) will regain popularity with physicians and dentists because by staying C-III it is refillable and can be faxed or called into a pharmacy.
After October 6th, 2014 pharmacists won’t be able to honor refills on any new prescriptions containing hydrocodone. However, if you have a current prescription for a HCP written before October 6th, it will be “grandfathered” in and any remaining refills will be honored until its 6-month expiration date. More information about the upcoming decision by the DEA and FDA is available at

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