toxicology

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Cautionary Tale: Vomiting Bouts And False Positive On Urine Test For Pot

Hollis Tufts, the teen who tested positive -- incorrectly -- for cannabis use in a cautionary tale published in the journal Pediatrics (Courtesy of the family)

Hollis Tufts, the teen who tested positive — incorrectly — for cannabis use in a cautionary tale published in the journal Pediatrics (Courtesy of the family)

The title got me: “13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire.”

What pot? What fire? Oh, dear, recurrent vomiting. What troubling case report was this, in this week’s Pediatrics journal?

The case, written up by Dr. Diana Felton of Boston Children’s Hospital and colleagues, was indeed troubling, but also instructive, on two counts:

First, its main lesson: a medication for gastrointestinal problems — a proton pump inhibitor called pantoprazole — can cause a false positive result on a urine test for marijuana use.

And second, though marijuana is generally known to have anti-nausea effects, it has been increasingly recognized over the last decade that heavy, long-term use can bring on cycles of vomiting, a phenomenon called Cannabinoid Hyperemesis Syndrome. (It can also bring on compulsive bathing in hot water. I know. Sounds crazy. But I’m not making it up. More on that later.)

She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”

Dr. Felton and colleagues write that as the use of organic and synthetic cannabinoids — pot-like compounds — increases, “the number of patients with Cannabinoid Hyperemesis Syndrome will surely grow.”

Now to their tale. The patient was a 13-year-old Massachusetts girl who suffered from recurrent bouts of vomiting, a condition known as Cyclic Vomiting Syndrome. She was on her fourth bout of vomiting in six weeks when she was brought in to the Emergency Department, retching.

Hit by a stroke while still in the womb, the girl could not speak, and had been hospitalized repeatedly for such vomiting attacks. This time, among other tests, “the treating physician opted to send a urine toxicology screen to evaluate for possible Cannabinoid Hyperemesis Syndrome.” It came back positive for cannabinoids. Social services got involved. A protective order was filed.

“Given the patient’s severe physical and developmental limitations, it was clear that she was unable to access or administer the cannabinoids herself,” the paper says.

Let’s just pause for a moment to put ourselves in the place of the patient’s parents. I imagine myself exploding: “So you’re accusing us of giving our disabled daughter so much pot that it made her throw up? Are you out of your mind???”

Not too far off, says Jessica Tufts of Topsfield, whose daughter, Hollis, now almost 15, was the patient in the paper. She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”

“They bring me into a room and they say, ‘We just wanted to let you know that Hollis has tested positive for cannabinoids,” she recalls. “I said, ‘How on earth could she be getting it? We don’t smoke it. We don’t cook it. We never even touched it. So how is she getting it?’ I flew into a panic because she can’t say, ‘Somebody at school is feeding me pot brownies or whatever.’ We were trying to figure out all the points of contact that could possibly explain it.”

And, “We got progressively more terrified, because, as the mom of a child who’s going to be limited all her life and can’t tell you what’s going on, your worst nightmare is that some caregiver who is out of your control has done something to her.” Continue reading

Real Health Risks In That Iconic Pepper Spray Image

Yes, my bet is that when the time comes to pick the defining image of 2011, the U.C. Davis pepper spray cop photo by student photographer Brian Nguyen will be it. (I can’t post it here because the rights are reserved, but the YouTube version is above, showing a uniformed officer streaming the orange pepper spray into the faces of seated protesters on no visible provocation. The Atlantic has the photos here.)


Megan Garber of the Nieman Journalism Lab does a superb job here of summing up the power of that image and its possible effects on the Occupy movement. (The post also includes some of the black humor that has sprouted around the image on the Internet, including one caption that reads, “Didn’t you hear? Pepper spray is a vegetable now.”)

In case you hear “pepper” and think of benign sprinkles on mashed potatoes, Deborah Blum, a Pulitzer-winning science journalist, sets you straight here on the Speakeasy Science blog. Deborah delved into toxicology for her latest book, “The Poisoner’s Handbook,” and shares a central lesson: “The dose makes the poison.”

We might hear “pepper spray” and think of the mild discomfort of a jalapeno, but she points out that on the widely used “Scoville Scale” of a pepper’s burn, where eating-peppers might rate in the hundreds, the police pepper spray would rate in the millions.

“It may be time to demand a more serious look at the risks involved,” she writes, citing recent papers on potential health effects. They include permanent damage to the cornea from repeated doses, and exacerbation of allergies, among others. She writes: Continue reading