Toxicology, medical education, & more

Just What the Doctor Ordered

I launched Acri Muller Consulting 7 ½ years ago. Time has flown by. Despite that long stretch of time, this summer was the first time I took a long trip and really unplugged (no working on the road). I’ve had time away here and there, but have always at least kept up with email. Not this time. And it felt amazing. (Just what the doctor ordered!)

I took a road trip with my daughter on the Pacific Coast Highway, San Francisco to Santa Barbara. A few years ago, I made a similar trip, but it was from Los Angeles to San Francisco over only 4 days. I decided to drive less miles over a longer period of time (plus going south was nicer since you’re driving right along the coast instead of one lane over). My daughter and I have memories from this trip that we will always treasure.

Janet Falk, PhD did a LinkedIn post on how to craft your “out of office” message. She summarized some great tips, including to let clients know how to reach you in the event something cannot wait until your return. For this trip though, cell service was spotty (#BigSur) so that made pre-trip office organizing even more important. I made sure clients with very active cases or projects knew ahead of time that I would be 100% out of the office. As hard as it is to do when you are a “company of one”, I definitely won’t wait 7 ½ years for my next true vacation!

#consultantlife #worklifebalance

Cannabidiol (CBD)

“CBD” and you. Perfect together? Maybe. Are you getting a drug test anytime soon? Is your legal client? As a toxicologist, I’m not here to give you my opinion on how well non-prescription CBD works for pain, anxiety, etc. (or how well it doesn’t work). I’ll leave that to the naturopathic doctors and pharmacists who specialize in this area. I will, however, give you some information to better understand how non-prescription CBD can affect drug testing results.

Over a hundred compounds known as cannabinoids are in the Cannabis sativa plant (marijuana and hemp are two varieties of this plant). Tetrahydrocannabinol (THC) is one of the cannabinoids in Cannabis sativa, and its concentration varies depending on if the plant is a marijuana plant or hemp plant (< 0.3% THC). THC is a psychoactive cannabinoid, but just like the dose makes the poison, the dose makes the high (the amount of THC in hemp plants is too low to produce a “high”). CBD is another cannabinoid from the Cannabis sativa plant, but it is not psychoactive.

There are three types of CBD products: full-spectrum (contains many cannabinoids plus THC; however, since it’s from the hemp plant, the amount of THC “should” be minimal); broad-spectrum (contains many cannabinoids but “should” not contain any THC); and CBD isolate (contains no cannabinoids other than the CBD). Keep in mind that distributors of non-prescription CBD are not required to show consistent concentrations from batch to batch (although some distributors do take extra steps to do so). This is why I said “should” when describing the THC content of CBD products. (Note that there is a prescription form of CBD indicated for a specific type of pediatric seizure disorder. The FDA regulates that product, unlike non-prescription CBD formulations, which are not considered drugs.)

Drug tests for marijuana use look for THC (active parent drug) and/or THC metabolites (ie, breakdown products) in the blood or urine. Patients using a CBD product may test positive for marijuana use depending on how much THC is in their CBD product, the minimum detection threshold of the drug test, how efficiently they metabolize and eliminate THC, and how often they use the product. I’ve encountered situations where someone is using CBD, not marijuana, and tests positive for marijuana use. But wait…CBD isn’t “marijuana”, and there wasn’t a “high”. So why did the CBD-user test positive? This is because the CBD product contained THC in some quantity, and although not enough to give a “high”, it was enough to trip a drug screen. CBD users need to be aware of this if they are subject to drug testing for employment, custody dispute resolution, or otherwise. 

#cannabis #cbd #employmentlaw #divorcelaw #expertwitness

Beach Trip: Leave the Benzene at Home

Fun in the sun? Don’t forget your sunscreen. But leave the benzene at home! Yes, I’m talking about the recall by Neutrogena, et al (https://lnkd.in/eeZ4t-Q). There are trace amounts of benzene in some of their aerosol sunscreens. Benzene sounds scary. It is. It’s a human carcinogen. Meaning? It can cause cancer. Now, the dose makes the poison (how many times have you heard me say that?). But “trace amounts” add up! We are exposed to benzene on a daily basis via inhalation, ingestion, and yes, via skin. Even though the amount in these products is “very low”, I agree with the advice to throw out these products. Why add to your daily benzene exposure? For this fair-skinned tox doc who wears sunblock to get the mail, it’s back to the drawing board on finding a safe (safer!) sunblock. 

#toxicology #benzene #sunscreen #expertwitness

Using a Natural Product? Educate Yourself

Natural products. Herbals. Nutraceuticals. Supplements. Different terms for the same thing (homeopathic preparations are a bit different). The term “natural” makes patients feel safe and secure, like they’re doing something good for their health. As a toxicologist, there’s always a scary story to tell. Think of this as food for thought: natural does not automatically mean safe. Opium (natural: from the opium poppy plant); digoxin (natural: from the foxglove plant); cyanide (natural: in many fruit seeds). You get the picture. But to me, patients thinking “natural means safe” is not the biggest issue with natural products. The problem is that it can become the wild, wild west, and patients can be harmed. Snake oil, anyone? When evaluating if you should take a natural product, get curious. What testing is done by the manufacturer? Remember, efficacy and safety testing are not required - the FDA does not consider natural supplements to be drugs, although they can have very real pharmacologic effects. Not to say FDA-approved drugs cannot cause harm, but that is a post for another day.

Here are some things to consider when deciding to take a natural product or if you’re an attorney with a case that in some way involves a natural product. Is the manufacturer making health claims? That’s a no-no for labeling of these products (and relates to cases I’ve been consulted on as an expert witness). The labeling is allowed to state: “supports the immune system” (or any other body system). But the label cannot say “treats COVID-19 infection”. See the difference? After you’ve done some research on the company, checked for quality assurance testing (if any), and made sure the label is compliant, what’s next? Make sure the natural product does not interact with any medications (research this and ask your prescriber or pharmacist) or has the potential to worsen any medical condition. For example, if you have an autoimmune disease, you should not take a natural supplement that revs up your immune system.

Another consideration when it comes to natural products: adulterants: things thrown in the mix but aren’t on the label - they may even be harmful contaminants or actual prescription drugs. What? Viagra is in there? A liver toxic compound? (know what manufacturers you can trust - research, ask questions, consult a naturopathic doctor). Adulterants in such products are another issue where I’ve been consulted as an expert witness. And finally, even if there is a case where harm may, or may not, have been done to a patient due to medications, look at what natural remedies may be in the mix. They may have played a role and that can shed light on the patient’s clinical course. #naturalproducts #naturalmedicine #toxicology #expertwitness #herbalmedicine

Food-Borne Toxins: Unwanted Dinner Guests

Food poisoning. What are the first things that come to mind? That’s right…one bucket, maybe two buckets (vomiting and diarrhea, that is). Not all food poisoning is that simple though. Some food-borne toxins can cause neurological symptoms and even death. (Toxicologists are always ready to share scary news) But remember…common things are common (and those last 2 are not, thankfully).

After what I suspect is a food-borne illness in a family member this past weekend, I wanted to post some pearls about food-borne illness. This is for you picnic-goers as well as attorneys thinking about current or upcoming cases related to food poisoning.

It is difficult to tease out food-borne illness symptoms from those of other illnesses (such as gastroenteritis). But there are a few clues. The typical “24 hour stomach bug” is often a food-borne illness. That fast and furious “bug”, sometimes accompanied by a high fever and lots of “fluid losses”, has food poisoning written all over it. I say “probably” because without laboratory testing for the organism, we don’t know. This is almost never done. Why? Because the symptoms in your run-of-the-mill “food poisoning” episode are miserable, but fortunately usually short-lived (so no reason to get labs). That being said, I have yet to see food itself tested in such cases to prove the source of food poisoning.

The other clue that an illness is due to food poisoning is a story of numbers. Who else ate the food? And did they all get sick? This is not a slam dunk as sometimes one person may eat a portion with less bacteria. For example, my significant other and I shared a salad with chicken. Several hours later, he was ill. I was not. Does that mean it wasn’t food poisoning because I didn’t get sick? Not necessarily. He may’ve eaten a piece of chicken with the “X” on it, so to speak, while I didn’t.

So there are 3 clues (but not definitive ways) to put food poisoning higher up on the list of diagnoses when there are fever, vomiting, and diarrhea: illness lasts for 24 hours or less; others who ate the same food also got sick; and timing (the illness is not immediate. It takes a few hours, maybe even takes a couple of days to show up after eating the suspicious food). With that, keep these tips in mind from a toxicologist: keep hot foods hot, and cold foods cold; if in doubt, throw it out; and fish should smell like…”almost nothing” (if it smells strong, it’s rotting). And pack those ice packs for your summer picnics.

For further info on safe food handling and storage for meat, poultry, or egg products, call the USDA Meat and Poultry Hotline toll free at 1-888-MPHotline (1-888-674-6854). #foodborneillness #toxicology #foodsafetymatters