For centuries, multiple civilizations have used cannabis to treat various medical conditions, including seizures. This week researchers from NYU Langone’s Comprehensive Epilepsy Center found a chemical in marijuana to do just that.

A study published in the New England Journal of Medicine found that a liquid medication containing cannabidiol, one of the many chemicals in marijuana, reduced convulsive seizures in children by half.

Created by GW Pharmaceuticals, Epidiolex, brand name, was the drug used in this study and has not yet received FDA approval.

As opposed to THC, tetrahydrocannabinol, the psychoactive ingredient in marijuana, cannabidiol does not cause euphoria and has been the subject of many studies for its medicinal applications.

In this study, researchers tested 120 children with Dravet’s syndrome and found those given Epidiolex not only suffered less seizures, but 5% of the children were seizure-free during the 14 week trial.

Side effects, however, were reported such as fatigue, vomiting, diarrhea and anorexia (loss of appetite).

What is a seizure?

 

A seizure occurs when there is abnormal electrical activity in the brain.  If the electricity doesn’t conduct properly, brain function gets disrupted. This could lead to convulsions  (involuntary jerking movements), loss of muscle tone, changes in senses such as vision, hearing and smell, loss of bladder control, loss of consciousness and sometimes stroke, brain damage and death.

What is Epilepsy?

 

Epilepsy is a neurological disorder in which a person has recurrent, unprovoked seizures.

What is Dravet Syndrome?

 

Dravet Syndrome is a rare genetic condition that starts in infancy.  Children can suffer a variety of seizures and may eventually suffer from developmental delay and learning disorders.  What makes Dravet Syndrome so severe is the fact that the seizures are refractory to many anti-seizure medications.

 

 

More research needs to be done in this area, but these preliminary findings give parents and the medical community hope that a pharmaceutical option could exist in the near future for these devastating and potentially fatal seizures.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in News & Information

Multiple states in the US currently allow recreational marijuana or medicinal use of cannabis and multiple more states may be following suit in upcoming elections.

Even those who support the legalization have concerns over driver safety and how to determine if one is impaired.

Breathalyzers are currently being developed and tested but are not ready for roadway spot checks.  Moreover, breathalyzers may have difficulty accurately detecting both inhaled and ingested marijuana.

California law enforcement officers are piloting road-side saliva tests but objective data is still lacking regarding the accuracy of oral fluid tests.

Currently when law enforcement tests an impaired driver for marijuana use, a urine test can be performed which only looks for a metabolite called THC-COOH.    Despite its abbreviation it is a non-psychoactive component of marijuana, as opposed to delta-9-tetrahydrocannabinol (delta-9-THC), which does cause euphoria.  Hence the shortcoming to this testing method are twofold, as the non active THC-COOH isn’t even the correct metabolite to measure intoxication and it can linger in the body for weeks, hence not allowing an adequate quantitative measure to determining one’s impairment.

Two medical students, however, figured out what needs to be tested and how.  Graham Lambert and Charles Cullison, both entering their third year at Touro University Nevada, performed research for an American College of Legal Medicine (ACLM) poster contest.

One of the lead researchers and osteopathic medical student Graham Lambert said, “This is an issue because it’s non-psychoactive. It stays in the body for long periods of time, long after any psychoactive effects.” Their research lead them to conclude that testing should instead look for an alternate THC metabolite, 11-OH-THC.

Why?  Let’s break this down.  Now both delta-9-THC and 11-OH-THC are psychoactive compounds that can be tested in the blood.  However law enforcement has to determine whether euphoria was present and a factor in one’s unlawful driving.  Both delta-9-THC and 11-OH-THC crosses the blood brain barrier, a semi-permeable endothelial cell barrier that helps decide what substances can enter and leave the brain.  But 11-OH-THC’s is more readily active and can bind to the brain’s cannabinoid receptors tighter, lasting longer and causing more of a psychoactive effect.

Additionally, 11-OH-THC is a metabolite also seen in high quantities after ingesting marijuana edibles.

 

 

IMAGE FROM SAPAINSOUP.COM

 

In 2012, Sharma et al found the 11-OH-THC to last twice as long in the blood than delta-9-THC, which would make sense due its strong binding properties.  Yet the psychoactive 11-OH-THC will rapidly be metabolized to an inactive form hence its presence on a test will signify activity rather than just “hanging around”.

Once Lambert and Cullison determined this, they went to Assemblyman Steve Yeager, D-Las Vegas, who is Chair of the Assembly Judiciary Committee.  Yeager helped sponsor a bill, AB135 that would convert marijuana testing for drivers from the inaccurate urine test to a blood test that would look for specifically 11-OH-THC.

Also lead researcher and osteopathic medical student, Charles Cullison said, “Blood alone accurately shows the levels of hydroxy (11-OH-THC) and marijuana.”

In regards to getting the bipartisan law passed through the State Senate with a “Veto-less” majority,  Cullison stated, “We couldn’t have done this without the help of many people.”

After Nevada lawmakers passed AB 135, Governor Brian Sandoval signed it into law. The antiquated urine testing will not be used to test drivers pulled over for possible DUI but a blood test instead.

 

The legal limit of marijuana that is measured in nanograms per milliliter ng/ml would be 2 ng/ml for delta-9-THC and 5 ng/ml for 11 Hydroxy-THC.  This does not change with passage of AB135, nor do the circumstances surrounding when to test, as current protocols are in place once a person fails his sobriety test.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in News & Information
Wednesday, 24 May 2017 19:58

Allergies to Marijuana on the Rise

In 2015 Dr. Thad Ocampo and Dr. Tonya Rans published a paper looking at cannabis allergies that ranged from eczema to asthma to anaphylaxis.

 

Daily Mail now reports 36 million Americans could be allergic to marijuana, stating 73 percent of the 50 million people who react to pollen also have issues with cannabis – and the figure is rising. This comes as no surprise as marijuana is a plant that carries pollen. Those exposed to second hand cannabis may be at risk as well. In 1971, a 29 year old woman claimed to have smoked marijuana for the first time when she went into a full anaphylactic reaction, being unable to breath.

 

Cannabis sativa is one of the more common strains of cannabis used and its hypersensitivity could cause one to have any of  the following:

 

Cough

 

Sneezing

 

Wheezing

 

Rash

 

Itch

 

Hives

 

Runny eyes, conjunctivitis

 

Difficulty breathing

 

 

indica-vs-sativa-06-191-720x340.jpg

 

Image from Positive Vibrations

 

Cannabis indicia is the other more common strain, whose leaves are wider and may pose allergic risks as well. Dr. Ocampo and Rans also discusses cannabis seed encrusted seafood which caused an anaphylactic reaction in a patient who was not allergic to seafood.

 

EpiPens could provide support for those suffering reactions and may need to be on hand for those who smoke or are exposed to marijuana smoke.

 

Allergic reactions occur when an allergen enters the body and the immune system tries to reject it. This defense mechanism, however, could cause many symptoms, including bronchoconstriction, preventing one from being able to breathe.  EpiPens provide epinephrine opening up the bronchioles and therefore allowing air exchange.

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

 

Published in News & Information
Monday, 22 May 2017 17:15

Caffeine Can be a Killer

In April, a South Carolina high school student collapsed in class and later died.  The coroner’s report, revealed this week, cited caffeine as the cause.  The caffeine induced a cardiac arrhythmia, abnormal heart rhythm,  and 16-year old Davis Allen Cripe tragically died within an hour.

What’s shocking is the amount of caffeine he ingested was not very high.  According to Richland County Coroner Gary Watts, Cripe drank, within a two hour period, a large Mountain Dew, an energy drink, and a cafe latte from McDonald's. The teen had no medical problems or family history of heart issues.

A large Mountain Dew contains 54 mg per 12 fluid oz.  So a 20 oz drink would be close to 100 mg caffeine.

Energy drinks, depending on the brand, contain approximately 80 mg of caffeine per can.

A cafe latte from McDonald's, medium size, contains 142 mg of caffeine.

This in total would equal approximately 320 mg of caffeine ingested within a two hour period.

The lethal dose of caffeine in adults range from 150-200 mg/ kg body weight.  So a 70 kg adult could consume a toxic level of caffeine at 10 grams (10,000 mg).

So 320 mg of caffeine is well below the toxic level.  But what caffeine could do could be the more dangerous part.

Caffeine has been known to induce arrhythmias.  It’s a stimulant, hence it can affect the heart’s electrical conductivity that manages the organ’s pumping  action.  Once the electricity is disrupted, the heart muscle fails to have a predictable, rhythmic stimulation, hence cannot pump effectively.

Caffeine also causes vasoconstriction, so blood flow to the heart could be compromised, potentially inducing a heart attack.

In 2014, researchers from Barcelona found energy drinks to be linked to rare cases of heart attack and arrhythmia.

A cup of coffee averages 95mg of caffeine whereas an energy drink contains 80mg.  But the latter is consumed much quicker than a hot cup of Joe that needs to be sipped, hence the consumer takes in a larger load of caffeine in a shorter amount of time.  This could be too much too fast for the heart.

The following is a chart of average caffeine content in common drinks:

 

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (all Central times) at GCN.

 

Published in News & Information
Wednesday, 17 May 2017 19:39

Vaping Linked to Bladder Cancer

Dr. Sam Chang of Vanderbilt-Ingram Cancer Center in Nashville, reported in an American Urological News release, “We’ve known traditional smoking raises bladder cancer risk, and given the surge in popularity of e-cigarettes, it’s imperative we uncover any potential links.”

Chemicals in cigarettes and electronic cigarettes, such as nicotine, are excreted through the urine. Researchers examined the urine of e-cig users vs. those of non-smokers and found 92% of those who vaped had at least two of the five chemicals tested.

The University of Minnesota in 2015 identified chemicals commonly found in e-cig vapor to include:

Formaldehyde (human carcinogen)

Acetaldehyde (carcinogen related to alcohol drinking)

Acrolein (highly irritating and toxic)

Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)

Metals (possible carcinogens and toxicants)

In a second study, researchers looked at bladder tissue to see what nicotine and some of the chemicals in vapor could do. They found nicotine, nitrosamines and formaldehyde not only damaged lining but blocked the DNA repair, hence increasing risk of bladder cancer.

Although exact causes of bladder cancer are unknown, tobacco smoke has been the single greatest risk factor.  Other risk factors for bladder cancer include diets rich in fried foods, arsenic, radon, occupational exposure to aromatic amines in textile, rubber and paint plants, and some medications such as pioglitazone used in diabetes. Being exposed to a worm causing schistosomiasis can also put one at risk for bladder cancer.

Symptoms of bladder cancer include blood in the urine (hematuria), difficulty urinating due to obstruction, pain/burning with urination (dysuria), and sometimes no symptoms at all.

Bladder cancer is treated by surgery, radiation, chemotherapy or immunotherapy.  The earlier it's diagnosed, the easier it is to treat.

According to the American Cancer Society they project for 2017:

  • About 79,030 new cases of bladder cancer (about 60,490 in men and 18,540 in women)

  • About 16,870 deaths from bladder cancer (about 12,240 in men and 4,630 in women)

How many of these being related to electronic cigarettes is unknown.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

Published in News & Information

Three people have died, and nineteen suspected to be infected with Ebola in the Democratic Republic of Congo (DRC).  The World Health Organization (WHO) has confirmed the outbreak of Ebola after receiving reports of a cluster of cases.

The first case occurred April 22nd when a 39 year old symptomatic male traveled a great distance to reach a medical facility who tested him for Ebola.  By the time the results came back he was deceased and had exposed multiple people who assisted him with his travel and then medical care.  According to the CDC, six others had fallen ill in the same village and were taken care of by individuals who most likely did not wear protective gear.

The DRC had not seen any cases since 2014.  The West African Ebola epidemic spanned  from the end of December 2013 to 2016 infecting over 28,000 people and killing over 11,000.  The epidemic was one of the worst in Ebola’s history and its high mortality rate took countries such as Sierra Leone, Guinea, and Liberia by surprise. A vaccine was not available, and medications such as Zmapp were experimental and not in great supply.  Hospitals were not stocked with protective clothing able to prevent the minutest of exposure to the deadly virus.  Travel bans were difficult to institute and top that off with a lack of education on what we were dealing with and it was unfortunately the perfect storm for one of the deadliest outbreaks in recent history.

Ebola however emerged far before this.  Ebola was named after the Ebola River in Zaire and was first recognized in 1976 when it caused two outbreaks affecting 318 and 284 people respectively .  Multiple small outbreaks occurred since then according to the CDC:

1995           Democratic Republic of Congo          infected 315

2000           Uganda                                             infected 425

2007          Democratic Republic of Congo           infected 264

And multiple smaller sporadic cases occurred in the years between.

In January 2016 health officials declared the Ebola outbreak had ended, however cases continued to smolder.

Why this occurs is the virus may not leave the body completely.  Its been found to live in semen up to a year and some survivors can suffer a reinfection months later.  For example, in 2015 Dr. Ian Crozier successfully fought Ebola but two months after discharge, suffered a severe eye infection which turned out to be Ebola lurking in his eye.

A study in 2015 found Ebola be able to survive outside a human body for days and longer if within a liquid such as water or blood.   Mosquitoes are not known to transmit the virus however it can live in bats as well as monkeys and apes.  Pets have not been known to contract Ebola from  their sick owners put its been postulated that pigs could if in contact with a victim.

Ebola is a virus from the Flavivirus family that causes a hemorrhagic fever with symptoms of sudden fever, myalgias, headache and sore throat and then progressing to nausea and vomiting, liver and kidney issues and internal and external bleeding.

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

 

 

Published in News & Information

In a study published in the journal Nature Medicine, researchers from Hebrew University and the University of Bonn discovered that daily marijuana use could help prevent the “slowdown” that occurs in our brains as we age.

 

THC, tetrahydrocannabinol, the main psychoactive ingredient in cannabis, was found to boost memory and learning, cognitive function, in older mice.

 

In the study, researchers gave THC daily to groups of mice who were 2 months old, one year old and 18 months old. Then the mice solved a water maze.  The older mice who were not given the THC  had difficulty recognizing familiar objects and navigating  the maze. But those who were given THC scored similarly to younger vibrant mice, and did so for a month after the dosing stopped.

 

Now the younger mice given the THC appeared to score poorly compared to younger mice not given the THC. The study authors believe the THC is stimulating the brain’s endocannabinoid system, which is a biochemical pathway that slows down with aging.

What is the Endocannabinoid System?

 

It’s a system within the brain and spinal cord and peripheral nervous system with receptors that help regulate a variety of actions including memory, mood, appetite, and pain.  The body makes its own “cannabinoids” which work at the synapse where neurotransmitters are released.  Our own cannabinoids (endogenous cannabinoids, hence endocannabinoids) help regulate what is being neurotransmitted.  Exogenous (outside) THC that is inhaled/ingested competes with a body’s own cannabinoids for these receptors causing changes in what signals get released.



This isn’t the first time marijuana has been found  to improve brain health.

 

Previous studies found cannabis to increase brain-derived neurotrophic factor (BDNF) protecting brain cells and stimulating new cell growth. In 2008 a study in mice found THC to improve memory in older rats as well as decrease brain inflammation.

 

However in 2016 a study published in Nature found cannabinoids to activate CB1 receptors within the mitochondria of hippocampal neurons, which resulted in memory loss.  Their study suggested that chronic use of marijuana permanently affected the brain cell’s mitochondria, thereby causing long term memory loss.

 

So is marijuana good for the brain or not?  Studies in mice conflict however, researchers are slowly narrowing down why it helps and why it hurts.  Give it more time before placing any bets….

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

 

Published in News & Information

We commonly think of DUI’s, or Driving Under the Influence, a result of drinking alcohol and driving while intoxicated.  However what many people fail to realize is drugs, including prescriptions, could decrease your ability to drive safely, hence putting you at risk for a DUI when alcohol wasn’t even ingested.

 

A report from the Governors Highway Safety Association (GHSA) and the Foundation for Advancing Alcohol Responsibility found that more fatal crashes were the result of drug use as opposed to alcohol use.

 

These findings showed that although alcohol was involved in 37% of fatal crashes, prescriptions and illegal drugs were responsible for 43% of driver- related deaths. Looking deeper into data available from the National Highway Transportation Safety Administration (NHTSA), they found 36.5 % of drug related fatal car crashes were the result of marijuana use.

 

Now what about prescription drugs?  California Vehicle Code 23152(e) states, “It is unlawful for a person who is under the influence of any drug to drive a vehicle.” So what prescription drugs could impair one’s driving?

 

The obvious ones include the following:

 

Narcotics such as hydrocodone, oxycodone, morphine, codeine…to name a few

 

Muscle relaxants such as carisoprodol, cyclobenzaprine, methocarbamol……

 

Sleep aids such as zolpidem, eszopiclone….

 

Anti-anxiety medications such as diazepam, lorazepam, alprazolam, clonazepam…..

 

However surprisingly, these next groups of medications can also cause sedation:

 

Cholesterol medications such as statins:  lovastatin, atorvastatin, etc. may cause fatigue and recent studies have found them to cause “excessive tiredness”.

 

Stomach acid suppressants such as proton pump inhibitors:  omeprazole, lansoprazole have been reported to cause vitamin deficiencies such as B12 and magnesium which in turn can cause fatigue.

 

Antibiotics that treat many common infections:  Amoxicillin, azithromycin, ciprofloxacin have been known to cause fatigue.

 

Diuretics for blood pressure and water retention:  hydrochlorothiazide, furosemide cause potassium loss in the urine which may contribute to fatigue

 

Antihistamines:  anti-allergy medications such as diphenhydramine (Benadryl) are very sedating, which is why they are used in some over the counter sleep aids.  There are some reports that the younger generation of medications such as Zyrtec can cause drowsiness as well.

 

Blood pressure medications:  these can include the ACE inhibitors such as captopril, enalapril;  calcium channel blockers such as amlodipine; beta blockers such as metoprolol as well as the diuretic family mentioned previously.

 

Antidepressants: many antidepressants additionally help with anxiety through their sedating effects such as trazodone, paroxetine, and escitalopram to name a few.

 

Mood stabilizers, anti-seizure medications, and antipsychotics can cause fatigue as well.

Despite the rarity of these types of cases, the potential is still there for one to not only receive a DUI but injure himself or others if the prescription makes him less alert, i.e. decreases his “sobriety”.  Discuss with your medical provider if you feel drowsy after you take your medication and if there are less sedating options.

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

 

 

Published in News & Information

The 56 year old actress was receiving chemotherapy and radiation treatment for throat cancer.

A statement released by her husband, Steve Fleischmann, revealed she had back in 2016 woke up noticing a small amount of blood on her pillow case thinking she had bitten her tongue.  A biopsy later revealed she had squamous cell carcinoma on her left tonsil. The cancer eventually spread not allowing her to eat or drink and she required a feeding tube.  This week she died peacefully at home in bed next to her husband and the coroner revealed the cancer had spread to her spleen and brain.

 

According to Erin Moran’s costar, Anson Williams who played Potsie, “She kept very quiet”……”We all kept quiet too, out of respect for Erin. She couldn’t speak, but her texts were very [positive].”

What is “Throat Cancer?”

The throat, pharynx, is divided into three parts.

Nasopharynx – above the soft palate, the upper part of the throat behind the nose

Oropharynx – between the soft palate and the epiglottis, the middle part of the throat including the back wall, sides, tonsils and posterior 1/3 (back) of the tongue.

Hypopharynx – the lowest part that leads to the esophagus and larynx (voice box)

Cancer in any of these anatomical sections can be considered “throat cancer”.  Cancer of the larynx (voice box) is called laryngeal cancer and is considered separate from hypopharyngeal cancer.

Esophageal cancer is cancer of the esophagus (gullet) and is considered separate from “throat cancer” as well.

 

What are the symptoms of throat cancer?

Symptoms of throat cancer include:

  • Chronic sore throat

  • Hoarseness

  • Voice changes

  • Chronic cough

  • Difficulty swallowing

  • Painless lump in the neck

  • Neck Pain

  • Ear Pain

  • Weight loss

 

to name a few.

What are the risk factors?

Risk factors for throat cancer include:

  • HPV (Human Papillomavirus) – causing rising rates of especially oropharyngeal cancer

  • Epstein Barr Virus – related to increased risk of nasopharyngeal cancer

  • Tobacco Use

  • Alcohol use

  • Gastroesophageal reflux disease (heartburn)

  • Poor diet, especially lack of fruits and vegetables

How is throat cancer treated?

 

As one can see by the list of symptoms, throat cancer often gets mistaken for common cold symptoms.  Unfortunately, by the time throat cancer is diagnosed, it has reached a more advanced stage.  Depending on where the cancer is located, various treatments can be instituted including surgery, chemotherapy, radiation, and targeted drug therapy.

Which famous people battled throat cancer?

 

Celebrities who succumbed to throat cancer include:

 

Sammy Davis Jr., age 64

Michael Crichton, suspected throat cancer, age 66

President Ulysses S. Grant, suspected throat vs. esophageal cancer, age 63

Bob Denver (Gilligan’s Island), age 70

Carl Perkins, age 75

 

to name a few.

 

In 2010, Actor Michael Douglas successfully battled “throat cancer” that originated from a tumor at the base of his tongue.

 

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

 

Published in News & Information
 

Multiple countries use vending machines that offer free syringes and needles to drug users, but this resource will be the first in the United States to help curb the spread of disease in IV drug users.

The machines will be offered and run by the Southern Nevada Health District, Nevada AIDS Research and Education Society and Trac-B Exchange.  Dr. Jerry Cade, who co-founded University Medical Center of Southern Nevada’s HIV clinic, said, “There’s zero downside and lots of pluses.”

Many health agencies, including the World Health Organization (WHO) recommend offering clean needles to users (200 sterile needles and syringes per drug injector per year).  Offering free needles has not been proven to incite or increase drug use, and “clean needles” will allow users, victim to their addictions, a safer way to inject without being exposed to HIV, hepatitis C and other blood borne pathogens.

Each kit is free and users can receive one twice a week.  Each kit contains the following:

  • 10 syringes

  • a tourniquet

  • a disposal container for used syringes

  • alcohol swabs to clean the skin prior to use

  • Bandages

  • an information sheet about where one could go for addiction treatment.

In order to use the machine, users must “register” without the requirement of giving personal information.  Once registered a card with a code is given that allows access to the machine.

The machines will be located at AFAN (Aid for AIDS of Nevada), the Community Counseling Center and Trac-B on West Charleston Blvd.

The initial steps could deter some from coming forward to use the machines, but many who use IV drugs WANT to get help and prevent further medical complications.  The outreach this provides, offering help to those who are addicted, is a huge step in our fight against heroin overdose and infectious disease spread.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.

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