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  -  | |   !  || <    :|. _ //.| 0 | /|: |*| | | A  | || ||:
  =  \*/   +  ||  /     | =|\ |. 0 |. \  | : | | a || | V | >===
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~-=           |`.   `"  ~    `~  u      '   V     |__|  V  .====|

<- Back to 2006.03.09.

Via e-mail, several individuals provided responses paraphrased
below.  Certain measures were taken to protect the innocent, and
to make me look good.

>All opiods have the property of respiratory suppression (of
>which one useful property is cough suppression).
>Dextromethomorphan (as in Robitussin "DM") is an opiod

No, it's a dissociative tranquilizer whose effects are primarily
mediated through the NMDA receptor.

>but retains its useful property of suppressing cough.

Neither opioids nor DXM have any selectivity for cough.


I did some research on acetaminophen, and found no reason to
believe my recommendations would be harmful.  I also didn't find
any support for my claim that Tylenol is better than Advil for
fever.  I still suspect I'm right, but I pulled that section of
my post anyway.

Two studies I saw found them to be equally effective at reducing
fever in young children.  In any case, it isn't the strength of
the anti-fever effect that's the risk factor for Reye's syndrome.
That's a special problem with Aspirin.  Ibuprofen is now approved
for children -- I didn't know that.

>As to the analgesic effects of assorted OTC medication
>including NSAIDs, they all have roughly the same analgesic
>effects, probably because, unlike opiods, they exhibit a ceiling
>effect -- after a certain dose additional drug will not provide
>any additional analgesia.

I agree.  But I wouldn't want to take the amount of Aspirin
required to give the relief 400mg ibuprofen does.


>I myself am one of the chicken noodle types.

Getting good nutrition while sick is super-important.  Chicken
broth has very digestible protein and stuff in it, and hot fluids
can help clear the head.

>Sudafed is definitely a better first-line agent

I don't know if patient outcomes have ever been studied with
Sudafed, but they definitely don't improve and almost certainly
worsen if it's taken long enough.  Epinephrine is clearly immuno-
suppressive -- since it's adrenergic, it shuts down sexual,
immune, and (whaddya know) digestive function.

I titled my post "Curing..." because I have something I think
improves outcomes for rhinovirus infection.  Of course this
should be studied, but since there's "no established medical use"
of cannabis (which isn't even true, since there are FDA-approved
antiemetics based on cannabinoids), it's very hard to do studies
to establish any.

>given its [THC's] side-effect profile

What side-effects are you referring to?  The only thing I can
think of is that in some cases it appears to suppress imumne
response -- in one Canadian study, it seemed to stop macrophages
from destroying lung tissue in response to smoke.  Which, it was
suggested, accounted for the less-than-expected lung damage
observed in pot smokers.  Overall it's not understood.  All
that's really known is that some immune cells express cannabinoid

>When I was on the medicine service, I took every opportunity to
>use Marinol for my patients who weren't eating very well for
>whatever reason just to see if it worked.  AIDS, cancer, etc
>(This was only 5 patients or so).  They invariably got zonked
>out, confused, lethargic, with the notable exception of my one
>AIDS patient who had a long drug history.  Maybe her previous
>marijuana use made her less susceptible to the drug's bad
>effects.  All of them ate like champions though, which was nice
>to see.  Obviously these people were in sorry shape to begin
>with, and are not comparable to the healthy patients who ate the

I've never tried Marinol.  I'm glad it worked.  If people were
getting zonked, the dose was probably too high.  It's good to
take THC with a little fat -- smooths out plasma peaks -- but
otherwise on a near-empty stomach.  A small (3 in^3) piece of
brownie is the carrier I use, on an otherwise empty stomach with
a dose that's low enough to be rendered inactive in some if taken
after a full meal.  Though I can believe that really ill patients
might get zonked on any amount.

The word on the street is that the plant source is preferred,
supposedly because of its broad cannabinoid profile.  I've read
that other cannabinoids are so much less active than THC that
they could have no importance.  However, I don't think anybody
really knows this, and it would be a way to explain the apparent
subjective differences between varieties of pot.

Another complaint is that oral delivery is problematic if the
patient is vomiting.  I believe I heard there is an inhaler in
trials...  A puff of smoke did save my life once after a vicious
night of drinking, after fasting, water, salted pretzels, and
Pepto Bismol failed.  The effect was instantaneous.

>Perhaps other medications with similar effects might be worth
>trying out? 

I think so.  It would also be nice to have a selective CB2
agonist, and to identify CB3 if it exists...


Wow, I hadn't seen this page.  Excellent stuff here.  Looks like
such an agonist may be coming down the pike.  The language in
that section is a bit suspect, though, so I won't hold my breath.