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Fuel for a Killer

What Drugs Had Cho Taken?

by FRED GARDNER

Virginia Tech suspended or expelled 32 students last year for illicit drug use, according to Kris Reinertson, a junior who heads the Students for a Sensible Drug Policy chapter. Reinertson doesn’t know how many of the cases involved marijuana.

Virginia Tech applies a double-standard when it comes to alcohol and marijuana, he says. "It’s three strikes for underage drinking and zero tolerance for marijuana possession." SSDP has been campaigning for a review of the policy. "The Ivy League and many other colleges have a three strikes policy for marijuana," says Reinertson. "That’s what we want to see on here."

When we hear about a lethal outburst such as the one at Virginia Tech, millions of Americans wonder whether the perpetrator was on Prozac or some other strong psychotropic drug. Given how readily doctors prescribe antidepressants and stimulants and sedatives and anti-psychotics to anyone presenting with an emotional problem, the odds are very high that Seung-Hoi Cho had been put on one (or more).

The frequency with which SSRIs induce bizarre, violent flip-outs heightens the odds that Cho had been a user. But 10 days after the killings, Cho’s records from the student health center have not been made public and the media is not pressing for their release. We wonder: will university administrators manage to keep Cho’s medical records sealed in the name of privacy or confidentiality or patients’ rights or some other fine-sounding abstraction? Cho’s reputation could not be damaged further, obviously. It’s their reputation (and endowment) they care about.

Pharmaceutical companies pay vast sums to lawyers, lobbyists and public relations firms to deny and evade responsibility for the damage their products cause. Former Congressman Bob Barr is now on the Big Pharma payroll. He weighed in with a syndicated column last week- " ‘Ambien’ Defense Causing Headaches for Prosecutors"- that used Virginia Tech as a hook, took a shot at gun-control advocates, and sought to exonerate the makers of whatever drugs Cho or any other deranged person may have been on at the time of their flip-out.

"Barely had Seung-Hui Cho completed his carnage by taking his own wretched life, than those seeking to divert focus from the tortured mind of a mentally deranged young man were declaring that responsibility for the carnage lay not with the individual who perpetrated it, but rather with the system that gave him the tools by which he chose to carry out his deeds While the methods employed by trial lawyers through which this latest defense theory is raised are many, the primary vehicle of choice appears to be the popular sleep medication, Ambien; largely, no doubt, as a result of the market share enjoyed by this drug."

Ambien is a sleeping pill that last year generated about $2.3 billion for its manufacturer, Sanfoi-Aventis. U.S. doctors wrote some 27.6 million prescriptions for Ambien in 2006, out of 44 million scripts for all sleeping pills. Lunesta, whose ads feature a moth on the verge of extinction, is second with 5.8 million scripts.

Sanofi is being sued by thousands of Ambien users who, while sleeping, engaged in various activities -eating, driving making purchases over the internet- which they did not recall upon waking. Sanofi’s prescribing information had noted, merely, "Somnambulism is a possible rare adverse event." But somnambulism is a reflex, frying some eggs or driving is complex behavior.

In March the FDA instructed Sanofi et al to strengthen the warnings on their labels and recommended -not required- that they conduct additional clinical studies into sleep-driving, etc.

Bob Barr’s convoluted column is part of the sleeping-pill manufacturers’ counter-thrust. He goes on:

"The pharmaceutical companies that manufacture these medications include on their Web sites, in their advertising and in printed materials accompanying the products, detailed warnings about potential side effects and misuse of the drug. The companies and their products are tightly regulated by the federal Food and Drug Administration. In fact, just one month ago, the FDA urged the companies to include expanded warnings with the prescriptions. Key among the listed contraindications for the drugs is the necessity to use them only with a full night’s sleep, and to avoid any drinking of alcohol before or after taking the pills; but the medications continue to be abused. One well-known trial lawyer in Georgia, William C. Head, for example, noted that in the overwhelming majority of cases in which sleep-disorder drugs are involved, the person consumed alcohol. Still, the efforts to raise the specter of the drugs absolving the user of criminal or civil responsibility continue."

"History has shown that permitting such defenses as the so-called ‘Ambien defense’ to be viewed as legitimate, especially if accompanied by just a few instances in which the tactic is successful in court — as happened recently in an Austin, Texas, Driving While Intoxicated case — will quickly become pervasive and lead to increased irresponsible, possibly criminal, behavior.

"We have no way of knowing in what contexts the Ambien defense or its progeny will rear its ugly head in the years and decades to come, if it is allowed to take hold. What we do know, even now as the defense is just starting to develop, is that teens and adults alike are modifying their behavior — taking medications that have legitimate but serious effects, for the wrong reasons and under improper circumstances, then posing a danger to themselves and others — based on the possibility that they will not be held accountable for the results of their actions. This is a danger none of us can afford."

Barr has been hired as a lobbyist by the Marijuana Policy Project.

Last week we noted the poignant juxtaposition of the Virginia Tech story and coverage of a study in the Journal of the American Medical Association advocating a weaker warning on the Prozac label regarding suicidal ideation. That same issue of JAMA, April 18, contained a study showing that for-profit dialysis chains give patients much higher doses of Epogen than non-profit clinics. Epogen, made by Amgen Inc., is a synthetic version of a hormone that stimulates the production of red blood cells. During dialysis it is added to the blood as toxins are removed.

The for-profit dialysis chains get a quarter of their income from the sale of Epogen -plus rebates from Amgen based on how much product they move. Investigators from the Medical Technology and Practice Patterns Institute looked at 134,000 patients treated in 2004.

Some patients at for-profit clinics were found to be getting three times more Epogen than their counterparts at non-profits. "It’s clear there is a profit incentive," says co-author Dennis Cotter.

FRED GARDNER edits O’Shaughnessy’s, the Journal of Cannabis in Clinical Practice (soon to have a presence on the web). He can be reached at fred@plebesite.com