Topic: Xyrem and Doctors

I’ve got to admit, I must have already been living in the world of alternative medicine by the time the FDA approved Xyrem.  As far as I can figure, it’s exactly the same as the street drug GHB.  Us pharmacology types call this gamma hydroxybutyric acid.  In a stable salt form that people can take as a prescription drug, it can also be called sodium oxybate.  Among other sets of cognoscenti with whom I would usually not hang out — read “on the street” — it is known as various other things that those initials can stand for such as “Georgia Home Boy” or “Grievous Bodily Harm,” a lovely term from old British law.  There have been a couple of high profile American cases where Xyrem was used as a date-rape drug.  The FDA has warned against taking dietary supplements that contain it.  It’s the very same chemical as GHB.  It is also an FDA approved prescription drug.

Xyrem has FDA approval for narcolepsy with cataplexy according to the National Center for Biotechnology Information (NCBI).  This is very rare stuff, occurring in about 0.02% of the population.  Look closely and you will see a lovely disclaimer on the right hand side of their web page.  It’s written by French authors.  Maybe it is not a coincidence, then, that the only patient with this condition whom I ever saw in my life was in my French education during a brief rotation in pediatrics.  I remember a thin, weak, and pale looking pre-teen who looked pretty sleepy.  I was told he was going to get some kind of amphetamine.  A Maryland psychiatrist was recently nailed by the cops for prescribing this stuff for unapproved uses.  He laughed it off and is now out on bail — and still practicing.  He was actually recommending this drug for chronic pain and depression.  There are, to put it mildly, several other drugs for chronic pain and depression.  The doctor in question made a lot of money, and was laughing, and said something about freedom of speech and expressing his belief about this drug. I could find nothing else about this case later.

In my speaking days, I remember the FDA saying I should not speak about non-FDA approved uses of medications.  There was a cute lady drug rep that I thought then was cuter than I could ever be.  Except now, I am cuter than she ever was.  There was a paper I had to sign saying that I would not speak on non-approved uses of a certain drug.  But of course I could talk about the research, although I could not actually recommend this.  I signed.  I think I really needed the few hundred bucks then.

Oh, have I mentioned that the American Journal of Emergency Medicine provided an abstract of a review of 226 deaths by GHB?

Multiple sources show the efficacy of cannabis, or marijuana, on chronic pain and depression.  Not only is it not FDA approved for anything, but it is still classified as a Schedule I drug and deemed not of medical utility.  I am not the only one who is concerned that this useful drug has its use determined by political and not pharmacological concerns.  This is my anger.  This is why a marijuana doctor is an honest and good thing to be.