Organophosphate poisoning
Organophosphate poisoning is poisoning due to organophosphates (OPs). Organophosphates are used as insecticides, medications, and nerve agents. Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion. While onset of symptoms is often within minutes to hours, some symptoms can take weeks to appear. Symptoms can last for days to weeks.
Organophosphate poisoning occurs most commonly as a suicide attempt in farming areas of the developing world and less commonly by accident. Exposure can be from drinking, breathing in the vapors, or skin exposure. The underlying mechanism involves the inhibition of acetylcholinesterase (AChE), leading to the buildup of acetylcholine (ACh) in the body. Diagnosis is typically based on the symptoms and can be confirmed by measuring butyrylcholinesterase activity in the blood. Carbamate poisoning can present similarly.
Prevention includes banning very toxic types of organophosphates. Among those who work with pesticides the use of protective clothing and showering before going home is also useful. In those who have organophosphate poisoning the primary treatments are atropine, oximes such as pralidoxime, and diazepam. General measures such as oxygen and intravenous fluids are also recommended. Attempts to decontaminate the stomach, with activated charcoal or other means, has not been shown to be useful. While there is a theoretical risk of health care workers taking care of a poisoned person becoming poisoned themselves, the degree of risk appears to be very small.
OPs are one of the most common causes of poisoning worldwide. There are nearly 3 million poisonings per year resulting in two hundred thousand deaths. Around 15% of people who are poisoned die as a result. Organophosphate poisoning has been reported at least since 1962.
Walgreens
In September 2012 the U.S. Drug Enforcement Administration (DEA) accused Walgreens of endangering public safety and barred the company from shipping oxycodone and other controlled drugs from its Jupiter, Florida, distribution center. The DEA said that Walgreens failed to maintain proper controls to ensure it didn't dispense drugs to addicts and drug dealers. The DEA also said that six of Walgreens' Florida pharmacies ordered in excess of a million oxycodone pills a year. In contrast, in 2011, the average pharmacy in the U.S. ordered 73,000 oxycodone tablets a year according to the DEA. One Walgreens pharmacy located in Fort Myers, Florida, ordered 95,800 pills in 2009, but by 2011 this number had jumped to 2.2 million pills in one year. Another example was a Walgreens pharmacy located in Hudson, Fla., a town of 34,000 people near Clearwater, that purchased 2.2 million pills in 2011, the DEA said. Immediate suspension orders are an action taken when the DEA believes a registrant, such as a pharmacy or a doctor, is "an imminent danger to the public safety." All DEA licensees "have an obligation to ensure that medications are getting into the hands of legitimate patients," said Mark Trouville, former DEA special agent in charge of the Miami Field Division. "When they choose to look the other way, patients suffer and drug dealers prosper."