Re: Rethinking brief interventions for alcohol in general practice
In some parts of the world, the primary care to prevent harm from heavy alcohol use [1] should take into account that a surrogate could have been consumed even if the “beverage” was purchased in a legally operating shop or pharmacy.
In December 2016, 77 lethal cases were reported from a mass poisoning in Irkutsk, Russia. According to the available information [2,3], the poisoning was caused by the Hawthorn bath lotion containing according to the label “93% of ethyl alcohol, hawthorn extract, lemon oil, diethyl phthalate and glycerol”, while the chemical analysis demonstrated that the lotion “contained methyl alcohol and antifreeze” [3]. There is a suspicion, however, that the poisoning was caused by the hawthorn (Crataegus) tincture sold in pharmacies, containing 70% ethanol, and prescribed by drops to cardiology patients [4]. The hawthorn tincture is a pharmacy product most frequently consumed by drinkers in Russia [5,6]. Some people buy it as they hope to obtain better quality alcohol than that sold in bottle stores. Converted to absolute alcohol, the tincture is currently more expensive than cheap vodka: 50 ml of the tincture costs about 1 US dollar. It is known that legally sold alcoholic beverages in Russia often contained technical alcohol [7]. The author has found no information on “bath lotions” containing 93% ethanol. There could have been misinformation intended to veil the fact that methyl alcohol had been used in pharmacies as a cheap substitute for medicinal ethanol.
Another mass poisoning occurred in several places in the Russian Federation in 2006. The number of poisonings with marked jaundice during the period August-November 2006 was reported to be 12,611, including 1189 lethal cases, reportedly caused by disinfectant Extrasept-1, containing 0.08-0.15% of diethyl phthalate and 0.1-0.14% of polyhexamethylene guanidine hydrochloride (PHMG) sold in vodka bottles [8,9]. Factual figures are unknown. In addition, “chloride compounds” i.e. organochlorides have been mentioned as possible causative factors [10], which seems to be more probable as PHMG has no strong hepatotoxicity; its LD50 in rats has been estimated to be 600 mg/kg, while the rats died with the symptoms of nerve injury [11,12]. The data on the PHMG mass poisoning [9] were cited in [12] and could have influenced conclusions. If these data are incorrect, they may be misleading for the toxicity assessment of PHMG and polyhexamethylene biguanide (PHMB) broadly used as antimicrobial agents. More details are in [7].
References
1. McCambridge J, Saitz R. Rethinking brief interventions for alcohol in general practice. BMJ 2017;356:j116.
2. 2016 Irkutsk mass methanol poisoning. Wikipedia https://en.wikipedia.org/wiki/2016_Irkutsk_mass_methanol_poisoning (22 Jan. 17)
3. 48 people die after drinking bath lotion with antifreeze in Siberia. RT News 19 Dec, 2016 https://www.rt.com/news/370706-methanol-lotion-poisoning-siberia/ (22 Jan. 17)
4. Hawthorn tincture. https://vapteke.com.ua/drugs/crataegus-l_arterium.php (22 Jan. 17)
5. Monakhova YB, Kuballa T, Leitz J, Lachenmeier DW. Determination of diethyl phthalate and polyhexamethylene guanidine in surrogate alcohol from Russia. Int J Anal Chem 2011:704795.
6. Gil A, Polikina O, Koroleva N, et al. Availability and characteristics of nonbeverage alcohols sold in 17 Russian cities in 2007. Alcohol Clin Exp Res 2009;33:79-85.
7. Jargin SV. Alcohol abuse and toxicity of alcoholic beverages in Russia: Recent history. ARC J Addiction 2016;1:21-29. https://www.researchgate.net/publication/311922946_Alcohol_Abuse_and_Tox...
8. Luzhnikov EA. Medical Toxicology. Moscow: Geotar-Media; 2014.
9. Ostapenko YN, Brusin KM, Zobnin YV, et al. Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol. Clin Toxicol (Phila) 2011;49: 471-7.
10. Khaltourina D, Korotayev A. Alcohol control policies and alcohol-related mortality in Russia: Reply to Razvodovsky and Nemtsov. Alcohol Alcohol 2016;51:628-9.
11. Asiedu-Gyekye IJ, Mahmood SA, Awortwe C, Nyarko AK. A preliminary safety evaluation of polyhexamethylene guanidine hydrochloride. Int J Toxicol 2014;33(6):523-31.
12. Asiedu-Gyekye IJ, Mahmood AS, Awortwe C, Nyarko AK. Toxicological assessment of polyhexamethylene biguanide for water treatment. Interdiscip Toxicol 2015;8:193-202.
Rapid Response:
Re: Rethinking brief interventions for alcohol in general practice
In some parts of the world, the primary care to prevent harm from heavy alcohol use [1] should take into account that a surrogate could have been consumed even if the “beverage” was purchased in a legally operating shop or pharmacy.
In December 2016, 77 lethal cases were reported from a mass poisoning in Irkutsk, Russia. According to the available information [2,3], the poisoning was caused by the Hawthorn bath lotion containing according to the label “93% of ethyl alcohol, hawthorn extract, lemon oil, diethyl phthalate and glycerol”, while the chemical analysis demonstrated that the lotion “contained methyl alcohol and antifreeze” [3]. There is a suspicion, however, that the poisoning was caused by the hawthorn (Crataegus) tincture sold in pharmacies, containing 70% ethanol, and prescribed by drops to cardiology patients [4]. The hawthorn tincture is a pharmacy product most frequently consumed by drinkers in Russia [5,6]. Some people buy it as they hope to obtain better quality alcohol than that sold in bottle stores. Converted to absolute alcohol, the tincture is currently more expensive than cheap vodka: 50 ml of the tincture costs about 1 US dollar. It is known that legally sold alcoholic beverages in Russia often contained technical alcohol [7]. The author has found no information on “bath lotions” containing 93% ethanol. There could have been misinformation intended to veil the fact that methyl alcohol had been used in pharmacies as a cheap substitute for medicinal ethanol.
Another mass poisoning occurred in several places in the Russian Federation in 2006. The number of poisonings with marked jaundice during the period August-November 2006 was reported to be 12,611, including 1189 lethal cases, reportedly caused by disinfectant Extrasept-1, containing 0.08-0.15% of diethyl phthalate and 0.1-0.14% of polyhexamethylene guanidine hydrochloride (PHMG) sold in vodka bottles [8,9]. Factual figures are unknown. In addition, “chloride compounds” i.e. organochlorides have been mentioned as possible causative factors [10], which seems to be more probable as PHMG has no strong hepatotoxicity; its LD50 in rats has been estimated to be 600 mg/kg, while the rats died with the symptoms of nerve injury [11,12]. The data on the PHMG mass poisoning [9] were cited in [12] and could have influenced conclusions. If these data are incorrect, they may be misleading for the toxicity assessment of PHMG and polyhexamethylene biguanide (PHMB) broadly used as antimicrobial agents. More details are in [7].
References
1. McCambridge J, Saitz R. Rethinking brief interventions for alcohol in general practice. BMJ 2017;356:j116.
2. 2016 Irkutsk mass methanol poisoning. Wikipedia https://en.wikipedia.org/wiki/2016_Irkutsk_mass_methanol_poisoning (22 Jan. 17)
3. 48 people die after drinking bath lotion with antifreeze in Siberia. RT News 19 Dec, 2016 https://www.rt.com/news/370706-methanol-lotion-poisoning-siberia/ (22 Jan. 17)
4. Hawthorn tincture. https://vapteke.com.ua/drugs/crataegus-l_arterium.php (22 Jan. 17)
5. Monakhova YB, Kuballa T, Leitz J, Lachenmeier DW. Determination of diethyl phthalate and polyhexamethylene guanidine in surrogate alcohol from Russia. Int J Anal Chem 2011:704795.
6. Gil A, Polikina O, Koroleva N, et al. Availability and characteristics of nonbeverage alcohols sold in 17 Russian cities in 2007. Alcohol Clin Exp Res 2009;33:79-85.
7. Jargin SV. Alcohol abuse and toxicity of alcoholic beverages in Russia: Recent history. ARC J Addiction 2016;1:21-29. https://www.researchgate.net/publication/311922946_Alcohol_Abuse_and_Tox...
8. Luzhnikov EA. Medical Toxicology. Moscow: Geotar-Media; 2014.
9. Ostapenko YN, Brusin KM, Zobnin YV, et al. Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol. Clin Toxicol (Phila) 2011;49: 471-7.
10. Khaltourina D, Korotayev A. Alcohol control policies and alcohol-related mortality in Russia: Reply to Razvodovsky and Nemtsov. Alcohol Alcohol 2016;51:628-9.
11. Asiedu-Gyekye IJ, Mahmood SA, Awortwe C, Nyarko AK. A preliminary safety evaluation of polyhexamethylene guanidine hydrochloride. Int J Toxicol 2014;33(6):523-31.
12. Asiedu-Gyekye IJ, Mahmood AS, Awortwe C, Nyarko AK. Toxicological assessment of polyhexamethylene biguanide for water treatment. Interdiscip Toxicol 2015;8:193-202.
Competing interests: No competing interests