Food Expiration Dates Don’t Mean What Most People Think They Mean
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Have you ever wondered why rock salt that formed during the Precambrian era has a label on it saying that it expires next month? To take something more delicate, how about eggs that expire next Thursday; isn’t that oddly specific for something that is surely affected by many variables? What matters, and what doesn’t?
Covering their assets
The US in particular wastes huge amounts of food, with 37% of food waste coming from households. Confusion over date labels is a major contributor, accounting for 20% of household food waste. Many people misinterpret these labels, often discarding food that is still safe to eat—which is good for the companies selling the food, because then they get to sell you more.
Date labels were introduced in the 70s with the “open dating” system to indicate optimal freshness, not safety. These dates are often conservative, set by manufacturers to ensure food is consumed at its best quality and encourage repeat purchases. However, many foods remain safe well past their labeled dates, including shelf-stable items like pasta, rice, and canned goods, as well as frozen foods stored properly.
Some foods do pose safety risks, especially meat and dairy products, as well as many grain-based foods, all of which which can harbor harmful bacteria. Infant formula labels are strictly regulated for safety. However, most date labels are not linked to health risks, leading to unnecessary waste.
When it comes down to it, our senses of sight, smell, and taste are more reliable than dates on packaging. Some quick pointers and caveats:
- If it has changed color in some way that’s not associated with a healthily ripening fruit or vegetable, that’s probably bad
- If it is moldy, that’s probably bad (but the degree of badness varies from food to food; see the link beneath today’s video for more on that)
- If a container has developed droplets of water on the inside when it didn’t have those before, that’s probably bad (it means something is respiring, and is thus alive, that probably shouldn’t be)
- If it smells bad, that’s probably bad—however this is not a good safety test, because a bad smell may often mean you are inhaling mold spores, which are not good for your lungs.
- If it tastes different than that food usually does, that’s probably bad (especially if it became bitter, pungent, tangy, sour, or cheesy, and does nor normally taste that way).
Some places have trialled clearer labelling, for example a distinction between “expires” and merely “best before”, but public awareness about the distinction is low. Some places have trialled removing dates entirely, to oblige the consumer to use their own senses instead. This is good for the seller in a different way than household food waste is, because it means the seller will have less in-store waste (because they can still sell something that might previously have been labelled as expired).
For more on all of this, enjoy:
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What is silicosis and what does research say about it?
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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.
Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.
Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.
But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.
The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.
Silicosis in modern industries
Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.
The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.
The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.
A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.
An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.
Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.
In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.
In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.
However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.
A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.
The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.
Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”
Silicosis symptoms and treatment
Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.
Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.
There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.
Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.
Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.
In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.
Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.
Research roundup
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.
Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.
However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”
The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.
The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.
“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.
Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.
The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.
The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.
“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.
Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.
“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.
A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.
These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.
The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.
“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”
Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.
From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.
Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.
At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.
The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.
“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”
Additional research
Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Bridging The Generation Gap Over The Holidays
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Often seen as a time for family connection, this same holiday period is often experienced as a time of family tension. But it doesn’t have to be that way!
Hopefully this will be of benefit to readers of all ages, but we’re going to write with the largest age-group of our readership, which is people who are most likely to have Gen-Z grandkids.
why are we writing about this?
Not only are health and happiness closely linked, and not only is mental health also just health, but… In terms of the healthy longevity secrets of the “Blue Zones”, strong intergenerational connections are usually a feature.
First, the obvious:
Any holiday tensions, of course, don’t usually start with grandkids, and are more likely amongst the adults, but some points of friction can be the same:
- Differences of opinion on political/social/economic issues
- Difference of opinion on parenting/dating choices
- Differences of opinion on life priorities
And yes, by the way, that includes even young teens (and perhaps younger) having opinions on these things—we are living in an information age, and this does mean a lot of information is a lot more accessible than it used to be, including for kids. Problems (at all ages) may occur when someone is only really exposed to views from within a certain “bias bubble”, but for better or worse, most people will have an opinion on most well-known things.
As a general rule of thumb, all of these differences of opinion can be shelved if (and only if) those involved seek to avoid conflict. And while age is no guarantee of maturity, often it’ll be the older person(s) in the strongest position to redirect things. So, have a stack of “safe” topics up your sleeve.
Bonus: you can also have non-conversational distractions up your sleeve! These may be kitchen-related, for example (time to produce something distracting, or if the nascent conflict was only between you and one other person, time to go check on something, thus removing yourself from the situation).
Next, about “family time” and technology
It can be tempting to try to have a “phones away” rule, but this will tend to only exacerbate a younger person’s withdrawal.
Better: ask (with a tone of cheerful curiosity, not accusation) about what captures their attention so. Ask about their favorite YouTubers or TikTokers or whatever it is that it is for them. Learn about that Subreddit.
Or maybe (more likely for Millennials) they were following what is going on in the world via social media, which takes on an intermediary role for the delivery of world news. Hopefully this won’t run into the differences of opinion that we mentioned up top, but it could also be a perfectly good avenue of conversation, and maybe there’s more common ground than you might expect.
Meanwhile, if you’re the older generation present, chances are your own social media use is more about the human element. That’s great, but watch out:
A common faux pas is taking pictures without asking, let alone posting them online without asking. For many people this may seem an odd thing to object to, but generationally speaking, the younger someone is (down to the upper single digits, anyway) the more likely they might feel strongly about this. So, ask first.
The reason, by the way, is that in this age of digital hypervisibility, what we choose to share online can be a deeply personal thing. And, say what you will about the pros or cons of someone carefully curating an image of how they wish to be seen, shortcutting through that for them with a candid photo posted on Facebook will not endear you to them, even if you can’t see anything wrong with the photo in question, for example.
See also: Make Social Media Work For Your Mental Health
Show an interest, but don’t interrogate
This one doesn’t take too much explanation. If people want to share about their lives, they’ll need only the smallest nudge to do so. If someone passes up an opportunity to talk about something you showed an interest in, chances are they have their own reasons for not wanting to talk about it. This might be hurtful if you feel like they’re keeping you out of their life, but the best way to get them to talk to you is just to be a good listener—not an interrogator that they have to dodge.
For some powerful tools on this, see: Listening, Better
Lastly, if things aren’t so good…
43% of people are currently experiencing some sort of familial estrangement, so if that’s you, you’re not on your own.
Sometimes, it really is too late to fix things, but sometimes it isn’t; we put together a guide that might help:
Family Estrangement & How To Fix It
Take care!
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Are Brain Chips Safe?
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Ready For Cyborgization?
In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.
We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!
However, of the answers we did get…
- About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
- About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
- About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
- One (1) person said “Electrode outside the skull are good; chips on the brain are bad”
But what does the science say?
We’re not there yet safetywise: True or False?
True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.
The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.
- Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
- Bad news: to say it did not go well would be an understatement
The Gruesome Story of How Neuralink’s Monkeys Actually Died
The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.
Electrodes outside the skull are good; chips on/in the brain are bad: True or False?
True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:
How the Utah Array is advancing BCI science
The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:
- The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
- The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.
In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.
I am right to be a little worried about giving companies access to my brain: True or False?
True or False, depending on the nature of your concern.
For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.
For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.
Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.
Take care!
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Stimulant Users Are Caught in Fatal ‘Fourth Wave’ of Opioid Epidemic
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In Pawtucket, Rhode Island, near a storefront advertising “free” cellphones, J.R. sat in an empty back stairwell and showed a reporter how he tries to avoid overdosing when he smokes crack cocaine. KFF Health News is identifying him by his initials because he fears being arrested for using illegal drugs.
It had been several hours since his last hit, and the chatty, middle-aged man’s hands moved quickly. In one hand, he held a glass pipe. In the other, a lentil-size crumb of cocaine.
Or at least J.R. hoped it was cocaine, pure cocaine — uncontaminated by fentanyl, a potent opioid that was linked to about 75% of all overdose deaths in Rhode Island in 2022. He flicked his lighter to “test” his supply. He believed that if it had a “cigar-like sweet smell,” he said, it would mean that the cocaine was laced with fentanyl. He put the pipe to his lips and took a tentative puff. “No sweet,” he said, reassured.
But this method offers only false and dangerous reassurance. A mistake can be fatal.
It is impossible to tell whether a drug contains fentanyl by the taste or smell. “Somebody can believe that they can smell it or taste it, or see it … but that’s not a scientific test,” said Josiah “Jody” Rich, an addiction specialist and researcher who teaches at Brown University. “People are going to die today because they buy some cocaine that they don’t know has fentanyl in it.”
The first wave of the long-running and devastating opioid epidemic began in the United States with the abuse of prescription painkillers in the early 2000s. The second wave involved an increase in heroin use, starting around 2010. The third wave began when powerful synthetic opioids such as fentanyl started appearing in the supply around 2015. Now experts are observing a fourth phase of the deadly epidemic.
The mix of stimulants such as cocaine and methamphetamines with fentanyl — a synthetic opioid 50 times as powerful as heroin — is driving what experts call the opioid epidemic’s “fourth wave.” The mixture of stimulants and fentanyl presents powerful challenges to efforts to reduce overdoses because many users of stimulants don’t know they are at risk of ingesting opioids, so they don’t take overdose precautions.
The only way to know whether cocaine or other stimulants contain fentanyl is to use drug-checking tools such as fentanyl test strips — a best practice for what’s known as “harm reduction,” now embraced by federal health officials in combating drug overdose deaths. Fentanyl test strips cost as little as $2 for a two-pack online, but many front-line organizations also give them out free.
Nationwide, illicit stimulants mixed with fentanyl were the most common drugs found in fentanyl-related overdoses, according to a study published in 2023 in the scientific journal Addiction. The stimulant in the fatal mixture tends to be cocaine in the Northeast, and methamphetamine in the West and much of the Midwest and South.
“The No. 1 thing that people in the U.S. are dying from in terms of drug overdoses is the combination of fentanyl and a stimulant,’’ said Joseph Friedman, a researcher at UCLA and the study’s lead author. “Black and African Americans are disproportionately affected by this crisis to a large magnitude, especially in the Northeast.”
Friedman was also the lead author of another new study, published in the American Journal of Psychiatry, that shows the fourth wave of the opioid epidemic is driving up the mortality rate among older Black Americans (ages 55-64) and, more recently, Hispanic people. Friedman said part of the reason street fentanyl is so deadly is that there’s no way to tell how potent it is. Hospitals have safely used medical-grade fentanyl for surgical pain because the potency is strictly regulated, but “the potency fluctuates wildly in the illicit market” Friedman said.
Studies of street drugs, he said, show that in illicit drugs the potency can vary from 1% to 70% fentanyl.
“Imagine ordering a mixed drink in a bar and it contains one to 70 shots,” Friedman said, “and the only way you know is to start drinking it. … There would be a huge number of alcohol overdose deaths.”
Drug-checking technology can provide a rough estimate of fentanyl concentration, he said, but to get a precise measure requires sending drugs to a laboratory.
It’s not clear how much of the latest trend in polydrug use — in which users mix substances, such as cocaine and fentanyl, for example — is accidental versus intentional. It can vary for individual users: a recent study from Millennium Health found that most people who use fentanyl do so at times intentionally and other times unintentionally.
People often use stimulants to power through the rapid withdrawal from fentanyl, Friedman said. And the high-risk practice of using cocaine or meth with heroin, known as “speedballing,” has been around for decades. Other factors include manufacturers’ adding the cheap synthetic opioid to a stimulant to stretch their supply, or dealers mixing up bags.
Researchers say many people still think they are using unadulterated cocaine or crack — a misconception that can be deadly. “Folks who are using stimulants, and not intentionally using opioids, are unprepared to respond to an opioid overdose,” said Brown University epidemiologist Jaclyn White Hughto, “because they don’t perceive themselves to be at risk.” Hughto is a principal investigator in a new, unpublished study called “Preventing Overdoses Involving Stimulants.”
Hughto and the team surveyed more than 260 people in Rhode Island and Massachusetts who use drugs, including some who manufacture and distribute stimulants such as cocaine. More than 60% of the people they interviewed in Rhode Island had bought or used stimulants that they later found out had fentanyl in them. And many of the people interviewed in the study also use drugs alone. That means that if they do overdose, they may not be found until it’s too late.
In 2022, Rhode Island had the fourth-highest rate of overdose deaths involving cocaine in 2022, after Washington, D.C., Delaware, and Vermont, according to the Centers for Disease Control and Prevention.
The fourth wave is also hitting stimulant users who choose pills over what they perceive as more dangerous drugs such as cocaine in an effort to avoid fentanyl. That’s what happened to Jennifer Dubois’ son Cliffton.
Dubois was a single mother raising two Black sons. The older son, Cliffton, had been struggling with addiction since he was 14, she said. Cliffton also had been diagnosed with attention-deficit/hyperactivity disorder and a mood disorder.
In March 2020, Cliffton had checked into a rehab program as the pandemic ramped up, Dubois said. Because of the lockdown at rehab, Cliffton was upset about not being able to visit with his mother. “He said, ‘If I can’t see my mom, I can’t do treatment,’” Dubois recalled. “And I begged him” to stay in treatment.
But soon after, Cliffton left the rehab program. He showed up at her door. “And I just cried,” she said.
Dubois’ younger son was living at home. She didn’t want Cliffton doing drugs around his younger brother. So she gave Cliffton an ultimatum: “If you want to stay home, you have to stay drug-free.”
Cliffton went to stay with family friends, first in Atlanta and later in Woonsocket, an old mill city that has Rhode Island’s highest rate of drug overdose deaths.
In August 2020, Cliffton overdosed but was revived. Cliffton later confided that he’d been snorting cocaine in a car with a friend, Dubois said. Hospital records show he tested positive for fentanyl.
“He was really scared,” Dubois said. After the overdose, he tried to “leave the cocaine and the hard drugs alone,” she said. “But he was taking pills.” Eight months later, on April 17, 2021, Cliffton was found unresponsive in the bedroom of a family member’s home.
The night before, Cliffton had bought counterfeit Adderall, according to the police report. What he didn’t know was that the Adderall pill was laced with fentanyl. “He thought by staying away from the street drugs and just taking pills, he was doing better,” Dubois said.
A fentanyl test strip could have saved his life.
This article is from a partnership that includes The Public’s Radio, NPR, and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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5 Ways To Avoid Hearing Loss
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Hear Ye, Hear Ye
Hearing loss is often associated with getting older—but it can strike at any age. In the US, for example…
- Around 13% of adults have hearing difficulties
- Nearly 27% of those over 65 have hearing difficulties
Complete or near-complete hearing loss is less common. From the same source…
- A little under 2% of adults in general had a total or near-total inability to hear
- A little over 4% of those over 65 had a total or near-total inability to hear
Source: CDC | Hearing Difficulties Among Adults: United States, 2019
So, what to do if we want to keep our hearing as it is?
Avoid loud environments
An obvious one, but it bears stating for the sake of being methodical. Loud environments damage our ears, but how loud is too loud?
You can check how loud an environment is by using a free smartphone app, such as:
Decibel Pro: dB Sound Level Meter (iOS / Android)
An 82 dB environment is considered safe for 16 hours. That’s the equivalent of, for example moderate traffic.
Every 3 dB added to that halves the safe exposure time, for example:
- An 85 dB environment is considered safe for 8 hours. That’s the equivalent of heavier traffic, or a vacuum cleaner.
- A 94 dB environment is considered safe for 1 hour. That might be a chainsaw, a motorcycle, or a large sporting event.
Many nightclubs or concert venues often have environments of 110 dB and more. So the safe exposure time would be under two minutes.
Source: NIOSH | Noise and Hearing Loss
With differences like that per 3 dB increase, then you may want to wear hearing protection if you’re going to be in a noisy environment.
Discreet options include things like these -20 dB silicone ear plugs that live in a little case on one’s keyring.
Stop sticking things in your ears
It’s said “nothing smaller than your elbow should go in your ear canal”. We’ve written about this before:
What’s Good (And What’s Not) Against Earwax
Look after the rest of your health
Our ears are not islands unaffected by the rest of our health, and indeed, they’re larger and more complex organs than we think about most of the time, since we only tend to think about the (least important!) external part.
Common causes of hearing loss that aren’t the percussive injuries we discussed above include:
- Diabetes
- High blood pressure
- Smoking
- Infections
- Medications
Lest that last one sound a little vague, it’s because there are hundreds of medications that have hearing loss as a potential side-effect. Here’s a list so you can check if you’re taking any of them:
List of Ototoxic Medications That May Cause Tinnitus or Hearing Loss
Get your hearing tested regularly.
There are online tests, but we recommend an in-person test at a local clinic, as it won’t be subject to the limitations and quirks of the device(s) you’re using. Pretty much anywhere that sells hearing aids will probably offer you a free test, so take advantage of it!
And, more generally, if you suddenly notice you lost some or all of your hearing in one or more ears, then get thee to a doctor, and quickly.
Treat it as an emergency, because there are many things that can be treated if and only if they are caught early, before the damage becomes permanent.
Use it or lose it
This one’s important. As we get older, it’s easy to become more reclusive, but the whole “neurons that fire together, wire together” neuroplasticity thing goes for our hearing too.
Our brain is, effectively, our innermost hearing organ, insofar as it processes the information it receives about sounds that were heard.
There are neurological hearing problems that can show up without external physical hearing damage (auditory processing disorders being high on the list), but usually these things are comorbid with each other.
So if we want to maintain our ability to process the sounds our ears detect, then we need to practice that ability.
Important implication:
That means that if you might benefit from a hearing aid, you should get it now, not later.
It’s counterintuitive, we know, but because of the neurological consequences, hearing aids help people retain their hearing, whereas soldiering on without can hasten hearing loss.
On the topic of hearing difficulty comorbidities…
Tinnitus (ringing in the ears) is, paradoxically, associated with both hearing loss, and with hyperacusis (hearing supersensitivity, which sounds like a superpower, but can be quite a problem too).
Learn more about managing that, here:
Tinnitus: Quieting The Unwanted Orchestra In Your Ears
Take care!
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Bromelain vs Inflammation & Much More
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Let’s Get Fruity
Bromelain is an enzyme* found in pineapple (and only in pineapple), that has many very healthful properties, some of them unique to bromelain.
*actually a combination of enzymes, but most often referred to collectively in the singular. But when you do see it referred to as “they”, that’s what that means.
What does it do?
It does a lot of things, for starters:
❝Various in vivo and in vitro studies have shown that they are anti-edematous, anti-inflammatory, anti-cancerous, anti-thrombotic, fibrinolytic, and facilitate the death of apoptotic cells. The pharmacological properties of bromelain are, in part, related to its arachidonate cascade modulation, inhibition of platelet aggregation, such as interference with malignant cell growth; anti-inflammatory action; fibrinolytic activity; skin debridement properties, and reduction of the severe effects of SARS-Cov-2❞
Some quick notes:
- “facilitate the death of apoptotic cells” may sound alarming, but it’s actually good; those cells need to be killed quickly; see for example: Fisetin: The Anti-Aging Assassin
- If you’re wondering what arachidonate cascade modulation means, that’s the modulation of the cascade reaction of arachidonic acid, which plays a part in providing energy for body functions, and has a role in cell structure formation, and is the precursor of assorted inflammatory mediators and cell-signalling chemicals.
- Its skin debridement properties (getting rid of dead skin) are most clearly seen when using bromelain topically (one can literally just make a pineapple poultice), but do occur from ingestion also (because of what it can do from the inside).
- As for being anti-thrombotic and fibrinolytic, let’s touch on that before we get to the main item, its anti-inflammatory properties.
If you want to read more of the above before moving on, though, here’s the full text:
Anti-thrombotic and fibrinolytic
While it does have anti-thrombotic effects, largely by its fibrinolytic action (i.e., it dissolves the fibrin mesh holding clots together), it can have a paradoxically beneficial effect on wound healing, too:
For more specifically on its wound-healing benefits:
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Anti-inflammatory
Bromelain is perhaps most well-known for its anti-inflammatory powers, which are so diverse that it can be a challenge to pin them all down, as it has many mechanisms of action, and there’s a large heterogeneity of studies because it’s often studied in the context of specific diseases. But, for example:
❝Bromelain reduced IL-1β, IL-6 and TNF-α secretion when immune cells were already stimulated in an overproduction condition by proinflammatory cytokines, generating a modulation in the inflammatory response through prostaglandins reduction and activation of cascade reactions that trigger neutrophils and macrophages, in addition to accelerating the healing process❞
~ Dr. Taline Alves Nobre et al.
Read in full:
Bromelain as a natural anti-inflammatory drug: a systematic review
Or if you want a more specific example, here’s how it stacks up against arthritis:
❝The results demonstrated the chondroprotective effects of bromelain on cartilage degradation and the downregulation of inflammatory cytokine (tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8) expression in TNF-α–induced synovial fibroblasts by suppressing NF-κB and MAPK signaling❞
~ Dr. Perephan Pothacharoen et al.
Read in full:
More?
Yes more! You’ll remember from the first paper we quoted today, that it has a long laundry list of benefits. However, there’s only so much we can cover in one edition, so that’s it for today
Is it safe?
It is generally recognized as safe. However, its blood-thinning effect means it should be avoided if you’re already on blood-thinners, have some sort of bleeding disorder, or are about to have a surgery.
Additionally, if you have a pineapple allergy, this one may not be for you.
Aside from that, anything can have drug interactions, so do check with your doctor/pharmacist to be sure (with the pharmacist usually being the more knowledgeable of the two, when it comes to drug interactions).
Want to try some?
You can just eat pineapples, but if you don’t enjoy that and/or wouldn’t want it every day, bromelain is available in supplement form too.
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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