Project Title:
Listerine - Straight Up or On The Rocks?

Group No.:

29

Group Name:

L.A.

News URL:

http://www.dangerous-minds.net/modules.php?op=modload&name=News&file=article&sid=28

Author:

David Abel

News Paper:

Boston Globe

Area Key Word:

listerine, mouthwash, substance abuse, intentional ingestion, homeless, toxicity

Chemistry Key Word:

phenol, methyl salicylate, ethanol, thymol, menthol, eucalyptol

Editorial Comment:

David Abel writes about Boston's growing dilemma of intentional mouthwash ingestion by the homeless population. Abel states that the misuse of Listerine, and other mouthwash brands, is due to its intoxicating effects and its easy availability. Author states that the danger of Listerine lies with its relatively high alcohol content, as much as 27%, compared with only 12% in wine. The controversy of the issue stems from those experts believing that stemming the availability of intoxicating mouthwashes, especially on Sundays when alcohol in unavailable, will result in an increase in life-threatening alcohol withdrawal seizures. This article is accurate in the fact that mouthwash does have a relatively high alcohol content compared to alcohol. The article does not, however, address the effects of all the other compounds present in mouthwash that greatly increases its toxicity and health risks. Substances such as phenol and methyl salicylate result in more dangerous symptoms than just the alcohol content itself. Thus forms the problem for the highly alcohol-dependent person unable to seek viable treatment options, especially those people in the homeless population. At a high level of alcohol dependence a certain baseline level of alcohol must be maintained in the body; if this level is unable to be maintained there is a very high risk of life-threatening, and quite possibly fatal, alcohol withdrawal, or delirium tremens (DTs). This self-medicating option is complicated by Blue Laws, those laws restricting commerce, especially alcohol sales, on Sundays. This leaves mouthwash, with its high alcohol content and unrestriced sale, as an easy but dangerous alternative.

Ethanol Metabolism Biochemical Pathway



In order to perform ethanol metabolism our cells contain alcohol dehydrogenase (ADH) which oxidizes ethanol to acetaldehyde. Acetaldehyde is oxidized to acetate by acetaldehyde dehydrogenase. Acetaldehyde and acetate are toxic leading to the many side effects (the hangover) that are associated with alcohol consumption

Question 1:

Topic Significance
This topic has significance for the alcohol-dependent homeless population. The availability of legal and harmful intoxicants such as mouthwash is worsening the growing health problems among the homeless population. Because mouthwash is so inexpensive and readily available is has become increasingly popular as an intoxicant. The intentional ingestion of mouthwash has not only short-term effects but also potential long-term effects. Mouthwash ingestion has health effects beyond regular alcohol ingestion due to its relatively high ethanol content and phenol content. The news media article discusses the increasing incidents of mouthwash theft from convenience stores due to the increased popularity of drinking mouthwash. The article discusses how the legality of mouthwash allows for public consumption and unchecked purchasing, unlike the controlled sale and purchase of alcohol. This has lead to an increase in public inebriation, with all of its public effects and personal health problems.

Don't Listerine and Drive!!!!!!!!!! Don't Listerine and Drive!!!!!!!!!! Don't Listerine and Drive!!!!!!!!!!


News Source
The article, by author David Abel of the Boston Globe is a credible source of news. It is not, however, referenced well to a scientific journal article. The author makes several references to studies and experts but does not provide further information about them.

Answer 1:

Sources

  1. High alcohol content spurs street popularity
    The Boston Globe writes about mouthwash ingestion by the homeless.
  2. Listerine
    The Official Listerine Website.
  3. Delirium Tremens (DTs)
    The life-threatening consequences of alcohol withdrawal.
  4. Blue Laws
    Why you can't buy alcohol or cars on Sunday.
  5. Phenol
    Physical properties and hazards.
  6. Methyl Salicylate
    Physical properties and hazards.
  7. Ethanol Metabolism
    Biochemical pathway of ethanol metabolism.
  8. A Public Health Approach to Reducing Morbidity and Mortality Among Homeless People in Boston
    Original research describing the homeless situation in Boston.
  9. Cardiac Arrest Risk
    Cardiac asystole after mouthwash ingestion.
  10. CNS Depression
    More health effects of mouthwash ingestion.
  11. Fatal Methyl Salicylate Overdose
    If putting it on your skin can kill you, what about drinking it?

Question 2:

Abstract
Compared to other groups urban homeless populations suffer a high rates of premature death. One of the influential reasons for this is because of the chronic abuse of various substances including Listerine. To address this issue the Massachusetts Department of Public Health (MDPH) was asked to further investigate this concerning and reoccurring problem. The total study included 13 isolated homeless deaths in Boston and the main mechanisms and causations of them. The study's main goal is to examine the struggles associated to street living and provide preventive measures to help decrease fatalities.

Original Research Source
O'Connell J, Mattison S, Judge C, Allen J, Koh H. A Public Health Approach to Reducing Morbidity and Mortality Among Homeless People in Boston. Journal For Public Health Management and Practice, 2005 July/August.

Answer 2:

Questions

1. How do the chemical components of Listerine compare to regular drinking alcohol?

2. What are the health effects of ingesting mouthwash?

3. Is there an alternative to drinking mouthwash that can also prevent alcohol withdrawal symptoms?

4. Is Listerine ingestion harmful or beneficial to the end-stage alcohol?

5. Should Listerine be regulated by the government as a controlled substance, similar to alcohol and other drugs?

Question 3:

How do the chemical components of Listerine compare to regular drinking alcohol?

Listerine contains multiple compounds which are eucalyptol, menthol, methyl salicylate, thymol, and alcohol. When compared to regular drinking alcohol, listerine contains high ethanol concentrations of 21.6% in the flavored product and 26% in the original gold Listerine Antiseptic; regular wine is about 12%, beer is 3%-7%.

Eucalyptol


Menthol


Methyl Salicylate


Thymol


Alcohol

Answer 3:

What are the health effects of ingesting mouthwash?

Listerine contains 27% alcohol, producing severe intoxication from this ingredient alone. The presence of the other compounds, however, increases the negative health effects of ingestion. Therefore, due to the presence of multiple compounds found in mouthwash, excessively drinking it can result in a polypharm overdose. Polypharm overdoses, caused by multiple drugs or compounds, can be much more difficult to treat than a simple single-drug overdose and can much worse outcomes. Some of the symptoms can range from CNS depression to cardiac arrest. Worse case, ingestion of these compounds can result in death. In June of this year a 17- year-old died of a methyl salicylate overdose by overuse of topical skin cream containing the compound; this danger is only multiplied by actual ingestion.

As previously mentioned, there are also serious health effects just from the alcohol content of the mouthwash. Alcohol effects the benzodiazepine-GABAa-chloride receptor complex, ultimately leading to a decrease in chloride ion movement and may lead to seizure susceptibility. Chronic ethanol use also leads to up-regulation of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptors, also related to alcohol withdrawal seizures.

Question 4:

Is there an alternative to drinking mouthwash that can also prevent alcohol withdrawal symptoms?

The obvious answer to a mouthwash alternative is traditional drinking alcohol. This would seem an appropriate, immediate response to severe alcohol addiction; the daily use of alcohol prevents chronic alcoholics from experiencing life-threatening withdrawal symptoms. A better alternative than actual alcohol use would be preventative measures taking by modern day medicine. Some of these treatments include prescribing medications such as dilantin or tranxene. Both of these medications are very effective in controlling alcohol withdrawal and or associated symptoms.

Answer 4:

Is Listerine ingestion harmful or beneficial to the end-stage alcoholic?

Overall, Listerine consumption can be very detrimental to the body despite its advantages to decreasing the symptoms and danger of life-threatening alcohol withdrawl. Excessive Listerine injestion can be a very dangerous self-treatment option and can lead to various health problems, in addition to the already present alcoholism, and, ultimately, death. This type of treatment holds far worse consequences than drinking regular alcohol due to the extra toxic compounds present in the solution. On the other hand, there are often no other readily available solutions to those faced with these challenges.

Question 5:

Should Listerine be regulated by the government as a controlled substance, similar to alcohol and other drugs?

Listerine and similar mouthwashes should be regulated. The precedent of product regulation has been set long ago; the government monitors and regulates the use of alcohol, tobacco, and countless other substances. The argument that end-stage alcoholics need this as a source of alcohol to prevent withdrawal is not justification for allowing its blatant abuse. Government needs to step in to provide alternatives so that those addicted to alcohol can receive the support they need.
When public health is in danger, there must be a balance between freedom and regulation. The government has created a situation over time in which a population of people are pushed to drink Listerine. The lack of health care funding in this country has resulted in a shortage of treatment centers for substance abuse; this perpetuates the abuse problem of this population. The common 'Blue Laws" that prohibit alcohol sales on Sunday create a situation in which readily available Listerine is the only available source of alcohol. The combination of these two conditions, not to mention the numerous other factors regarding homelessness, cannot be separated from the choices and rules that government has made. To relieve this same government from responsibility for these decisions is irresponsible. There must either be changes to the conditions that have led to the dangerous intentional consumption of mouthwash or an address of this problem itself. As this is an acute problem requiring an immediate solution, the necessary solution would be to regulate the sale and use of mouthwash.

Answer 5:



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