olism: co-segregation of oxidative 0of the glutamate-NMDA (N-methdemethylation with debrisoquin hyyl-D-aspartate) receptor complex.7 droxylation. Clin Pharmacol Ther 1985; Dextrorphan had the same effects 38: 618-624 as phencyclidine in animal studies of drug self-administration and of [The author responds.] discrimination paradigms.8 A factor in the extent of metabolism of Drs. Schadel and Sellers raise a dextromethorphan is the genetic very interesting hypothesis, about polymorphism of cytochrome which I am not in a position to P-450 2D6: 7% to 10% of Cauca- comment. At Sellers' suggestion I sians lack the enzyme and cannot attempted to contact the patient. metabolize dextromethorphan to However, I learned that she is out dextrorphan, whereas in others of the country and cannot be there is extensive metabolism.9 reached. We predict that the patient described in the report is an ex- David Francis Craig, MD, FRCPC professor of psychiatry tensive metabolizer of dextro- Assistant Faculty of Medicine methorphan. There was thus sub- Memorial University of Newfoundland stantial conversion to dextror- St. John's, Nfld. phan, which accounted for the phencyclidine-like effects.
Mordecai Schadel, MD Edward M. Sellers, MD, PhD Clinical Research and Treatment Institute Addiction Research Foundation Departments of pharmacology, medicine and psychiatry University of Toronto Toronto, Ont.
References 1. Isbell H, Fraser HF: Actions and addiction liabilities of dromoran derivatives in man. J Pharmacol Exp Ther 1953;
106: 524-530 2. Dodds A, Revai E: Toxic psychosis due to dextromethorphan [C]. Med J Aust 1967; 2:231 3. McCarthy JP: Some less familiar drugs of abuse. Med J Aust 1971; 2: 10781081 4. Fleming PM: Dependence on dextromethorphan hydrobromide [C]. BMJ 1986; 293: 597 5. Orell MW, Campbell PG: Dependence on dextromethorphan hydrobromide [C]. Ibid: 1242-1243 6. Bornstein S. Czermak M, Postel J: A propos d'un cas d'intoxication medicamenteuse volontaire au bromhydrate de dextromethorphane. Ann Med Psychol (Paris) 1968; 1: 447-451 7. Tortella FC, Pellicano M, Bowery NG: Dextromethorphan and neuromodulation: old drug coughs up new activities. TIPS 1989; 10: 501-507 8. Szekely JI, Sharpe LG, Jaffe JH: Induction of phenycylidine-like behavior in rats by dextrorphan but not dextromethorphan. Pharmacol -Biochem Behav 1991; 40: 381-386 9. Schmid B, Bircher J, Preisig R et al: Polymorphic dextromethorphan metab844
CAN MED ASSOC J 1992; 147 (6)
The Toronto Free Hospital for Consumptive Poor I was formerly medical director of the Canadian Tuberculosis Association, now the Lung Association, and was responsible for the national program against tuberculosis. The article by Peter Wilton (Can Med Assoc J 1992; 146: 1812-1814) is a fascinating review of the activities of the National Sanitarium Association, as the Toronto Free Hospital for Consumptive Poor called itself. This title was a source of some annoyance to the other tuberculosis associations in Canada, because the Toronto organization continued to call itself "national" even though it was a local constituent of the national body, the Canadian Tuberculosis Association. I cannot agree with Wilton's statement that "there is some doubt that the painful procedure [induction of pneumothorax] provided any benefit."' In selected cases of pulmonary tuberculosis in which no pleural adhesions had developed, pneumothorax short-
ened the time in a sanitarium by a year or more and resulted in arrest of the disease in a very high proportion of cases. Pneumothorax induction was not painful, nor was the pneumothorax itself I know because I had a pneumothorax for 3 years with a successful result - I am alive nearly 50 years later. I also did thousands of pneumothorax "refills" for my patients, who all agreed that the procedure was painless. C. William L. Jeanes, MD Consultant Tropical Health and Quarantine Bureau of Communicable Disease Epidemiology Laboratory Centre for Disease Control Department of National Health and Welfare Ottawa, Ont.
Mandatory drug testing: Boon for public safety or launch of a witch-hunt? T would like to correct a significant error of fact in this arti..Lcle, by Richard Sutherland (Can Med Assoc J 1992; 146: 1215-1220). The substance of the quotations attributed to Jim Britton (who is not an employee of Imperial Oil Limited) as they relate to the company's employee-assistance program is incorrect. Our comprehensive program is alive and well and continues to provide a confidential counselling service to all employees and their families. Furthermore, there never was a "huge meeting" planned to approve the program, nor was a meeting "scrapped" because of the Exxon Valdez incident. Alcohol and drug testing is but one component of a wideranging policy that reflects Imperial Oil's commitment to the health and safety of its employees and the public and to environmental protection. In our compaLE 15 SEPTEMBRE 1992
Mordecai Schadel, MD Edward M. Sellers, MD, PhD Clinical Research and Treatment Institute Addiction Research Foundation Departments of pharmacology, medicine and psychiatry University of Toronto Toronto, Ont.
References 1. Isbell H, Fraser HF: Actions and addiction liabilities of dromoran derivatives in man. J Pharmacol Exp Ther 1953;
106: 524-530 2. Dodds A, Revai E: Toxic psychosis due to dextromethorphan [C]. Med J Aust 1967; 2:231 3. McCarthy JP: Some less familiar drugs of abuse. Med J Aust 1971; 2: 10781081 4. Fleming PM: Dependence on dextromethorphan hydrobromide [C]. BMJ 1986; 293: 597 5. Orell MW, Campbell PG: Dependence on dextromethorphan hydrobromide [C]. Ibid: 1242-1243 6. Bornstein S. Czermak M, Postel J: A propos d'un cas d'intoxication medicamenteuse volontaire au bromhydrate de dextromethorphane. Ann Med Psychol (Paris) 1968; 1: 447-451 7. Tortella FC, Pellicano M, Bowery NG: Dextromethorphan and neuromodulation: old drug coughs up new activities. TIPS 1989; 10: 501-507 8. Szekely JI, Sharpe LG, Jaffe JH: Induction of phenycylidine-like behavior in rats by dextrorphan but not dextromethorphan. Pharmacol -Biochem Behav 1991; 40: 381-386 9. Schmid B, Bircher J, Preisig R et al: Polymorphic dextromethorphan metab844
CAN MED ASSOC J 1992; 147 (6)
The Toronto Free Hospital for Consumptive Poor I was formerly medical director of the Canadian Tuberculosis Association, now the Lung Association, and was responsible for the national program against tuberculosis. The article by Peter Wilton (Can Med Assoc J 1992; 146: 1812-1814) is a fascinating review of the activities of the National Sanitarium Association, as the Toronto Free Hospital for Consumptive Poor called itself. This title was a source of some annoyance to the other tuberculosis associations in Canada, because the Toronto organization continued to call itself "national" even though it was a local constituent of the national body, the Canadian Tuberculosis Association. I cannot agree with Wilton's statement that "there is some doubt that the painful procedure [induction of pneumothorax] provided any benefit."' In selected cases of pulmonary tuberculosis in which no pleural adhesions had developed, pneumothorax short-
ened the time in a sanitarium by a year or more and resulted in arrest of the disease in a very high proportion of cases. Pneumothorax induction was not painful, nor was the pneumothorax itself I know because I had a pneumothorax for 3 years with a successful result - I am alive nearly 50 years later. I also did thousands of pneumothorax "refills" for my patients, who all agreed that the procedure was painless. C. William L. Jeanes, MD Consultant Tropical Health and Quarantine Bureau of Communicable Disease Epidemiology Laboratory Centre for Disease Control Department of National Health and Welfare Ottawa, Ont.
Mandatory drug testing: Boon for public safety or launch of a witch-hunt? T would like to correct a significant error of fact in this arti..Lcle, by Richard Sutherland (Can Med Assoc J 1992; 146: 1215-1220). The substance of the quotations attributed to Jim Britton (who is not an employee of Imperial Oil Limited) as they relate to the company's employee-assistance program is incorrect. Our comprehensive program is alive and well and continues to provide a confidential counselling service to all employees and their families. Furthermore, there never was a "huge meeting" planned to approve the program, nor was a meeting "scrapped" because of the Exxon Valdez incident. Alcohol and drug testing is but one component of a wideranging policy that reflects Imperial Oil's commitment to the health and safety of its employees and the public and to environmental protection. In our compaLE 15 SEPTEMBRE 1992
