Posts Tagged ‘oxycontin’

Downers and the cycle of drugs of choice

Friday, April 16th, 2010

Several states are reporting a record number of deaths from opiod overdoses as well as related increase health issues from the misuse of prescription drugs. People who might start by experimenting with vicodin or oxycodone (OxyContin) can find themselves rapidly becoming addicted, and discover they cannot afford to continue on the pills due to the cost on the streets.  So we are seeing a shift to opiods, especially heroin, fueled by the low prices and increased purity of what is coming in from Mexico and  Afghanistan. We  continue our discussion with a look at the cycle of drug use and what appears to be the beginning of a new period of downer popularity.

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Transcript (edited):

CNS:    Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions.

CNS:    Hi and welcome to the CNS Addiction Podcast.  I am Howard LaMere here with Dr. Darryl Inaba as we look at the news this week. A story from the Oklahoma Bureau of Narcotics and Dangerous Drug Controls reports that last year they saw the highest number of deaths from drug related incidents ever,  and another news item covers the fact that the governor of Ohio commissioned a new task force aimed at curbing that state’s growing prescription drug abuse problem.  We’ve recently talked about the apparent decline in traditional illicit drugs – cocaine, marijuana and heroin – and the upswing in prescription drugs even though heroin is less expensive than it was back into the 60’s. How does the cycle of use go?

DARRYL:    Well, Howard, it’s not just heroin it’s actually all the opiate and opioid drugs that are increasingly being prescribed. Oregon has seen that for the last 5 years or so.   Ohio and Oklahoma are now seeing a massive increase in the diversion of OxyContin, and Vicodin.  I think Oklahoma is the first state to computerize and monitor their entire schedule 2 and maybe even schedule 3 drugs – controlled substances that are prescribed in the state – to see where they go and how they are being handled.   But this all hearkens back to our prediction years ago – we noticed this strange phenomena of 10 to 30 year cycles in which the prominent drugs of abuse and/or those catching the general public’s attention through the media move back and forth between uppers and downers.

CNS:    It seems like meth has at least stabilized for the time being.

DARRYL:    Right.  We’ve been in an “upper” cycle since the 1980’s when crack cocaine exploded and that was followed by Ice and crystal meth through into the 2000’s and if we’re right on track with past cycles, we’re due to go into a heavy “downer” cycle where the major drug abuse will involve sedating drugs, drugs that depress the brain, numb the senses and induce sleep.  Prescription drugs are sort of leading the way with the comeback of opiate abuse – Vicodin, OxyContin, codeine and the other opiates – and what we’re going to now see, is a growing increase of use of heroin.  The last time I looked, OxyContin was selling for 50 dollars for an 8 mg pill and Vicodin was selling for 25. Because of the influx of heroin from various sources and our inability to stop drugs from entering our borders, the price is down to 5 dollars – a nickel bag, you know, which was unheard since back in the 1960’s and 50’s. We had “nickel bags” but then they were 10 dollars and then 25 dollars, but now because it is readily availability and the new growing populations of opiate abusers, heroin is back on the radar. Heroin and other opiates are tremendously addictive – causing a very rapid onset of addiction.  I do not think addiction is as quick as nicotine, which is probably the fastest, but the path from experimentation to full scale addiction is rapid. Heroin lends itself to injection and very quickly we have people injecting opiates as a form of use, more so than with cocaine, methamphetamine or other drugs.  So much so that back in the 1960’s and 70’s, when I was working with Dr. George (Skip) Gay we published a paper with Dr. John Newmeyer warning “Heroin, it’s so good.  Don’t even try it once”  because we’ve found people who went from just experimenting, just trying to see what it would do when they smoked it, to full scale addiction very quickly.  Because heroin is more often injected than other drugs that has resulted in an increase of the hepatitis C epidemic which is much more virulent than an HIV infection.  It is easier to contract, much more rapidly spread into a much broader population and it seems like we may be unable to corral the hepatitis C epidemic as well as we did the HIV epidemic.

CNS:    People who experimented just one time ended up with that disease.

DARRYL:    Dr. Newmeyer just published a paper stating that the consequences of slippage, or from using an IV needle – either sharing or not sharing or using the rigs …a person has a 1 in 40 chance… (1 in 40 injections) of ending up with HIV, whereas with HCV or hepatitis C it was more like a 1 in 10 or 1 in 5 chance.

CNS:    Which are not very good odds.

DARRYL:    Absolutely. And as you mentioned – a lot of people just got infected from one experiment.  There are a couple of  cases in San Francisco where cocaine addicts just used a snorter…a tooter…that they stuck up their nose to snort  cocaine and they got  hepatitis C.  So, it’s just much easier spread than other viruses.

CNS:    And of course, increasingly these viruses are immune to the drugs that we’ve developed to treat them, creating an even larger problem.  Once you get it, you’ve got it.

DARRYL:    The reason for heroin’s attractiveness has always eluded me.  We do animal experiments that show that cocaine is the most compulsive inducing drug and the second most compulsive inducing drug is heroin followed by the other opiates.                                                                                                                                                                                                                Why they have that magic, that ability to attract people…I’m not always sure.  When you ask for descriptions of cocaine and how it affects the brain, users talk about brain orgasms and heightened senses and an ability to manifest and experience things and feel great and marvelous about yourself – so those are reasons to be attracted to cocaine.  But when people talk about heroin, they often refer to it as a euphoric.  I’ve tried to figure out exactly what constitutes euphoria and the closest I’ve come was an explanation given by a female pharmacist who was addicted to opiates – she told me that euphoria is the total abolishment of pain, both physical and emotional pain while under the influence of heroin or opiate drugs and that it lasts for at least for the duration of the time that you’re under the influence of the drug. It totally dissolves all the pain that a person suffers.  Both physical pains, emotional pains and all of the feelings of frustration and lack of confidence don’t bother you anymore. I still don’t see how that can have such a heavy influence on people that they get so addicted so quickly but it happens. When a person uses heroin the first time their brain stem is stimulated in an area called the chemotrigger zone this causes severe nausea and chances are you will throw up all over the place – especially if you try to move because that actually intensifies the nausea – that sounds very unattractive to me.

CNS:    You would think so.

DARRYL:    It actually causes projectile vomiting.  Sometimes in the hospital when patients are post-surgical, are on morphine doctors often prescribe Compazine or Phenergan to block the effect on the chemotrigger zone so when the patient gets a shot of morphine for pain relief they won’t be nauseated and throw their cookies up all over the sheets, which is not very attractive to the nursing staff.  If someone forgets the Compazine and a patient gets their first shot of Demerol or Dilaudid or morphine they will get very sick and throw up, even in the hospital.  Given all of that – it eludes me as to why people develop such an attachment to something that they’re willing to inject something in their arm – suffer the nausea and vomiting, suffer the pain from the injection in order to seek what?  I’m going to have to study this further and try and get more information from those clients who are addicted to heroin.

CNS:    Maybe we should put that out there as a question.  Send in your comments…your experiences. Without some kind of clarity of understanding treatment becomes more difficult.

DARRYL:    The treatment for opiates is less successful than the treatment for alcohol, cocaine and methamphetamine.  More people addicted to opiates relapse, are unable to maintain long periods of sobriety compared to people addicted to other drugs.  That doesn’t mean that treatment is bad – we still get good results from treating opiate addicts, but there are fewer positive outcomes and it may be, as you say, because we really don’t fully understand that attachment and what people are gaining from it so we can compete some other way in order to  get people clean.

CNS:    It will be interesting to see how the research continues and to watch the trends to see if we are indeed in a new downer cycle. As always – your comments and questions are most welcome.

 
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MCAT, prescription drug abuse leading to heroin, and more about pot

Friday, April 9th, 2010

A look at mephedrone or MCAT -  a  synthetic verson of the eastern African khat plant – is  a strong stimulant, with reports coming from UK, where it has become very popular, of  serious overdose issues.   Prescription drugs misuse and abuse continues as an escalating problem especially among young people – and the increased possibility of addiction to opiod pain medication leading to heroin use — made more pronounced by the flooding of the market with high potency and low cost heroin coming in from Mexico and Afghanistan. Also more on the implications of legalizing marijuana.

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Transcript (edited):

CNS:   Hi and welcome once again to the CNS Addiction Podcast.  I am Howard LaMere with Dr. Darryl Inaba.  Looking at the recent news of addiction, drug use and dependency, I see a lot of stories about things we’ve talked about recently, like the addicting qualities of eating, especially high fat/high flavor items like bacon, chocolate, potato chips and desserts, a big story just came out in Scientific American (http://www.scientificamerican.com/article.cfm?id=addicted-to-fat-eating) about that.  Also the continuing story on legalizing marijuana in California where the question will be on the ballot – what will that mean to the people using it medicinally, the people growing it and the government.  If it passes in California, it’s still going against federal law. We’ll have to wait to see what happens. Let’s talk more about prescription drugs and some of the substances that are being abused and causing serious illnesses.  There are some stories about a sharp upturn in the last few years especially among adolescences in the use of pharmaceuticals and what that leads to. Kids start on the OxyContin from their parent’s drug cabinet and because it is such an expensive drug, they end up substituting heroin. The other interesting item out of the UK is this new craze going on with something called MCAT.

DARRYL:      It is mephedrome and it’s been around for awhile. It is related to khat which East Africans have chewed for generations, maybe up to 1000 years. The shrub produces leaves which must be picked fresh because the (drug substance) cathinone is destroyed by the environment within 24 hours.  So because it was found Africa and the leaves needed to be fresh – it has never been a big item here. But what happened in the United States in the early 90’s was the development of a synthetic version called “methcathinone” by putting a metho group on it, a CH3 group on the apparent compound cathinone, it became more stable in the environmental and it could be sold off as a pill or powder.

CNS:   Is it just as strong?

DARRYL:      Yes, they claim it was just as strong.  Pharmacologists say it wasn’t as strong, but what we’re seeing now in Europe is a number of deaths related to its (methcathione) use.  We don’t see many deaths associated with methamphetamine abuse, so it must be that the methcath is much stronger than even methamphetamine.  But it’s growing there (in Europe) and its potential for abuse here stems from the fact that there are no laws that prohibit methcathinone.  So, like many other new drugs, it’s finding its way on the internet and you can buy it. I’ve also heard of people in this country gaining access on the internet to fresh cut khat leaves, and have heard that the chemical properties really don’t get destroyed within 24 hours, so it can be cut and shipped and people can get high.  On a personal note – Amnesty International contacted me once and asked me to detoxify a person from Somalia who was trying to come into the United States to be with his family, but he was a known khat addict so the US wouldn’t let him in.  I said,” Sure we can detoxify him.”   We detoxify methamphetamine users so we had it all set up and I never heard from the guy.  He never showed up for treatment.  About 5 years later he gets busted for growing khat trees in Monterey!  So there might be some local crop available on the west coast. Khat is definitely an upper and mephedrome or MCAT or whatever they want to call it – synthetic cathinone – looks like it’s going to be another drug that’s is now on the DEA’s radar to classify very soon.

CNS:   I think the UK is talking about taking action immediately because it is   apparently being sold as a plant fertilizer.

DARRYL:      So is synthetic marijuana which is now causing a lot of problems and sold as incense as well.  And I remember isobutyl nitrite – Russian locker room – sold as a room deodorizer, and sometimes it is sold as shoe polish.  You know….as long as you don’t call it a food, drug or cosmetic, you don’t come in violation of any drug laws for testing or anything and you can market it for what you’re using, but what happens if it gets abused strongly?  Then the government has to look at it a different way and maybe reclassify it.

CNS:   Is there anything else we can say to expand on pharming – the off-label use of pharmaceuticals that is becoming an ever increasing phenomenon, especially amongst young people.

DARRYL:      Well we’ve been watching that develop for a long time in our area.   Over the last 3 years there have been conferences and reports and such indicating an incredible increase in the abuse of diverted prescription drugs, by adolescences They get them from the internet or by raiding their parents and grandparents medicine cabinets, and more often when young kids go to dinner with their parents to their neighbor’s or their parents friend’s home they rush into the bathrooms to see what they’ve got and take everything that’s available.  There was a recent bust I believe in Oregon, where millions of dollars worth of pharmaceuticals were stolen.  The thieves busted in like a major sophisticated theft operation, like a sting….like a diamond or art theft …they broke in from the ceiling, cutting through and lowered  themselves down with these special belts and stuff and hauled off something like 73 million dollars worth of pharmaceuticals.

More kids are taking prescription drugs and diverting prescription drugs than are abusing marijuana, cocaine, heroin and a lot of other drugs.  Actually right now, the statistics show that prescription drugs are being abused by 20% of the teen population in the United States and probably a little bit higher here in Oregon because Oregon ranks towards the top.  I have noticed that during the last 5 years or so, a 500 or 600% increase in abuse among teenagers than in the previous era.  And between 1995 and 2004, there was a 3000% increase in abuse of prescription drugs.  OxyContin, Vicodin – those are still the preferred drugs The sad part about that is that once people get addicted to opiates, their thirst and their tolerance for opiates grows exponentially.  OxyContin is expensive on the street, selling for like 50 dollars a pill.  And the heroin  glut that’s on the market from Afghanistan, Mexico, South America, Golden Triangle, Southwest Crescent, the golden crescent – all those areas have now actually decreased the price of heroin to like 5 dollars a bag. A nickel bag or a nickel paper was last heard of during the early 1960’s.  So heroin with costing 5 dollars a nickel bag and OxyContin costing 50 dollars a pill, it becomes very attractive for prescription drug abusers to turn their attentions to heroin, and once they turn their attention to heroin, the number of users who use intravenously is so much higher than with other drugs.  We are seeing another epidemic of intravenous drug abuse and intravenous heroin abuse because of the way prescription drugs are being diverted.

CNS:   And all the complications that leads to – hepatitis and potentially HIV.   I know you’re not an economist, but if we legalize marijuana, what will be the fate of all those who have illegally made so much money through the years …it’s not like these people are just going to go straight.  They’re going to find something else to sell under the radar. We’re seeing that in California, there is a lot of violence associated with small towns, small operation growers bumping up against people stealing from them, or feeling competition from the major drug smugglers.

DARRYL:      Well, the political climate has changed towards legalizing marijuana.  Not just for medical purposes, but just to legalize it overall.  I think in the 1990’s, in California, only 22% of the polled voters favored legalizing marijuana.  In the year 2006 or so, you are looking at 46% and current polls are saying that 56…or over half the voters now favor legalizing marijuana.  Not for social or health reasons but purely because of the economic factor involved.  Governor Brown…Willy Brown, San Francisco mayor, California governor…writes an op-ed column in the San Francisco Chronicle and he wrote, “truth be told, there’s just too much money to be made both by the people who grow marijuana in the cities and counties that would like to tax it, not to vote for it.”  So that whole scene has changed where even Governor Schwarzenegger is saying we need to look at this, we need to look at the potential revenue.  There is a 9 block area in Oakland, California called “Oaksterdam” and a guy – Richard Lee is making millions of dollars through several pot shops set up already where you can get weed to smoke a lot faster than you can get a cup of coffee. People like him are going to be in the forefront of financing the lobby to get marijuana legalized.  This is too lucrative a thing to pass up and what I don’t understand is why nobody is looking at the long-term costs.  You know the short term gains are going to be huge.  You know people are going to jump on the bandwagon.  They will probably tax the paraphernalia, the names, everything about it. Nicotine….caffeine, heroin, cocaine – they all generate money.  People are just going to do whatever they can to get the money necessary to continue accessing these things.  But in the long run, what about the traffic accidents?  We know marijuana can cause traffic accidents.  What about the health issues?  We know it causes airway disease.  Maybe not as much cancer as does nicotine but certainly emphysema and a lot of airway diseases that come about from it.  All of these costs are not being looked at.  The fact is….it’s the general public will be voting on this – not the experts – and the general public seems to be of the mind to make marijuana legal.  It’s a threat, I think, to recovering people.  There are people who recognize that they are addicted to marijuana and are struggling to stay clean.  If it becomes legal, it will make it a lot harder because people will be smoking it wherever, and those in recovery will smell it and perhaps make them crave it.  Marijuana is one of those psychoactive drugs that operate in the same place in the brain where fat operates and as we predicted a long time ago – does the same thing to a brain as does cocaine, heroin and other drugs. If people who are vulnerable to addiction, or are in recovery use it – it can lead them to relapse by creating a craving for the drug that they most want and prefer.

CNS:   As is often the case throughout human history, we tend to act on the basis of short-term gains and don’t consider the long-term picture.  To our listeners – if you have comments or questions, send us an email.

 
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Dangerous Additives Altering Street Drugs

Wednesday, September 30th, 2009

This weeks Addiction radio podcast looks at the news of a veterinary drug, levamisole being added to cocaine, causing illness and deaths, and other ways the street makes drug even more dangerous then their natural form. Dr Inaba explains.

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CNS: Hi, welcome once again to the addiction radio pod cast from CNS Productions. I’m Howard LaMere here with Dr. Darryl Inaba. Darryl, there’s a disconcerting story here about cocaine showing up with a dangerous veterinary medicine and I wondered what you thought about that, what you might know about that.

Darryl: Yeah, actually levamisole which is an anathematic – a medicine used to deworm cows, actually when cows pick up parasites like worms. It started appearing in as a cut or an additive to cocaine here on the west coast, actually Oregon, Washington, British Columbia, and was causing a lot of concern actually caused a lot of illness as well. A month or so before this, this article broke from the midwest and back east it seems to be appearing now as well and it raised some concern about the authorities in Oregon because they didn’t know why anybody would do this and what it was meant to be. They didn’t know if it was just merely in more dense cut – sometimes drug traffickers with a chemical like cocaine or a powder like heroin used things to cut it with that are more dense, meaning weigh more from the size that these things are sold be merely by weight so if you bring in something that’s cut with something that weighs heavier you get a better price for the same amount of drug that you put into them. But as I looked at it, in a response in the mail I got for the state of Oregon it, it appeared that again, this street or traffickers, manufacturers, probably as it was coming up from South America began to look at ways of altering street drugs and, and maybe putting cuts in it that would add to the effects of the drug or, make it more potent or make it less toxic or whatever and as it turns out levamisole this anti worming drug actually releases some dopamine – that same reward reinforcement chemical that cocaine releases to make you feel good – so maybe this is an attempt to, or somebody thought, boy this felt good when they accidentally exposed themselves to levamisole mixed with cocaine in South America or something and decided to add it to the cocaine they’re trafficking. The problem is that levamisole is fairly toxic, it can affect blood cells, it can affect a variety of medical problems and now there are stories not only where dozens of several sickened by it but there were actual three deaths that occur to this combination. So it seems to me this will be a quick end to this product being added to cocaine unless some cocaine dealer was trying to kill you. I mean why would you want to kill off your customers? You want something to actually make them want the cocaine more but not to kill them off, so…

CNS: But if they’re actually doing it in Columbia and other areas where it grows then …

Darryl: This has happened before you know, street drugs continue to be adulterated and misrepresented, diluted with things that aren’t very healthy but not intentionally they’re done so to either make it more, make more money on it or make the drug more potent or have less side effects, what ever they do and they’re not, they’re not pharmaceutical manufacturer firms, they don’t have any testing requirements, they don’t have any kind of pretrial tests with it so they don’t know what’s going to happen, they don’t know what’s it all about. I remember when street chemists were trying to manufacture Demerol, that opium narcotic here and they ended up creating a chemical as an adulterant to their manufacturing product process that resulted in creating a, or causing Parkinsonism in a lot of people that were taking it or most the people were exposed to it and that’s a horrible, horrible thing to happen; they had end states Parkinson overnight due to MPTP that was an adulterant left over in the manufacturer process and everything got snuffed out very quickly because again you don’t want your customers to be, to want more of your product you don’t want them to die off or be too sick to use it.

CNS: Right

Darryl: Then when other chemists said well why don’t we just make fentanyl maybe that’s going to be safer, that’s not going to cause the Parkinsonism side effect and it’s so much more potent than heroin or morphine that you just have to make a little bit of it and dilute it real well and sell it off to people and make tons of money. Well, they knew that if they made fentanyl they would be breaking the control substance abuse act and so they went to making street derivatives, alpha-methyl, thiofentanyl, sufentanyl, a bunch of different derivatives and of course they didn’t test it out and they had no way of knowing that although fentanyl is like a hundred times stronger than morphine they knew alternative isomer products the sufentanyl, the thiofentanyl,  the alpha-methoxyfentanyl, turned out to be a thousand times, six thousand times, one, one of them was I think twenty thousand times stronger than morphine. So when they sold it off as heroin they had people just dying all over the country with it and they had to quit that right a way because again they’re losing good customers.

CNS: Where does it go, where does it lead?

Darryl: Yeah, I think it’s not the end of it. We’re going to continue to see people trying to put additives or finding new drugs. A recent story we did about ephrins, the AIDS drug, people learning in South Africa to, instead of taking it for their AIDS, just smoking it to get off on it. I mean those things are just amazing to me that people are always searching for a buzz and they’re always going and they’re going to find them and however they find them through toxic substances or natural or synthetic substances and whether or not they’re going to be toxic or not. It doesn’t seem to matter, they’re interested in finding a new buzz more than they’re interested in health.

CNS: Yeah, hopefully you don’t die along the way. You know somewhere here there’s a story here about oxycontin, which of course is a derivative another derivative of morphine and all the things that people go through to over ride the safety precautions that are built in.

Darryl: Well, you know, that’s an interesting combination of stories because here with oxycontin we have the pharmaceutical industry themselves trying to modify or change a medication and trying to prevent it from being abused so they altered it – they, they took a schedule two controlled substance which was actually sold off as Percodan and there, and a long time when in1970 when they were first developed was known to be heavily addicted and so scheduled two and they reformulated into little pellets with oxycontin that created a time release of the chemical so that you wouldn’t get a big bolus of the oxycodone just by taking it and they thought that would prevent it from being abused and they sold the government on it. I know that they had to have intelligence if you will or they had to ask people to say you know will this be a decent modification then to prevent oxycontin from being abused and I know they must have gotten input from various people you know the streets too smart for that kind stuff. The street is going to figure out how to deal with this an they went ahead the government approved it, so they went on a big oxycontin sales campaign, they sold a tons of it for the safer non addictive opiate for chronic pain condition and within only I think a matter of weeks or months the street figured out hey you just take these tablets or capsules and smash up all the things that are in them and therefore you smash up that protective coating, you can inject it, you can snort it, and you can get that rush of you know some of these products, the original percodan only contained like five milligrams of oxycodone or ten milligrams. Some of these contain eighty to hundred, over a hundred milligrams of oxycodone, but it was safe because it was wrapped up in these coatings but what they did was by crushing it, even just chewing on it, you can just chew it as you go down. They, they eliminated that protection and so we have now a mass number of oxycontin deaths, a lot of oxycontin abuse situations, and the same thing that you would see on the street, trying to manipulate drugs and stuff to make them either safer or potent they just create more problems. Its interesting because the pharmaceutical industry isn’t giving up on this, the last few conferences of American Society of Addiction Medicine many pharmaceutical companies were there presenting that they have all kinds of ways of making a very addictive opiate that’s used for pain, say morphine even or oxycodone or hydrocodone that all are being abused. They said we’ve got a way of making this so that it’s not going to be abused and one of the renditions that had been recently released that they took a tablet of oxycodone and they didn’t take a tablet of oxycodone they took a tablet of naltrexone, a narcotic antagonist, orally active narcotic antagonist. If you take this by mouth naltrexone, then you have any opiates in your system its going to block them out and they compressed that tablet to a very compressed cork or compressed powder that if somebody took that orally it, it’s so compressed that it will just go through your whole system, just come right out and as you go to the bathroom come through you without being absorbed and therefore wont affect your head and then on top of that they sprayed the morphine or they sprayed oxycontin so that if oxycodone so that if somebody wanted to abuse it for its release by crushing it they, they had the protective coating, they sprayed it on the naltrexone and if somebody took that tablet, chewed it, or they smashed it down to get all the morphine or oxycodone in it released from that protective coating what they would do is also smash up the naltrexone and therefore end up with a blocker in their head and get nothing out of that process. Well you know I’m sure the streets are going to figure out, actually I could figure it out in a second but, but we don’t want to add to probably on the street but it’s very clear to me what you’ve got to do in order to make that opiate available from that compressed tablet. Then there are a lot of other techniques being showcased and pharmaceutical companies are always looking to come up with some way of getting around abuse of these things but when there’s just too much desire from street users, they always seem to find a way.

CNS: It is true we always do, being the clever critters that we are, always figure a way around it. Well we’ll come back to this again I’m sure as the pharmaceutical world and the street world continue to make new news. If you have any comments or questions that you would like to pose to us we’d be very happy to hear them. Stop by our website which is cnsproductions.com, drop us an email, and if it’s a question we’ll try to get to it on a future program, and if it’s a comment we’d love to hear them. Darryl thank you very much.

Darryl: Hey thanks Howard, always great talking to you.

CNS: Talk to you soon, bye. That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com.

 
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