The nonmedical use of prescription or over-the-counter (OTC) medications implies that the user is using them for reasons other than those indicated in the prescribing literature or on the box label. The abuse of these medications is a national issue.Intentional The nonmedical use of a prescription or over-thecounter (OTC) medication implies that the user is using it for reasons other than those indicated in the prescribing literature or on the box label.1 The abuse of these medications is a national issue. Prescription medications are those pharmaceuticals dispensed by a pharmacist on the presentation of a prescription written by a physician, dentist, or other health care provider who is legally authorized to write prescriptions. OTC medications are pharmaceuticals that do not require a prescription and are sold on the shelves of markets, stores, and pharmacies.

Background: The use of acetylcholinesterase (AChE) activity testing in pesticide poisoning often falls on family physicians when evaluating a suspected poisoning or when monitoring the health of pesticide applicators.Methods: A review of the literature and consideration of three illustrative cases shows misunderstandings in the pathophysiology of the enzyme and in procedures for effective testing and monitoring of AChE levels.Results and Conclusions: The physiologic characteristics of acetylcholine neurotransmission are described and related to carbamate and organophosphate poisoning. Pre-exposure monitoring is described using the California plan. A 23 percent variance in AChE levels exists among normal patients. It is necessary, therefore, to establish baseline levels to overcome individual variance. The practice of measuring of AChE levels in acute poisoning is limited. In employees who have been monitored and for whom baseline AChE levels have been established, a diagnosis of poisoning can be made by comparing postexposure AChE levels with baseline levels. If there is no baseline level recorded, and if the offending chemical is in question, the clinician must base treatment on the clinical signs and symptoms. (J Am Board Fam Pract 1999;12:307-14.)

Objective: This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Low Back Disorders Guideline reviews the evidence and recommendations developed for non-invasive and minimally invasive management of low back disorders. Methods: Systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking. A total of 70 high-quality and 564 moderate-quality trials were identified for non-invasive low back disorders. Detailed algorithms were developed. Results: Guidance has been developed for the management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 121 specific recommendations. Conclusion: Quality evidence should guide treatment for all phases of managing low back disorders.

Five cases of poisoning by cypermethrin, a pyrethroid pesticide, are presented. The chemical was inadvertently introduced to the air-conditioning ducts and the patients inhaled it. Exposed patients experienced shortness of breath, nausea, headaches, and irritability. The exposure was compounded by repeated entry into the contaminated area and slow referral to a physician experienced in pesticide exposures.

The California ChE monitoring program serves as a useful and cost-effective means of preventing organophosphate and carbamate overexposure. Elimination of the third baseline test requirement should be considered.