Another example of the DEA re-interpreting the CSA to serve their agenda ?

Posted on February 6, 2017 by Pharmaciststeve

Man sentenced for selling synthetic marijuana at Delavan store

http://www.gazettextra.com/20170206/man_sentenced_for_selling_synthetic_marijuana_at_delavan_store

MILWAUKEE—The man who owned the Delavan Smoke Shop and sold pounds of synthetic marijuana as incense will serve five years of supervised release with nine months of home confinement, a judge decided.

David Yarmo, 49, pleaded guilty in November to selling a misbranded drug in 2014 and money laundering charges.

U.S. District Judge Lynn Adelman handed down his sentence Friday in federal court in Milwaukee.

Both offenses stemmed from his selling packages of aromatic potpourri that did not list the controlled substance AB-Fubinaca as an ingredient. He also wrote a check to his supplier using money earned from prior sales of the packages.

According to a memo filed with the court by Yarmo’s attorney, John Markham of Boston:

In 2006, Yarmo bought the business at 127 Park Place, which was frequented by police officers, attorneys and judges.

Yarmo was a valued member of the community, operating a store that had 10 full- and part-time employees at one time. The store sponsored concerts in a local park and had donated sound equipment to the city’s park and recreation department.

In September 2012, the Drug Enforcement Administration seized Yarmo’s incense inventory, valued at $100,000, alleging it contained a drug similar in chemical structure to a controlled substance.

Yarmo sued to get his inventory returned, arguing that it did not contain a banned substance. However, in May 2013, before the court could rule on Yarmo’s request, the DEA listed a substance in his inventory as a controlled substance, and the court concluded it could not return it to him.

In February 2014, the DEA listed AB-Fubinaca as a controlled substance. On April 4, 2014, the DEA and local law enforcement returned to Yarmo’s shop and seized packages that contained AB-Fubinaca.

Yarmo had bought 778 pounds of “aromatic potpourri,” which contained AB-Fubinaca, between Feb. 26 and March 28, 2014, according to the plea agreement.

The DEA also seized the balances of two of Yarmo’s bank accounts, totaling $776,097, contending they were obtained from the sale of controlled substances.

Yarmo agreed to forfeit $404,802, the store’s checking account balance, which was obtained from AB-Fubinaca sales received after it was listed as a controlled substance. The government returned the store’s $371,295 savings account balance to Yarmo.

Yarmo maintained that he did not know AB-Fubinaca had become illegal to possess, but he conceded that the government did not have to prove he knew that AB-Fubinaca was a controlled substance, only that he was selling a substance the government could prove he knew contained AB-Fubinaca.

The Smoke Shop was closed by court order in a nuisance lawsuit the city of Delavan filed in Walworth County Court.

Yarmo has since opened a store in Harvard, Illinois, but sells no loose incense products. Residency law requires him to live there, but he commutes to the Delavan area to be with his family, Markham said.

Markham had asked Adelman for a probation-only sentence, arguing that Yarmo was unaware that AB-Fubinaca had been listed as a controlled substance only seven weeks before his store was searched.

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Hemp Industries Association Sues DEA

Posted on February 6, 2017 by Pharmaciststeve

Hemp Industries Association Sues DEA Over Illegal Attempt to Regulate Hemp Foods as Schedule I Drugs

http://www.military-technologies.net/2017/02/06/hemp-industries-association-sues-dea-over-illegal-attempt-to-regulate-hemp-foods-as-schedule-i-drugs/

WASHINGTON, Feb. 6, 2017 /PRNewswire-USNewswire/ — The Hemp Industries Association (HIA), the leading non-profit trade association consisting of hundreds of hemp businesses, has filed a motion to hold the Drug Enforcement Administration (DEA) in contempt of court for violating an unchallenged, long-standing order issued by the U.S. Court of Appeals in San Francisco, prohibiting the agency from regulating hemp food products as Schedule I controlled substances. Specifically, the HIA asserts that the DEA continues to operate with blatant disregard for the 2004 ruling made by the Ninth Circuit Court of Appeals, which permanently enjoined the DEA from regulating hemp fiber, stalk, sterilized seed and oil, which are specifically exempted from the definition of ‘marijuana’ in the federal Controlled Substances Act.

To read the motion, please visit: https://thehia.org/resources/Documents/Legal/HIA-v-DEA-9th-Circuit-Motion.pdf.

“We will not stand idly by while the DEA flouts the will of Congress, violates the Ninth Circuit order, and harasses honest hemp producers trying to make a living with this in-demand crop,” said Colleen Keahey, Executive Director of the Hemp Industries Association. “Hemp is a healthy superfood with vital nutrients such as Omegas 3 and 6, protein, fiber and all 10 essential amino acids that are ideal for today’s family.  The DEA must stop treating hemp, hempseed and hempseed oil, which is a nutritious ingredient, as something illicit. We have to address the challenges that thwart the domestic industry’s progress and especially those that mislead state Departments of Agriculture and limit entry of legal hemp products into the marketplace.”

Historically, the DEA has made persistent efforts to regulate hemp products. In 2001, DEA issued an Interpretive Rule attempting to ban all hemp seed and hempseed oil food products that contained even minuscule, insignificant amounts of residual THC. The HIA immediately filed suit to stop the enforcement of this rule, which resulted in what became known as the “Hemp Food Rules Challenge.”  Ultimately, the subsequent ruling made by the Ninth Circuit issued serendipitously on February 6, 2004, found that the DEA had not followed necessary scheduling procedures to add non-psychoactive hemp to the list of Schedule I controlled substances; and additionally, that Congress clearly did not intend that hemp be prohibited by the Controlled Substance Act when it adopted language from the 1937 Marijuana Tax Act to define the drug ‘marijuana.’ To read the full 2004 court opinion, please visit: http://www.votehemp.com/PDF/HIAvDEA_9th_final_decision.pdf.

In December of 2016, the DEA in conjunction with the North Dakota Department of Agriculture (NDDA) indicated to Healthy Oilseeds, LLC that shipment of the company’s hemp products made from hemp grown under the state’s hemp pilot program and Congress’ Agricultural Act of 2014 (Farm Bill), would require a permit from the DEA, as the hemp protein powder and hempseed oil food items were subject to DEA regulation. Specifically, Healthy Oilseeds received communication from the NDDA stating that export of its hemp products to other states was prohibited, “because industrial hemp is a Schedule I controlled substance under the Federal Controlled Substances Act.” To view this correspondence between NDDA and Healthy Oilseeds LLC, please visit: https://thehia.org/resources/Documents/Legal/HIA-v-DEA-9th-Circuit-Motion-Exhibits.pdf.

DEA’s actions violate the clear Congressional intent of not only of the Farm Bill, which defines industrial hemp as distinct from ‘marijuana’ and legalizes its cultivation and processing under licensing programs in place in 31 states; but also further violate the Consolidated Appropriations Act of 2016, which specifically prohibited federal authorities from using funds to obstruct the “transportation, processing, sale, or use of industrial hemp…within or outside the State in which the industrial hemp is grown or cultivated.” Hence, the DEA may not require lawfully licensed hemp farmers or manufacturers in the U.S. to register for a permit to engage in interstate commerce of industrial hemp products.  Indeed, by taking this action, the DEA is violating federal law, misusing taxpayer dollars, and thumbing its nose at Congress.

“Here in Kentucky, our Commissioner of Agriculture, Ryan Quarles, has built a successful pilot program that works closely with local law enforcement and is creating desperately needed economic opportunity for hundreds of farmers,” stated Bill Hilliard, CEO of Atalo Holdings, Inc.  “As states have wisely taken the initiative in this growing industry, the DEA doesn’t need to be interfering on our farms.”

Joe Sandler, HIA’s lead counsel, further stated:  “Thirteen years ago DEA was told in no uncertain terms by the U.S. Court of Appeals that Congress had made its intent clear:  DEA has no power to regulate hemp seed and oil, and the hemp food and beverage products made from them.  It is disappointing that the industry has to revisit the issue, and take this step to compel DEA to obey the law.”

On January 13, 2017, the Hemp Industries Association, among other petitioners, filed a Petition for Review with the Ninth Circuit Court of Appeals, to challenge the DEA’s recent effort to append Schedule I of the Controlled Substances Act to include lawful hemp-derived non-psychoactive cannabinoids such as cannabinol, which the DEA has arbitrarily termed “Marijuana Extract.” In addition to this suit, and today’s actions taken to affirm the legality of hemp food products, the HIA does intend, in due course, to challenge the DEA’s repeated refusal to abide by other Congressional directives on industrial hemp.

The Hemp Industries Association (HIA) represents the interests of the hemp industry and encourages the research and development of new hemp products.  More information about hemp’s many uses and hemp advocacy may be found at www.TheHIA.org.

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/hemp-industries-association-sues-dea-over-illegal-attempt-to-regulate-hemp-foods-as-schedule-i-drugs-300402745.html

SOURCE Hemp Industries Association

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Pneumonia vaccine may not be effective in rheumatoid arthritis patients

Posted on February 6, 2017 by Pharmaciststeve

Pneumonia vaccine may not be effective in rheumatoid arthritis patients

http://www.clinicaladvisor.com/infectious-diseases-information-center/pneumonia-vaccine-not-effective-in-rheumatoid-arthritis-patients/article/635670/

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) may not be effective for preventing pneumonia in patients with rheumatoid arthritis (RA) who are at risk for infections, according to a study published in Arthritis Research & Therapy.

Kiyoski Migita, from the Japanese Hospital Organization and Department of Rheumatology at Fukushima Medical University, and colleagues conducted a double-blinded, randomized, placebo-controlled trial across rheumatology departments in Japanese National Hospital Organization hospitals. The study included 900 RA patients who had been treated with biological or immunosuppressive agents.

The study participants were randomly assigned to receive PPSV23 (n=464) or placebo (n=436). The researchers examined incidences of all-cause pneumonia and pneumococcal pneumonia as the primary end point and death from pneumococcal pneumonia, all-cause pneumonia, or other causes as the secondary end point.The researchers found that 17 of the patients (3.7%) who received the vaccine and 15 of the patients (3.4%) in the placebo group developed pneumonia. The overall rate of pneumonia was 21.8 per 1,000 person-years among patients with RA. In addition, the presence of interstitial pneumonia (hazard ratio, 3.601) was associated with an increased risk of pneumonia among RA patients.

The investigators note that the patient population in the current study had a high risk of infection, and the results may not be applicable to other RA populations.

“While PPSV23 vaccination is recommended for adults ≥65 years of age, our results suggested uncertainty regarding its effectiveness for pneumonia in RA patients at high risk for infections,” the study authors wrote. “Clinicians should keep in mind the patient’s age and the presence of interstitial pneumonia because such patients are at an increased risk of developing pneumonia.”

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MJ.. LEGAL IN COLORADO… DEA PULLS DOCS’ DEA LICENSE for recommending MJ to pts ???

Posted on February 6, 2017 by Pharmaciststeve

DEA pulls certificates for two Colorado doctors in medical marijuana controversy

http://www.denverpost.com/2017/02/06/dea-pulls-doctors-certificates-medical-marijuana/

The federal Drug Enforcement Administration has pulled the medicine-prescribing certificates of two Colorado doctors, after those physicians had their state licenses suspended in Colorado over medical marijuana recommendations.

The doctors — Gentry Dunlop and Janet Dean — were two of five Colorado physicians whose licenses the state Medical Board suspended last summer, alleging that the doctors wrote improperly large numbers of medical marijuana recommendations authorizing high plant counts..

Last week, the DEA published a notice in the Federal Register that it had revoked Dean’s certificate of registration, which allows her to prescribe controlled substances. The move was not unexpected, and the DEA’s notice said the revocation was a consequence of the state license suspension, which blocked the doctor from practicing medicine or prescribing medication in Colorado, and not the result of new information.

Late last month, the DEA published a similar notice for Dunlop. Searches of the Federal Register for notices relating to the other suspended doctors turned up nothing.

Four of the suspended doctors — everyone but Dean — filed suit over the suspensions last year. After winning a brief reprieve, a judge in Denver allowed the suspensions to continue while the doctors’ administrative appeals progressed. The doctors appealed the judge’s order; meanwhile, their cases at the Medical Board are also still pending. Lee Rasizer, a spokesman for the state agency that houses the Medical Board, said he could not comment on the cases.

The doctors were each accused of recommending that hundreds of patients be allowed to grow or possess more than the standard six marijuana plants per patient. The doctors say their suspensions were arbitrary, and that all of their recommendations conformed to the law and policy.

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Man’s best friend – can legally use Marijuana

Posted on February 5, 2017 by Pharmaciststeve

Medical marijuana for dogs

http://news4sanantonio.com/news/local/medical-marijuana-for-dogs-02-03-2017

SAN ANTONIO – Medical marijuana… for your dog? It’s real – and according to the Drug Enforcement Administration, perfectly legal.

“Kona is my 13-year-old Dutch Shepherd mix,” says Bea Adams as she pets her dog.

Adams recently noticed a change in Kona’s behavior.

“I hadn’t slept in weeks,” Adams says. “She kept me up at night, licking.”

Kona’s red, itchy skin was caused by seasonal allergies, a common ailment. Veterinarian Dr. Michelle Bammel at Westridge Pet Hospital suggested a treatment called Therabis.

“It’s just a natural antihistamine,” Dr. Bammel says.

The natural ingredient is CBD hemp oil. It’s not legal for humans, but DEA spokesperson Melvin Patterson says it’s okay for pets because pet products aren’t considered for human consumption.

“I tell people: it’s not pot. That’s the first thing out of their mouths,” Dr. Bammel says.

She says the treatment won’t get your dog high because it doesn’t contain THC.

“The joke is industrial hemp is kind of the sober cousin of marijuana,” Dr. Bammel says.

She recommends pouring the packet in your dog’s food, and the chemical ingredients will relieve itching and anxiety.

“There’s a lot of great attributes to it that you can get without having your dog get high or all the psychotropic effects of it – they don’t have those,” Dr. Bammel says.

Adams says Therabis cleared up Kona’s skin.

“I’d say about the third day on it, the itching was completely gone,” the dog owner says.

She urges dog loves concerned about the stigma of medical marijuana to consult with their veterinarians.

“I think they should keep an open mind on any natural product, especially for the dogs,” Adams says.

 

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By law, pharmacies are not required to report complaints/mis-fills

Posted on February 5, 2017 by Pharmaciststeve

Channel 2 Investigates reveals pharmacies with most complaints about prescription errors

http://www.click2houston.com/news/investigates/channel-2-investigates-reveals-pharmacies-with-most-complaints-about-prescription-errors

The number of complaints filed has nothing to do with the number of mis-fills that actually occur. Unless prescribers or pts file complaints with the state Board of Pharmacy… it is just “swept under the rug”..

HOUSTON – Channel 2 Investigates is revealing the local pharmacies with the most complaints about prescription errors.

Many mistakes never get reported, and there are steps you can take to prevent a dangerous mixup.

  •   Evan Merritt is just 7 months old. In his short life, he’s been through a lot.

“He’s had a rough several months of life,” said Evan’s mother, Krisztina. “He’s kind of hit every bump in the road.”

Merritt was born with a serious kidney condition. He’s already had one surgery and a second surgery is just weeks away.

“He was placed on a maintenance antibiotic from birth,” Krisztina said.

In October, Merritt’s doctor prescribed a new antibiotic.

“We gave him that antibiotic every day for 30 days,” Krisztina said.

When it was time to refill the prescription, Krisztina claims something was off.

“The two medicines looked so different,” Krisztina said.

Merritt’s dad went back to the pharmacy to check it out.

“The pharmacy tech was shocked,” Krisztina said.

Merritt’s parents think the new prescription was right, but what he had taken every day for the previous month was wrong.

“It was terrifying,” Krisztina said. “I didn’t know if it was a medication with long-term implications on his health. I still don’t know that.”

The family contacted CVS and, “We then filed a complaint with the Texas State Board of Pharmacy Licensing,” Krisztina said.

CVS said, “We fully investigated Ms. Merritt’s complaint last fall and determined that her child’s prescription was filled correctly. A thorough review of the safety procedures during the filling of the prescription in question found that all steps were performed correctly and no error was made. We informed Ms. Merritt of our findings in November.”

The case is not closed yet. The State Pharmacy Board is still investigating.

For months, Channel 2 Investigates poured through complaints about prescription errors.

By law, pharmacies are not required to report complaints. Most of the time, complaints come voluntarily from doctors or patients.

The CVS pharmacy on the 9500 block of Broadway in Pearland had the most complaints in our area — five since 2010.

The Walgreens on the 6800 block of South Fry road in Katy received four complaints.

“We see, it’s a wide range,” said Allison Vordenbaumen Benz, R.Ph., M.S., director of professional services with the Texas State Board of Pharmacy. “All the way from something that involves a miscount. If the patient was supposed to receive 30 tablets and they only received 28. They might have the wrong directions for use on the prescription label, they might have a situation where one patient gets another patient’s prescription or it’s the wrong drug, or it’s the right drug but the wrong strength.”

While a miscount might sound insignificant, mistakes like this can be deadly.

“Fortunately, that does not happen very often,” Benz said.

Channel 2 Investigates also found three complaints filed against the CVS on the 3800 block of Old Spanish Trail. In one case, the patient was “bedridden and experiencing end-stage liver failure.”

After receiving the wrong medicine, the patient became “non-responsive” and was hospitalized for 15 days.

The pharmacy is now on a two-year probation.

Board action can range from a warning letter to losing a license.

View Document: Dispensing Error Guidelines

So how can you help prevent pharmacy mistakes?

1. Talk to your pharmacist. Ask the pharmacist to look at the drug and dosage before you leave.
2. Look at the insert that comes with the medication. Compare the shape, size, markings and color of the medicine before you take it.

“Never, ever take it for granted that the prescription you fill and pick up is exactly what you think it is,” Krisztina said.

CVS also told Channel 2 Investigates “Errors are very rare, but when they happen we investigate to determine how it occurred as part of our process of continual improvement.”

When you discover a problem, it’s important to file a complaint, which you can do here.

CVS’s complete statement:

“The health and well-being of our patients is our number one priority. Our pharmacists follow comprehensive quality assurance processes to ensure prescription safety and accuracy. Every prescription dispensed at CVS Pharmacy undergoes a multi-step review by a pharmacist prior to being dispensed to a patient.

We fully investigated Ms. Merritt’s complaint last fall and determined that her child’s prescription was filled correctly. A thorough review of the safety procedures during the filling of the prescription in question found that all steps were performed correctly and no error was made. We informed Ms. Merritt of our findings in November. In addition, we resolved the complaint concerning the 4-year old incident that occurred at our Old Spanish Trail pharmacy with the Board of Pharmacy back in 2014 and took corrective action with the pharmacy.

As a health care company that strives to help people on their path to better health, we seek out new technology and innovations to enhance safety, we engage with industry experts for independent evaluations of our systems, and we are committed to continually improving our processes to help ensure that prescriptions are dispensed safely and accurately.

Prescription errors are a very rare occurrence, but when they happen we do everything we can to take care of the patient’s needs, including contacting their prescriber to address any health concerns. In addition, we require our pharmacies to report such events to the company’s patient safety organization as part of our program to learn from these incidents and continuously improve quality and patient safety.”

Walgreen’s complete statement:

“The four complaints at the store inquired about occurred between 2008 and 2011. In two of those cases the Texas State Board of Pharmacy concluded its investigation by dismissing the complaints with no disciplinary action taken.  With all prescriptions filled in our pharmacy, our first concern is always the patient’s well-being. We take this issue very seriously and have a multi-step prescription filling process with numerous safety checks in each step to reduce the chance of human error. In the event an error occurs, we investigate what happened and work to prevent it from happening again.”

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Improving Opiate Drug Utilization Review Controls ?

Posted on February 3, 2017 by Pharmaciststeve

Improving Drug Utilization Review Controls

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-01.html

It looks like CMS (Center for Medicare & Medicaid Services) is trying to implement CDC opiate dosing guidelines on all Part D/Medicare Advantage pts. More “bureaucratic creep” on the guidelines… that – per the CDC – did not bear the weight of law.

While not stated in this information, there has been other “rumors” that CMS via their Part D providers to restrict pts to a single provider and pharmacy.  This statement really concerns me ….“sponsors are expected to reduce beneficiary overutilization of opioids and maintain access to needed medications“...  and if a particular pharmacy that a pt is locked into… has a pharmacist on staff that “is not comfortable” filling opiates… the pharmacy is out of stock for a number of reasons… how much influence or FORCE to get the Part D program and the pharmacy to “maintain access to needed medications”… how long will a pt have to suffer thru cold turkey withdrawal… while the “wheels of the bureaucracy” gets corrective action in place ?  After all the “pharmacy crawl” will not be a option.. since the pt is locked-in to a particular pharmacy… which may or may not be a singular store and not all the stores in an entire chain.

Medicare/Medicaid has a “freedom of choice of providers” by pts from day one… now they are going to take that freedom away at their opinion of a pt’s MAY be getting excessive opiates. Once again, there is seemingly no consideration for the pt’s severity/intensity of pain, CYP-450 enzyme metabolism defect of opiates. Like everything else with a “cookie cutter” type of medical care… those 5%-10%  at each end of the “bell curve”..  those “out-liers” are just SCREWED in regards to getting adequate therapy.

Maybe we should be on the lookout for increased passage of “assisted suicide” laws…to help those out-liers with access to a “final solution” to resolve their chronic pain issues ?


To address the opioid epidemic, CMS has implemented a medication safety approach by which sponsors are expected to reduce beneficiary overutilization of opioids and maintain access to needed medications. CMS also implemented the Overutilization Monitoring System (OMS) to help oversee sponsors’ compliance with this CMS overutilization guidance. Building upon these successes, CMS is proposing a number of updates to these policies intended to address drug utilization concerns within the Part D program for 2018, including:

  • Proposing revisions to the retrospective drug utilization review criteria used to identify potential opioid over utilizers through the OMS to better align with the CDC guideline on opioid prescribing, reduce false positives, and maintain a policy that is still manageable for sponsors; and
  • Proposing establishing the expectation for sponsors to, at a minimum, implement hard formulary-level safety edits based on a cumulative morphine equivalent dose (MED) approach to prospectively prevent opioid overuse at point of sale at the pharmacy.   

Process
Comments on the proposed Advance Notice and Draft Call Letter are invited from the industry, seniors, consumer advocates, and the public, and must be submitted by March 3, 2017. The final 2018 Rate Announcement and Call Letter, including the final Medicare Advantage and FFS growth percentage and final benchmarks will be published by Monday, April 3, 2017. 

Comments can be emailed to: AdvanceNotice2018@cms.hhs.gov. 

The Advance Notice and Draft Call Letter may be viewed through: http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/ and selecting “Announcements and Documents.”

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“stewardship” a euphemism for dictator/master over others ?

Posted on February 3, 2017 by Pharmaciststeve

Curbing abuse and overdoses through opioid stewardship

https://www.addictionnow.com/2017/01/30/curbing-abuse-overdoses-opioid-stewardship/

http://the-stewardship.org/metaphors.htm

“The steward, or “keeper of the hall”, was the official in a medieval household responsible for its management. Under the feudal system, it was the lord who had all of the legal authority. The steward had only a delegation of that authority, and a mandate to administer the estate. His stewardship of the estate was all-inclusive, from the broadest policies to the most trivial details. For the estate to function properly, the steward needed to hold himself accountable for all that took place in the household. He might delegate; but he would maintain an interest in all happenings, make it his business to know all of the operational details, and know when to intervene and when to concentrate on other matters.”

Last December, the Centers for Disease Control and Prevention (CDC) updated its website with information about antibiotic stewardship — a practice that describes a coordinated effort to reduce unnecessary prescriptions for antibiotics. The overarching goal, the CDC stated, was to provide the best standard of care and minimize the spread of antibiotic-resistant bacteria.

According to the CDC, at least 30 percent of antibiotics prescribed in an outpatient setting are unnecessary, and the amount of inappropriate antibiotic use may be close to 50 percent in outpatient settings.

Would establishing a standard for opioid stewardship reduce the rates of overprescription and, in turn, the rising rates of opioid overdoses?

Last year, the CDC urged primary care physicians to turn to physical therapy, over-the-counter medication and exercise before writing a prescription for opioids for pain management.

Dr. Tom Frieden, former CDC director, said in an interview that the risks for addiction and death related to opioid painkillers are “very well documented.”

With opioid prescriptions in the U.S. reaching all-time highs, the concept of opioid stewardship is beginning to gain traction among key stakeholders.

The problem of opioid overprescription is not unique to the United States.

Canada has become the world’s second largest opioid consumer in recent years. The Institute for Safe Medication Practices Canada (ISMP) created an Opioid Stewardship Program to help key stakeholders become more aware of the risks of overprescribing opioids.

In November, the ISMP released a safety bulletin for community practitioners titled Safer Decisions Save Lives, which recommended best practices for opioid prescriptions. Among their suggestions were not prescribing potent opioids for minor pain, reserving chronic opioid therapy for patients who have chronic pain that impedes daily functions and have not responded to non-opioid treatments, treating an opioid regimen as a therapeutic trial, educating patients about the risks and potential of overdose, and recognizing opioid use disorder before writing a prescription.

Establishing a standard for opioid stewardship requires a collaborative effort from gatekeepers.

“We have to come together as health care professionals and governments to collaboratively work on the issue,” said Phil Emberley, director of professional affairs for the Canadian Pharmacists Association. “The first is we have to improve our drug information systems that pharmacists have access to, and we also have to give pharmacists the ability to adapt prescriptions in order to better manage their patients’ pain.”

Education is also an important component of creating a standard for opioid stewardship. Pennsylvania’s Physician General Dr. Rachel Levine said that there are efforts underway in her state to…

work with medical schools in establishing a set of core competencies related to opioid prescriptions and create continuing education programs for physicians and other health care professionals. The state has also written specialty- and location-specific prescribing guidelines, which have been submitted to respective medical boards for review, acceptance and affirmation.

Technology can also play a role in opioid stewardship. Prescription Drug Monitoring Programs (PDMP) allow medication dispensers such as pharmacists to input information about a patient into a statewide database, which physicians can be required to access before writing a prescription. The benefit of a PDMP is the access to information about a patient’s history with a controlled substance that a physician may not have previously had. The information available through a PDMP would give a physician a more complete profile of a patient, which can be taken into consideration before writing a prescription.

According to the CDC, PDMPs are among the most “promising state-level interventions” to improve overprescription rates of opioids.

“Opioids are essential medications in our medical toolbox, but we have to use them more carefully and more judiciously,” Levine said. “And we need to make sure that we moderate the prescriptions, the length of the prescriptions and the doses.”

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I guess that compassion and empathy is no longer part of healthcare ?

Posted on February 2, 2017 by Pharmaciststeve

This showed up on Face Book page of CVS

Highly highly disappointed in Fayetteville, WV pharmacy! I normally don’t fill Rx there however Wal Marts system was down and they no idea when they would be back up. I literally was just discharged from a reliable hospital an hour away due to having lost my baby and having surgery last night. I took my pain Rx to be filled there. I am literally in my pajams with my hospital braclete still on and the pharmacist immediately profiled me and refused to refill my Rx regardless that it came from a WV state hosptial with a clear water mark and all
necessary Rx information printed on the Rx. She stated there is no pharmacy that would fill it because it wasn’t within a 20 mile radius!! There are 0 large hospitals much less reliable hosptials within 20 miles of that pharmacy. As well as my high risk obstetrics physican is located an hour away. I could understand if I have had multiple pain Rx filled there before but this was the first time and my first pain Rx being filled anywhere in 11 months. Not to mention the fact it was for a 20 count of pills with no refills. I understand there is a current drug epedicm in WV but I should not have been singled out and profiled especially in this situation, given what I have just been through and my Rx history. We asked her to please call the physicans office and or the hosptial and verify I was literally just discharged and she refused stating she wouldn’t because she didn’t have a relationship with the physican. I was unaware that pharmacists had a standing “relationship” with every physican even in their local area. She was not compassionate or caring at all despite me expressing to her what I had just been through. I assure you, CVS has lost my business and not just for Rx if that’s how they want to treat people. Thankfully Kroger was understanding and clearly stated it came directly from the hospital what issue could there possibly be. I have no control over the fact there are no obstetrics physicans or hosptial to facilate pregnant woman within a 20 mile radius of Fayeteville, WV and where I reside. This is not an appropriate way to treat a mother who just found out her baby has died and was taken into surgery within the last 24 hours.

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How things has changed since we have middlemen to “save us money” ?

Posted on February 2, 2017 by Pharmaciststeve

I often post about the average prescription price was $4 – $5… before the PBM’s (prescription benefit managers) got into interfering with the prescription distribution system in  1970.

This is two prescriptions for Marilyn Monroe from 1962 with prices on them.. the average for those five BRAND NAME medications was $5.01 and four of them were LESS THAN $4.00

Generic was suppose to save everyone money…but… today we have abt a 85% generic utilization and the PBM’s control abt 90% of the prescription distribution market place in one way or another … and the average prescription price today is pushing $60.00.

If one applied the CPI (Consumer Price Index) or COLA ( Cost of Living Adjustment ) to those prices back in the pre-PBM days.. and disregarding that 85% of today’s prescriptions are generics.. would suggest that the average prescription prices would be in the mid-low $30 range…  The question has to be asked — who is getting the other $20-$30 when a prescription is filled ?  Those middlemen whose primary task was to save the system money ?

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