Tuesday, August 21, 2007

Old and Unused Meds for Fuel!

I have to look into this when I have the time, but it sounds pretty neat and a good way to use unfilled and returned medication. The article repeats the facts from the NCPIE report and uses some local stats that I am not including - just the mention of these programs from the Waldo County Citizen:

Prescriptions: Alternative Fuel by Patrick Walsh

I was surprised to read in a recent Associated Press article that a company called Capital Returns was generating electricity from burning outdated or recalled prescription drugs. These are unused drugs from pharmacies and manufacturers. With 28 percent of the “returns market,” this company was able to generate enough electricity to power 220 homes last year. The company figures that only about 1 percent of unused or recalled drugs are returned, but that 1 percent has a value of $4 billion to $5 billion.......

.....The lack of compliance, coupled with the lack of a system for consumers to return unused drugs, led to an innovative program being developed by the Maine Benzodiazepine Study Group and the Center on Aging at the University of Maine.

Funded by the Federal Environmental Protection Agency, the project will provide for return of drugs by mail and proper disposal. The EPA is involved because the prevailing practice of “flushing” unused drugs has caused a negative impact on water quality.

Unused drugs also have been diverted to the black market and represent a source for youth drawn to what they see as a “safe” drug alternative to illegal street drugs.

In looking at youth substance-use issues, we have heard about “pharm” or “Skittles” parties where youth as young as middle school age take their chances on prescription drugs dumped in a bowl. These may come from the family medicine cabinet and may be designed to control blood pressure, blood sugar, for pain management or who knows?In a related item, a bill presented to the Maine Legislature this session that would have outlawed any pharmaceutical advertising that made a false claim or “contains language recommending that viewers, listeners or readers ask physicians about any specific prescription drug” was declared dead May 17.

So we will continue to hear “ask your doctor” on every other ad during the evening news. And as a result, some of us may end up with very expensive medications that we don’t want and that could end up as fuel to generate electricity.

Now, consider that Waldo and Knox counties share the highest rate of drug prescriptions written in Maine — one per person, or more than 50,000 per year in each county — according to an analysis by the State Prescription Monitoring Program.

Monday, August 13, 2007

Problems with Skin Patches

I have always been a big fan of medication patches from the begining for medication adherence. I remember first seeing "the patch" for smoking sensation and am glad that they are able to adapt this technology for Alzheimer's and Parkinson's. Although I do remember my father smoking and chewing Nicorette while using the patch, and getting incredibly sick.

I had heard about problems with the contraceptive patch, but had never heard of a narcotic patch. I can see how these problems can occur, especially for older patients who put a patch on Monday, then forget on Wednesday and put another one on. Although I would think they would solve this problem with packaging.

And discarded patches seem to be a problem as well. Here's an article I found from the Toronto Star from 8/7/07. It only discusses Canadian problems, but I'm sure they are applicable in the US.

Skin Patches Have Their Downside by Nancy J. White.

Morag Dickie liked the convenience. She could just slap the nitroglycerin patch onto her body in the morning and not worry about popping pills.

"I could feel a consistent flow of energy," says Toronto resident Dickie, 55, a heart patient.

That's the idea behind a skin patch – an easy-to-use method with smooth, controlled drug release, not the peaks and valleys of ingested medicine. In the U.S. last month, the Food and Drug Administration approved the first skin patch to treat Alzheimer's disease. In May, it gave the green light to a drug patch for Parkinson's disease. Last year, medicinal patches were approved Attention Deficit Hyperactivity Disorder and depression.

Researchers are developing an insulin patch for diabetics.

But it's also a system that can present problems from the occasional skin irritation – the reason Dickie, who has sensitive skin, had to eventually give up her patch – to unintended poisonings. Three people in this country have died from use of the narcotic fentanyl patch, according to the Institute for Safe Medication Practices Canada (ISMPC).

In June, a federal jury in the U.S. awarded $5.5 million to the father of a 28-year-old man who died in 2003 while wearing a fentanyl patch for chronic hip pain after a car accident.

In Canada, prescription patches are approved for a handful of uses, including contraception and hormone replacement therapy, pain relief, smoking cessation, prevention of motion sickness and control of angina.

As for new ones, Health Canada does not disclose drugs it is reviewing, according to a spokesman. The patch to treat the dementia of Alzheimer's has been submitted to Health Canada and the manufacturer hopes for approval next year, says Jason Jacobs, a spokesman for Novartis Pharmaceuticals Canada. That patch delivers the drug Exelon or rivastigmine, which is currently sold in Canada for oral use.

Patches provide a smoother delivery of drugs than tablets, which send medication for absorption to the intestine, and may lessen the potential for side effects by avoiding a high peak.

They are longer-acting, some up to a week. "There's better compliance when the patient doesn't have to worry about taking a medicine three or four times a day," says Bill Wilson, pharmacy director at Mount Sinai Hospital.

Patients may, however, forget they're wearing a patch, especially since some are clear. "We've had reports of more than one patch of the same drug put on a person," says Sylvia Hyland, vice president of the non-profit group ISMPC.

Youngsters have been poisoned by chewing ondiscarded patches or putting them on. "Children are fascinated by stickers and bandages," says Hyland. "A thrown-away patch still has some drug in it."

The ISMP has had reports from emergency room staff concerned by unlabelled patches. And the most dangerous are the patches delivering fentanyl, a narcotic. "They need to be prescribed appropriately for chronic severe pain, not acute pain," explains Hyland. "Physicians need to be very knowledgeable about the patch."

Two of the Canadian deaths from the fentanyl patch were adolescents. The deaths occurred in 2004. It's supposed to be only for adults, says Hyland.

The birth-control patch, EVRA, has also raised concerns after a study indicated women using it in the U.S. had an increased risk of blood clots in the legs and lungs than women on an oral contraceptive. Another study, however, showed no difference in the risk.

Friday, August 10, 2007

Compounding Pharmacists - Who knew?

In a lot of my research on medication non-adherence (that is the new accepted term for noncompliance), I come across what researchers deem as the "important role of the pharmacists". Especially in all of the pharmacists surveys and reports! For me (I have taken two or three medications on and off for 8 years) I just pick up my drugs and leave. I recall once, maybe five years ago, the pharmacist gave me the option of getting a generic as opposed to the branded drug - and I think I took it.

BUT after thinking about their role a couple of weeks ago, I started engaging the pharmacist. I had a phlegmy cough in Nantucket over the 4th of July weekend and wondered what I should take - musanex (sp), robitussin, etc... She was very helpful and outlined the pros and cons of each. Helpful, but not exactly prescription help.

So in the last two days I was surprised to find two articles about compounding pharmacists - a job I never knew existed. I have always just gotten my pills as they come from the pharma company. I guess other people are pickier than I am. At least both articles state that it helps with Medication Non-Adherence.

Here are the two articles:

The first from the website Hometownlife by Nathan Mueller:

Kenny Walkup has hands that can turn a solid into a liquid; change the taste of medicine to anything from bubble gum to beef; and change certain aspects of a prescription to remove parts that people or animals are allergic too.
OK, Walkup does not do it all with his hands — some high-tech equipment and technicians also play a role — but they are a key reason Specialty Medicine Compounding Pharmacy has been successful.

"I always liked working with my hands. I should have been a mechanic but I can't fix a car," he joked. "Plus it gives me a chance to be creative." But he can fix medicine.

Walkup's job as a compounding pharmacist is solely based on the individual he is working for. He works with the patient and physician to create a medication that will work for the customer.

The most common situation he comes across is "patient non-compliance." Many people or animals are allergic to certain parts of a prescription or sensitive to strengths, and a compounding pharmacist can — with physician consent — change the strength, change the form from solid to liquid, etc. and change the flavor. Flavors range from chocolate to pineapple to bubble gum for humans and from apple to catnip to chicken for pets.

"All prescriptions are made from scratch, specific to each patient," he said. Walkup owned both the compound pharmacy and the South Lyon Pharmacy before splitting them in February 2003. He has been in South Lyon since 1998.

A graduate of the School of Pharmacy at Ohio Northern University in Ada, Ohio, Walkup joined the Professional Compounding Centers of America and began training there before opening the pharmacy in South Lyon. His pharmacy is a clinical site for Ohio Northern and the University of Michigan, and he gives lectures and does work for both universities.

"I enjoy (talking to students) but I like being in the lab too," he said. "Most of the new stuff I make myself the first time."
The pharmacy has been so successful that it was recently featured on the Heath Watch on the Channel 4 News. Reporter Rhonda Walker said the pharmacy was the "ultimate when it comes to personalized medicine."

It also touched on a story about a patient, Noel Gelfund, who was undergoing treatments to remove a birthmark and the pain killing cream he needed was discontinued. Walkup got to work and formed a new cream that worked better and cost half as much.

Gelfund was killed in a car accident in 2004 and the cream was named "Noel's Numbing Cream" in his honor.
Walkup donates 20 percent of the proceeds of the sale of the product to the Sturge-Weber Foundation which researches Port Wine Stain conditions.

"I have the best job in the world," Walkup said. "I get to help people and do something I truly enjoy."

Here's the second article from the Salt Lake Tribune by Fitzgerald Petersen

Tad Jolley may have the pharmacy business coursing through his veins, but innovation runs in them, too. Jolley was recently awarded "Innovative Pharmacy Practice" by the Utah Pharmacy Association at their yearly convention. Jolley won for his creation of an in-house program to train pharmacy technicians, who are a critical component to Jolley's pharmacy business.

Prior to the creation of the program, aspiring pharmacy technicians would need nine months of schooling before becoming certified. Jolley's program allows technicians in training to receive a paid education while gaining valuable work experience. Jolley benefits by gaining technicians who know their way around his unique store.

Jolley's pharmacies specialize in compounding, which Jolley calls "a lost art." Compounding is highly specialized and involves mixing ingredients specifically for each patient. Of the hundreds of pharmacies competing to fill prescriptions in the Salt Lake Valley, only a handful offer this special service. Most simply rely on pre-made formulations from big drug companies.

Tad Jolley is the third generation of compounding pharmacists to sit behind the counter of the family business. Joel Jolley opened the first Jolley's Pharmacy in 1954. Fifty-three years and four stores later, the family business is still going strong.

Jolley's Pharmacy employs 30 pharmacy technicians in all, so the in-house program makes a significant impact - and not just for Jolley's. The program has caught on with other pharmacies as well. Jolly has received numerous calls from colleagues asking for his advice on implementing their own in-house training. Jolley acknowledges that his program "does something outside the norm" but, he says, "It's helped a lot of other pharmacists as well."

Though Jolley has been working as a pharmacist since 1980, he still loves picking up his mortar and pestle to serve the community. While his award from the association hangs modestly on a wall in his store, he hopes the positive impact of his training program will be felt for years.

Compounding the cure

Pharmacy compounding is the long-established tradition in which medicines that are specially prepared by pharmacists to meet patients' individual needs. Physicians often prescribe compounded medications when:
* Medications are discontinued by or generally unavailable from pharmaceutical companies.
* The patient is allergic to certain preservatives, dyes or binders in available off-the shelf medications.
* Treatment requires tailored dosage strengths for patients with unique needs.
* A pharmacist can combine several medications the patient is taking to increase compliance.
* The patient cannot ingest the medication in its commercially available form.
* Medications require flavor additives to make them more palatable for some patients, most often children.

Monday, August 6, 2007

NCPIE Report

Yes, I have been very late in posting this. I appologize. The NCPIE report that is referenced in many articles around the country and in my last post can be found at http://www.talkaboutrx.com.

Dr. Allan Showalter at Alignmap is always up to date and I cannot express my thoughts about the report better than he at: