Take Back programs aim to reduce prescription drug abuse by collecting unused and expired medications from the public for safe disposal. Data from the Medication Cleanout program in Texas shows that significant amounts of controlled and non-controlled substances are collected, indicating overprescribing by doctors. Analysis found that patients are often prescribed more medication than they need, with many unopened containers being returned. This points to a broken pharmaceutical system that is costing lives through addiction and overdose while wasting healthcare funds. More data is still needed to understand prescription refill practices and their role in accumulating unused medications in homes.
The document discusses the issue of drug diversion, which is defined as the diversion of legally prescribed drugs for illegal purposes. It notes that drug diversion costs the US healthcare system an estimated $72.5 billion per year. Veterinary practices are at risk of drug diversion due to their access and storage of controlled and non-controlled substances. Diversion can occur through various means and at different points in the distribution process. The document outlines regulatory requirements and penalties for diversion violations to emphasize the importance of compliance for veterinary practices.
This document discusses a presentation on whether pharmacists should fill opioid prescriptions or not. It includes the presenters, learning objectives, and disclosures. It then summarizes Karen Ryle's presentation on red flags pharmacists should watch out for when dispensing controlled substances like opioids. These include things like "cocktailed" prescriptions, no individualized dosing, early refills, out-of-area doctors and patients, and mostly cash prescriptions. It also discusses integrating prescription drug monitoring program data into pharmacy workflows to more easily check for signs of abuse or diversion.
Madan Lal, a 65-year-old male, was admitted to the hospital with abdominal pain and nausea. He had been taking chlorpromazine for psychosis. Examination revealed jaundice. Liver function tests showed elevated bilirubin, ALT, and alkaline phosphatase. The patient was diagnosed with chlorpromazine-induced liver injury which resolved after stopping the medication. ADR reporting form was completed for the case.
Mr. Sushant Gupta, a 30-year-old male diagnosed with meningitis, developed chills, rigors, fever, and urticaria after administration of intravenous vancomycin. The reaction subsided with antihistamine. Reintroduction of vancom
Description and comparison of drug diversion in pharmacies by pharmacists, in...Juanita Draime
1. The document examines cases of drug diversion reported to state pharmacy boards between 2008-2013, finding most cases involved pharmacy technicians diverting controlled substances for personal use.
2. A total of 811 cases were identified across 9 states, with technicians comprising 71.4% of cases. Technicians were also more likely than pharmacists or interns to divert drugs for sale.
3. Most common disciplinary actions taken by boards were license revocation or surrender (62.5%), with disciplinary actions varying significantly based on employee type and reason for diversion.
This document discusses the need for a five-year recovery standard for evaluating substance abuse treatment outcomes. It presents evidence from studies of Physician Health Programs which show that extending treatment and monitoring to five years leads to much higher rates of long-term abstinence compared to typical short-term treatment programs. The brain science of addiction demonstrates that substance use disorders are chronic relapsing conditions, so treatment needs to provide sustained support over multiple years to achieve stable recovery.
The document summarizes findings from a study of prescription drug monitoring program (PDMP) data in Los Angeles County. It finds that 0.3% of patients, or 5,153 individuals, were identified as "doctor shoppers" who received opioid prescriptions from at least 4 prescribers and 4 pharmacies in 2012. Compared to non-doctor shoppers, doctor shoppers were more likely to be female, aged 35-64, pay with private funds, use specific long-acting opioid drugs in higher doses, and obtain a greater number of opioid pills, prescriptions, and days of supply.
Pharmacogenetics and therapeutic drug monitoring practiceLarry Baum
This document discusses pharmacogenetics and therapeutic drug monitoring. It describes how pharmacogenetics can help determine the best drug and dose for individuals by examining genetic factors that influence drug metabolism and response. Two key types of pharmacogenetic effects - analog and digital - are described. Several examples of pharmacogenetic testing for drugs like carbamazepine, allopurinol and cancer therapies are provided. The role of genes like HLA-B*1502, HLA-B*5801, CYP2C9 and VKORC1 in drug responses are outlined. Therapeutic drug monitoring is also discussed as a way to track drug levels in patients' blood to ensure efficacy and safety. Several classes of drugs that are commonly monitored
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
The document discusses the issue of drug diversion, which is defined as the diversion of legally prescribed drugs for illegal purposes. It notes that drug diversion costs the US healthcare system an estimated $72.5 billion per year. Veterinary practices are at risk of drug diversion due to their access and storage of controlled and non-controlled substances. Diversion can occur through various means and at different points in the distribution process. The document outlines regulatory requirements and penalties for diversion violations to emphasize the importance of compliance for veterinary practices.
This document discusses a presentation on whether pharmacists should fill opioid prescriptions or not. It includes the presenters, learning objectives, and disclosures. It then summarizes Karen Ryle's presentation on red flags pharmacists should watch out for when dispensing controlled substances like opioids. These include things like "cocktailed" prescriptions, no individualized dosing, early refills, out-of-area doctors and patients, and mostly cash prescriptions. It also discusses integrating prescription drug monitoring program data into pharmacy workflows to more easily check for signs of abuse or diversion.
Madan Lal, a 65-year-old male, was admitted to the hospital with abdominal pain and nausea. He had been taking chlorpromazine for psychosis. Examination revealed jaundice. Liver function tests showed elevated bilirubin, ALT, and alkaline phosphatase. The patient was diagnosed with chlorpromazine-induced liver injury which resolved after stopping the medication. ADR reporting form was completed for the case.
Mr. Sushant Gupta, a 30-year-old male diagnosed with meningitis, developed chills, rigors, fever, and urticaria after administration of intravenous vancomycin. The reaction subsided with antihistamine. Reintroduction of vancom
Description and comparison of drug diversion in pharmacies by pharmacists, in...Juanita Draime
1. The document examines cases of drug diversion reported to state pharmacy boards between 2008-2013, finding most cases involved pharmacy technicians diverting controlled substances for personal use.
2. A total of 811 cases were identified across 9 states, with technicians comprising 71.4% of cases. Technicians were also more likely than pharmacists or interns to divert drugs for sale.
3. Most common disciplinary actions taken by boards were license revocation or surrender (62.5%), with disciplinary actions varying significantly based on employee type and reason for diversion.
This document discusses the need for a five-year recovery standard for evaluating substance abuse treatment outcomes. It presents evidence from studies of Physician Health Programs which show that extending treatment and monitoring to five years leads to much higher rates of long-term abstinence compared to typical short-term treatment programs. The brain science of addiction demonstrates that substance use disorders are chronic relapsing conditions, so treatment needs to provide sustained support over multiple years to achieve stable recovery.
The document summarizes findings from a study of prescription drug monitoring program (PDMP) data in Los Angeles County. It finds that 0.3% of patients, or 5,153 individuals, were identified as "doctor shoppers" who received opioid prescriptions from at least 4 prescribers and 4 pharmacies in 2012. Compared to non-doctor shoppers, doctor shoppers were more likely to be female, aged 35-64, pay with private funds, use specific long-acting opioid drugs in higher doses, and obtain a greater number of opioid pills, prescriptions, and days of supply.
Pharmacogenetics and therapeutic drug monitoring practiceLarry Baum
This document discusses pharmacogenetics and therapeutic drug monitoring. It describes how pharmacogenetics can help determine the best drug and dose for individuals by examining genetic factors that influence drug metabolism and response. Two key types of pharmacogenetic effects - analog and digital - are described. Several examples of pharmacogenetic testing for drugs like carbamazepine, allopurinol and cancer therapies are provided. The role of genes like HLA-B*1502, HLA-B*5801, CYP2C9 and VKORC1 in drug responses are outlined. Therapeutic drug monitoring is also discussed as a way to track drug levels in patients' blood to ensure efficacy and safety. Several classes of drugs that are commonly monitored
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients”Fred Jorgensen
“The Value of Drug Monitoring in Chronic Opioid Therapy Patients” delivered by Dr. Harry Leider, M.D., MBA, and Chief Medical Officer of Ameritox, Inc. This presentation was delivered during the ”Managing a Patient’s Pain in Today’s Regulated Environment” portion of the 2009 ASPMN Annual Conference.
This document discusses pharmacovigilance and the role of consumers in reporting adverse drug reactions (ADRs) in India. It outlines how India established a pharmacovigilance program to monitor ADRs. Underreporting of ADRs by healthcare professionals is a limitation, so consumer reporting can help detect more ADRs earlier, especially for over-the-counter drugs. India has launched forms and a mobile app to facilitate consumer ADR reporting to strengthen pharmacovigilance. While consumer reporting cannot replace healthcare professional reporting, it can complement it.
The Pharmacy and Therapeutics Committee (PTC) is responsible for advising on the appropriate therapeutic use of drugs in a hospital. The PTC frames policies, evaluates drugs for the hospital formulary, ensures drug safety, monitors adverse drug reactions, reports product defects, develops emergency drug lists, and conducts drug utilization reviews. It is composed of at least three physicians, a pharmacist who serves as secretary, a nurse, and a hospital administrator. The PTC meets at least six times per year to review these responsibilities and ensure proper drug use in the hospital.
Safe Prescribing Practices Conference for Medical Professionals, June 2013Heidi Denton
Participants will:
Report their intent to support and/or actively work towards incorporating best practices in responsible prescribing guidelines into their everyday practice of medicine.
Report an increased knowledge of the Michigan Automated Prescription System (MAPS) and the benefits of reporting regularly to MAPS.
Report intent to support and/or actively work towards incorporating consistent use of the MAPS into their everyday practice of prescribing controlled substances.
Report that at the training they received easy to use tools that can help them to better educate their patients on the importance of taking medications as prescribed.
Gain an increased knowledge of local, state, and national substance abuse and mental health treatment resources.
The Drug and Therapeutics Committee (DTC) establishes drug policies and committees to promote the safe and rational use of drugs in hospitals. The DTC has advisory, educational, and drug safety monitoring roles. It develops essential drug lists, treatment guidelines, and monitors medication errors and adverse drug reactions. The DTC also conducts drug utilization reviews and establishes emergency drug lists. It reports drug product defects and ensures transparency and ethical standards in its operations.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Forensic pharmacovigilance: Newer dimension of pharmacovigilanceRosmirella Cano Rojas
This document discusses the emerging field of forensic pharmacovigilance, which involves applying pharmacovigilance expertise to help solve legal cases. Pharmacovigilance aims to ensure patient safety by monitoring adverse drug events, while forensic sciences investigate legal matters. Forensic pharmacovigilance can help determine if a drug caused an adverse effect in a victim. It may provide expert opinions on illicit drug use, help solve criminal or civil cases involving drugs, and identify counterfeit or substandard drugs. Challenges include reluctance of medical professionals to participate in legal proceedings and limitations of extrapolating data to real cases. Overall, forensic pharmacovigilance represents a new dimension for pharmacovigilance that
The document outlines the roles and functions of a Drug and Therapeutics Committee (DTC) in a hospital. The DTC advises on drug-related issues, develops drug policies, evaluates drugs for inclusion in the hospital formulary, promotes rational drug use, manages adverse drug reactions, and monitors drug safety. It is composed of physicians, pharmacists, nurses, and administrators. The DTC meets regularly to assess drug use, identify issues, and conduct interventions to improve prescribing and reduce costs while maintaining patient safety.
AN OVERVIEW ON PHARMACO THERAPEUTIC COMMITTEE - M.L.SUSHMITHAlakshmisushmitha2
The Pharmacy and Therapeutics Committee (PTC) is an advisory committee composed of physicians, pharmacists, nurses, and administrators that assists in developing policies related to drug evaluation, selection, and use in hospitals. The PTC prepares the hospital drug formulary, selects drug suppliers, adds or removes drugs from the formulary, develops drug information resources, monitors adverse drug reactions, and ensures drug quality and safety. It also establishes emergency drug lists, reports defective drug products, and conducts drug utilization reviews to optimize prescribing and medication management in the hospital.
The document discusses the increasing abuse of heroin in the United States and its link to prescription drug abuse. It provides data from reports showing that people who abuse prescription painkillers are 19 times more likely to abuse heroin. With increased demand, drug trafficking organizations have increased heroin availability and purity. Law enforcement data demonstrates rising heroin seizures and overdose deaths linked to increased prescription opioid abuse. The document examines how some prescription opioid abusers may be turning to cheaper heroin as painkiller restrictions take effect.
This document discusses urine toxicology testing for drugs of abuse. It describes the types of drugs that can be detected through urine testing, including amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, and PCP. It outlines the normal detection windows for these drugs in urine and discusses specimen collection and screening versus confirmatory testing methods. The document also addresses issues like interferences, adulterants that can produce false negatives, and challenges in drug testing. It provides details on opiate detection specifically and introduces the Ameritox Rx Guardian urine drug monitoring program.
Establishing a drug information centerkatta amulya
This document discusses establishing a drug information center. It begins by introducing the main functions of a drug information center which is to provide written or verbal drug-related information to healthcare professionals and the public. It then classifies drug information centers into hospital based, industry based, and community based. The document outlines the need for drug information centers by discussing their primary function of responding to drug therapy inquiries and services like drug evaluation, education, and pharmacovigilance. It also covers staffing, resources, literature databases, and concludes by emphasizing the importance of efficient drug information centers for optimal patient care.
Spontaneous reporting schemes for biodrug adverse reactions,Vishwajeet Upadhye
This document discusses spontaneous reporting and monitoring schemes for adverse reactions, drug-drug interactions, and drug-food interactions related to biologics. It outlines the key features of an adverse reaction monitoring program, including establishing ongoing surveillance systems, notifying prescribers of suspected reactions, collecting and analyzing reaction reports, identifying high-risk patients and drugs, evaluating the cause of reactions, documenting reactions in patient records, and reporting serious reactions to regulators. The roles and benefits of pharmacists in developing, maintaining, and evaluating such monitoring programs are also described.
Proper Disposal of Unwanted Medicines with a Focus on the Aging. Source:U.S. ...SerPIE Repository
This document discusses proper disposal of unused medicines, with a focus on educating older adults. It provides background on legislation around drug disposal and initiatives in various states. Key points covered include the Secure and Responsible Drug Disposal Act of 2010, federal and state guidelines on proper disposal methods like take-back programs or mixing with undesirable substances before throwing away, and examples of education programs targeting older adults in the Potomac River basin to promote safe disposal.
This document discusses medication safety and the dangers posed by common household medications to children. It notes that medicines are the leading cause of child poisoning, with nearly 52,000 children under age 6 seen in emergency rooms in 2017 for medicine poisoning. Several common medications are listed that can be fatal to a 10kg child in very small doses, such as a single pill. The document also covers lethal drug interactions and the importance of safe medication disposal to prevent accidental poisoning.
The document discusses the high cost of medications in Colombia, which is limiting access to healthcare. It presents evidence that the prices of medications, especially high cost drugs to treat catastrophic illnesses like cancer, have increased far more than would be expected based on supply and demand. This is due to malpractices like overpricing by pharmaceutical companies. The government's solution of price regulation has had limited effectiveness. A better approach would be using cost-effectiveness analysis and operations research to prioritize health needs, optimize budgets, and find equitable solutions to rationalize spending on medications.
Drugs used in special populations | Geriatric | Pediatric patients | Pregnant...Shaikh Abusufyan
Rectal diazepam would be an appropriate drug and route of administration for the casualty officer to terminate the convulsions in this case. Rectal administration provides a non-invasive alternative route when intravenous access cannot be obtained, and rectal diazepam is commonly used for the treatment of prolonged seizures in pediatric patients.
Urine is commonly used for drug testing due to its availability in large volumes and high drug concentrations. It can detect drugs for 1-3 days except marijuana which is detectable for up to 2 weeks. Urine testing is non-invasive but samples can be adulterated. The most common urine drug testing uses automated immunoassays for screening, followed by GC-MS confirmation if screening is positive. Urine testing can detect various drugs including opioids, benzodiazepines, amphetamines, and cocaine. Detection windows vary by drug from 1-7 days.
Pharmacist: Thorya Al-zahrany
Member In National Drug Information Center
supervisor of medication patient education at pharmacy care administration at Medina Region
Best Practices in Controlling Prescription Drug CostsPSG Consults
An insightful pharmacy benefit cost containment overview co-presented by Jeff Legg, PSG's Consulting Services VP and Labor Practice Leader, at the 2016 IFEBP Conference in Orlando.
The document discusses a hospital formulary, which is a list of pharmaceutical agents approved by a hospital's medical staff for use in treating patients. It includes important information about the drugs like dosage, indications, and side effects. The formulary system helps regulate drug procurement, prescribing, dispensing, and administration. It aims to provide effective treatment options while reducing costs and improving quality of care. The formulary must be regularly revised to reflect new drugs and policies. A pharmacy and therapeutics committee manages additions and deletions based on drug evaluations.
This document discusses pharmacovigilance and the role of consumers in reporting adverse drug reactions (ADRs) in India. It outlines how India established a pharmacovigilance program to monitor ADRs. Underreporting of ADRs by healthcare professionals is a limitation, so consumer reporting can help detect more ADRs earlier, especially for over-the-counter drugs. India has launched forms and a mobile app to facilitate consumer ADR reporting to strengthen pharmacovigilance. While consumer reporting cannot replace healthcare professional reporting, it can complement it.
The Pharmacy and Therapeutics Committee (PTC) is responsible for advising on the appropriate therapeutic use of drugs in a hospital. The PTC frames policies, evaluates drugs for the hospital formulary, ensures drug safety, monitors adverse drug reactions, reports product defects, develops emergency drug lists, and conducts drug utilization reviews. It is composed of at least three physicians, a pharmacist who serves as secretary, a nurse, and a hospital administrator. The PTC meets at least six times per year to review these responsibilities and ensure proper drug use in the hospital.
Safe Prescribing Practices Conference for Medical Professionals, June 2013Heidi Denton
Participants will:
Report their intent to support and/or actively work towards incorporating best practices in responsible prescribing guidelines into their everyday practice of medicine.
Report an increased knowledge of the Michigan Automated Prescription System (MAPS) and the benefits of reporting regularly to MAPS.
Report intent to support and/or actively work towards incorporating consistent use of the MAPS into their everyday practice of prescribing controlled substances.
Report that at the training they received easy to use tools that can help them to better educate their patients on the importance of taking medications as prescribed.
Gain an increased knowledge of local, state, and national substance abuse and mental health treatment resources.
The Drug and Therapeutics Committee (DTC) establishes drug policies and committees to promote the safe and rational use of drugs in hospitals. The DTC has advisory, educational, and drug safety monitoring roles. It develops essential drug lists, treatment guidelines, and monitors medication errors and adverse drug reactions. The DTC also conducts drug utilization reviews and establishes emergency drug lists. It reports drug product defects and ensures transparency and ethical standards in its operations.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Forensic pharmacovigilance: Newer dimension of pharmacovigilanceRosmirella Cano Rojas
This document discusses the emerging field of forensic pharmacovigilance, which involves applying pharmacovigilance expertise to help solve legal cases. Pharmacovigilance aims to ensure patient safety by monitoring adverse drug events, while forensic sciences investigate legal matters. Forensic pharmacovigilance can help determine if a drug caused an adverse effect in a victim. It may provide expert opinions on illicit drug use, help solve criminal or civil cases involving drugs, and identify counterfeit or substandard drugs. Challenges include reluctance of medical professionals to participate in legal proceedings and limitations of extrapolating data to real cases. Overall, forensic pharmacovigilance represents a new dimension for pharmacovigilance that
The document outlines the roles and functions of a Drug and Therapeutics Committee (DTC) in a hospital. The DTC advises on drug-related issues, develops drug policies, evaluates drugs for inclusion in the hospital formulary, promotes rational drug use, manages adverse drug reactions, and monitors drug safety. It is composed of physicians, pharmacists, nurses, and administrators. The DTC meets regularly to assess drug use, identify issues, and conduct interventions to improve prescribing and reduce costs while maintaining patient safety.
AN OVERVIEW ON PHARMACO THERAPEUTIC COMMITTEE - M.L.SUSHMITHAlakshmisushmitha2
The Pharmacy and Therapeutics Committee (PTC) is an advisory committee composed of physicians, pharmacists, nurses, and administrators that assists in developing policies related to drug evaluation, selection, and use in hospitals. The PTC prepares the hospital drug formulary, selects drug suppliers, adds or removes drugs from the formulary, develops drug information resources, monitors adverse drug reactions, and ensures drug quality and safety. It also establishes emergency drug lists, reports defective drug products, and conducts drug utilization reviews to optimize prescribing and medication management in the hospital.
The document discusses the increasing abuse of heroin in the United States and its link to prescription drug abuse. It provides data from reports showing that people who abuse prescription painkillers are 19 times more likely to abuse heroin. With increased demand, drug trafficking organizations have increased heroin availability and purity. Law enforcement data demonstrates rising heroin seizures and overdose deaths linked to increased prescription opioid abuse. The document examines how some prescription opioid abusers may be turning to cheaper heroin as painkiller restrictions take effect.
This document discusses urine toxicology testing for drugs of abuse. It describes the types of drugs that can be detected through urine testing, including amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, and PCP. It outlines the normal detection windows for these drugs in urine and discusses specimen collection and screening versus confirmatory testing methods. The document also addresses issues like interferences, adulterants that can produce false negatives, and challenges in drug testing. It provides details on opiate detection specifically and introduces the Ameritox Rx Guardian urine drug monitoring program.
Establishing a drug information centerkatta amulya
This document discusses establishing a drug information center. It begins by introducing the main functions of a drug information center which is to provide written or verbal drug-related information to healthcare professionals and the public. It then classifies drug information centers into hospital based, industry based, and community based. The document outlines the need for drug information centers by discussing their primary function of responding to drug therapy inquiries and services like drug evaluation, education, and pharmacovigilance. It also covers staffing, resources, literature databases, and concludes by emphasizing the importance of efficient drug information centers for optimal patient care.
Spontaneous reporting schemes for biodrug adverse reactions,Vishwajeet Upadhye
This document discusses spontaneous reporting and monitoring schemes for adverse reactions, drug-drug interactions, and drug-food interactions related to biologics. It outlines the key features of an adverse reaction monitoring program, including establishing ongoing surveillance systems, notifying prescribers of suspected reactions, collecting and analyzing reaction reports, identifying high-risk patients and drugs, evaluating the cause of reactions, documenting reactions in patient records, and reporting serious reactions to regulators. The roles and benefits of pharmacists in developing, maintaining, and evaluating such monitoring programs are also described.
Proper Disposal of Unwanted Medicines with a Focus on the Aging. Source:U.S. ...SerPIE Repository
This document discusses proper disposal of unused medicines, with a focus on educating older adults. It provides background on legislation around drug disposal and initiatives in various states. Key points covered include the Secure and Responsible Drug Disposal Act of 2010, federal and state guidelines on proper disposal methods like take-back programs or mixing with undesirable substances before throwing away, and examples of education programs targeting older adults in the Potomac River basin to promote safe disposal.
This document discusses medication safety and the dangers posed by common household medications to children. It notes that medicines are the leading cause of child poisoning, with nearly 52,000 children under age 6 seen in emergency rooms in 2017 for medicine poisoning. Several common medications are listed that can be fatal to a 10kg child in very small doses, such as a single pill. The document also covers lethal drug interactions and the importance of safe medication disposal to prevent accidental poisoning.
The document discusses the high cost of medications in Colombia, which is limiting access to healthcare. It presents evidence that the prices of medications, especially high cost drugs to treat catastrophic illnesses like cancer, have increased far more than would be expected based on supply and demand. This is due to malpractices like overpricing by pharmaceutical companies. The government's solution of price regulation has had limited effectiveness. A better approach would be using cost-effectiveness analysis and operations research to prioritize health needs, optimize budgets, and find equitable solutions to rationalize spending on medications.
Drugs used in special populations | Geriatric | Pediatric patients | Pregnant...Shaikh Abusufyan
Rectal diazepam would be an appropriate drug and route of administration for the casualty officer to terminate the convulsions in this case. Rectal administration provides a non-invasive alternative route when intravenous access cannot be obtained, and rectal diazepam is commonly used for the treatment of prolonged seizures in pediatric patients.
Urine is commonly used for drug testing due to its availability in large volumes and high drug concentrations. It can detect drugs for 1-3 days except marijuana which is detectable for up to 2 weeks. Urine testing is non-invasive but samples can be adulterated. The most common urine drug testing uses automated immunoassays for screening, followed by GC-MS confirmation if screening is positive. Urine testing can detect various drugs including opioids, benzodiazepines, amphetamines, and cocaine. Detection windows vary by drug from 1-7 days.
Pharmacist: Thorya Al-zahrany
Member In National Drug Information Center
supervisor of medication patient education at pharmacy care administration at Medina Region
Best Practices in Controlling Prescription Drug CostsPSG Consults
An insightful pharmacy benefit cost containment overview co-presented by Jeff Legg, PSG's Consulting Services VP and Labor Practice Leader, at the 2016 IFEBP Conference in Orlando.
The document discusses a hospital formulary, which is a list of pharmaceutical agents approved by a hospital's medical staff for use in treating patients. It includes important information about the drugs like dosage, indications, and side effects. The formulary system helps regulate drug procurement, prescribing, dispensing, and administration. It aims to provide effective treatment options while reducing costs and improving quality of care. The formulary must be regularly revised to reflect new drugs and policies. A pharmacy and therapeutics committee manages additions and deletions based on drug evaluations.
This document summarizes a presentation on insights from state policies and interventions to curb prescription drug overdoses. It describes several interventions:
1) PRIMUM, a system in North Carolina that alerts prescribers to patients' risk of misusing or abusing opioids at the point of care.
2) A project in Rhode Island that developed protocols to improve opioid prescription safety for trauma patients, including alerts if prescriptions exceed dosage thresholds and requiring naloxone co-prescriptions.
3) A study in Pennsylvania that used Medicaid claims data to identify risk factors for opioid overdoses, such as high dosage and multiple prescribers/pharmacies, to target high-risk patients.
This document discusses polypharmacy in the elderly, defined as using more than 5 medications. It notes that polypharmacy prevalence increases with age, reaching 50% in those over 65. Consequences can include adverse drug reactions, reduced quality of life, and increased healthcare costs. Pharmacokinetic changes in aging like decreased liver and kidney function must be considered. The Beers Criteria provide guidance on inappropriate medications in elders. Interventions to reduce polypharmacy risk include regular medication reviews, educating patients, and using a personal health record.
The pharmaceutical industry generates over $145 billion in annual worldwide sales, with the United States representing the largest market. Drug development costs are substantial, though estimates vary significantly. Marketing and profits account for a large portion of pharmaceutical expenditures. Prescription drug costs in the US are the highest in the world due to a lack of price regulation. Many elderly Americans lack adequate drug coverage, negatively impacting health outcomes and costs. Inappropriate self-medication of OTC drugs in children is also common. Generics have increased in market share but remain much cheaper than brand drugs.
Pharmacoepidemiology involves applying epidemiological methods to study drug use and effects in large populations. It is primarily concerned with post-marketing drug safety surveillance but also analyzes patterns of drug use and assesses effectiveness. Pharmacoepidemiological studies use large healthcare databases and are important for identifying adverse drug reactions, determining risk factors, and improving appropriate medication use. Common study designs include cohort studies, case-control studies, and randomized controlled trials. Pharmacoepidemiology plays a key role in drug regulation, marketing, clinical practice, and public health policy.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
This document discusses the history of drug regulation laws in the United States. It begins by covering early federal laws like the 1906 Pure Food and Drug Act that required labeling of drug contents but did little to regulate safety. The 1938 Food, Drug, and Cosmetic Act and later amendments in 1951 and 1962 strengthened regulations by requiring pre-market approval of drugs as safe and effective. The Controlled Substances Act of 1970 established a drug scheduling system to regulate substances based on abuse and medical potential. The document also discusses issues around legalization debates, prevention strategies, drug testing policies, and criticisms of discriminatory enforcement practices.
Americans pay significantly more for prescription drugs than people in other Western nations. In 2000, Americans paid 60% more on average for brand name drugs compared to seven other Western nations. By 2003, Americans paid 81% more on average. For many patented drugs in 2003, Americans paid 58-118% more than people in Switzerland, Britain, Germany, Canada, Sweden, France, and Italy. High drug costs in the US are driven by the pharmaceutical industry spending billions on marketing to doctors, creating influence over prescribing decisions and loyalty to brand name drugs. Marketing accounts for 30% of drug costs while research and development accounts for only 10-15%. Expensive new drugs are heavily marketed, including for off-label uses, driving up overall
This document discusses pharmacovigilance and adverse drug reaction reporting. It defines types of adverse drug reactions and the role of pharmacovigilance in monitoring drug safety. It describes the Yellow Card Scheme used in the UK to collect reports of suspected adverse reactions which are then analyzed by the MHRA to ensure drug safety. New drugs are placed under additional monitoring through the Black Triangle Scheme to closely track any adverse effects.
The document discusses orphan drugs and regulations around them in various markets. It provides an overview of orphan drug policies in the US, EU, Australia, and Canada. The US Orphan Drug Act of 1983 was the first legislation to promote orphan drug development. It offers 7 years of market exclusivity. The EU and Canada have since established their own orphan drug frameworks that similarly aim to incentivize development of treatments for rare diseases through exclusivity periods, fee waivers, and assistance programs. However, orphan drugs regulations still face challenges around definitions of rare diseases, clinical data requirements, pricing and reimbursement.
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In this webinar:
● Primer for attendees attending the November 15-16 Drug Pricing Policy Summit
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● Description of legal frameworks, government responsibility centres and their mandates for treatment access, with reference to specific opportunities for patient engagement
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Clinical Pharmacology in Orphan Drug DevelopmentE. Dennis Bashaw
This is the fourth talk that I gave in Asia back in May. It was presented at the Konect (Korea National Enterprise for Clinical Trials) 3rd symposia that was held in Seoul at Seoul National University.
Pharmacovigilance is the science of monitoring the effects of medicines after they have been licensed for use, in order to identify new safety hazards and assess risks and benefits. It aims to improve patient care and safety in relation to medicine use. The thalidomide disaster in the 1960s demonstrated the need for formal pharmacovigilance systems to detect adverse drug reactions. Spontaneous reporting by healthcare professionals and mandatory reporting by manufacturers are key methods for collecting information on adverse drug events. Reports are assessed for causality and contribute to the ongoing evaluation of medicines to ensure their safe and effective use.
3.6. Reducing Pharmaceutical Waste in Clinical Care (Kreisberg)Teleosis Institute
This document discusses current federal and state activities around minimizing pharmaceutical waste. It outlines research being done on occurrence and treatment options for pharmaceuticals in the environment. It also discusses federal legislation like the Safe Drug Disposal Act and various state legislation regarding take-back programs. The document notes that 54% of people throw medicines in the trash and 35% flush them, contributing to pharmaceuticals in waterways. It provides strategies to minimize waste at the prescribing, dispensing, and patient levels, and encourages proper disposal and take-back programs.
Introduction to rational use of drugs and role of pharmacist in rational use...Adhin Antony Xavier
This document discusses strategies for promoting rational use of drugs in healthcare systems. It recommends establishing a national drug regulatory authority to oversee drug quality, developing treatment guidelines and an essential drug list. Healthcare professionals should be provided drug information and undergo continuing education on rational prescribing. Generic names should be used and drugs prescribed according to their intended therapeutic uses and appropriate dosages. Quality of drugs must be ensured and irrational self-medication discouraged through public education. Monitoring drug use through indicators can help evaluate prescribing practices and promote rational drug utilization.
1) Prescription drug abuse in the U.S. has reached epidemic levels, with overdose deaths, opioid sales, and treatment admissions all rising in parallel since 1999. 2) To reverse the epidemic, efforts are needed to improve prescription drug monitoring programs (PDMPs), ensure safer opioid prescribing practices, expand access to treatment including buprenorphine, and support state-level prevention strategies. 3) Early evidence suggests that real-time, universal PDMPs; mandating their use; integrating them into electronic health records; and comprehensive laws can all help to reduce doctor shopping, opioid prescribing, and overdose deaths.
This document discusses ethical issues related to pharmaceutical marketing and promotion. It notes that most physicians have relationships with the pharmaceutical industry, including receiving gifts and drug samples. It also outlines WHO ethical criteria for drug promotion, including that claims should not contain misleading statements to induce unjustified drug use. The document advocates establishing national frameworks to promote governance and prevent corruption related to drug promotion and procurement.
This document discusses ethical issues related to pharmaceutical marketing and promotion. It notes that most physicians have relationships with the pharmaceutical industry, including receiving gifts and drug samples. It also outlines WHO ethical criteria for drug promotion, including that claims should not contain misleading statements to induce unjustified drug use. The document advocates establishing national frameworks to promote governance and prevent corruption related to drug promotion and procurement.
This document discusses medication errors, including definitions of key terms like adverse drug events and adverse drug reactions. It provides classifications and reasons for medication errors, as well as methods to prevent, identify, and minimize errors. These include implementing systems-based approaches, reducing reliance on memory through automation, standardizing processes, and employing checks and policies. Reporting of medication errors is also addressed.
1. Take Back Programs as Part of the Solution to the Prevention of Prescription Drug Abuse
Dr. Jeanie Jaramillo
Director, Medication Cleanout™
Managing Director, Texas Panhandle Poison Center
Assistant Professor, Texas Tech University Health Sciences Center School of Pharmacy
30th Annual Conference
Savannah, GA
October 21-24, 2014
2. What is a “take back” program?
•The definition of medication “take back” programs vary
•Generally, a medication take back program is some variation of a periodic event in which unused, expired, or no longer needed medications are collected for disposal
•Programs vary in who they accept items from (i.e. the public vs. clinics, nursing homes, etc. or a combination)
3. What requirements are there for take back programs?
•Rules and requirements vary by state
•Include local, state, and Federal
–Law enforcement
–Environmental
–Department of transportation
–State board of pharmacy
4. Take Back Programs
What they can do:
•Remove unused meds from homes
•Increase public awareness of home meds as source for abuse & poisonings
•Provide info/data on availability of meds in homes – what’s out there?
•Address ONE source of meds – i.e. homes/med cabinets
What they can’t do:
•Keep people from doctor shopping for the purpose of abusing or diverting meds
•Stop physicians from knowingly and willingly overprescribing medications for abuse purposes (i.e. pill mills)
•Provide any info regarding people who use all of their meds or do not participate in take back programs
5. Medication Cleanout™
•Program to allow households to bring meds for appropriate disposal
•Began in 2009 with Amarillo Police Department, Amarillo Independent School District, Texas Tech School of Pharmacy
•Combination poison prevention, abuse/crime prevention, research effort
•2010 received HHS/HRSA Poison Center Incentive Grant - $100K X 3 years; economy tanked; years 2 & 3 were pulled
•Program continued on minimal funds
6. Medication Cleanout™
•35 events to date across the Texas panhandle
•20,229 pounds of unused meds collected
–1,344 pounds of controlled substances (7%)
–18,885 pounds of non-controlled substances (93%)
•832 pounds of sharps
10. Looks Good – Has It Helped?
•Texas Prevention Impact Index (TPII) – collects data specific to 41 county West Texas region (Region 1)
•Misuse & abuse of prescription drugs by students in Amarillo ISD has declined over the last 3 years counter to national trend
•Participants reported that parents and peers disapprove of abuse of prescription meds over that of tobacco, alcohol, and marijuana
•Many other confounders to consider
11. What other data does Medication Cleanout collect?
Data entry screen from Pharmaceutical Collection Monitoring System™ (PCMS)
www.cas-co.com
12. Medication
# of Containers
Unused %
pentazocine (e.g. Talwin)
54
91%
methadone
30
88%
butorphanol (Stadol)
36
87%
androgen (testosterone)
111
87%
benzodiazepines (Xanax,etc)
1585
85%
fentanyl
204
85%
morphine
232
85%
buprenorphine (suboxone)
14
82%
meperidine (Demerol)
14
81%
other sedative/hypnotic
574
80%
Controlled Substances Collected –
Portion Unused as Compared to Originally Filled
Results compiled from PCMS™ using ToxiCALL® Data Analysis by Computer Automation Systems, Inc.
13. Medication
# of Containers
Unused %
propoxyphene (Darvon)
15
78%
diphenoxylate/atropine (Lomotil)
199
78%
tramadol*
147
77%
other GABA anticonvulsant (Lyrica)
415
75%
hydrocodone/ APAP (Lortab)
3593
69%
APAP/ other adult formulation
49
68%
APAP/ propoxyphene** (Darvocet)
1178
68%
Hydromorphone (Dilaudid)
25
68%
Carisoprodol (Soma)
129
68%
APAP/ codeine
415
65%
hydrocodone alone or combo other than APAP
109
62%
*tramadol became controlled in Texas 8/14/14 (most tramadol appears as non-controlled)
** FDA recommended against continued prescribing of propoxyphene 11/19/10
15. So, what does all of this mean?
•Significant overprescribing is occurring
•Patients are being prescribed greater quantities than they need; particularly with controlled substances
•In many cases, physicians could be prescribing HALF the amount of controlled substances
•Prescribe less with refills, if needed, to avoid accumulation of unneeded medications in the home
16. How do we use this information?
•Publish data in medical literature
•Educate healthcare community to include physicians, pharmacists, nurse practitioners, etc.
•Advocate for changes in the healthcare industry – prescribing large quantities of medications for minor procedures should not be acceptable
•Consider 15 day limits (MaineCare model) on initial prescriptions for:
–medications frequently discontinued due to side effects,
–medications with high discontinuation rates,
–medications with frequent dose adjustments
•Ensure cost effectiveness without wasting or discarding medications
17. Educate the Public
•Let consumers know that keeping excess meds in the home presents a risk
•Educate consumers that they can ask their pharmacy for a “partial fill” of a medication
•Remind them to safeguard medications, especially controls (lock them up if possible – monitor them otherwise)
•Talk to their children about the dangers of prescription abuse
18. More Data Needed
•Pharmaceutical system in the U.S. is broken
•Auto-refills and mail order are leading to large accumulations of meds in homes
•Ludicrous that refills can be distributed without a patient confirming that:
a)They still use the medication and,
b)They need more of it.
•This is costing the healthcare industry (and tax payers) billions of dollars a year
19. More Importantly
•This is costing people their lives!
–Not just in terms of life and death
–Quality of life
–Addiction
–Gateway to other drugs of abuse
20. Car 188
These medications were brought in by the adult son of a deceased couple, both of whom speculatively died of cancer. The labels on these meds indicated that they were primarily from a mail-order pharmacy. Many of these meds were unopened. This photograph included only the non-controlled substances from Car 188. The next two slides detail quantities of both the collected controls and non- controls.
21. Car 188 – Case Example
Product: Strength: Quantity: Est. Value:
diazepam 5 2385 $140.12
hydrocodone/apap 10/325 500 $349.50
hydrocodone/apap 5/500 22 $3.11
Lyrica 75 84 $235.68
morphine 30 6699 $3,678.58
morphine 15 3338 $966.90
MS Contin 30 3 $9.36
MS Contin 15 6 $9.85
oxycodone/apap 5/500 802 $322.81
temazepam 30 180 $90.09
carisoprodol 350 50 $50.00
TOTAL 14069 $5,855.99
Controlled Substances
Estimated street value $385,000 (Based on 2011 National Drug Intelligence Center values)
23. Contact Information
Jeanie Jaramillo, PharmD
jeanie.jaramillo@ttuhsc.edu
Texas Panhandle Poison Center/TTUHSC SOP
1300 S. Coulter, Suite 105
Amarillo, TX 79106
(806) 414-9402
www.MedicationCleanout.com
(806)414-9495
24. Computer Automation Systems, Inc. Aurora, Colorado www.cas-co.com info@cas-co.com (303) 680-7774
The Pharmaceutical Collection Monitoring System™ (PCMS) is a web- based data collection tool developed by Computer Automation Systems, Inc. PCMS utilizes an interface with Micromedex® Solutions as a resource for the consistent categorization and collection of medication-related information for research and reporting purposes.
ToxiCALL® Data Analysis, also developed by Computer Automation Systems, Inc., is an analysis and reporting tool that allows for user- defined reporting and/or analysis of PCMS data on demand.