The Community PharmacistDispensing Good Medicine…Preventing Drug Abuse

Adrian Goram, PharmD, CPhPharmacistPublix PharmacyPensacola, FL

Pensacola BizNet

MeetingMay 1, 2014

7:30am

DisclosureI am here today as a pharmacist

to promote pharmacy practice and to raise an awareness of common drugs at risk for abuse in our community.

I am currently employed by Publix Pharmacy, Pensacola, FL.

No financial compensation was provided for this presentation.

Objectives

Describe the practice of good medicine

Identify several prescription (Rx) and Over the Counter (OTC) drugs and drug classes commonly abused

Describe the pharmacist’s efforts to fight drug abuse

Local Pharmacy Practices

Sacred Heart(Pensacola &

Destin)

Baptist (Pensacola & Gulf

Breeze)

West FloridaSanta Rosa

MedicalFWB Medical

WalgreensWal-Mart Sam’s ClubC V S

Rite-Aid

A & ECantonmen

t DrugsEnsley Drugs

Pensacola ApothecaryRx Express

PublixTargetKroger

Winn Dixie

Pharmacists Do More Than Just Dispense Pills

Drug Indication?Side Effects?Compliance?

What if I miss a dose?

OTC recommendatio

n?CAN I DRINK?

COUNSEL

Right patientRight drugRight dose

Right amount

DISPENSE

Drug AllergiesFood Allergies

Drug Interactions

Contraindications

SCREEN

PatientHealthcare

ProviderDrugDose

SupplyValid Rx

Valid MDInsurance

COST

VERIFY

Excessive Alcohol Use: Common Denominator for Rx & OTC Abuse

Which teenage gender drinks the most?Boys

Girls

Excessive Alcohol Use: Common Denominator for Rx & OTC AbuseRef: Partnership for a Drug Free America 2009

Which teenage gender drinks the most?Boys 52%

Girls 59%

For a full report go to:

www.dcf.state.fl.us/programs/samh/publications/fysas/08Survey/EscambiaCounty.pdf

www.dcf.state.fl.us/programs/samh/publications/fysas/10Survey/county_slideshows/Santa%20Rosa%20County.pdf

Tampons, Skittles & Gummy Bears Soaked with Vodka

Alternative Alcohol Sobriety Test

Prescription (Rx) Drug Abuse: A Widespread Concern Among TeenagersThe rate for Rx drug abuse is the fasting

growing epidemic in the U.S.48 million teenagers (>12 years old) used

Rx drugs for illicit or recreational uses.Nearly 14% met the criteria for abuse or

dependence.Nearly 3 million youths (age 12-25 years)

become new Rx Abusers each yearFemales; the most frequent abuser of Rx

drugs across ALL age groups

Ref: Chertoff JL:PharmCon 0798-0000-11-095-H01-P

Common Triggers for Rx and OTC Drug Abuse

Strong Media InfluenceInternet Savvy

Strong Peer PressureStress

BULLYING

Ease of AccessEasily

ConcealedCheap & Legally

Purchased

Thrill SeekersSheer

BoredomDysfunction

al Family Issues

Three Pharmacologic Classes of Rx Drugs Commonly Abused

OPIOID ANALGESICS

BENZODIAZEPINES

AMPHETAMINES

Pain Relievers Anti-AnxietySedatives/

Tranquilizers

Stimulants

OXYCODONEOxyContin, Percocet

ALPRAZOLAMXanax

METHYLPHENIDATERitalin, Concerta

HYDROCODONENorco, Lortab, VicodinVicoprofen

CLONAZEPAMKlonopin

AMPHETAMINE +DEXTROAMPHETAMINE MIXED SALTSAdderall

MORPHINEMS Contin, Avinza, Kadian

DIAZEPAMValium

DEXTROAMPHETAMINEDexedrine

HYDROMORPHONEDilaudid

***NON-BENZOs*** Sleep Aids

CODEINE ZOLPIDEMAmbien

METHADONEDolophine

ESZOPICLONELunesta

FENTANYLDuragesic

A Recent Study of Nearly 9 Million Drug Abusers Report:

5.3 Million Abuse Pain Relievers

2 Million Abuse

Tranquilizers

1.3 Million Abuse

Stimulants

Three OTC Drug Products Commonly AbusedPseudoephedrine

(PSE)Caffeine Dextromethorpha

n (DXM)Cough/Cold ProductsSudafed, Allergra-DClaritin-D, Zyrtec-D, Mucinex-D, Alka-Seltzer-D, Tylenol Sinus

No Doz Vivarin Awake

Cough/Cold ProductsMucinex-DM Robitussin DMCorricidin DM

Pain RelieversCo-Advil,

Pain RelieversGoody’s Powders, BC Powders, Anacin, Excedrin, Vanquish

Weight Loss Hydroxycutt, Diet Fuel

BeveragesCoffee, Energy Drinks, Red Bull, Monster, etc.

Four Pivotal Areas to Prevent Rx Drug AbuseRef: Epidemic: Responding to America’s Prescription Drug Abuse Crisis 2011

Education Tracking & Monitoring

Proper Drug Disposal

Enforcement

PARENTAL VIGILENCE• Inspect your kid’s bedrooms, Internet

accounts, laptops, cellphones, etc.• Changes in behavior, habits, friends,

hangouts, etc.• Home drug test kits• Referral source to Law Enforcement

and Drug Addiction & Treatment Centers

• HEALTHCARE PRACTITIONERS• MDs, Dentists, RNs, NPs, PAs• Compliance to evidence-based

guidelines

Federal & State Supported Prescription Drug Monitoring Programs (PDMP)Monitoring and Tracking of PSE SalesPatients who “Doctor Shop”Unethical and Suspicious Prescribing:• Narcotics & Pill Mills• Forgeries, Stolen Prescription Pads• Self-Medication• Beyond the respective scope of

practice

Clean Your Medicine Cabinet• 70% of illicit users of pills were

retrieved from family & friends, as compared to 5% from drug pushers

• Properly dispose of unwanted & expired pills

• DO NOT FLUSH IN TOILET• Place disposed meds in a zip-lock

sealed bag or Tupperware-like container filled with cat litter or coffee ground then place in trash

• ANNUAL PRESRIPTION DRUG TAKE-BACK DAY Collects all unwanted pills at a participating pharmacies

•www.deadversion.usdoj.gov/drug_disposal/takeback

•CHARITABLE MED DONATION DROP OFF?

Partner with local law (Narcotics) enforcementIdentify Pills Share data among pharmacies for unlawful or unethical activities:• Doctor Shopping• Unscrupulous Prescribing Patterns• Forgeries• Stolen Prescription Pads • Increased Customer Traffic for PSE

Sales

Local Drug Abuse & Treatment Centers

Meridian1920 N. J St.

(850) 469-3502

Teen Challenge of Pensacola(

www.pensacolamen.teenchallenge.cc

) 8600 Hwy US 98

(850) 453-4300

Lakeview Center Pathway (

www.bhcpns.org) 6425 Pensacola Blvd

(850) 453-7722

New Beginnings Recovery Homes (www.newbeginningsrecovery.com) 820 Gerhardt Dr (850) 439-1522

Acceptance Counseling 3 W. Garden St

Lakeview Center Medication

1800 N Palafox St (850) 466-3400

Drug & Alcohol 24 Hour Helpline

(850) 944-7802

Drug & Alcohol Rehab in Florida at Twelve Oaks

(www.twelveoaks.crchealth.com) 2068 Health Core Dr.

Navarre, FL(850-763-6340)