s PSE Diversion in the US | I2P: Information to Pharmacists - Archive
Publication Date 01/09/2009         Volume. 1 No. 4   
Information to Pharmacists


From the desk of the editor

Welcome to the September 2009 issue of i2P E-Magazine - Information to Pharmacists.
In this edition I would point you to the Pharmedia link where trends in US pharmacy consumers are noted and matched to the Australian counterpart.
There is a strong similarity between the two countries.
In this commentary a direction and a strategy is suggested.
Please feel free to add your comment in the panel provided at the foot of this commentary, as it is a very important issue for Australian pharmacists.

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Another Step Back?

Neil Johnston

Anyone who has followed the story of convenience clinics in the US would have come to a simple conclusion very early in their investigations.

That conclusion would have been that with a few exceptions, the market being serviced in primary care was identical to that serviced by Australian pharmacists.

What was commonly known as “counter prescribing” in Australia became known as the “Minute Clinic” or Rediclinic in the US.

Now we have a development here in Australia where nurse-led clinics are being hosted by pharmacies, with the initial players being the Revive Clinic and the Pharmacy Alliance Group, consisting of 186 franchisees, all based in Perth, Western Australia.

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Pharmacies to write prescriptions? Yet another conflict?

Neil Retallick

The divide between who writes prescriptions in Australia and who dispenses them has traditionally been seen as an important construct in minimising any conflict of interest.
Will the evolution of nurse practitioners working in pharmacies mean that this protection mechanism for the average Australian (and their taxes) is dissolved?

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Location rules, regulation rules and money rules

Chris Wright

The National Competition Policy Review of Pharmacy has surely failed to protect the industry from itself.
The objectives of the restrictions include; “ Keeping pharmacy business small enough to facilitate the close personal supervision of their professional operation by the proprietor pharmacists.”
Oh, yeah, just how does that work?
And… “Protecting pharmacy businesses from perceived “unfair competition” and market dominance from large pharmacy-owning corporations and chains and, in some jurisdictions, Friendly Societies”.

Come on, let’s be serious!

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Advancing to garbage at the speed of light

Pat Gallagher

I am going to preach to you dear reader.
So what is new with that you will say?
Plenty, because I truly do believe in this creed, which is the belief that without rigorous control of core data integrity the whole e-health plot is flawed.
This boring subject has been raised in these pages several times and there is no doubt the message has sort of got through, but ‘sort of’ is way, way too far from being acceptable. You see this mishmash problem in the pharmacy daily as you use different PDE numbers for the same product when you buy from more than one wholesaler.
You cope with different proprietary product identification and then use the GS1 barcode, on the product pack, to close the sale at the POS (you do, you do use that barcode don’t you!).
All of this means you have to use the wetware technology tool to interpret and map information from one system to another; and the minute you introduce wetware you introduce errors.

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Pharmacy women’s Congress 2009 - Opportunities for learning

Karalyn Huxhagen

All of us have that neat stack of literature either beside our bed, under the desk or overflowing off the kitchen bench. If you are like me some are half read, bookmarked for later more in depth reads or stripped of relevant articles for pharmacy assistant training modules.
I also have a system with my emails and RSS feeds that categorises them to the ‘to be read when I have time file’. On a morning not so long back when I could lay in bed and clear this email in tray I completed a competition on the Pharmacy Daily website for the Pharmacy women’s Congress 2009. To my ultimate surprise I won!!

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The finish line of the Pharmacy Melbourne Cup is in sight…who will be the winners?

Garry Boyd

Comment about the future of pharmacy has been a daily occurrence for seemingly as long as Cook plotted a course up the eastern seaboard.
He hit the rocks, as will many of the so-called “players” attempting to seek proprietorship over parts of the pharmacy puzzle will.
Whether it be fact or Chinese whispers, a number of “core”(sorry Kev) “assets” have the attention of many.

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Paracetamol Problems in New Zealand

Staff Writer

Paracetamol overdosing is emerging as a problem in New Zealand similar to other western economies around the world.
In Australia we have seen some of larger chain pharmacies encouraging the sale of high volumes of paracetamol by deep discount, 
Despite protests from a range of pharmacists, little has been done to prevent the spread of irresponsible paracetamol sales.
Pharmacy Boards state they need an official complaint backed up with evidence of adverse events resulting from inappropriate selling.
Liver damage is one adverse event, sometimes requiring a liver transplant to rectify the damage.
There is no easy solution for paracetamol is such a useful drug.
However, there is a strong argument for confining all paracetamol sales to pharmacies irrespective of the potential inconvenience.
In fact, if the general principle applied that all medicines should be sold from a pharmacy, the need to sell other types of merchandise would dissipate.
It's worth a thought 

People overdosing on paracetamol

Source Otago Times

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Health IT Needs More Money - What's New About That?

Staff Writer

The consistent mismatch of approaches to Health IT continue to occur, even with the best efforts of Minister for Health and Ageing (Nicola Roxon) trying to uncover the best way forward.
Costs, both in the government and private sectors, have continually expanded to now stellar $ numbers.
Nicola Roxon's focus on the patient and building out from that point, will see her win the day.
Vendors (such as the Pharmacy Guild) who are canny enough to mould their systems to her view of the world, may eventually get a "nod" of some sort, provided the systems developed genuinely provide a scale of economy, saving development costs as well as delivering the specified benefits to health generally.
Commitment has been made to a National Broadband Network (NBN) and a 16-digit patient identifier so movement to shared health records is nearly possible, with the AMA making some "noises" towards a form of electronic health record (but not a full record).

Source: Australian IT


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UK Opposed to Direct to Consumer Advertising

Staff Writer

Proposals that would allow the pharmaceutical industry to provide drug information directly to consumers has been opposed by the Royal Pharmaceutical Society.
This against a EU background to develop an informational infrastructure that could be delivered to all of the European community.
A conflict of interest clearly exists between the public's interest to receive accurate and objective information and the pharmaceutical industry's objective of building revenue and market share. 

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NZ Considers Project Stop

Staff Writer

The New Zealand Pharmacy Guild has commented on the efficiency of Project Stop in Australia and wants to introduce it to NZ pharmacists.
They would also like to extend its use for other medication tracking.
NZ interest may further stimulate a faster uptake of the system in Australia, and by comparing notes in developing the use of the software, governments may be encouraged to fund a range of extensions.

Pharmacies Fight to Stop P-Runners
Source: Stuff.co.nz

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Health Insurers to feel the cold winds of change

Staff Writer

At last there is a move to sort out the high costs and inefficiencies inherent in Australia's private health insurance system.
Not that the private funds are totally to blame.
Government policies built around the Medicare levy (an extra tax, unless you take out private insurance), the limited range of benefits payable by private funds (because of government controls) has led to a high level of dissatisfaction by people privately insured.
It appears that an entity titled Medicare Select, may be utilised to negotiate and "bulk buy" health services, including those of the state-owned hospitals.
Private health funds, including Medibank Private, would be involved in managing the services on behalf of their members.
This new system has a real potential to reduce major health costs.

Medibank backs system shake-up

Mark Metherell
Source: BrisbaneTimes.com.au

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QUMAX –where to from here?

Karalyn Huxhagen

In April 2010 the current program for QUMAX (Quality use of medicine in aboriginal community controlled centres) will come to an end.
This was a pilot program and work is being done to look at where to from here?
Like all pilots the program took some time to achieve its goals but achieve them it did.
The evaluation process has been ongoing and the feedback from pharmacists and patients has been excellent.

Comments: 1

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UK Media Shutdown on Complementary and Alternate Medicine Information

Staff Writer

Will the issues revolving around complementary and alternate medicine (CAM) use ever be resolved?
Outcries from some respected science authorities deride all CAM as "witchcraft", yet most pharmacists would know of at least one good outcome from CAM.
For example, recent research into Traditional Chinese Medicine has uncovered the fact that some herbal remedies for the treatment of heart conditions, help to restore the nitrous oxide (NO) balance in the body, in part by converting nitrites and nitrates absorbed from foods, to beneficial NO (allowing proper dilation of blood vessels, subsequent reduction in blood pressure and gradual depletion of arterial plaque).
This information is now evidence-based, but will you see it appearing in mainstream medical publications?
It is my belief that while many critics of CAM definitely have a valid case for some complaint (particularly when patients are financially exploited), there are many "experts" that have been blind to information that could prove useful (and cheaper) for their patients, simply because they were unaware of the evidence available.
It is simply hidden from view under the sheer volume of total information that is being published and disseminated to health profesionals.
In February 2008 the respected BBC came under fire for providing information on CAM's and withdrew this popular service. I was unaware of this happening and have provided one of the media stories reporting the incident, for others who may have been unaware.
The BBC is a public broadcaster (like Australia's ABC) and serves the interests of the general population free from commercial pressure.
As 41% of people in the UK use CAM the decision to close down the service was certainly a controversial one.
A recent visit to the BBC site demonstrated some CAM news stories, mostly geared towards the potential problems that may be associated with its use.
This is a shame because the BBC are well placed to research evidence surrounding CAM's and provide a much needed and unbiased site for solid information.

Source: NaturalNews.com


The BBC Abandons Its Complementary Medicine Website Due to Pressure

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Software Licences Trigger Software Investment Review

Staff Writer

Many firms that licence key software programs are tightening up licencing conditions such as who is entitled to received free licences and what scale of charges apply.
Clients are reluctant to pay fee increases for basically the same software each year, but charitable and aged care organisations will be hit hard for licences that formerly were available to them free of charge.
Obviously there will be some hard negotiating coupled with a review of the actual software required.
One alternative may be to replace Microsoft with the Sun Open Office suite of programs that virtually duplicates the entire range of programs contained in Microsoft Office and comes entirely free of any cost. Open Office can also convert to any of the Microsoft formats.
Pharmacists may like to consider the change as well.

Source: Aged Care Guide


Aged Care IT Investment Put on Hold

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Supporting the Carers

Staff Writer

With the Baby Boomer retirement revolution due to start in 2010, one of the key needs will be an army of carers to provide home support needs.
Traditionally, this has fallen to family members, usually female.
And with a considerable number of carers being elderly themselves, there will be a human resource shortfall in this area.
One obvious solution is to elevate this activity to that of a career and the necessity to put training processes in place coupled with appropriate remuneration.
Government has made some moves in this regard, but not nearly enough nor in a timely fashion.
There is an opportunity for pharmacy to provide a support service in the form of "Pharmacy in the Home" services.
Creating the outreach is the difficult part, but pharmacies that do not try and participate will lose market share to those who do provide the service.

Carer at home issues raised by NHHRC reform proposals

Source: Aged Care Guide

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The Importance of Vitamin D3 in Aged Care

Staff Writer

A walk in the sun to generate a reasonable level of vitamin D3 is said to delay the need for a knee replacement.
But this vitamin is also implicated in heart health, cancer prevention, osteoporosis, arthritis and immune modulation, as in multiple sclerosis.
In fact, it is said that vitamin D3 is involved with over 1100 individual genes in an average person.

Even if you get sun exposure, if you utilise sunscreen preparations the conversion reaction in the skin is virtually negated, or if you have a shower 15 minutes after exposure, the vitamin washes away before being absorbed through the skin.
Old skin is also inefficient as a medium for generating and absorbing the vitamin.
While sun exposure is the cheapest and most optimal way of getting a daily dose of vitamin D3, a back up through oral supplementation is also recommended. 

Knee replacements delayed by sun

Source: Aged Care Guide


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Pharmacy in the Home Opportunity emerging

Neil Johnston

The following story published by Drug Topics mirrors a trend that has already commenced in Australia.
A more conservative customer/patient is emerging, in part driven by government attempts to convert branded drugs on the PBS to a cheaper generic version.
Harsher economic conditions have also played a major part.
As we all know, not all customer/patients are convinced of the value involved in changing from long established brands, no matter what arguments are offered.
That means two distinct classes of health consumers are forming up within Australian pharmacies.
Note also that the value-conscious health consumer illustrated in the article is less impulse driven and creates a shopping list before leaving home.
And in the background, high levels of government stimulus spending means that the ability for government to fund existing and future services is at risk, and resources will have to be rationed even more than they are currently.
But this trend opens up a range of opportunities for pharmacists to develop a range of services targeted for customers/patients within their homes.
Mark Coleman discusses a "Pharmacy in the Home" concept further along this article.

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PSE Diversion in the US

Con Berbatis

articles by this author...

Con Berbatis is a pharmacy researcher attached to Curtin University in Western Australia. For i2P, he identifies Australian and global research reports that may be useful for pharmacists to include in their own planning initiatives.

Editor : Up to the year 2005, Australia and the USA appear to have had the highest per capita consumption of pseudoephedrine (PSE) of any country.

PSE has been widely diverted as a precursor into the production of methamphetamine which has been most commonly synthesised in domestic labs for local distribution.

The widespread abuse of PSE have led to epidemic criminal activity and human misery in both countries.

Pharmacies in the USA and Australia have been a major source of pseudoephedrine and the retail control is a serious challenge to pharmacy.

In the June 2007 issue of i2P , research reporter Con Berbatis reported the benefits of the Project Stop program together with supporting statistics.
Since then, the Drug and Alcohol Review journal has published a report by the Curtin University team entitled :
Linked electronic ,medication systems in community pharmacies for preventing pseudoephedrine diversion : a review of international practice and analysis of results in Australia.

The US National Association of Boards of Pharmacy (Mount Prospect, Illinois) have published the following commentary on the study in the August 2009 issue of the NABP Newsletter.

This is the first known occasion that the NABP has published Australian work.

Reference: Lewalski E. Interconnectivity of electronic PSE tracking systems shown to reduce illegal manufacture of Meth. NABP Newsletter. August 2009 .
At : http://www.nabp.net/ftpfiles/newsletters/NABP/nabp082009.pdf

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Interconnectivity of Electronic PSE Tracking Systems Shown to Reduce Illegal Manufacture of Meth

Much like bacteria that mutate to resist antibiotics, methamphetamine traffickers have adapted their methods to evade the restrictions that, for a while, weakened their operations. In response to these tactical mutations, regulatory and law enforcement authorities are augmenting their curative strategies. The use of interconnected electronic tracking systems to record and monitor pseudoephedrine sales at the point of purchase has proven effective in reducing diversion of these products. A study published in 2009 in Drug and Alcohol Review, which followed diversion trends by jurisdiction in Australia, confirms the efficacy of this technological remedy.

In the few years follow¬ing implementation of the Combat Methamphetamine Epidemic Act of 2005 in the United States, which restricted consumer pur¬chases of pseudoephedrine-containing products and required pharmacists to log all such purchases, the illicit production of meth¬amphetamine in the US declined. After a signifi¬cant drop in 2007, how¬ever, “methamphetamine availability stabilized and possibly increased after the first half of 2008,” accord¬ing to the National Drug Threat Assessment 2009 compiled by the National Drug Intelligence Center of the US Department of Jus¬tice (DOJ). The report ties the increased availability to escalated domestic produc¬tion of the drug.

DOJ attributes the resur¬gence in US methamphet¬amine production, in part, to producers obtaining the precursor ingredients from local retail sources. To buck the tracking system, meth¬amphetamine traffickers are known to acquire large quan¬tities of pseudoephedrine, the precursor chemical used in the manufacture of meth¬amphetamine, by organizing multiple, successive purchases of pseudoephedrine-contain¬ing products in quantities at or below legal limits in mul¬tiple retail locations – a prac¬tice known as “smurfing.” Pseudoephedrine tracking systems that are not intercon¬nected generally fail to flag these multiple purchases.

To address this shortfall, several states in recent years have implemented or shown interest in implementing electronic tracking systems that record the sales of pseudoephedrine-containing products. Such systems enable retailers to transmit informa¬tion on pseudoephedrine sales to an electronic database accessible to appropriate law enforcement and regulatory agencies at the state level. In¬formation from these systems can be used by enforcement authorities to reduce the number of domestic metham¬phetamine labs by preventing the sale of pseudoephedrine in excess of legal limits, and to identify and prosecute individ¬uals involved in smurfing and others involved in metham¬phetamine production.

Both Kentucky and Arkan¬sas have demonstrated success with linked electronic moni¬toring systems in reducing pseudoephedrine diversion. The implementation of Meth¬Check in 15 Laurel County, KY pharmacies in 2005, and of LeadsOnlabs MethMontior in 18 North Little Rock, AR pharmacies in 2006, both led to increased numbers of local illicit laboratory seizures, in¬creases in methamphetamine-associated arrests, and savings in law enforcement resources. In 2008, Kentucky and Arkan¬sas became the first two states to legislate linked monitor¬ing systems to be installed in pharmacies for recording and tracking pseudoephedrine purchases.

To support states in their efforts to set up linked track¬ing systems, and to encourage and support planning for interconnectivity between state systems, the DOJ Office august 2009 147

of Justice Programs’ Bureau of Justice Assistance (BJA) in spring 2009 was accept¬ing grant applications for a Methamphetamine Precursor Chemical Diversion Train¬ing and Technical Assistance provider. Applications were due June 23 for the grant, which is being funded under the Edward Byrne Memo¬rial Justice Assistance Grant Program.

The recently published results of the aforementioned study conducted in Austra¬lia support the theory that interconnectivity between tracking systems reduces methamphetamine produc¬tion. The study, undertaken by researchers at two Austra¬lian universities, found linked electronic tracking systems to be successful in preventing pseudoephedrine diversion in Queensland, Australia.

The study evaluated the effectiveness of a linked elec¬tronic medication recording system (LEMS), implemented into Queensland pharmacies in 2005 as part of the Pharma¬cy Guild of Australia’s “Project STOP” initiative to prevent the diversion of pseudoephedrine. The LEMS is a Web-based sys¬tem that electronically records pseudoephedrine purchase information at the point of sale and instantaneously transfers the data to a central collection system. A global positioning system depicts the location of the pharmacy where the data were entered. The system enables authorized pharma¬cists, law enforcement officials, and health department staff to view the data to identify cases of suspected diversion and to compare pseudoephedrine purchases with wholesaler supplies to pharmacies.

To measure the impact of the LEMS program on Queensland pharmacies, the study tracked the number of illegal laboratories seized in Australia by jurisdiction from 1996-1997 to 2005- 2006. Based on the histori¬cal trends for lab seizures in each jurisdiction over the span of years, researchers were able to measure actual results against projected results that follow historical trends.

Results indicated that the total numbers of illegal laboratories seized yearly in Australia by jurisdiction from 1996-1997 to 2005- 2006 appeared to stabilize – except in Queensland. The reported number of illegal seizures in Queensland in 2005-2006 was significantly lower than that predicted from historical data. Nation¬ally, however, the num¬ber of labs seized was not significantly different from predictions. In other words, the study found a significant decline in the number of illegal methamphetamine labs seized in Queensland in 2005-2006 compared to that of other Australian jurisdictions that did not use a LEMS. The authors point to this decline as suggestive of the effective use of LEMS in Queensland pharmacies to reduce pseudoephedrine diversion.

While an increased raw number of seizures in a single year would suggest improved enforcement, as it did in Kentucky and Arkansas, the decline seen in Queensland compared to projections based on historical trends and actual results seen in other juris¬dictions, on the other hand, points to a reduction in the existence of these illegal labs in the first place.

“For the 12-month pe¬riod ending June 2006,” the study authors report, “the Australian Crime Com¬mission attributed Project STOP with part of the reduction in illegal labora¬tories in Queensland and with more than 30 arrests following electronic com¬munications from partici¬pating pharmacies.”

While the study authors note that the “reliance on total yearly results of just one indicator, namely a reduction in the number of seized illegal laboratories, is insufficient in drawing firm conclusions,” the trends were indicative enough that in April 2007, 85% of Queensland’s com¬munity pharmacies were enrolled in Project STOP. In 2008, the Pharmacy Guild of Australia began implement¬ing the LEMS nationally through pharmacies with the assistance of a government grant.

Thus far, the evidence points to interconnectivity between pseudoephedrine tracking systems as a promising remedy to the societal ill brought on by the illegal production of methamphetamine


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