To any RPH who wants to import medicine for their pharmacy..... Please make sure you have filled out all your importation forms. Do not imitate a RPH who was convicted of importing without a license. For more, check out the article in Drug Topics. It is available here http://drugtopics.modernmedicine.com/drug-topics/news/pharmacist-accused-internet-fake-pill-scheme?page=0,1

After reading an older article in US Pharmacist here are some thoughts:

Is your CPR up to date so that you can immunize? That may be needed.

Are you seeing a spike in flu like symptoms? It's time to call the health department.

Inhaled anthrax isn't contagious, but the flu is. Most likely your patients may need to see the article printed out to believe you, but if you have your white coat on you may be more credible, unless you are worried about white coat induced hypertension of your patients. 

http://legacy.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/Bioterrorism.htm&pub_id=8&article_id=798

The CDC has tips on what should be in your prep kit. 

http://www.bt.cdc.gov/preparedness/kit/disasters/

Did you know? There are five titles to the Bioterrorism Act of 2002, and you can get electronic updates.

On a more morose note here's an article from last year that talks about a California RPH who went to jail because he helped Pakistanis attack US soldiers. 

http://www.huffingtonpost.com/2013/03/29/oytun-ayse-mihalik-sentenced_n_2981266.html

I skim the slideshows at dictionary.com occasionally. They even have a word of the day email. It helped me out one day when I was talking to a classmate, and he said "I've never heard that word before, what does it mean?" On another day, another person jokingly implied I should have job security because of my vocabulary skills.

Dictionary.com claims that there is only 1 word in the english language that has X, Y, and Z in the word. Atarax. Hydroxyzine.

This is why chemistry is useful to learn. There are carbon bonds, hydrogen bonds, etc. There are single and double bonds. A good chemistry student will know if the chlorine was ortho, meta, or para....

Yes there is a link between today (911) and pharmacy.

Andy Stergachis, professor of epidemiology and affiliate professor of pharmacy for University of Washington, had the following commentary on the role of a RPH during a disaster:

Who is your health departments "health officer" ?

Which agents would villains like to use to harm your neighbors, and what preventive antibiotics might be useful for you to have in your pharmacy?

What local clinics would need a volunteer RPH?

Do you have time (and money) to take a training class on how to prepare for an ER?

Here's the washington state link:

http://www.wsparx.org/emergencyprep

Here's some link to the FDA page & CDC's pages:

http://www.bt.cdc.gov

http://www.fda.gov/EmergencyPreparedness/Counterterrorism/default.htm

Hear ye, hear ye community pharmacy staff…..want a free CE? Especially one that may help you do your job better? It's more than 12 months old, but less than 24.I just discovered it.

https://www.humana.com/provider/support/on-demand/linet

https://www.brainshark.com/humana/2013LINET

Interesting, that insurance companies are allowed to make CEs, but manufacturers aren't. Though, after a brief recollection of Pharma's behavior most RPHs know why manufacturers aren't.

Humana made a 1 CE module about Limited Income NET Tutorial. Brief registration including your NABP number is required. Techs can also take it for credit.  Here's the 9 aspects of it:

1. List the four categories of individuals eligible for the program. 
2. List the four steps required to submit a claim. 
3. Identify the bank identification number (BIN) and processor control number (PCN)
   required to submit claims to the program. 
4. Extract required beneficiary data for claim submission. 
5. Describe temporary enrollment. 
6. Extract data from E1 transactions. 
7. Define what retroactive coverage is for Medicare’s Limited Income NET program. 
8. Identify members eligible for retroactive coverage in the program. 
9. Identify additional Medicare Limited Income NET Program resources available via the
   Web and the dedicated Limited Income NET Help Desk. 

• Accreditation
  Humana Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Universal Program Number for Pharmacists is 0619‐0000‐ 13‐019‐H04‐P. The Universal Program Number for Pharmacy Technicians is 0619‐0000‐13‐019‐ H04‐T. 

Speaking of Marijuana

Here are three photos of marijuana products manufactured in the US prior to the rescheduling of the product by the DEA. You'll notice that two have poison on the bottle, and one does not. Perhaps the product should be regulated the same way as Psuedophedrine, behind the counter? Perhaps the US should have products which require patients to speak to a pharmacy worker first? Do our Australian cousins have it right (which have 3 types of medicines: RX, OTC, and behind the counter)? I have no knowledge of what schedule Australia considers marijuana. Image source: wikimedia commons.

https://commons.wikimedia.org/wiki/Cannabis_sativa#/media/File:Lilly96B.jpg

https://commons.wikimedia.org/wiki/Cannabis_sativa#/media/File:Lilly96A.jpg

Medical Marijuana Study.

So NABP makes a blurb about The study “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010,”

Please note is that consumer use wasn't legalized in Washington and Colorado until 2012.  Medical marijuana may play a role? Yes, from a historical standpoint marijuana was in use in prior centuries in the US, but despite various lawsuits, even most Americans grew up only knowing that it was illegal.

The abstract mentions that three left coastal states of the lower 48 had medical marijuana before 1999. From then until 2010, 10 more states passed it. Authors assert that each year there was less opioid overdose deaths in states with marijuana access than without. 

So how does that reconcile with the fact that the very components of marijuana which reduce pain, are also associated with mental imbalance and a lack of cognitive thinking? (Source DrugStoreNews CE by medical marijuana expert).

The authors do not reconcile that point.

How about the fact that for almost everyone, an otherwise illegal substance, is legal if you're *really* sick and in pain. 

Thus, the authors say: more studies and time are needed.

Another aspect not always mentioned is that the younger generation wants it legal because they believe it is not as harmful as other illegal drugs. There is the belief among the young that they are invincible. Though also, let's not forget the impact that TV shows can have on one's belief's.
There's the fact that when alcohol was made illegal during prohibition and we had gangsters making money off its sale, and so libertarians like the now deceased Milton Friedman say "Well if we decriminalize it, maybe the drug traffickers will not be able to make a profit motive selling it illegally so lets try this social experiment."

What to do, what to do? Ah controversy....

National take back day……Saturday, September 27, 2014

Be aware.    Got drugs? Perhaps you have some you really don't need?

So the number of unintentional overdose deaths in NYC has gone from 638 in 2000 792 in 2001 remained in the 700s until 2005 (796) then increased to 828 in 2006 then shrunk to 695 in 2007, 618 then 593 then a low point of 541 in 2010 then increased 630, 730, then 782 in 2013. Politicians can't take credit for such bizarre movements of overdosing.  Of course based on statistics one can talk about the DRAMATIC RISE from the low point of 541 to the scary top of 782. over a 3 year period.  Many of them were from opioids (77%). 

     Di-acetyl morphine, which doesn't cause addiction in the UK (according to one website), is a menace to the Empire State, or at least Empire City. It is involved slightly more than half (54%)* of the overdoses. Here's a great example of percentages versus figures. Heroin killed 50% more people PER CAPITA in 2013 than it did in 2010. Here's the numbers: 209 versus 420. 

    Methadone's per capita rate is similar between 2008 and 2013 (2.4 vs 2.5 per 100,000). Most people needed to take 2 drugs to overdose. Anxiety medication was used 60% of the time. 

* 420/.54 = 777.8       778*.54~420 so I'm unsure why in the graph it has 782 as the # of unintentional deaths, but I doubt that one needs to quibble about math since there was an annotation that numbers may be changing. Bronx inhabitants eked out Staten Islanders (8.8 vs 8.6 per 100,000) in overdosing. The largest increase by ethnicity was among Hispanics/Latinos, but the largest group of people who died was Whites. Heroin is most commonly used by poor people. So, yes Virginia, poverty knows all racial groups. 

Source: http://www.nyc.gov/html/doh/downloads/pdf/epi/databrief50.pdf