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Pharmacy News Online: APhA Releases Two Nuclear Pharmacy Books

APhA Releases Two Nuclear Pharmacy Books

The American Pharmacists Association (APhA) has just released two new references on the use of radiopharmaceuticals and the use of pharmacologic agents in diagnostic imaging. The books are entitled Nuclear Pharmacy Quick Reference and Diagnostic Imaging for Pharmacists.

Nuclear Pharmacy Quick Reference (ISBN 978-1-58212-151-2; spiral bound; 145 pages; $29.95 [$24.00 for APhA members]) compiles key information that nuclear pharmacists rely on in their daily tasks. Much of the information was drawn from the third edition of the classic Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine by Richard Kowalsky and Steven Falen. In addition, Nicki L. Hilliard, PharmD, BCNP, supplied helpful new tables on drug interactions and Kara D. Weatherman, PharmD, BCNP, contributed a useful review of the clinical uses of radiopharmaceuticals.

The book was edited by Clyde N. Cole, MS, Stanley M. Shaw, PhD, and Richard J. Kowalsky, PharmD. Cole is director of pharmacy standards for GE Healthcare in Chicago, IL. Shaw is professor emeritus of nuclear pharmacy at Purdue University College of Pharmacy, West Lafayette, IN. Kowalsky is associate professor of pharmacy and radiology at the University of North Carolina, Chapel Hill, and director of the Nuclear Pharmacy Laboratory at UNC Hospitals.

Diagnostic Imaging for Pharmacists (ISBN 978-1-58212-153-6; softbound; 273 pages; $74.95 [$60.00 for APhA members]) provides practicing pharmacists, pharmacy technicians and radiology department personnel with a basic understanding of the pharmaceuticals used as part of the imaging process. The book presents practical information, not covered in most pharmacy school curricula, on diagnostic imaging techniques and the proper use, indications and routes of administration for each pharmacologic agent. Included is an introduction to each of the following imaging modalities: x-ray, nuclear medicine and PET imaging, MRI and ultrasound.

Blaine Templar Smith, BSPharm, PhD, and Kara D. Weatherman, PharmD, BCNP, edited the work. Smith was chair, Department of Pharmaceutical Sciences, Saint Joseph College School of Pharmacy, Hartford, CT, when the book was written. Weatherman is clinical assistant professor of pharmacy practice at Purdue University College of Pharmacy with primary responsibility in the areas of nuclear pharmacy and diagnostic imaging.

State AG seeks action on prescription drug abuse ‘crisis’

Hoping to attack the growing problem of prescription drug abuse, state Attorney General Eric T. Schneiderman today called for legislation that would require doctors and pharmacists to use a statewide Internet database to review patients’ prescription histories and report when new prescriptions are written and filled.

The abuse of legitimately produced controlled substances that are channeled into the illicit drug trade is “the nation’s fastest growing drug problem, and in recent years has reached epidemic proportions,” Schneiderman says in a new, 42-page report. “It affects every sector of society, straining our healthcare and criminal justice systems, and endangering the future of our younger generations.”

The report touts Schneiderman’s proposed Internet System for Tracking Over-Prescribing (I-STOP) Act as legislation “that would exponentially enhance the effectiveness of New York’s existing (prescription monitoring program) to increase detection of prescription fraud and drug diversion.”

Gregg Dworkin, a recovering abuser who has lectured at high schools in Westchester and Rockland counties, half-jokingly said he came up with the I-STOP idea in the 1990s, after he crashed his motorcycle on a desert highway in Tempe, Ariz.

He nearly lost his leg in the 120-mph wipeout, and started abusing painkillers.

“When I was running around chasing doctors, doctor shopping, I just couldn’t believe I was getting away with this,” said Dworkin, 39. “I was going to Duane Reade on one corner and CVS on another to fill prescriptions, really laughing at the system. It occurred to me how easy it would be to stop me from doing this.”

But doctors, pharmacists and some in law enforcement expect big-time abusers and dealers will still find a way around the system by using fake identities to fill multiple orders, and by selling and buying prescription narcotics on the black market.

“There are positives and negatives in something like this,” said Jay Rothbaum, owner of Hillcrest Thriftmed Pharmacy in Nanuet and treasurer of the 300-member Westchester and Rockland Society of Pharmacists. “There certainly are people who abuse prescription medications, and this would be a tool to help identify them, but it wouldn’t be foolproof. People use false identification all the time to get around things like this. There are also privacy issues.”

Some also fear good doctors might drop certain patients who are in serious need of medication.

“If there are many requirements, or sanctions applied to physicians who prescribe controlled substances to people who might have abused these (medications), it may very well be a deterrent to good physicians to treat patients with addictions or abuse problems,” said Dr. Gregory Bunt, medical director of Daytop Village treatment services and president-elect of the New York Society of Addiction Medicine.

Bunt supports the initiative but said the “the devil is in the details.”

Under Schneiderman’s proposal, the state Health Department would establish an online controlled substance reporting system that operates in “real time” and mandates its use by doctors when writing prescriptions and pharmacists when filling them. The current system, he says, “is outdated with regard to how and when data is collected, who has access to it and how it is used.”

The start-up price tag would be up to $10 million, but would not add much in ongoing costs to the state budget, his office says.

I-STOP — first proposed last year — would allow doctors and pharmacists to provide controlled medications to patients who need them and “arm them with the necessary data to detect potentially dangerous drug interactions, identify patterns of abuse by patients, doctors and pharmacists, help those who suffer from crippling addictions and prevent potential addiction before it starts,” the report says.

Schneiderman points to a number of studies that identify the abuse of prescription medications as the nation’s fastest-growing drug problem, noting that painkiller overdoses killed nearly 15,000 people nationwide in 2008. The report says that in New York, the number of painkiller prescriptions being written grew from 16.6 million in 2007 to almost 22.5 million in 2009. A National Survey on Drug Use and Health by the federal government revealed that from 2002-09 the use of cocaine and methamphetamine among adults 18 to 25 decreased while the abuse of prescription drugs increased. Access to prescription narcotics through legal and illegal means has grown four-fold in the past decade, Schneiderman said.

The increase in prescription drug abuse inevitably manifests itself in criminal activity, as shown by incidents in the lower Hudson Valley, including:

– the case of Harrison pharmacist Scott Burko, who in June was sentenced to two years in federal prison after admitting that he stole $400,000 worth of steroids from Stop & Shop pharmacies in Westchester, Orange and Dutchess counties between 2003-06.

– the arrest in November of a New City psychiatrist, a Ramapo pharmacist and 13 others on charges of selling tens of thousands of prescription pills across Rockland County.

– the arrest of a Mohegan Lake pharmacy technician accused of trying to sell oxycodone, hydrocodone and Xanax to federal agents in a suburban Buffalo parking lot. Charles O’Garro, of Yorktown, faces up to 20 years in prison and a $1 million fine if convicted.

Will Plummer, special agent in charge of the New York City regional office of the U.S. Drug Enforcement Administration, said his agents have seen a 286 percent increase in prescription drug cases since 2009. That includes suburban communities throughout Westchester, Rockland and Putnam counties.

Guy Repicky, a Westchester County detective, is assigned to a DEA task force that focuses on prescription narcotics. He said the most dangerous trend now is for abusers to crush up and snort heavy-duty painkillers designed to be released over 12 hours.

These new extended-release (ER) tablets have literally been landing users in the emergency room.

“It’s deceiving to a teenager who crushes the pill up and doesn’t realize he’s getting the full dose immediately,” Repicky said. “We’ve had some overdoses as a result of this.”

Dr. Robert Marcus, director of the emergency department at Northern Westchester Hospital in Mount Kisco, said the state database could help his staff counter the growing problem they’re experiencing with addicts who report chronic pain in order to fuel their habit.

“In the ER (emergency room), we only know what’s been prescribed in our hospital,” he said. “Many of these patients go to different physicians, and those physicians prescribe medication without knowing they have multiple prescriptions from elsewhere and are either abusing or selling them.”

Marcus said he’s written prescriptions for five or six pills, only to learn later from a conscientious pharmacist that a patient has added a zero to try to get 50 or 60 pills.

Rothbaum, of the pharmacy association, said his main concern when filling prescriptions “is to make sure I’m not giving someone a drug that might hurt them. As pharmacists, we have to be able to make judgements about the people we’re dispensing medications to. I’m confident that the customers that I fill prescriptions for are using them for legitimate purposes. I don’t want to hassle the grandma coming from the dentist with a prescription for 12 Tylenol with codeine. To mandate that I enter information into the database would have limited value. I don’t think it would accompish what they want.”

Marc Levitt, pharmacist and owner of Marinelli’s Village Pharmacy in Elmsford, said the database would help him crack down on the increasing number of customers who present stolen prescriptions and engage in doctor and pharmacy “hopping.”

He’ll call police when he suspects someone, but perpetrators typically run out the door as soon as he picks up the phone.

“If someone walks into us with a prescription, we really have no way of knowing now if the patient had another one filled yesterday,” Levitt said.

He said the database could be a great tool but believes many people would still circumvent it.

“For the average person that’s just looking for drugs on a casual basis, I think this system would be great,” he said. “But for someone that is using this as a business, they’re going to find ways around it by using different names. That’s a story for another day.”

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