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Addressing opioid drug misuse in America

ID-100317718Morbidity and Mortality Weekly Report published a study that links prescription opioid misuse with illicit opioid use, specifically heroin. The study investigated tendencies of heroin users in the US from 2002 to 2013, among all demographics. There was a 90% increase in the rate of people diagnosed with past-year heroin use or dependence; the majority of which were among men, 19-25 years old, people of less than US$ 20000 annual household income, people living in urban areas, and those without health insurance. Moreover, there was a highest (138%) increase in past year heroin users who reported past year use of non-medical opioid pain relievers, followed by reports of cocaine use.  Some of the initiatives taken to minimize opioid misuse problems include the hand-held auto injector for naloxone that was approved by the FDA and the extensive Prescription Drug Abuse Prevention Plan lunched by the White House. In addition, a recommended action against opioid misuse was to provide better access and insurance coverage to evidence-based substance abuse treatments such as buprenorphine or methadone, promoting naloxone use for opioid pain reliever abuse and heroin overdoses. What programs related to opioid misuse are offered through your practice?

For additional information please read THE LANCET

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New safety warnings for two classes of diabetes drugs: What pharmacists should know?

ID-100265172New safety warnings were issued by the FDA for dipeptidyl peptidase–4 (DPP-4) inhibitors, and sodium–glucose linked transporter–2 (SGLT-2) which are two oral agents for blood glucose control in type 2 diabetes. Warning of heart failure risk associated with one of the DPP-4 inhibitors, saxagliptin, were voted to be included on the drug label based on a large study (SAVOR). The study had nearly 16,500 people with type 2 diabetes and risk factors for cardiovascular events; more hospitalization due to heart failure occurred in the saxagliptin group (3.5%) than in the placebo group (2.8%) over 2 years of follow up. However, two other large randomized controlled trials (EXAMINE and TECOS) did not confirm this risk. The safety warning for SGLT-2 inhibitors was published after reports of diabetic ketoacidosis (DKA), a dangerous accumulation of acid in the blood, which required emergency visit or hospitalization in people with type 1 and type 2 diabetes. Yet, the reports did not prove a cause and effect link between the medications and DKA. When dispensing DPP-4 inhibitors and SGLT-2 inhibitors, it is recommended for pharmacists to assess patients’ specific risk factors and weigh them against benefits, providing appropriate patient counseling. How many of your patients are prescribed these two classes of drugs?

For additional information please visit APhA

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Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers

ID-100316690The Center for Disease Control (CDC) analyzed Internet survey data from 2012-2013 about the knowledge and the consequent attitudes towards antibiotics of approximately 15,000 health care providers and adult consumers, from both Hispanic and non-Hispanic communities in the US. Based on the data, 48% of Hispanic while only 25% of non-Hispanic consumers believed that taking an antibiotic would cure their cold faster. Also, the majority of Hispanic adult consumers were obtaining their antibiotics from sources other than physicians (e.g., family members, friends, neighborhood grocery stores). Fifty four percent of health care providers believed that patients expect them to prescribe an antibiotic when they complain of cough and cold, while only 26% of all consumers had the same expectation.  Participating providers were discouraged from prescribing antibiotics because of the potential for resistance, side effects or allergic reactions, and cost. Moreover, knowledge of antibiotic resistance and their negative effects on the normal bacteria were lacking among the Hispanic consumers. The CDC believes improving access to health care might help reducing the risks of antibiotic self-administration, and also recommends public health initiatives to minimize inappropriate antibiotic use for Hispanic and other minority populations. The CDC encourages the use of their multilingual patient education programs such as “Get Smart: Know When Antibiotics Work” (http://www.cdc.gov/GetSmart/Community). If you are working with patients from diverse ethnic groups, do you see the same pattern in your community? How do you deal with antibiotic use and its challenges with your patients?

For additional information please visit CDC

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Did reports of side effects contribute to drop in bone drug use?

The JID-10036305ournal of Bone and Mineral Research recently published a study that examines effects of media reports on the use of oral bisphosphonates. Google trends were utilized to get data from 1996 to 2012 for the media reports; the Medical Expenditure Panel Survey and the National Inpatient Sample were used to obtain data regarding fracture outcomes in the United States. Researchers studied patients aged 55 years and older and those hospitalized for hip fractures. In 2008, 15.8% of women older than 55 were using bisphosphonates and in 2010, 1.9% of men used this category of agents. Despite a decade of bisphosphonates use and their effectiveness and lower safety risks concerns, a sharp decline (more than 50%) in their use was noticed between 2008 and 2012 corresponding with a series of media reports that highlighted a rare yet serious adverse effects of bisphosphonates. Series of spikes in Internet search activity for alendronate (Fosamax) occurred between 2006 and 2010 immediately after media reports. The decline in use was mostly noted among white women, rural residents and women with less than a high school degree. It occurred even though doctors and drug regulators did not make recommendations to stop the use. The negative reports about bisphosphonates overlooked the risk of fall-related injuries manifested by osteoporosis, or thinning bones. It is also possible that newer medicines for osteoporosis have contributed to this decline of the decades-old bisphosphonates. What are your thoughts about the methodology of this research, biophosphonates, and the findings?

For additional information please read Journal of Bone and Mineral Research

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Lower Is Better — LDL Cholesterol and IMPROVE-IT

The Imheartproved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) by Cannon et al. is the first clinical trial to show a benefit of adding a non statin lipid-modifying agent to statin therapy. The trial included 18,144 patients with an acute coronary syndrome who were randomly assigned to either simvastatin (40 mg) plus ezetimibe (10 mg) or to simvastatin (40 mg) plus placebo. After 7 years cardiovascular death, major coronary event or nonfatal stroke were 2 % significantly lower in the simvastatin-plus-ezetimibe group than in the simvastatin-monotherapy group (32.7% vs. 34.7%). The IMPROV-IT trial supported that excess low-density lipoprotein (LDL) cholesterol is a causal factor in the development of atherosclerotic vascular disease; suggesting that reducing LDL cholesterol levels, regardless of the mechanism, should produce a corresponding reduction in cardiovascular events. What are your thoughts about the results of this research? How will this change your practice?

For additional information please read NEJM

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Countries Should Raise Taxes on Tobacco, Says WHO

There are 33 counID-100334651tries that impose 75% or more tax on tobacco.  According to World Health Organization (WHO) they represent only 10% of world population.  As part of its six point action plan on curbing tobacco use, the WHO, encouraged countries to apply the recommended “three quarter of a cigarette packet price” taxes raise. The most recent WHO report showed that raising taxes was the most effective and cost efficient way to reduce the prevalence of smoking.

Do you agree with/like this WHO policy?  What are some of the other effective measures/tools for quitting smoking that you share with your patients?

For additional information please read BMJ.

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What will it take to create a tobacco-free world?

ID-10072097This week, an international public health and public policy team published a three-paper series in The Lancet in which they discuss a new campaign in the fight against tobacco-smoking. This group of experts hopes to create a tobacco-free world, defined as less than 5% of the world’s adult population using tobacco products (including smokeless tobacco), by the year 2040. They are calling for global support in their efforts to achieve this as they believe it will prevent hundreds of millions of deaths in the remainder of this century alone. Tobacco-smoking has become an increasingly global concern involving middle and low-income countries. For roughly a decade, The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) has been working on this problem but it is believed that they alone cannot influence countries worldwide to set goals to end smoking and cannot stop the tobacco industries’ pursuit of new, potentially lifelong customers. Do you think a tobacco-free world is feasible by the year 2040? What available pharmacological and non-pharmacological approaches can be employed to quit smoking?

For more information, please click here.

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FDA launches drug shortages mobile app

ID-10055509The U.S. Food and Drug Administration (FDA), the federal agency responsible for protecting the public health by assuring safety and effectiveness of drugs and drug products, has launched its first mobile application (app) earlier this week. The purpose of the app is to inform healthcare professionals and consumers about current and resolved drug shortages and drug product discontinuations. Users of the app can search by a drug’s generic name/active ingredient or browse by therapeutic category. This app is intended to provide convenient and quick drug supply information in the palm of your hands. Additionally, individuals have the opportunity to report a suspected drug issue or shortage to the FDA through the use of this app. It is available free of charge for Apple and Android mobile devices by searching “FDA Drug Shortages”. Would the convenience of receiving/sharing drug supply information encourage you to use this mobile app? How do you keep up to date with drug supply news?

For more information, please click here.

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Cholesterol in food not a concern, new report says

ID-100167748The Department of Health and Human Services and the Department of Agriculture post dietary guidelines, known as the Dietary Guidelines for Americans, every five years in an attempt to optimize the American diet promoting healthier lives. They previously made a dietary recommendation that American consumers limit their cholesterol intake to a maximum of 300 mg/day. MyPlate, formerly known as the Food Pyramid, relies on such guidelines and for many years, the consumption of foods containing high levels of cholesterol was firmly discouraged. However, the recent Scientific Report of the 2015 Dietary Guidelines Advisory Committee stated that “Cholesterol is not considered a nutrient of concern for overconsumption.” The Advisory Committee does not believe based on the evidence that there is enough association between dietary and serum cholesterol. The sparing consumption of foods high in cholesterol has been supported for decades and this revolutionary statement may significantly change American dietary patterns. Have you started discussing this new report with your colleagues? Are you prepared to counsel patients inquiring about this latest change in guidelines?

For additional information please visit CNN Health.

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