October 2014 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association OCT. 2014

Medical Marijuana: Can We Call This Medicine?

Board of Pharmacy Licensure Disciplinary Proceedings Compounding Violations, Pharmacy Audit Disputes Mergers and Acquisitions Commercial, Civil and Criminal Proceedings KAHAN ◆ HEIMBERG, PLC

Pharmacist Attorney Brian A. Kahan, R.Ph., J.D. Licensed Florida Pharmacist and Attorney

STATEWIDE REPRESENTATION 561-392-9000 bkahan@kahanlaw.com 2300 N.W. Corporate Blvd., Suite 123 Boca Raton, FL 33431 The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

e bl i la 7 va / A 24

A Pharmacist And A Lawyer PHARMACY CONSULTING & STAFFING SOLUTIONS Pharmacist & Technician Staffing Pharmacy Management Temporary & Vacation Coverage

Open a Pharmacy (Retail & Compounding) Licensing for All States Medicaid & BOP Inspection Preparation Assistance with Insurances Policy & Procedures Buy/Sell a Pharmacy WE ARE PROVEN TO BE THE MOST RELIABLE AND TRUSTED STAFFING & CONSULTING FIRM EPC is Pharmacist Owned and Operated www.epcepc.com (855) 374-1029

Increase Profits Independent…But Not Alone. PPSC is Your Partner for Success For more on how PPSC can maximize the potential of your independent pharmacy, visit www.ppsconline.com or call toll-free 888-778-9909.

2 |

FLORIDA PHARMACY TODAY

Every day, pharmacies depend on PPSC to simplify purchasing, reduce costs and identify new revenue sources – making a significant impact on their bottom line. PPSC can help you: EXPAND use of high-profit generics CREATE effective store layout ENHANCE third-party profits CAPTuRE MTM revenue EsTAblisH new business niches INCREASE your overall margins

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 9 Campus Corner 22 Buyer’s Guide

VOL. 77 | NO. 10 OCTOBER 2014 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

10 12 18 20 21

Medical Marijuana: Can we Call this Medicine? Speaker of the House Delegates Report Call for Award Nominations Call for Resolutions to the 2015 House of Delegates Pharmacy Time Capsule 2014

OCTOBER 2014

FPA Calendar 2014-2015

OCTOBER 18-22 NCPA Annual Meeting Austin Texas NOVEMBER 1-2

Committee and Council Meetings Orlando

27-28 Thanksgiving - FPA Office Closed DECEMBER 2-3

Florida Board of Pharmacy Meeting

6-7

Law and Regulatory Conference Sarasota

25-26 FPA Office Closed

JANUARY 10

Pharmacy Leadership Conference Orlando

24-25 FPA Clinical Conference Sandestin MARCH 8-9

Pharmacist Legislative Days and Health Fair Tallahassee

Mission Statements: of the Florida Pharmacy Today Journal

The Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

APRIL 18-19 Law and Regulatory Conference Tampa MAY 16-17 Law and Regulatory Conference Jacksonville JUNE 24-25 125th Annual Meeting and Convention St. Augustine

For a complete calendar of events go to www.pharmview.com Events calendar subject to change CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2015 or prior to licensure renewal. Consultant pharmacists and technicians will need to review their licenses and registrations by December 31, 2014. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www.pharmview.com

of the Florida Pharmacy Today Board of Directors

The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the

Journal in its goal of self-support.

Advertisers EPC........................................................................ 2 THE HEALTH LAW FIRM.............................. 16 KAHAN HEIMBERG, PLC............................... 2 PPSC...................................................................... 2 PHARMACY BROKER...................................... 8

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 U/F — Art Wharton (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

4 |

FLORIDA PHARMACY TODAY

E-MAIL YOUR SUGGESTIONS/IDEAS TO dave@fiorecommunications.com

The President’s Viewpoint SUZANNE KELLEY, FPA PRESIDENT

Getting to the Truth: The Role of the Pharmacist in Measuring Pain

“Are you in pain?” “Are you experiencing any pain?” “What is your pain level?” I am sure you have been asked these questions or you know someone who has been asked these questions when at the ER. Vital signs are measurements of your body’s most basic functions. Pain is the fifth vital sign and is just as important as your blood pressure, body temperature, respiration rate and pulse rate. A person’s body temperature can be taken orally, rectally and by axillary. With a special thermometer, the temperature of the ear drum can be measured, which is a reflection of the body’s core temperature. By the use of yet another type of thermometer, the temperature of the skin on the forehead can be quickly determined. The number of times a heart beats per minute is the pulse rate. This pulse rate can also indicate the heart rhythm and strength of the pulse. There are several places that the pulse can be found and measured, including the side of the neck, the inside of the elbow or at the wrist. The most common place that the pulse rate is taken is at the wrist. Blood pressure can be measured manually and automatically. The only way a person can take his or own blood pressure is using an automatic blood pressure device. If the blood pressure is measured manually, a stethoscope and blood pressure cuff are utilized. As we all know, the automatic or electronic devices can also measure the heart rate and/or pulse. The number of breaths a person takes per minute is the respiration rate. The rate of breathing includes inhalation and exhalation. It is best that the patient not be aware that the respiratory rate is being counted. Additionally, the pattern and comfort of the respira-

tion should be noted. So how should pain be measured? According to the 1994 IASP Task Force on Taxonomy, pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Unfortunately, if the individual in pain cannot communicate, this does not mean that he or she is not in pain. In early life, we all learn the application of the word through our experiences related to injury. Pain is always subjective. Can we measure anything that is subjective? Only the person experiencing the pain can describe or define it. Oftentimes, pain is caused by intense or damaging stimuli such as hitting a thumb with a hammer, stubbing a toe, burning a finger or fracturing a bone. So, back to the question, “Can we measure pain, which is subjective?” In 1968, legendary nurse Margo McCaffery defined pain as, “pain is what the person says it is and exists whenever he or she says it does.” Pain needs to be reported and it should not be ignored. Pain needs to be treated. If pain goes untreated, the body suffers and permanent damage may result. When a person is in pain, there can be increased blood pressure, pulse and respirations. Of course, there are parasympathetic responses to severe and deep pain. Pain is measured in many ways, and with various pain assessment scales. There is the Wong-Baker FACES Pain Rating Scale. This is a tool that consists of six pictures of faces from a happy face depicting “No Hurt” to a crying face depicting “Hurts Worst.” The patient is instructed to point to the face that best describes his/her pain. Another assessment scale is the “O – 10 Numeric Pain Rating Scale” which goes

Suzanne Kelley 2014-2015 FPA President

from “0” meaning “No Pain” to “10” depicting “Worst Possible Pain.” There are “Body Maps,” “Pain Thermometer,” and a numerical/visual analogue scale. For babies and premature babies, there are few assessment tools for pain. In the hospice realm, we are told that we should always believe the patient until we have been proven otherwise. This can be tough, as I mentioned before, because pain is subjective. A patient could be smiling but still be in pain. Should that patient be denied pain medications? Certainly not! The interesting thing is that the same pain experienced by two unique people could be rated completely differently. For example, two brothers, who happen to be twins, go skiing at a beautiful resort in Vail. They have three wonderful days of skiing with perfect weather, but on the fourth day these brothers (Mo and Bo) try the double black slope. Unfortunately, each one veers off the slope and hits a tree. Ironically, the trees they hit are identical and both break the OCTOBER 2014

2014 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work diligently all year long on behalf of our members.

Terry Gubbins.......................................................................... Chairman of the Board Suzanne Kelly...............................................................................................FPA President Tim Rogers................................................................................................... President Elect Alexander Pytlarz................................................................................................Treasurer Bob Parrado................................................Speaker of the House of Delegates Jackie Donovan...........................Vice Speaker of the House of Delegates Jennifer Raquipo..............................................................Interim Director, Region 1 Michael Hebb........................................................................................ Director, Region 2 Stephen Grabowski........................................................................ Director, Region 3 Linda Lazuka........................................................................................ Director, Region 4 Jason Beattie...................................................................................... Director, Region 5 Luther Laite IV.................................................................................... Director, Region 6 Kimberly Jones................................................................Interim Director, Region 7 Humberto Martinez......................................................................., Director, Region 8 Mitchell Fingerhut......................................................... Interim Director, Region 9 Christine Gegeckas............................................................................. President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair...........................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary.............. Verender Gail Brown, brownvgrx4304@hotmail.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Member........................................................Cristina Medina, cmmedina@cvs.com Member................................................................Norman Tomaka, FLRX9@aol.com Member........................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com Journal Reviewer....................... Dr. Melissa Ruble, mruble@health.usf.edu Journal Reviewer....................................Dr. Angela Hill, ahill2@health.usf.edu

6 |

FLORIDA PHARMACY TODAY

right leg in the exact same place. The ski patrols bring them to the ER at the local hospital. Mo and Bo are each in an exam area and are asked by the ER nurse as well as the ER doctor to rate their pain on a “1 – 10” scale. Mo is in complete agony and says that his pain is “off the chart or beyond 10.” Bo is joking with all and rates his pain as a 5 on this same “1 – 10” pain scale. Now, which one of the twins is telling the truth? Can they both be right? Who should the ER staff believe? As I mentioned previously, pain is subjective. How can subjectivity be measured? It is quite tough, but it can be done by skillful staff. Now, let’s take this a bit further. Mo and Bo are both being discharged with several prescriptions for controlled drugs and bring these prescriptions to your pharmacy. Mo is clean cut and dressed professionally in a suit. Bo is disheveled with long hair, a beard and torn clothes, and is quite dirty. Are all of these prescriptions legitimate? Do you treat both Mo and Bo in the same manner? Do you distrust Bo due to his appearance? Are the red flags going up? Do you know why you may be feeling more uncomfortable with Bo? Are you stereotyping? Perhaps not, but how do you subconsciously react to each prescription? We must do our due diligence and ensure that the patient in pain gets their pain medication. Of course, we must ensure that there is that patient and doctor relationship. The prescription must be legitimate and any questionable prescriptions must be verified. Don’t ignore the red flags, but don’t let the red flags go up unnecessarily. Know your patients! Try to have a pharmacist/pharmacy relationship with the patient to encourage loyalty. Be their pharmacist for all of their prescriptions. Don’t be a roadblock for that legitimate patient in pain and keep them from receiving their pain medications. Yes, we tread that thin line when filling prescriptions for our patients. Just ensure that the prescription you are filling is legitimate. Be your patient’s advocate! This is part of your “Pharmacy Passion!” n

Executive Insight BY MICHAEL JACKSON, RPH MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION

We Didn’t Start the Fire

he past several months I spent many hours on the highways and interstate roads of our state visiting our local associations and pharmacy schools, and attending various meetings. You get to appreciate all kinds of music sitting behind the steering wheel. Tuning into an ‘80s radio station, I heard a song released in 1989 by Billy Joel entitled “We Didn’t Start the Fire.” We hear music all the time and on occasion the lyrics may stick. This particular song had a lot of lyrics that included subject matter from just about everywhere. It is impossible to count the number of times I heard this song played, but for some particular reason this musical piece began to stick with me like sap on a pine tree. Perhaps it had something to do with the artist performing the song taking issue with his generation being blamed for the world’s problems. A few days ago, I received a telephone call from a consumer looking for medication to treat back pain. This is not unusual as the Association receives many calls from consumers looking for help with issues. In some cases we can assist by connecting these patients with members in their communities, while in other instances we must refer these callers to other resources. In this case, the consumer was looking for a controlled substance that was difficult to find in their community. It is common knowledge within the pharmacy practice community that there is considerable scrutiny of prescriptions presented for controlled substances. Policy changes within the Florida Legislature, Board of Pharmacy rules on the standards of practice for the dispensing of controlled substances for the treatment of pain and revisions to the general health professions statutes have

been the genesis behind the new due diligence that pharmacists have implemented in their practices. Also, recent changes to the federal Controlled Substance Act; such as standards for the issuing of multiple prescriptions for C-II drugs on the same date, rescheduling of hydrocodone combination products

As recently as May of 2013, there was a presentation by the DEA in Brussels, Belgium, on prescription drug trafficking and abuse trends. That presentation included 2010 data trends showing Florida as a problem area with largescale diversion.

and the placing of tramadol, in the Controlled Substance Act, mean that our dispensing of these medications are being closely scrutinized. As recently as May of 2013, there was a presentation by the DEA in Brussels, Belgium, on prescrtiption drug trafficking and abuse trends. That presentation included 2010 data trends showing Florida as a problem area with large-scale diversion. This seems to contrast with a 2012-2013 report published on the eForcse website (Florida Prescription

Michael Jackson, B.Pharm

Drug Monitoring Program) showing overall dispensing trends of controlled substance declining and a 41 percent reduction of deaths caused by oxycodone, as reported by Florida medical examiners. Still, with policy changes and increased regulatory scrutiny by federal and state agencies, our member stakeholders are caught between fulfilling the health needs of legitimate patients, access to adequate inventory from suppliers and push back from some within the prescriber community who may call into question why pharmacists are making inquiries about patient-prescribed drug therapy. I am a believer that more rather than less dialogue is needed between prescribers and pharmacist dispensers. Such collaboration has demonstrated improved patient outcomes and is a guard against potential drug-use misadventures. Perhaps prior to 2010 there were issues in Florida, but with significant OCTOBER 2014 |

FPA STAFF Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200

Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall, ext. 211

Educational Services Office Assistant Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110

FLORIDA PHARMACY TODAY BOARD Chair..................................... Carol Motycka, St. Augustine Vice Chair.........................Jennifer Pytlarz, Herndon, Va. Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Verender Gail Brown, Orlando Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Member....................................Cristina Medina, Hollywood Member................................. Norman Tomaka, Melbourne Member..............................Stuart Ulrich, Boynton Beach Member.......................Don Bergemann, Tarpon Springs Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2014, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. FLORIDA PHARMACY ASSOCIATION

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web 8 Address: | F L O Rhttp://www.pharmview.com IDA PHARMACY TODAY

changes in state laws and rules, the landscape is now different. Many of these changes were applied to the prescriber community such as (but not limited to) restrictions on physician dispensing of controlled substances, tamper-resistant prescription blanks and increased background screening and permitting requirements. Also, wholesalers (who are also being scrutinized) began a program of close monitoring of the purchasing habits of their clients. Remember that with all these issues facing pharmacists, several things are abundantly clear. Prescriptions received by pharmacies have been issued by practitioners who have a valid and current DEA and state license to practice. Florida and federal laws permit prescriptions to be filled for patients who do not live in the market areas where a pharmacy is located. A pharmacist cannot fill a prescription that has not been written, and there should be a valid physician patient relationship when prescriptions are is-

sued to the patient. Pharmacists must also do a drug utilization review on patients, and data shows that we query the PDMP program database with regularity. We didn’t start the fire! There is a lot of regulatory and policy oversight on our industry when it comes to the dispensing of controlledsubstance prescriptions. Our state laws do not allow us to initiate prescription drug therapy with the exception of a few limited cases allowed by regulations, yet we are constantly under the microscope. Patients with real needs may be turned away because of inventory issues or perhaps even the fear by the pharmacy of showing up on a federal radar screen. In the effort to control abuse, doctor shopping and pharmacy shopping changes have occurred in Florida. I believe that many of our issues have been corrected, but new problems with patient access are developing that need attention. It’s time for the pendulum to swing back to the center. n

SELLING YOUR PHARMACY? Pharmacybrokers.com has contact with hundreds of pharmacy owners and buyers. We observe, follow and analyze the market and know where to find the best opportunities. If you are interested in purchasing or selling a pharmacy, ours is the brokerage firm best suited to meet your needs.

Campus Corner BYCLASS MICHAEL JACKSON, RPH OF FLORIDA, ORLANDO CAMPUS BY BAO LAM, PHARM.D. CADIDATE, OF 2017, UNIVERSITY

Lifelong Learning in Pharmacy is an Endless Journey

lbert Einstein once said, “Intellectual growth should commence at birth and cease only at death.” Ever since our childhood, we have been taught to chase our goals and successes. Whether it was about passing that next test or getting a college degree, we all consider the measure of our success to be our degrees and certificates. Yet, we don’t really stop and think about how every day is a new day, filled with new challenges. The profession of pharmacy is progressive and dynamic, with new guidelines and drug discoveries happening every day. This past summer, both pharmacists and pharmacy students had a chance to meet and share ideas for a chance to gain knowledge about the current pharmacy world. The University of Florida College of Pharmacy was honored to host the 10th International Conference on Life Long Learning in Pharmacy in Orlando. The first meeting held in the United States since 1994, this year’s theme was The Magic of Discovery: What Lies Ahead. The conference was designed to facilitate and discuss new ideas, challenges and solutions to promote lifelong learning in the profession of pharmacy. In addition to six workshops, 21 small group sessions, 20 oral communications and two poster sessions, there were three keynote speakers and a special presentation by UF College of Pharmacy Dean Julie A. Johnson, Pharm.D. The conference “launched” at the Kennedy Space Center with Mr. Russell Romanella, NASA’s former Director of Safety and Mission Assurance. Later, attendees were invited to “dive down” and dine at SeaWorld’s Sharks Underwater Grill.

The author and fellow Student Pharmacist Diplomats pause for a Gator chomp outside the Kennedy Space Center.

The 2014 Conference Chairman, Sven Normann, Pharm.D., assistant dean of pharmacist education and international affairs at the UF College of Pharmacy, welcomed more than 160 attendees, representing more than 18 countries. As an added element, 12 Student Pharmacist Diplomats from the college’s four campuses attended and assisted with conference logistics. The Student Diplomats enjoyed the opportunity for professional development through networking and learning from a diverse group of educators from all over the world. It was a rewarding experience for students to see a difference perspective outside of the classroom. Stanley Luc, a third-year pharmacy student, said he was “not surprised to be so involved, as all of the attendees have a tremendous and genuine interest

in students and pharmacy education.” Rich Royster, a second-year pharmacy student, reflected on how he had “the chance to meet and develop relationships with some of the movers and shakers of the pharmacy industry.” He also added that by networking with so many minds around the world, there might be a possibility of setting up “fourth-year rotations (in Australia).” Lifelong learning does not have to start post graduation, but every day is a chance for us to learn and expand our horizons! The 11th International Conference, Sailing New Waters – Expand Your Horizons, will be hosted in Croatia in July 2016. For more information about the conference, please visit: www. lllpharm.com. n

OCTOBER 2014

Medical Marijuana: Can We Call This Medicine? Carol Motycka, Pharm.D. BCACP Matthew D. Bull and Heather Wilson, Fourth-Year Students, UF College of Pharmacy

Carol Motycka, Pharm.D. BCACP

Matthew D. Bull

Heather Wilson

Florida has recently joined the discussion already started in 34 other states, “What is marijuana?” Currently, there are 20 states that have legalized medicinal marijuana, and 14, including Florida, that have pending legislation. In June 2014, Governor Rick Scott signed into law SB 1700, better known as the “Charlotte’s Web” bill. This bill approved the use of what is being called medical-grade marijuana, which allows for the use of a non-smokeable form of marijuana containing less than 0.5 percent THC (the hallucinogenic component of marijuana) and greater than 15 percent cannabidiol (the ingredient thought to aid in the treatment of various conditions including intractable seizures in children). Qualified patients may be added into a compassionate use registry by their physician and be provided with medical grade marijuana to treat seizures or persistent muscle spasms when alternative therapies are not sufficient. Interestingly, GWPharma has been granted Orphan drug status on Epidiolex, which is a drug containing 94 percent cannabibiol. This “Charlotte’s Web” elixir is available for use through the patient’s physician. Parents and physicians are encouraged to contact GWPharma at (917) 280-2424 or visit http://www.gwpharm.com/Epidiolex.aspx for more information. We also currently have two marijuana derivatives on the market, Marinol and Cesamet, with other derivatives of marijuana in clinical trials for specific indications including Sativex (an oromucosal spray containing THC and cannabidiol), which is available in Europe. On November 4, voters will have the task of considering Amendment 2, the Florida Right to Medical Marijuana Ini-

tiative. The amendment would allow for the medical use of marijuana by “qualifying” patients or caregivers who have been issued marijuana by a licensed physician for use in the following “debilitating medical conditions:” cancer, multiple sclerosis, glaucoma, hepatitis C, HIV, AIDS, ALS, Crohn’s disease, Parkinson’s disease or other conditions for which a physician believes that the medical use of marijuana would likely outweigh the potential health risks for a patient. Opponents of the bill state that this is the loosest language seen to date in regard to medical marijuana because of the addition of the last part of the definition of a debilitating medical condition: “or other conditions for which a physician believes that the medical use of marijuana would likely outweigh the potential health risks for a patient.” When considering this bill as a health care provider, it is imperative that we discuss whether or not we should consider this a medicine and if so, what role will pharmacists need to play if Ammendment 2 indeed passes. Most of the arguments are directed at the cultural ramifications of letting the drug get a foothold in the state. However, the interesting question that is not being asked is, “What makes marijuana a medicine, anyway?” In general terms, a medicine is any substance that someone takes to treat an illness, but this isn’t the definition that exists in the cultural consciousness, nor the one intended when invoking the term “medicinal marijuana.” The more common expectation is that something referred to as a medicine has a degree of official status — and more importantly — accountability for the consequences of the agent. In fact, the term “medicine” is ubiquitously used as a synonym for the word “drug” as defined by the FDA. The biggest difference for our purposes is that a “drug” is officially recognized for its safety and efficacy, and in this regard, “medicinal” marijuana can not technically fall in this classification. There is an in-depth process by which a substance can become a drug (or medicine), and it has been refined over many years. This process ensures that anything offered to citizens as medicine has been proven through clinical trials to consistently provide the purported effect without causing harmful side effects. Although marijuana has been studied over the years and continues to be studied extensively today, marijuana has very little evidence to support many of the claims for

...there is no precedence of any medication coming to market by popular vote. In general, the public lacks the training and knowledge to make an informed decision and discern the suitability of a medication for an entire population... 10

FLORIDA PHARMACY TODAY

usage. ■■ http://clinicaltrials.gov/ct2/results?te rm=marijuana+or+cannabis+and+sm oked&no_unk=Y&cntry1=NA%3AUS ■■ http://clinicaltrials.gov/ct2/results?te rm=cannabidiol&Search=Search Moreover, there is no precedence of any medication coming to market by popular vote. In general, the public lacks the training and knowledge to make an informed decision and discern the suitability of a medication for an entire population, which is why we utilize the FDA process to bring a medication to market. Consider for a moment Thalidomide. Had it not been for the rigorous process of our FDA and caution by a brilliant scientist, Dr. Frances Oldham Kelsey, the phocomelia seen in thousands of babies in Europe and Canada may have been observed here in the United States. This incident brought forth the Kefauver Harris Ammendment of 1962, which strengthened the FDA’s stance on safety and efficacy of medications prior to coming to market. Ignoring for a moment whether or not marijuana might be considered safe for the public individually, and collectively in the long term, proven consistency in quality or proven efficacy with large scale studies have not been completed. A large proportion of the so-called efficacy is anecdotal in nature, by far the lowest form of evidence, and further drug safety testing would be needed for approval. Also, the marijuana plant is inherently inconsistent. It is grown as different strains with varied chemical makeups by many individuals who often are without education or training in pharmaceuticals. Within the plant, there are considered to be over 420 different chemicals, many of which we do not fully understand in regard to effects on the human body. Also, we are only beginning to uncover the many drug interactions with marijuana, which will become an important part of our professional duties if Amendment 2 passes. As use of marijuana increases across the country, the shortterm and long-term side effects continue to be studied. A recent article in the New England Journal of Medicine reviewed several of these adverse effects that are most prominently known to date including impaired short-term memory, paranoia and psychosis, addiction, altered brain development in adolescents, cognitive impairment and lowered IQ, chronic bronchitis and impaired motor coordination (Volkow ND et al. N Engl J Med 2014;370:2219-2227). The Florida Legislature must lean heavily on experts, such as pharmacists and pharmacy associations, to provide insight in order to guide and shape laws. It is understandable

that many have been hesitant to claim an official position and open themselves up to either liability on one side or being labeled as uncaring on the other side. Regardless of positions or laws enacted, the real question is why we would want to consider marijuana as a medicine, or allow a medication to come to market by popular opinion? It is possible that the “medicinal” term is being used to ease recreational marijuana use much like the metaphor suggests: a spoonful of sugar helps the medicine go down. If clear-minded, consenting adults want to vote on whether or not smoking marijuana is a crime, that is a different argument, but it may be very dangerous to exploit the practice of medicine to advance a political agenda. As pharmacists, we must consider all of the facts when making the decision whether or not to support Amendment 2. If Amendment 2 does pass as recent polls have suggested, it will be up to us to understand all of the drug interactions, adverse effects and potential uses of marijuana as we are ultimately the most accessible health care workers and can provide the important and potentially life-saving information to our patients who may use it.

OCTOBER 2014 |

Speaker of the House Delegates Report Presented to the House of Delegates Greetings to the members of the Florida Pharmacy Association and to all pharmacists across the State of Florida. I am honored to have the opportunity to bring you the results of the House of Delegates voting on the twelve resolutions presented to the House and the actions taken on each by the FPA Board of Directors. The resolutions and the results of the voting are as follows:

JOIN US FOR THE 2015 Annual Meeting and Convention at the Renaissance World Golf Village

2014-1 Florida Professional Board Membership Contact: Joseph Koptowsky, Docjik1215@aol.com Whereas, Florida is a geographically large state with a very diverse population; and such population is unevenly distributed and composed of many urban and rural areas. Furthermore, the needs of the citizens of different areas of the state often differ from one geographical region to another. In addition, the needs and situations of professional practices may have demands, requirements and nuances unique to some environments, and Whereas, the governor appoints members to the professional boards in the State of Florida. Whether the professional board is Cosmetologist, Medicine, Pharmacy, Nursing, etc., board membership selection and appointment should consider the geographic distribution of the population. Such a requirement of geographical and population representation and membership is no different from the allocation of electoral precincts inherent in legislative elections and representation, Therefore be it Resolved, that the Florida Pharmacy Association encourage the Governor to propose and the legislature to enact legislation ensuring representation utilizing population density and distribution as guidelines to aid and guide the selection of candidates for professional boards. Intent: to ensure equal representation to the boards that decide upon issues that affect our practice. PASSED 2014-2 Allow Resolutions to be submitted up to 30 days before House of Delegates (HOD) Contact: William Garst, wgarst1025@cox.net Whereas, every year the rules of the

FLORIDA PHARMACY TODAY

HOD have to be suspended for each resolution that has not been submitted prior to the March 15th deadline, Whereas, many ideas that are the nucleus of resolutions are formed after the deadline, Whereas, resolutions can be submitted electronically as a file that can be sent to the HOD Directors via email for consideration and approval, Therefore be it Resolved, that the FPA HOD consider allowing Resolutions to be submitted electronically to the Speaker of the HOD up to 60 days before the HOD convenes during the Annual FPA Meeting, and that Resolutions so submitted be considered timely filed and not subject to a suspension of the rules Problem: Many important resolutions are not formed by the deadline for submission through no fault of anyone. Intent: to allow resolutions more time for submission if done electronically, for ease of sharing with the HOD Directors for consideration and approval. AMENDED PASSED AS AMENDED 2014-3 Dual membership category in FPA and FSHP Contact: William Garst, wgarst1025@cox.net Whereas, many pharmacists have interests in FPA and FSHP, Whereas, some people choose one or the other due to costs, Therefore be it Resolved, that FPA and FSHP confer together for each organization to establish a Dual Membership category providing membership in both the FPA and FSHP. The Dual Membership will be a discounted membership fee to be less than the cost of joining each organization individually, Problem: FPA membership needs to be increased. Intent: A possible way to increase membership. PASSED

2014-4 BCPS (BCAPS) CE to count as Consultant Pharmacist CE Contact: William Garst, wgarst1025@cox.net Whereas, BCPS CE is of high quality, Whereas, BCPS CE is extensive, demanding, and expensive, Therefore be it Resolved that the FPA petition the Board of Pharmacy to allow accredited BCPS CE to count towards the requirements to maintain a Consultant Pharmacist license. Problem: The magnitude of CE requirements for BCPS and Consultant CE. Intent: To reduce the CE burden of BCPS Pharmacists and Consultant Pharmacists, and may be an avenue of increasing the number of Consultant Pharmacists. RESOLUTION FAILS 2014-5 Petition the Medical Board of Florida to have FPA Annual Meeting CE count towards Florida Physician CME Contact: William Garst, wgarst1025@cox.net Whereas, it has been mentioned that FPA would like more interaction with physicians, Whereas, the Pharmacist and Physician perspectives of patient care are sometimes in conflict, Therefore be it Resolved that the FPA investigate the feasibility and advisability of obtaining joint accreditation provider status to facilitate interprofessional continuing professional education and development, Problem: Pharmacist and Physician relations are sometimes strained. Intent: To encourage physicians to attend FPA Annual CE as a way to increase interaction between physicians and pharmacists in a positive atmosphere. FAILED MOTION TO RECONSIDER PASSES RESOLUTION AMENDED FOR RECONSIDERATION RECONSIDERED RESOLUTION AS AMENDED PASSES

2014-6 Creation of a Student Pharmacist Council Contact: Ashley Rowand, arowand@ufl.edu Whereas, no official current FPA council exists that focuses solely on student pharmacists and student involvement. Whereas, FSHP currently has a council devoted to student affairs and, Whereas, with six schools of pharmacy in the state and soon to be seven; students are currently in need of a permanent voice. Whereas, one major ongoing focus of this council would be to help ensure the transition from student pharmacist member to pharmacist member of the FPA Therefore be it Resolved, that FPA form a standing student pharmacist council, patterned after its current council structure; and Be it Further Resolved, this council be co-chaired by a student pharmacist, chosen by the FPA President, with an FPA pharmacist member designated as the other co-chair. Problem: While many pharmacists work hard to provide wonderful opportunities for student pharmacist development through the FPA, students are eager to have a council devoted to their own initiatives and issues. Student pharmacists are an underutilized resource that can help bring great change and ultimately increase membership in the organization. Intent: To continue to develop and grow the student voice in the FPA and increase student pharmacist opportunities for participation in the FPA as well as help to bridge the transition from student pharmacist to Pharmacist member. PASSED 2014-7a Creation of Student Positions on the Board of Directors Contact: Ashley Rowand, arowand@ufl.edu Whereas, currently nine members are elected to regional director positions but not one member is a student, and

Whereas, there are six schools of pharmacy in the state, soon to be seven Therefore to be Resolved, that the FPA amend its Constitution and ByLaws to add one directors seat designated for a student pharmacist to run for election. Problem: Currently, the student voice is under represented, even when we make up such a large portion of membership in the FPA. Intent: To increase student voice and involvement in the strategic planning and policy of the FPA. PASSED 2014-7b Requirements for Selection of Student Positions on the Board of Directors Contact: Ashley Rowand, arowand@ufl.edu Whereas, the House of Delegates has approved Resolution 2014-7a, amending the FPA Constitution and By-Laws to add one director seat to be designated for a student pharmacist. Therefore be it Resolved, student pharmacists interested in running shall demonstrate approval by their respective school dean, and Be it Further Resolved, that the student pharmacist director must maintain appropriate academic standards during their term in office, and Be it Further Resolved, that this elected student pharmacist serves as an ad-hoc member on the student pharmacist council. Problem: There is no student pharmacist represented on the House of Delegates. Intent: To increase student voice and involvement in the strategic planning and policy of the FPA PASSED COMMENTARY January, 2014, the FPA board of directors met for the purpose of finalizing the FPA Strategic Plan, a set of goals and objectives to drive the organization over the next three to five years. In creating this plan, one objective that was discussed was the changing role of the pharmacist. It was further discussed that this changing role, would of necesOCTOBER 2014

sity also call for changes to the role of the pharmacy technician. The Speaker of the House of Delegates was charged with creating a Policy Statement that would address those changes to the role of the pharmacy technician that would allow the pharmacist time to perform those functions that are now a part of the practice of pharmacy. The changes recommended in this Resolution would necessitate a legislative change to FS 465 to allow pharmacy technicians to perform these additional tasks, and FS 465 should also be changed legislatively to hold pharmacy technicians accountable for these new tasks. To that end, this Resolution is presented to the House of Delegates for their consideration. 2014-10 Policy Statement Regarding the New Role of Pharmacy Technicians Contact: Gary Koesten, Speaker, House of Delegates Whereas, The practice of pharmacy is an ever evolving profession, and Whereas, As the role of the pharmacist is continuing to expand as regards administering immunizations, performing MTM services, patient counseling, and other practice issues, and Whereas, pharmacy technicians play an integral role in the day to day operation of pharmacies regardless of practice type, and Whereas, the role of the pharmacy technician is ever expanding due to performance and responsibilities of these practice sites in conformity with Florida laws, rules, and regulations, Therefore be it Resolved, that the FPA House of Delegates convened, implement a Policy Statement on this changing role of pharmacy technicians within the practice of pharmacy. Said policy statement should include the following provisions: In facilities with more than one (1) pharmacy technician, at least one (1) pharmacy technician should be certified by the PTCB or similar certifying organization. In facilities with only one (1) pharmacy technician, that technician should be certified by the PTCB or similar cer14

FLORIDA PHARMACY TODAY

tifying organization. Therefore be it Further Resolved, Subject to the provisions of Chapter 465, these certified pharmacy technicians should be allowed to receive new prescriptions over the phone and be held accountable for their actions. Subject to the provisions of Chapter 465, these certified pharmacy technicians should be allowed to receive changes to existing prescriptions over the phone and be held accountable for their actions. Subject to the provisions of Chapter 465, these certified pharmacy technicians should be allowed to transfer prescriptions from or to another pharmacy and be held accountable for their actions. Subject to the provisions of Chapter 465, these certified technicians should be allowed to check the product of another Certified pharmacy technician and be held accountable for their actions. Certified pharmacy technicians should be allowed to perform any task asked of by the PDM so long as the health and welfare of the public is not jeopardized. Problem: While the role of the pharmacist in health care is expanding within defined parameters,, the role of the pharmacy technician is also expanding without any clear, defined, statement relating to this expansion of their role. Intent: To ensure pharmacists can maximize the practice of pharmacy through the expanded role of pharmacy technicians, ensuring that at all times, the health and welfare of the public is protected. MOTION TO REFER TO PROFESSIONAL AFFAIRS COUNCIL MOTION TO REFER PASSES RESOLUTIONS SUBMITTED UNDER NEW BUSINESS 2014-11 Lobby the FL legislative bodies for pharmacist involvement in the regulations involved in the “dispensing” of Medical Marijuana Contact: Steven Nemeroff, PharmD, CPh, drsteve24@hotmail.com Whereas, HB/SB 1030 “Compassion-

ate Medical Cannabis Act of 2014” aka “Charlotte’s Web Bill” was signed into law June 16, 2014 Whereas, Amendment #2 is on the November ballot for Florida voters to decide on a more comprehensive medical marijuana legislation Whereas, the Office of Compassionate Use has been formed in the State of Florida and has already conducted its first public rulemaking workshop, Whereas, the State of Connecticut has developed a model of medical marijuana distribution that puts forth regulations mandating pharmacist owned “dispensing facilities”, Whereas, Connecticut and Oregon have reclassified marijuana to a schedule II controlled substance, thus allowing pharmacists the legal rights to handle and dispense this medication. Therefore be it Resolved, that FPA take an active stance in lobbying for pharmacist involvement in shaping medical marijuana laws. Problem: Medical marijuana IS coming to Florida. The initial bill includes regulations regarding cultivation, extraction, and testing for contaminants, but is vague in regards to distribution and dispensing. The law is intended for critically ill patients including children and elderly patients that have multiple co-morbidities. If pharmacists do not step up, these dispensaries will be run by people who are not health care professionals and do not understand the complexities of medication and disease state management. Intent: To advocate for regulations that involve pharmacist oversight in the dispensing of medical marijuana. To advocate for a legislative model that mirrors Connecticut and allows for pharmacist owned and operated “dispensing facilities” that are not traditional pharmacies but follow a similar set of rules. To advocate for reclassification of marijuana to a schedule II controlled substance. MOTION TO SUSPEND THE RULES OF THE HOUSE TO CONSIDER THIS ITEM OF NEW BUSINESS RULES SUSPENDED ON A STANDING VOTE COUNT MOTION TO AMEND

AMENDMENT PASSES RESOLUTION PASSES AS AMENDED 2014 – 12 RESOLUTION HHCS Health Group of Companies and The Independent Pharmacy Network Advocate the Florida Pharmacy Association Oppose the “Florida Right to Medical Marijuana Initiative, Amendment 2 (2014)” Contact: N. Lois Adams, B. Pharm., MBA, CRPh, VP Florida Independent Pharmacy Network 407-898-4427/ email: nloisadams@hhcs.com Problem: This proposed, initiated amendment to the Constitution of the State of Florida has been rushed in haste to the state of Florida voters. Florida Governor Rick Scott just signed into law SB 1030, the “Compassionate Medical Cannabis Act of 2014,” on June 16, 2014. This was a significantly narrower medical marijuana law to be administered in a more regulated, controlled manner. Since this law doesn’t go into effect until Jan. 1, 2015, many voters are unaware of the recent law and mistakenly think the ballot Amendment 2 they’re voting on is for the limited use of “medical” marijuana, the law that has already been passed. When, in fact, they’re actually voting on a MUCH broader proposed marijuana amendment. Intent: The intent of this resolution is to create strong opposition to the November 4, 2014 Florida Constitutional Ballot Amendment 2 Initiative and for the Florida Pharmacy Association to join the HHCS Health Group of Companies, the Independent Pharmacy Network, other Florida medical associations and law enforcement in informing the voters of their united, cooperative, strong opposition to this ballot by exposing the fact Florida just passed a medical marijuana law and that this amendment is masquerading as “medical” marijuana, when it is actually for dispensing all forms of marijuana for a broad range of undefined “medical uses.” Secondly, the medical community and law enforcement would like to

join together in exposing the negative and potentially very serious social repercussions and long-term medical effects of marijuana usage and the dangers of passing such a broad, lenient amendment that goes far beyond dispensing cannabis for “medical use;” in actuality, the legalization of all forms of marijuana, not just medical-grade, low -THC cannabis. Whereas, marijuana is on the list of federally controlled substances as a Schedule I narcotic, we oppose this amendment. It is a highly volatile, psychoactive (mind-altering) drug. Marijuana is in the same category assigned to heroin, PCP and LSD. Schedule 1 drugs are defined as a category of drugs not considered legitimate for medical use. The myths that marijuana is not dangerous or harmful are untrue. Legalizing it sends a highly inaccurate message to our youth. Education is the key to realigning the perceptions and social myths of this drug with the actual scientific evidence. And Whereas, Florida Governor Rick Scott just signed into law SB 1030 on June 16, 2014 for the controlled delivery of medical-grade marijuana (specifically, a “non-euphoric,” low-THC strain, 0.8 percent or less of THC, called “Charlotte’s Web”) under very specific guidelines, this amendment is a rush to legalize the drug for a wide range of conditions with very little restrictions. This amendment initiative is an attempt to mislead voters into thinking they’re voting for a “medical” marijuana amendment, when in fact, Senate Bill 1030 already fully covers that issue. The ballot reads, “Allows the medical use of marijuana for individuals with debilitating diseases,…” Basically, this could include any condition from back pain to trouble sleeping as determined by a licensed Florida physician. This language is far too lenient and vague with no restrictions on the locations these doctors will operate, nor the backgrounds or training of patients’ “caregivers,” nor age restrictions on smoking marijuana, nor multiple other necessary restrictions. Therefore, it is an attempt to legalize marijuana in broad strokes across Flor-

ida under the false guise of “medical” marijuana. This amendment would legalize ALL cannabis (not just the low THC “medical” marijuana that doesn’t create a “high”) for medical use. “Charlotte’s Web,” the true “medical marijuana” bill is for only a low-THC oral cannabis oil versus the amendment which includes all forms of cannabis (including smoking), with no restrictions on the level of THC (a level of higher than 0.8 percent causes psychoactive effects and slight hallucinogenic effects distorting reality and altering mood, memory, concentration & coordination). Voters must be educated on the difference between this amendment and the “Charlotte’s Web” bill which has already been passed. “Charlotte’s Web” was a significantly narrower, medical grade, one strain, low-THC marijuana bill. The “Charlotte’s Web” bill specifies that no other satisfactory alternative treatment option existed, access to the drug is provided through a cannabis oil (not smoking), and included misdemeanor charges for patients fraudulently misrepresenting their condition and for physicians who order the drug for patients not suffering from narrowly specified conditions (including cancer, epilepsy symptoms of seizures or severe and persistent muscle spasms and Lou Gehrig’s disease). Whereas, most of the Florida Legislature’s Republican leadership opposed the constitutional ballot initiative, as well as the Florida Sheriff’s Association and the Florida Medical Association. If this amendment is passed, it is essentially the legalization of marijuana in the state of Florida, along with its misuse and abuse. The amendment is far too broad in scope on every level. Note: Attorney General Pam Bondi (R) filed a challenge to the Florida Supreme Court. She argued, “The proposal hides the fact that the Amendment would make Florida one of the most lenient medical-marijuana states, allowing for limitless ‘other conditions’ specified by any physician. With no ‘condition’ off limits, physicians could authorize marijuana for anything, any time, to anyone, of any age. But rathOCTOBER 2014

er than tell voters of this extraordinary scope, the summary uses language to prey on voters’ understandable sympathies for Florida’s most vulnerable patients—those suffering ‘debilitating diseases.’” Whereas, there is a critical need for greater testing/studies of this drug prior to any such broad dispensing of this Schedule 1 narcotic. Patient health and public safety must be considered. The effects of the drug include impairment of working memory, short-term memory, concentration, cognitive capacities, a reduction of psychomotor coordination, seizures in some individuals, fatigue and a lack of motivation. Studies have shown that even casual marijuana usage can produce changes in parts of the brain associated with emotions and motivation with more significant effects to users under age 20 (harming actual brain development). Marijuana usage can also cause longlasting changes in the hippocampus, a brain area critical for learning and memory. In addition, it can be harmful

to the brain and create memory and attention problems. Studies have also linked it to contributing to mental health problems and experimenting with other drugs, plus hindering the memory of students preparing for exams (thereby impacting learning and success). It can also compromise the brain organ during its vulnerable developmental period and lead to altered cognitive and social development. Plus, some studies show regular marijuana use in early teens lowers IQ into adulthood. In addition, legalizing marijuana would make it cheaper and within the budget of more children, thus increasing its consumption among our precious youth. Not to mention the accidental ingestion by small children of “pot brownies” and other edibles resulting in increased trips to the emergency room. In the haste to put this amendment on the ballot, they have failed to consider that the public must first be fully educated on the existing research that has

been conducted on the negative health effects of marijuana, along with the impact of marijuana on driving crashes. Otherwise, passage of such a broad bill will purposefully expose children, teen and adults to the potentially lifechanging, mind-altering, life-long consequences of this drug. Whereas, after smoking marijuana, it is both illegal and very unsafe to drive a car, we encourage your opposition to this amendment. Smoking marijuana then driving negatively impacts a driver’s attentiveness, perception of time and speed and ability to draw on information obtained from past experience. There’s no warning label on cannabis. Florida would show increased traffic accidents and fatalities associated with driving under the influence of marijuana. Vehicle accidents are already the leading cause of death of teens aged 16-19. Add a lack of driving experience to the use of marijuana and other substances and the results can be tragic. Also, a certain percentage of all us-

Representing Health Care Professionals

• DOH Investigations • Licensure Discipline • Medicare/Medicaid Defense George F. Indest III, J.D., M.P.A., LL.M.

• Administrative Hearings • Contracts and Contract Litigation

1101 Douglas Avenue Altamonte Springs, Florida 32714 Telephone: (407) 331-6620 www.TheHealthLawFirm.com 16

FLORIDA PHARMACY TODAY

ers do become addicted and that number almost doubles for those who start smoking marijuana in their youth. Plus, with all we’ve learned from cigarette smoking through cancer-related studies, the fact is that smoking is bad for the health. Whereas, the positive attributes of “medical” marijuana, including relief of symptoms of nausea, anxiety, inflammation and convulsions can be treated with other FDA-regulated medications such as Marinol (pain) and Cesamet (cancer). Current medications adhere to both strict quality controls and specific dosing guidelines for the various disease treatments. This amendment dangerously includes no such quality controls on these untested strains of marijuana, nor dosing information for marijuana. Regarding dosing, there is also a temptation to “self-medicate” with marijuana. This amendment allows marijuana to be dispensed not by a pharmacist, but by unspecified “centers.” The result could be seedy pot shops, like “pill mills” located next to schools, churches and in family-oriented, community plazas. The damage to family-friendly communities and local businesses that work hard to maintain a positive image, could be extensive and irreversible. Furthermore, the fiscal impact of this amendment is still undetermined. One aspect to be determined is that of the potential reduction in currently prescribed, approved, regulated medications for pain, atypical psychosis, nausea, muscle spasms, potentially inhibiting growth of certain cancer cells, etc. Studies will have to be conducted to determine the extent of the reduction in traditional pharmaceuticals used to treat the same conditions treated by the untested, unapproved, potentially harmful marijuana. Whereas, there are countless other considerations of such a broad legalization of this drug that have not yet been addressed, including, but not limited to: public locations where this drug will be allowed to be smoked, exposure to second-hand carcinogenic smoke, the impact of long-term prenatal exposure to fetuses, physical locations of the recommending physicians’ offices (near

schools, churches, etc.), stringent controls on the growers regarding growing and sorting the strains according to various THC levels and quality control issues. There are also complications involved with the fact that there are thousands of different strains of this untested drug, all with varying levels of THC. Also, by having both alcohol and marijuana legalized, the rate of a higher drug abuse rate in Florida would be greater. Adding another drug to the mix is not a good idea. Therefore be it Resolved, that Florida Pharmacy Association join with the HHCS Health Group of Companies and The Independent Pharmacy Network in strong opposition to the “Florida Right to Medical Marijuana Initiative, Amendment 2” on the Nov. 4, 2014 State of Florida ballot and work to educate the voters on the serious consequences to the health and public safety of all Florida’s citizens in passing such a broad, unregulated amendment. And, to make voters aware that “medical” marijuana was already signed into law in Florida to go into effect Jan. 1, 2015 and that this amendment is falsely posing as a “medical” marijuana amendment when it will actually serve to make Florida the most lenient marijuana state in the entire United States. MOTION TO SUSPEND THE RULES OF THE HOUSE TO CONSIDER THIS ITEM OF NEW BUSINESS RULES SUSPENDED ON A STANDING VOTE COUNT RESOLUTION PASSES RESOLUTIONS 2014-4 FAILED TO PASS. RESOLUTIONS 2014-2 AND 2014-5 WERE AMENDED AND PASSED AS AMENDED.

Board of Directors met on August 24 to review each resolution and approve them as defined by the FPA’s governance structure. After deliberation on each resolution the Board of Directors voted to approve the House of Delegates resolutions except for Resolution 2014-12. The Speaker of the House of Delegates is the representative of the House of Delegates on the FPA Board of Directors and as such I will ask the Board of Directors to revisit Resolution 2014-12 for further discussion at the November 2, 2014 FPA Board of Directors meeting. All Resolutions that passed and have been approved by the FPA Board of Directors will be assigned to the appropriate Councils by President Suzanne Kelly for their deliberations on the implementation of these resolutions. It is my pleasure to serve as the Speaker of the House of Delegates of the Florida Pharmacy Association. If you have any questions or concerns regarding the above resolutions or any resolution you may be considering for the June, 2015 House of Delegates meeting please contact me at: bobparrado1@ hotmail.com Thank you for all that you do every day to advocate for the profession of pharmacy. Bob Parrado, BPharm., R.Ph. Speaker of the Florida Pharmacy Association House of Delegates

Resolution 2014-10 “Policy Statement Regarding the New Role of Pharmacy Technicians” was referred by the House of Delegates to the Professional Affairs Council. The Speaker of the House will work with the Professional Affairs Council to evaluate and prepare the policy statement. The Florida Pharmacy Association OCTOBER 2014

C A L L

F O R

APhA Foundation and NASPA Bowl of Hygeia Awarded to a pharmacist for outstanding community service above and beyond professional duties. The use of the following selection criteria is required: ■■ The recipient must be a Florida licensed pharmacist and a member of FPA. ■■           ■■ T recipient has not previously received the award. ■■               two  on its award committee or an officer of the association in other than an ex officio capacity. ■■   has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession. James H. Beal Award Awarded to the "Pharmacist of the Year." The criteria established for this award is that the recipient be a Florida registered pharmacist and a member of FPA, who has rendered outstanding service to pharmacy within the past five years. Criteria: ■■   must be a Florida registered pharmacist and a member of the FPA. ■■   has rendered outstanding service to pharmacy within the past five years. Technician of the Year Award Awarded annually to a Florida pharmacy technician who is recognized for his/her outstanding performance and achievement during his/her career. Criteria: ■■ Candidate must be a member of the Florida Pharmacy Association for at least two years. ■■ Candidate must have demonstrated contributions and dedication to the advancement of pharmacy technician practice.

FLORIDA PHARMACY TODAY

N O M I N A T I O N S ■■ Candidate must have demonstrated

contributions to the Florida Pharmacy Association and/or other pharmacy organizations. ■■ Candidate must have demonstrated commitment to community service. ■■ Candidate is not a past recipient of this award. R.Q. Richards Award This award is based on outstanding achievement in the field of pharmaceutical public relations in Florida. Criteria: ■■  recipient must be a Florida registered pharmacist and a member of the FPA. ■■   has displayed outstanding achievement in the field of pharmaceutical public relations in Florida. Frank Toback/AZO Consultant Pharmacist Award Criteria: ■■ Candidate must be an FPA member, registered with the Florida Board of Pharmacy as a consultant pharmacist in good standing. ■■ Candidate should be selected based on their outstanding achievements in the field of consultant pharmacy. DCPA Sidney Simkowitz Pharmacy Involvement Award Presented annually to a Florida pharmacist who has been active at the local and state pharmacy association level in advancement of the profession of pharmacy in Florida. Criteria: ■■ A minimum of five years of active involvement in and contributions to the local association and FPA. ■■ Candidate must have held office at local level pharmacy association. ■■ Member in good standing for a period of at least five years in the FPA and must have served as a member or chairman of a committee of the association. ■■ Candidate must have been actively involved in a project that has or could potentially be of benefit to members of the profession.

F P A

Pharmacists Mutual Companies Distinguished Young Pharmacist Award Awarded to a young pharmacist for their involvement and dedication to the practice of pharmacy. Criteria: ■■ Licensed to practice for nine years or less. ■■ Licensed to practice in the state in which selected. ■■ Participation in national pharmacy association, professional programs, and/or community service. IPA Roman Maximo Corrons Inspiration & Motivation Award Interamerican Pharmacists Association created this award to honor the memory of Roman M. Corrons who inspired and motivated countless pharmacists to participate actively and aspire to take on leadership roles in their profession. Roman was always there with guidance and support that motivated pharmacists and encouraged visionary leadership, approachable active membership and succession planning. This award recognizes the motivators among us who inspire others to continue to advance the profession. Criteria: ■■ The recipient must be a Florida Licensed Pharmacist and a member of the FPA. ■■ Candidate should motivate others to excel within the profession by encouraging them to be leaders. ■■ Candidate is not necessarily an association officer, but guides, supports and/or inspires others. A brief description on the candidate’s motivational/inspirational skills must accompany the nomination. The Jean Lamberti Mentorship Award The Jean Lamberti Mentorship Award was established in 1998 to honor those pharmacists who have taken time to share their knowledge and experience with pharmacist candidates. The award is named in honor of long time FPA member Jean Lamberti for her effort in working with pharmacy students.

A W A R D S

2 0 1 4 - 2 0 1 5

Criteria: ■■ The recipient must be an FPA member. ■■ The recipient must serve as a role model for the profession of pharmacy. Upsher Smith Excellence in Innovation Award Awarded to honor practicing pharmacists who have demonstrated innovation in pharmacy practice that has resulted in improved patient care. Criteria: ■■ The recipient has demonstrated innovative pharmacy practice resulting in improved patient care. ■■ The recipient should be a practicing pharmacist within the geographic area represented by the presenting Association.

Qualified Nominee: A pharmacist practicing within the geographic area represented by the presenting Association. Cardinal Generation Rx Award The Cardinal Health Generation Rx Champions Award recognizes a pharmacist who has demonstrated excellence in community-based prescription drug abuse prevention. The award is intended to recognize outstanding efforts within the pharmacy community to raise awareness of this serious public health problem. It is also intended to encourage educational prevention efforts aimed at patients, youth and other members of the community. The nominee must be a pharmacist who is a member of the state association. Self-nominations are allowed. Applica-

tions will be evaluated based upon the following criteria: ■■ Commitment to community-based educational prevention efforts aimed at prescription drug abuse ■■ Involvement of other community groups in the planning and implementation of prevention programs ■■ Innovation and creativity in the creation and implementation of prevention activities ■■ Scope/magnitude of prescription drug abuse efforts ■■ Demonstrated impact of prescription drug abuse prevention efforts

DEADLINE FOR NOMINATIONS: FEBRUARY 28, 2015 FPA AWARDS NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NOMINATED BY:

Name:

Address:

Date Submitted: Signature:

FOR THE FOLLOWING AWARD: (Nomination Deadline February 28, 2015)  APhA Foundation and NASPA Bowl of Hygeia  James H. Beal Award

Please describe briefly below the nominee's accomplishments, indicating why you feel he or she should receive this award. (Attach additional sheets if necessary.)

 R.Q. Richards Award  Frank Toback/AZO Consultant Pharmacist Award  DCPA Sydney Simkowitz Award  Pharmacists Mutual Co. Distinguished Young Pharmacist Award  IPA Roman Maximo Corrons Inspiration & Motivation Award  The Jean Lamberti Mentorship Award  Upsher Smith Excellence in Innovation Award  Cardinal Generation Rx Award

MAIL NOMINATONS TO: Annual Awards, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS FEBRUARY 28, 2015

OCTOBER 2014

CALL FOR RESOLUTIONS TO THE 2015 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in May 2015 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is April 24, 2015! PLEASE NOTE THIS DEADLINE. The following information will be needed when submitting resolutions: 1. Name of organization: The name of the organization submitting the resolutions(s); 2. Name and telephone number of individuals: A contact in the event clarification or further information is needed; 3. Problem: A statement of the problem addressed by the resolution; 4. Intent: A statement of what passage of the resolution will accomplish; 5. Resolution Format: Please type and use double spacing. TITLE OF RESOLUTION NAME OF ORGANIZATION WHEREAS , AND

WHEREAS :

THEREFORE BE IT RESOLVED (THAT THE FPA OR SUBDIVISION OF FPA)

CONTACT NAME AND PHONE #: PROBLEM: INTENT:

Return this form to: Membership Coordinator, Florida Pharmacy Association, 610 North Adams Street, Tallahassee, Florida 32301 or fax (850) 561-6758

FLORIDA PHARMACY TODAY

Pharmacy Time Capsule 2014 ■■ ■■

■■

1989

1964

Twenty-five years ago

Fifty years ago

There were 74 accredited colleges of pharmacy in the United States (including Puerto Rico). 1989 graduates figures included: 5721 BS; 836 PharmD (1st professional degree); and 222 PharmD (2nd degree). The conservative Heritage Foundation published “Assuring Affordable Health Care for All Americans,” which called for a mandate to purchase health insurance. Losec (omeprazole) was first marketed in the U.S. by Astra. In 1990, FDA required a name change to Prilosec to avoid confusion with Lasix.

■■ ■■ ■■ ■■

1964 graduates figures included: 2029 BS and 166 PharmD (1st professional degree) Keflin (cephalothin sodium, Lilly) was the first cephalosporin to be marketed in the U.S. The average cost of a prescription was $3.41 Luther L. Terry, M.D., Surgeon General of the U.S. Public Health Service, released the first report of the Surgeon General’s Advisory Committee on Smoking and Health linking cigarette smoking to lung cancer and other lung problems.

1939

1914

Seventy-five years ago

One hundred years ago

The first Blue Shield plan was begun as an insurance to cover physicians’ fees.

■■

Cocaine, used in many patent medicines and tonics, was widely available in pharmacies and other retail establishments until banned in 1914.

By: Dennis B. Worthen Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America’s history.  Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org.

OCTOBER 2014

BUYER’S GUIDE florida PHARMACY TODAY

ADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

PHARMACY RESOURCES Abbott Diabetes Care Hernan Castellon (305) 220-0414 PPSC Retail Pharmacy Purchasing Program (888) 778-9909

LEGAL ASSISTANCE Kahan ◆ Heimberg, PLC Brian A. Kahan, R.Ph., Attorney at Law 561-392-9000 Fried Law Office, P.A. Dennis A. Fried, M.D., J.D. (407) 476-1427 The Health Law Firm George F. Indest III, J.D., M.P.A., LL.M. (407) 331-6620

PHARMACEUTICAL WHOLESALER

PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Bob Miller, BPharm, CPH (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPH President (855) 374-1029

TEMPORARY PHARMACISTS – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPH President (855) 374-1029 Rx Relief (800) RXRELIEF

McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953

Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.

FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 412-4166 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm DRUG INFORMATION CENTER Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org NATIONAL COMMUNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org RECOVERING PHARMACISTS NETWORK OF FLORIDA (407) 257-6606 “Pharmacists Helping Pharmacists”