2018-06 Georgia Pharmacy by Georgia Pharmacy Association

2018 GEORGIA PHARMACY CONVENTION • JUNE 21-24 • NASHVILLE

June/July 2018

THE OPIOID CRISIS:

PLAYING YOUR PART

THE CRITICAL ROLE FOR PHARMACISTS

contents 12 PLAYING YOUR PART As the fight against opioid abuse intensifies, pharmacists are in a unique position to do something about it. Here’s what ... and how.

8 shout outs

20 PharmPAC

The latest entries into GPhA’s 100% Club and President’s Circle

Investors in the future of pharmacy in Georgia

17 feature story 4

2 prescript

Putting a stop to it The steps pharmacists can and do take to counter drugseeking behavior

22 postscript Knowing the numbers GPhA President Liza Chapman says good-bye in her last column as GPhA president

We’re not in Kansas any more CEO Bob Coleman looks back on his first year at GPhA’s helm.

23 contact us Who does what at GPhA — and how to reach us

3 quick hits

24 the back page

What’s happening in the Georgia pharmacy world Surprising OTC painkiller news, the flu season (finally) wraps up, and much more

The lighter side of pharmacy and healthcare news

SUBSCRIPTIONS

Georgia Pharmacy magazine is the official publication of the Georgia Pharmacy Association. Unless otherwise noted, the entire contents of this publication is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International license. Direct any questions to the editor at akantor@gpha.org.

June/July 2018

Chief Executive Officer Bob Coleman President and Chair of the Board Liza Chapman President-Elect Tim Short Immediate Past President Lance Boles

Editor Andrew Kantor Director of Communication akantor@gpha.org Art Director Carole Erger-Fass ADVERTISING All advertising inquiries should be directed to Dianne Jones at djones@gpha.org or (404) 419-8129. Media kit and rates available upon request.

Georgia Pharmacy is distributed as a regular membership service, paid for with membership dues. Single issues are $10 per issue domestic and $20 international. Practicing Georgia pharmacists who are not members of GPhA are not eligible for subscriptions.

POSTAL

Georgia Pharmacy (ISSN 1075-6965) is published bi-monthly by GPhA, 6065 Barfield Road NE, Suite 100 Sandy Springs, GA, 30328. Periodicals postage paid at Atlanta, GA and at additional mailing offices. POSTMASTER: Send address changes to Georgia Pharmacy magazine, 6065 Barfield Road NE, Suite 100, Sandy Springs, GA 30328.

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PRESCRIPT From the CEO

We’re not in Kansas anymore It’s official. I’ve completed my first year as CEO of GPhA. And what a wild and fulfilling ride it’s been so far. Early on, members asked me if joining GPhA felt like trying to drink from a fire hose. To be honest, it didn’t. It felt more BOB COLEMAN like trying to drink from one of those tankers they use to put out forest fires! Time changes all things, so it’s beginning to feel more like drinking from a garden hose now — albeit a very forceful garden hose! I’ve traveled the state and, for that matter, the country, talking to GPhA members, pharmacists, wholesalers, staff at the national associations, elected representatives, and my fellow CEOs at the various state pharmacy associations. The common thread through all the people in pharmacy I’ve met is the desire for the best outcomes for the patients they ultimately serve. And part of those outcomes involve the pharmacist’s role in becoming a greater part of the solution to the current opioid epidemic. In this issue we explore some of the ways in doing so, from working closer with physicians to having naloxone in stock and understanding that dispensing it does not require a prescription in Georgia. I recently attended a half-day meeting conducted by Congresswoman Karen Handel on solutions and it was clear to me there are no simple solutions that any single group can apply. Public health agencies, doctors, pharmacists, courts, and law enforcement all hold partial keys to the solution and working together is the only way things will improve. Speaking of Kansas, GPhA President-Elect Tim Short and I recently attended NCPA’s annual leadership conference, held this year in Kansas City. It was a great opportunity for presidents elect and CEOs of state associations to get together, hear from distinguished speakers and panels, discuss a myriad of topics related to the industry’s future, and sharpen our leadership skills. 2

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IT’S BEGINNING TO FEEL MORE LIKE DRINKING FROM A GARDEN HOSE NOW — ALBEIT A VERY FORCEFUL GARDEN HOSE. While all the presentations were interesting, one in particular caught my attention: a briefing on a forthcoming campaign to promote pharmacy to the general public. In my opinion, getting our message to the public presents an incredible opportunity for pharmacy and pharmacists nationwide. I’ll be sharing more information about this initiative as it develops. The title of my column in the winter issue of Georgia Pharmacy magazine was “On the road again…”. It doesn’t seem that long ago, but since then we’ve been back on the road — again — for the AIP summer meeting in Macon, then legislative briefings in Tifton, Acworth, Augusta, Dublin, Statesboro, Atlanta, Athens, Waycross, Peachtree City, and Macon. (My special thanks to Jonathan Sinyard, Chris Thurmond, and Liza Chapman for conducting some of these events, and GPhA board members for attending. And thank you to all GPhA members, guests, and sponsors for attending.) GPhA members and staff have also represented your interests in Washington, D.C. during the annual fly-in coordinated by NCPA. I’m looking forward to seeing you in Nashville later this month. It’s going to be a great convention. We know you’re going to have a great time, but please don’t hesitate to let us know anything we can do to make your convention even better. In the next issue, we’ll take a look at the results of our annual member survey and membership growth so far this year. Until then, see you in Nashville! Georgia Pharmacy A S S O C I AT I O N

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OPEN

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Bob Coleman is chief executive officer of the Georgia Pharmacy Association. June/July 2018

QUICK HITS ANTIBIOTICS CAN MAKE VACCINES LESS EFFECTIVE Exposing babies to antibiotics in their first year might reduce the effectiveness of vaccines by affecting their gut microbiomes. So finds a study out of Australia — but it also found the effect is reversible by restoring those gut microbes.

WALMART TO RESTRICT OPIOIDS The company said it will it would restrict initial acute opioid prescriptions to no more than a seven-day supply starting within the next 60 days. And in 2020 it will begin requiring all prescriptions for controls to be in electronic form to cut down on potential fraud.

read more @ gphabuzz.com June/July 2018

If it was a skeeter, it would’ve bit me Warmer weather makes bugs happier — especially the ones carrying all those nasty “vector-borne” diseases. And thus the CDC has seen a dramatic jump in diseases transmitted by mosquitoes, ticks, and fleas: They’ve more than tripled since 2004 (when the CDC began tracking in detail) — from 27,000 a year in 2004 to 96,000 in 2016. Bottom line: They are going to be really bad this year. They are spreading diseases — including new ones — faster than before. Your patients/ customers (and you) should get covered. Here’s your 60-second guide: • The best protection you can use is a combination of 1) permethrin on clothing and 2) either picaridin (20% concentration) or DEET (2050% concentration). • Permethrin: Spray on clothing, especially sleeves, collars, and the

bottoms of pants/shorts. Let dry. It will last through several washings. • Picaridin/DEET: Higher concentrations give longer protection, not better protection. At most, expect about four or five hours. (A major study found that DEET over 50% concentration had no benefit.) • Picaridin advantages: It’s non greasy, has no odor, it doesn’t dissolve plastics like sunglasses. Further, there are potential issues with DEET at high concentrations in children. • DEET advantage: It may be better against ticks. • Side note: Oil of lemon eucalyptus (30% concentration) is excellent for repelling mosquitoes, but doesn’t work for ticks. Other “natural” repellents like citronella or lavender just don’t work, or only work for a short time.

Insurance premiums look like they’re going way up next year The first insurance filings for 2019 are emerging, and it looks like, as expected, we’re going to see some hefty premium increases as healthy people are able to leave the market and insurers raise premiums to compensate. The good news is that most people who buy their policies through ACA marketplaces won’t be hit — they’ll receive federal subsidies to cover those increases. The (potential) bad news is that these price hikes may spill over into the employer marketplace as well.

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QUICK HITS OLD MACDONALD HAD THE RIGHT IDEA Want some long-term relief from allergies? Move near a farm. A Dutch study found that what’s been called the “hygiene hypothesis” — early exposure to allergens actually keeps the body from developing allergies — applies to adults, not just children. Regular exposure to trees, grass, dust mites, and animals can reduce allergic reactions over time.

THE FLU IN REVIEW The 2017-18 flu season claimed the lives of at least 145 Georgians (those are just the ones who were able to get medical care) — compared to nine last season. Next year’s flu vaccine probably won’t be much better The upcoming flu shot (i.e., for later this year) will protect against the H3N2 flu, which is the strain expected to hit for the 2018-19 season. Unfortunately, the vaccine is not likely to be as effective as health authorities would like. That’s because the egg-based process used to create it introduces two mutations that limit the vaccine’s effectiveness. But the good news.... Looking over the data, even a weak flu vaccine makes a tremendous difference. That’s because when enough people get the vaccine, even if it only protects some of them, it reduces how well

the flu can spread. According to researchers at the Yale School of Public Health, ‘a vaccine that was only 20 percent effective would avert 21 million infections and almost 130,000 hospitalizations -- and save 61,000 lives -- assuming 40 percent of the population received it.’ Billionaires offering millions for universal flu vaccine The Bill & Melinda Gates Foundation and Google co-founder Larry Page have a proposition: If you want to develop a universal flu vaccine, they’re prepared to help fund it with grants ranging from $250,000 to $2 million over two years to start, and then up to $10 million if human studies are warranted.

FDA could approve first marijuana-derived drug A LITTLE BIG FOR ITS BRITCHES Larry’s Drive-in Pharmacy in tiny Madison, W. Va., has agreed to pay that state $550,000 after it was found the pharmacy had dispensed “nearly 10 million doses of painkillers in 11 years to a county of fewer than 25,000 people.” The pharmacy is no longer in business. 4

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Epidiolex, an anti-seizure medication derived from marijuana leaves, received a “yes” recommendation from FDA staff, followed quickly by a unanimous vote from a separate FDA advisory panel. The recommendation is non-binding, but the FDA usually listens to it. That means, come late June, the agency could approve the first marijuana-derived product for the U.S. market. Epidiolex is essentially a pharmaceutical-grade version of cannabidiol (aka CBD oil), and does not contain THC. June/July 2018

BE (BETTER) PREPARED The fifth annual National Health Security Preparedness Index ranked Georgia below the national average for health emergency preparedness overall, but there are some bright spots. This latest report found we’ve improved significantly since 2013, especially in “Environmental & Occupational Health” — meaning our water and food is protected in case of disaster (e.g., the zombies will have a hard time getting into the warehouses), and we can “protect emergency responders from health hazards while on the job.” Our two big weak spots are “Healthcare Delivery” and “Community Planning & Engagement Coordination.” That means we’re not great at getting healthcare where it needs to be — for example, if there’s a disaster in a rural area, communications issues between various agencies and communities could hamper the response. You can read more at nhspi.org/ states/Georgia.

SOME THINGS WORK REALLY WELL TOGETHER. Mike Tarrant, CFP® proudly announces his recogniion as a GPhA Corporate Sponsor Mike has extensive experience working with pharmacists and pharmacy owners, offering a ‘no generics’ approach to financial planning. Learn more at www.financialplanningrx.com

Integrated Financial Group | 200 Ashford Center North, Suite 400 | Atlanta, GA 30338 Securiies oﬀered through LPL Financial, member FINRA/SIPC. Advisory Services oﬀered through IFG Advisory, LLC, a registered investment advisor. Integrated Financial Group and IFG Advisory, LLC, are separate ennnes from LPL Financial.

DRUG PRICING CHAOS Consumer Reports looked at out-ofpocket drug pricing (i.e., for people without insurance), checking the prices at “more than 150 pharmacies in six metropolitan regions around the U.S. asking for their retail cash prices for a one-month supply of five commonly prescribed drugs.” What did it find? Chaos. No, seriously; the price for that “basket” of five drugs varied from $66 to $1,351. Some independents were inexpensive, others were expensive. Even different locations of a single chain had different prices, depending on what discounts the staff could come up with. Staff members at some pharmacies used store coupons and other vouchers to offer our shoppers much lower prices; others provided modest discounts or none at all. June/July 2018

Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA. AREAS OF PRACTICE Professional Licensing Medicare and Medicaid Fraud and Reimbursement Criminal Defense Administrative Law Healthcare Law Legal Advice for Licensed Professionals

WWW.FRANCULLEN.COM (404) 806-6771 • admin@francullen.com

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GABAPENTIN ABUSE ON THE RISE As opioid prescriptions get cut, physicians are looking at other painkillers, and that’s got people abusing drugs like gabapentin (which debuted more than 20 years ago as a treatment for nerve pain). and the FDA starting to investigate. “We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.

Looks like we’re winning THE NUMBER OF OPIOID PRESCRIPTIONS IS GOING DOWN

250 PRESCRIPTIONS DISPENSED (IN BILLIONS)

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THE OPIOID WAR:

200 150

OPIOID PRESCRIPTIONS FILLED

100 50 0

2000

2005

2010

2015

2017

Source: IQVIA “SMART–Launch Edition,” 12/2017

The fight against opioid abuse is showing some results. A report from market research firm IQVIA found that opioid prescriptions fell by 10.2 percent in 2017 over the year before. Even better, the drop was 16.1 percent for the highest doses. This is the biggest in 25 years. And at the same time medication-assisted therapy for opioid dependence almost doubled.

CARRYING NALOXONE In May, The U.S. Surgeon General took the unusual step of calling for more Americans to carry naloxone. But there’s the issue of cost, especially to cash-strapped municipalities. In fact, the drug’s manufacturer has even raised the price of the drug. So a group of U.S. senators has asked the Department of Health and Human Services to use the power it has under the national emergency declaration to negotiate a lower price: “No police officer, no firefighter, no public health provider, and no person should be unable to save a life because of the high price.”

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June/July 2018

Caffeine: the wonder drug Just say yes There are, out there — possibly even in your own neighborhood — caffeine deniers. These are otherwise normal people who don’t believe caffeine is a wonder drug. They might say something like, “I hear caffeine can cause arrhythmia.” If so, you can now say, “Nope!“ That’s because a new review published in JACC: Clinical Electrophysiology finds that “Regular intake of coffee and tea

does not appear to be associated with the risk of arrhythmia.” Think of it as ‘coffee goggles’ Apparently, drinking coffee can give you a more-favorable opinion of your colleagues, and help you work with them better. Or, as a study out of UC Davis put it, “subjective evaluations of the participation of other group members and oneself are also positively influenced.”

CARTER INTRODUCES 340 TRANSPARENCY BILL U.S. Representative Buddy Carter has introduced a bill to hopefully help drug companies cut the amount of discounts they have to give certain hospitals. His 340B Optimization Act would require 340B hospitals (which receive drug discounts for providing care to a large number

June/July 2018

of low-income patients) to report their outpatient care to the indigent as well as inpatient care. Drug companies — and Carter — have said they believe these hospitals skew their numbers “to make it look like there’s more indigent care than there actually is” in order to receive the discounts.

EPIPEN SHORTAGE HITS U.S. Manufacturing delays are causing a worldwide shortage of EpiPens. It began in Canada and the U.K., but soon spread to the U.S. While Pfizer manufactures the actual pens, it’s Mylan Pharmaceuticals that decides how those EpiPens are allocated to different countries. It had been able to keep the U.S. supply stable; as late as mid-April Mylan said there was no shortage of EpiPens in the States. Unfortunately, that was short-lived: In early May the company said that consumers might have trouble getting them due to manufacturing issues. And soon after that the FDA officially listed the EpiPen as a drug in shortage, where it stands today.

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SHOUT-OUTS

100% Club

A S S O C I AT I O N

Georgia Pharmacy

A S S O C I AT I O N

ENT’S

These are the newest members of GPhA’s 100% Club — Georgia pharmacies where 100 percent of employees are GPhA members. Find out more at GPhA.org/100percent.

CL CIR E

PRESID

A S S O C I AT I O N

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These are the newest members of the GPhA’s President’s Circle — GPhA members who recruit their fellow pharmacists, technicians, academics, and others to become part of the association. Recruit a member and join! GP.Logos.Final.indd 1

3/21/18 1:02 PM

The Apothecary, Doerun Owner: Julie Gay Ball Ground Pharmacy, Ball Ground Owner: Jeff Richardson Forbes Drug Company, Vienne Owners: Frank Morgan and Steve Morgan

Frank Barnett, Nashville

Frank Morgan, Vienne

Barry Bryant, Appling

Steve Morgan, Vienne

Michelle Cruson, Bonaire

William Posey, Tifton

Andrew Holt, Douglas

Kimberly Potter, Griffin

Ira Katz, Atlanta

Ross Rainey, Jefferson

Sumner Kelly, Columbus

Jaclyn Scott, Kathleen

Jonathan Knight, Reynolds

Jack Shepherd, Dublin

Drew Miller, Griffin

Chris Thurmond, Athens

Gina Mirza, Athens

Tommy Whitworth, LaGrange

Knight’s Pharmacy, Reynolds Owner: Jonathan Knight McRae’s Pharmacy, Douglas Owner: Andrew Holt Tifton Drugs, Tifton Owner: William Posey Village Drug Shop, Athens Owner: Chris Thurmond Wynn’s Pharmacy, Griffin Owner: Drew Miller

calendar

Georgia Pharmacy A S S O C I AT I O N

All CPEasy courses are conducted by webinar from the comfort of your home, office, or wherever you have an Internet connection. Visit GPhA.org/cpeasy for more information. Visit GPhA.org/education for all our education offerings. BLACK & WHITE OPEN

2018 GEORGIA PHARMACY CONVENTION June 21 – 24; Nashville Omni Visit GPhAconvention.com for info.

Trends in Prescribing and Coverage for Pain Management (CPEasy) July 29; 7:30 – 9:00 p.m. July 31; 7: – 9:00 p.m.

Naloxone: Working Together to Save a Life (CPEasy) July 11; Noon – 1:30 p.m. July 12; 7:30 – 9:00 p.m.

APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists August 12; 8:00 a.m. – 5:00p.m.; Sandy Springs

The SBIRT Approach: Improving Care for Patients with Substance Abuse Disorders (CPEasy) July 18; Noon – 1:30 p.m. July 19; 7:30 – 9:00 p.m. GPhA’s Practical Skills Refresher Course July 21; 9:00 a.m. – 1:00 p.m. Suwanee

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The Dreaded OSHA Update (CPEasy) August 14; 7:30 – 8:30 p.m. August 23; 7:30 – 8:30 p.m. September 6; 7:30 – 8:30 p.m. 2018 New Law Update (CPEasy) September 13; 7:30 – 9:00 p.m.

Pharmacy Abbreviations and Calculations for Technicians (CPEasy) October 4; 7:30 – 9:00 p.m. Laws and Regulations in Georgia: What Pharmacy Technicians Must Know (CPEasy) October 11; 7:30 – 9:00 p.m. 30 Medications and Classifications Pharmacy Technicians Need to Know (CPEasy) October 18; 7:30 – 9:00 p.m. APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists December 2; 8:00 a.m. – 5:00 p.m.

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AIP MEMBERS GET IT

They get benefits They get help ✔ Help working with Medicare and Medicaid ✔ Help with audit relief ✔ Help with MAC appeals ✔ Help buying and selling a pharmacy

✔ Audit relief (AIP efforts saved members more than $320,000)

They get connections

✔ Services specifically for compounding pharmacies

✔ Connections to other independent pharmacies throughout the state

✔ Free business consultations with pharmacy experts

✔ Partnerships with OTC and nutritional supplement companies

✔ Access to the comprehensive AIP Pharmacy Manual, which offers extensive material about buying, selling, and managing a pharmacy — including information about regulatory issues and agencies

✔ A chance to learn and network at AIP’s fall and spring statewide meetings ✔ Access to telehealth and chronic care management resources through CriticalKey

With AIP, independent never means alone. No other state association in the country has an organization like the Georgia Pharmacy Association’s Academy of Independent Pharmacy. We are proud to represent our members and our profession! For more information, visit GPhA.org or call Verouschka Betancourt-Whigham at (404) 419-8102

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THE OPIOID CRISIS:

Playing Your Part BY PHILLIP RATLIFF

hen taking aim against opioid abuse and misuse, John Bringuel, statewide project director with the Georgia Prescription Drug Abuse Prevention Initiative, knows where to set his sights: We have to score a direct hit, he says, “against ‘the big A,’ which is access.” Boiled down, he explains, access is numbers game. Over-demand and oversupply have saturated the country with opioids. Access is also a matter of flow — the potential of prescription opioids to be misused or diverted from this vast well of opioids we’ve been filling. Pharmacists may have more modest impact on opioid saturation, Bringuel says. Pharmacists should start by having serious conversations with patients about safe storage. After all, we keep them behind the counter to keep people from them. Why wouldn’t patients protect them as well? “I wouldn’t buy a gun and just put it on my 10 Georgia Pharmacy

kitchen counter,” Bringuel says. “Why do that with opioids?” He continues: “Without any apprehension or guilt, if I’m a pharmacist I’m going to have a couple of drug safes for sale in my pharmacy. Suggest that the patient buy an in-home medication safe. For a small investment, you’re providing yourself with the greatest protection.” Pharmacists also need to discuss where opioids go once they’re no longer needed. Fewer than five percent of patients, according to Bringuel, properly dispose of drugs. Pharmacists can point to a number of disposal methods — mail back programs, drop off boxes, chemical solutions — any method of disposal short of flushing down the toilet. And if that’s the only means to keep your child or neighbors child from getting hold of these drugs then by all means don’t rule it out, Bringuel says, only half joking. When it comes to prescription dropboxes, Bringuel has become Georgia’s equivalent of Johnny Appleseed. He’s placed 228 controlled substance dropboxes, in 25 pharmacies and 139 sheriff offices across the state, and momentum for the dropbox program is still building. “The goal is saturation,” June/July 2018

tl;dr* • Pharmacists should start by having serious conversations with patients about safe storage. that keeps pace with opioid saturation. Bringuel points out that, besides availability, there are attitudinal factors pharmacists need to keep in mind. Patients are often reluctant to dispose of opioids for economic reasons. “I paid for them. Why throw them out?” the thinking goes. And perhaps the most lethal assumption is that, because a drug is legal, it must be safe. Bringuel is quick to correct this line of thinking. “The three biggest killers of us are all legal: tobacco, alcohol, and prescription drugs,” he says. “Opioids should be thought of as tools. They’re safe when used properly.” Like chainsaws and routers, opioids are powerful — that’s why they’re effective — and risky. Pharmacists should emphasize to patients the first rule of shop class: “Respect the tools or they’ll cut your hand off,” Bringuel says.

• Fewer than five percent of patients properly dispose of their drugs. • Like chainsaws and routers, opioids are powerful: “Respect the tools or they’ll cut your hand off.” • Patients appreciate being offered naloxone proactively. • “If you’re willing to reach out to other organizations, dispensing naloxone does not have to come with a loss.” • “If we hope to achieve change, it’ll have to happen the workflow — in day-to-day patient care. • Discerning signals of opioid misuse and abuse in patients is fraught with the potential of partiality. • When in doubt, call prescribers. • Mental suffering, not physical pain, is at the heart of prescription opioid addiction. *

A POUND OF CURE If prescription opioids are a potentially dangerous tool, even the most careful patient should be prepared for an accident. That’s the thinking behind naloxone. The logic is straightforward but actual conversations with patients about naloxone are anything but, says pharmacist Amanda Khalil. For her residency at Barney’s Pharmacy in Augusta through The University of Georgia, Khalil identified high-risk opioid patients to receive naloxone — at Barney’s, those were patients undergoing chronic opioid therapy, those using opioids concurrently with a benzodiazepine or antidepressant, or those using an extended-release formulation of an opioid. She approached them as they were waiting for their prescription opioids to be filled. “Since there is still a stigma surrounding opioid abuse, I tried to discuss the topic sensitively, avoiding words such as ‘overdose,’” she says. Khalil described naloxone as a medication used to reverse the effects of pain medication, in case of accidental overdose or diversion: “I often compared [naloxone] to an EpiPen by saying ‘We hope this is something you never need, but if you do, you have it on-hand for emergencies.’” To her surprise, patients responded well to the offer of naloxone. They had heard positive news stories and they shared the fears of children accidentally taking opioids. Some mentioned the loss of a loved one who might have been saved by naloxone. Scientific surveys supported what Khalil was noticing in her one-on-one encounters. Patients June/July 2018

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appreciate being offered naloxone proactively. “We thought we’d get pushback, that people would be offended, Khalil says. “Price was sometimes an issue, but patients were not offended that we were doing this. It’s a fear most pharmacists would have. But it wasn’t like that.”

GETTING PAID Creating such a program can come with benefits. The naloxone program sometimes generates revenue, says Ashley London, Barney’s pharmacy manager. Often that means finding a form of naloxone that you don’t lose money on. Khalil credits GPhA Clinical Services Director Amanda Gaddy with helping her look for ways to overcome the reimbursement barrier. Dispensing naloxone can generate revenue, but it may take a little legwork to determine what formulation of naloxone is covered by the patient’s insurance and doesn’t result in the pharmacy losing money. “If you’re willing to reach out to other organizations, dispensing naloxone does not have to come with a loss. There is money and resources out there to be spent on this,” London says. Taking a page out of Bringuel’s book, Khalil also helped Barney’s develop a dropbox program — one of three in Augusta. The Richmond County Medical Society helped fund the Medsafe box and the liners that go with it, which Barney’s promoted Georgia Pharmacy 11

cover story primarily by word of mouth with help from a local news story. The dropbox program has garnered wide community response. Even people who don’t get their medication at Barney’s are coming in, London says. One woman, concerned for her grandchildren, brought in a 12-gallon trash bag filled with medications amassed over 17 years. That the kind of difference Khalil sees as her job to make. “Pharmacists are at the front line,” she says. “You’re the last person the patient talks to.”

PARTNERS Such is the thinking behind the Georgia Pharmacy Association’s partnership with Alliant Quality. Recognizing that pharmacists are uniquely positioned to help stem opioid-related deaths, Alliant and GPhA teamed up to increase naloxone dispensing in community pharmacies. Program goals are ambitious. There are currently 10 pharmacy teams participating in the project, which hopes to dramatically increase naloxone dispensing to high-risk communities in South Georgia and the Atlanta metro area. “Each year five percent of Medicare opioid users are hospitalized or treated in the ER for an opioid-related event,” says Opioid Safety and Pharmacy Interventions Technical Lead Michael Crooks. “We want naloxone dispensing in our target communities to keep pace. Right now we’re at twotenths of a percent.” Participants complete some work on their own, viewing brief recorded webinars and complete progress-monitoring assignments. But the heart of the program is the monthly meeting during which participants interact to share successes and failures and learn from one another. Echoing the project’s collaborative nature: the emphasis on pharmacies staffed with teams committed to doing something different. “Our approach is quality improvement, which is process driven,” Crooks says. “If we hope to achieve change, it’ll have to happen in the workflow — in day-to-day patient care. That requires a change at the level of the pharmacy as a whole, including technicians and pharmacists, and not just the commitment of one or more passionate individuals.” There’s another level of collaboration between GPhA and Alliant. Crooks notes that GPhA’s cur12 Georgia Pharmacy

PHARMACISTS ARE AT THE FRONT LINE. YOU’RE THE LAST PERSON THE PATIENT TALKS TO rent opioid education programming is aligned with Alliant’s project goals. At the Georgia Pharmacy Convention and in its July opioid safety webinar series, the association is offering sessions on naloxone, SBIRT, prescribing guidelines, and PDMP — “all tools that can help pinpoint high risk patients or populations who might benefit from naloxone,” Crooks says.

DETECTING THE PROBLEM Stemming patient access to opioids is a tricky business — a balance of competing patient interests achieved entirely discursively. Want to know if a pain medication is working? Ask the patient. Want to know if the patient is an addiction risk? Talk to and observe the patient. Guidelines can help remove some guesswork, but they bring their own ambiguities, with the potential to pit prescriber against dispenser, patient against healthcare professional. In the end, guidelines are no substitute for professional judgement. “There are a whole bunch of people with guidelines,” says P. Tennent Slack, clinical co-chair of the Medical Association of Georgia’s Think About It Campaign. Third-party payers are in on the act. Pharmacy chains are in on the act, placing restrictions on how many pills they’ll fill at one time. “There are so many fingers in the pie that it’s gone from a confusing situation to an even more confusing situation,” Slack says. Hard and fast restrictions aren’t always in the best interest of the patient. Pain treatment is highly individualized. Pharmacists and physicians need latitude to make the best medical judgment. Slack believes in a balanced approach, one that both dials back over-prescribing of opioids and acknowledges the therapeutic importance of opioids — “which relieve suffering and help maintain quality of life and function for millions of Americans.” June/July 2018

One grant, three free courses Because they are prescribed and dispensed by people with advanced degrees in white coats and not out of the back of a van, prescription medications are widely viewed as safe to take in ways that weren’t prescribed: safe to hoard, safe to self-medicate with, safe to share with others. “A lot of individuals tend to think that it is okay grab leftover medications from their homes. Even if the medicine was not prescribed to them, they may think that ‘if I have the same symptoms it should be okay for me.’ Taking someone else’s prescription or not using your medication as prescribed is dangerous.’” So says Tiffany Cuthbert of the Georgia Department of Behavioral Health and Developmental Disabilities. Unfortunately, parents are sometimes complicit, she says, sharing medications with children

June/July 2018

with the best intentions … but with consequences they didn’t foresee. Not just unexpected effects — we’re talking about sharing and trading medications with friends. The Georgia DBHDD received a $2 million grant from SAMHSA — the U.S. Substance Abuse Mental Health Services Administration — to educate patients in five high-need Georgia communities on the dangers of medication sharing. Over five years, $20,000 annually of that grant will be coming to GPhA to help pharmacists deliver opioid-abuse interventions. So far GPhA has used it to develop free webinars on a range of topics aligned with program goals, live programming at the Georgia Pharmacy Convention, information on PDMP at fall and spring region meetings, and media.

Here’s the line-up — all three courses are free and provide 1.5 hours of CPE. Visit GPhA.org/education for details. • Naloxone: Working Together to Save a Life July 11, noon; or July 12, 7:30 p.m. • The SBIRT Approach: Improving Care for Patients with Substance Abuse Disorders July 18, noon; or July 19, 7:30 p.m. • Trends in Prescribing and Coverage for Pain Management July 29 or July 31, both at 7:30 p.m.

Georgia Pharmacy 13

cover story But on the pharmacist end, the watchword isn’t latitude; it’s consistency, straight down the line. Discerning signals of opioid misuse and abuse in patients is fraught with the potential of partiality. Pharmacists must apply effective, objective criteria, without allowing disparities based on race, ethnicity, or socioeconomic status to creep into their judgments. The opioid epidemic crosses all those lines. So said participants in a 2012 American Pharmacists Association conference on the subject. Program participants identified several red flags for abuse. Some of these were in the prescription — prescription modifications, inappropriate dosages, evidence of multiple prescribers, a prescription outside the prescriber’s scope of practice. Others red flags take the form of patient demeanor or behavior. This sort of assessment is trickier. But let one illegitimate prescription slip through the cracks, and pharmacists can expect more to follow. The workgroup agreed that there are practical remedies to helping patients who they suspect are abusing or misusing opioids. Take advantage of the PDMP database. Schedule an MTM consultation with the patient — it’s the best way to get a thorough picture of the patient’s medication history. Be ready to recommend agencies that can help those with an opioid addiction. When in doubt, call prescribers. Always be mindful of the need for balance between vigilance against abuse and misuse, and the need to get opioids to patients who need them. For prescribers, balance can mean screening for addiction risk and looking for alternative treatments, Slack says. If opioids are prescribed, use the lowest effective dose and pill count. Assuming there’s not a concern about abuse, it’s essential to get patients involved in their own care when it comes to opioid therapy. Ask them what medication will best allevi-

IF A PRESCRIPTION SEEMS OUTSIDE THE CDC GUIDELINES CALL THE PRESCRIBER ate their pain. Some patients may request acetaminophen or NSAIDs in lieu of opioids, for example. “It’s a matter of common sense that the prescriber should try and reduce the exposure of the patient to opioids,” Slack says. Slack believes that pharmacists have a gatekeeper role to play. Star with the CDC guidelines as a basic barometer. If a prescription seems outside those guidelines, call the prescriber to get a better handle on treatment goals — “a reasonable first step” before refusing to fill a prescription or complaining to the medical board. As the pendulum is swinging toward restrictions, prescribers and dispensers alike should brace themselves for pushback from patients. We are a pill-oriented, “get results now” culture, which means patients typically want pain treated by the quickest means possible. And as the rapidly expanding fifty-plus population feels the pains of aging, there will be increasing calls for effective pain management. “It’s an interesting crossroads,” Slack says. John Bringuel cautions that we not confuse motivations behind proper opioid use with what’s driving abuse and misuse. Mental suffering, not physical pain, is at the heart of prescription opioid addiction, he says. Fueling addiction, he says, is an assumption we all, to some degree, carry around: that pills are the solution to human suffering and confusion. In fact, there are many other solutions to mental suffering: medical, psychological, and/or faith-based solutions that patients are circumventing in favor of the relief opioids seem to offer. As the 2012 APhA task for noted, pharmacists need to be ready to talk to patients about addiction treatment resources. Pharmacists must be tactful, but they also must be direct. When a pharmacist dispenses drugs, they become the patient’s responsibility, Bringuel says. Patients need to hear this. The pharmacist may be the only person telling patients to be careful. Georgia Pharmacy A S S O C I AT I O N

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2018

JUNE 21-24 • OMNI NASHVILLE

The 2018 Georgia Pharmacy Convention is the biggest gathering of Georgia’s pharmacy professionals all year. Hundreds of pharmacists, pharmacy owners, technicians, and students from across Georgia will come to Nashville to grow, play, and connect. Be sure to check out all the courses and events — and the ways to have fun. We’ll see you in the Music City!

Lively general sessions The anchors of the 2018 Georgia Pharmacy Convention are our three general sessions, flanked by hours and hours of CPE. Grow with... n

Motivational speaker and humorist Brad Montgomery

APhA’s Randy McDonough on transforming your pharmacy practice

Mercer College of Pharmacy Dean Brian Crabtree on value-added services

CPE and more CPE Bottom line: You can easily acquire 15 hours of CPE, choosing from the more than 48 hours we're offering. These are topics you want and need — we know because we asked. Build a better pharmacy team. Learn smarter diabetes counseling and med sync. Find out about the newest treatments. Get updated on the latest technology. Hear about new Georgia pharmacy law. And more — lots more. All this, all in one place, all up to date. You won't get that anywhere else. Every course is ACPE accredited for both pharmacists and pharmacy technicians.

Grow. Play. Connect.

GPhAconvention.com

opioids

PUTTING A STOP TO IT COUNTERING DRUG SEEKING BEHAVIOR IN GEORGIA PHARMACIES BY ANNIE HAYOUNG LEE, PAMIZ A. ALIBHAI, AND CANDACE W. BARNETT

Picture these two scenarios: 1. Four patients enter the pharmacy together with multiple prescriptions from the same prescriber for oxycodone 10mg, #150. The patients and prescribers are from out-of-state. 2. A patient enters the pharmacy with a prescription for hydrocodone-APAP 10mg/325mg, #120. The same prescription had been filled a few days ago for this patient. When questioned, the patient states the previously filled medication “fell down the sink.” The above scenarios are probably familiar to Georgia community pharmacists as they confront the nation’s opioid crisis. They fall under the category of “drug-seeking behavior,” and there are some specific strategies to counter it in the pharmacy. Opioid use disorder is a medical condition characterized, according to the DSM-V, by addiction and abuse “that leads to clinically significant impairment or distress.” Drug seeking behavior as one research described it, is “a pattern of actions aimed at obtaining narcotic drugs through prescription diversion strategies.” Some of those actions should raise red flags, such as: • Forging prescriptions • Repeated prescriptions for “cocktail” combinations June/July 2018

• Requests for early refills • Arriving in groups • Paying for large percentages of prescriptions with cash Too many of those prescriptions end up — sooner or later — leading to an overdose. The CDC reports that in 2015 there were more than 33,091 deaths in the United States from drug overdoses involving an illicit or prescribed opioid. Since 2000, there have been more than 300,000 deaths due to opioid overdose in the U.S. Nearly half the opioid related deaths in the U.S. involve prescribed opioids, most commonly methadone, oxycodone, or hydrocodone — see the chart. (While methadone can be used for treating opioid addiction, it is frequently abused as a bridging agent by active addicts. Methadone’s prolonged pharmacokinetic half-life helps to minimize the severity of unpleasant effects of drug withdrawal until active addicts obtain their next high.) Close to one in four Americans receiving longterm opioids for non-cancer pain report that they suffer from opioid addiction according to a 2017 study published by the CDC. The longer the duration of opioid therapy, the greater the likelihood of chronic use, as well as potential for abuse. Georgia Pharmacy 17

opioids OVERDOSES IN GEORGIA, 1999-2016

NUMBER OF DEATHS PER YEAR

600

500

PRESCRIPTION OPIOID OVERDOSE DEATHS

1999-2016 TOTALS PRESCRIPTION OPIOID OVERDOSE DEATHS: 5,654 HEROIN OVERDOSE DEATHS: 536

400

300

HEROIN OVERDOSE DEATHS

200

100

2016

2015

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

Source: Georgia Department of Public Health

PHARMACIST INTERVENTIONS Pharmacists can be particularly effective in identifying and reducing drug seeking behavior by virtue of the frequent contact with patients and their position as the final barrier to access. Pharmacists are also trained to recognize red flags; educate patients about the proper usage, storage, and disposal of medications; and provide counseling on side effects and risks associated with abuse. Pharmacists can reduce diversion by utilizing the state’s prescription drug monitoring program — the statewide electronic database accessible to pharmacists and prescribers that collects designated data on controlled substances dispensed in the state. As of March 2017, 49 out of 50 states utilize a PDMP; only Missouri has not implemented one. PDMP databases provide a listing of a patient’s prescriptions for scheduled medications, the prescriber, and the pharmacy where it was filled. Reviewing the PDMP permits detection of patterns of doctor and pharmacy shopping, overuse, and “cocktail” combination use. This allows the pharmacist to intervene once a problem is detected.

COMMUNITY PHARMACY STRATEGIES CVS Health announced a national opioid management program that started in February through its pharmacy benefit manager, CVS Caremark. The program will limit all opioid prescriptions to a seven-day supply for certain acute prescriptions for patients who are new to opioid therapy. Additionally, this program will limit the daily dosage of opioids dispensed based on their strength, and require use 18 Georgia Pharmacy

GEORGIA RULES AND REGULATIONS FOR CONTROLLED SUBSTANCES With detrimental outcomes related to narcotics and drug-seeking behavior rising dramatically, states’ rules and regulations are evolving to minimize and discourage drug-seeking behavior. The Rules and Regulations of the Georgia Board of Pharmacy (Rule 480-22-02) state that any pharmacist knowingly filling a purported (forged, false) prescription for a controlled substance — as well as the person issuing it — shall be subject to disciplinary action. Additionally, hard copies of any schedule II controlled substance orders must be on security paper with a manual signature of the prescriber (Rule 48022-03), and refills of a prescription for schedule II controlled substances are prohibited (Rule 480-22-05). Furthermore, pharmacists shall input specific prescription, patient, and prescriber information for Schedule II to V controlled substances into the PDMP database every 24 hours (rather than the pre-2017 requirement of every 7 days). Pharmacists are also encouraged (but not required) to consult the PDMP prior to dispensing in order to address duplicative- and over-prescribing of controlled substances. The biggest change to come, effective July 1, 2018, is that prescribers are required to review a patient’s PDMP information prior to prescribing a scheduled II opioid and any benzodiazepine. (Also note that effective July 1, 2017, management of the Georgia PDMP moved from the Georgia Drugs and Narcotics Agency to the Georgia Department of Public Health.)

June/July 2018

of immediate-release formulations before extended-release formulations are dispensed. As a result, it is anticipated that prescribers will also make an effort to adjust their opioid prescribing practices. While filling these prescriptions, CVS pharmacists will be required to counsel patients about the risk of addiction as well as proper and secure medication storage and disposal. WalMart announced a similar strategy in May (to take effect by early July), and also that it will require, by 2020, that all prescriptions for controls be sent electronically to cut down on potential fraud. In more than half its pharmacies across the U.S., the Kroger Company incorporated a forced PDMP review setting within its prescription software, which prompts the pharmacist to consult PDMP data for opioid prescriptions. If the pharmacist attempts to bypass the forced review, the workflow is automatically blocked. Since that change, Kroger pharmacist reviews of the PDMP data have increased more than 500 percent, resulting in a negative growth in controlled substance prescriptions in stores using the system. According to C. Lea Bonner and Joshua D.

Kinsey (instructors of pharmacy law at Mercer University College of Pharmacy and former community pharmacy owners), some independent pharmacies have expanded their best practices at the point of prescription drop-off to include PDMP review by pharmacists for all controlled substances. Furthermore, they predict greater adoption of this strategy after the Georgia Department of Public Health implements training for pharmacy technicians, who can then have their own PDMP login. As the final gateway to patients, pharmacists have a critical role of the fight against opioid abuse — it’s important that we take every step we can. From recognizing drug-seeking behavior to establishing policies to limit opioid use, know and use the tools you have. The fight against the epidemic is winnable, but we each need to be part of it. Georgia Pharmacy A S S O C I AT I O N

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About the authors Annie Hayoung Lee and Pamiz A. Alibhai are recent Doctor of Pharmacy graduates of Mercer University College of Pharmacy, and Candace W. Barnett, Ph.D., is professor and executive associate dean at Mercer University College of Pharmacy.

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Georgia Pharmacy 19

INVESTING IN PHARMPAC IS INVESTING IN YOUR PRACTICE. 2018 PHARMPAC INVESTORS The following pharmacists, pharmacy technicians, students, and others have joined GPhAâ&#x20AC;&#x2122;s PharmPAC for the 2017 calendar year. The contribution levels are based on investment through May 3, 2018.

Diamond Investors ($4,800 or $400/month)

RALPH BALCHIN Fayetteville

CHARLES BARNES Valdosta

MAC McCORD Atlanta

SCOTT MEEKS Douglas

FRED SHARPE Albany

Titanium Investors ($2,400 or $200/month)

DAVID GRAVES Macon

LON LEWIS St. Simons Island

BRANDALL LOVVORN Bremen

DEAN STONE Metter

David Graves, Macon, PharmPAC chairman 20 Georgia Pharmacy

June/July 2018

2018 PHARMPAC INVESTORS Platinum Investors ($1,200 or $100/month)

Gold Investors ($600 or $50/month)

BRUCE BROADRICK THOMAS BRYAN, JR. WILLIAM CAGLE HUGH CHANCY KEITH CHAPMAN WES CHAPMAN DALE COKER BILLY CONLEY BEN CRAVEY BLAKE DANIEL AL DIXON JACK DUNN ROBERT HATTON CASSIE HAYES MARSHA KAPILOFF IRA KATZ

JAMES BARTLING WILLIAM BREWSTER LIZA CHAPMAN BARON CURTIS MARSHALL CURTIS MAHLON DAVIDSON SHARON DEASON BENJAMIN DUPREE KEVIN FLORENCE KERRY GRIFFIN JOHNATHAN HAMRICK MICHAEL ITEOGU STEPHANIE KIRKLAND GEORGE LAUNIUS EUGENE MCDONALD BOBBY MOODY

SHERRI MOODY SUJAL PATEL DARYL REYNOLDS ANDY ROGERS JAMES THOMAS WILLIAM TURNER CHUCK WILSON H.D. WILSON III M KE TARRANT / INTEGRATED FINANCIAL GROUP

Bronze Investors

Member Investors

Phil Barfield Bryce Carter Mathew Crist Larry Harkleroad Phillip James Brenton Lake Micheal Lewis Wallace Partridge Amanda Stankiewicz

Marla Banks Jeffery Felton Bryan Keen Kimberly Kaminski Laird Miller Melissa Olsen Tri Phan Gina Roland George Sanders Austin Tull James White

Silver Investors ($300 or $25/month)

Nelson Anglin Ann Ayers Michael Azzolin Claude Bates James Carpenter Michael Crooks Ed Dozier Gregory Drake Marshall Frost Joe Holt

JEFF LUREY IVEY MCCURDY AMY MILLER DREW MILLER HOUSTON ROGERS JOHN SANDLIN TIM SHORT TERESA SMITH CARL STANLEY DENNIS STRICKLAND CHRIS THURMOND DANNY TOTH ALEX TUCKER TOMMY WHITWORTH

Susan Kane Willie Latch Tracie Lunde Hillary Jack Mbadugha Donald Piela, Jr. Terry Shaw Jonathan Sinyard Renee Smith Richard Smith Marie Tomblin

($150 or $12.50/month)

(up to $150)

HELP US REACH OUR GOAL FOR 2018! Visit GPhA.org/PharmPAC to find out more.

Goal: $130,000

$32,312*

$130,000

*As of May 3, 2018

David Graves, Macon, PharmPAC chairman June/July 2018

Georgia Pharmacy 21

POSTSCRIPT From the President

A Change of Practice This past winter seemed that it would never end. It surely didn’t help with the state of Georgia being covered in snow in early December. The groundhog seeing its shadow began LIZA CHAPMAN to take on a whole new meaning as six more weeks of cold weather dragged on into spring. Spring’s pleasant climate was short lived and quickly changed into summer temperatures. Reflecting upon climate and seasons changing without much notice causes me to wonder about how quickly the profession of pharmacy is evolving as well as how quickly my time as your Georgia Pharmacy Association president has flown by. The past year’s headlines ranged from the opioid epidemic; mergers/acquisitions of insurance companies, PBMs, and retail pharmacies; and escalating drug pricing — just to name a few topics. The headlines changed as rapidly as the weather report. As with changing headlines, the profession of pharmacy and its pharmacists must be adaptable to the fluctuations as we adjust to the change of season. Think of it as a change of practice. How willing are you to accept change? Are you willing to accept a change of practice, so you can remain relevant professionally? As pharmacists, our ultimate goal is to take care of our patients regardless of practice setting, but as margins are becoming thinner, change must occur in order that the doors of our community, health-system, and long-term care pharmacies remain open; patients rely on pharmacists as their most accessible health care provider. What new services are you willing to offer? Immunizations, medication reconciliation and synchronization, and MTM services? Are you having conversations with employer groups about the services you can provide? Pharmacies 22 Georgia Pharmacy

aligning together to form enhanced services networks can make the communication with health benefit decision makers an easier task. Development of such networks is vital to the profession and the offering of services will improve patient care outcomes. In the future, more information will be available about GPhA’s efforts to expand CPESN Georgia. As with any event that is unpredictable, change can be frightening because of the uncertainty. However, we must be willing

WE MUST BE WILLING TO ACCEPT CHANGE AND ALSO SERVE AS “CHANGE AGENTS” TO MAKE THINGS HAPPEN to accept change but also serve as “change agents” to make things happen. As an owner you may be considering adding a service or as an employee pharmacist you may contemplating a career move. Never be afraid to take a chance for change. You may discover it is one of the best decisions you ever made. Pharmacists willing to accept a change of practice are the trend setters and remain relevant within the profession. It has truly been my honor to have served you as the leader this past year of the forward-moving and premier pharmacy association of Georgia. My prayer is that I have advanced the profession in a positive direction and maybe have inspired a few of you to have a change of practice. I know that many of you have encouraged me to make a positive difference that will elevate my practice in the future. Georgia Pharmacy A S S O C I AT I O N

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Liza Chapman is GPhA’s 2017-2018 president and founder/CEO of Patient Centered Pharmacy Services, LLC. June/July 2018

contact OPEN

Keep in touch

REACH US AT 404.231.5074 OR GPhA.ORG

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GPhA LEADERSHIP President & Chair of the Board LIZA CHAPMAN, Dawsonville liza.chapman@kroger.com President-Elect TIM SHORT, Cumming garph9@aol.com Immediate Past President LANCE BOLES, Hartwell lanceboles@hotmail.com Directors ASHISH ADVANI, Atlanta aaadvani@gmail.com WES CHAPMAN, Bishop weschapmanpc@gmail.com SHARON DEASON, Newnan sdeason99@hotmail.com AMY MILLER, Gainesville amylulapharmacy@gmail.com FRED SHARPE, Albany fsharpe@u-save-it.com JONATHAN SINYARD, Cordele sinyardj@gmail.com KEVIN FLORENCE, Athens add.drug@gmail.com CHRIS THURMOND, Athens vildrug@bellsouth.net Chief Executive Officer BOB COLEMAN bcoleman@gpha.org

For membership questions Mary Ritchie Director of Membership Operations (404) 419-8115 mritchie@gpha.org For questions about our magazine, blog, websites, or social media Andrew Kantor Director of Communication akantor@gpha.org For questions about our educational offerings Phillip Ratliff Education Consultant (404) 426-1140 pratliff@gpha.org For questions about any of our insurance products Dianne Jones Vice President of Finance & Administration (404) 419-8129 djones@gpha.org For questions about governmental affairs Bob Coleman, CEO bcoleman@gpha.org For questions about the Board of Directors or GPhA governance policies Merrily Bennett Executive Assistant and Governance Manager (404) 419-8173 mbennett@gpha.org Ruth Ann McGehee Executive Assistant and Governance Manager rmcgehee@gpha.org

For operational or accounting questions: Dianne Jones Vice President of Finance & Administration (404) 419-8129 djones@gpha.org Patricia Aguilar Accounting Coordinator (404) 419-8124 paguilar@gpha.org

For assistance with independent-pharmacy issues Jeff Lurey, R.Ph. VP of Independent Pharmacy (404) 419-8103 jlurey@gpha.org For questions about your AIP membership Verouschka “V” Betancourt-Whigham Manager of AIP Member Services (404) 419-8102 vbwhigham@gpha.org AIP Member Service Representatives Rhonda Bonner (229) 854-2797 rbonner@gpha.org Charles Boone (478) 538-6425 cboone@gpha.org

GPhA’S MEMBER SERVICE PARTNERS InfiniTrak infinitrak.us Track and trace compliance software (844) 464-4641 Pharmacy Quality Commitment pqc.net Quality assurance compliance resources (866) 365-7472 Pharmacy Technician Certification Board ptcb.org (800) 363-8012 SoFi sofi.com/gpha Student-loan refinancing (855) 456-7634

Got a concern about a GPhA program or service? Want to compliment or complain? Drop a note to info@gpha.org.

Melissa Metheny (678) 485-6126 mmetheny@gpha.org Gene Smith (423) 667-7949 gsmith@gpha.org

Georgia Pharmacy A S S O C I AT I O N

June/July 2018

Georgia Pharmacy 23

the back page

BY ANDREW KANTOR

They call this medicine? A Canadian “naturopath,” citing both werewolves and vampires, treated a boy who probably has ADHD with saliva from a rabid dog. And that treatment is approved by the Canadian government. “In mythology the bite of a werewolf can also turn other creatures into werewolves. The mythology around vampires is very similar,” she wrote. “Bottom line: Homeopathy can work wonders for children with behavioural disorders if the remedy can be clearly perceived.”

How much is that Barilla in the window? Earlier this year, reports hit the news saying ‘Guess what? Pasta is good for you!’ It was based on a study out of St. Michael’s Hospital in Toronto that claimed pasta has a low glycemic index, and thus causes smaller increases in blood sugar levels. Turns out those studies were funded by — wait for it — the pasta companies, specifically the Barilla Group. In fact, at least 10 of the studies about pasta published since 2008 were funded directly or indirectly by Barilla.

I heard you already! Sheesh! When it comes to adherence, a survey by Express Scripts finds that a nagging spouse is really not appreciated — and doesn’t help with adherence. According to the findings, nearly one-third of those taking prescription medications for chronic conditions say they are not concerned about forgetting to take their medications. They also don’t want to be nagged by their spouse/partner, rating them as the most annoying source of reminders to take their medicine. What does work: financial rewards and electronic reminders.

24 Georgia Pharmacy

A hangover pill? Yes ... maybe A UCLA professor and his team has developed a pill that allows you — well, mice — to get drunk but have those nasty morning effects negated by enzymes. “I decided to design an antidote that could help people enjoy wine or cocktails or beer without a hangover,” wrote the lead author, “and at the same time create a lifesaving therapy to treat intoxication and overdose victims in the ER.” Preliminary tests on mice showed that “the animals given the drug woke from their alcohol-induced slumber faster than their untreated counterparts,” he reported, “something all college students would appreciate.” Human trials could begin within a year. June/July 2018

Pharmacy

Tomorrow. Imagine That.

phmic.com

All products may not be available in all states and territories.

Georgia Pharmacy A S S O C I AT I O N

6065 Barfield Road NE | Suite 100 Sandy Springs, GA 30328

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2018 GEORGIA PHARMACY CONVENTION

Nashville June 21-24, 2018

It’s the perfect mix of networking, education, and the country’s most vibrant music and entertainment scene. From Music Row and the Grand Ole Opry, to the Country Music Hall of Fame, to the acclaimed Nashville Zoo and historic mansions and plantations, Nashville is an amazing city to visit (at night and in between sessions, of course).

The Georgia Pharmacy Convention is in the Omni Nashville hotel — a hop, skip, or jump from all the city has to offer. Check out GPhAconvention.com for more details!

2018

Join hundreds of pharmacists, technicians, students, and other professionals for three days in glorious Nashville!