PJNE Fall 2018

VOL 15. NO 4 FALL 2018

Fall 2018

PHARMACY JOURNAL OF NEW ENGLAND

PLUS

02 Nalxone 08

Preparing for the Holidays

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09 Flu Se aso n W arm- Up Pharmacists of Yesterday, Image captured from: cdn.aarp.net Today & Tomorrow

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THE OPIOID EPIDEMIC IN NEW ENGLAND

12 INSIDE PAGE 10 Flu Season Warm-Up Flu Warm-Up PAGE 18 2018 NEPC Recap PAGE 28 What is Happening in The News

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Table of Contents Opioid Related Deaths | The Trends................................................................PAGE 4 Pharmacy Facts of New England.....................................................................PAGE 5 Immunization Updates....................................................................................PAGE 6 On The Horizon Opioid Stewardship NSS-2 Bridge Device..............................................................................PAGE 10 Our Role | Naloxone.........................................................................................PAGE 11 New & Exciting Best Practice Advisory for Naloxone....................................................PAGE 12 Syringe Service Programs...............................................................................PAGE 13 Addiction...Can Come in Many Forms ............................................................PAGE 15 2018 NEPC Recap.............................................................................................PAGE 18 Pharmacists of Yesterday, Today & Tomorrow..............................................PAGE 21 Bringing Awareness.........................................................................................PAGE 24 Preparing for The Holidays.............................................................................PAGE 26 Sleep Hygiene..................................................................................................PAGE 27 What is Happening in The News.....................................................................PAGE 28

A special thanks to APPE students Sarah Provencher, Roman Jani, Phoebe Regis, Christopher Merrick and Aydin Destan for the help of this issue's content, framework and design.

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Fighting the Opioid Epidemic in New England Dear Readers, The leaves are changing and dropping all across New England, signaling another transition, both literal and metaphorical. But as we prepare for winter and 2019, we are also reminded of the events, challenges, and opportunities that have gotten us here.

We kicked off the fall season with another successful New England Pharmacists Convention. Held at Foxwoods from September 13-14, the 14th annual regional event attracted a large crowd of engaged pharmacists, pharmacy technicians and students in addition to many dynamic speakers, including Lucinda Maine of AACP, who delivered the keynote address this year.

The event also brought a variety of exhibitors and CE tracks, including one that focused on mental health and addiction.

From presentations on medication-assisted therapy for opioid use disorder to PTSD to treatment resistant depression, this part of the Convention sparked a lot of interest among pharmacists across all practice settings. There is no doubt that pharmacists care about the role they play in fighting mental health and substance use disorders.

In 2017, more than 72,000 Americans died from drug overdoses, including illicit drugs and prescription opioids, as reported by the CDC Wonder. This statistic marks a two-fold increase in drug overdoses in a decade. That’s why the fall issue of PJNE is so important to us. Whether educating patients about the life-saving medication Naloxone or helping patients with smoking cessation, this issue aims to help you advance your role in addiction overall—while keeping you informed about other hot topics that affect the pharmacy profession.

Sincerely,

Lindsay De Santis Executive Vice President

Massachusetts Pharmacists Association

Editors:

Lindsay De Santis, Nathan Tinker

Nathan Tinker, PhD CEO Connecticut Pharmacists Association

Design & Production: Kathy Harvey-Ellis

The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher.Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619.

Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org

Submitting Articles to the Pharmacy Journal of New England™ The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication.

All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.

Please submit manuscripts to: PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: lcapobianco@ctpharmacists.org

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Pharmacy Journal of New England • Fall 2018

From the CPA’s Desk…

Dear Readers: As the new CEO at the Connecticut Pharmacists Association (CPA), I wear many hats.

Editor-in-Chief of PJNE is one of these hats, and I’m excited to share in this venture with MPhA. Before going any further, though, I want to give a huge huge thank you to Marghie Giuliano, for her 19 years leading CPA! She has left a legacy that will be hard to equal-and a strong, effective and active association. As we all know, change can be difficult, but over the past few weeks, Marghie has been a mentor, guide, and partner in transitioning the organization. Both CPA and I are in her debt, and we wish her all the best in her next adventure.

Since assuming my new role on October 1, it has been a bit of a whirlwind. On October 4, I appeared before the state Insurance Department to testify against the proposed CVS-Aetna merger. Just one week later, the Department of Justice (DOJ) conditionally approved the $69 billion vertical integration deal. Now that the Connecticut state Insurance Department has approved the merger, CPA hopes Connecticut will enact strong legislation that allows the Insurance Department to regularly and aggressively regulate the new entity. Any savings generated by negotiated drug prices should be directly passed on to consumers. We will continue to keep a close watch on the long-term impact of this merger.

On a different note, you may have noticed that we are completely redesigning PJNE. As we continue to do so, I want to invite you to help us make this publication useful, insightful, informative, and relevant. Your knowledge and insight can be a great asset, and I invite you to contribute to PJNE as a writer. Whether your expertise is patient care, immunization or diabetes, the business of pharmacy, whatever—we can use your experience. Write about something you’re passionate about and send it to us.

The New England pharmacy community is exactly that—a vital, active, community—and I am excited to join it.

Nathan Tinker CEO

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Opioid-Related Deaths | The Trends As one of the most prominent topics in the nation today, opioid-related deaths

Opioid-Related Deaths (2016)

have been on the rise in New England since 2010. The Centers for Disease

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Control and Prevention (CDC) reports that

Per 100,000 persons

in 2016, the average opioid-related deaths per 100,000 people in each New England state was higher than the national average, which is 13.3 per 100,000 persons.

35.8 29.7

30

24.5

26.7

25.2

18.4

20

13.3

10

In 2016, synthetic opioids were the leading cause of overdose-related deaths

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in all New England states with the

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the CDC, a total of 1,923 overdoserelated deaths were caused by synthetic

Overdose-Related Deaths (2016)

opioids. It’s important to note that opioids, such as fentanyl, are being laced overdoses nationwide.

In 2016, New Hampshire had the highest opioid-related death rate, 35.8 per 100,000 persons, and highest overdose caused by synthetic opioids rate, 27.9 per 100,000 persons, when compared to the

Per 100,000 persons

into heroin and contributing to many

other states. Massachusetts had the most opioid-related deaths in 2016, at 1,945 deaths, compared to the other New England states. Their opioid related death rate was even higher than the other 5 states combined, which had 1,914 Synthetic opioids include fentanyl, carfentanil, and their analogues

deaths total.

Opioid-Related Deaths in NE

Source: CDC Wonder

Per 100,000 persons

30

20

10

0

4

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

Pharmacy Journal of New England • Fall 2018

Pharmacy Facts of New England

The Alcohol and Drug Abuse Program (ADAP) waiting list peaked in 2015, including 615 people. The waiting list has since decreased in 2017 to only 104 people.

Contains the second highest rate of opioidrelated overdoses in the entire country.

In 2017, ages 30-39 had the highest rates of opioid misuse.

In 2015, prescribers wrote 2.3 million prescriptions for opioid pain relievers, equating to 64.0 prescriptions for every 100 persons.

In 2014, almost 6 out of 10 admissions for substance abuse treatment also had a previously diagnosed mental illness.

In 2017, 76% of all confirmed opioid-related deaths were male and 80% were white. Only 0.6% were Asian.

In 2014, 80 percent of all drug crime that police investigated in Providence involved heroin.

Sources: Official State Websites and CDC

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A Review of Immunization Updates for the Pharmacist By: David Kuczynski, PharmD candidate, Grant Stimes PharmD, and Jennifer Girotto, PharmD, BCPPS Introduction The Centers for Disease Control and Prevention (CDC) have published some significant changes to immunization recommendations in 2018. A few new immunization products have also been approved by the Food and Drug Administration.

These changes are summarized below and affect influenza, zoster, hepatitis and mumps vaccines.

Influenza Influenza vaccine is the most common vaccine that pharmacists administer. Therefore, it is essential to understand the current recommendations. This season all vaccines will include, an A/Michigan/45/2015 A(H1N1)-pdm09-like virus strain, an A/SingaporeINFIMH-16-0019/2016 A(H3N2)-like virus strain, and a B/Colorado/06/2017-like (B/Victoria lineage) virus strain.

Additionally, all quadrivalent vaccines include a B/ Phuket/3073/2013(B/Yamagata) strain. 1 As many patients may ask, the A/H3N2 and B/Victoria strains in this year’s vaccine differ from those in 2017-18 influenza vaccine.

Specifically, they changed the A/H3N2 to the new A/ SingaporeINFIMH-16-0019/2016 H3N2-like strain, because of poor vaccine efficacy in 2017-2018 [25% (CI 13%-36%)] season. This change is hoped to provide a better match to A/ H3N2 circulating strains. 1 Another change to this year’s vaccine is with the B/Victoria strain. This has been changed to the B/Victoria /Colorado/06/2017 strain because of both a change in the circulating strain and a reported low vaccine effectiveness [42% (CI 25% - 56%)] last season.2 For the 2018-2019 season, the CDC continues to recommend that all patients 6 months-of-age and older, without contraindications receive an age appropraite influenza vaccine. The available influenza vaccines for the 2018-2019 season are summarized in Table 1.

For the first time in a few years, the CDC has included the 6

live-intranasal influenza vaccine (LAIV4) as an option for patients3 The CDC had not recommended the vaccine in recent years due to a few consecutive years demonstrating poor in protection against influenza, especially H1N1 strain.

3,4 It is currently uncertain why the LAIV4 had poor protection in these years. Some suggest it was due to a decrease in viral replication within the nasal epithelium, or antibody interference limiting viral replication from prior influenza vaccination, or even an interference between vaccine strains causing a lack of protection against the H1N1 immune protection. 3,5 The manufacturer has worked to improve some parts of the process. Specifically they identified an H1N1 component that appears to have an increase in intranasal viral replication and similar antibody development against H1N1 to pre-pandemic H1N1 influenza. 3 Unfortunately, there has been no clinical influenza outcome data available yet to substantiate that these improvements will result in improved protection, since it has not been recommended to be used in the past few years. 3 The CDC’s Advisory Committee for Immunization Practices (ACIP), based on their review of these data has recommended that LAIV4 be an option for use in this season, but because of this lack of outcome data, The American Academy of Pediatrics recommends that the LAIV4 only be used in patients who would otherwise receive no vaccine this influenza season.3,6 If LAIV4 is going to be used, it is important to remember some of the basics regarding indications, dosing, administration, as well as contraindications and precautions. It is FDA approved for patients between the ages of 2 and 49 years-old. Since the LAIV4 is administered intranasally, patients that have nasal congestion that could impede delivery of the vaccine spray should either have vaccine administration deferred to another day or should receive their vaccination completed with the inactivated shot instead. To administer the vaccine, the cap should be removed with the divider clip remaining in place.

The vaccine should be sprayed into one nostril of the patient in an upright position. 7 The divider clip is then removed and the other half of the vaccine is sprayed into the patient’s other nostril. Patients that sneeze after administration do not warrant revaccination. 7 LAIV4, should not be given to anyone who cannot receive the inactivated vaccine. There are however additional contrain-

Pharmacy Journal of New England • Fall 2018

dications for the LAIV4. Like other live vaccines, LAIV4 should not be administered to patients who are immunocompromised (e.g. HIV, cancer, chemotherapy, or congenital immunodeficiency) or pregnant. It is also contraindicated in children less than 5 years old who have had medically attended wheezing in the past 12 months, children less than 5 years old with a diagnosis of asthma, children and adolescents who are receiving aspirin or salicylate-containing therapy, caregivers of severely immunocompromised patients, and in patients who have received an influenza antiviral therapy (e.g. osteltamivir) within the previous 48 hours. 7 Precautions to receipt of LAIV include those for the inactivated vaccine and add to that caution for those 5 years old and greater with asthma, or other chronic diseases that may pre-dispose them to complication from influenza infection. Examples of these conditions would include chronic pulmonary, cardiac, renal, hepatic, neurologic, hematologic and metabolic disorders. 7 Zoster Vaccine Shingrix® (RZV), (GlaxoSmithKline Biologics) is a recently FDA approved inactivated subunit zoster vaccine. 8 It was recommended in early 2018, by the CDC as the preferred vaccine for the prevention of herpes zoster in immunocompetent adultsaged 50 years of age and older, including those who had previously received the Zostavax®, (ZVL) (Merck & Co, Inc.). 8,9 RZV has a few important differences when compared to ZVL. RZV is an inactivated vaccine that is administered in 2 doses, separated by 2 to 6 months. This vaccine contains a unique ASO1b adjuvant that provides a potent and prolonged response. 10 Unfortunately, this strong response also results in more frequent adverse events.

Although no head-to-head studies were conducted, the RZV appeared to have higher vaccine effectiveness and longer duration of protection when compared to data from ZVL trials.

For example, RZV demonstrated reported vaccine effectiveness of 89.8% (95% CI 84.2 to 93.7) and prevention of postherpetic neuralgia of 88% (68.7-97.1) in patients 70 years-old and older. 10,11 In similar evaluations the ZVL showed vaccine effectiveness of 51.3 (95% CI 44.2 to 57.6) and prevention of postherpetic neuralgia of 66.5% (47.5-79.2) for those 60 years and older. 12 The RZV also has shown a long duration of immunogenicity with approximately 85% of patients 70 years and older showing response at 4 years. 11 Unfortunately, patients who receive RZV also report a high

rate of adverse effects. 12,13 In these trials, injection site reactions in the RZV group ranged between 74.1% and 81.5% and 74.1% and systemic reactions were recorded at 53% to 66.1%12,13 High rates of Grade 3 adverse reactions were also noted. 12,13 Injection site reaction were considered Grade 3 if redness or swelling was more than 3.93 inches or the reaction that prevented normal everyday activity. Systemic reactions were defined as Grade 3 if the patient had an oral temperature higher than 39.0oC (102.2oF) or experienced any systemic adverse events that prevented everyday activities.

In phase III trials, 9.5% (50 years and older) and 8.5% (70 years and older) of patients reported Grade 3 injection site reactions that lasted for no more than 2 to 3 days. Grade 3 systemic reactions lasting 1 to 2 days were reported in 11.4% for those in the 50 years and older and 6.0% for those 70 years and older studies. 12,13 It is also important to note that the frequency of Grade 3 systemic reactions was higher in the second dose reported at 8.5% (95% CI 7.7 to 9.4) then the first dose 5.9% (95% CI 5.2 to 6.6) in patients 50 years and older. 12 In adults 70 years and older there was no increased frequency of Grade 3 systemic reactions noted after the second dose. 11 A cost-effectiveness model also supported the use of RZV. The cost-effectiveness model suggested that RZV versus placebo would prevent over 100,000 cases of herpes zoster, 11,000 episodes of postherpetic neuralgia, and prevent about 15,000 complications.14 It described an incremental costeffectiveness of $11,864 per quality-adjusted life-year. Further, they also compared the RZV versus ZVL and estimated that RZV could save over $96 million dollars by preventing an additional 71,000 cases of herpes zoster and 6,000 episodes of postherpetic neuralgia.14 Hepatitis B In 2018, ACIP recommended HEPLISAV-B® (HepB-CpG) (Dynavax Technologies Corporation) a new recombinant, adjuvant hepatitis B vaccine approved for patients 18 years and older. Is the only two dose (separated by 1 month) Hepatitis B vaccine currently FDA approved.15 HepB-CpG uses a novel, non-aluminum, 1018 adjuvant that utilizes a cytidinephosphate-guanosine-oligodeoxynucleotide (CpG-ODN) that binds to toll-like receptor (TLR) 9,16 A randomized controlled trial that included almost 5,000 adults compared rates of seroconversion or antibodies >10mIU/ml to Hepatitis B surface antigen between HepB7

CpG and one of the currently approved Hepatitis B vaccines (Engerix-B, HBsAg-Eng). The HepB-CpG group had seroprotection rates of at least 90% overall and in all subpopulations stratified by age, sex, smoking status, and obesity whereas, HBsAg-Eng produced an overall seroprotection rate of 81% and it ranged from 67.7% to 92.9% in subpopulations.17,18 As a result, this newly found adjuvant produced mild and serious adverse events at 45.6% and 5.4% when compared to Engerix-BÂŽ (HBsAg-Eng) (GlaxoSmithKline Biologicals) at 45.7% and 6.3%, respectively. 18 Cardiovascular adverse events were also observed at 0.27% and 0.14% for HepB-CpG and HBsAgEng while attaining seroprotection rates non-inferior to generic Hepatitis B vaccines.19 Both vaccines produced similar adverse effects of approximately 45% reporting mild adverse reactions and about 6% having serious adverse events. The only exception is that observed myocardial infarction was numerically higher in a HepB-CpG group of one randomized controlled trial. In this study 14 of 5,587 patients in the HepBCpG and 1 of 2,781 patients in the HbsAg-Eng group had a myocardial infarction. 20 The relative risk of myocardial infarction was not significant 6.97% (CI 0.92 to 52.97%) and was only found to be higher in that trial. 20 Because it is uncertain if this myocardial infarction risk could be a rare but clinically significant effect, the FDA mandated a cardiovascular disease post-marketing surveillance of HepB-CpG. The CDC has added the HepB-CpG as a recommended option for non-pregnant adult patients who require Hepatitis B vaccination after review of the efficacy and safety. In this population no one Hepatitis B vaccine brand is preferred over another. It is however important to try and continue using the same manufacturer for the complete Hepatitis B vaccination series.

It is recommended if HepB-CpG is used with a different manufacturer, the series should be administered as 3 doses with a minimum interval of 4 weeks, 8 weeks, and 16 weeks between dose 1 and 2, dose 2 and 3, and dose 1 and 3, respectively19 Mumps On January 12, 2018, the CDC recommended a 3rd dose of a mumps virus-containing vaccine to administered to patients who are at high-risk for mumps during a mumps outbreak.21

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High-risk patients are identified as those who have an increased risk of exposure or duration of exposure to person(s) infected with mumps. The efficacy and safety of the third dose has been studied in a few recent studies. During an outbreak of mumps at the University of Iowa, 4,700 students (of a total of 20,946 enrolled) received a third dose of mumps vaccine to reduce likelihood of mumps diseases. Mumps was diagnosed in 259 students. 22 Attack-rates of mumps disease were significantly lower among students who received 3 doses compared to 2 doses (6.7 vs 14.5 per 1000 students; p<0.001, respectively). 22 In another study, 1,755 sixth to twelfth -grade students were offered a third dose of the MMR vaccine during a mumps outbreak. This study reported an 8-fold decrease in attack-rates among patients who received three doses of the MMR vaccine compared with two MMR doses (0.06% and 0.48%, respectively). 23 This third dose also appeared safe as the proportion of adverse events reported after receiving a third dose of MMR were less than or similar to studies that evaluated of first- and second-dose MMR vaccinations and no serious adverse effects were reported within 2 months of receiving the third dose of the MMR vaccine. 24 Conclusion In 2018, CDC recommended that patients receive their annual flu shot and reintroduced the LAIV4 intranasal dosage form for patients to utilize; however, the American Academy of Pediatrics only recommends administering the LAIV4 to patients who otherwise would not receive their annual flu vaccine. The CDC has also stated a preference for patients to receive RZV, the new recombinant varicella zoster vaccine over LZV to prevent varicella zoster in immunocompetent adults aged 50 years and older. Additionally, there is a new hepatitis B vaccine, HepB-CpG is added as an option for Hepatitis B vaccination but no preference has been made for any one brand of Hepatitis B vaccine over another. Lastly, the CDC has added the recommendation that patients receive a third dose of MMR vaccine during an active mumps outbreak to reduce the likelihood of developing a mumps infection.

To view the references and graphs involved with this article, visit www.ctpharmacists.org.

Pharmacy Journal of New England • Fall 2018

Flu Season Warm-Up HOW CAN YOU PREPARE FOR FLU SEASON?

ARE YOU ONE OF THESE PEOPLE?

In addition to getting the flu vaccine, hand washing is your best method of protection. Other methods of preventing the flu include sneezing away from people and covering your mouth when you cough. It is also important to drink plenty of fluids and get at least 8 hours of sleep.

Some groups are more likely to have complications from the seasonal flu. These include: -Adults age 65 and older - Children younger than 2 years old - People of any age who have chronic medical conditions (e.g. diabetes, asthma, congestive heart failure, lung disease) - Pregnant women

WHO SHOULD GET VACCINATED? The CDC encourages all people over the age of 6 months old to be vaccinated for the flu. Even women who are pregnant, or planning to become pregnant, can be vaccinated. Even if you feel completely healthy, it is better to be safe and get your flu shot.

Some people are more at risk to get the flu than others, so be sure to ask your doctor or local pharmacist for more information.

WHERE CAN YOU GET VACCINATED? Getting your flu shot is easier than ever these days. The doctor’s office is no longer your only option. There are other places that are easily accessible, with less lines and less waiting. For example, you can get your flu shot at: - Your local pharmacy - Your local grocery store if they contain a pharmacy - Urgent care

Population Statistics for At-Risk Patients

Keep in Mind Formulating the flu vaccine involves many complexities and although the flu vaccine was not as active against the prevalent strains last year, the bottom line is some protection is better than no protection.

Source: U.S. Census, CDC

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On the Horizon

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Opioid Stewardship

NSS-2 Bridge Device

Walmart Pharmacies across the U.S are implementing an opioid stewardship program-an interdisciplinary approach used to address the opioid epidemic.

Among the key components Walmart plans to highlight in their opioid stewardship program include: -Tools to help pharmacists stop fraudulent or inappropriate prescriptions - Measures to reduce the amount of opioids dispensed - Provide free accessible disposable solutions - Support and provide education to youth customers and youth aimed at curbing abuse - Provide tools to help reduce risk of death by overdose - Advocate for state and national policies aimed at curbing abuse and misuse

The NSS-2 Bridge is a new device that has recently been approved by the FDA to reduce opioid withdrawal symptoms.

This small device is placed behind the ear and helps to relieve physical symptoms through electrical stimulation. The device is approved for usage up to five days and is battery operated.

NSS-2 Bridge device is only available by prescription and is contraindicated in individuals with hemophilia, a pacemaker, or psoriasis vulgaris.

HOW IS WALMART DOING IT? Walmart will limit initial acute opioid prescriptions to no more than a 7 day supply nationwide, with up to a 50 morphine milligram equivalent maximum per day. In states where prescriptions are restricted to fewer than seven days, Walmart will abide by the governing law. This policy aligns with the Centers for Disease Control and Prevention (CDC) 2016 recommendations, according to Walmart.

Under the program, Walmart pharmacies not only carry Naloxone, but also use NarxCare, a controlled-substance tracking tool with "real-time interstate visibility."

Another change will take effect on Jan. 1, 2020: a requirement that all controlled-substance prescriptions be submitted electronically.

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Data sources: fda.gov corporatewalmart.com NPR

Pharmacy Journal of New England • Fall 2018

Our Role | Naloxone HOW TO EDUCATE PATIENTS ON NALOXONE Inform patients about how and when to administer naloxone.

Also, educate patients about naloxone's pharmacologic properties and adverse reactions. Patients should also alert others about the medication since it is generally not selfadministered.

Reg Flag signs and symptoms indicating a possible opioid overdose include: - Slow or shallow respiration to no respiration in an unconscious person - Pin-point pupils - Unresponsiveness - Blue skin or lips

INSURANCE COVERAGE FOR NARCAN® NASAL SPRAY

"Knowing how to use naloxone and keeping it within reach can save a life."

- Jerome Adams, Surgeon General

In the United States, 94% of insurers have coverage for Narcan® and nearly 73% of prescriptions have a co-pay of $10 or less.

GOOD SAMARITAN OVERDOSE IMMUNITY LAWS These laws generally provide legal protection from arrest, charge and/or prosecution for certain controlled substance possession and paraphernalia offenses when a person who is either experiencing an opiate-related overdose or observing one calls 911 for assistance or seeks medical attention.

Be sure to look up your state's specific laws and regulations regarding administration of emergency medical services for an overdose.

Source: Narcan.com

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New & Exciting Best Practice Advisory for Naloxone Hartford Health Care recently developed and implemented a new system into its primary care offices to help combat the opioid epidemic. The system identifies high-risk chronic opioid users by looking at the patient's Morphine Equivalent Daily Dose (MEDD), High-Risk Co-Prescribing, High-Risk Co-Mobordities, and Previous History of Substance Abuse.

- A chronic opioid patient is someone who has been on an opioid for greater than 90 days in the last 180 days or has had a dispense for an opioid in the last 90 days AND is currently on an opioid. Patients can also qualify by having a MEDD greater than 90 or having a Controlled Substances Agreement on file.

- A high risk patient is someone who is flagged as a chronic opioid patient and has a MEDD greater than 50 OR has a high-risk comorbidity (mental health disorder, anxiety, COPD, sleep apnea, or CHF), a high risk coprescription (benzodiazepine, CNS muscle relaxant, sedative hypnotic, or barbiturate), or has a history of substance abuse.

If the patient meets the above definition of being a high risk chronic opioid patient, an alert will fire when a prescriber enters an order for an opioid that explains the CDC guidelines for naloxone prescribing and displays the patient risk factors. The alert will prompt the provider to prescribe naloxone for the patient per best practice guidelines.This system was first implemented into Hartford Healthcare’s medical group, and upon testing, was found to be a great success.The goal is to implement this system into all of Hartford Healthcare’s sites to combat the opioid epidemic and to make sure that patients are receiving the best quality of care.

PER CDC GUIDELINES ON DETERMINING WHEN TO INITIATE OR CONTINUE OPIOIDS FOR CHRONIC PAIN:

PER CDC GUIDELINES ON OPIOID SELECTION, DOSAGE, DURATION, FOLLOW-UP, AND DISCONTINUATION:

Source: CDC

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Special thanks to Scott Bonczek Pharm.D. Rph. MSHS-HCQ for providing this information

Pharmacy Journal of New England • Fall 2018

Syringe Service Programs

Syringe Exchange Programs per State 10

Number of Facilities

8 6 4 2 0

CT

MA

ME

NH

RI

VT

Source: nasen.org

Prevalence of HIV Infection Rate (2015) 350 280 210 140 70

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Offered in other countries, such as Canada, supervised injection sites are legally sanctioned and medically supervised facilities that are aimed at reducing burden from public drug use. These sites provide a hygienic and stress-free environment in which individuals are able to consume illicit IV drugs.

This legislation modifies the restriction on use of federal funds for programs distributing sterile needles or syringes for HHS programs.

Although a provision in this legislation still prohibits the use of federal funds to buy sterile needles for a hypodermic injection of any illegal drug, it allows for federal funds to be used for other aspects of syringe exchange programs if the state or local health department, in consultation with the CDC, finds evidence of a demonstrated need, (i.e. experiencing, or at risk for, a major increase in hepatitus infections due to an injection drug use). Click here for more info.

C

THINGS TO CONSIDER

The Consolidated Appropriations Act of 2016

Per 100,000 persons

Intravenous drug users are at a substantially higher risk of receiving and transmitting HIV, viral hepatitis and other blood borne infections by using non-sterile needles and syringes. Syringe service programs give individuals who inject drugs access to sterile needles and syringes to help reduce their risk of getting or transmitting these diseases. These community-based programs provide sterile needles free of cost and facilitate safe disposal of used needles and syringes. The CDC and U.S. Department of Health and Human Services (HHS) describe these exchange programs as “an effective component of a comprehensive, integrated approach to HIV prevention among persons with IV drug use.”

Most syringe service programs will also offer: - Additional prevention materials (e.g., alcohol swabs, vials of sterile water, condoms) - Education on safer injection practices and wound care - Overdose prevention - Referral to substance use disorder treatment programs including medication-assisted treatment - Counseling and testing for HIV and hepatitis C - Linkage to critical services and programs, such as HIV care, treatment, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) services; hepatitis C treatment, hepatitis A and B vaccinations; screening for other sexually transmitted diseases and tuberculosis; partner services; prevention of mother-to-child HIV transmission; and other medical, social, and mental health services.

Source: CDC

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2017 Recipients of the “Bowl of Hygeia” Award

Larry Presley Alabama

John McGilvray Alaska

Alan Barreuther Arizona

Sue Frank Arkansas

Pierre Del Prato California

Mary Petruzzi Connecticut

Noel Rosas Delaware

Goar Alvarez Florida

Hewitt Ted Matthews Georgia

Ed Cohen Illinois

Ahmed Abdelmageed Indiana

Tim Becker Iowa

Merlin McFarland Kansas

Melody Ryan Kentucky

Gregory Poret Louisiana

Greg Cameron Maine

Cynthia Boyle Maryland

Anita Young Massachusetts

Dennis Princing Michigan

Denise Frank Minnesota

David French Mississippi

David Farris Missouri

Matthew Bowman Montana

Gary Rihanek Nebraska

Mark Decerbo Nevada

Hubert Hein New Hampshire

Thomas F.X. Bender, Jr. New Jersey

David Lansford New Mexico

John T. McDonald III New York

Steve Caiola North Carolina

Tim Weippert North Dakota

Debra Parker Ohio

Ben Allison Oklahoma

Mercy Chipman Oregon

Jerry Musheno Pennsylvania

Marisa Carrasquillo Puerto Rico

Gary Kishfy Rhode Island

Terry Blackmon South Carolina

Tim Tucker Tennessee

Chris Alvarado Texas

Kurt Price Utah

Pat Resto Virginia

The “Bowl of Hygeia”

In Memoriam: Rob Loe South Dakota Keith Campbell Washington Daneka Lucas Washington DC

Kevin Yingling West Virginia

Thad Schumacher Wisconsin

Joe Steiner Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA History Hall located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.

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Pharmacy Journal of New England • Fall 2018

Addiction...Can Come In Many Forms

thisdishisvegetarian.com

In the United States, tobacco use is the leading cause of preventable disease, disability, and death. Accounting for nearly half a million premature deaths, smoking and exposure to secondhand smoke is a nation-wide crisis. Even after the abundance of data that has come out within the last few decades linking nicotine to a greatly increased risk of respiratory diseases, cancers (especially lung cancer), stroke, and heart disease, nearly 40 million adults nationwide still smoke cigarettes, and about 4.7 million middle and high school students use at least one tobacco product. More than 3,800 youth younger than 18 years smoke their first cigarette every day. In the United States, 16 million people live with a serious illness caused by smoking. To combat this highly addictive and destructive habit, the United States Health Care system spends nearly $170 billion on medical care each year to treat smoking-related disease in adults.

Source: CDC

Tips for Busy Pharmacists Working in retail is rarely ever equivalent to a spa day. Pharmacists have many responsibilities on their plate, such as helping individuals with smoking cessation. Using the 5 As – Ask, Advise, Assess, Assist, and Arrange – is a quick and easy way to gather information on an individual. Also, it could be beneficial if a technician or intern questions the patient while waiting for the prescription. This eases the workload on the pharmacist, as well as gives more responsibility to an intern.

Smokeless tobacco is not burned and includes tobacco that can be sucked, chewed, spit, swallowed or spit less.

This may appeal to youth because it comes in flavors such as cinnamon, berry, vanilla, and apple.

Types of smokeless tobacco: - Chewing tobacco (loose leaf, plug, or twist and may come in flavors) - Snuff (moist, dry, or in packets [U.S. snus]) - Dissolvables (lozenges, sticks, strips, orbs) Smoking Tobacco is burned Types of smoking tobacco: - Clove cigarettes (kreteks) - Menthol cigarettes - Light, hand-rolled, natural, or herbal cigarettes - Bidis (flavored cigarettes) - Hookahs (water pipes) - Cigars

How strong is your patient's nicotine addiction? Visit https://smokefree.gov/challenges-when-quitting/withdrawal/nicotine-addictionquiz to learn more.

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Addiction... Can Come In Many Forms DID YOU KNOW THAT NOT EVERY ALCOHOLIC IS THE SAME? There are 5 different types of alcoholics: 1. Young adult This is the largest group, which makes up 32% of alcoholics in the United States. Young adult alcoholics on average are aged 24 years old, and are likely to binge drink.

2. Young adult antisocial This group makes up 21% of alcoholics in the United States with an average age of 26 years old. These drinkers usually begin drinking at the age of 15 and develop alcoholism by the age of 18. Members of this group also have an increased likelihood of drug use, especially of marijuana, cocaine and opioids.

3. Functional This group makes up 19% of all alcoholics in the United States. A functional alcoholic will drink on a daily basis, usually ingesting at least five drinks throughout a single day.

However, despite this excessive drinking, functional alcoholics can still maintain a relationship and career. The average age for this group is typically middle-aged.

4. Intermediate familial This group makes up 19% of all alcoholics., and usually begin drinking by the age of 17. However, alcoholism does not usually become a problem until members of this group reach their early 30s.

5. Chronic severe This group makes up 9% of all alcoholics, and consists of mostly men, with a family history of alcoholism. Chronic severe alcoholics have a much higher rate of personality disorder, other mental illnesses and/or severe drug abuse issues.

Picture Source: deadlyvibe.com.au Data Source: projectknow.com

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“Every alcoholic is different, from their reasons for drinking to their methods of trying to cope with life as they drink.”

-PROJECT KNOW INTERESTING STATISTICS - According to the Collaborative Study on the Genetics of Alcoholism, the child of an alcoholic parent is four to nine times more likely to become an alcoholic than a child without an alcoholic parent.

- In 2008, alcohol was connected in some way to 31 percent of traffic accidents.

Pharmacy Journal of New England • Fall 2018

IF YOU OR A LOVED ONE SUFFER FROM ANY OF THESE SUBSTANCE USE DISORDERS

cognitive-psychiatry.com

Contact 1 (877) 589-7257 CALLING A HELPLINE IS A POSITIVE STEP TOWARDS RECOVERY. TAKE THAT FIRST STEP NOW AND CALL. 17

2018 New England Pharmacists Convention The 14th Annual New England Pharmacists Convention kicked off on Thursday, September 13, 2018 at Foxwoods Resort Casino with several certificate training programs, CE programs and a welcome reception in the Exhibit Hall.

Marghie Giuliano, the former CEO of the Connecticut Pharmacists Association (left), poses with Alicia Mam daCunha (center), past president of the Massachusetts Pharmacists Association(MPhA) and Lindsay DeSantis, the executive vice president of MPhA (right) in the Exhibit Hall.

From left: Lisa Bragaw, president of the Connecticut Pharmacists Association, Lucinda Maine of AACP and Delilah Barnes, president of the Massachusetts Pharmacists Association

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The Convention continued on Friday, September 14 with a keynote address presented

by Lucinda Maine, the Executive Vice President & CEO of the American Association of Colleges of Pharmacy (AACP). Maine's talk highlighted the AACP's new public awareness campaign aimed at raising the profile of pharmacy as an essential health care profession. Together with other pharmacy and health care organizations, the AACP formed a coalition called, "Pharmacists for Healthier Lives."

Pharmacy Journal of New England â&#x20AC;˘ Fall 2018

2018 New England Pharmacists Convention

Thank You to All Our Sponsors & Exhibitors:

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2018 New England Pharmacists Convention

Thank You to All Our Sponsors & Exhibitors:

Pharmacy Community Research Network

Red Hawk

Rx Disposal

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Pharmacy Journal of New England • Fall 2018

Pharmacists of Yesterday RUDY BURGESS, RPH Retired Independent & Institutional Pharmacist HOW LONG DID YOU PRACTICE PHARMACY? I started practicing in 1951 and I officially retired my license in 2017 at the age of 89. Before that, I was a cook in the U.S. Navy.

WHAT AREA OF PHARMACY DID YOU WORK IN? I started off working in retail for 16 years. After taking a break from pharmacy for less than a year, I ultimately decided to go back and do relief work. I worked for Blue Health Hospital in a substance abuse facility for 13 years and retired in 1997. After that, I took a part time job with a community substance abuse center and retired in 2017 at the age of 89.

WHY PHARMACY? It was a choice between pharmacy and baseball and I was talked out of baseball because of the color barrier. Pharmacy was my fall back.

HOW HAS PHARMACY CHANGED SINCE YOU GRADUATED? It has changed an awful lot. When I first started practicing we did not label the bottles with the name of medications. We were also not allowed to tell the patients what the medication was for unless we had the doctor's permission. There were independent pharmacies on almost every corner and each county had their own organization. Also, my tuition for UCONN was $150 per semester.

WHAT DO YOU NOTICE IS THE DIFFERENCE BETWEEN RPH AND PHARMD? There really is not a big difference beyond the title. PharmD's get more education then we had, but a lot of the clinical interactions are the same.

HOW DO YOU FEEL ABOUT THE OPIOID EPIDEMIC? It is terrible. I think they should have started working on this issue at least 20 years ago. They just did not care about it before it reached the suburbs and by that time it was too late.

DO YOU FEEL PHARMACISTS SHOULD HAVE PRESCRIBING RIGHTS? I really don't know about that. I will leave that question to individuals who are more up to date with that information. We have the knowledge and background to do it but I just don't know.

HOW FAR IS TOO FAR FOR PHARMACY? Good question. As long as a pharmacist is overseeing everything, things will probably be alright.

LASTLY, IF YOU WERE A DRUG WHAT WOULD YOU BE AND WHY? I would probably be some kind of antibiotic or a drug that cures some rare, problematic disease. I would be a mystery, undiscovered drug. But definitely one that cures.

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Pharmacists of Today BRIAN REID, RPH Big Y Pharmacy, Ellington CT | Store #73 HOW LONG HAVE YOU BEEN PRACTICING? I've been practicing pharmacy for 22 years. I originally worked at CVS after graduating from MCPHS Boston and held various positions there. I then transitioned to pharmacy manager of Big Y Pharmacy.

WHAT AREA OF PHARMACY DO YOU WORK IN? I work in a grocery store as a Community Pharmacy Manager.

WHY PHARMACY? Well I like science and I like working with the public so it was a combination of those two which led me to retail pharmacy.

WHAT MADE YOU CHOOSE YOUR PATH? When I started, there were really only two options and I enjoyed the longer hours with more days off offered in a retail setting.

HOW HAS PHARMACY CHANGED SINCE YOU GRADUATED? It has changed in two major ways. First, technology has made vast improvements and second, pharmacists were not giving immunizations 22 years ago.

WHERE DO YOU SEE PHARMACY MOVING TOWARDS IN 5-10 YEARS? I think retail pharmacy will target younger graduates because of its high workload. I also think independent pharmacies will become close to obsolete.

WHAT DO YOU NOTICE IS THE DIFFERENCE BETWEEN RPH AND PHARMD? In my opinion, PharmDs tend to speak to patients in more clinical terms, while RPHs will break things down to the patients in a more layman's term.

HOW DO YOU FEEL ABOUT THE OPIOID EPIDEMIC? I think it is decreasing drastically with the restrictions that prescribers have been given, especially with the 7 day supply limit on initial opioid prescriptions.

DO YOU FEEL PHARMACISTS SHOULD HAVE PRESCRIBING RIGHTS? Yes, but only on certain medications.

HOW FAR IS TOO FAR FOR PHARMACY? The amount of prescriptions that pharmacists are checking is honestly too many and there should be a limit on how many prescriptions a pharmacist can verify in one day.

LASTLY, IF YOU WERE A DRUG WHAT WOULD YOU BE AND WHY? I would be Vancomycin because if all else fails you call on me.

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Pharmacy Journal of New England • Fall 2018

Pharmacists of Tomorrow SARAH PROVENCHER Western New England University | Doctor of Pharmacy Candidate 2019 WHAT YEAR OF SCHOOL ARE YOU IN? I just entered my PY-4 year at Western New England University.

Before that I completed my Bachelor of Science in Pharmacy Studies there.

DO YOU CURRENTLY WORK FOR A PHARMACY? Yes, I've worked at the pharmacy in a local community grocery store for the past 5 years.

WHAT AREA OF PHARMACY ARE YOU INTERESTED IN? I would like to pursue a career in ambulatory care after I graduate.

WHAT MADE YOU CHOOSE YOUR PATH? I went to an open house for my undergrad at WNEU. The school had just started its pharmacy program, which seemed new and exciting, so I looked into it and decided it was a good fit for me.

WHERE DO YOU SEE PHARMACY IN 5-10 YEARS? I think the role of pharmacists are going to expand. Our profession is becoming much more clinical and we are going to be needed in areas like pharmacokinetics and pharmacogenomics where we really are the experts.

WHAT DO YOU NOTICE IS THE DIFFERENCE BETWEEN RPH AND PHARMD? Mostly generational, but I am glad they added the extra year of schooling for the PharmD. Transitioning from RPh to PharmD helped move pharmacists away from just a dispenser title to now a more paramount member of the healthcare team.

HOW DO YOU FEEL ABOUT THE OPIOID EPIDEMIC? I think it has become a national crisis. Our society is taking steps to try and negate the issue with methadone clinics and clean needle programs, but there are still a lot of social stigmas associated with heroin and opioid abuse that act as barriers.

Unfortunately, these barriers must be broken down before we can really address and make headway on this issue.

DO YOU FEEL PHARMACISTS SHOULD HAVE PRESCRIBING RIGHTS? Yes, but with limits. Pharmacists do have the knowledge base to prescribe medications that either don't require a diagnosis or require only a simple diagnosis. Hopefully we'll be moving towards this in the future.

HOW FAR IS TOO FAR FOR PHARMACY? We are pushing for everything to fit into an algorithm and sometimes lose sight of our own clinical opinions. There is also so much pressure on the pharmacists in bigger chains to meet quotas, push immunizations, increase automatic refills, etc. that a lot of basic patient care can be forgotten.

LASTLY, IF YOU WERE A DRUG WHAT YOU BE AND WHY? Zoloft I guess, to make everyone around me happy!

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This Fall...Bring Awareness Did you know that November is...

National Hospice/Palliative Care Month National Family Caregivers Month National Home Health Care Month National Alzheimers Disease Awareness Month

American Diabetes Month Lung Cancer Awareness Month Stomach Cancer Awareness Month

November Spotlight: American Diabetes Month

healthfinder.gov

Sponsor: American Diabetes Association Diabetes is one of the leading causes of disability and death in the United States. Secondary conditions to diabetes are blindness, nerve damage, kidney disease, and other health problems if uncontrolled. November is used to raise awareness about diabetes risk factors and encourage those, at risk, to make healthy changes.

EPIDEMIOLOGY 1 in 10 Americans have diabetes, that equates to more than 30 million people.

84 million adults in the United States are at high risk of developing type 2 diabetes.

People who are at high risk for type 2 diabetes can lower their risk by eating healthy, getting more physical activity, and losing weight.

COUNSELING TIPS FOR YOUR PATIENTS Encourage patients to seek healthy alternatives in their diets and limit the amount of sugar they ingest: - Maximum of 6 tsp or 25 grams each day for women - Maximum of 9 tsp or 38 grams each day for men Encourage patients to engage in 150 mins each week of moderate intensity exercise, such as brisk walking or 75 mins each week of rigorous activity, such as running. In addition, encourage patients to undergo strength training, such as lifting weights, at list 2 days a week. Encourage patients to get their blood pressure and cholesterol checked regularly.

For a Quick Comparison of the Different Diabetic Medications Refer to Page 30 of this Link | To Be Used Only For Educational Purposes: https://www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf

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Pharmacy Journal of New England â&#x20AC;˘ Fall 2018

Bringing Awareness: December 2018 World AIDS Day Founded in 1988, World Aids Day is an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Visit https://www.worldaidsday.org/ to learn more.

National Handwashing Awareness Week To

Personal hygiene starts and ends with our hands. From December 2December 8, talk to patients about the 4 principles of hand awareness: 1) Wash your hands when they are dirty and before eating; 2) Do not cough into hands; 3) Do not sneeze into hands; and 4) Don't put your fingers in your eyes, nose or mouth.

National Influenza Vaccination Week To

Establish by the CDC in 2005, National Influenza Vaccination Week aims to highlight the importance of continuing flu vaccination through the holiday season and beyond. From December 2-December 8, share the CDC's resources, vaccination messages, and activities with your patients and loved ones.

Save the Date!

CPA Holiday Open House Stop by the CPA office in Rocky Hill, CT on Thursday, December 13 for a holiday open house! The free networking event will take place from 4-6:30 p.m. right before the monthly Board of Directors meeting. Refreshments will be served.

CPA 2019 Mid-Winter Conference The CPA 2019 Mid-Winter Conference will take place on Thursday, February 7, 2019 at the Aqua Turf Club in Plantsville, CT. The event will feature over a dozen high-impact educational and information sessions are planned, in addition to a variety of speakers.

Sponsorship opportunities are available. Visit www.ctpharmacists.org for more details.

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Preparing for The Holidays How to Counsel Your Patients Healthy Alternatives of Favorite Holiday Dishes

White Meat Turkey with No Skin

Bread and/or Meat Stuffing

Wild Rice or Quinoa Stuffing

Mashed Potatoes

Mashed Cauliflower

Pumpkin or Pecan Pie

Oatmeal Crunch Apple Pie

Canned Gravy

Homemade, Low-Carb Gravy

Eggnog

Dark chocolate hot cocoa

Beer or Wine

Clear Liquor w/ Club Soda or Seltzer

Sweet Potato Casserole

Green Bean Casserole

Creamy Dressing (ranch, casear, etc.)

Vinaigrette Based Dressing

Try This Recipe Out:

Fried Turkey or Turkey with Skin

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Keto Gravy Ingredients - 2 cups of stock/drippings - 1/2 cup heavy whipping cream - 4 Tbsps butter - 1 tsp pepper -1/2 tsp xanthan gum

Source: ketoconnect.net

Instructions 1. Combine cream, butter, broth/drippings in a sauce pan over medium-high heat 2. Bring to boil and reduce and simmer for 10-15 mins 3. Add xanthan gum and pepper 4. Stir until it thickens to your licking

Pharmacy Journal of New England • Fall 2018

Sleep Hygiene | Non-Pharmacological Counseling Tips For Your Patients Avoid daytime napping, but if necessary, limit naps to 30 minutes.

Although napping does not make up for an inadequate nights sleep, a nap of 20-30 minutes can help to improve mood, alertness and performance.

Establish a regular sleep pattern.

Individuals should go to bed and wake up at about the same time daily, even on the weekends. Beds should also only be used for sleeping, and other activities, such as watching TV, should be avoided.

Avoid stimulants and alcohol close to bedtime.

Stimulants include products with caffeine and nicotine in them. Stimulants and alcohol should be avoided for at least 4-6 hours before bedtime.

Exercise.

Exercise should be done regularly but not within 2-4 hours of bedtime.

Avoid food that can be disruptive right before bedtime.

Avoid foods that can lead to heartburn such as heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks. These foods can trigger indigestion, which disrupts sleep. If hungry, patients should eat a light snack, but avoid eating meals within 2 hours before bedtime.

Create a pleasant sleep environment.

Mattress and pillows should be comfortable and the bedroom should be cool (between 60 and 67 degrees). Avoid extreme temperatures, bright light from lamps, cell phone and TV screens and non-relaxing background noises.

MEDICATIONS THAT MAY CAUSE INSOMNIA alcohol anabolic steroids antidepressants anticonvulsants antihypertensives antineoplastics amphetamines anorexiants beta-adrenergic agonists (albuterol) beta blockers caffeine corticosteroids decongesants diuretics levodopa nicotine oral contraceptives thyroid medications

Source: sleepfoundation.org

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What's Happening in The News?

Picture Source: trupartnercu.org

APhA Attends White House Event on Nation's Opioid Epidemic

Picture by John S, Cropped to Fit Page | flickr.com

In October, the American Pharmacists Association (APhA) visited the White House to take part in an event to commemorate the many efforts to curb the national opioid epidemic. The invitation serves as recognition that pharmacists are a necessary resource to patients and a vital member of the health care team working to combat the prescription drug and opioid abuse epidemic.

During the White House event, titled “A Year of Historic Action to Combat the Opioid Crisis,” President Donald Trump signed legislation recently passed by Congress to add more resources for Americans suffering from addiction, including expanding access to medication-assisted treatments like methadone. The historic event aligned with American Pharmacists Month (APhM) theme and central message that pharmacists are “Easy to Reach and Ready to Help.”

Source:pharmacist.com

White House Signs Legislation Banning 'Gag Clauses' Besides the recent opioid legislation, pharmacy leaders also applauded the bipartisan legislation that will remove the barriers preventing pharmacists from helping patients find the least expensive way to purchase their prescription drugs. In October, President Trump signed The Patient Right to Know Drug Prices Act, S.2554 and the Know the Lowest Price Act, S.2553, which prohibits pharmacy benefit managers( PBMs) from imposing provisions in pharmacy contracts that prohibit pharmacists from telling patients when the cash price of a drug is less than the copay or price patients pay through their insurance, also known as ‘gag clauses.’ Leaders from both APhA and the National Community Pharmacists Association(NCPA) attended the bill signing.

Source:pharmacist.com

WHAT DOES THE CVS-AETNA MERGER MEAN FOR OTHER STATES? Although CVS Health's $69 billion merger with Aetna still requires some state approvals, the Department of Justice's approval marked a major milestone of the deal. What does this approval mean for other vertical integration deals in the works? An article published by the Boston Globe speculates that the DOJ's approval could help prompt a health care merger in Massachusetts. For example, Boston-based hospital giant Partners HealthCare and Wellesley-based insurer Harvard Pilgrim are in talks about a combination, with a focus on improving the experience for patients while controlling costs.

Source:bostonglobe.com

DEA RESCHEDULES EPILEPSY CANNABIDIOL DRUG The US Drug Enforcement Administration (DEA) rescheduled the epilepsy cannabidiol drug Epidiolex (GW Pharmaceuticals) from a Schedule I to Schedule V controlled substance, the classification with the lowest degree of restriction. This announcement comes after the U.S. Food and Drug Administration (FDA) approved the drug in June for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) or Dravet syndrome in patients aged 2 years and older. The DEA's decision to move Epidiolex to Schedule V was based on nonclinical and clinical data regarding its potential for abuse.

Source:medscape.com

FDA APPROVES EXPANDED USE OF QUAD INFLUENZA VACCINE The US Food and Drug Administration (FDA) issued an extended approval for the quadrivalent formulation of the Afluria influenza vaccine, in individuals 6 months of age and older. Produced by Seqirus, the quadrivalent vaccine is designed to protect against 2 influenza A strain viruses and 2 influenza B strain viruses. It is an inactivated vaccine which is available in single-dose, pre-filled syringes and multi-dose vials. The vaccine is available nationwide for the 2018-2019 influenza season.

Source:pharmacytimes.com

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