WINTER SPRING 2018 Pharmacy P E R S P E C T I V E S

School Wins National Weaver Award CU Skaggs School of Pharmacy and Pharmaceutical Sciences was selected as the winner of AACP’s Lawrence C. Weaver Transformative Community Service Award. Presented annually, the award is bestowed on a school that has demonstrated a commitment to its community through the development of programs that go beyond the traditional role of academic pharmacy. In addition to bragging rights, the school will receive $5,000 to be used to support community partners/programs, along with a commemorative sculpture. The award will be presented at AACP’s Annual Meeting in July. Kudos to Dr. Gina Moore for her commitment in prepar- ing the application submission and coordinating site visits, as well as to the faculty and students who perform these community services throughout the year and those who participated in the site visit presentations.

In This Issue

2-4 Fourth-year pharmacy student Megan Student Life Wary vaccinates a Stock Show attendee. 6-9 Pharmacists Tread Carefully Into the World of Medical Cannabis NATIONAL WESTERN Pharmacy students provided free flu shots, as well as health screenings to nearly 2,500 attendees at this year’s National Western Stock Show. Health screenings included height and weight measurements, BMI, blood pressure, blood glucose, 10 vision and an oral health screen. In addition to helping the community, the students get a chance to work with other health Car-T Therapy May be Cost professions students and provide health education and information to people who may not otherwise have access to care. Effective 11-13 Tackling the Opioid Epidemic 14-16 Alumni Corner Welcome :

DISCOVERING

HERBY DANA BRANDORFF FUTURE

ara Azimi comes from a family that pharmacists work closely with and of medical professionals and encouraged her to explore the field of CU alums who have helped pharmacy. her determine a career path Working at the Apothecary, beginning that is right for her. While her junior year at CU-Boulder, helped so- both of her parents and sister are in the lidify her pursuit of a career in pharmacy. Sphysical therapy field, and her brothers Under the tutelage of her pharmacist su- n this edition of Pharmacy Perspectives, you are physicians, Sara has chosen a different pervisors, “I saw how they interacted with will celebrate our school’s achievements and health care path. She will be entering CU patients, answered their questions, and I recent awards including the AACP Lawrence C. Skaggs’ PharmD program in the fall of became advocates for them. I saw how Weaver Transformative Community Service Award, 2018 to pursue her dream of becoming their open communication reassured the which recognizes our school for programs that go a pharmacist. patients about taking their medications. beyond the traditional role of academic pharmacy; Her interest in pharmacy was affirmed This really inspired me.” learn about our alumni and how they are impact- at a young age. In addition to her exposure to the ing the world through volunteering; discover “My favorite subject in high school was field as an assistant at the Apothecary, how pharmacists are treading into the medical biochemistry,” says Azimi, “AP Biology Sara drew on her brothers’ knowledge marijuana landscape nationally; and uncover the taught me about this microscopic world and experience, too. According to Azimi, research that that our faculty are conducting on of molecules and how medications can be “They both mentioned how awesome the value of a new cancer therapy. used to interact with this world in order their pharmacists are and how much they You will be transported to Cambodia to experi- to cure diseases and eliminate ailments.” depend on them as practicing physicians.” ence a service learning opportunity that one of our Azimi recalls sharing her enthusiasm Having shadowed and worked with clin- pharmacy students participated in during summer for the subject with her siblings. Her ical and retail pharmacists, Sara was also break, and see pharmacy through the eyes of high brother, Ehsan, who was a medical stu- able to experience firsthand the value of school students interested in health care careers. dent at the time, said that was something a pharmacist on the health care team. We encourage you to learn more about our school and the people who make it a success. For those who have graduated and those who, work, study and learn here, there is much to celebrate. And remember, keep in touch as we want to hear from you. Make sure to check out our blog site at www.cupharmacyperspectives.org and remember to follow the school on our social media channels listed below:

@CUpharmacy | @cupharmacy /15098479 | @cupharmacy UCDSchoolofPharmacy

Sincerely,

Ralph J. Altiere, PhD Dean, University of Colorado Skaggs School of Pharmacy and Sara Azimi Pharmaceutical Sciences

2 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

CU Connections BY DEVIN LYNNE

n 1976, Yolanda Azimi graduated from the University of Colorado with a bachelor’s degree in physical therapy, starting a family tradition of attending CU. Yolanda was a The Azimi Family first-generation college graduate and has in- Istilled the importance of a high-quality education in her children. Now, her sons, Ehsan (’06) and Hassan EHSAN (’09), and daughters, Mariam (’14) and Sara (’18), 2006 CU Boulder summa cum laude in have all attended CU. biochemistry with distinction “Without the support of the Williams Family 2010 Medical College of Wisconsin Foundation, I would not have attended college be- Practices medicine in Boston, MA cause my parents could not afford to send me,” said Yolanda. She was driven by her desire to become a physical therapist and give back to her community. HASSAN Yolanda was determined to make a difference in 2009 CU Boulder summa cum laude in Morgan County, Colo., making her the perfect biochemistry with distinction candidate for support from the Williams Family 2013 CU School of Medicine Foundation. This foundation is dedicated to enhanc- Orthopedic residency at University of ing rural health. She has delivered on that promise California San Diego spending the past 40 years as a physical therapist. The Azimi Family Her career began in the Fort Morgan Community Now, Yolanda continues to practice PT as the Hospital (FMCH) as a physical therapist. After she director of rehab services at Eben Ezer Lutheran MARIAM was married, she worked for three years at Lutheran Care Center. She is also working with CU to help Western State College bachelor’s degree Medical Center in Denver before returning to foster a new generation of health professionals. “I in exercise and sports medicine Morgan County to raise her family while continu- enjoy staying connected to the school that made 2014 CU Physical Therapy Program, ing to practice physical therapy (PT) in the area my career possible and has inspired my lifelong doctor of physical therapy hospitals. Yolanda served as the director of rehab learning,” said Yolanda. In addition to mentoring Practices physical therapy in services at FMCH for another six years, then at physical therapy students, she is giving back to Fort Worth, TX East Morgan County Hospital for 20 years. She also CU Anschutz. helped design the first warm water therapy pool and “To give to CU Anschutz is the best way to be aquatic therapy program in the rural community. To part of moving health care forward in a constantly SARA help recruit and retain physical therapists in rural changing environment. I became a physical ther- CU Boulder neuroscience communities, Yolanda helped develop the PTA apist because I wanted to help people. Giving to Accepted to CU Skaggs School of Program at Morgan Community College and was CU Anschutz is the best way that one person can Pharmacy and Pharmaceutical Sciences a clinical instructor for PT/PTA students. help many people.” class of 2022

INVEST IN STUDENTS. TRANSFORM THE FUTURE.

Stories similar to the Azimi family’s are made possible by generous supporters. By giving to scholarships, you are helping students realize their dreams and focus on their education. These students will soon become leaders in pharmacy, transforming the field.

When you give to the School of Pharmacy 100th Anniversary Scholarship Fund, you invest in the future of pharmacy.

To support scholarships at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, visit giving.cu.edu/pharmacyscholarships or call 303-724-8227.

www.ucdenver.edu/pharmacy 3 Student Life:

P-3 Pulkit Jain, standing second from left, pictured with fellow volunteers in Cambodia.

nstead of taking some time off living in a country where we don’t have to walk between his second and third-year, several miles to get medical treatment,” he said. CU Pharmacy student Pulkit Jain During his time there he said he observed turned his summer vacation into a a healthcare system that is in need of some learning opportunity. reform, specifically when it comes to medica- He volunteered in Cambodia, tions. “A lot of the doctors were prescribing Iassisting medical teams under the supervi- antibiotics. They weren’t checking signs and sion of physicians. His cousin, a physician symptoms or if they had an infection.” He and founder of an organization called Save worked with physicians to set up a better pro- Each One, made the opportunity possible. cess to determine what a patient really needs. The organization provides care to rural, un- Jain says the communication skills he’s I KNOW WHAT derserved areas. Jain was the only pharmacy learned as a student at CU Pharmacy came in student in the group. handy during his time in Cambodia, “One of The locations where they provided care were the things I was able to do there was improve YOU DID LAST so remote that Jain and the other volunteers how doctors interact with patients.” would travel up to 14 hours per day just to Even though Jain was there for only two SUMMER reach patients. “From the day I landed and the weeks, he still feels like he made an impact, “I BY STEPHANIE CARLSON first day I got to a site, the first thing that came think I did make a difference. The doctors were to my mind was, we are really fortunate to be truly very appreciative of my help.”

4 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

P-4 Rupa Parikh poses with her winning poster.

A high school student tests her reading comprehension and math skills during the acetaminophen challenge. Student’s Poster Wins Top HIGH SCHOOL Spot at Research Forum STUDENTS RECEIVE t has taken all four years of “wanted to get involved and understand the pharmacy school, but P-4 different paths I could take with pharmacy.” DOSE OF Rupa Parikh has completed At the beginning, she was more interested her study on the availability of in clinical pharmacy, but after her APPE PHARMACY emergency contraception (also (Advanced Pharmacy Practice Experience) known as the morning after rotation at Allergan — a multi-national phar- pill), specifically in Arizona maceutical company that produces branded SCHOOL and Utah. And, her work is and generic drugs, and performs pharmaceuti- paying off. cal research and development — changed her n Feb. 23 - 25, Her poster was selected as the Top Poster mind. That rotation specifically shifted her approximately Ind at the 32 Annual Student Research Forum interest to clinical research. a thousand at CU Anschutz where she competed against Currently, Parikh is completing a manu- Colorado high more than 60 presenters from the Schools script about the EC study with the hopes of school students of Medicine, Pharmacy, Public Health, and being published in the American Journal of descended the Graduate School. The judges said that Public Health. upon the her study was an “important health topic for Renaissance Hotel in Denver for the women, the study was well designed and the Health Occupations Students of results have the potential for addressing emer- STUDY HIGHLIGHTS: America (HOSA) annual state confer- gency contraceptive (EC) access and proper • Access to EC remains a concern despite its Oence. The conference highlights many administration.” over-the-counter status professions in health care and includes To perform the study, Parikh enlisted the • EC was “completely accessible” in half of skills competitions, presentations and help of CU Pharmacy faculty member Laura the pharmacies in Arizona and Utah exhibits. CU Pharmacy was front and Borgelt, PharmD, along with Carol Stamm, • Consumers in Arizona were significantly center with numerous speakers includ- MD, Garth Wright, MPH, Melissa Gamble, less likely to have complete access to EC than ing students, faculty and marketing BA, Leanne Rupp, LCSW, and Rachel consumers in Utah staff who showcased careers, education Johnson, BA. To address accessibility, Parikh • Comprehensive education may benefit all and research in pharmacy. Watch our and those assisting with her study, called over pharmacy employees to reduce EC access HOSA highlights video on our youtube 1,000 pharmacies in Arizona and Utah. barriers and provide information to prevent channel: www.youtube.com/user/ When Parikh began her study, she unintended pregnancies. UCDSchoolofPharmacy

www.ucdenver.edu/pharmacy 5 Medical Cannabis:

Timothy Wang, security; Briana Nocera, patient access representative; Amanda Labbe, PharmD; Juli Bradley, office manager; Bobby Lavoie, CPhT; Marlene Chasse, CPhT; Slomski; and Geri Ann Bradley, RPh. PHARMACISTS GET IN THE GAME The law permitting the use of medical cannabis in Connecticut was enacted in 2012, and it took two years to work out issues such as how to license dispensaries and pharmacists, where medical cannabis providers would obtain their products, and what conditions would qualify pa- tients for a card. Four more states—Arkansas, Minnesota, New York, and Pennsylvania—went on to mandate pharmacist involvement in the pro- vision of medical cannabis. Though pharmacists are a common thread, the laws vary widely in what qualifying conditions make patients eligible for the program, how pharmacists and prescribers become authorized to pre- scribe or dispense, whether pharmacists or physicians must be onsite at dispen- saries or be available as a consultant only, and more. Here’s how it works in Connecticut. To get a medical marijuana card, Peter Casolino a patient must be diagnosed by a Connecticut physician or advanced practice registered nurse as having one Pharmacists Tread Carefully Into or more qualifying conditions. The only stipulation is that the provider has an active controlled substance the World of Medical Cannabis registration in good standing and has BY RACHEL BALICK; REPRINTED FROM JANUARY 2018 ISSUE OF PHARMACY TODAY WITH access to the Connecticut Prescription PERMISSION OF THE AMERICAN PHARMACISTS ASSOCIATION Monitoring Program. “They don’t need any special cer- tification; they just need to register with the State of Connecticut to cer- he Healing Corner, a medical cannabis dispensary located in Bristol, CT, could pass for tify patients,” Slomski said. To work a spa. A potted sedge and weeping fig tree stand between padded chairs and loveseats. with patients using medical cannabis, The walls are painted a cool taupe, and a blue tabletop fountain softly burbles in the however, pharmacists are encouraged reception area. There’s even a smiling Buddha statue in the consultation room, where to educate themselves by participating David Slomski, PharmD, or one of the other three Healing Corner pharmacists reviews a in continuing education and keeping menu of the dispensary’s offerings to select a product that will best suit a patient’s disease up to date on any developments in the state and treatment goals. But make no mistake—the Healing Corner is devoted to the medical cannabis field. A dispensary care of patients who have tried and failed to find relief through traditional medications. pharmacist must be onsite at the dis- TWhen Connecticut finally allowed medical cannabis dispensaries to begin seeing patients in 2014, pensary facility during business hours. Slomski didn’t waste any time jumping on board. Fresh out of University of St. Joseph School of Pharmacy in Hartford, Slomski—now dispensary manager at the Healing Corner—was eager to seize the opportunity to be an entrepreneur and pioneer in the industry. “My license number is three,” he said. THE LEGAL OUTLOOK IS HAZY Slomski is also chair of the Connecticut Pharmacists Association (CPA) Medical Marijuana Dispensary Joseph Friedman, RPh, MBA, is Academy, a continuing education creator and presenter, and winner of CPA and Pharmacists Mutual’s chief operations officer at PDI Medical, 2015 Distinguished Young Pharmacist Award. a dispensary located in Buffalo Grove, Connecticut was certainly the right place to do it. It was the first state in the nation to mandate that IL. Illinois does not mandate that phar- a registered pharmacist be onsite at all medical cannabis dispensaries. macists be involved with the dispensing

6 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

of medical cannabis, but Friedman has been an active national basis, it continues to be illegal,” said Gina “A lot of the traditional drug information participant and advocate for pharmacists as providers Moore, PharmD, MBA, assistant dean for clinical compendia do not contain information about of medical cannabis and is a frequent presenter at health and professional affairs at University of Colorado marijuana uses or drug interactions. At least the conferences across the country. Skaggs School of Pharmacy and Pharmaceutical evidence is starting to be published, whether or Among pharmacists, one question he said he gets a Sciences in Aurora, CO. not it’s anecdotally. But pharmacists should look lot is, “I’d love to get into this industry. Am I going to Megan Veselov, PharmD, a former New York at different sources of information for potential be taken away in handcuffs?” dispensary pharmacist who is now an instructor at drug interactions for marijuana,” said Moore. “There are questions that have to do with federal law Albany College of Pharmacy and Health Sciences In the absence of good science, pharmacists versus state law, and which one really takes precedence, in Albany, NY, urges pharmacists to stay on top of who treat patients using medical cannabis rely on even in a particular state where medical cannabis is evolving policy, especially at the state level. “There is a each other to solve tenacious problems or share legal,” Friedman said. lack of standardization in laws between states, which cases in which a patient has responded particu- States that allow medical cannabis typically treat it can be confusing for patients and providers. Each larly well to a certain strain, dosage, or delivery as if it were a Schedule II drug, based on the rules and state has different regulations regarding what medical method. It’s a bit of guess and check, but by work- regulations imposed to dispense it—the Oregon Board conditions can be treated using cannabis, dosage forms, ing together, medical cannabis pharmacists have of Pharmacy even officially reclassified it as Schedule II labeling requirements, quantities that can be purchased, put together their own sort of research. in 2010—so it can be used therapeutically. Even so, no and so on,” she said. “When [Connecticut pharmacists] first got one can say for certain how or if the federal government started, we were making educated guesses in will take any legal action against pharmacists and other terms of recommending the appropriate dosage dispensers of what remains a Schedule I drug federally. IT’S NOT EASY BEING GREEN forms and strain types for patients. We did this The picture is even hazier since U.S. Attorney General Federal prohibition also restricts the amount of by leveraging our resources in other countries, Jeff Sessions has indicated his Department of Justice medical cannabis research that can be conducted, like Canada and Israel. They both have federal may be willing to crack down on cannabis. and that’s a major issue for health professionals medical marijuana programs, so they have some “We’ve reached the threshold of more than 50% who are open to treating patients with cannabis double-blinded, placebo-controlled clinical trials of the states [allowing or approving] medical mar- but wary of a lack of scientific evidence. where they’re comparing cannabis extracts to ijuana legislation, but in terms of federal law, the “Doctors and pharmacists aren’t seeing peer-re- conventional pharmaceuticals. So early on and DEA and FDA have refused to reclassify marijuana viewed articles and research studies in their trade even continuously, we’re always scouring the as anything other than a Schedule I drug. So, on a magazines and scientific journals,” said Friedman. publications that hit the shelves,” Slomski said.

Adult- and Comprehensive CBD/low medical-use medical THC product No marijuana regulated laws marijuana law law access law Source: National Conference of State Legislatures

www.ucdenver.edu/pharmacy 7 Medical Cannabis:

“Now that the patient count has grown and “Once I understand the patient and the medi- we’ve been in operation for three years, it’s gotten cations they’re on and the goal of therapy, I make to a point where we’ve been documenting our pa- sure they understand what cannabis is and how it tient outcomes,” Slomski said. “And when we get can help them,” Friedman said. “I go through the a new patient, we do have a little bit of a database different routes of cannabis administration and help where we could see, ‘Okay, this patient’s similar them understand the difference between sativa and demographic, similar symptom relief—these are indica. I talk about the strains and the THC and things that have worked well for other patients,’ and CBD ratios. So, these are quite comprehensive con- that allows us to make a better recommendation for versations—it’s never just a 5-minute thing. There’s our newest patients.” a lot to it.” “There’s a lot of networking and conversations that go on. I don’t know everything, I don’t claim to know everything, but I do reach out and have WHO COULD BENEFIT FROM MEDICAL conversations with those who are more knowl- CANNABIS? edgeable,” Friedman said. Most states with medical cannabis laws limit its use “The problem is standardization—every dis- to patients diagnosed with a predefined set of qual- pensary’s product is different. Manufacturers may ifying conditions. Common qualifying conditions have similar dosages of THC [tetrahydrocannab- are cancer, HIV/AIDS, multiple sclerosis, cachexia Associate Dean Gina Moore, PharmD inol] and CBD [cannabidiol], but the varying or wasting syndrome, glaucoma, amyotrophic lateral and associated symptoms, as the diagnosis of cancer, excipients may potentially alter the absorption, sclerosis (ALS), Crohn disease, and seizures. More ALS, or any chronic disease is accompanied by co- distribution, and metabolism. So it’s very hard to states are beginning to include pain, PTSD, and morbidities like anxiety, depression, and insomnia. extrapolate data in products available in various problems with sleep. Some are less explicit—the Medical cannabis can affect multiple symptoms states. But we’re doing that anyway because it’s District of Columbia and California both allow use across various systems, which affects quality of life,” the best we have,” said Melani Bersten, PharmD, for any condition that cannot be adequately treated said Bersten. a dispensary pharmacist in Minnesota. “Similar by other means and that limits a patient’s ability to Connecticut dispensary pharmacists gained au- to when pharmacists compound medications, we perform activities of daily living. thority to treat pediatric patients with certain condi- understand the basic pharmacologic properties “I did not necessarily expect the diversity of pa- tions in October 2016. “We are currently treating six and hypothesize what will happen in the body. tients finding relief with medical cannabis [in New pediatric patients. We’re using high-CBD cannabis Our only solution under the current legal re- York]. There tends to be a stigma or stereotype of oils or tablets to treat their seizure disorders with strictions is to start low and go slow and prepare individuals who use cannabis, but we really see every some of these medical cannabis preparations that our patients for the experimental nature of the demographic and a wide variety of medical condi- aren’t intoxicating—they don’t have THC, which medicine.” tions,” said Veselov. causes the euphoric effect associated with cannabis “As far as selecting the strains, I know what But there are also patients for whom medical can- use, but they provide the therapeutic effect of CBD,” we have in inventory. I know the species and nabis might not be a good choice. “One of the things Slomski said. the ratios of the cannabinoids and I know what we look out for are any cardiovascular comorbidities, they do, and I know what this patient is trying to because especially with the inhaled cannabis, it could accomplish, and so I make my recommendations decrease blood pressure with a paradoxical increase HOW SHOULD PATIENTS USE CANNABIS? based on that,” Friedman said. “There’s a little bit in heart rate. So any of our cardiovascular patients, “A lot of people’s perception about medical marijuana of trial and error, but we try to minimize the error we’re going to caution them about that,” Slomski said. is what they see on the news. You see file footage from and get to a benefit a lot faster than just throwing “Consulting with patients on their medical can- Colorado, California, where there’s jars of marijuana on products at them and saying, ‘Hey, try this.’” nabis requires assessing the patient’s goals of therapy display, and that’s just not the case,” Slomski said.

said Matt Makelky, PharmD, clinical neurology research CBD OIL AND THE MYTH fellow at University of Colorado (UC) Skaggs School of Pharmacy and Pharmaceutical Sciences. Makelky also OF “NATURAL” CURES works at UC Hospital’s epilepsy clinic. “And the reality is that CBD does interact with some medications, and if think in general people think that CBD and THC are you’re doing this unguided, bad things could happen.” cure-alls and that because they’re natural products, “ Makelky participates in research on CBD’s effect they don’t have drug interactions, there are no on Parkinson disease, using certain products with side effects. I see it all the time online—‘You have reliable properties to “figure out the holy grail a migraine? Try CBD oil,’ ‘You have pain, try CBD oil,’” of doses”—not an easy feat, since DEA places Clinical pharmacy neurology research fellow Matt Makelky, PharmD I

8 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

“Everything that [Healing Corner has] is in the conventional prescription bottles, labeled as a conventional prescription. And there are a lot of other things besides the smokable form—tab- lets, capsules, sublingual preparations like sprays, breath strips, tinctures—and we find that the vast majority of our new patients who are naive to cannabis go to those dosage forms,” Slomski continued. Still, “having an inhaled delivery route—oils for vaporization—is ideal for many of our patients using cannabis for immediate symptom relief,” said Minnesota’s Bersten. “It’s fast-acting [and] avoids the gut and the liver to a greater extent than swallowing cannabis.” Drug interactions are a big factor in making choices about medical cannabis treatment. “Drug interactions have not been very well documented, because unfortunately, with [medical marijuana] being federally illegal, there haven’t been con- “I think we’re just starting to become aware traditional pharmacy, it makes them feel much trolled trials here in the United States to see what of more drug interactions that are possible with more comfortable adding medical marijuana as a the [interactions] are,” said Slomski. marijuana, and we need to treat marijuana like any therapeutic option for their patients.” “We work very closely with physicians for pa- other substance that somebody might be taking and “Medical cannabis is bringing us back to treating tients who are on warfarin and antiepileptic drugs, to get a full history and understand some of the the patient as a whole and supporting patients for especially with the pediatric patients. There’s a adverse effects that might be present,” said Moore. symptom self-management through education, or fairly well-documented interaction between CBD Veselov agrees. “Many patients are utilizing can- referring to a physician as recommended,” Bersten and clobazam (Onfi—Lundbeck), so for any of nabis for their various medical conditions but may added. our patients who are on [Onfi], we always get on be hesitant to be open about it. Cannabis is just like Though Slomski has found an entrepreneurial the phone with the physician to make sure that any other medication, with drug interactions, side outlet and new way to practice pharmacy by work- they keep a close eye on those levels,” Slomski said. effects, and dosing considerations. We need to be ing in the dispensary, seeing patients’ quality of life Friedman also uses caution with patients taking including it in our conversation with our patients improve is what’s most rewarding. drugs that experience has shown could interact and make sure we are as educated on cannabis as “It’s just tremendous when parents tell us their with medical cannabis products. “Corticosteroids, we would be with any therapy,” she said. child was able to either cut back on the amount warfarin, some hospital-administered antibiotics. of traditional antiepileptic drugs that they are on, Certainly, there are additional drug interactions with the supervision of their child’s neurologist, by where something’s going to make you lethargic, and SEEING RESULTS substituting with some of these medical cannabis cannabis can accentuate that,” he said. “Cannabis “Pharmacists are trained to do consultations, re- products,” Slomski said. increases the level or effect of a lot of different med- cord keeping for controlled substances, and keeping “And it’s a great source of pride to have patients ications, and whether that’s going to be clinically [of ] accurate inventories,” Slomski said. “So when with PTSD come in and say, ‘Hey, I slept for 8 hours significant or not is certainly something to have a health care providers realize pharmacists are doing for the first time in 15 years’—something as simple conversation with the patient about.” the dispensing, that this is operated almost like a as that. To hear that from patients, it’s fantastic.”

“cumbersome” regulations on product sources, • Warfarin and said, ‘I’m thinking about using CBD, what do you access, and storage but little guidance on com- • Zonisamide think?’ I would want to know what meds they’re on. pounding. “We don’t want to get it too high and • Eslicarbazepine acetate (Aptiom—Sunovion) And if they’re on any prescription meds, they need to they have toxic effects, or too low and they’re not • Cyclosporine talk to their doctor because there’s just no guidance, getting any relief.” • Calcium channel blockers and the doctor needs to know,” Makelky said. CBD is thought to be an inhibitor of CYP 3A4 • Benzodiazepines “I think the big takeaway point is that CBD is good, and CYP 2D6. Makelky cautions pharmacists whose • Haloperidol (Haldol—Johnson & Johnson) but it’s not benign. It can interact with other drugs, patients are both using medical cannabis and • Atorvastatin (Lipitor—Pfizer) and we don’t understand it enough to where people taking the following drugs—“just to name a few • Simvastatin should be administering it to themselves without any possibilities,” he said. “If I were in the pharmacy and somebody came up physician or pharmacist involvement.”

www.ucdenver.edu/pharmacy 9 Research:

health. They significantly extended the lives of some patients, much more on average, than traditional CAR-T THERAPY, ONE OF THE chemotherapy. “The CAR-T science is beyond NEWEST THERAPIES FOR CANCER, whether the therapies work for cer- tain patients and is now questioning its value,” he said. “CAR-T is prom- MAY BE COST EFFECTIVE ising on the clinical side but there is BY DAVID KELLY some feeling of sticker shock related to the price. Is it worth it? Yes, it seems to be.” esearchers from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Does the cost-effectiveness of Sciences, selected by the non-profit ICER (Institute for Clinical and Economic Review) to therapies matter in the U.S.? estimate the cost-effectiveness of the newly approved CAR-T therapies, have found the clinical “The straightforward answer to benefit may justify the expensive price. that question is yes,” said McQueen, The treatments involve removing immune cells known as T-cells from the patient, genetically PhD, assistant professor of phar- engineering them to kill cancer cells and then putting them back in the body. The therapy is macy. “Insurance companies have known as CAR-T or chimeric antigen receptor T-cell therapy and is FDA approved for some a higher likelihood of providing B-cell cancers, including recurrent childhood leukemia and adult lymphoma. access and payment for therapies REvidence suggests potential great benefit from these therapies, but the treatments are costly. The acute lympho- that are considered good value for blastic leukemia therapy, known as Kymriah, costs $475,000 while the lymphoma treatment, Yescarta, costs $373,000. money.” So ICER enlisted the help of pharmaceutical outcomes research faculty Melanie Whittington, R.Brett McQueen, Campbell, who is director of and Jon Campbell from the CU Skaggs School of Pharmacy to generate evidence on whether the treatments, already pharmaceutical outcomes research approved by the FDA, are cost-effective. graduate track at the Center for The draft report of their findings was published recently on the ICER website. After a public comment period, the Pharmaceutical Outcomes Research researchers in collaboration with ICER, finalized the report and presented the findings at a public forum on March 2, 2018. at CU Anschutz, noted that cost-ef- In the draft report, they compared CAR-T therapies to chemotherapy, taking into account patient survival, quality fectiveness doesn’t mean cheapest of life and health care costs from the health care system perspective over the lifetime of a patient receiving the therapies. and it doesn’t mean denying access. “We take into account the clinical evidence, quality of life data, and health system costs to generate cost-effec- “It’s about ensuring patients have tiveness evidence,” said Whittington, PhD, research instructor at the CU School of Pharmacy. access to high value care while sus- According to Jon Campbell, PhD, associate professor of pharmacy, the cost-effectiveness findings for both CAR-T taining our health system for future therapies were `promising’ and suggested that they may be a good use of our health care resources toward improving generations,” he said.

Jon Campbell Melanie Whittington R. Brett McQueen

10 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

Admiral James Winnefeld speaks about his son’s overdose death during the including the ibuprofen (Advil) and acetamino- “We would never have predicted our son would Dreamland in Denver event phen (Tylenol) you can buy over the counter in fall victim to the scourge,” James Winnefeld said, a drug store. adding the past few months have been “a living hell.” “It’s almost an urban legend that opioids are The Winnefelds thought Jonathan had turned ‘the good stuff,’ the best pain relievers there are,” a corner in his fight with opioid use disorder. He Valuck said. “That’s wrong.” had gone through more than a year of rehab and Valuck is a professor at the CU Skaggs School was excited to begin college. However, he relapsed of Pharmacy and Pharmaceutical Sciences and shortly before starting DU. is the director of the Colorado Consortium for Losing a child to the opioid epidemic puts the Prescription Drug Abuse Prevention. Winnefelds in “a club none of you ever want to be Valuck told the crowd there’s strong evidence a part of,” Mary Winnefeld said. “Unfortunately, that other medication is more effective, despite membership in this club is growing every day.” opioids’ reputation. Rotating ibuprofen and In 2017, an estimated 66,000 Americans died of acetaminophen has been shown to decrease pain an overdose. better than using opioids. That’s true even for The Winnefelds founded SAFE in November, people who undergo surgery or have a painful shortly after James wrote an article in The Atlantic acute injury. about what his family learned while trying to Myths also remain about the safety of opioids. help Jonathan recover. Its goal is to use effective, One is that they can be safely combined with evidence-based action to prevent overdoses and other medications. Opioids suppress breathing, to mitigate the opioid epidemic. and when used with other medications with sim- ilar effects, such as some anti-anxiety medications, TED TALK STYLE they can be lethal. “THE POSTER DRUG OF OUR TIME” “Drug interactions are an extremely important Investigative reporter Sam Quinones literally wrote EVENT FOCUSES and an underappreciated part of this epidemic,” the book on the opioid epidemic. “Dreamland: The Valuck said. A substantial number of accidental True Tale of America’s Opiate Epidemic” is an ency- ON BUSTING overdose deaths occur when opioids are mixed clopedic look at how drug dealers, pharmaceutical with benzodiazepines. companies, doctors, and economic decline combined OPIOID MYTHS The biggest myth of all, Valuck said, is that to create the epidemic. medication can completely eliminate someone’s Quinones had to overcome a misconception of his BY MICHAEL DAVIDSON pain. The right treatment can decrease pain, and own when he started writing “Dreamland.” At first, he the medical community needs to work to correct thought he was telling a true crime story. Instead, he ost of what you know about patients’ expectations. found a more profound story. opioid pain relievers such “We have to quit using the word painkiller, “If you are writing about heroin, you are really as Vicodin and OxyContin because we can’t kill it,” Valuck said. “We need to writing about heroin and who we are [as a country],” is wrong. Your perception figure out how to manage and treat it.” Quinones said. of the type of person who In his view, the loss of community institutions, jobs, becomes addicted to her- and the fraying of America’s social fabric are major Moin and the underlying causes of the opioid and “A LIVING HELL” contributors to the opioid epidemic. The connections heroin epidemics might be wrong as well. Jonathan Winnefeld didn’t seem like the type of that hold communities together have withered, con- Correcting myths and challenging preconcep- young man who would die of an overdose. He came tributing to isolation which feeds addiction. tions were running themes during an evening of from a good family and was about to start college at Quinones recently testified before Congress, TED talk-style presentations about the opioid epi- the University of Denver. But the 19-year-old had and he repeated his message at CU Anschutz. He demic held at the University of Colorado Anschutz battled addiction for years. thinks America needs a program like the Marshall Medical Campus in January. The event, titled Jonathan died in September from an overdose of Plan to rebuild communities that have been dev- Dreamland in Denver, drew nearly 600 people heroin laced with fentanyl. Jonathan’s death came astated by the epidemic. and was organized by the Colorado Consortium three days after his parents helped him move into the People are taking action at the grassroots level by for Prescription Drug Abuse Prevention and dorms at DU, where he was to start his freshman year. raising awareness and devoting more attention to the Emergency Medical Minute. The University The Winnefelds shared their family’s story while prevention and recovery. He’d like to see the federal of Colorado Skaggs School of Pharmacy and introducing a new nonprofit they have founded called government offer more support, especially financial Pharmaceutical Sciences, which is the home of the Stop the Addiction Fatality Epidemic, or SAFE. Their support. Consortium, was one of the event sponsors. hope is that other families learn from their story. “Help them along, give them the funding they need One message the Winnefelds have been sharing is over the long haul, not just one year,” Quinones said. that opioid addiction can affect any family. Jonathan He thinks the grassroots efforts could mitigate the BUSTING MYTHS came from a military family—his father, James, is a re- epidemic and repair the damage it’s caused. There are a lot of myths about opioids, tired admiral and former Vice Chairman of the Joint “I think it’s a magnificent opportunity to correct according to Robert Valuck, PhD. One is that Chiefs of Staff, the second-highest ranking position some things and really make America great again,” they’re more effective than other pain relievers, in the U.S. military. he said.

www.ucdenver.edu/pharmacy 11 Tackling the Opioid Epidemic: Professor Rob Valuck sharing a favorite pastime

T A C K L I N G T H E O P I O I D EPIDEMIC

ur talented faculty are working to solve some of the country’s most pressing health issues, including the widespread opioid epidemic. In the U.S. last year, more than 63,000 people died of a drug overdose, with opioids involved in 75 percent of those deaths. The crisis also hits close to home, with at least 504 deaths in Colorado caused by opioid overdose. OOne of our best and brightest going to a treatment center and being give back leftover medications and minds, Robert Valuck, PhD, RPh told, “sorry, we can only give treatment prevent others from using them is focusing on the opioid epidemic to one out of ten people.” Even with the non-medically. with his research and efforts on be- evidence based treatments that are avail- half of the Colorado Consortium for able, we are woefully below capacity to What gives you hope in the face of Prescription Drug Abuse. By building deal with all of the need that’s out there. this epidemic? strategic partnerships with the con- We have an overdose antidote (nalox- We’re helping sortium’s volunteers at federal, state Can you share how the Colorado one) that works. There are effective change lives. We’re and local levels, Dr. Valuck is bring- Consortium for Prescription treatments that work, and recovery is ing communities closer to solving the Drug Abuse is overcoming obsta- possible. Most importantly, lives can working to raise opioid epidemic. We connected with cles in health care and tackling be saved. This outcome is secured by Dr. Valuck to hear about this critical the opioid epidemic? the treatment providers, policymakers issue and his important work. With almost 500 volunteers includ- and others who are aiming to make a public awareness, ing experts from state and federal difference. People are engaged—they’re Robert Valuck, PhD, RPh agencies and task forces, nonprofit collaborating and talking about the ep- improve education, Graduated From: University of organizations, health care provid- idemic. They really care. We’re working Colorado; University of Illinois at ers to public health officials, we’re across all sectors in the state to do good research, treatment Chicago helping change lives. We’re working work and solve this issue. Interests at CU: Center for to raise public awareness, improve and safe disposal. Pharmaceutical Outcomes Research, education, research, treatment and If you weren’t fighting the opioid - ROBERT VALUCK Pharmacoepidemiology and drug safety safe disposal. One of our initiatives epidemic, what do you think you’d Joined CU: 1994 involves addressing the “medicine be doing? cabinet” problem. Often times, I love to fly fish, so I’d try to make it a What significant hurdles do health unused prescribed opioid pills are living but most likely starve while try- care professionals face in addressing left over in the medicine cabinet, ing. A couple years ago I did a big fish- the opioid epidemic? and then are used by friends or ing trip up in Jackson, Wyoming with Right now, we have a 90 percent treat- family members for whom they my son. There, we floated the Snake ment gap for patients with substance use weren’t prescribed. We’re trying River, through the Teton Mountains, disorders. Theoretically, this situation to get disposal boxes in every com- catching trout. You don’t get anything would be similar to a cancer patient munity in Colorado so people can prettier than that.

12 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

help us build on these successes and make a major impact on this epidemic in Colorado and nationally.” The Colorado Consortium’s achievements include launching a statewide TakeMedsSeriously public awareness campaign, installing medica- tion safe disposal boxes in 36 counties, distributing 2,500 lifesaving naloxone kits to first responders in high-risk counties, and training 2,500 health care providers about safe prescribing and pain management practices. This grant from the Foundation enables the Colorado Consortium to further expand its reach throughout the state and to build a model of prevention that is replicable nationwide. “Prescription drug abuse is not just a Colorado problem. It is a national epidemic,” said Karen McNeil- Colorado Consortium for Miller, president and CEO of the Foundation. “We are interested in Prescription Drug Abuse Prevention, helping change the destructive tra- jectory of this epidemic and want to ensure that future efforts spearheaded Housed at CU Skaggs School of by the Colorado Consortium are as impactful as possible.” Pharmacy, Receives $1.5 Million Combined with a $1 million BY DAVID KELLY grant from the state of Colorado, this funding from the Foundation will ac- celerate efforts to combat the growing substance abuse crisis through a Center for Substance Abuse Prevention, estab- he Colorado Health Foundation has invested more than $1.5 million to advance lished last May at CU Anschutz as a Colorado’s efforts to fight substance abuse and the opioid epidemic plaguing result of Senate Bill 17-193 to build on the state. the Colorado Consortium’s successes The grant supports the Colorado Consortium for Prescription Drug in prevention, education and research. Abuse Prevention, housed at the University of Colorado Skaggs School CU Anschutz Medical Campus of Pharmacy and Pharmaceutical Sciences at the University of Colorado Chancellor Donald M. Elliman, Anschutz Medical Campus. Jr. said the university is committed Robert Valuck, PhD, a professor at the CU Skaggs School of Pharmacy, directs the con- to leveraging the momentum built Tsortium, which was established by Gov. John Hickenlooper in 2013 to coordinate the state’s through the consortium and the response to the misuse of medications including opioid pain medications. center to help Colorado effectively “Our mission is to reduce the misuse and abuse of prescription drugs in Colorado through address the opioid epidemic. policy work, programs and partnerships throughout the state,” Valuck said. “This tremendous “Addressing the opioid epidemic support from the Colorado Health Foundation will speed our efforts to create lifesaving change and preventing substance abuse are throughout our communities and to stem the rising tide of opioid abuse in Colorado.” top priorities, not only for the CU Since the Colorado Consortium’s establishment five years ago, this innovative collaboration Anschutz Medical Campus but for has leveraged state and institutional investments to attract more than $30 million to advance the entire state of Colorado,” he said. its collective mission. The Consortium and its staff have reached 19 of Colorado’s 64 counties “The Colorado Health Foundation’s through partnerships with state agencies, organizations and community coalitions, and have ele- investment in this effort represents a vated Colorado as a leader in successful community engagement for opioid addiction prevention. critical milestone in our progress, and “The Consortium led by Dr. Valuck has laid a strong foundation and has had early success I am confident that we will build upon in addressing the opioid epidemic,” said Ralph J. Altiere, Dean of the CU Skaggs School of our shared commitment and early suc- Pharmacy and Pharmaceutical Sciences. “The Colorado Health Foundation investment will cesses to save lives.”

www.ucdenver.edu/pharmacy 13 Alumni Corner:

In addition to my FDA-specific pharmacy officers that deployed to work, I have responsibilities to the the Middle East to rebuild the drug Commissioned Corps to maintain supply infrastructure of war-torn readiness to deploy at all times in countries, to Liberia to help treat response to emergent public health local healthcare providers infected FROM INFANTRY TO disasters, or to national security spe- with Ebola, and more recently, to cial events, such as when I deployed Puerto Rico to ensure people have PUBLIC HEALTH to provide medical logistics support continued access to life-saving BY LT OFIR NOAH NEVO, CU PHARMACY CLASS OF 2012 to the United Nations General medications in the aftermath of Assembly in 2016. I also engage in Hurricane Maria. It is truly an honor

Note: The views expressed in this article are those of the author and not necessarily those of the US Food and Drug Administration, the US Public Health Service Commissioned Corps, or the Department of Health and Human Services.

s a military combat veteran, I had a strong desire to pursue a career where I could continue serving the greater good. The Commissioned Corps of the US Public Health Service (USPHS) has provided me an incredible opportunity to do so as aA pharmacist. The Commissioned Corps is one of the seven uniformed services of the United States, and consists entirely of commissioned officers with a variety of health professional and scientific backgrounds. USPHS officers are assigned to agencies throughout the Department of Health and Human Services, and several other federal agencies such as the Bureau of Prisons (BOP), Immigration and Customs Enforcement, and US Coast Guard. The top three agencies USPHS phar- macy officers are assigned to are the Indian Health Service, BOP, and the US Food and Drug Administration (FDA). After graduating with my PharmD in 2012 from CU, I commissioned in early 2015. My first and current assign- ment is with the FDA in Silver Spring, MD. I work in the Ofir Noah and Raymond Nevo celebrate their marriage at San Francisco City Hall. Division of Pharmacovigilance, where I am responsible for identifying and evaluating new drug safety signals for psy- chotropic drugs in the postmarketing setting. It is extremely professional activities that exem- and a privilege to be part of such a fulfilling work where I apply my clinical knowledge in a plify the core values of our service strong, compassionate, and devoted unique way, and produce work that results in mitigating – Leadership, Service, Integrity, and team of pharmacists. serious drug safety issues and enables patients to make better Excellence – such as precepting phar- As stated in the March of the informed decisions regarding the medications they take. macy students, or volunteering at a USPHS, “In the silent war against military pharmacy to assist with staff disease no truce is ever seen.” The shortages and maintain my pharmacy United States has many public practice competencies. health challenges that pharmacists What I love the most about can play key roles in tackling, such as being a USPHS officer is that I am providing clinical pharmacy services part of a network of dedicated and to underserved patient populations, talented officers who are passionate ensuring the integrity of the Nation’s about public health and serving drug supply, and evaluating postmar- their country, and who are eager to keting drug safety data. I encourage support each other in meeting our pharmacy students and recent grad- mission of protecting, promoting, uates to consider a career in public

Lt Nevo shortly after being called to active and advancing the health and safety health, as there is plenty of exciting Ofir Noah and Raymond take their vows. duty and graduating from Officer Basic Course. of our Nation. I have met USPHS and impactful work for us to do!

14 CU Skaggs School of Pharmacy and Pharmaceutical Sciences WINTER SPRING 2018

The Meads (Sue, Lauren, Kelly and Tim) at Kelly’s graduation from medical school at the Uniformed Services University for Health Sciences. for inaccuracy and waste.” They have discovered that their pharmacy back- grounds and attention to detail come in handy. In fact, Tim is the stucco master. “The parallels to compounding are remarkable,” comments Mead. “Who knew that there are a lot of similarities between the two skill sets – building homes and the practice of pharmacy?” remarks Mead. Tim is pharmacy director for PharMerica, Inc. a nationwide long term care pharmacy provider, and Sue is director of Pharmacy at The Apothecary Wardenburg Health Center at the University of Colorado Boulder.

Building a home in Juarez. Pharmacy Family Learns R E C E N T L Y Life Lessons and Skills by H O S T E D SCHOOL OF Building Houses Together P H A R M A C Y BY DANA BRANDORFF EVENTS Representing 60 years of CU pharmacy graduates (1954-2014) alumni from our program who live ue and Tim Mead (’79 and ’75 respectively), together with their daughters, have built a and work in the Phoenix area broke strong family bond by building houses for others. “In addition to learning how to roof, bread at Buca di Beppo in November. stucco and cut wood, the experience taught us how to give back, to see that we are part of Co-hosted by Bob Light (’78) and a bigger world, and to reflect on how much we have,” says Sue Mead. Imanibom Etukeren (’14), the event The Meads have helped build dozens of homes in Juarez, Mexico, a Texas border town attracted a dozen alums in the area. located close to El Paso. “In fact, our younger daughter Kelly, has built more houses than Dean Altiere, Associate Dean Laura Tim and I,” says Mead. Having built 16 homes by the time she was a teenager, Kelly would Borgelt and Development Director travel to Juarez by herself – sometimes twice a year – to assist the community. “She learned how to work Jonathan Wanderstock rounded out as a team – an incredibly valuable skill to learn at a young age. I believe that set her up well for her current the attendees. profession as an orthopedic surgeon.” Several CU Pharmacy alumni, and SThe family’s involvement is a direct result of their church – Trinity Lutheran Church – and its association even a couple of incoming students, got with Casas Por Cristo, a not-for-profit whose mission is to build homes, relationships and opportunities. together in Long Beach, CA at the end Dedicated to meeting the physical needs of better housing while meeting the spiritual needs of the recipients, of February. Dean Ralph Altiere and the organization has provided more than 5,000 families with homes throughout Mexico, Guatemala and Associate Dean Laura Borgelt (‘97), Dominican Republic. along with alumni Charles Brown (‘64) According to Mead, “Tim and I are ‘Jacks of All Trades,’ when it comes to house building, but we tend and Katherine Johnson (‘13), hosted the to be in charge of cutting the wood. We have learned to measure twice and cut once as there is no room event at the Sky Room Steak House.

www.ucdenver.edu/pharmacy 15 Nonprofit Organization University of Colorado Anschutz Medical Campus U.S. Postage PAID School of Pharmacy Denver, CO Mail Stop C238 Permit NO. 831 12850 E. Montview Boulevard Aurora, CO 80045 Address service requested

HOW TO REACH US Pharmacy Perspectives – Volume 9, Issue 2 – is published twice a year by the University of Colorado l Anschutz Medical Campus for alumni and friends of the Skaggs School of Pharmacy and Pharmaceutical Sciences. Edited and written by Dana Brandorff unless otherwise noted throughout. Photos by Stephanie Carlson and Dana Brandorff. Design by Ozzmata.com. We welcome your comments, news and story ideas.

University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences C238 12850 E. Montview Boulevard / Aurora, CO 80045 [email protected] / 303.724.4618

UPCOMING OPPORTUNITIES TO MIX, MINGLE AND RECONNECT.

ALL ALUMNI EVENTS: (’68) and Cindi Gelman (’78) are leading the charge Clarissa Manzi (’13) recently announced her for their respective classes. Contact Dana Brandorff at engagement to Tyler Zappia whose nuptials will Alumni Reception and Presentation on [email protected] for more information. be held 8/18/18. Opioid Addiction in Colorado • Date: April 25, 2018, 5:30 – 7:30 p.m. CLASS NOTES: • Featured Speaker: Robert Valuck, PhD Melissa Erin (‘ 13 ) announced her engagement • Where: Antlers Hotel, 4 South Cascade Avenue, to Jason Philipson, an air traffic controller at LAX. Colorado Springs, CO 80903 Melissa is currently an emergency medicine • Cost: $20 (early bird registration) includes hors pharmacist at Cedars Sinai Medical Center in d’oeuvres and two drink tickets Los Angeles. Dinner at Scoma’s Restaurant, San Francisco • Date: May 31, 2018, 6 – 8 p.m. • Where: Scoma’s Restaurant, 1965 Al Scoma Thoai Nguyen Weinstock (’13) and her Way, Pier 47, San Francisco, CA 94133 husband, Jake, welcomed their son, Hudson Anh • Cost: $40 early bird registration, $45 after May 1. Weinstock, on 2/5/18. Includes three course dinner with a starter, entrée and dessert, one drink ticket. R.S.V.P. at ucdenver.edu/healthalumnievents or call 303-724-2518. • Matt Thielbar (’07) was featured in a story in School of Pharmacy Events: the Pueblo Chieftain regarding the closure of Fortieth and 50th year class reunion plans are Centura Health’s Coumadin clinics at St. Mary- underway. So, if you are a member of the Class of Corwin Medical Center and St. Thomas More 1968 or 1978, you’ll want to take note. Ron Kennedy Hospital in Canon City in January.