National Association of Boards of Pharmacy® February 2010 / Volume 39 Number 2

newsletter National Association of Boards of Pharmacy® February 2010 / Volume 39 Number 2

aid to government the profession JCPP ‘Future Vision’ Sets Course for Advancement the public of Pharmacy Practice 1904 to 2010 The Joint Commission been aimed to ensure of Pharmacy Practitioners public health and Upcoming (JCPP) brings together the safety by optimizing Events chief executive and chief the medication use elected officers of national process. Working col- April 13, 2010 pharmacy associations, laboratively through Committee on including NABP, to create the JCPP, leaders in Constitution and Bylaws a forum for discussion and the profession “ac- Meeting opportunity for collabora- knowledged that the April 19, 2010 tive work on issues and pri- focus of pharmacy FPGEE Administration orities of pharmacy prac- must move beyond tice. Established in 1977, the important but narrow among pharmacy organiza- May 22-25, 2010 the JCPP meets quarterly aspect of ‘right drug to the tions and other stakeholders NABP 106th Annual Meeting and forms workgroups that right patient’ and encompass have been formed, and have Hyatt Regency focus on priority projects. the responsibility for assuring helped to shape new state Orange County The JCPP has facilitated that appropriate outcomes are and national legislation and Anaheim, CA strategic planning efforts achieved when medications regulations. For example, that have shaped positive are part of a patient’s indi- JCPP coalitions helped in- July 21-22, 2010 NABP Program Review change in the practice of vidual treatment plan.” This fluence changes that resulted and Training/New pharmacy for more than perception of the function in Medicare’s prescription Executive Officers 30 years, and will continue and responsibility of pharma- drug benefit requirement for Orientation Program to influence pharmacy cy practice helped to facilitate medication therapy manage- NABP Headquarters practice through its vision changes such as the shift to ment services as of 2006. articulated in “Future Vi- a universal doctoral level of sion of Pharmacy Practice.” education, and practice and Future Impact legal changes that have helped Through the “Future Past Impact pharmacists to increase their Vision of Pharmacy Prac- Recommendations result- scope of services. tice,” adopted by JCPP ing from JCPP conferences Also as a result of JCPP member organization and quarterly meetings have collaborations, coalitions (continued on page 26) In This Issue. . . . Legal Briefs: Association News: 2009 Symposium: 106th Annual Professional Share and Share FPGEE Administered Pharmacists, Meeting: Affairs Update: Alike Successfully as Doctors, Scientists, NABP Seeking DEG Poisonings Computerized Format and Policy Makers Poster Session Prompt Reminder in 2009; Applicants Share Viewpoints Participants for 106th to Consult Have Access to Scores on Legalization of Annual Meeting Guidance Online Medical Marijuana Document 28 31 34 42 44 Feature News nabp newsletter

Joint Commission captured in the pharmacy of their practice, pharmacists The NABP Newsletter (continued from page 25) journals.” will achieve public recogni- (ISSN 8756-4483) is The 2015 future vision is tion as practitioners who are published 10 times a executive officers in 2004, detailed in the document in essential to providing effec- year by the National the JCPP will continue to three sections: the founda- tive health care. Association of Boards of influence positive change tions of pharmacy prac- In January 2008, the Pharmacy® (NABP)® to educate, to inform, in the practice well into tice, how pharmacists will JCPP released the final ver- and to communicate the the next decade. The JCPP practice, and how pharmacy sion of “An Action Plan for objectives and programs “Future Vision of Pharmacy Implementation of the JCPP of the Association and Practice,” endorsed by each “As boards of pharmacy, Future Vision of Pharmacy its 66 member boards JCPP member organiza- Practice.” In the plan, the of pharmacy to the tion’s board of directors, I feel that it is also JCPP identifies three critical profession and the envisions what pharmacy imperative for us to areas for initial focus as public. The opinions practice should look like in embrace this future they work toward achiev- and views expressed in 2015, as summarized in the ing the vision. Specifically, this publication do not document’s opening state- vision, and through practice model, payment necessarily reflect the ment: “Pharmacists will be policy, and communication official views, opinions, our statutes and or policies of NABP the health care professionals regulations define and are deemed areas that must or any board unless responsible for providing be articulated and planned. expressly so stated. The patient care that ensures advance that vision in The action plan details suc- subscription rate is optimal medication therapy the context of patient cess factors, objectives, and $35 per year. outcomes.” care and protection of recommended action steps In his incoming speech that should be met for each at the NABP 105th An- the public health . . .” critical area. National Association of Boards of Pharmacy nual Meeting in May 2009, Gary A. Schnabel, RN, RPh, Three workgroups were 1600 Feehanville Drive President Gary A. Schnabel, NABP President formed to focus on each Mount Prospect, IL RN, RPh, endorsed the critical area, helping to 60056 future vision outlined in realize the future vision of 847/391-4406 the JCPP “Future Vision of practice will benefit society. pharmacy practice. The ac- www.nabp.net Pharmacy Practice,” stating, The first section outlines the tion plan document makes [email protected] “As boards of pharmacy, I foundations of pharmacy clear that JCPP anticipates feel that it is also imperative education that prepares more discussions to help Carmen A. Catizone for us to embrace this future pharmacists “to provide align the action steps of the Executive Director/ vision, and through our patient-centered and popula- implementation plan and Secretary statutes and regulations de- tion-based care that opti- the policies of participating fine and advance that vision mizes medication therapy.” organizations. Thus, in keep- in the context of patient care The second section explains ing with the organization’s Larissa Doucette and protection of the public that the pharmacist’s scope is mission, JCPP continues to Communications Manager health. . . If the boards of to include managing medica- implement its initiatives, in- pharmacy can provide the tion therapy, accounting cluding the “Future Vision of regulatory environment that for patients’ therapeutic Pharmacy Practice,” through ©2010 National fosters the vision on behalf outcomes, and promoting the collaborative efforts it Association of Boards of the patient and the pro- patient wellness. The section fosters. of Pharmacy. All rights tection of the public health, also emphasizes that as they The JCPP’s “Future Vi- reserved. No part of then this collective vision work with other health care sion of Pharmacy Practice” this publication may be reproduced in any of practitioners and regula- professionals, pharmacists and “An Action Plan for manner without the tors will serve as one of the will be the most trusted Implementation of the JCPP written permission of pillars of a new foundation source of medications and Future Vision of Pharmacy the executive director/ for the practice of pharmacy supplies, and the primary Practice” can be downloaded secretary of the National first proposed some 30 years resource for advice regarding from the National Alliance Association of ago and discussed ad nau- medication use. Finally, the of State Pharmacy Asso- Boards of Pharmacy. seam every year since those last section stresses that, by ciations’ Web site at www words were first spoken and realizing the expanded scope .naspa.us/vision.html.

26 Feature News february 2010 NABP, State, and Federal Actions Help Fight Executive Cybercrime Linked to Internet Drug Outlets Committee

On November 30, of such brand abuse. As ‘Canadian Pharmacy’ Rich Palombo 2009, the Federal Trade verified by Internet security Internet security experts Chairperson Commission (FTC) an- experts and the prosecu- and anti-spam researchers One-year term nounced the charges and tors in the recent FTC case, have identified Web sites Gary A. Schnabel settlements – topping $15.15 Canadian pharm spam touting the name “Canadi- President million – against two indi- campaigns are capable of an Pharmacy” as the oldest, One-year term viduals behind an expansive sending massive volumes largest, and most spammed William T. Winsley international spam network of spam e-mail because of Internet drug outlets. By President-elect responsible for promoting the they are run by organized some estimates, in Sep- One-year term fraudulent “Canadian Health- crime networks and employ tember 2009, 60-70% of Malcolm J. Broussard care” brand name. Spamhaus, sophisticated technological spam promoted the fraudu- Treasurer an independent anti-spam methods. lent Canadian Pharmacy One-year term research group, called this “brand,” which is part of a Karen M. Ryle network the largest “spam Using ‘Canada’ to network affiliate program. Member, District 1 gang” in the world. FTC, Lure Patients Such programs provide Serving third year of a Food and Drug Administra- Spam promoting sup- links, Web page templates, three-year term tion (FDA), and Centers for posed Canadian online and the e-mail addresses to Elizabeth Scott “Scotti” Disease Control and Preven- pharmacies, which are be spammed to their affili- Russell tion (CDC) continue to fight trusted as safe by some ates. Affiliates then direct Member, District 2 such cybercrimes through Internet consumers hoping traffic to those Web pages Serving third year of a investigations, warning let- to purchase discount drugs, through spammed links, three-year term ters, and public awareness in fact, makes up the largest and they receive commis- Michael A. Burleson efforts. Several state boards of portion of spam promoting sions on any resulting sales. Member, District 3 pharmacy and states’ attorney questionable online phar- Stefan Savage, an associate Serving second year of a general offices have also taken macies, and spammers use professor of computer sci- three-year term steps to fight rogue Internet deceptive domain names ence and engineering at the Gregory Braylock, Sr drug outlets and raise aware- and brandjacking tactics University of California, Member, District 4 ness. And, in addition to to lure consumers to click San Diego, and Cisco’s chief Serving second year of a actions taken to fight rogue on links to fraudulent Web security researcher, Patrick three-year term Internet drug outlets, NABP sites. In fact, the October Peterson, told Network Lloyd K. Jessen has undertaken several initia- 2009 Spam Report from World, a publication for Member, District 5 tives to help educate, and thus McAfee states, “Canada is network and IT profession- Serving third year of a help protect, the public from the largest victim of brand als, that Canadian Phar- three-year term related cybercrimes. identity theft in the world.” macy may be linked to the Joseph L. “Joe” Adams The January 2010 NABP In reality, most of these GlavMed affiliate program. Member, District 6 Newsletter reported on the fraudulent Web sites are In fact, Peterson indicated Serving first year of a rise in cybercrimes – such not hosted in Canada, nor that GlavMed.com is fueled three-year term as malware attacks, phish- do the millions of spam by the infamous Storm Cathryn J. Lew ing schemes, and online e-mails promoting “Cana- botnet, a vast network Member, District 7 identity theft – that are fa- dian” pharmacies originate of personal computers Serving first year of a cilitated by deceptive spam from Canada. This decep- compromised with soft- three-year term e-mail messages promoting tion puts at serious risk ware that enables hackers Hal Wand questionable pharmaceuti- those United States pa- to send spam (See January Member, District 8 cal Web sites. As explained, tients, who – despite federal 2010 NABP Newsletter). He Serving second year of a such crime is also facilitat- regulations – seek Canadian explained to Network World three-year term ed by deceptive brand name online pharmacy products that the Storm botnet NABP Executive Committee abuse and cybersquatting, that they perceive to be as makes a request to GlavMed elections are held each year and Canadian pharmacies safe as US pharmacy prod- every hour to acquire spam at the Association’s Annual suffer the highest volume ucts, at a fraction of the cost. (continued on page 30) Meeting.

27 Legal Briefs nabp newsletter Share and Share Alike By Dale J. Atkinson, JD

oards of pharmacy are created and found that an affidavit of empowered to protect the public by another expert for the pa- B tient created a factual issue carrying out the intent of the legislation that precluded summary to regulate the profession in the interest judgment in favor of the of public protection. Regulatory boards licensee. While the matter was are state agencies and enjoy numerous awaiting a trial on the mer- legal powers and protections designed to its, the licensee surrendered allow enforcement of the laws, while at the his medical license to the Nebraska Department of same time recognizing the legal rights of Health and Human Servic- the applicants and licensees. Examples of es (DHHS) in resolution of board powers and protections include the an administrative investigation. DHHS had alleged right to issue, deny, and renew licenses; that during the years 2000 fully investigate allegations of wrongdoing; through 2008, the licensee gather and present evidence at a formal engaged in inappropriate sexual touching of other hearing; and discipline or sanction patients during non-gy- individuals found to have violated the necological examinations. laws, all under the protection of immunity The licensee waived his rights to a hearing, pleaded in the event of a challenge to the process. no contest to the allegations, and surrendered his Past newsletter articles accused of negligence in a license for a minimum of have addressed the impor- medical malpractice case, two years. tance of coordinating inves- specifically failing to diag- Based upon the tigations with law enforce- nose and treat a spinal cord licensure surrender in an ment authorities to ensure injury resulting in continu- administrative proceeding, that evidence gathered ing pain and discomfort the patient amended her will be admissible in the in the patient’s back. In a civil complaint in the mal- event the matter proceeds previous decision, the Ne- practice proceedings and to a trial or administrative braska Supreme Court af- sought to obtain through hearing on the merits. In firmed a lower court ruling discovery the complaint addition to the interplay that excluded the patient’s and investigative files of the between the criminal and expert witness, but reversed DHHS which resulted in administrative investiga- and remanded the lower the licensure surrender. The tions is the use or admis- court’s ruling that awarded patient also sought to take sibility of evidence and/ summary judgment in a second deposition of the or convictions (or judg- favor of the licensee. Sum- licensee to inquire about ments) previously secured mary judgment allows for a the licensure surrender and in administrative and/or judicial ruling without the the acts which precipitated criminal proceeding(s) in necessity of a trial in that the administrative prosecu- subsequent civil matters there are no issues of fact tion. In short, the patient (eg, malpractice). Consider in dispute and the court argued that she did not give the following. can rule on matters of law. informed consent to allow An emergency room In its previous ruling, the the licensee to render medi- physician (licensee) was Nebraska Supreme Court cal care because the licensee

28 Legal Briefs february 2010

did not disclose his “com- 3. whether the additional credential holder (licensee). pulsions and unfitness” to information related to The court noted the closed the patient. The licensee the licensee’s unpro- session rights of the boards argued against turning over fessional conduct was regarding disciplinary the requested documents relevant to the civil mal- actions and immunity in that the administrative practice proceedings. provided to boards, board complaint and investigative The court reviewed the members, and report- files were irrelevant to the procedural issues relative to ing persons or entities, all civil proceedings and were the filing and administra- in an effort to promote statutorily privileged. tive prosecution of licensees the reporting of alleged The lower court judge accused of wrongdoing wrongdoing in the inter- overruled the objections of under the practice act. The est of public protection. It the licensee and continued Attorney General’s Office held that the legislature did the civil malpractice trial determines whether to file not intend to protect the so that additional discovery a petition with the DHHS credential holder (licensee) could be conducted regard- against a licensee based from discovery of the ing the allegations and upon a complaint. As set underlying facts supporting surrender of the licensee’s forth under law, the peti- disciplinary proceedings medical license. The tion, once filed, becomes a after the attorney general licensee sought a judicial public record. If there is a has filed a petition. Finally, order from the Nebraska contested hearing, the com- the court stated that to Supreme Court in the form plaint and investigative ma- enforce the privilege under of a mandamus preventing terials that are made part of these circumstances would the additional discovery. the record are also public produce an absurd result The court first ad- and subject to disclosure. as the patient has already dressed that a mandamus Further, reports within the waived her rights through is an action at law whereby investigative materials are the filing of the malpractice a writ is issued compelling public to the extent they litigation. the performance (or non- are admitted and become a In so recognizing the performance) of certain part of the record of a con- right of the patient to acts upon a lower court. A tested hearing. But if ma- conduct further discovery, writ of mandamus can also terials are not included in the court also held that be imposed upon a person the contested hearing, the the patient had the right or corporation. The person DHHS’s incident reports, to request and review the seeking the mandamus has underlying complaints, and reports and other docu- the burden of proof and investigative records are mentation in the possession must establish clearly and statutorily privileged from of the DHHS and acquired conclusively the entitle- discovery. in the investigation of the ment of the remedy. In the In its analysis, the court administrative proceedings. Attorney Dale J. Atkinson is current matter, the court noted that evidentiary The court held that this a partner in the law firm of narrowed the issues to: privileges are narrowly issue was also disposed of Atkinson & Atkinson, outside 1. whether the patient was construed. It also empha- through the privilege analy- counsel for NABP. entitled to additional sized that the privilege sis noting that the licensee discovery on informa- statutes do not run to the was not a party to the confi- tion held by the board, original source, in this case, dential matters, he was the 2. whether the complaints the licensee. Nor do the subject of the investigation. and investigatory infor- disciplinary statutes indi- Thus, the licensee was not mation held by the board cate the legislature intended entitled to claim the privi- was privileged, and the privilege to protect the (continued on page 30)

29 Feature News nabp newsletter

Cybercrime “Canadian Healthcare” I-SaveRx drug reimporta- Pharmacy patients (continued from page 27) brand used similar spam tion program has been should be aware that most tactics and volume. The adopted for deceptive use. Internet drug outlets claim- templates, the link to be ringleader running this From 2004 to 2009, the ing to be Canadian and spammed, and the e-mail expansive spam network, a I-SaveRx program, created selling prescription medica- addresses to spam. New Zealand citizen resid- by the state of Illinois, oper- tions to US patients are not Spamtrackers.eu, an ing in Australia, and his ated online with the intent providing drug products anti-spam research or- accomplice, a US citizen, to save enrollees money by approved for sale in Canada ganization, describes the recruited spammers from reimporting prescription to Canadians. In fact, an layers of fraudulent claims around the world to create drugs from Canada to the FDA report released in made on recent Canadian messages directing users participating US citizens. August 2005 indicated that Pharmacy Web sites. New to Web sites run by the The states of Illinois, Wis- 85% of drugs promoted on versions of these fraudulent Affking affiliate program. consin, Missouri, Kansas, the Internet as “Canadian” Web sites display a logo for According to FTC, the and Vermont participated were actually manufactured a non-existent agency, the spammers deceptively in the program, which in and shipped from 27 American Drug Admin- marketed drugs under operated online at the countries, including India, istration, that mimics the Affking’s Canadian Health- domain name i-saverx. Costa Rica, and Vanuatu. authentic logo for FDA, as care brand, when in fact net. Though the program When circumventing the well as a logo for the non- the products ordered on closed as of February 2009, closed and tightly regulated existent Canadian Inter- associated Web sites were the Web site isaverx.com US supply chain and pur- national Drug Association shipped from India, not now operates and adver- chasing drugs from unap- that mimics the legitimate Canada. The spam made tises services similar to the proved foreign sources, the Canadian International unlawful claims about the former Illinois program. risk of receiving counterfeit Pharmacy Association logo. drug products it marketed, Isaverx.com is included in medication goes up. In addition, sites displayed and the Web sites promoted NABP’s Not Recommended fake VeriSign Secured Seals failed to secure buyers’ list of Internet drug out- Blackmarket B2B and Secure Sockets Layer credit card information. lets as it appears to be out Exchange certificates, in an attempt to Similar domain and of compliance with US Fueling such counter- convince visitors that credit Web site names can make it pharmacy laws and practice feiting, business-to-busi- card transactions are secure. difficult for computer users standards, but the similar ness exchange Web sites As reported in an FTC to discern which Web sites domain name may confuse include marketing for large press release, the recent case are legitimate and which consumers into associating quantities of unapproved against the spammers who are not. For example, the it with the former Illinois active pharmaceutical in- promoted the fraudulent name of the now defunct program. (continued on page 32)

Legal Briefs argued that she would have evidence.” Agreeing with a As evident from this (continued from page 29) asked additional and/or Seventh Circuit case where- opinion, the administrative different questions of the by a criminal defendant complaint and investiga- lege in his attempts to block licensee when conducting was permitted to impeach a tive file may, under certain the discovery of materials discovery had she known witness (psychiatrist) with circumstances, be discover- related to administrative about the administrative evidence that he was about able in a subsequent civil proceedings. action. The court held that to lose his license, the court case involving the licensee. Finally, the court the relevance of matters held that parties generally Of course, while an admin- addressed whether the in discovery is broad, as have a right to discover istrative case is essential information involving the opposed to the relevance information that might to the public protection disciplinary action (sexual of matters attempted to impeach a witness. Thus, mission of the regulatory misconduct from 2000 to be introduced at trial. The the court held, while em- board, civil cases may pro- 2008) was relevant to the standard for relevance in phasizing that such ruling vide an element of deter- malpractice action related discovery includes informa- did not address admissibil- rence and ultimate public to alleged misdiagnosis of tion which “appears reason- ity at trial, that the patient protection as well. spinal injuries in the emer- ably calculated to lead to was entitled to conduct the Stetson v Silverman, 770 gency room. The patient the discovery of admissible requested discovery. N.W. 2d 632 (NE 2009)

30 Association News february 2010 FPGEE Administered Successfully as Computerized Format in 2009; Applicants Have Access to Scores Online

Nearly 2,000 tests were the allotted testing break administered in 2009 to after administering the 2010 FPGEE Administration Schedule foreign-educated phar- FPGEE in April to provide April 19, 2010 macists seeking licenses a more conducive testing September 30, 2010 to practice in the United experience for applicants. States. With roughly 900 Usually lasting about applicants sitting for the six-and-a-half hours, the educational equivalency of FPGEE practice examina- April 14 Foreign Pharma- administration day can applicants’ foreign phar- tion written and developed cy Graduate Equivalency be long; however, appli- macy education and their by NABP and designed to Examination® (FPGEE®) cants are now provided a foreign licensure and/or help familiarize applicants and approximately 1,100 30-minute break between registration status. In addi- with the FPGEE. This Web- applicants sitting for the the morning and after- tion to passing the FPGEE, based practice examina- October 1 examination, noon testing sessions. This applicants are required tion exhibits the types of these administrations break was increased by 15 to demonstrate English questions provided on the marked completion of the minutes beginning with language proficiency by actual FPGEE and sup- first year of the return of the October 2009 adminis- attaining the combination plies applicants with a score the computerized FPGEE. tration. of the minimum passing estimate upon completion of Like the paper-and- Test of English as a Foreign the examination. The cost of pencil examination, the Examination Scores Language™ (TOEFL®) and the Pre-FPGEE is $50. computerized FPGEE was Available Online Test of Spoken English™ Additional informa- administered once in the In addition to taking a scores or the minimum tion regarding the FPGEE, spring and once in the computerized examination, passing TOEFL Internet- FPGEC, and Pre-FPGEE fall; however, applicants applicants now have the based Test score. is available in the FPGEC were able to choose from ability to download their NABP encourages ap- Application Bulletin and in more than 200 Pearson examination scores from plicants preparing to sit the Examination Programs VUE testing sites located a secure Web page acces- for the FPGEE to take the section of the NABP Web within the continental sible from the NABP Web Pre-FPGEE®, the official site at www.nabp.net. United States instead of site, rather than waiting to only three. receive them via mail. This Approximately 75% benefit, which also became Distribution of Applicants of, or 150, Pearson VUE available in 2009, expedites Who Took the FPGEE in 2009 testing sites were utilized the score retrieval process. by the 2,000 FPGEE ap- With this new process, the plicants during the April scores are available within 25% and October 2009 admin- about six weeks of the istrations and each site examination. All applicants held anywhere from one who sat for the FPGEE Western Central FPGEE applicant to 44 ap- in October should now Eastern plicants. This number was have access to their scores a vast change from past through the Web site. years – when an average of Applicants are required 58% 800 applicants were seated to take the FPGEE as a in one testing room. component of the NABP 17% With a smooth transi- Foreign Pharmacy Gradu- tion, the computerized ate Examination Commit- FPGEE has received a tee™ (FPGEC®) certifica- positive response from tion process. The FPGEC In 2009, the eastern third of the United States saw the largest applicants. NABP made Certificate serves as a number of FPGEE applicants, with approximately 58% testing in that one minor adjustment to means of documenting the region.

31 Feature News nabp newsletter

Cybercrime Users should visit the legiti- lic from cybercrimes related medications online, as (continued from page 30) mate Web sites of businesses to the online sales of fraudu- well as the associated risks where they have accounts, or lent pharmaceuticals. of additional cybercrimes. gredients (APIs), which are contact companies directly NABP distributes a bi- NABP continues to reach often sold to produce the before entering private data • monthly report to state • out to the major search drugs distributed through into an online form. and federal regulators, engines, encouraging Internet drug outlets, as Boards of pharmacy and and other patient advo- them to more effectively revealed in Mark Monitor’s their licensees can assist cacy groups, providing filter rogue Internet drug Summer 2009 Brandjack- by reminding patients and updated data on Internet outlets out of their paid ing Index. According to the consumers that federal law drug outlets as well as advertising programs. report, listings on business- prohibits the direct-to- current information on The Internet Pharmacies to-business exchange sites consumer sale of drugs from related topics, such as cy- • section of the NABP selling bulk powdered other countries to patients bercrime trends. Web site helps educate APIs have increased 80%, in the US because they are NABP is also available to the public about the and such sites also sell not FDA-approved, and thus • assist in educational pre- dangers of buying drugs unapproved branded pills. their safety and efficacy can- sentations. For example, online and provides Further, listings from these not be guaranteed. in December 2009, NABP links to related patient suspicious sources include Patients who do wish staff delivered a presenta- information. advertisements for unap- to purchase drug products tion focused on the role proved generic versions of through Internet pharmacies that rogue Internet drug State Actions patent-protected drugs. can be advised to consult the outlets play in the rise of Several state boards of (VIPPS®) Verified Internet prescription drug abuse pharmacy – including Ohio, User and Consumer Practice Pharmacy Sitescm in the US at a Prescription Idaho, Delaware, Kansas, Protection section of the NABP Web Drug Abuse Summit in Kentucky, New Mexico, Wyo- As McAfee and other site, which also includes a Bismarck and Fargo, ND. ming, and Vermont – help to security services warn, the list of Not Recommended NABP is developing educate their members and best protection against Internet drug outlets. • educational materials licensees about fraudulent cybercrimes is for com- to help pharmacists Internet drug outlets and puter users to avoid clicking NABP Actions and other health care related activity through par- on links in spam e-mails, NABP has undertaken practitioners educate the ticipation in the NABP state regardless of where the mes- several initiatives to help public about the dangers newsletter program. Many sage appears to originate. educate and protect the pub- of purchasing prescription state boards of pharmacy

Senate Votes Against Proposed Federal Drug Importation Law

Federal law guiding care Distribution Manage- tion program and the vast domestically and then drug importation came ment Association and Food resources that it would exported to foreign under discussion again, and Drug Administration require. countries. The MEDS as Senator Byron Dorgan (FDA), argued that impor- Similar legislation has Act passed, but was not proposed in December tation programs risk public been introduced to Con- implemented by the US 2009 an amendment to al- health safety by allowing gress several times over the Department of Health low personal prescription patients to receive drugs past decade. and Human Services. medication importation as not approved by FDA and The Medicine Equity and The Pharmaceutical Mar- part of the Patient Protec- by increasing the risk that • Drug Safety Act of 2000 • ket Access Act of 2003 tion and Affordable Care counterfeit and adulter- (MEDS Act) would have would have allowed indi- Act. Proponents of the law ated medications enter the allowed pharmacists and viduals to import certain believed it would provide domestic supply chain. FDA wholesalers to reimport drug products. In the patients with lower-cost, Commissioner Margaret into the United States, summer of 2003, the act safe prescription medica- Hamburg also emphasized FDA-approved prescrip- passed in the House, but tions. Opponents of the the difficulty of imple- tion medications that died before it was passed law, including the Health- menting such an importa- had been manufactured by the Senate. As indicat-

32 Feature News february 2010 also display on their Web state newsletter. At that time, prescriptions for commonly issued a public alert regard- sites a link to the Internet one pharmacist and one phar- abused prescription medica- ing a phishing scam in which Pharmacies section of the macy had licenses revoked tions to be based on a docu- the fraudulent e-mail mes- NABP Web site. Kentucky due to this practice. mented patient evaluation. sage claimed to be from CDC and North Carolina require In Kansas, investigation North Dakota passed similar and informed recipients of Internet drug dispensers in by agents from the Attorney legislation which specifies the need to register for a those states to be accredited General’s office led to the that a face-to-face exam by statewide, CDC-sponsored by VIPPS. The Ohio, North closing of an Internet drug the prescribing practitioner H1N1 vaccination program. Dakota, and New York state outlet in March 2008, and the is required for patients wish- In reality, if a user clicked boards of pharmacy also for- conviction of the pharmacist ing to purchase prescrip- the link provided, malicious ward information about In- in May 2009 and the phar- tion medication through an code was downloaded to the ternet drug outlets to NABP; macy owners in November Internet pharmacy. user’s computer. NABP investigates these sites 2009. In 2003, a disciplin- Anti-spam research and forwards this data to ary action taken by the Iowa Federal Actions groups, NABP, and other FDA. NABP encourages the Board of Pharmacy led to a FDA, FTC, and CDC organizations, have also boards of pharmacy to share six-year criminal prosecution continue to take measures partnered with these gov- any information or concerns in which federal authorities against the online marketing ernment agencies to work they may have pertaining to found evidence that Union of fraudulent pharmaceuti- toward locating and foiling Internet drug outlets. Family Pharmacy had illegally cals and related cybercrimes. cybercriminals, including Board of pharmacy dispensed more than a million For example, OnGuard On- large networks of organized hearings and investigations prescription pain, diet, and line is a government-spon- Internet criminals. How- by states’ attorney general psychiatric medications over sored program educating ever, since the methods of offices have helped to deter a six-month period for two computer users about avoid- cybercriminals help keep illegal dispensing and sales of Florida-based Internet com- ing online identity theft and them elusive, raising aware- prescription drugs through panies. The prosecution led to other cybercrimes. OnGuard ness and educating users Internet drug outlets. The the convictions of 26 people in Online, www.onguardonline about the risks of becoming Ohio Board held hear- a US District Court. .gov, provides free buttons a victim to pharmaceutical- ings regarding pharmacists Recent state legislation and banners that link to its related cybercrime remains who accepted offers to fill also helps to protect patients Web site. CDC also helps to one of the most effective prescriptions for question- purchasing medications on- alert the public about new ways to protect patients able Internet pharmacies, as line. “Justin’s Law,” passed in Internet crimes and scams. from this public health reported in its February 2008 Minnesota in 2008, requires On December 1, 2009, CDC threat.

ed in a 2003 “Statement ferred to committee and Japan, New Zealand, or which allowed for per- of Administration Policy” cleared from the records Switzerland within one sonal drug importation from the Executive Office without being considered year. This act was referred met with much debate in of the President, the Bush by either the House or to committee and died. Congress, and the Senate administration strongly Senate. The Pharmaceutical voted against the pro- opposed the act due to In 2004, Senator Dorgan • Market Access Act was posed legislation with 48 drug safety and efficacy • introduced the Pharma- reintroduced in Janu- votes opposed and 51 in issues related to reim- ceutical Market Access ary 2009, and proposed favor of passing the law; porting medications. and Drug Safety Act regulations permitting 60 votes were required The Medicare Prescrip- of 2004, which would pharmacists, pharma- to pass. While Presi- • tion Drug Improvement have allowed personal cies, and wholesalers to dent Obama supported Act, introduced in 2004, importation of prescrip- import qualifying drugs reimportation legislation aimed to lower prescription drugs by registered from certain countries as part of his presidential tion costs for Medicare exporters or registered into the United States. campaign, the current patients, and included importers from Canada The act has been referred White House adminis- provisions to allow the within 90 days of passage, to committee. tration warned against reimportation of medi- and from Australia, Eu- The December 2009 the proposed amend- cations. The act was re- ropean Union countries, proposed amendment, ment.

33 2009 Symposium nabp newsletter Pharmacists, Physicians, Scientists, and Policy Makers Share Viewpoints on Legalization of Medical Marijuana

More than 120 board of marijuana debate including The Federal Status of Sabet noted that some pharmacy members, prac- a detailed explanation of the groups took the Depart- titioners, and other stake- pharmacological attributes Marijuana ment of Justice decision to holders in the practice of of the cannabis plant. Cur- Kevin Sabet, PhD, no longer use its resources pharmacy gathered to dis- rently, he is working under special advisor for policy to pursue prosecution of le- cuss the issues surrounding grants from the National In- and strategic planning for gitimate users and distribu- the legalization of medical stitutes of Health and major the Office of National Drug tors of medical marijuana marijuana. With this issue pharmaceutical companies Control Policy (ONDCP), in states that have legalized as the focus of the first day to isolate compounds from discussed the federal stance such activities as a sign that of the NABP Symposium, herbal cannabis in order to on medical marijuana the Obama administration held December 3-4, 2009, develop drugs. Mackie is stating that marijuana is, is softening its stance on attendees heard about the especially focused on the en- and will continue to be, a marijuana as a Schedule pros and cons of medical docannabinoid system and Schedule I controlled sub- I substance. Sabet stated marijuana from physicians, how it works in the body. stance. Sabet told attendees that this interpretation is pharmacists, federal and Mackie explained that that the decline of youth completely “off base,” and, state regulators, advocates, cannabis is a complex drug use that began in 1997 in fact, ONDCP Director R. and other pharmacy pro- mixture of compounds, ended in 2009 and youths’ Gil Kerlikowski, President fessionals. including delta-9-tetrahy- perceived risk of drug Barack Obama, and Vice Kenneth Mackie, MD, drocannabinol (THC), as use is declining. Drugged President Joe Biden have all Linda and Jack Gill Chair well as other compounds. driving has also become a said that moving marijuana of Neuroscience and pro- He stated that THC pro- problem, he said. A recent to Schedule II is a “non- fessor in the Department duces its effects by interact- study showed that 16% of starter.” of Psychological and Brain ing with the endocannabi- night time, weekend drivers Sciences at Indiana Univer- noid system, and that there tested positive for marijua- Should Marijuana be sity Bloomington, began the are very real differences na. He noted that 10% of a Medical Option? day’s programming with between oral THC and people who use marijuana Barry D. Dickinson, an overview of the medical medical marijuana. become dependant. PhD, the American Medical Association’s (AMA) director of science and biotechnology and the secretary of the AMA Council on Science and Public Health, discussed a recent AMA report on medical marijuana. Based on AMA’s findings, the 2009 report concluded the following: • The AMA supports Presenters Provide an In-depth Look at Medical Marijuana drug approval by federal During the early morning portion of the session Legalization of Drugs: Is the Time Right for Medical scientific and regulatory Marijuana?, attendees were provided with facts about the medical use of marijuana and current federal review to establish laws regarding marijuana, as well as the policies certain health care associations and organizations have safety and efficacy, and in place. Pictured from left to right: Alice Mead, JD, director of United States professional relations, GW appropriate standards for Pharmaceuticals; Barry D. Dickinson, PhD, director, Science & Biotechnology, and secretary, Council identity, strength, quality, on Science and Public Health, American Medical Association; session moderator Gary A. Schnabel, RN, purity, packaging, and RPh, NABP president; Kenneth Mackie, MD, Linda and Jack Gill Chair of Neuroscience and professor, labeling, rather than by Department of Psychological and Brain Sciences, Indiana University Bloomington; Kevin Sabet, PhD, ballot initiative or state special advisor for policy and strategic planning, Office of National Drug Control Policy; and Caren Woodson, MPP, director of government affairs, Americans for Safe Access. legislative action. (continued on page 36)

34 2009 Symposium february 2010 Public-Private Partnerships Offer Many Opportunities for Resource-Challenged Boards of Pharmacy

On the second day of the with trained personnel NABP Symposium, which to handle the project. was held December 3-4, This group must under- 2009, attendees gathered to stand the actual cost of learn about public-private the project, not just the partnerships and how price, but rather the value. boards of pharmacy can Sometimes a project might benefit from such arrange- mean spending more up ments. Richard Norment, front, but the long-term MA, executive director of value of the project should the National Council for be worth more than the Public-Private Partnerships, initial expenditure. began the day with an over- 3. Detailed Business Plan/En- view of what public-private forceable Contract: Rather partnerships are and gave than specifying a design Symposium Session Attendees Learn of Current some examples of partner- to the private sector, the Public-Private Partnerships ships on both the state and public sector needs to pro- Richard Norment, MA, executive director, National Council for federal levels. Norment vide performance expec- Public-Private Partnerships (left), provided attendees with an explained that public-pri- tations. If the project does overview of the concept of public-private partnerships as well vate partnerships are “joint not meet the agreed upon as details on current and proposed programs during the Friday ventures” or “collaborative metrics then the public early morning segment of the session Public-Private Partnerships: practices” as opposed to sector can withdraw from Stimulus Packages for Dwindling State Resources. This portion of privatization, which gives the agreement because the the session was moderated by Hal Wand, MBA, RPh, member, NABP Executive Committee (right). all assets and control to the contract will be void. private company. Further, 4. Guaranteed Revenue in a public-private partner- Stream: The public sector each sector’s motivation. Foundation, shared her ex- ship, resources from both must recognize that the The private sector does periences with public-pri- the public and private sec- private sector needs to not enter into public- vate partnerships including tors are combined, yet the be able to earn back the private partnerships as those of the Arizona Early public maintains control. money spent up front. a result of philanthropy; Education Funds, the Af- He noted that public- 5. Stakeholder Support: private companies will fordable Housing Initia- private partnerships do not Communicating with only take projects that tive, and education reform. answer all problems, but stakeholders is critical; are worth their while. The success of all of these they can leverage resources. if the public does not Norment concluded programs, she said, hinged Norment listed six keys understand why the that while public-private on leadership within the to making a public-private partnership is being partnerships are not always community, advocacy partnership work. formed, there will be easy, they can be a valuable groups, buy-in from prac- 1. Statutory and Political En- backlash. option. Such partnerships titioners in the field, clear vironment: It is important 6. Pick Your Partner Care- are often a means to cost- ownership, and strategic to have someone with po- fully: Public-private effective programs. Finally, planning. litical power pushing for a partnerships are long- he noted that public-private Next, Kim E. Light, public-private partnership term relationships; so, it partnerships require a PhD, professor at the contract. This is necessary is important to be sure genuine partnership and University of Arkansas for because often there are no that the private com- open communication Medical Sciences College statutes in place to allow pany selected is experi- between the public and of Pharmacy, and executive for public-private partner- enced and provides the private sectors. secretary of the Arkansas ships. best value – not just the Janita Gordon, BS, Pharmacy Support Group, 2. Organized Structure: This lowest price. Also, it is senior advancement officer described the public-private includes a dedicated unit important to remember of the Arizona Community (continued on page 38)

35 2009 Symposium nabp newsletter

Medical Marijuana To produce standardized affairs at Americans for marijuana to obtain its (continued from page 34) starting materials that Safe Access, an organiza- benefits, but rather use a would meet FDA process tion promoting use and vaporizer or take the drug • The future of criteria, medical marijuana research of cannabis, orally. Both Aggarwal and cannabinoid-based would need to be an herbal stated that there is cur- Carter stated that phar- medicine lies in the material grown by clones rently enough research to macists play an important rapidly evolving field under rigorous conditions, support the use of medical role in that pharmacists of botanical drug ideally computer con- marijuana. She called for are the ones who can substance development, trolled greenhouses. Mead government agencies to compound tinctures and as well as the design of added that even if “can- work together to develop a capsules for patients in molecules that target nabis” itself were moved to solution to provide patients addition to providing various aspects of Schedule II, a specific can- safe access to medical counseling on proper use. the endocannabinoid nabis or cannabis-based marijuana. Donald I. Abrams, MD, system. product would need FDA professor of clinical medi- • To the extent that approval to be available by Are These Medical cine at the University of rescheduling marijuana prescription. She con- Miracles? California, San Francisco, out of Schedule I will cluded that development of Sunil K. Aggarwal, stated that through his benefit this effort, such a an effective drug derived PhD, MS-IV, a medical research he has increas- move can be supported. from cannabis takes time. student and researcher at ing evidence of medical • Physicians who comply Recently improved tech- University of Washington marijuana’s antimalignant with their ethical nology and research on the School of Medicine, and effects as well as its anti- obligations to “first do endocannabinoid recep- Gregory T. Carter, MD, inflammatory and antid- no harm” and to “relieve tor system means that we MS, professor of rehabili- ioxant effects. However, pain and suffering” are only at the early stages tation medicine at Univer- he noted, it is difficult to should be protected. of developing modern sity of Washington School study marijuana as a drug Dickinson noted that marijuana medications, of Medicine, discussed the not only due to bureau- while AMA recommends and numerous preclinical successes they have had cratic limitations, but reviewing marijuana’s studies, clinical trials, etc, with patients who were also because it is difficult status as a Schedule I drug, are required. treated with medical mari- to find patients who are this recommendation is Caren Woodson, MPP, juana. Carter noted that willing to participate in not an endorsement of director of government his patients do not smoke studies. state-based medical cannabis programs, but rather is intended to facilitate the development of cannabis- based drugs under the current drug review process. Alice Mead, JD, director of United States professional relations at GW Pharmaceuticals, noted that the FDA process must not be forgotten when considering legalization of medical marijuana. Drug products that are approved through the FDA process Speakers Share their Knowledge of Medical Marijuana are surrounded by a robust Speakers presented real-life examples of successful medical marijuana treatment during the late morning body of data to give a risk/ portion of the session Legalization of Drugs: Is the Time Right for Medical Marijuana? Pictured from left benefit balance for the to right: Donald I. Abrams, MD, professor of clinical medicine, University of California, San Francisco; drug. Currently, she said, session moderator William T. Winsley, MS, RPh, NABP president-elect; Gregory T. Carter, MD, MS, medical marijuana does professor of rehabilitation medicine, University of Washington School of Medicine; and Sunil K. Aggarwal, PhD, MS-IV, medical student/researcher, University of Washington School of Medicine. not fit into the process.

36 2009 Symposium february 2010 A Regulatory Approach to Medical Marijuana Paula Sahleen-Bucking- ham, associate analyst for the California Department of Public Health Medical Marijuana Program, and Ja- cob Appelsmith, JD, special assistant to the California Attorney General, discussed the current status of medical marijuana in California and the related programs. Appelsmith stated that What Are the States Doing? legalization of medical Representatives from state agencies shared how medical marijuana programs have been incorporated marijuana by a state is pos- into their states’ laws and regulations during the early afternoon segment of the session Are We Going sible because each state has to Legalize Medical Marijuana? Pictured from left to right: Jacob Appelsmith, JD, special assistant to the the right to criminalize or attorney general, California Office of the Attorney General;Lloyd K. Jessen, RPh, JD, executive director and not criminalize whatever it drug control program administrator, Iowa Board of Pharmacy, and member, NABP Executive Committee; chooses. California’s Propo- Scott Galenbeck, JD, assistant attorney general, Iowa Office of the Attorney General; session moderator sition 215 is a constitutional Karen M. Ryle, MS, RPh, member, NABP Executive Committee; and Paula Sahleen-Buckingham, associate analyst, California Department of Public Health, Medical Marijuana Program. provision that decriminal- izes possession if the individual has an oral or written illegal firearm possession or a dual class in Iowa. While The Board plans to make recommendation. Addition- methamphetamine produc- marijuana is classified as a a recommendation to the ally, collectively cultivating tion. Schedule I drug, it is also Iowa legislature at a special marijuana for oneself is no This year, Californians classified as a Schedule meeting on February 17, longer considered criminal will be voting on two ballot II drug for those patients 2010. Jessen explained that in that state. initiatives which would qualified to use medical in making this recommen- Appelsmith admitted decriminalize marijuana marijuana pursuant to Iowa dation, the Board will con- to shortcomings in the (medical and non-medical), Code Section 124.206(7)(a). sider many factors regarding language of the proposi- Appelsmith said. These However, there are currently marijuana including abuse tion, which allows each local ballot initiatives permit pos- no rules in place. Recently, potential, medical viability, government within the state session and sale for personal the Board denied a petitioner and the risk to the public. to develop its own rules use of one ounce of mari- request for the reclassifica- Jessen added that Iowa and regulations. As such, in juana, permit cultivation tion of marijuana. Through Governor Chet Culver and areas that lack well thought for personal use of up to 25 the appeals process, the the Iowa Office of Drug out rules and regulations square feet, provide controls board was directed by a Control Policy do not there is widespread abuse related to persons under judge to reconsider its ruling. support the legalization of of Proposition 215. For age 21, and allow for local As such, the Board has held medical marijuana. example, Los Angeles has taxation and regulation of public hearings and is re- Scott Galenbeck, JD, 600 to 1,000 dispensaries, marijuana. searching the science behind assistant attorney general in whereas a more appropriate Lloyd K. Jessen, RPh, JD, medical marijuana. While the Iowa Office of the Attor- number for the city would executive director and drug most citizens they heard ney General, stated that the be less than 100 dispensa- control program adminis- from are in favor of medical legalization issue in front of ries. In areas with wide- trator of the Iowa Board of marijuana, Jessen stated that the Board is not about med- spread abuse, California Pharmacy, discussed the most pharmacists in Iowa ical marijuana, but rather law enforcement focuses on public hearings that are are not in favor of legaliza- is about legalization of all those dispensaries that are underway in Iowa. Due to tion despite the support of marijuana. Galenbeck gave profiteering or are involved an anomaly in the law, he the Iowa Pharmacy Associa- an overview of the litigation in other activities such as explained, marijuana has tion. (continued on page 45)

37 2009 Symposium nabp newsletter Public-Private Partnerships (continued from page 35) partnership of the Arkansas Pharmacist Recovery Net- work (APRN). He explained that APRN receives funding from the Arkansas Board of Pharmacy, but that APRN handles all pharmacist recovery issues and contracts. Additionally, Executive Committee members on APRN have legislative im- Presenters Provide View of Current State Public-Private Partnerships munity from prosecution. The Symposium closed on Friday with a look at current state public-private partnerships and a panel Finally, Joshua M. Bolin, discussion during the late morning segment of Public-Private Partnerships: Stimulus Packages for BA, field services senior Dwindling State Resources. Pictured from left to right: session moderator (Current State Public-Private manager at NABP, ex- Partnership Projects) Elizabeth Scott “Scotti” Russell, RPh, member, NABP Executive Committee; Joshua plained the public-private M. Bolin, BA, field services senior manager, NABP;Kim E. Light, PhD, professor, University of Arkansas partnership that the Asso- for Medical Sciences College of Pharmacy, and executive secretary, Arkansas Pharmacy Support Group; Janita Gordon, BS, senior advancement officer, Arizona Community Foundation; and session moderator ciation has with the Mary- (Panel Discussion) Michael A. Burleson, RPh, member, NABP Executive Committee. land Board of Pharmacy. Like many boards of pharmacy, legislators are asking tions to another party. The provides Maryland with up funds as well as Board the Maryland Board of Maryland Board sought subject matter experts at investigators and staff for Pharmacy to do more with out NABP to perform this a cost savings, and frees other projects. less resources. For example, function. in 2009 the Maryland The Maryland Board Board was to begin enforc- already recognizes VAWDCM Presentation handouts can be found on the ing a law that required (Verified-Accredited NABP Web site at www.nabp.net in the out-of-state wholesale drug Wholesale DistributorsCM) Meetings/Educational Sessions section. distributors to be inspect- accreditation but the ed. To accomplish this, the Board wanted the ability Board would either have to have NABP perform Sponsorships Support Successful to have its own inspectors inspections only. Serving survey the wholesale drug as the Board’s designee, Symposium distributors, get inspec- NABP uses a Maryland NABP would like to thank the following companies tion information on the inspection form, allow- and organizations for their generous sponsorships wholesale distributor from ing the Maryland Board and grants that contributed to the success of the 2009 another board of phar- to have control. NABP Symposium. macy or regulating body, surveyors record their or the wholesale distribu- observations of the facility, • Astellas Pharma US, Inc tor would need to have but the Board makes the • CVS Caremark Corporation an accreditation that was ultimate decision as to if Long Term Care Pharmacy Alliance approved by the Board. the wholesale distributor • None of these options ap- passes inspection. • Medco Health Solutions, Inc peared to be feasible, but During negotiations, Omnicare, Inc language in the regulations NABP determined that it • Pfizer Inc allowed a fourth option could provide its services • for the Board. Specifically, for $850 per inspection. • ScriptPro LLC the phrase “or its desig- This includes surveyor Walgreen Co nee” allowed the Board fees, paper work, and • to outsource the inspec- travel expenses. This

38 Association News february 2010 First Internet-Based MPJE State-Specific Review Provides Convenience and Flexibility; 113 Representatives Participate

NABP held its first a wonderful way for us to the Internet-based format, Internet-based Multistate review Wyoming’s stat- boards do have a defined Pharmacy Jurisprudence utes and rules,” says Mary period of time to access their Examination® (MPJE®) State- Walker, executive director of information. All MPJE par- Specific Review October the Wyoming State Board of ticipants had two full weeks 5-19, 2009, as a means to Pharmacy. to review items. When the increase involvement and Each participating state’s participating state completes development of the exami- operational pool and new its review, NABP closes the nation, as well as to offer a pretest questions are posted board’s Web site access for MPJE State-Specific Review more convenient and flexible on a secure Web site for the examination and security each year to determine the approach for state boards of boards to review; reviewers purposes. appropriateness of items in pharmacy to participate. are able to see only the ques- Although the MPJE State- the MPJE for candidates In the past, the meetings tions that are part of their Specific Review’s format has seeking licensure. In 2010, were held as a three-and- state’s pool. Each participat- changed, the participants’ two additional boards, South a-half day event that took ing board is provided with its objectives have remained Dakota and Oklahoma, will place in different locations own username and password the same. The review still be utilizing the MPJE. These throughout the United and is able to designate promotes the three primary boards will participate in the States, and boards were pro- multiple representatives to responsibilities and goals next scheduled MPJE State- vided the opportunity each complete the work. as the boards review items Specific Review. year to attend a session. As In addition, the Internet- specific to their own state: The MPJE consists of 90 many of the boards experi- based format is designed to 1. review all the newly multiple-choice test questions ence shrinking staffs and be used by multiple users developed questions to that are based on a nationally budgets, the new Internet- simultaneously. For Mary determine which of them uniform blueprint of phar- based format has enabled Inguanti, member of the apply to their state; macy jurisprudence com- boards with limited time and Connecticut Commission of 2. review all questions petencies. The questions are resources the opportunity Pharmacy, this was a helpful currently approved for approved by the state boards to become involved in the way to encourage collabora- their state to ensure all of pharmacy and address review. tion among board staff. “It the items are appropriate; federal law as well as specific Many boards responded was very helpful to permit and laws in each state. with positive feedback on the multiple reviewers to log in 3. ensure all questions ac- The next MPJE State- change to an Internet-based simultaneously for success- curately reflect contem- Specific Review is tentatively format. ful completion of this very porary pharmacy law as scheduled for August 2-16, “It was a very interesting large scope of work,” says it applies to pharmacy 2010. way to do the review and Inguanti. practice. For more information we appreciate all the work While the time frame Currently, 45 boards uti- about the MPJE State-Specific NABP went through to get for boards to complete the lize the MPJE and are asked Review, please contact custserv this up and running. It was MPJE is more flexible with to participate in at least one @nabp.net.

Timely and Reliable Pharmacy News To subscribe, send an e-mail to NABPnews@ Just a Click Away! nabp.net with the word Subscribe written in both Looking for breaking news and time-sensitive the subject line and body of the e-mail from the information relating to pharmacy legislation, address you wish to subscribe. regulations, and competency? Look no further! Questions? Contact custserv@ NABP brings you e-News, a free biweekly electronic nabp.net. Archives of e-News newsletter delivered directly to your e-mail, providing are available in the News up-to-date articles on policy issues and pharmacy section of the NABP Web site practice standards. at www.nabp.net.

39 106th Annual Meeting nabp newsletter Meeting Program May 22-25, 2010 Hyatt Regency Orange County Anaheim, CA

Saturday, May 22, 2010 Noon - 4 pm 1:30 - 6 pm First Business Session Optional Tour: Southern California 9 am - 7 pm Experience 12:30 - 1:30 pm Registration/Information Desk Open Keynote Address (Afternoon free) 2 - 4 pm Joe Flower, Health Care Economist Tuesday, May 25, 2010 Pre-Meeting CPE 4 - 5 pm 7:30 am - 4:15 pm 5 - 6 pm Special Program Registration/Information Desk Open Annual Meeting Orientation 5 - 6 pm 8 - 9 am 7 - 10 pm NABP Executive Director Service Continental Breakfast President’s Welcome Reception Recognition Reception Honoring NABP President 9 - 10:30 am Monday, May 24, 2010 Gary A. Schnabel and his wife Executive Officer and Board Member CPE Tammy 7 am - 2 pm Dinner will be served Registration/Information Desk Open 9 - 10:30 am Dress: business casual Compliance Officer CPE 7 - 8:15 am Sunday, May 23, 2010 NABP/USP Breakfast 10:45 am - 12:15 pm Sponsored by United States Joint CPE 6:30 am - 6 pm Pharmacopeial Convention Registration/Information Desk Open 12:15 - 1:30 pm 8:15 - 10:15 am Lunch Break 7:30 - 8:30 am Joint CPE (On your own) Fun Run/Walk 10:30 am - noon 1:30 - 4 pm 8 - 11:30 am Second Business Session Final Business Session Joint CPE Educational Poster Session – Noon - 12:30 pm 5:45 - 6:45 pm Innovative Public Protection Projects Informal Member/Candidate Awards Dinner Reception Discussion 8 - 11:30 am 7 - 11 pm Hospitality Brunch and Educational Annual Awards Dinner Table Top Display Dress: semiformal

Note: The 106th Annual Meeting schedule is subject to change.

NABP and the NABP Foundation is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. ACPE Provider Number: 205. Participants may earn ACPE-approved continuing pharmacy education credit from NABP. Participants in continuing pharmacy education programs will receive credit by completing a “Statement of Continuing Pharmacy Education Participation” and submitting it to NABP. A validated Statement of Continuing Pharmacy Education Credit will be sent as proof of participation within approximately six weeks. Full attendance and completion of a program evaluation form for each session are required to receive continuing pharmacy education credit and a Statement of Continuing Pharmacy Education Credit.

Continuing Legal Education (CLE) Policy: NABP staff will be available to assist attendees on an individual basis to apply for CLE credit for attending CPE sessions. To apply for CLE credit, attendees must initiate the program approval process in their own states by completing and submitting the appropriate application materials and forms. NABP will provide documentation as necessary.

40 106th Annual Meeting february 2010 Health Care Economist Joe Flower to Provide Expertise on the Future of Health Care During Annual Meeting Keynote Address

Attendees will have the 50 Years of Cardiology,” In addition to author- opportunity to hear from Journal of the American ing three major health care experienced Health Care College of Cardiology (Vol. compendia and several Economist Joe Flower as 35, No. 4, 2000). In addi- hundred articles, Flower he shares his views on the tion, Flower has written is a contributing editor at future of health care during frequently about genomics Health Forum Journal and the NABP 106th Annual and the biotech revolution Physician Executive. His Meeting, to be held May for, among others, Health recent clients include DNA 22-25, 2010, at the Hyatt Central.com and the Amer- .com, the Global Business Regency Orange County in ican College of Cardiology. Network, the World Health Anaheim, CA. Flower is the author or Organization, and the De- Flower, who will speak coauthor of several books partment of Defense. on “Health Care: Better, including Encyclopedia of Flower is also a founding Faster, Cheaper,” has been Computers and Computer member of the International writing, speaking, and History (2000), China’s Health Futures Network. He Information and on- consulting about change Futures (2000), The holds a master’s degree from line registration for the and the future for nearly 21st Century Healthcare San Francisco State Univer- 106th Annual Meeting are two decades. He is principal Leader (1999), and The sity, with postgraduate work available in the Meetings author of, “Technological Encyclopedia of the Future in education at University of section of the NABP Web Advances and the Next (1996). California, Berkeley. site at www.nabp.net.

Registration Now Available for 106th Annual Meeting

The NABP 106th Annual ceive the early registration rates. Both types of registration offer Meeting, Eureka! Partnering to In order to receive these rates, attendees three payment options: Save Public Protection – Boards attendees must register on or 1. Mailing in the payment of Pharmacy and NABP, is fast before April 12, 2010. 2. Using a credit card (American approaching. Taking place May Online registration may be Express, MasterCard, or Visa) 22-25, 2010, the meeting will be accessed via the Meetings sec- 3. Paying in Anaheim held at the Hyatt Regency Or- tion of the NABP Web site at For more information about ange County in Anaheim, CA. www.nabp.net. A printable reg- the 106th Annual Meeting, visit the Attendees are encouraged to istration form is also available Meetings section of the NABP Web register now to ensure they re- for download. site at www.nabp.net.

Around the of Pharmacy. Conradi’s will expire on September • Jason Kizer, PharmD, Association appointment will expire 1, 2012. has been appointed on December 31, 2014. Ronald Wallace has a member of the Board Member • Tennessee Board of Joli Martini, PharmD, been appointed a public Appointments Pharmacy. Kizer’s • has been appointed a member of the Georgia appointment will Mark Conradi, RPh, member of the Delaware State Board of Pharmacy. • expire on January 1, JD, has been appointed State Board of Pharmacy. Wallace’s appointment 2015. a member of the Martini’s appointment will expire on July 6, Alabama State Board 2013.

41 106th Annual Meeting nabp newsletter NABP Seeking Poster Session Participants for th Tips for 106 Annual Meeting Submitting a NABP is currently seek- as schools and colleges of cist, during display times. Poster ing poster session partici- pharmacy, are invited to Posters must coincide with For those interested pants for its Annual Educa- participate. the Poster Session theme, in participating, the tional Poster Session. This Participants may earn “Innovative Public Protec- following is a list of year the poster session will one contact hour (0.1 CEU) tion Projects.” Assembly suggestions on prepar- focus on “Innovative Public of Accreditation Council for time will be available on ing a poster: Protection Projects,” and will Pharmacy Education-ap- Sunday, May 23, from 6:30 - be held during the NABP proved continuing pharmacy 7:45 am. Student presenters • Poster topics must 106th Annual Meeting, May education (CPE) credit for are welcome and must be adhere to the theme 22-25, 2010, in Anaheim, CA. their attendance and partici- accompanied by a licensed “Innovative Public The Poster Session will pation. Please note, present- pharmacist. Pharmacy Protection Projects.” be held Sunday, May 23, ers are not automatically school students will receive Keep the poster title from 8 - 11:30 am, and will qualified for CPE. To earn a free voucher valued at $50 • short, highlighting offer those displaying posters CPE, presenters and partici- to take the Pre-NAPLEX®, the topic. the opportunity to share pants must spend at least one a practice examination for information about their hour interacting with other students preparing for the Make the font size organization’s latest legisla- Poster Session presenters. North American Pharmacist • at least 14 point tive issues, technology, policy Participating boards Licensure Examination®. and double-space development, and/or disci- and schools and colleges Those interested in paragraph lines to plinary cases as they relate to of pharmacy will be pro- participating should contact ensure readability innovative public protection vided with one four-foot NABP Professional Affairs from a distance of projects, with other phar- by six-foot bulletin board, Manager Eileen Lewalski via two to four feet. macy professionals. which should be manned by e-mail at elewalski@nabp State boards of pharmacy a qualified representative, .net by Monday, March 1, Enlist the help of members and staff, as well such as a registered pharma- 2010. • students and/or interns on rotation in your office to prepare the poster. Prepare handouts to • provide an overview Travel Grant Available to Qualified Voting of the poster and/ or additional Delegates for 106th Annual Meeting information including contact NABP is accepting Annual Meeting travel plications be submitted names, should travel grant applications expenses, including air- to NABP Headquarters attendees have for the 106th Annual fare, hotel rooms, meals, prior to the Annual questions. Meeting held May 22-25, taxis, parking, and tips. Meeting. All applicants The display 2010, at the Hyatt Re- The grant does not include will be informed of • should be manned gency Orange County in Annual Meeting registra- whether or not they have by a qualified Anaheim, CA. tion fees. qualified for the grant. representative, State board of phar- Grant applications may For more informa- such as a registered macy qualified voting be obtained from NABP tion on the Annual pharmacist, delegates will have the upon the direct requests Meeting Travel Grant, throughout the opportunity to receive of executive officers of the contact the NABP Ex- duration of the up to $1,500 in grant state boards of pharmacy. ecutive Office at session. monies to assist with NABP requests that ap- [email protected].

42 Association News february 2010 NABP Explains Rogue Internet Drug Outlets’ Role in Diversion and Abuse During Prescription Drug Abuse Summit

NABP recently par- tightly regulated to ensure start selling drugs online. ers. NABP continues to ticipated in a Prescription safety. Outside that circle of Bearing in mind that these research Web sites selling Drug Abuse Summit for protection, however, those affiliate network programs prescription drugs and re- health care professionals, safeguards vanish, and the are behind thousands of port its findings to the state hosted by North Dakota odds of getting counterfeit Web sites selling prescrip- boards of pharmacy, federal Attorney General Wayne or substandard medication tion drugs, it follows that regulators, and interested Stenehjem. The one-day rise substantially. the operators of most In- stakeholders, as well as summit, taking place on Since NABP launched ternet drug outlets have no to the public through the December 8 in Bismarck, its Internet Drug Outlet knowledge of, or concern Internet Pharmacies section ND, and again on Decem- Identification program for, patient safety. of its Web site. The Associa- ber 9 in Fargo, ND, was in May 2008, staff has Drug Enforcement tion engages in and con- convened to create aware- reviewed more than 5,000 Administration (DEA) tinues to seek partnership ness of the rampant abuse Web sites selling prescrip- links the dramatic increase opportunities with other and diversion of dangerous tion medications. Of those, in prescription drug abuse entities to educate health and addictive prescription 96% appear to be operat- in recent years to ease of care professionals and the medications. Addressing ing out of compliance access and has named public on the dangers of more than 600 health care with basic pharmacy laws the Internet as one of the buying prescription drugs professionals in all, NABP and practice standards. biggest culprits. Hydro- online, thereby empowering revealed that most Web Those sites found to be codone is the most com- patients to make informed sites selling prescription noncompliant are listed as monly diverted and abused choices. drugs operate illegally, Not Recommended on the pharmaceutical in the US, Also at the summit, reviewed the criteria for NABP Web site. Internet and Internet drug outlets North Dakota State Board legitimately operating pharmacies accredited sell an inordinate volume of Pharmacy Execu- Internet pharmacies, and by the (VIPPS®) Verified of hydrocodone, among tive Director Howard C. illustrated how rogue Inter- Internet Pharmacy Prac- other controlled substance Anderson, Jr, moderated net drug outlets contribute tice Sitescm or Vet-VIPPScm painkillers. a panel discussion detail- to the problem of prescrip- programs are listed as Rec- DEA tracked 34 known ing the functionality and tion drug abuse. ommended. These Internet or suspected rogue Inter- successes of the state’s There is a common mis- pharmacies have success- net drug outlets and found prescription drug man- conception that prescrip- fully completed NABP’s that these sites dispensed agement program. Other tion medications purchased rigorous 19-point criteria 98.6 million dosage units of presentations provided from any Internet drug evaluation and on-site hydrocodone combination insight on appropriate outlet are safe. The per- inspection to ensure they products in 2006. Con- pain management, ex- ception that prescription adhere to the highest stan- trolled substances account plained law enforcement drugs are safer than street dards for quality assurance for approximately 11% of efforts, and described the drugs contributes to the and patient safety. prescriptions dispensed tragic results of the misuse popularity of their abuse. Patients would be well- by legitimate brick-and- of prescription narcotics. What many patients fail advised to consider who mortar pharmacies. By These presentations are to realize, however, is that is on the other end of an contrast, controlled sub- available on the North when purchasing medi- Internet-based transac- stances accounted for 95% Dakota Office of Attorney cations from unknown tion involving the sale of of prescriptions dispensed General Web site, at www sources online, the quality prescription medications. by these rogue sites. NABP .ag.state.nd.us. and safety of those medi- Virtually anyone with research confirms that con- More information on cations is also unknown. a computer and a bank trolled substances are read- the Internet Drug Outlet Patients have grown to account can sign on to be- ily available online without Identification program is trust prescription medica- come an affiliate of a rogue a prescription. available in the Internet tions in the United States Internet drug outlet net- Knowledge is key to Pharmacies section of the because the manufactur- work, establish a Web pres- protecting the public from NABP Web site at www ing and supply systems are ence using a template, and these high-tech drug deal- .nabp.net.

43 Professional Affairs Update nabp newsletter

DEG Poisonings Prilosec®/Prilosec OTC™ Safe Use Initiative – Collabo- has issued an emergency Prompt Reminder (omeprazole) with Plavix® rating to Reduce Preventable use authorization (EUA) (clopidogrel). When used Harm from Medications,” for the investigational to Consult Guidance properly, both drugs describes the program in antiviral drug peramivir Document provide significant ben- detail and is available for intravenous (IV) in cer- Due to recent reports efit; however, when taken download at www.fda.gov/ tain adult and pediatric on diethylene glycol (DEG) together, Plavix’s ability to downloads/Drugs/DrugSafety/ patients with confirmed poisonings associated with block platelet aggregation UCM188961.pdf. or suspected 2009 H1N1 contaminated glycerin in may be reduced by about influenza infection who pharmaceutical syrups, Food half. Prilosec blocks the FDA Guidance for are admitted to a hospi- and Drug Administration liver enzyme CYP2C19, Compounding tal. Peramivir may only (FDA) advises practitioners to preventing Plavix from Multiple Prescriptions be used for hospital- consult the 2007 “Guidance metabolizing into its active of Tamiflu Oral ized adult and pediatric for Industry Testing of Glyc- form, thereby reducing the patients, based on one erin for Diethylene Glycol.” effectiveness of Plavix. The Suspension or more of the following The guidance recommends Plavix label has been updat- To assist pharmacists reasons: certain precautions should be ed with warnings regarding in meeting demand during The patient is not taken to prevent use of glyc- treatment with Prilosec and shortages of commercially • responding to either erin, or other excipients, such other drugs that may in- manufactured Tamiflu® oral oral or inhaled antiviral as propylene glycol, contami- hibit the CYP2C19 enzyme. suspension, FDA released therapy. nated with DEG. FDA has More information can be “Guidance to Pharmacies When drug delivery by no reason to believe that the found in the November on Advance Compounding • a route other than an United States supply of glycer- press release on FDA’s of Tamiflu Oral Suspen- IV route – eg, enteral in is contaminated with DEG, Web site at www.fda.gov/ sion to Provide for Multiple (absorbed by the but a number of deaths result- NewsEvents/Newsroom/ Prescriptions.” This pub- intestines) or inhaled – ing from DEG-contaminated PressAnnouncements/ lication provides instruc- is not expected to be glycerin have been reported in ucm191169.htm. tions for compounding the dependable or feasible. other countries. FDA advises suspension in advance of For adults only, when that pharmacy compound- FDA Launches Safe receiving prescriptions when • the clinician judges IV ers using glycerin to prepare Use Initiative demand is high, a practice therapy is appropriate drug products either test for On November 4, 2009, FDA considers acceptable if due to other DEG content or ensure that FDA announced the launch the amount compounded circumstances. testing was properly done of the Safe Use Initiative, a is commensurate with the The EUA was issued by the supplier. Information program designed to reduce number of valid prescrip- in response to a request on excipients at risk for DEG the likelihood of prevent- tions reasonably anticipated from the Centers for contamination can be found able harm from medication by the pharmacy within 24 Disease Control and Pre- in a US Pharmacopeia bul- use. Through the program, hours. The update also in- vention, and will expire letin available at www.usp.org/ FDA aims to collaborate with cludes instructions for stor- when the declaration of hottopics/propyleneGlycolSorbi health care professionals and ing, dispensing, and counsel- emergency is terminated tolInformation.html. other stakeholders to identify ing patients regarding the or the authorization is The FDA guidance docu- drugs and drug classes that medication. The guidance revoked by the agency. ment can be downloaded are linked to preventable document is available at www FDA emphasizes that at www.fda.gov/downloads/ harm, and to develop, imple- .fda.gov/Drugs/DrugSafety/ peramivir is the only in- Drugs/GuidanceComplian ment, and evaluate cross- InformationbyDrugClass/ travenously administered ceRegulatoryInformation/ sector interventions to reduce ucm188629.htm. influenza treatment cur- Guidances/ucm070347.pdf. harm. To further advance the rently authorized for use Safe Use Initiative, FDA in- EUA for Investigational under the EUA for 2009 FDA Warns to Avoid tends to hold a series of public IV Antiviral Peramivir H1N1 infections. Use of Plavix with meetings to gather feedback to Treat 2009 H1N1 More information is and will open a public docket Influenza available at www.fda.gov/ Prilosec/Prilosec OTC to receive comments on the NewsEvents/Newsroom/ FDA warns that pa- report and proposed candi- On October 23, 2009, PressAnnouncements/ tients should avoid using date cases. The report, “FDA’s FDA announced that it ucm187813.htm

44 2009 Symposium february 2010

Medical Marijuana For example, one option is (continued from page 37) to phase out the personal production of medical mari- history pertaining to the juana. Additionally, a pilot current medical marijuana program is being discussed legalization case noting that in which patients would need the plaintiff has a history as to go through a pharmacist a marijuana advocate. He to obtain medical marijuana. added that the individual seeking the legalization of Legalizing Medical medical marijuana gave no Marijuana – Creating statutory basis for change. a Slippery Slope? Galenbeck also noted that public opinion on the issue Andrea Barthwell, MD, is shifting, citing a Novem- FASAM, founder and chief NAPRA Shares Canada’s Policies on Medical Marijuana; ber 23, 2009 Washington executive officer of EMGlob- Post article that stated 44% al LLC, and former deputy Speakers Discuss Impact of Legalization in the US of people in the United director for demand reduc- Carole Bouchard, BPharm, MAP, executive director, National Association of Pharmacy Regulatory Authorities (NAPRA)(left), States are for full legalization in the ONDCP, voiced shared her insight on the development of the Marihuana Medical tion – a 13% increase in her opposition to the use Access Regulations in Canada during the early afternoon portion nine years. of medical marijuana. She of the session Are We Going to Legalize Medical Marijuana? In stated that the focus should addition, Eric E. Sterling, JD, president, Criminal Justice Policy What has Canada be on scientific development Foundation (right), and Andrea Barthwell, MD, FASAM, founder and Done? of properties from the plants chief executive officer, EMGlobal LLC, and former deputy director Carole Bouchard, into effective drugs, not- for demand reduction, Office of National Drug Control Policy (not BPharm, MAP, executive ing that breakthroughs are pictured), provided views on how legalizing medical marijuana director of the National pending. Other issues she could impact the United States. This portion of the Thursday early afternoon session was moderated by Karen M. Ryle, MS, RPh, Association of Pharmacy cited include: member, NABP Executive Committee (not pictured). Regulatory Authorities, creating a pathway for discussed Canada’s recent • similar legalization legalization of medical arguments for other drugs of the drug is not a rational juana was rescheduled as a marijuana. Currently, 4,000 like cocaine and heroin; argument. Sterling went on Schedule II drug. For Case patients are approved to lack of accountability in to say that opponents are 2, participants were to con- use medical marijuana and • the manufacturing and against legalization because sider what actions boards of 2,000 doctors are trained to distribution process; if Americans see others us- pharmacy need to take with make recommendations for unsafe delivery systems; ing medical marijuana they medical marijuana remain- patients. • black market profit will decide that marijuana is ing a Schedule I drug. Current operational is- • potential if medical not dangerous as a recre- Those discussing Case 1 sues include the fact that the marijuana is taxed; and ational drug and that any noted that it would be fairly product is home grown and the potential for abuse. behavioral aspects can be easy to follow Schedule II is not approved at a federal • Eric E. Sterling, JD, managed. laws if medical marijuana level with standard quality president of the Criminal became a Schedule II drug; regulations. Additionally, Justice Policy Foundation, Attendees Discuss however, the difficulty lies there is no documentation took the opposite view as Two Scenarios in the fact that currently for doctors on what the Barthwell, stating that the After hearing the presen- there are no products for appropriate dosage is for pa- federal government has tations on both sides of the pharmacists to purchase and tients relative to the patients been rejecting legalization argument, attendees had the dispense. In light of this, a illness or physical make- legislation due to politics, opportunity to participate United States Pharmacopeial up. Bouchard stated that despite scientific proof of in roundtable discussions. (USP) Convention mono- Canada’s current medical the efficacy of marijuana. For Case 1, participants graph would be needed to marijuana system is a quick He stated that the argu- were asked to discuss what help with guidelines for fix and the future of the ment that allowing medical actions boards of pharmacy growers, suppliers, and program is being considered. marijuana will lead to abuse would take if medical mari- (continued on page 47)

45 State Board News nabp newsletter

Alarming Trend in in Ohio. However, a patient Often pharmacists are therapy is appropriate and Ohio’s ‘Accidental’ who is being treated at a the first to detect a physi- reasonable. Drug Poisonings major cancer center clinic cian who begins to stray may really see multiple pre- from patient care into drug South Carolina Board The Ohio Department scribers due to the clinical trafficking. The Board often of Health (ODH) recently rotations of the hospital’s receives complaints from Approves Updates to noticed an alarming trend. house staff physicians. In pharmacists when physi- OTC Compounding In 2008, deaths from “ac- other words, a pharmacist cians begin to prescribe During its September cidental” drug overdoses should not automatically unusual quantities and 2009 meeting, the South exceeded the number of assume that a patient is unusual combinations of Carolina Department of traffic fatalities in Ohio. doctor shopping until they drugs. The Board encour- Labor, Licensing, and Regu- While traffic fatalities have do some checking. ages pharmacists to moni- lation – Board of Pharmacy remained fairly consistent The Board encourages tor this issue and contact approved the reinstatement from year to year, drug pharmacists to use the Ohio the Board when they have of Policy and Procedure overdose deaths have risen Automated Rx Reporting such concerns. No. 133 regarding over-the- at an alarming rate. A large System (OARRS) report to Some indicators that counter (OTC) compound- majority of those overdoses verify the legitimacy of a there may be a problem ing. The following is a list of involve prescription opiates, patient (particularly a new with a physician who treats minimum guidelines: often combined with other patient) who presents a “pain” include patients that 1. Component products drugs or alcohol; however, prescription for a controlled all get the same drug(s) in used in OTC com- opiates are appearing as a substance. The OARRS the same quantities (pain is pounding should be primary cause in most of report is a valuable tool that not like an infection where available to the public. these deaths. In response to gives information (names, one dose fits all); when 2. Compounded product this trend, ODH has started addresses, etc) on the pre- most of the patients receive should be made on a holding local planning scribers and pharmacies used prescriptions for the highest patient-specific need meetings around the state. by that patient. If the patient strengths available (most and kept behind the The Ohio State Board of is receiving controlled sub- patients do well on hydro- pharmacy counter Pharmacy reminds phar- stances from one prescriber codone/APAP 5/325); when under supervision of the macists that they can, and (or one clinic) only, then a the doctor’s parking lot is pharmacist. must, play a role in ad- pharmacist’s comfort level full of cars from out of state 3. Compounded product dressing this epidemic. Ac- with the prescription should or from several counties labels should include cording to Board rule 4729- be better than it would be if away; when you find that active ingredients, 5-20 OAC, pharmacists they found the patient had the doctor only takes cash; strength, dosage, direc- must perform prospective visited 10 prescribers and when the patients always tions for use, expiration drug utilization review on eight emergency rooms in pay you cash for their pre- date, and one of the every prescription filled, the last six months. scriptions (or they pay cash following: including detecting and In addition, the Board for the second prescription a. lot number; resolving issues relating reminds pharmacists that after Medicaid or another b. batch number; to overuse of medica- they need to know the pre- insurer paid for the first); c. control number; or tions. When a pharmacist scribers and the patients. or when the patients appear d. identification determines that a patient is If the patient lives a long in van loads rather than number, as well as receiving opiates from mul- distance away from the individually. appropriate auxiliary tiple prescribers, the phar- pharmacy, it would be pru The Board notes that labels. macist should take steps to dent to question why the the workload in most 4. Patients should receive make sure the treatment prescription is being pre- pharmacies is high and detailed written or is legitimate before dis- sented there. Furthermore, difficult to deal with on a verbal information and pensing the prescription. if the prescriber’s office is daily basis, but reminds counseling with all Often, a patient who is also located a long distance pharmacists that they compounded products. seeing multiple prescribers from the pharmacy as well must use good judgment 5. Records of products is doing so just to obtain as the patient, the ques- when filling prescriptions. provided to patients the drugs. This is defined tion to ask is why does the Pharmacists have a duty to must be maintained in law as deception (doctor patient need to drive there the patients and to society in a readily retrievable shopping) and it is a felony to fill the prescription. to ensure that the drug manner.

46 Association News february 2010

Volunteers Sought for Committee and Task Force Positions NABP is seeking volunteers from interested board staff to volunteer for or task force. All materials will be its active member boards of pharma- NABP task forces. forwarded to NABP President-elect cy to serve on the Association’s 2010- All submissions must be sent to William T. Winsley, MS, RPh, who 2011 committees and task forces. NABP Executive Director/Secretary will make the appointments when Each executive officer and board Carmen A. Catizone by Friday, June he becomes NABP president follow- member interested in serving on a 4, 2010. Letters should outline the ing the Association’s 106th Annual committee or task force is encour- volunteer’s applicable experiences Meeting. For more information on aged to submit a letter of interest and accomplishments, along with the volunteering for a committee or task and a current resume or curriculum reasons he or she wishes to be consid- force, contact the NABP Executive vitae. In addition, NABP encourages ered for appointment to a committee Office at [email protected].

Medical Marijuana marijuana only be distribut- juana remained a Schedule pharmacists would need (continued from page 45) ed through pharmacies with I drug, stated that if phar- to be educated on its use special permits and accredi- macists were to get involved and interactions with other control and distribution tation. One group said that in the movement to allow drugs. Finally, one group of the drugs. One group although boards of pharmacy medical marijuana, boards stated that it is not the place pointed out that some do not regulate pharmaceuti- would need to work with of the boards of pharmacy states allow for compound- cal companies, in the case law enforcement and the US to petition for drug reclas- ing of botanicals through a of medical marijuana the Department of Justice Bureau sification and that as state monograph, but that states boards should promulgate of Alcohol, Tobacco, Firearms regulators they do not want would need to change their rules on the production of and Explosives. All agreed to tell federal regulators laws to include medical medical marijuana. that pharmacists should be how to regulate. marijuana. Furthermore, it Those discussing Case involved if marijuana is used NABP has no position was discussed that medical 2, in which medical mari- for medical purposes and that on medical marijuana.

Newly Accredited DMEPOS Facilities The following facilities were accredited through the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) program:

90th Street Pharmacy Lane Drugs North Scott Pharmacy, Inc Summit Medical Pharmacy New York, NY Brooklyn, NY Eldridge, IA Inc Central-Clearing Drugs, Inc Luna Park Pharmacy, Inc Oatts Drug Company, Inc Summit, IL Chicago, IL Brooklyn, NY Dublin, GA The Heights Community Drum’s Pharmacy, Inc Marcia Pharmacy Osborne Pharmacy and Health Pharmacy Inc Enfield, NC New York, NY Care New York, NY Health First Pharmacy MDS Pharmacy Inc Lynn, MA Total Pharmacy Care Greensburg, KY Skokie, IL Pharmacy Express Pikeville, KY Illini Clinic Pharmacy Mid Concourse Pharmacy Inc Glasgow, KY Wall Drugs of Johnsonville, Silvis, IL Bronx, NY Van Buren, AR Inc Johnsonville, SC IV & Home Health Services New Horizon Pharmacy Corp Porter Pharmacy & Gifts, Inc of Texas Sunnyside, NY Cochran, GA Weirick & Patterson Houston, TX Primacare Plus Pharmacy Inc Pharmacy Inc Norm’s Pharmacy Colfax, IA Tarzana, CA Flushing, NY A full listing of the nearly 1,000 accredited DMEPOS companies representing close to 30,000 facilities is available on the NABP Web site at www.nabp.net.

47 nabp newsletter

National Association of Boards of Pharmacy 1600 Feehanville Drive Mount Prospect, IL 60056

NABP 106th Annual Meeting May 22-25, 2010 See pages 40-42 for details. Quick and easy registration is available in the Meetings section of the NABP Web site, www.nabp.net, under 106th Annual Meeting.