When People Fail

opi_lance-armstrong_12413.jpg

Handout photo of Lance Armstrong speaking with Oprah Winfrey in AustinI am personally struggling with two pieces of information today.  The first is that Lance Armstrong has come clean with Oprah about his doping scandal.  I had hoped that it was all fabricated by those who were jealous, but alas he is guilty.  I cannot even understand why the leagues (baseball, biking etc...) don't realize that the cost of winning is at ALL costs.  Why not just make these substances all legal and do away with that aspect of what we are capable of doing on our own.  This is 2013.  I would say at this point most sports has seen their very best without enhancement.  What is left?  Enhancement. I know that seems bizarre for a pharmacist to say publicly that doping for sports should be made legal, but that is what I am saying.  As long as it stays illegal, the coaches and trainers and others involved in making the best of the best will go at all lengths to find substances that are not yet known or tested and continue to dope.  It is inevitable.

The other piece of information that I am struggling with today is that a former classmate in pharmacy school (who I will call Ed for his own privacy) has made a deal in pleading guilty in a case that I have had a hard time understanding.

You see, Ed was the type of student in our class who was a man of character.  He was one of the good guys.  I believe he was already married and was in the pharmacy fraternity that was more studious and less partying.  You can imagine that I was in the partying one and you would imagine right.  Ed has a large family now; he has small children and a wife that need him.

Ed has had some legal trouble in which there was some sort of federal charge brought against him for distributing controlled substance (Oxycontin) from his pharmacy.  I don't know how this whole thing began, but apparently it began fairly innocent enough with perhaps one bad decision or perhaps another part of the story that I do not know.  Maybe it was driven by needing money.  Perhaps it was driven by a bad decision further snowballing into extortion by some drug addicted criminals.

Either way, Ed is going to likely go to prison for around five years or so, and my heart breaks for him.

I know that it is easy for many to condemn a man like Lance Armstrong for doping but the bigger offense being the lies he told over the years and nastiness that ensued.  He threatened, sued and was a bully for the most part.  He "beat" cancer of the brain metastasized from testicular cancer, and he founded Livestrong.  There was good to the fame and notoriety even if he came by it by cheating.  Does the means justify the end?  Sometimes?

Fifteen years ago I would have looked at both men making bad decisions and would have spewed my opinion, and it would have been quite judgmental.  I tend to not do that as much because the situation is much more complicated the older I get.  You see, people fail.  People are human - even the most trusted professional, the pharmacist.  The moment that I believe that I am infallible of filling will be the moment where I am the most vulnerable.  We must always strive to do our best.  Do not compromise even for a moment the integrity and good name you have.  It is all you have in the way of public opinion, and in the case of Ed, I was a little saddened to read that he has struck a deal with the government about pleading guilty to one count and going to prison.  He will be sentenced right before this summer, and I dread it for him and his sweet wife and children.

I do hope for a silver lining for Lance Armstrong somehow.  I hope that he is able to look back at his life and see his own shortcomings and how they shaped him into something even better.  Yes, he made a mistake and turned that mistake into a snowball of lies and more denials that took years for him to admit, but there are good things that he has done.

My friend made a mistake and is going to pay the consequence for it by missing five years of his children's lives.  Both of them still are men I can admire for good things in the past and I hope even better things in the future.  Somehow.

 

 

Oxycontin Reformulation and the Heroin Effect

According to multiple news agencies and a letter published by New England Journal of Medicine, former Oxycontin addicts are moving over to a cheaper readily available illegal substance to get high -- heroin.

Effect of Abuse-Deterrent Formulation of OxyContin

N Engl J Med 2012; 367:187-189July 12, 2012

Article

TO THE EDITOR:

In August 2010, an abuse-deterrent formulation of the widely abused prescription opioid OxyContin was introduced. The intent was to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation. We examined the effect of the abuse-deterrent formulation on the abuse of OxyContin and other opioids.

Data were collected quarterly from July 1, 2009, through March 31, 2012, with the use of self-administered surveys that were completed anonymously by independent cohorts of 2566 patients with opioid dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders,4th edition, who were entering treatment programs around the United States and for whom a prescription opioid was the primary drug of abuse (i.e., heroin use was acceptable but could not be the patient's primary drug). Of these patients, 103 agreed to online or telephone interviews to gather qualitative information in order to amplify and interpret findings from the structured national survey.

Effect of Abuse-Deterrent OxyContin., the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled.

Interviews with patients who abused both formulations of OxyContin indicated a unanimous preference for the older version. Although 24% found a way to defeat the tamper-resistant properties of the abuse-deterrent formulation, 66% indicated a switch to another opioid, with “heroin” the most common response. These changes appear to be causally linked, as typified by one response: “Most people that I know don't use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper, and easily available.” It is important to note that there was no evidence that OxyContin abusers ceased their drug abuse as a result of the abuse-deterrent formulation. Rather, it appears that they simply shifted their drug of choice.

Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be in solving the growing problem of opioid abuse.

Theodore J. Cicero, Ph.D. Matthew S. Ellis, M.P.E. Washington University in St. Louis, St. Louis, MO cicerot@wustl.edu

Hilary L. Surratt, Ph.D. Nova Southeastern University, Coral Gables, FL

Crime and Pharmacy

I have been visiting this topic over and over... both on the internet searching around, in the local paper which shouts of a 40-something year old woman who is robbing local pharmacies (with a gun), memories from my own past of being held up at gunpoint, and discussing with a retail pharmacist this past weekend in regards to how unsafe it is. (HERE at least). An article quoted in full:

Local Pharmacies React To Rise In Crime As Demand For Certain Prescription Drugs Escalates

In light of the recent shooting pharmacies are on high alert.

The shooting that took place Sunday morning at Haven Drugs in Medford has caused many local pharmacists to focus on the alarming statistics that crime in pharmacies across the region is skyrocketing, as the demand for certain prescription drugs, namely strong opiate painkillers, is increasing.

Michael Hushin, owner and manager of Lakeland Pharmacy in Ronkonkoma said he has already been robbed at gunpoint about a year and a half ago. He now has controlled substances locked away, has obtained a pistol permit and keeps a baseball bat behind the counter.

The armed robber had come to Lakeland Pharmacy for 80mg Oxycodone.

"The biggest strength they make. It's the major score right off the bat," said Hushin.

He was alarmed about the recent shooting which seemed to fly in the face of all reason.

"This particular case was extremely different, there was absolutely no provocation. I don't even know how you protect against that," Hushin said.

When Lakeland Pharmacy was robbed, a man handed over a note, and then came behind the counter. Hushin said, "He was armed. He wanted one thing; and we tried to give him what he wanted."

Store customer, Jessica Greig, 18, said, "I'm going into the medical field. I would never work in a pharmacy now."

She is also more on guard as a customer.

"If I saw someone sketchy, I would definitely run out of the store," Greig said.

According to Hushin, some stores are considering not stocking certain medications.

"I don't know if I'd go that far. It's not fair to the people who need the medicines," he said.

Hushin said this is the second or third death of a pharmacist that he knows of occurring in the last six months, in the New York area.

"They were all robberies. Some of them very brazen, all related to pharmacy theft for opiates."

Slater Pharmacy's pharmacist Martin Robinson said that while they have never experienced a hold-up in their store, he was still shaken up.

"People don't realize that just by going to work each day your life is in danger," he said. "We're dealing with very desperate people."

The store has some basic precautionary measures in place such as surveillance cameras, asking customers to remove hats and sunglasses, and is considering not stocking certain medications.

"It's hard to be helpful, and deny people at the same time," Robinson said.

"My husband gave me a kiss goodbye because he knew I was coming to the drugstore," said Debbie Breithaupt, a longtime customer of Slater Pharmacy. "It hit home. It's just another place they made us feel unsafe."

Rick Ammirati, owner of Friendly Drugs, said he hasn't experienced any increase in criminal activity, or heard of anything unusual in the area. He does, however, have friends in the industry that have had robberies.

"It just puts you on high alert to take a second look at everybody that comes in now," said Ammirati. "It's heightened awareness."

 

------------------------

 

There IS a rise in pharmacy crime. It IS riskier to be a retail pharmacist today than thirty years ago.