Sample records for prescription drug overdose

  1. Multiple ER Visits Linked to Risk of Prescription-Drug Overdose Death

    MedlinePLUS

    ... Visits Linked to Risk of Prescription-Drug Overdose Death Researcher sees 'important window' of opportunity for intervention ... emergency departments appear to be a predictor of death from a prescription drug overdose, a new study ...

  2. Drug Overdose Deaths, Hospitalizations,

    E-print Network

    MacAdam, Keith

    Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky, 2000 - 2012 #12; Kentucky Injury Preven on and Research Center Drug Overdose Deaths, Hospitaliza ons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Drug overdose deaths, 20002012

  3. Antidiarrheal drug overdose

    MedlinePLUS

    ... containing diphenoxylate or atropine. Diphenoxylate is a weak opioid, a class of drugs which includes morphine and other narcotics. Nonmedicinal use of prescription opioids, in adults and teens, is an extensive and ...

  4. CDC Vital Signs: Prescription Painkiller Overdoses

    MedlinePLUS

    ... agonist therapy. Use prescription drug monitoring programs (PDMPs)—electronic databases that track all controlled substance prescriptions in ... real time data reporting and access, integration with electronic health records, proactive unsolicited reporting, incentives for provider ...

  5. Prescription Drugs

    MedlinePLUS

    ... body, especially in brain areas involved in the perception of pain and pleasure. Prescription stimulants , such as ... of drug that causes changes in your mood, perceptions, and behavior can affect judgment and willingness to ...

  6. Prescription Drug Abuse

    MedlinePLUS

    ... street drugs. Why Do Some People Abuse Prescription Drugs? Some people experiment with prescription drugs because they ... friends — is actually breaking the law. Continue Which Drugs Are Abused? The most commonly used prescription drugs ...

  7. Prescription Drugs and Cold Medicines

    MedlinePLUS

    ... Drugs of Abuse » Prescription Drugs & Cold Medicines Prescription Drugs & Cold Medicines Email Facebook Twitter What is Prescription Drug Abuse: Some medications have psychoactive (mind-altering) properties ...

  8. Prescription Drug Abuse

    MedlinePLUS

    ... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that ... purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include narcotic painkillers, ...

  9. Prescription Drugs Online

    NSDL National Science Digital Library

    Fox, Susannah

    The cost of prescription drugs and related concerns have become issues in politics, and there is a growing interest in learning more about exactly how many American use the Internet to find out about prescription drugs, and additionally, how many Americans may be purchasing prescription drugs over the Internet. The Pew Internet & American Life Project has recently released a 17-page report (authored by Susannah Fox) that highlights the results of a 2200-person telephone survey that took place from May to June 2004 on just this subject. Some of the findings include the observation that close to 64 percent of American households contain a regular user of prescription drugs, and that approximately 26 percent of these households have used the Internet to look for information about prescription drugs. Perhaps the most interesting finding from the report is that 62 percent of Americans think purchasing prescription drugs online is less safe than purchasing them at a local pharmacy.

  10. Trends in Prescription Drug Abuse

    MedlinePLUS

    ... HIV/AIDS Medical Consequences Mental Health Pain Prevention Substance Abuse in Military Life Treatment Trends & Statistics Publications Funding ... Drug Abuse » Trends in prescription drug abuse Prescription Drug Abuse Email Facebook Twitter Trends in prescription drug abuse ...

  11. 76 FR 2691 - Prescription Drug Products Containing Acetaminophen; Actions To Reduce Liver Injury From...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-14

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0021] Prescription Drug Products Containing Acetaminophen; Actions...Unintentional Overdose AGENCY: Food and Drug Administration, HHS. ACTION:...

  12. Prescription Drug Abuse

    ERIC Educational Resources Information Center

    Hamilton, Gloria J.

    2009-01-01

    This article presents current statistics on nonmedical use of both categories of prescription medications by high school and college students. The incidence of nonmedical use of prescription medications continues to increase among high school and college students. Two categories of drugs that are commonly used for reasons other than those for…

  13. Injection drug users trained by overdose prevention programs: Responses to witnessed overdoses

    PubMed Central

    Lankenau, Stephen E.; Wagner, Karla D.; Silva, Karol; Kecojevic, Aleksander; Iverson, Ellen; McNeely, Miles; Kral, Alex H.

    2012-01-01

    In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n=30) trained by two OPPs in Los Angeles were interviewed in 2010–11 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPP. Injecting the victim with naloxone was the most common recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPP, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques. PMID:22847602

  14. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

    PubMed Central

    Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

    2015-01-01

    Objective To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004-09. Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420?386) who received VHA medical services and opioid analgesics. Main outcome measure Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. Results During the study period 27% (n=112?069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. PMID:26063215

  15. Overdose experiences among injection drug users in Bangkok, Thailand

    PubMed Central

    2010-01-01

    Background Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. Methods Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. Results These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). Conclusions Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions. PMID:20465842

  16. Preventing and Recognizing Prescription Drug Abuse

    MedlinePLUS

    ... Abuse » Preventing and recognizing prescription drug abuse Prescription Drug Abuse Email Facebook Twitter Preventing and recognizing prescription drug abuse To ensure proper medical care, patients should discuss ...

  17. Medicare Health and Prescription Drug Plans

    MedlinePLUS

    ... and Prescription Drug Plans Medicare Health and Prescription Drug Plans This data collection covers private plans participating ... weighted) Medicare Advantage: Regional Benchmarks, by Component Prescription Drug Plans: Enrollment Medicare Prescription Drug Plans: Stand Alone ...

  18. Diclofenac sodium overdose

    MedlinePLUS

    Diclofenac sodium is a prescription medicine used to relieve pain and swelling. It is a nonsteroidal anti-inflammatory drug (NSAID). Diclofenac sodium overdose occurs when someone accidentally or intentionally ...

  19. Adolescent Nonmedical Prescription Drug Use

    ERIC Educational Resources Information Center

    Ford, Jason A.; Watkins, William C.

    2012-01-01

    For many adolescents today, the most common form of substance use is nonmedical prescription drug use. Fittingly, many researchers, policy makers, and people who work with youth are concerned about the serious problems associated with nonmedical prescription drug use (NMPDU). In this article, authors Jason Ford and William Watkins provide an…

  20. What Are Some Commonly Abused Prescription Drugs?

    MedlinePLUS

    ... some of the commonly abused prescription drugs? Prescription Drug Abuse Email Facebook Twitter What are some of the commonly abused prescription drugs? Although many medications can be abused, the following ...

  1. Popping Pills: Prescription Drug Abuse in America

    MedlinePLUS

    ... Prescription Drug Abuse in America Popping Pills: Prescription Drug Abuse in America Email Facebook Twitter NIDA recently challenged ... Infographics that present current scientific information about prescription drug abuse in interesting, novel, and creative ways to help ...

  2. Prescription and over-the-counter medication in deliberate self-poisoning and accidental overdosing--preliminary study.

    PubMed

    Szkolnicka, Beata

    2005-01-01

    186 case records of patients who overdosed pharmaceuticals (confirmed by toxicological lab analysis) hospitalized at the Department of Clinical Toxicology during three months of 2000 were analyzed for age, sex, type of medication, reason for poisoning (intentional or accidental overdosing). Patients poisoned with prescription medication (Rx group) were compared with those who overdosed nonprescription (OTC-group) medications (alone or combined with Rx). Relative frequency of medication drug poisoning was highest in the 40-49 age group (28.5%) and was followed by the group of young adults (20-29 years; 24.2%). The lowest frequency (2.2%) was noted in the 60-69 age group. Of 186 cases analyzed, in 163 (87.6%) prescription medication (Rx) and in 23 (12.4%) OTC alone or co-ingested with Rx were involved (chi2 = 63.9; p < 0.001). The Rx and OTC groups were not significantly different as to reason for poisoning (chi2 = 0.7; p = 0.792) with significant overrepresentation of deliberate ingestion in both the group analysed (chi2 = 114.39; p < 0.001 for Rx, and chi2 = 13.49; p = 0.002 for OTC). Most adults attempting suicide used Rx with the highest incidence in the 40-49 age group (31.1%). Adolescents (14-19 years) with female over-representation ingested rather OTC pharmaceuticals (40.9%). Acetaminophen (alone or combined with benzodiazepines or/and ethanol) and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common OTC medications used for deliberate self-poisoning. PMID:16225126

  3. Can naloxone prescription and overdose training for opioid users work in family practice?

    PubMed Central

    Leece, Pamela; Orkin, Aaron; Shahin, Rita; Steele, Leah S.

    2015-01-01

    Abstract Objective To explore family physicians’ attitudes toward prescribing naloxone to at-risk opioid users, as well as to determine the opportunities and challenges for expanding naloxone access to patients in family practice settings. Design One-hour focus group session and SWOT (strengths, weaknesses, opportunities, and threats) analysis. Setting Workshop held at the 2012 Family Medicine Forum in Toronto, Ont. Participants Seventeen conference attendees from 3 Canadian cities who practised in various family practice settings and who agreed to participate in the workshop. Methods The workshop included an overview of information about naloxone distribution and overdose education programs, followed by group discussion in smaller focus groups. Participants were instructed to focus their discussion on the question, “Could this [overdose education and naloxone prescription] work in your practice?” and to record notes using a standardized discussion guide based on a SWOT analysis. Two investigators reviewed the forms, extracting themes using an open coding process. Main findings Some participants believed that naloxone could be used safely among family practice patients, that the intervention fit well with their clinical practice settings, and that its use in family practice could enhance engagement with at-risk individuals and create an opportunity to educate patients, providers, and the public about overdose. Participants also indicated that the current guidelines and support systems for prescribing or administering naloxone were inadequate, that medicolegal uncertainties existed for those who prescribed or administered naloxone, and that high-quality evidence about the intervention’s effectiveness in family practice was lacking. Conclusion Family physicians believe that overdose education and naloxone prescription might provide patients at risk of opioid overdose in their practices with broad access to a potentially lifesaving intervention. However, they explain that there are key barriers currently limiting widespread implementation of naloxone use in family practice settings.

  4. Initiation into Prescription Opioid Misuse among Young Injection Drug Users

    PubMed Central

    Lankenau, Stephen E.; Teti, Michelle; Silva, Karol; Bloom, Jennifer Jackson; Harocopos, Alex; Treese, Meghan

    2011-01-01

    Background Prescription opioids are the most frequently misused class of prescription drugs among young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse among young injection drug users (IDUs) are scarce. Methods An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse among IDUs aged 16 to 25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. Results Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant’s own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common among those who progressed to sniffing and injecting opioids. Conclusion Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use among this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin. PMID:21689917

  5. Substance use - prescription drugs

    MedlinePLUS

    ... kinds of drugs that are misused include depressants, opioids, and stimulants. DEPRESSANTS These medicines are also known ... if they try to stop the drug abruptly. OPIOIDS Opioids are powerful painkillers. They are prescribed to ...

  6. “I Felt Like a Superhero”: The Experience of Responding to Drug Overdose Among Individuals Trained in Overdose Prevention

    PubMed Central

    Wagner, Karla D.; Davidson, Peter J.; Iverson, Ellen; Washburn, Rachel; Burke, Emily; Kral, Alex H.; McNeeley, Miles; Bloom, Jennifer Jackson; Lankenau, Stephen E.

    2013-01-01

    Background Overdose prevention programs (OPPs) train people who inject drugs and other community members to prevent, recognise and respond to opioid overdose. However, little is known about the experience of taking up the role of an “overdose responder” for the participants. Methods We present findings from qualitative interviews with 30 participants from two OPPs in Los Angeles, CA, USA from 2010–2011 who had responded to at least one overdose since being trained in overdose prevention and response. Results Being trained by an OPP and responding to overdoses had both positive and negative effects for trained “responders”. Positive effects include an increased sense of control and confidence, feelings of heroism and pride, and a recognition and appreciation of one’s expertise. Negative effects include a sense of burden, regret, fear, and anger, which sometimes led to cutting social ties, but might also be mitigated by the increased empowerment associated with the positive effects. Conclusion Findings suggest that becoming an overdose responder can involve taking up a new social role that has positive effects, but also confers some stress that may require additional support. OPPs should provide flexible opportunities for social support to individuals making the transition to this new and critical social role. Equipping individuals with the skills, technology, and support they need to respond to drug overdose has the potential to confer both individual and community-wide benefits. PMID:23932166

  7. Can we prevent drug related deaths by training opioid users to recognise and manage overdoses?

    PubMed Central

    Gaston, Romina Lopez; Best, David; Manning, Victoria; Day, Ed

    2009-01-01

    Background Naloxone has been evidenced widely as a means of reducing mortality resulting from opiate overdose, yet its distribution to drug users remains limited. However, it is drug users who are most likely to be available to administer naloxone at the scene and who have been shown to be willing and motivated to deliver this intervention. The current study builds on a national training evaluation in England by assessing 6-month outcome data collected primarily in one of the participating centres. Methods Seventy patients with opioid dependence syndrome were trained in the recognition and management of overdoses in Birmingham (n = 66) and London (n = 4), and followed up six months after receiving naloxone. After successful completion of the training, participants received a supply of 400 micrograms of naloxone (in the form of a preloaded syringe) to take home. The study focused on whether participating users still had their naloxone, whether they retained the information, whether they had witnessed an overdose and whether they had naloxone available and were still willing to use it in the event of overdose. Results & Discussion The results were mixed - although the majority of drug users had retained the naloxone prescribed to them, and retention of knowledge was very strong in relation to overdose recognition and intervention, most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose. The paper discusses the reasons for the reluctance to carry naloxone and potential opportunities for how this might be overcome. Future issues around training and support around peer dissemination are also addressed. Conclusion Our findings confirm that training of drug users constitutes a valuable resource in the management of opiate overdoses and growth of peer interventions that may not otherwise be recognised or addressed. Obstacles have been identified at individual (transportability, stigma) and at a systems level (police involvement, prescription laws). Training individuals does not seem to be sufficient for these programmes to succeed and a coherent implementation model is necessary. PMID:19781073

  8. Treating Prescription Drug Addiction

    MedlinePLUS

    ... 1MB) Online Only Featured Publications Drugs, Brains, and Behavior: The Science of Addiction Marijuana: Facts Parents Need to Know Marijuana: Facts for Teens Heroin ?Research Reports This series of reports simplifies the ...

  9. Non-fatal overdose and subsequent drug treatment among injection drug users

    PubMed Central

    Pollini, Robin A.; McCall, Lisa; Mehta, Shruti H.; Vlahov, David; Strathdee, Steffanie A.

    2013-01-01

    Overdose is a leading cause of death among illicit drug users. 924 injection drug users (IDUs) in Baltimore, Maryland, were interviewed to characterize overdose events and determine the circumstances under which they lead to drug treatment. Overall, 366 (39.7%) reported at least one non-fatal drug overdose. Most (96.2%) used heroin on the day of their last overdose and almost half (42.6%) used heroin and alcohol but few (4.1%) used tranquilizers or benzodiazepines. Five percent were in drug treatment when the overdose occurred and 7.1% had been incarcerated two weeks prior. One in four IDUs (26.2%) sought drug treatment within 30 days after their last overdose of whom 75% enrolled. Speaking with someone about drug treatment after the overdose was associated with treatment seeking (AOR 5.22; 95% CI: 3.12, 8.71). Family members were the most commonly cited source of treatment information (53.7%) but only those who spoke with spouses, crisis counselors and hospital staff were more likely to seek treatment. Not being ready for treatment (69.6%) and not viewing drug use as a problem (30.7%) were the most common reasons for not seeking treatment and being placed on a waiting list was the most common reason for not subsequently enrolling in treatment (66.7%). Of the IDUs treated by emergency medical technicians, emergency room staff, or hospital staff, only 17.3%, 26.2% and 43.2% reported getting drug treatment information from those sources, respectively. Interventions that provide drug treatment information and enhance motivation for treatment in the medical setting and policies that reduce barriers to treatment entry among motivated drug users are recommended. PMID:16310322

  10. Supporting drug prescription through autocompletion.

    PubMed

    Ehrler, Frederic; Lovis, Christian

    2013-01-01

    Computerized prescription is a central component in modern clinical information systems. It allows scheduling drugs delivery, exams and other types of care. It is thought to be a useful tool for the reduction of medication errors and for the improvement of medication logistics. Whereas the success of the computerized prescription depends on the unambiguous selection of the manipulated concepts, there is a strong variability between the preferred terms of clinicians of different backgrounds. Moreover, users sometimes want to use synonyms or don't know the exact spelling of the term. This makes the search for desired procedure name through large size vocabularies time-consuming for users. In order to facilitate the prescriptions process, we have built a tool that proposes the most likely terms based on the first letters inputted by the user. The tool helps selecting the most appropriate term by ranking the possible results in a clever manner. Experimental evaluation shows promising results and indicates the tool ease the terminology manipulations. PMID:23542981

  11. Changing Prescription Drug Sector: New Expenditure Methodologies

    PubMed Central

    Genuardi, James S.; Stiller, Jean M.; Trapnell, Gordon R.

    1996-01-01

    Estimating spending for prescription drugs has become increasingly difficult over the past 15 years as extensive changes have taken place within the retail prescription drug industry. Expenditures for prescription drugs in retail outlets grew rapidly during the 1980s and early 1990s. New retail outlets emerged and existing sites lost market share. New mechanisms for reimbursing drug purchases led to the flow of rebates between manufacturers and insurers, bypassing retailers. These and other major industry changes required the development of new estimating methodologies for tracking prescription drug expenditures within the National Health Accounts (NHA). PMID:10158730

  12. Pattern and Risk Factors for Intentional Drug Overdose in Saudi Arabia

    Microsoft Academic Search

    Hamdan Al-Jahdali; Abdulaziz Al-Johani; Ahmad Al-Hakawi; Yassen Arabi; Qanta A Ahmed; Jamal Altowirky; Salih Binsalih

    2004-01-01

    Background: Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic. Methods: Using

  13. Psychosocial and contextual correlates of opioid overdose risk among drug users in St. Petersburg, Russia

    PubMed Central

    Grau, Lauretta E; Green, Traci C; Torban, Mikhail; Blinnikova, Ksenia; Krupitsky, Evgeny; Ilyuk, Ruslan; Kozlov, Andrei P; Heimer, Robert

    2009-01-01

    Background Opioid overdose in Russia is a problem that has grown more severe as heroin abuse expanded over the past decade, yet few studies have explored it in detail. In order to gain a clearer understanding of the situation, 60 drug users, both in and out of drug treatment in St. Petersburg, were interviewed concerning their overdose experience and knowledge about overdose recognition and prevention. Methods Using a semi-structured interview, we sought to identify and describe local attitudes, knowledge and experience (both self-sustained and witnessed) of opioid overdose. Bi-variate and multiple logistic regressions were performed in order to identify the relationship between overdose experience and sociodemographic factors, risk behaviors, and clinical psychiatric measures. Results We found that having experienced or witnessed an opioid overdose within the previous year was common, overdose knowledge was generally high, but nearly half the participants reported low self-efficacy for effectively intervening in an overdose situation. In bivariate analyses, self-reported family problems (i.e., perceived problematic family interactions) were positively associated with both experiencing (t56 = 2.49; p < 0.05) and with witnessing a greater number of overdoses in the previous year (rhos = 0.31; p < 0.05). Having previously overdosed [Adjusted Risk Ratio (ARR) 1.7, 95% Confidence Interval (CI) 1.1–2.6] and higher SCL-90-R somatization scores (ARR 1.2, 95% CI 0.96 – 1.5) were independently associated in multivariable analyses with self-sustained overdose experience in the past year. Greater perceived likelihood of experiencing a future overdose and concern about medical problems were independently associated with witnessing a higher number of overdoses within the previous year. Over two thirds of the participants expressed interest in receiving training in overdose prevention and response. Conclusion Opioid overdose experience is very common among drug users in St. Petersburg, Russia, and interest in receiving training for overdose recognition and prevention was high. Future research should target the development of effective overdose recognition and prevention interventions, especially ones that include naloxone distribution and involve drug users' families. PMID:19630963

  14. Combating Misuse and Abuse of Prescription Drugs

    MedlinePLUS

    ... get high,” which is an example of prescription drug abuse. Q: What's the difference between misuse and abuse? ... doses than prescribed. That is an example of drug abuse because the person is specifically looking for that ...

  15. Chlorpromazine overdose

    MedlinePLUS

    Chlorpromazine is a prescription medication used to treat psychotic disorders. It may also be used for other reasons, such as preventing nausea and vomiting. Chlorpromazine overdose occurs when someone accidentally or intentionally takes ...

  16. Exposure to prescription drugs labeled for risk of adverse effects of suicidal behavior or ideation among 100 Air Force personnel who died by suicide, 2006-2009.

    PubMed

    Lavigne, Jill E; McCarthy, Michael; Chapman, Richard; Petrilla, Allison; Knox, Kerry L

    2012-10-01

    Prescription drugs for many indications are labeled with warnings for potential risk of suicidal ideation or behavior. Exposures to prescription drugs labeled for adverse effects of suicidal behavior or ideation among 100 Air Force personnel who died by suicide between 2006 and 2009 are described. Air Force registry data were linked to administrative prescription data. Descriptive statistics illustrate utilization: 89 personnel had a prescription history, 35 filled at least one prescription labeled with a warning, 26 had antidepressants on hand at death, and 2 died by drug overdose. Most airmen were not exposed to any prescriptions labeled for risk of suicidal ideation or behavior prior to death by suicide. PMID:22934922

  17. The “Black Box” of Prescription Drug Diversion

    PubMed Central

    Inciardi, James A.; Surratt, Hilary L.; Cicero, Theodore J.; Kurtz, Steven P.; Martin, Steven S.; Parrino, Mark W.

    2009-01-01

    A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine if there are consistent patterns of diversion among various populations of prescription drug abusers. Data are drawn from the RADARS® System, the National Survey of Drug Use and Health (NSDUH), the Delaware School Survey, and a series of quantitative and qualitative studies conducted in Miami, Florida. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted. In all of the studies examined, the use of the Internet as a source for prescription drugs is insignificant. Little is known about where drug dealers are obtaining their supplies, and as such, prescription drug diversion is a “black box” requiring concentrated systematic study. PMID:20155603

  18. Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders.

    PubMed

    Green, Traci C; Bowman, Sarah E; Zaller, Nickolas D; Ray, Madeline; Case, Patricia; Heimer, Robert

    2013-05-01

    Poisonings are the leading cause of adult injury death in the United States. Over 12 weeks in 2011, 143 key informant interviews were conducted using a structured interview guide in three study sites in New England. This analysis focuses on the 24 interviews with emergency department providers, substance use treatment providers, pain specialists, and generalist/family medicine practitioners. Using an iterative coding process, we analyzed statements regarding support and concern about naloxone prescription for pain patients and drug users. The study's implications and limitations are discussed and future research suggested. The Centers for Disease Control and Prevention funded this study. PMID:23647168

  19. Psychotropic drug prescription in rehabilitation

    Microsoft Academic Search

    G. S. Ungvari; A. H. T. Pang; H. F. K. Chiu; C. K. Wong; F. C. K. Lum

    1996-01-01

    Rational pharmacotherapy helping chronic psychiatric patients in the difficult process of reintegration into the community is an important prerequisite of successful rehabilitation. Results of a survey conducted at the opening of a rehabilitation facility in Hong Kong revealed a number of illogicalities in prescription patterns. Frequently encountered faulty treatment decisions incompatible with the recommendations of modern literature included polypharmacy, higher

  20. NonNon--medical Use of Prescription Drugsmedical Use of Prescription Drugs on College Campuseson College Campuses

    E-print Network

    New Hampshire, University of

    NonNon--medical Use of Prescription Drugsmedical Use of Prescription Drugs on College CampusesonNationally, there has been a rise in college students using prescription drugs,students using prescription drugsNon--medical Use of Prescription Drugs on College Campusesmedical Use of Prescription Drugs on College Campuses #12

  1. The street value of prescription drugs

    Microsoft Academic Search

    Amin Sajan; Trevor Corneil; Stefan Grzybowski

    Background: Although most physicians are aware of the potential for abuse and re- sale of prescribed medications, little has been done to document it. The purpose of this study was to determine which prescription drugs have street value, what that value is and why these drugs are used. Methods: A descriptive cross-sectional survey using a semistructured interview technique was carried

  2. Abuse of Prescription (Rx) Drugs Affects Young Adults Most

    MedlinePLUS

    ... combined—and many more needed emergency treatment. Top Graph: The nonmedical use of prescription drugs is highest ... prescription drugs nonmedically in the past year. Middle Graph: Three thousand young adults died from Rx drug ...

  3. Prescription Drug Misuse among Homeless Youth

    PubMed Central

    Rhoades, Harmony; Winetrobe, Hailey; Rice, Eric

    2014-01-01

    Background Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. Methods A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. Results Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated withdecreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. Conclusions Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions. PMID:24613220

  4. Cost Overdose: Growth in Drug Spending for the Elderly, 1992-2010

    NSDL National Science Digital Library

    2000-01-01

    Posted in July by Families USA (see the December 1, 1995 Scout Report), this report is billed as "the first study to both analyze the increase in prescription drug spending for the elderly from 1992 to 2000 and to project further increases over the next 10 years." The report gives data on average expenditures on prescription drugs for seniors, average number of prescriptions, average out-of-pocket costs, total expenditures on health care and prescription drugs for seniors, and more. Among the significant findings: "Annual spending on prescription drugs per elderly American will grow from $559 in 1992 to an estimated $1,205 in 2000, an increase of 116 percent."

  5. Strategies Used by Adults to Reduce Their Prescription Drug Costs

    MedlinePLUS

    ... Strategies Used by Adults to Reduce Their Prescription Drug Costs On This Page Key findings Adults used ... medication Adults used several strategies to reduce prescription drug costs. Figure 1. Percentages of adults who used ...

  6. Patterns of Prescription Medication Diversion among Drug Dealers

    ERIC Educational Resources Information Center

    Rigg, Khary K.; Kurtz, Steven P.; Surratt, Hilary L.

    2012-01-01

    This research examined the following questions: (1) how do drug dealers acquire their inventories of prescription medications? and (2) which types of prescription medications do dealers most commonly sell? Data are drawn from a National Institute on Drug Abuse-funded research study that examined prescription drug diversion and abuse in South…

  7. Resonant Messages to Prevent Prescription Drug Misuse by Teens

    ERIC Educational Resources Information Center

    Twombly, Eric C.; Holtz, Kristen D.; Agnew, Christine B.

    2011-01-01

    Prescription drug misuse is a major health problem, particularly among teens. A key step in curbing misuse is the development of effective prescription drug prevention messages. This paper explores the elements of prescription drug misuse prevention messages that resonate with teens using data from focus groups with seventh and eighth grade…

  8. Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City

    PubMed Central

    Khosla, Nidhi; Juon, Hee Soon; Kirk, Gregory D; Astemborski, Jacqueline; Mehta, Shruti H

    2011-01-01

    Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005–06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs. PMID:21868170

  9. Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City.

    PubMed

    Khosla, Nidhi; Juon, Hee Soon; Kirk, Gregory D; Astemborski, Jacqueline; Mehta, Shruti H

    2011-12-01

    Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005-06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs. PMID:21868170

  10. State System of Higher Education Prescription Drug Card Program*

    E-print Network

    Hardy, Christopher R.

    that the brand name drug be dispensed. Out of Pocket Maximum Not Applicable Network Pharmacy Pharmacy Files Claim Brand Formulary Prescription Drug $15 copayment $30 copayment Brand Non-Formulary Prescription Drug $30 you purchase a brand drug that has a generic equivalent you will be responsible for the brand drug

  11. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  12. 21 CFR 201.100 - Prescription drugs for human use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01 false Prescription drugs for human use. 201.100 Section 201.100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  13. 21 CFR 201.100 - Prescription drugs for human use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01 false Prescription drugs for human use. 201.100 Section 201.100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  14. 21 CFR 201.100 - Prescription drugs for human use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01 false Prescription drugs for human use. 201.100 Section 201.100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  15. 21 CFR 201.100 - Prescription drugs for human use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01 false Prescription drugs for human use. 201.100 Section 201.100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  16. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  17. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  18. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  19. 21 CFR 201.100 - Prescription drugs for human use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    21 Food and Drugs 4 2013-04-01 2013-04-01 false Prescription drugs for human use. 201.100 Section 201.100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)...

  20. Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

    PubMed Central

    2012-01-01

    Background Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners. Methods This qualitative study included former prison inmates (N = 29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis. Results The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family. Conclusions Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs. PMID:22966409

  1. 76 FR 56201 - Prescription Drug User Fee Act; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-12

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0128] Prescription Drug User Fee Act; Public Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public...

  2. Prescription drug misuse among club drug-using young adults.

    PubMed

    Kelly, Brian C; Parsons, Jeffrey T

    2007-01-01

    Nonmedical prescription (Rx) drug use has recently increased, particularly among young adults. Using time-space sampling to generate a probability-based sample of club-going young adults (18-29), 400 subjects provided data on Rx drug misuse. Club-going young adults misuse Rx drugs at high rates. An overwhelming majority of the sample indicated lifetime use of pain killers, sedatives, and stimulants. A majority indicated recent pain killer use. Variations by gender and sexuality exist in this population. Young lesbian/bisexual women emerged as the group most likely to abuse Rx drugs. Research into the contexts influencing these patterns is imperative. PMID:17994483

  3. Is Nonmedical Prescription Opiate Use a Unique Form of Illicit Drug Use?

    PubMed Central

    Catalano, Richard F.; White, Helene R.; Fleming, Charles B.; Haggerty, Kevin P.

    2010-01-01

    Nonmedical prescription opiate (NMPO) use is of great concern because of its high addiction potential, cognitive impairment effects, and other adverse consequences (e.g., hormonal and immune system effects, hyperalgesia and overdose). Due to the combination of drugs used by those who are NMPO users, it is difficult to isolate the negative effects of NMPO use from the effects of other legal and illicit drugs. Based on a stage model of substance use, this study tested whether NMPO use represents a unique form of illicit drug use among emerging adults and whether there are unique consequences of early NMPO use. We used longitudinal data from 912 emerging adults from the Raising Healthy Children study who were interviewed at least annually from the first or second grade through age 21. The findings indicated that almost all NMPO users have also used marijuana and a large majority has also used other drugs, such as cocaine and ecstasy. In addition, more frequent users of NMPOs are also more frequent users of other drugs. Except for violent behavior, NMPO use explained little unique variance in negative outcomes of use (e.g., drug use disorder, mood disorder, nonproductive behavior, poor health, and property crime) beyond that explained by other illicit drug use. Future studies examining the predictors or consequences of NMPO use and nonmedical use of other prescription drugs need to consider use within the context of other drug use. PMID:20864261

  4. Prescription Drug Abuse Information in D.A.R.E.

    ERIC Educational Resources Information Center

    Morris, Melissa C.; Cline, Rebecca J. Welch; Weiler, Robert M.; Broadway, S. Camille

    2006-01-01

    This investigation was designed to examine prescription drug-related content and learning objectives in Drug Abuse Resistance Education (D.A.R.E.) for upper elementary and middle schools. Specific prescription-drug topics and context associated with content and objectives were coded. The coding system for topics included 126 topics organized…

  5. 76 FR 1174 - Drugs for Human Use; Drug Efficacy Study Implementation; Oral Prescription Drugs Offered for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket Nos. FDA-1981-N-0361...5213, 6290, 6303, 6514, 8658, 11935, and 12152] Drugs for Human Use; Drug Efficacy Study Implementation; Oral Prescription...

  6. 77 FR 12310 - Drugs for Human Use; Drug Efficacy Study Implementation; Prescription Drugs That Contained...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-29

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-1978-N-0441] (formerly 78N-0324); DESI 10392] Drugs for Human Use; Drug Efficacy Study Implementation; Prescription...

  7. Teens and Prescription Drugs: An Analysis of Recent Trends on the Emerging Drug Threat

    ERIC Educational Resources Information Center

    Office of National Drug Control Policy, 2007

    2007-01-01

    This report synthesizes a number of national studies that show the intentional abuse of prescription drugs to get high is a growing concern, particularly among teens. The analysis shows that teens are turning away from street drugs and using prescription drugs to get high. New users of prescription drugs have caught up with new users of marijuana.…

  8. Acetaminophen and codeine overdose

    MedlinePLUS

    Acetaminophen (Tylenol) and codeine is a prescription pain medicine. It is a narcotic, which means it has ... to relieve pain while making you feel sleepy. Acetaminophen and codeine overdose occurs when someone accidentally or ...

  9. 42 CFR 423.159 - Electronic prescription drug program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through...information regarding eligibility for drug benefits, medication history, or related health or drug information for Part D...

  10. 42 CFR 423.159 - Electronic prescription drug program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through...information regarding eligibility for drug benefits, medication history, or related health or drug information for Part D...

  11. Prescription drug coverage, utilization, and spending among Medicare beneficiaries

    Microsoft Academic Search

    Margaret Davis; John Poisal; George Chulis; Carlos Zarabozo; Barbara Cooper

    1999-01-01

    Outpatient prescription drugs are not a covered benefit under Medicare. There have been proposals in the past to expand Medicare benefits to include drug coverage, and current discussions dealing with \\

  12. Medicare Beneficiaries and Free Prescription Drug Samples: A National Survey

    Microsoft Academic Search

    Jennifer Tjia; Becky A. Briesacher; Stephen B. Soumerai; Dennis Ross-Degnan; Jerry H. Gurwitz

    2008-01-01

    The authors reply: We agree with Zipkin that free prescription drug samples will not solve the problem of cost-related medication nonadherence (CRN). However, we argue that use of free prescription drug samples is widespread and indicative of physician attempts to increase economic access to medications. Our previous study demonstrated that 29% of disabled and 13% of elderly Medicare beneficiaries reported

  13. A Political History of Medicare and Prescription Drug Coverage

    Microsoft Academic Search

    THOMAS R. O LIVER; P HILIP R. L EE; H ELENE L. L IPTON

    2004-01-01

    This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking

  14. Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach

    ERIC Educational Resources Information Center

    Jones, Beth A.; Fullwood, Harry; Hawthorn, Melissa

    2012-01-01

    With the growing awareness of adolescent prescription drug abuse, communities and schools are beginning to explore prevention and intervention strategies which are appropriate for their youth. This article provides a framework for developing a collaborative approach to prescription drug abuse prevention--called the Prevention Awareness Team--that…

  15. Prescription Drugs, Over-the-Counter Drugs, Supplements and Herbal Products

    MedlinePLUS

    ... drugs, supplements and herbal products Smoking, alcohol and drugs Don’t smoke, drink alcohol or use drugs ... page It's been added to your dashboard . Prescription drugs, over-the-counter drugs, supplements and herbal products ...

  16. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Requirements for qualified retiree prescription drug plans. 423.884 Section 423.884...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Payments to Sponsors of Retiree Prescription Drug Plans § 423.884 Requirements for...

  17. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Requirements for qualified retiree prescription drug plans. 423.884 Section 423.884...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Payments to Sponsors of Retiree Prescription Drug Plans § 423.884 Requirements for...

  18. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...benefits with other providers of prescription drug coverage. 423.464 Section 423...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part D Plans With Other Prescription Drug Coverage § 423.464...

  19. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Requirements related to qualified prescription drug coverage. 423.104 Section 423...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Benefits and Beneficiary Protections...Requirements related to qualified prescription drug coverage. (a) General....

  20. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Requirements related to qualified prescription drug coverage. 423.104 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Benefits and Beneficiary Protections...Requirements related to qualified prescription drug coverage. (a) General....

  1. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Requirements for qualified retiree prescription drug plans. 423.884 Section 423.884...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Payments to Sponsors of Retiree Prescription Drug Plans § 423.884 Requirements for...

  2. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...benefits with other providers of prescription drug coverage. 423.464 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part D Plans With Other Prescription Drug Coverage § 423.464...

  3. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Requirements for qualified retiree prescription drug plans. 423.884 Section 423.884...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Payments to Sponsors of Retiree Prescription Drug Plans § 423.884 Requirements for...

  4. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...benefits with other providers of prescription drug coverage. 423.464 Section 423...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part D Plans With Other Prescription Drug Coverage § 423.464...

  5. 42 CFR 423.56 - Procedures to determine and document creditable status of prescription drug coverage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...document creditable status of prescription drug coverage. 423.56 Section 423.56...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Eligibility and Enrollment...document creditable status of prescription drug coverage. (a) Definition....

  6. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Requirements related to qualified prescription drug coverage. 423.104 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Benefits and Beneficiary Protections...Requirements related to qualified prescription drug coverage. (a) General....

  7. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Requirements related to qualified prescription drug coverage. 423.104 Section 423...PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Benefits and Beneficiary Protections...Requirements related to qualified prescription drug coverage. (a) General....

  8. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...benefits with other providers of prescription drug coverage. 423.464 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part D Plans With Other Prescription Drug Coverage § 423.464...

  9. 78 FR 28860 - Announcement of Requirements and Registration for: “Data Rx: Prescription Drug Abuse Infographic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ...for: ``Data Rx: Prescription Drug Abuse Infographic Challenge'' Authority...The ``Data Rx: Prescription Drug Abuse Infographic Challenge Concept...the growing trend of prescription drug abuse. The infographic should be...

  10. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Requirements related to qualified prescription drug coverage. 423.104 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Benefits and Beneficiary Protections...Requirements related to qualified prescription drug coverage. (a) General....

  11. 42 CFR 423.56 - Procedures to determine and document creditable status of prescription drug coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...document creditable status of prescription drug coverage. 423.56 Section 423.56...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Eligibility and Enrollment ...document creditable status of prescription drug coverage. (a) Definition....

  12. 42 CFR 423.464 - Coordination of benefits with other providers of prescription drug coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...benefits with other providers of prescription drug coverage. 423.464 Section 423...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part D Plans With Other Prescription Drug Coverage § 423.464...

  13. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Requirements for qualified retiree prescription drug plans. 423.884 Section 423.884...CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Payments to Sponsors of Retiree Prescription Drug Plans § 423.884 Requirements for...

  14. Combinations of Prescription Drug Misuse and Illicit Drugs among Young Adults

    PubMed Central

    Kelly, Brian C.; Wells, Brooke E.; Pawson, Mark; LeClair, Amy; Parsons, Jeffrey T.

    2014-01-01

    Background Prescription drug misuse remains a critical drug trend. Data indicate that young adults in nightlife scenes misuse prescription drugs at high rates. As such, continued surveillance of the patterns of prescription drug misuse among young adults is necessary, particularly assessments that spotlight specific areas of risk, such as polydrug use. Methods Prevalence and correlates of recent combinations of prescription drugs and other substances among urban young adults recruited at nightlife venues using time-space sampling are assessed via prevalence estimates and logistic regression analyses. Results Overall, 16.4% of the sample reported combining illicit drug use with prescription drug misuse. Of those who reported any prescription drug misuse, 65.9% used prescription drugs in combination with at least one of the illicit drugs assessed. The most common combination was marijuana, followed by alcohol, cocaine, ecstasy, and psychedelics. Being male and identifying as gay, lesbian, or bisexual predicted the combination of prescription drugs with ecstasy, cocaine, and psychedelics. Conclusions Rates of combining alcohol and illicit drug use with prescription drug misuse were high, especially among men and those identified as a sexual minority. These rates are alarming in light of the host of negative health outcomes associated with combining prescription and illicit drugs. PMID:24462348

  15. Patterns of prescription medication diversion among drug dealers

    PubMed Central

    Rigg, Khary K.; Kurtz, Steven P.; Surratt, Hilary L.

    2012-01-01

    This research examined the following questions: (1) how do drug dealers acquire their inventories of prescription medications? and (2) which types of prescription medications do dealers most commonly sell? Data are drawn from a National Institute on Drug Abuse-funded research study that examined prescription drug diversion and abuse in South Florida. In-depth semi-structured interviews (n = 50) were conducted with an ethnically diverse sample of prescription drug dealers from a variety of milieus to assess patterns of diversion. Audiotapes of the interviews were transcribed, coded, and thematically analysed using the NVivo 8 software program. Dealers relied on a wide array of diversion methods including visiting multiple pain clinics, working with pharmacy employees to steal medications from pharmacies, and purchasing medications from indigent patients. The type of medication most commonly sold by dealers was prescription opioid analgesics, and to a lesser extent benzodiazepines such as alprazolam. These findings inform public health policy makers, criminal justice officials, the pharmaceutical industry and government regulatory agencies in their efforts to reduce the availability of diverted prescription drugs in the illicit market. Specifically, these data support the need for statewide prescription drug monitoring programs and increased training for healthcare workers who have access to controlled medications. PMID:22665955

  16. Essays on prescription drug benefits in Medicare managed care

    E-print Network

    Hall, Anne Elizabeth, 1971-

    2005-01-01

    In this thesis, I estimate a structural demand model for prescription drug benefits by Medicare beneficiaries using data from the Medicare HMO program. I then use the utility parameter estimates to explore other questions ...

  17. Misplaced marketing Misplaced fears of off label prescription drug marketing

    Microsoft Academic Search

    Chester S. Galloway

    2003-01-01

    The United State Food and Drug Administration gives approval for prescription drugs that are shown to be safe and effective to treat specific conditions. But once the drug is available, physicians can prescribe it for other “off label” uses, the positive therapeutic side effects that are discovered by the medical communities’ own information networks. The pharmaceutical manufacturers would like to

  18. The effects of competition on prescription-drug-product substitution.

    PubMed

    Kralewski, J E; Pitt, L; Dowd, B

    1983-07-28

    Almost all states have enacted legislation, that allows pharmacists to substitute drug products when filling prescriptions. We studied the effects of competition in the drugstore service area on the use of less costly drug products and the pricing of prescriptions under the drug-product-selection law in Minnesota. In 38 drugstores in the Minneapolis-St. Paul area, rates of substitution of generic or less-costly brands and prescription prices were analyzed according to the degree of competition in the drugstore's service area, as measured by the pharmacists' perceptions and the number of competing drugstores within a 1-mile radius. Although higher levels of competition were associated with increased use of generic drugs for prescriptions written generically, competition did not appear to affect either dispensing patterns for prescriptions written for brand-name products or the retail prices of brand-name or generic products. These findings do not support the hypothesis that competition reduces prescription-drug prices through improved selection of drug products at the retail pharmacy level. PMID:6866035

  19. ‘It’s more about the heroin’: Injection drug users’ response to an overdose warning campaign in a Canadian setting

    PubMed Central

    Kerr, Thomas; Small, Will; Hyshka, Elaine; Maher, Lisa; Shannon, Kate

    2014-01-01

    Aims To assess heroin injectors’ perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses. Design Semi-structured qualitative interviews Setting Vancouver, Canada. Participants Eighteen active heroin injectors Measurements Semi-structured interview guide focussing on heroin injectors’ perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations. Findings Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages. Conclusions Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk. PMID:23551565

  20. 21 CFR 250.100 - Amyl nitrite inhalant as a prescription drug for human use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...nitrite inhalant as a prescription drug for human use. 250.100 Section 250.100...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL SPECIAL REQUIREMENTS FOR SPECIFIC HUMAN DRUGS New Drug or Prescription...

  1. 78 FR 8446 - Center for Drug Evaluation and Research; Prescription Drug Labeling Improvement and Enhancement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 201, 314, and 601 [Docket No. FDA-2013-N-0059] Center for Drug Evaluation and Research; Prescription Drug Labeling Improvement and Enhancement...

  2. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons - United States, 2014.

    PubMed

    Wheeler, Eliza; Jones, T Stephen; Gilbert, Michael K; Davidson, Peter J

    2015-06-19

    Drug overdose deaths in the United States have more than doubled since 1999. During 2013, 43,982 drug overdose deaths (unintentional, intentional [suicide or homicide], or undetermined intent) were reported. Among these, 16,235 (37%) were associated with prescription opioid analgesics (e.g., oxycodone and hydrocodone) and 8,257 (19%) with heroin. For many years, community-based programs have offered opioid overdose prevention services to laypersons who might witness an overdose, including persons who use drugs, their families and friends, and service providers. Since 1996, an increasing number of programs provide laypersons with training and kits containing the opioid antagonist naloxone hydrochloride (naloxone) to reverse the potentially fatal respiratory depression caused by heroin and other opioids. In July 2014, the Harm Reduction Coalition (HRC), a national advocacy and capacity-building organization, surveyed 140 managers of organizations in the United States known to provide naloxone kits to laypersons. Managers at 136 organizations completed the survey, reporting on the amount of naloxone distributed, overdose reversals by bystanders, and other program data for 644 sites that were providing naloxone kits to laypersons as of June 2014. From 1996 through June 2014, surveyed organizations provided naloxone kits to 152,283 laypersons and received reports of 26,463 overdose reversals. Providing opioid overdose training and naloxone kits to laypersons who might witness an opioid overdose can help reduce opioid overdose mortality. PMID:26086633

  3. Epidemiological study of epilepsy by monitoring prescriptions of antiepileptic drugs

    Microsoft Academic Search

    R. Banfi; G. Borselli; C. Marinai; A. Borgheresi; A. Cavalieri

    1995-01-01

    The aim of this study is to evaluate a simple and effective method of acquiring epidemiological information about epilepsy. Data on antiepileptic drug prescriptions was collected, the utilization pattern being based on defined daily doses (DDDs). Antiepileptic drugs are epidemiological tracers of epilepsy due to their chronic and highly specific usage. Consequently, a prevalence rate for the whole population may

  4. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...as studies in laboratory animals or in vitro, that the studies have clinical significance...for a prescription drug in animal or in vitro tests and have not been shown by adequate...the case of anti-infective drugs, in vitro data may be included in the...

  5. How Can I End a Prescription Drug Habit Safely?

    MedlinePLUS

    ... for Parents for Kids for Teens Teens Home Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Q&A School & Jobs Drugs & Alcohol Staying Safe Recipes En Español Making ... Stretching A Guy's Guide to Body Image How Can I End a Prescription Drug ...

  6. A New Prescription for Fighting Drug Abuse

    ERIC Educational Resources Information Center

    Schachter, Ron

    2012-01-01

    It's a drug prevention conversation--and program--that was largely missing as recently as a decade ago in most middle and high schools. In those days, the principal concern of health educators and disciplinarians alike was to keep students from misusing alcohol and illegal street drugs such as ecstasy, cocaine and even heroine. But driven by the…

  7. Closing the Prescription Drug Coverage Gap

    MedlinePLUS

    ... and there’s a $2 dispensing fee that gets added to the cost. Mrs. Anderson will pay 45% of the plan’s cost for the drug ($60 x .45 = $27) ... and there’s a $2 dispensing fee that gets added to the cost. Mr. Evans will pay 65% of the plan’s cost for the drug and dispensing fee ($22 ...

  8. 76 FR 68295 - Reducing Prescription Drug Shortages

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ...medicines include cancer treatments, anesthesia drugs...are critical to the treatment and prevention of serious...of sterile injectable cancer treatments has increased by about...and patients make alternative arrangements...

  9. Prescription and Over-the-Counter Drug Abuse Prevention. Prevention Update

    ERIC Educational Resources Information Center

    Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention, 2010

    2010-01-01

    According to the White House Office of National Drug Control Policy, "abuse of prescription drugs to get high has become increasingly prevalent among teens and young adults. Past year abuse of prescription pain killers now ranks second--only behind marijuana--as the Nation's most prevalent illegal drug problem." Use of prescription drugs without a…

  10. An Information System for Drug Interactions: Pharmaceutical Care and Prescription

    Microsoft Academic Search

    Luciano Roberto Hirano; Cláudia Seiko Yokoyama; Silvio Bortoleto; Hugo Bulegon

    2009-01-01

    Many advances in medicine, but the occurrence of errors that accompany the completion of forms are inevitable for the human condition [3]. An information system is to achieve the prescription indicating possible drug interactions, reducing a large number of incidents related to medical errors. The implementation of the system also reduces the time of hospital beds and administrative costs, allowing

  11. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

    Microsoft Academic Search

    M. Mofizul Islam; Ian S McRae

    2014-01-01

    Background In an effort to control non-medical use and\\/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health,

  12. Trust in Online Prescription Drug Information Among Internet Users

    Microsoft Academic Search

    Ajit M. Menon; Aparna D. Deshpande; Matthew Perri III; George M. Zinkhan

    2003-01-01

    The proliferation of both manufacturer-controlled and independent medication-related websites has aroused concern among consumers and policy-makers concerning the trustworthiness of Web-based drug information. The authors examine consumers' trust in on-line prescription drug information and its influence on information search behavior. The study design involves a retrospective analysis of data from a 1998 national survey. The findings reveal that trust in

  13. Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

    PubMed Central

    Ayers, John W.; Brownstein, John S.; Bronstein, Alvin C.; Ewald, Michele Burns; Bourgeois, Florence T.

    2013-01-01

    BACKGROUND AND OBJECTIVES: Nontherapeutic medication ingestions continue to be a major pediatric health problem, with recent increases in ingestions despite a number of public health interventions. It is unknown how changes in adult prescription drug use relate to pediatric medication poisonings. The objective of the study was to measure the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identify high-risk classes of medications and pediatric age groups. METHODS: We measured monthly pediatric exposures and poisonings using the National Poison Data System and prescriptions written for adults using the National Ambulatory Medical Care Surveys for 2000 through 2009. Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, ?-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 years were analyzed by using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described. RESULTS: Adult medication prescriptions were statistically significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13- to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1%) and ?-blockers (59.7%), whereas serious injuries and hospitalizations occurred most frequently with opioids (26.8% and 35.2%, respectively) and hypoglycemics (19.5% and 49.4%, respectively). CONCLUSIONS: Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids and among children 0 to 5 years old. These associations have sizable impacts, including high rates of serious injury and health care use. PMID:23733792

  14. Drug "overdoses" among U.S. soldiers in Europe, 1978-1979. II. autopsies following deaths and near-deaths.

    PubMed

    Manning, F J; Ingraham, L H; DeRouin, E M; Vaughn, M S; Kukura, F C; St Michel, G R

    1983-02-01

    On-site investigations involving interviews with spouses, friends, coworkers, supervisors, and commanders were conducted following 37 deaths or near-deaths by drug overdose among U.S. soldiers stationed in Europe. Subjects were all active-duty soldiers put on the seriously ill list at any Army hospital with an initial diagnosis which included suspected drug overdose. Victims were typically single Black males, less than 22, high school graduates in excellent health. They had been in Germany 7-24 months, liked their jobs, and were judged better than average workers by both peers and supervisors. Fifty percent played on a unit sports team, 6 of 10 had German girlfriends, and one-third had prior disciplinary problems. Although nearly half had been previously identified as having a drug or alcohol problem, only two or three could be called addicts in even the broadest sense. Six cases were suicide gestures, and only these six cases did not involve heroin and/or alcohol. The modal case followed a party, with substantial drinking. In only 25% of the cases did the victim collapse upon injection. More often he went to bed, vomited during the night, and choked on or inhaled vomitus. The data suggest reexamination of two common myths: that heroin users comprise a very unique, albeit undesirable, sample of the general population; and that "overdose" deaths are the result of ignorance, incompetence, or indifference. PMID:6862734

  15. Development of a Patient-Centered Bilingual Prescription Drug Label

    PubMed Central

    Mohan, Arun; Riley, M. Brian; Boyington, Dane; Johnston, Phillip; Trochez, Karen; Jennings, Callie; Mashburn, Jennie; Kripalani, Sunil

    2013-01-01

    Research shows that prescription drug labels are often difficult for patients to understand, which contributes to medication errors and nonadherence. In this study, the authors developed and qualitatively evaluated an evidence-based bilingual prescription container label designed to improve understanding. The authors developed several prototypes in English only or in English and Spanish. The labels included an image of the drug, an icon to show its purpose, and plain-language instructions presented in a 4-time-of-day table. In 5 focus groups and interviews that included 57 participants, patients and pharmacists critically reviewed the designs and compared them with traditional medication labels and reformatted labels without illustrations. Patients strongly preferred labels that grouped patient-relevant content, highlighted key information, and included drug indication icons. They also preferred having the 4-time-of-day table and plain-language text instructions as opposed to either one alone. Patients preferred having pertinent warnings on the main label instead of auxiliary labels. Pharmacists and Latino patients valued having Spanish and English instructions on the label, so both parties could understand the content. The final label design adheres to the latest national- and state-level recommendations for label format and incorporates additional improvements on the basis of patient and pharmacist input. This design may serve as a prototype for improving prescription drug labeling. PMID:24093345

  16. Development of a patient-centered bilingual prescription drug label.

    PubMed

    Mohan, Arun; Riley, M Brian; Boyington, Dane; Johnston, Phillip; Trochez, Karen; Jennings, Callie; Mashburn, Jennie; Kripalani, Sunil

    2013-01-01

    Research shows that prescription drug labels are often difficult for patients to understand, which contributes to medication errors and nonadherence. In this study, the authors developed and qualitatively evaluated an evidence-based bilingual prescription container label designed to improve understanding. The authors developed several prototypes in English only or in English and Spanish. The labels included an image of the drug, an icon to show its purpose, and plain-language instructions presented in a 4-time-of-day table. In 5 focus groups and interviews that included 57 participants, patients and pharmacists critically reviewed the designs and compared them with traditional medication labels and reformatted labels without illustrations. Patients strongly preferred labels that grouped patient-relevant content, highlighted key information, and included drug indication icons. They also preferred having the 4-time-of-day table and plain-language text instructions as opposed to either one alone. Patients preferred having pertinent warnings on the main label instead of auxiliary labels. Pharmacists and Latino patients valued having Spanish and English instructions on the label, so both parties could understand the content. The final label design adheres to the latest national- and state-level recommendations for label format and incorporates additional improvements on the basis of patient and pharmacist input. This design may serve as a prototype for improving prescription drug labeling. PMID:24093345

  17. Redressing the Epidemics of Opioid Overdose and HIV among People who Inject Drugs in Central Asia: The Need for a Syndemic Approach

    PubMed Central

    Gilbert, Louisa; Primbetova, Sholpan; Nikitin, Danil; Hunt, Timothy; Terlikbayeva, Assel; Momenghalibaf, Azzi; Ruziev, Murodali; El-Bassel, Nabila

    2013-01-01

    Background Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research. Methods We conducted a comprehensive literature search of peer-reviewed publications and grey literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics. Results Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose. Conclusion The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia. PMID:23954070

  18. Five cases of fatal overdose from caffeine-containing "look-alike" drugs.

    PubMed

    Garriott, J C; Simmons, L M; Poklis, A; Mackell, M A

    1985-01-01

    Five cases of death from ingestion of "look-alike" dose forms are reported. "Look-alikes" are widely used non-prescription drugs sold as appetite suppressants or stimulants. Three of the cases had taken caffeine/ephedrine combinations, and two had taken caffeine only. All had lethal concentrations of caffeine detected in the blood (130 to 344 mg/L), and three had high ephedrine concentrations from 3.5 to 20.5 mg/L. Caffeine and ephedrine were measured in body fluids and tissues (when available) by SIM gas chromatography/mass spectrometry (GC/MS) after extraction with diethyl ether. PMID:4010239

  19. Our prescription drugs kill us in large numbers.

    PubMed

    Gøtzsche, Peter C

    2014-01-01

    Our prescription drugs are the third leading cause of death after heart disease and cancer in the United States and Europe. Around half of those who die have taken their drugs correctly; the other half die because of errors, such as too high a dose or use of a drug despite contraindications. Our drug agencies are not particularly helpful, as they rely on fake fixes, which are a long list of warnings, precautions, and contraindications for each drug, although they know that no doctor can possibly master all of these. Major reasons for the many drug deaths are impotent drug regulation, widespread crime that includes corruption of the scientific evidence about drugs and bribery of doctors, and lies in drug marketing, which is as harmful as tobacco marketing and, therefore, should be banned. We should take far fewer drugs, and patients should carefully study the package inserts of the drugs their doctors prescribe for them and independent information sources about drugs such as Cochrane reviews, which will make it easier for them to say "no thanks". PMID:25355584

  20. Co-Prescription Trends in a Large Cohort of Subjects Predict Substantial Drug-Drug Interactions

    PubMed Central

    Sutherland, Jeffrey J.; Daly, Thomas M.; Liu, Xiong; Goldstein, Keith; Johnston, Joseph A.; Ryan, Timothy P.

    2015-01-01

    Pharmaceutical prescribing and drug-drug interaction data underlie recommendations on drug combinations that should be avoided or closely monitored by prescribers. Because the number of patients taking multiple medications is increasing, a comprehensive view of prescribing patterns in patients is important to better assess real world pharmaceutical response and evaluate the potential for multi-drug interactions. We obtained self-reported prescription data from NHANES surveys between 1999 and 2010, and confirm the previously reported finding of increasing drug use in the elderly. We studied co-prescription drug trends by focusing on the 2009-2010 survey, which contains prescription data on 690 drugs used by 10,537 subjects. We found that medication profiles were unique for individuals aged 65 years or more, with ?98 unique drug regimens encountered per 100 subjects taking 3 or more medications. When drugs were viewed by therapeutic class, it was found that the most commonly prescribed drugs were not the most commonly co-prescribed drugs for any of the 16 drug classes investigated. We cross-referenced these medication lists with drug interaction data from Drugs.com to evaluate the potential for drug interactions. The number of drug alerts rose proportionally with the number of co-prescribed medications, rising from 3.3 alerts for individuals prescribed 5 medications to 11.7 alerts for individuals prescribed 10 medications. We found 22% of elderly subjects taking both a substrate and inhibitor of a given cytochrome P450 enzyme, and 4% taking multiple inhibitors of the same enzyme simultaneously. By examining drug pairs prescribed in 0.1% of the population or more, we found low agreement between co-prescription rate and co-discussion in the literature. These data show that prescribing trends in treatment could drive a large extent of individual variability in drug response, and that current pairwise approaches to assessing drug-drug interactions may be inadequate for predicting real world outcomes. PMID:25739022

  1. 21 CFR 14.160 - Establishment of standing technical advisory committees for human prescription drugs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 1 2012-04-01 2012-04-01 false Establishment...standing technical advisory committees for human prescription drugs. 14.160 Section 14.160 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...

  2. 21 CFR 250.101 - Amphetamine and methamphetamine inhalers regarded as prescription drugs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    21 Food and Drugs 4 2013-04-01 2013-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription drugs. 250.101 Section 250.101 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...

  3. 21 CFR 203.50 - Requirements for wholesale distribution of prescription drugs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01...Requirements for wholesale distribution of prescription drugs...50 Section 203.50 Food and Drugs FOOD AND DRUG ADMINISTRATION...MARKETING Wholesale Distribution § 203.50...

  4. Maternal exposure to prescription and non-prescription Pharmaceuticals or drugs of abuse and risk of craniosynosto sis

    Microsoft Academic Search

    Jacqueline S Gardner; Beatrice Guyard-Boileau; Beth W Alderman; Sandra K Fernbach; Carol Greenee; Ellen J Mangione

    1998-01-01

    Background The pre- and peri-natal drug exposures reported by women participating in a case-control study of children in Colorado were examined for association with infant craniosynostosis. Methods Mothers of case and control children underwent a standardized telephone inter- view and obstetric and newborn medical record review. The interview included questions on the use of prescription and non-prescription drugs, nutritional supplements,

  5. Prescription opioid misuse and its relation to injection drug use and hepatitis C virus infection: protocol for a systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background The production, prescription, and consumption of opioid analgesics to treat non-cancer pain have increased dramatically in the USA in the past decade. As a result, misuse of these opioids has increased; overdose and transition to riskier forms of drug use have also emerged. Research points to a trend in transition to drug injection among those misusing prescription opioids, where clusters of acute hepatitis C virus (HCV) infection are now being reported. This systematic review and meta-analysis aims to synthesize the prevalence of prescription opioid misuse in the USA and examine the rate of transition to injection drug use and incident HCV in these new people who inject drugs (PWID). Methods/design Eligible studies will include quantitative, empirical data including national survey data. Scientific databases will be searched using a comprehensive search strategy; proceedings of scientific conferences, reference lists, and personal communications will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa Scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis. Discussion A unique typology of drug use is emerging which is characterized by antecedent prescription opioid misuse among PWID. As the epidemic of prescription opioid misuse matures, this will likely serve as a persistent source of new PWID. Persons who report a recent transition to drug injection are characterized by high rates of HCV seroincidence of 40 per 100 person years or higher. Given the potential for the persistence and escalation of the consequences of prescription opioid misuse in the USA, there is a critical need for synthesis of the current state of the epidemic in order to inform future public health interventions and policy. Systematic review registration PROSPERO CRD42014008870. PMID:25178433

  6. Prevalence and Correlates of Prescription Drug Misuse among Socially Active Young Adults

    PubMed Central

    Kelly, Brian C.; Wells, Brooke E.; LeClair, Amy; Tracy, Daniel; Parsons, Jeffrey T.; Golub, Sarit A.

    2012-01-01

    Background Prescription drug misuse represents an emerging global drug trend. Data indicate that young adults are misusing prescription drugs at high rates. As such, continued surveillance of the patterns of prescription drug misuse among young adults is critical, particularly for those engaged in social scenes known to accommodate drug use. Methods Prevalence and correlates of lifetime and recent prescription drug misuse among urban young adults recruited at nightlife venues using time-space sampling are assessed via prevalence estimates and logistic regression analyses. Results In a diverse sample of 1,207 young adults, 44.1% reported lifetime prescription drug misuse, and 20.3% reported misuse during the past three months. Stimulants were the most common class of drug respondents misused within the past six months (16.7%), followed by pain killers (16.5%) and sedatives (14.5%). While no gender or sexual orientation differences in misuse prevalence existed, Black youth reported the lowest prevalence of misuse. In multivariate analyses, increased age was associated with lower odds of recent misuse, females report lower odds of recent use, and Black, Asian, and Latino individuals had lower odds of recent misuse than Whites. These odds varied by prescription drug type. Negative binomial regression analyses indicate that, among prescription drug misusers, women misuse prescription drugs less frequently. Younger individuals more frequently misuse stimulants and older individuals more frequently misuse sedatives. Racial variation existed with frequency of use across classes. Conclusions This study illustrates the need for health promotion efforts targeting prescription drug misuse among young adults who are highly socially active. Future research should focus on motivations for and factors associated with prescription drug misuse within youth cultures. Further research may provide a fuller sense of how to reduce the impact of prescription drug misuse for nations whose prescription drug problem lags behind that of the U.S. PMID:23036649

  7. Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City

    Microsoft Academic Search

    Nidhi Khosla; Hee Soon Juon; Gregory D. Kirk; Jacqueline Astemborski; Shruti H. Mehta

    2011-01-01

    Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We

  8. The drug cost gap and the diagnosis-prescription connection.

    PubMed

    Dross, David

    2008-01-01

    Although the rise in pharmacy benefit costs continues to outpace overall medical cost inflation, the gap is narrowing. Employers can improve cost and employee wellness even further with an innovative technique for drug therapy compliance called the Diagnosis-Prescription (Dx-Rx) approach. This article reports results from a 2007 national employer survey on pharmacy benefits and describes how the Dx-Rx innovation can keep patients and their doctors on track when it comes to controlling disease and driving down overall medical costs. PMID:19048746

  9. A free market solution for prescription drug crises.

    PubMed

    Baker, Dean

    2004-01-01

    The cost of prescription drugs is imposing an ever greater burden on families and varying levels of government. The vast majority of this cost is attributable to patent protection, since most drugs are actually relatively cheap to produce. The temporary monopolies provided by patent protection have been the main mechanism through which corporations have financed their drug research. This article examines the efficiency of publicly supported drug research relative to the current patent system. The author shows that even if publicly funded research were considerably less efficient on a dollar-per-dollar basis than patent-supported research, there would still be enormous gains from switching to a system of publicly supported research. The main reason for this conclusion is that patent monopolies lead to enormous economic distortions, including expensive sales promotion efforts, research into "copycat drugs," incentives to conceal unfavorable research findings, and other inefficiencies that economic theory predicts would result from a government-created monopoly. The gains from publicly supported research, coupled with a free market in the production of drugs, could reach into several hundred billion dollars annually within a decade. PMID:15346683

  10. 78 FR 46980 - Prescription Drug User Fee Rates for Fiscal Year 2014

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0007] Prescription Drug User Fee Rates for Fiscal Year 2014 AGENCY: Food and Drug Administration, HHS. ACTION:...

  11. 75 FR 15376 - Direct-to-Consumer Prescription Drug Advertisements; Presentation of the Major Statement in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 202 [Docket...0910-AG27 Direct-to-Consumer Prescription Drug Advertisements; Presentation of the Major...and Neutral Manner AGENCY: Food and Drug Administration, HHS. ACTION:...

  12. 78 FR 12760 - Guidance for Industry on Labeling for Human Prescription Drug and Biological Products...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-25

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2005-D-0153...Industry on Labeling for Human Prescription Drug and Biological Products--Implementing...Requirements; Availability AGENCY: Food and Drug Administration, HHS. ACTION:...

  13. 76 FR 41434 - Removal of Certain Requirements Related to the Prescription Drug Marketing Act; Opportunity for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-14

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 203 [Docket...Requirements Related to the Prescription Drug Marketing Act; Opportunity for Public Comment AGENCY: Food and Drug Administration, HHS. ACTION:...

  14. 75 FR 46952 - Prescription Drug User Fee Rates for Fiscal Year 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-04

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0390] Prescription Drug User Fee Rates for Fiscal Year 2011 AGENCY: Food and Drug Administration, HHS ACTION:...

  15. Prescription Drug Abuse: A Fast-Growing Problem | NIH MedlinePlus the Magazine

    MedlinePLUS

    ... this page please turn Javascript on. Feature: Preventing Drug Abuse and Addiction Prescription Drug Abuse: A Fast-Growing Problem Past Issues / Fall ... Mental Health Services Administration, 2005 National Survey on Drug Use and Health CLICK IMAGE TO ENLARGE I ...

  16. Mechanisms of Prescription Drug Diversion Among Drug-Involved Club- and Street-Based Populations

    PubMed Central

    Inciardi, James A.; Surratt, Hilary L.; Kurtz, Steven P.; Cicero, Theodore J.

    2010-01-01

    Objective Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. However, empirical data on diversion are limited. Method In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida—club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs. Results Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; “doctor shopping”; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and “stealing from grandma's medicine cabinet.” Conclusion While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and “sneak thefts” to the diversion problem may be understated. PMID:17305688

  17. 78 FR 21613 - Prescription Drug User Fee Act Patient-Focused Drug Development; Announcement of Disease Areas...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-0967] Prescription Drug User Fee Act Patient-Focused Drug Development; Announcement of Disease Areas for Meetings...

  18. 76 FR 11794 - Drugs for Human Use; Unapproved and Misbranded Oral Drugs Labeled for Prescription Use and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-03

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0100] Drugs for Human Use; Unapproved and Misbranded Oral Drugs Labeled for Prescription Use and Offered for Relief of...

  19. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area

    Microsoft Academic Search

    Karen H. Seal; Moher Downing; Alex H. Kral; Shannon Singleton-Banks; Jon-Paul Hammond; Jennifer Lorvick; Dan Ciccarone; Brian R. Edlin

    2003-01-01

    Naloxone, an injectable opiate antagonist, can immediately reverse an opiate overdose and prevent overdose death. We sought\\u000a to determine injection drug users’ (IDUs) attitudes about being prescribed take-home naloxone. During November 1999 to February\\u000a 2000, we surveyed 82 street-recruited IDUs from the San Francisco Bay Area of California who had experienced one or more heroin\\u000a overdose events. We used a

  20. 21 CFR 205.50 - Minimum requirements for the storage and handling of prescription drugs and for the establishment...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01 false ...requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution records. 205.50 Section...

  1. 21 CFR 205.50 - Minimum requirements for the storage and handling of prescription drugs and for the establishment...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01 false ...requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution records. 205.50 Section...

  2. 21 CFR 205.50 - Minimum requirements for the storage and handling of prescription drugs and for the establishment...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01 false ...requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution records. 205.50 Section...

  3. 21 CFR 205.50 - Minimum requirements for the storage and handling of prescription drugs and for the establishment...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01 false ...requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution records. 205.50 Section...

  4. 21 CFR 205.50 - Minimum requirements for the storage and handling of prescription drugs and for the establishment...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    21 Food and Drugs 4 2013-04-01 2013-04-01 false ...requirements for the storage and handling of prescription drugs and for the establishment and maintenance of prescription drug distribution records. 205.50 Section...

  5. Prescription Drug Misuse among Dating Partners: Within-Couple Associations and Implications for Intimate Relationship Quality

    PubMed Central

    Papp, Lauren M.

    2010-01-01

    This study examined the associations between dating partners' misuse of prescription medications and the implications of misuse for intimate relationship quality. A sample of 100 young adult dating pairs completed ratings of prescription drug use and misuse, alcohol use, and relationship quality. Results indicated positive associations between male and female dating partners' prescription drug misuse, which were more consistent for past-year rather than lifetime misuse. Dyadic associations obtained via actor-partner interdependence modeling further revealed that individuals' prescription drug misuse holds problematic implications for their own but not their partners' intimate relationship quality. Models accounted for individuals' alcohol-related risk and medically-appropriate prescription drug use, suggesting the independent contribution of prescription drug misuse to reports of relationship quality. The findings highlight the importance of considering young adults' substance behaviors in contexts of their intimate relationships. PMID:20853926

  6. An Exploration of Social Circles and Prescription Drug Abuse Through Twitter

    PubMed Central

    2013-01-01

    Background Prescription drug abuse has become a major public health problem. Relationships and social context are important contributing factors. Social media provides online channels for people to build relationships that may influence attitudes and behaviors. Objective To determine whether people who show signs of prescription drug abuse connect online with others who reinforce this behavior, and to observe the conversation and engagement of these networks with regard to prescription drug abuse. Methods Twitter statuses mentioning prescription drugs were collected from November 2011 to November 2012. From this set, 25 Twitter users were selected who discussed topics indicative of prescription drug abuse. Social circles of 100 people were discovered around each of these Twitter users; the tweets of the Twitter users in these networks were collected and analyzed according to prescription drug abuse discussion and interaction with other users about the topic. Results From November 2011 to November 2012, 3,389,771 mentions of prescription drug terms were observed. For the 25 social circles (n=100 for each circle), on average 53.96% (SD 24.3) of the Twitter users used prescription drug terms at least once in their posts, and 37.76% (SD 20.8) mentioned another Twitter user by name in a post with a prescription drug term. Strong correlation was found between the kinds of drugs mentioned by the index user and his or her network (mean r=0.73), and between the amount of interaction about prescription drugs and a level of abusiveness shown by the network (r=0.85, P<.001). Conclusions Twitter users who discuss prescription drug abuse online are surrounded by others who also discuss it—potentially reinforcing a negative behavior and social norm. PMID:24014109

  7. Caffeine overdose

    MedlinePLUS

    Caffeine is a substance that exists naturally in certain plants. It can also be produced synthetically and ... and a diuretic, which means it increases urination. Caffeine overdose occurs when someone accidentally or intentionally takes ...

  8. 21 CFR 14.160 - Establishment of standing technical advisory committees for human prescription drugs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Establishment of standing technical advisory committees for...Drugs § 14.160 Establishment of standing technical advisory committees for human prescription drugs. The standing technical advisory committees...

  9. 76 FR 58020 - Prescription Drug User Fee Act IV Information Technology Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-19

    ...Prescription Drug User Fee Act IV Information Technology Plan AGENCY: Food and Drug Administration...the availability of an updated information technology (IT) plan entitled ``PDUFA IV Information Technology Plan'' (updated plan) to...

  10. Multiple Prescription Drug Use among Rehabilitation Clients Referred for Psychological Evaluation.

    ERIC Educational Resources Information Center

    Keller, Mary Jane; Green, Monica A.

    1981-01-01

    Studied vocational rehabilitation clients' (N=110) use of multiple prescription drugs. Found 44 percent had parallel prescriptions from two or more physicians. Individuals were found to be largely uninformed about possible pernicious somatic and psychological sequelae of drug usage. Suggests recommendations for vocational rehabilitation efforts.…

  11. Are Direct to Consumer Advertisements of Prescription Drugs Educational?: Comparing 1992 to 2002

    ERIC Educational Resources Information Center

    Curry, Timothy Jon; Jarosch, Jeff; Pacholok, Shelley

    2005-01-01

    We investigate the educational value of direct-to-consumer (DTC) prescription drug advertisements from 58 popular magazines published in 1992 and 2002. We find that the number of DTC prescription drug ads increased nine-fold from 1992 to 2002, while the advertisements for other health care products increased only slightly. We examine changes in…

  12. The Effect of Direct to Consumer Advertising on Prescription Drug Prices and Sales

    Microsoft Academic Search

    Dhaval Dave; Henry Saffer

    2010-01-01

    The purpose of this study is to estimate the effect of direct-to-consumer advertising (DTCA) of prescription drugs on prescription drug prices and sales. Major increases in broadcast DTCA began in August 1997 when the FDA eliminated the requirement that broadcast advertising present all of the information on the product insert in the advertisement. From 1995 to 2005 DTCA went from

  13. Quick Facts About Medicare Prescription Drug Coverage and Protecting Your Personal

    E-print Network

    Goodman, Robert M.

    Quick Facts About Medicare Prescription Drug Coverage and Protecting Your Personal Information information can include your name; Social Security, Medicare, bank account, or credit card numbers. Medicare and others about Medicare prescription drug coverage: Keep all personal information, such as your Medicare

  14. Prescription Drug Misuse among University Staff and Students: A Survey of Motives, Nature and Extent

    ERIC Educational Resources Information Center

    Holloway, Katy; Bennett, Trevor

    2012-01-01

    Aims: To determine the prevalence and nature of prescription drug misuse among university staff and students in the UK. Methods: In 2009, an online questionnaire regarding non-medical use of prescription drugs was completed by 1614 students and 489 staff registered at a large university in Wales. The sample data were weighted to match the…

  15. Nonmedical Use of Prescription Drugs by College Students with Minority Sexual Orientations

    ERIC Educational Resources Information Center

    Duryea, Daniel G.; Calleja, Nancy G.; MacDonald, Douglas A.

    2015-01-01

    Results from the 2009 "National College Health Assessment" were analyzed by gender and sexual orientation for college students' nonmedical use of prescription drugs. Male and female students identified as having a minority sexual orientation (gay or bisexual) were significantly more likely to use nonmedical prescription drugs than…

  16. Bacitracin zinc overdose

    MedlinePLUS

    ... Small amounts of bacitracin zinc are dissolved in petroleum jelly to create antibiotic ointments. Bacitracin zinc overdose ... 1-800-222-1222. See also: Bacitracin overdose Petroleum jelly overdose Zinc oxide overdose

  17. Barely or fairly balancing drug risks? Content and format effects in direct-to-consumer online prescription drug promotions

    Microsoft Academic Search

    Jeremy Kees; Paula Fitzgerald Bone; John Kozup; Pam Scholder Ellen

    2008-01-01

    A critical requirement of direct-to-consumer (DTC) drug promotion on the Internet is the concept of fair balance. This means that prescription drug Web sites should provide an accurate, balanced portrayal of the risks relative to the benefits of using prescription medications. However, one of the most pervasive findings in con- sumer research is that risk perceptions are often not aligned

  18. 21 CFR 310.201 - Exemption for certain drugs limited by new-drug applications to prescription sale.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 5 2011-04-01 2011-04-01 false Exemption for certain drugs limited by new-drug applications to prescription sale. 310.201 Section 310.201 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  19. 21 CFR 310.201 - Exemption for certain drugs limited by new-drug applications to prescription sale.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 5 2012-04-01 2012-04-01 false Exemption for certain drugs limited by new-drug applications to prescription sale. 310.201 Section 310.201 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  20. 21 CFR 310.201 - Exemption for certain drugs limited by new-drug applications to prescription sale.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 5 2010-04-01 2010-04-01 false Exemption for certain drugs limited by new-drug applications to prescription sale. 310.201 Section 310.201 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  1. 21 CFR 310.201 - Exemption for certain drugs limited by new-drug applications to prescription sale.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 5 2014-04-01 2014-04-01 false Exemption for certain drugs limited by new-drug applications to prescription sale. 310.201 Section 310.201 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  2. Using National Drug Codes and Drug Knowledge Bases to Organize Prescription Records from Multiple Sources

    PubMed Central

    Simonaitis, Linas; McDonald, Clement J

    2009-01-01

    Purpose Pharmacy systems contain electronic prescription information needed for clinical care, decision support, performance measurements and research. The master files of most pharmacy systems include National Drug Codes (NDCs) as well as the local codes they use within their systems to identify the products they dispense. We sought to assess how well one could map the products dispensed by many pharmacies to clinically oriented codes via the mapping tables provided by Drug Knowledge Base (DKB) producers. Methods We obtained a large sample of prescription records from seven different sources. These records either carried a national product code or a local code that could be translated into a national product code via their formulary master. We obtained mapping tables from five DKBs. We measured the degree to which the DKB mapping tables covered the national product codes carried in, or associated with, our sample of prescription records. Results Considering the total prescription volume, DKBs covered 93.0% to 99.8% of the product codes (15 comparisons) from three outpatient, and 77.4% to 97.0% (20 comparisons) from four inpatient, sources. Among the inpatient sources, invented codes explained much – from 36% to 94% (3 of 4 sources) – of the non coverage. Outpatient pharmacy sources invented codes rarely – in 0.11% to 0.21% of their total prescription volume, and inpatient sources, more commonly – in 1.7% to 7.4% of their prescription volume. The distribution of prescribed products is highly skewed: from 1.4% to 4.4% of codes account for 50% of the message volume; from 10.7% to 34.5% of codes account for 90% of the volume. Conclusion DKBs cover the product codes used by outpatient sources sufficiently well to permit automatic mapping. Changes in policies and standards could increase coverage of product codes used by inpatient sources. PMID:19767382

  3. How removing prescription drugs from reimbursement lists increases the pharmaceutical expenditures for alternatives

    Microsoft Academic Search

    Özden Gür Ali; Ba?ak Topaler

    2011-01-01

    Changing the status of drugs from prescription-only to over-the-counter and removing them from reimbursement list has been\\u000a used as a cost reduction measure by several third-party payers. In June 2006, the Turkish government, in an effort to curtail\\u000a costs, removed many prescription drugs from the reimbursement list. This paper examines the effect of this policy on the expenditures\\u000a for drugs

  4. Direct-to-consumer ads can influence behavior. Advertising increases consumer knowledge and prescription drug requests.

    PubMed

    Peyrot, M; Alperstein, N M; Van Doren, D; Poli, L G

    1998-01-01

    This study examines the impact of direct-to-consumer (DTC) pharmaceutical advertising on prescription drug knowledge and the requesting behavior of consumers. The authors developed and tested a conceptual model of prescription drug knowledge and requests. Consumers' belief that drug advertising can educate them was associated with a greater amount of drug knowledge, and the belief they would upset physicians by asking for specific drugs was associated with less knowledge. The belief that drug advertising reduces prices was associated with greater probability of drug requests, and the belief that physicians should be the sole source of drug information was associated with lesser probability of request. Preference for generic drugs was associated with a lesser likelihood of requesting a specific drug. Media exposure and drug advertising awareness were associated with higher drug knowledge and a greater probability of drug requesting. PMID:10180332

  5. Windmills and pill mills: can PDMPs tilt the prescription drug epidemic?

    PubMed

    Gugelmann, Hallam; Perrone, Jeanmarie; Nelson, Lewis

    2012-12-01

    Prescription drug monitoring programs (PDMPs) are state-based registries of prescriptions for specific controlled substances. This overview will describe the history and funding of these databases, address those characteristics thought to be of greatest utility for PDMPs and review current literature regarding PDMP effectiveness and their potential limitations. Although more extensive research on PDMP outcomes is needed, these databases are an essential component in ongoing efforts to establish safe and compassionate prescription opioid stewardship. PMID:23180357

  6. [The message from heroin overdoses].

    PubMed

    Pap, Ágota; Heged?s, Katalin

    2015-03-01

    Drug use can be defined as a kind of self destruction, and it is directly linked to attitudes toward death and suicide occurring in a significant number of users of different narcotics. The aim of the authors was to look for the background of this relationship between drug and death and examine the origin, development, and motives behind heroin overdose based on an analysis of previous studies. It seems clear that pure heroin overdose increased gradually over the years. The fear of the police is the inhibitory factor of the overdose prevention and notification of emergency health care service. Signs of suicide could be the own home as the chosen location for heroin overdose and the presence of partners ("moment of death companion"). Interventions should include simple techniques such as first aid, naloxone administration, resuscitation, prevention of relapse of prisoners and social network extension involving maintenance programs. PMID:25702255

  7. Understanding Nonprescription and Prescription Drug Misuse in Late Adolescence/Young Adulthood

    PubMed Central

    Fleary, Sasha A.; Heffer, Robert W.; McKyer, E. Lisako J.

    2013-01-01

    This study explored the extent to which nonprescription and prescription drugs misuse among adolescents/young adults are related to their perception that it is safer than illicit drugs, ease of access, and lower societal stigma. Adolescents/young adults (N = 465; Mage = 18.57, SD = 0.86) completed an online survey about their nonprescription and prescription drug misuse, other substance use, and correlates of use. Perceived risk, societal stigma, and access to nonprescription and prescription drugs were predictive of misuse. Results support program planners working towards targeting perceived risk and societal stigma in reducing misuse and the need to restrict and monitor access to nonprescription and prescription drugs for adolescents/young adults. PMID:24826368

  8. NATIONAL SURVEY OF PRESCRIPTION DRUG INFORMATION PROVIDED TO PATIENTS (NSPDIPP)

    EPA Science Inventory

    National telephone surveys were conducted in 1992, 1994, 1996, and 1998 to determine how much prescription medicine information consumers receive and through which sources. Approximately 1,000 U.S. consumers who received a new prescription for themselves or a family member at a r...

  9. Prescription drugs purchased through the internet: Who are the end users?

    PubMed Central

    Inciardi, James A.; Surratt, Hilary L.; Cicero, Theodore J.; Rosenblum, Andrew; Ahwah, Candice; Bailey, J. Elise; Dart, Richard C.; Burke, John J.

    2012-01-01

    Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources. The scientific literature on this topic is limited to anecdotal reports or studies plagued by small sample sizes. Within this context, the focus of this paper is an examination of five national data sets from the U.S. with the purpose of estimating: (1) how common obtaining prescription medications from the Internet actually is, (2) who are the typical populations of “end users” of these non-prescribed medications, and (3) which drugs are being purchased without a prescription. Three of the data sets are drawn from the RADARS® (Researched Abuse Diversion and Addiction-Related Surveillance) System, a comprehensive series of studies designed to collect timely and geographically specific data on the abuse and diversion of a number of prescription stimulants and opioid analgesics. The remaining data sets include the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future (MTF) survey. Our analysis yielded uniformly low rates of prescription drug acquisition from online sources across all five data systems we examined. The consistency of this finding across very diverse populations suggests that the Internet is a relatively minor source for illicit purchases of prescription medications by the individual end-users of these drugs. PMID:20227199

  10. Naloxone for Opioid Overdose Prevention: Pharmacists’ Role in Community-Based Practice Settings

    PubMed Central

    Bailey, Abby M.; Wermeling, Daniel P.

    2015-01-01

    Background Deaths related to opioid overdose have increased in the past decade. Community-based pharmacy practitioners have worked toward overcoming logistic and cultural barriers to make naloxone distribution for overdose prevention a standard and accepted practice. Objective To describe outpatient naloxone dispensing practices, including methods by which practitioners implement dispensing programs, prescribing patterns that include targeted patient populations, barriers to successful implementation, and methods for patient education. Methods Interviews were conducted with providers to obtain insight into the practice of dispensing naloxone. Practitioners were based in community pharmacies or clinics in large metropolitan cities across the country. Results It was found that 33% of participating pharmacists practice in a community-pharmacy setting, and 67% practice within an outpatient clinic-based location. Dispensing naloxone begins by identifying patient groups that would benefit from access to the antidote. These include licit users of high-dose prescription opioids (50%) or injection drug users and abusers of prescription medications (83%). Patients were identified through prescription records or provider screening tools. Dispensing naloxone required a provider’s prescription in 5 of the 6 locations identified. Only 1 pharmacy was able to exercise pharmacist prescriptive authority within their practice. Conclusion Outpatient administration of intramuscular and intranasal naloxone represents a means of preventing opioid-related deaths. Pharmacists can play a vital role in contacting providers, provision of products, education of patients and providers, and dissemination of information throughout the community. Preventing opioid overdose–related deaths should become a major focus of the pharmacy profession. PMID:24523396

  11. 45 CFR 156.295 - Prescription drug distribution and cost reporting.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...that were provided under the QHP through retail pharmacies compared to mail order pharmacies, and the percentage of prescriptions for which...compared to all drugs dispensed, broken down by pharmacy type, which includes an independent...

  12. 45 CFR 156.295 - Prescription drug distribution and cost reporting.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...that were provided under the QHP through retail pharmacies compared to mail order pharmacies, and the percentage of prescriptions for which...compared to all drugs dispensed, broken down by pharmacy type, which includes an independent...

  13. What kind of patients and physicians value direct-to-consumer advertising of prescription drugs.

    PubMed

    Gönül, F F; Carter, F; Wind, J

    2000-06-01

    Direct-to-consumer (DTC) advertising of prescription drugs can enhance the physician-patient relationship, as well as benefiting its sponsor. However, overall benefits can only occur if the patients value the information enough to discuss it with their physicians and the physicians are not predisposed against the DTC information. We investigate the impact of demographics and exposure to marketing on consumers' and physicians' receptiveness to DTC advertising of prescription drugs, using data from two nationwide surveys. We find that consumers who have an ongoing need for health care, that is, those with children or with a chronic condition requiring medication, value prescription drug advertising more highly, while older consumers, consumers who have been sick recently, or more educated consumers are more likely to trust their physicians instead. We find that more experienced physicians, physicians who see more patients, or those who have more exposure to pharmaceutical advertisements are more accepting of DTC advertising of prescription drugs. PMID:10907324

  14. 21 CFR 201.57 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01...format of labeling for human prescription drug and biological products described in Â... 201.57 Section 201.57 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  15. 21 CFR 201.57 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01...format of labeling for human prescription drug and biological products described in Â... 201.57 Section 201.57 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  16. 21 CFR 201.57 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01...format of labeling for human prescription drug and biological products described in Â... 201.57 Section 201.57 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  17. 21 CFR 201.57 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01...format of labeling for human prescription drug and biological products described in Â... 201.57 Section 201.57 Food and Drugs FOOD AND DRUG ADMINISTRATION,...

  18. The impact of Medicare prescription drug coverage on the use of antidementia drugs

    PubMed Central

    2013-01-01

    Background Cholinesterase inhibitors and memantine are prescribed to slow the progression dementia. Although the efficacy of these drugs has been demonstrated, their effectiveness, from the perspective of patients and caregivers, has been questioned. Little is known about whether the demand for cholinesterase inhibitors and memantine are sensitive to out-of-pocket cost. Using the 2006 implementation of Medicare Part D as a natural experiment, this study examines the impact of changes in drug coverage on use of cholinesterase inhibitors and memantine by comparing use before and after Medicare Part D implementation among older adults who did and did not experience a change in coverage. Methods Retrospective analyses of claims data from 35,102 community-dwelling Medicare beneficiaries in Pennsylvania aged 65 or older. Beneficiaries were continuously enrolled in a Medicare Advantage plan from 2004 to 2007. Outcome variables were any use of donepezil (Aricept®), galantamine (Razadyne®), rivastigmine (Exelon®), tacrine (Cognex®), or memantine (Namenda®) each year and the number of 30-day prescriptions filled for these drugs. Independent variables included type of drug benefit pre–Part D (No coverage, $150 cap, $350 cap, and No cap as the reference group), time period, and their interaction. Sensitivity analyses were conducted to test if there are differences in use by drug class or if beneficiaries with a diagnosis of dementia pre–Part D experienced an increase in use post–Part D. Results The No coverage group had a 38% increase in the odds ratio of any use of antidementia medications (P?=?0.0008) post–Part D relative to the No cap group. All four coverage groups had significant increases in number of 30-day prescriptions (P?prescriptions (P?=?0.002) and the $350 cap group had a 15% increase (P?=?0.003) after adjusting for trends in the No cap group. Results from the sensitivity analysis for the sub-sample with a diagnosis of dementia pre–Part D show that each group had significant increases in 30-day prescriptions compared to the No cap control group (P?drug coverage under Medicare Part D. PMID:23621892

  19. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

    Microsoft Academic Search

    Hortensia Reyes-Morales; Laura del PilarTorres-Arreola; Magdalena Suárez-Ortega

    2007-01-01

    Background  In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been\\u000a little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed;\\u000a moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential\\u000a drug-drug and drug-disease interactions in prescriptions for

  20. Prospective Evaluation of Patients with Increasing Opiate Needs: Prescription Opiate Abuse and Illicit Drug Use

    Microsoft Academic Search

    Laxmaiah Manchikanti; Kim S. Damron; Vidyasagar Pampati; Carla D. McManus

    Background: Multiple aberrant behaviors have been described to identify patients abus- ing opioids and using illicit drugs. However, pa- tient behavior encompassing aggressive seek- ing or complaining about the need for higher doses of opioids has not yet been evaluated with regards to misuse or abuse patterns of prescription drugs and illicit drug usage. Objective: The objective of this study

  1. The Distortionary Effects of Government Procurement: Evidence from Medicaid Prescription Drug Purchasing

    Microsoft Academic Search

    Mark Duggan; Fiona M. Scott Morton

    2006-01-01

    The federal-state Medicaid program insures 43 million people for virtually all of the prescription drugs approved by the FDA. To determine the price that it will pay for a drug treatment, the government uses the average price in the private sector for that same drug. Assuming that Medicaid recipients are unresponsive to price because of the program's zero co-pay, this

  2. Early detection of drug interactions utilizing a computerized drug prescription handling system—focus on cerivastatin–gemfibrozil

    Microsoft Academic Search

    Tomás Morera; Guillermo Gervasini; Juan A. Carrillo; Julio Benitez

    2004-01-01

    Objectives Based on the recent cerivastatin experience, we retrospectively evaluated the effect of notifying a drug alert utilizing a computerized drug-handling system. Methods The evaluation was carried out during three periods: period I corresponded to all prescriptions issued during April, 2001 (“baseline period”), before the Spanish Drug Agency issued alerts on the concomitant therapy with cerivastatin and gemfibrozil; period II

  3. Preventing deaths from rising opioid overdose in the US - the promise of naloxone antidote in community-based naloxone take-home programs.

    PubMed

    Straus, Michele M; Ghitza, Udi E; Tai, Betty

    2013-09-01

    The opioid overdose epidemic is an alarming and serious public health problem in the United States (US) that has been escalating for 11 years. The 2011 National Survey on Drug Use and Health (NSDUH) demonstrated that 1 in 20 persons in the US aged 12 or older reported nonmedical use of prescription painkillers in the past year. Prescription drug overdose is now the leading cause of accidental death in the United States - surpassing motor vehicle accidents. Great efforts have been initiated to curb the overdose crisis. Notable examples of these efforts are (1) the Drug Enforcement Administration's (DEA) National Take-Back Initiative instituted in 2010; (2) the Prescription Drug Monitoring Programs (PDMPs) implemented in most US states to provide practitioners with point-of-care information regarding a patient's controlled substance use; (3) the naloxone rescue programs initiated in the community to avert mortality resulting from overdose. The use of naloxone rescue strategies has gained traction as an effective measure to prevent fatal opioid overdose. Many US federal-government agencies are working to make these strategies more accessible to first responders and community participants. This new approach faces many challenges, such as accessibility to naloxone and the equipment and training needed to administer it, but none is more challenging than the fear of legal repercussions. US federal-government agencies, local governments, health care institutions, and community-based organizations have begun to tackle these barriers, and naloxone take-home programs have gained recognition as a feasible and sensible preventive strategy to avoid a fatal result from opioid overdose. Although many challenges still need to be overcome, it is important for federal government research agencies to initiate and support independent and rigorous evaluation of these programs to inform policymakers how effective these programs can be to save lives and curb the opioid overdose public health crisis. PMID:24273417

  4. Prescription of drugs to pregnant women in France: the HIMAGE study.

    PubMed

    Beyens, Marie-Noëlle; Guy, Claire; Ratrema, Martine; Ollagnier, Michel

    2003-01-01

    The HIMAGE study, conducted in partnership with the principal Public Health Insurance Funds of the Loire region, analysed medicinal prescriptions during pregnancy on the basis of a representative sample of 911 pregnant women resident in this region of France. Altogether 93.5% received at least one prescription, with a mean of 10.9 different drugs per woman. The prescriptions were predominantly for drugs of the following Anatomical Therapeutic Chemical (ATC) classes: "alimentary tract and metabolism" (78%); "genito-urinary system and sex hormones" (62%); "nervous system" (62%); and "blood and blood-forming organs" (57%). Iron supplements, paracetamol, folic acid, magnesium, progesterone, oxaceprol, phloroglucinol, amoxicillin, domperidone and diosmine were the most frequently prescribed drugs. In total, 4.6% of the women were exposed to drugs involving a risk during pregnancy: principally nonsteroidal anti-inflammatory drugs (NSAIDs) prescribed from the sixth month onwards. This study revealed a high frequency of prescription of drugs to pregnant women, largely motivated by non-rational and to some extent culture-specific considerations, and it also highlighted the prescription of drugs known to involve risk during pregnancy. These results provide a basis for advising clinicians on the rational and safe use of drugs during pregnancy. PMID:15058494

  5. 21 CFR 200.200 - Prescription drugs; reminder advertisements and reminder labeling to provide price information to...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...price information to consumers. 200.200 Section... Prescription Drug Consumer Price Listing § 200...price information to consumers. (a) Prescription...include all charges to the consumer including, but not...intended to provide consumers with information...

  6. 21 CFR 200.200 - Prescription drugs; reminder advertisements and reminder labeling to provide price information to...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...price information to consumers. 200.200 Section... Prescription Drug Consumer Price Listing § 200...price information to consumers. (a) Prescription...include all charges to the consumer including, but not...intended to provide consumers with information...

  7. The Drug Facts Box: Improving the communication of prescription drug information.

    PubMed

    Schwartz, Lisa M; Woloshin, Steven

    2013-08-20

    Communication about prescription drugs ought to be a paragon of public science communication. Unfortunately, it is not. Consumers see $4 billion of direct-to-consumer advertising annually, which typically fails to present data about how well drugs work. The professional label--the Food and Drug Administration's (FDA) mechanism to get physicians information needed for appropriate prescribing--may also fail to present benefit data. FDA labeling guidance, in fact, suggests that industry omit benefit data for new drugs in an existing class and for drugs approved on the basis of unfamiliar outcomes (such as depression rating scales). The medical literature is also problematic: there is selective reporting of favorable trials, favorable outcomes within trials, and "spinning" unfavorable results to maximize benefit and minimize harm. In contrast, publicly available FDA reviews always include the phase 3 trial data on benefit and harm, which are the basis of drug approval. However, these reviews are practically inaccessible: lengthy, poorly organized, and weakly summarized. To improve accessibility, we developed the Drug Facts Box: a one-page summary of benefit and harm data for each indication of a drug. A series of studies--including national randomized trials--demonstrates that most consumers understand the Drug Facts Box and that it improves decision-making. Despite calls from their own Risk Communication Advisory Committee and Congress (in the Affordable Care Act) to consider implementing boxes, the FDA announced it needs at least 3-5 y more to make a decision. Given its potential public health impact, physicians and the public should not have to wait that long for better drug information. PMID:23942130

  8. The Drug Facts Box: Improving the communication of prescription drug information

    PubMed Central

    Schwartz, Lisa M.; Woloshin, Steven

    2013-01-01

    Communication about prescription drugs ought to be a paragon of public science communication. Unfortunately, it is not. Consumers see $4 billion of direct-to-consumer advertising annually, which typically fails to present data about how well drugs work. The professional label—the Food and Drug Administration's (FDA) mechanism to get physicians information needed for appropriate prescribing—may also fail to present benefit data. FDA labeling guidance, in fact, suggests that industry omit benefit data for new drugs in an existing class and for drugs approved on the basis of unfamiliar outcomes (such as depression rating scales). The medical literature is also problematic: there is selective reporting of favorable trials, favorable outcomes within trials, and “spinning” unfavorable results to maximize benefit and minimize harm. In contrast, publicly available FDA reviews always include the phase 3 trial data on benefit and harm, which are the basis of drug approval. However, these reviews are practically inaccessible: lengthy, poorly organized, and weakly summarized. To improve accessibility, we developed the Drug Facts Box: a one-page summary of benefit and harm data for each indication of a drug. A series of studies—including national randomized trials—demonstrates that most consumers understand the Drug Facts Box and that it improves decision-making. Despite calls from their own Risk Communication Advisory Committee and Congress (in the Affordable Care Act) to consider implementing boxes, the FDA announced it needs at least 3–5 y more to make a decision. Given its potential public health impact, physicians and the public should not have to wait that long for better drug information. PMID:23942130

  9. Modeling drug information for a prescription-oriented knowledge base on drugs.

    PubMed

    Milstein, C; de Zegher, I; Venot, A; Séné, B; Pietri, P; Dahlberg, B

    1995-09-01

    There exists little theoretical analysis how to represent knowledge on drugs required for computerized drug-prescription applications. A work package drug information modeling is described which was part of the European OPADE project. We describe the content and structure of a Drug Knowledge Base (DKB) designed to meet the requirements of decision-support systems in the domain of drug therapy, and to facilitate data transfer from various information sources. The definition of the DKB content is derived from the analysis of information requirements at the various stages of the process of the clinical usage of drugs (prescribing, administration, and follow-up). The DKB structure results from the classification of the various data items along two dimensions: (1) entities in the pharmaco-therapeutic domain for which information must be defined (the PharmacoTherapeutic Group, the Component, the ManufacturedPreparation, and the Presentation), and (2) the validity score of the pharmaco-therapeutic information (international, national, or local). PMID:7476462

  10. Suicide by gabapentin overdose.

    PubMed

    Middleton, Owen

    2011-09-01

    Gabapentin is an antiepileptic drug that is prescribed for both FDA-approved and multiple off-label conditions, and has a relatively safe side-effect profile. Rare cases of overdose-related adverse effects have been reported in the literature. Described herein are the circumstances and autopsy findings of a 62-year-old woman with a history of depression, whose death was caused by intentional ingestion of excess gabapentin. The postmortem peripheral blood gabapentin concentration as determined by high-performance liquid chromatography/tandem mass spectroscopy was 88 ?g/mL. Previously reported cases of individuals surviving gabapentin overdoses are discussed and compared with this case. Based on a review of the available literature, this appears to be the first published report of a death due solely to gabapentin toxicity. PMID:21554310

  11. Estimated cost of universal public coverage of prescription drugs in Canada

    PubMed Central

    Morgan, Steven G.; Law, Michael; Daw, Jamie R.; Abraham, Liza; Martin, Danielle

    2015-01-01

    Background: With the exception of Canada, all countries with universal health insurance systems provide universal coverage of prescription drugs. Progress toward universal public drug coverage in Canada has been slow, in part because of concerns about the potential costs. We sought to estimate the cost of implementing universal public coverage of prescription drugs in Canada. Methods: We used published data on prescribing patterns and costs by drug type, as well as source of funding (i.e., private drug plans, public drug plans and out-of-pocket expenses), in each province to estimate the cost of universal public coverage of prescription drugs from the perspectives of government, private payers and society as a whole. We estimated the cost of universal public drug coverage based on its anticipated effects on the volume of prescriptions filled, products selected and prices paid. We selected these parameters based on current policies and practices seen either in a Canadian province or in an international comparator. Results: Universal public drug coverage would reduce total spending on prescription drugs in Canada by $7.3 billion (worst-case scenario $4.2 billion, best-case scenario $9.4 billion). The private sector would save $8.2 billion (worst-case scenario $6.6 billion, best-case scenario $9.6 billion), whereas costs to government would increase by about $1.0 billion (worst-case scenario $5.4 billion net increase, best-case scenario $2.9 billion net savings). Most of the projected increase in government costs would arise from a small number of drug classes. Interpretation: The long-term barrier to the implementation of universal pharmacare owing to its perceived costs appears to be unjustified. Universal public drug coverage would likely yield substantial savings to the private sector with comparatively little increase in costs to government. PMID:25780047

  12. Prescription Drug Abuse: Some Considerations in Evaluating Policy Responses

    Microsoft Academic Search

    Bonnie B. Wilford

    1991-01-01

    Although psychotherapeutics are among the most tightly regulated commodities in the world, some small but significant number are regularly diverted from legitimate use for the purpose of sustaining abuse and dependence. Contemporary concerns about such diversion have prompted renewed interest in methods to curb physicians' prescriptive authority and monitor actual prescribing practices. In order to manage these proposed solutions in

  13. Medical and Nonmedical Users of Prescription Drugs among College Students

    ERIC Educational Resources Information Center

    Rozenbroek, Katelyn; Rothstein, William G.

    2011-01-01

    Objectives: To examine medical and nonmedical users of prescription opioids, central nervous system depressants, and stimulants taken individually and in combination. Participants: Undergraduates at an urban mid-Atlantic university with 12,000 students. Methods: A questionnaire administered in classes provided 413 responses, with a usable response…

  14. 76 FR 24901 - Request for Input To Inform a Possible Surgeon General Action on Prescription Drug Abuse in Youth

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-03

    ...Surgeon General Action on Prescription Drug Abuse in Youth AGENCY: National Institute on Drug Abuse, National Institutes of Health...SUMMARY: The National Institute on Drug Abuse, a Research Institute of the...

  15. A Decade of Controversy: Balancing Policy With Evidence in the Regulation of Prescription Drug Advertising

    PubMed Central

    Grande, David; Tarn, Derjung M.; Kravitz, Richard L.

    2010-01-01

    Direct-to-consumer advertising (DTCA) of prescription drugs has remained controversial since regulations were liberalized by the Food and Drug Administration in 1997. We reviewed empirical evidence addressing the claims made in the policy debate for and against DTCA. This advertising has some benefits, but significant risks are evident as well, magnified by the prominence of DTCA in population-level health communications. To minimize potential harm and maximize the benefits of DTCA for population health, the quality and quantity of information should be improved to enable consumers to better self-identify whether treatment is indicated, more realistically appraise the benefits, and better attend to the risks associated with prescription drugs. We propose guidelines for improving the utility of prescription drug advertising. PMID:19910354

  16. Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis

    Microsoft Academic Search

    Sarah L. Cutrona; Steffie Woolhandler; Karen E. Lasser; David H. Bor; Danny McCormick; David U. Himmelstein

    Objectives. Free prescription drug samples are used widely in the United States. We sought to examine characteristics of free drug sample recipients nationwide. Methods. We analyzed data on 32 681 US residents from the 2003 Medical Ex- penditure Panel Survey (MEPS), a nationally representative survey. Results. In 2003, 12% of Americans received at least 1 free sample. A higher pro-

  17. 77 FR 43337 - Drugs for Human Use; Drug Efficacy Study Implementation; Certain Prescription Drugs Offered for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ...DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket Nos. FDA-1975-N-0336...Hydrocortisone Acetate and Pramoxine Hydrochloride] Drugs for Human Use; Drug Efficacy Study Implementation; Certain...

  18. Characterizing the relationship between free drug samples and prescription patterns for acne vulgaris and rosacea

    PubMed Central

    Hurley, Michael P.; Stafford, Randall S.; Lane, Alfred T.

    2014-01-01

    Importance Describing the relationship between the availability of free prescription drug samples and dermatologists’ prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician’s office. Objective To investigate the relationships between free drug samples and dermatologists’ local and national prescribing patterns and between the availability of free drug samples and prescription costs. Design, Setting, and Participants Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of a nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of either acne vulgaris or acne rosacea in 2010. Main Outcome Measures National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples. Results On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase directly correlates with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples). Conclusions and relevance The benefits of free samples in dermatology must be weighed against potential negative impacts on prescribing behavior and prescription costs. PMID:24740450

  19. Comparative study of paediatric prescription drug utilization between the spanish and immigrant population

    PubMed Central

    2009-01-01

    Background The immigrant population has increased greatly in Spain in recent years to the point where immigrants made up 12% of the infant population in 2008. There is little information available on the profile of this group with regard to prescription drug utilization in universal public health care systems such as that operating in Spain. This work studies the overall and specific differences in prescription drug utilization between the immigrant and Spanish population. Methods Use was made of the Aragonese Health Service databases for 2006. The studied population comprises 159,908 children aged 0-14 years, 13.6% of whom are foreign nationals. Different utilization variables were calculated for each group. Prescription-drug consumption is measured in Defined Daily Doses (DDD) and DDD/1000 persons/day/(DID). Results A total of 833,223 prescriptions were studied. Utilization is lower for immigrant children than in Spanish children for both DID (66.27 v. 113.67) and average annual expense (€21.55 v. €41.14). Immigrant children consume fewer prescription drugs than Spanish children in all of the therapy groups, with the most prescribed (in DID) being: respiratory system, anti-infectives for systemic use, nervous system, sensory organs. Significant differences were observed in relation to the type of drugs and the geographical background of immigrants. Conclusion Prescription drug utilization is much greater in Spanish children than in immigrant children, particularly with reference to bronchodilators (montelukast and terbutaline) and attention-disorder hyperactivity drugs such as methylphenidate. There are important differences regarding drug type and depending on immigrants' geographical backgrounds that suggest there are social, cultural and access factors underlying these disparities. PMID:19995453

  20. Desisting From Prescription Drug Abuse: An Application of Growth Models to Rx Opioid Users

    PubMed Central

    Gunter, Whitney D.; Kurtz, Steven P.; Bakken, Nicholas W.; O’Connell, Daniel J.

    2012-01-01

    Modern desistance research has examined many facets of desistance, in terms of theoretical predictors of desistance and recidivism, and in terms of differing types of offending. Though predicting desistance from illegal drug use is among these topics, no research to date has examined the predictors of desisting from prescription opioid abuse. This study uses longitudinal data from 318 prescription opioid users to analyze the effects of various predictors of desistance on declining nonmedical prescription opioid use, with an emphasis on gender differences among participants. Results indicate that theoretical and demographic characteristics correspond with differing rates of decline and further vary by gender. PMID:22736809

  1. PRESCRIPTION PATTERN OF ANTIHYPERTENSIVE DRUGS IN A TERTIARY HEALTH INSTITUTION IN NIGERIA

    Microsoft Academic Search

    E. Etuk; S. A. Isezuo; A. Chika; J. Akuche; M. Ali

    Objective: This study examined the pattern of physicians' prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians' compliance with recommended guidelines. Methods: Records of 145 patients aged 17-91 (mean: 52.6 ± 14.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was

  2. Preventing drug interactions by online prescription screening in community pharmacies and medical practices

    Microsoft Academic Search

    Hillel Halkin; Itzhak Katzir; Irena Kurman; Joseph Jan; Becky Ben-Oz Malkin

    2001-01-01

    Background: Drug interactions have been shown to be preventable by computerized prescription entry and screening only in hospitals and not in community-based practice.Methods: We retrospectively evaluated the effect of online prescription screening in community pharmacies and physician offices of one health maintenance organization, phased in during 3 consecutive 6-month periods in 1998 to 1999 (period I, system active only in

  3. Postmarketing surveillance of adverse drug reactions in general practice. II: Prescription-event monitoring at the University of Southampton

    Microsoft Academic Search

    W H Inman

    1981-01-01

    An independent, non-regulatory drug surveillance research unit has been established at the University of Southampton. Its first task will be to set up a prescription-event monitoring scheme in general practice to enable the pattern of adverse events, as distinct from suspected adverse reactions associated with new drugs to be compared with that of older medicines. Prescriptions for selected drugs will

  4. Low Literacy Impairs Comprehension of Prescription Drug Warning Labels

    PubMed Central

    Davis, Terry C; Wolf, Michael S; Bass, Pat F; Middlebrooks, Mark; Kennen, Estela; Baker, David W; Bennett, Charles L; Durazo-Arvizu, Ramon; Bocchini, Anna; Savory, Stephanie; Parker, Ruth M

    2006-01-01

    BACKGROUND Adverse events resulting from medication error are a serious concern. Patients' literacy and their ability to understand medication information are increasingly seen as a safety issue. OBJECTIVE To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret commonly used prescription medication warning labels. DESIGN In-person structured interviews with literacy assessment. SETTING Public hospital, primary care clinic. PARTICIPANTS A total of 251 adult patients waiting for an appointment at the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) Primary Care Clinic. MEASUREMENTS Correct interpretation, as determined by expert panel review of patients' verbatim responses, for each of 8 commonly used prescription medication warning labels. RESULTS Approximately one-third of patients (n=74) were reading at or below the 6th-grade level (low literacy). Patient comprehension of warning labels was associated with one's literacy level. Multistep instructions proved difficult for patients across all literacy levels. After controlling for relevant potential confounding variables, patients with low literacy were 3.4 times less likely to interpret prescription medication warning labels correctly (95% confidence interval: 2.3 to 4.9). CONCLUSIONS Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons. PMID:16881945

  5. Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs.

    PubMed

    Buttorff, Christine; Andersen, Martin S; Riggs, Kevin R; Alexander, G Caleb

    2015-03-01

    Just under seven million Americans acquired private insurance through the new health insurance exchanges, or Marketplaces, in 2014. The exchange plans are required to cover essential health benefits, including prescription drugs. However, the generosity of prescription drug coverage in the plans has not been well described. Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum). Our secondary objective was to compare the exchange coverage to employer-sponsored coverage. Analyzing prescription drug benefit design data for the federally facilitated exchanges, we found wide variation in enrollees' out-of-pocket costs for generic, preferred brand-name, nonpreferred brand-name, and specialty drugs, not only across metal tiers but also within those tiers across plan types. Compared to employer-sponsored plans, exchange plans generally had lower premiums but provided less generous drug coverage. However, for low-income enrollees who are eligible for cost-sharing subsidies, the exchange plans may be more comparable to employer-based coverage. Policies and programs to assist consumers in matching their prescription drug needs with a plan's benefit design may improve the financial protection for the newly insured. PMID:25732498

  6. A qualitative exploration of prescription opioid injection among street-based drug users in Toronto: behaviours, preferences and drug availability

    PubMed Central

    Firestone, Michelle; Fischer, Benedikt

    2008-01-01

    Background There is evidence of a high prevalence of prescription opioid (PO) and crack use among street drug users in Toronto. The purpose of this qualitative study was to describe drug use behaviours and preferences as well as the social and environmental context surrounding the use of these drugs among young and old street-based drug injection drug users (IDUs). Methods In-depth interviews were conducted with 25 PO injectors. Topics covered included drug use history, types of drugs used, how drugs were purchased and transitions to PO use. Interviews were taped and transcribed. Content analysis was conducted to identify themes. Results Five prominent themes emerged from the interviews: 1) Combination of crack and prescription opioids, 2) First injection experience and transition to prescription opioids, 3) Drug preferences and availability, 4) Housing and income and 5) Obtaining drugs. There was consensus that OxyContin and crack were the most commonly available drugs on the streets of Toronto. Drug use preferences and behaviours were influenced by the availability of drugs, the desired effect, ease of administration and expectations around the purity of the drugs. Distinct experiences were observed among younger users as compared to older users. In particular, the initiation of injection drug use and experimentation with POs among younger users was influenced by their experiences on the street, their peers and general curiosity. Conclusion Given the current profile of street-based drug market in Toronto and the emergence of crack and POs as two predominant illicit drug groups, understanding drug use patterns and socio-economic factors among younger and older users in this population has important implications for preventive and therapeutic interventions. PMID:18928556

  7. Prescription Drug Abuse: Epidemiology, Regulatory Issues, Chronic Pain Management with Narcotic Analgesics

    PubMed Central

    Manubay, Jeanne M.; Muchow, Carrie; Sullivan, Maria A.

    2012-01-01

    Synopsis The epidemic of prescription drug abuse has reached a critical level, which has received national attention. Physicians must learn strategies to effectively treat chronic pain, and help reduce the rates of prescription drug abuse. This chapter will provide insight into the epidemiology of prescription drug abuse, explain regulatory issues, and provide guidelines for the assessment and management of pain, particularly with chronic opioid therapy. The use of informed consent forms, treatment agreements, risk documentation tools, and regular monitoring of the 4 “A's” helps to educate patients, as well as guide management based on treatment goals. By using universal precautions, and being aware of aberrant behaviors, physicians may feel more confident in identifying and addressing problematic behaviors. PMID:21356422

  8. Non-medical prescription drug and illicit street drug use among young Swiss men and associated mental health issues.

    PubMed

    Baggio, Stéphanie; Studer, Joseph; Mohler-Kuo, Meichun; Daeppen, Jean-Bernard; Gmel, Gerhard

    2014-01-01

    Non-medical use of prescription drugs (NMUPD) is increasing among the general population, particularly among teenagers and young adults. Although prescription drugs are considered safer than illicit street drugs, NMUPD can lead to detrimental consequences. The aim of the present study was to investigate the relationship between drug use (NMUPD on the one side, illicit street drugs on the other side) with mental health issues and then compare these associations. A representative sample of 5719 young Swiss men aged around 20 years filled in a questionnaire as part of the ongoing baseline Cohort Study on Substance Use Risk Factors (C-SURF). Drug use (16 illicit street drugs and 5 NMUPDs, including sleeping pills, sedatives, pain killers, antidepressants, stimulants) and mental health issues (depression, SF12) were assessed. Simple and multiple linear regressions were employed. In simple regressions, all illicit and prescription drugs were associated with poorer mental health. In multiple regressions, most of the NMUPDs, except for stimulants, were significantly associated with poorer mental health and with depression. On the contrary, the only associations that remained significant between illicit street drugs and mental health involved cannabis. NMUPD is of growing concern not only because of its increasing occurrence, but also because of its association with depression and mental health problems, which is stronger than the association observed between these problems and illicit street drug use, excepted for cannabis. Therefore, NMUPD must be considered in screening for substance use prevention purposes. PMID:24447983

  9. A prescription for unemployment? Recessions and the demand for mental health drugs.

    PubMed

    Bradford, W David; Lastrapes, William D

    2014-11-01

    We estimate the relationship between mental health drug prescriptions and the level of labor market activity in the USA. Based on monthly data from the National Ambulatory Medical Care Survey of physicians and aggregated by US census regions, we find that the number of mental health drug prescriptions (those aimed at alleviating depression and anxiety) rises by about 10% when employment falls by 1% and when unemployment rises by 100 basis points, but only for patients in the Northeast region. This paper is one of the first to look at compensatory health behavior in response to the business cycle. PMID:23956154

  10. [Evaluation of prescription practices for drugs charged in addition to DRG-based fees in Alsace].

    PubMed

    Kuss, Géraldine; Drogue, Nicole; Michel, Bruno

    2012-01-01

    Two studies led in parallel from May till June, 2009, were proposed in Alsace in order to analyze the hospital practices of prescription relative to 6 drugs charged in addition to the GHS: bevacizumab, gemcitabine, trastuzumab, etanercept, adalimumab and infliximab. The first study, led within 9 hospitals, allowed the collection of 343 situations of prescription. The second approach, based on the extraction of the PMSI data from the same hospitals, allowed the exploitation of 771 situations of prescription. The data collected on sites and from the PMSI respectively put in evidence 86.3% and 73.0% of prescriptions corresponding to guidelines. No unacceptable situation was revealed. The differences between approaches can be explained by the important proportion of unclassifiable situations extracted from the PMSI. These approaches bring complementary lightings and allow the OMEDIT of Alsace to take position in its missions of expertise and follow-up of therapeutic innovations. PMID:22874486

  11. Direct-to-consumer promotion of prescription drugs. Economic implications for patients, payers and providers.

    PubMed

    Findlay, S D

    2001-01-01

    Spending on outpatient prescription drugs in the US is accelerating rapidly. Although numerous factors are driving this trend, attention has recently focused on the role played by the marketing, promotion and advertising of pharmaceuticals, in particular direct-to-consumer (DTC) advertising. In 1997, the US Food and Drug Administration (FDA) issued a 'guidance' on such mass media promotion. The guidance altered existing FDA rules and effectively permitted pharmaceutical companies to promote prescription drugs on television and radio without giving detailed or even summary information on indications, efficacy or potential adverse effects. Since then, television commercials, in particular, and print advertisements in consumer magazines and newspapers have proliferated rapidly. Pharmaceutical companies spent $US1.8 billion on DTC advertising in 1999, a 40% increase over 1998. This spending in 1999 was heavily concentrated on about 50 drugs. Evidence is growing that DTC promotion of prescription drugs is: (i) alerting consumers to the existence of new drugs and the conditions they treat; (ii) increasing consumer demand for many drugs; (iii) contributing increasingly to the recent sharp increase in the number of prescriptions being dispensed; (iv) raising sales revenues; and, thus, (v) contributing to the higher pharmaceutical costs of health insurers, government and consumers. The public policy issues surrounding DTC advertisements centre on the following questions: (i) are the advertisements leading to the inappropriate clinical use of some drugs? (ii) are the advertisements inducing both consumers and physicians to choose more costly new brand-name drugs over less expensive, but equally effective, older brand or generic drugs? (iii) do television advertisements for prescription drugs contain a balanced amount of information on benefits versus potential adverse effects? and (iv) will the revenue benefits generated by DTC advertising cause pharmaceutical companies to focus more on developing products to treat prevalent but not life-threatening conditions, such as baldness, sexual dysfunction or memory loss? These questions are just beginning to be probed despite prescription drug spending, insurance coverage and payment policies having become major political issues in the US. PMID:11284378

  12. Prescription of controlled drugs by non-medical prescribers.

    PubMed

    Griffith, Richard; Tengnah, Cassam

    2011-11-01

    The Government has again promised to end the confusion over the range and use of controlled drugs by non-medical prescribers (NMPs). A recent written answer suggests that regulations allowing district nurses who are NMPs to prescribe the full range of controlled drugs will be in place by the end of October 2011. This is the third time successive governments have made such a commitment, and until it is confirmed district nurses who are independent nurse prescribers must limit their use of controlled drugs to those set out in the British National Formulary and Drug Tariff. This article sets out the limitations on an independent nurse prescriber's right to prescribe controlled drugs under current legislation. PMID:22067574

  13. EMS runs for suspected opioid overdose: Implications for surveillance and prevention

    PubMed Central

    Knowlton, Amy; Weir, Brian; Hazzard, Frank; Olsen, Yngvild; McWilliams, Junette; Fields, Julie; Gaasch, Wade

    2013-01-01

    Objective Opioid (including prescription opiate) abuse and overdose rates in the US have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a thirteen month time period (2008-2009), and census 2008 data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared to the demographic distributions of the EMS patient and city population and to prior study findings. Results Of 116,910 EMS incidents during the study period for patients 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. Overall incidence was 1.87 administrations per 1,000 population per year. Findings indicated naloxone administration peaked in summer months (31% of administrations), weekends (32%), and late afternoon (4-5:00pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among males, whites, and those in the 45-54 year age group. Findings on temporal patterns were comparable to findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug or alcohol related overdoses in Baltimore in 2008-9 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support of the data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose. PMID:23734988

  14. Understanding the Extra Help with Your Medicare Prescription Drug Plan

    MedlinePLUS

    ... medicare.gov using Medicare’s online enrollment center; • By paper application —Contact the company offering the drug plan ... January 2015 (Recycle prior editions) Printed on recycled paper Document Outline

  15. Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students

    PubMed Central

    Arria, Amelia M.; Caldeira, Kimberly M.; Kasperski, Sarah J.; O’Grady, Kevin E.; Vincent, Kathryn B.; Griffiths, Roland R.; Wish, Eric D.

    2009-01-01

    Objectives This longitudinal study examined the prevalence and correlates of energy drink use among college students, and investigated its possible prospective associations with subsequent drug use, including nonmedical prescription drug use. Methods Participants were 1,060 undergraduates from a large, public university who completed three annual interviews, beginning in their first year of college. Use of energy drinks, other caffeinated products, tobacco, alcohol, and other illicit and prescription drugs were assessed, as well as demographic and personality characteristics. Results Annual weighted prevalence of energy drink use was 22.6%wt and 36.5%wt in the second and third year of college, respectively. Compared to energy drink non-users, energy drink users had heavier alcohol consumption patterns, and were more likely to have used other drugs, both concurrently and in the preceding assessment. Regression analyses revealed that Year 2 energy drink use was significantly associated with Year 3 nonmedical use of prescription stimulants and prescription analgesics, but not with other Year 3 drug use, holding constant demographics, prior drug use, and other factors. Conclusions A substantial and rapidly-growing proportion of college students use energy drinks. Energy drink users tend to have greater involvement in alcohol and other drug use and higher levels of sensation-seeking, relative to non-users of energy drinks. Prospectively, energy drink use has a unique relationship with nonmedical use of prescription stimulants and analgesics. More research is needed regarding the health risks associated with energy drink use in young adults, including their possible role in the development of substance use problems. PMID:20729975

  16. Just What the Doctor Ordered: Using SAS® to Calculate Patient Drug Dose with Electronic Medical Record (EMR) Prescription Data

    Microsoft Academic Search

    Kathy Hardis Fraeman

    Electronic medical records (EMRs) are paperless digital versions of physicians' paper charts. EMRs can contain a myriad of health care information - including details of physician drug prescriptions - and research efforts with EMR data often include determining patient drug treatment patterns and dose modifications. Unfortunately, electronic versions of physician prescriptions are often as varied and undecipherable as their paper

  17. An Exploratory Study of Rape Survivors' Prescription Drug Use as a Means of Coping with Sexual Assault

    ERIC Educational Resources Information Center

    Sturza, Marisa L.; Campbell, Rebecca

    2005-01-01

    In this study we examined rape survivors' post assault use of prescription drugs, including sedatives, tranquilizers, and antidepressants. In a community-based sample of 102 sexual assault survivors, 44% had used prescription drugs post rape. Consistent with prior research on alcohol as a postassault coping mechanism, the current study found…

  18. Non-medical use of prescription drugs in a national sample of college women

    PubMed Central

    McCauley, Jenna L.; Amstadter, Ananda B.; Macdonald, Alexandra; Danielson, Carla Kmett; Ruggiero, Kenneth J.; Resnick, Heidi S.; Kilpatrick, Dean G.

    2015-01-01

    Non-medical use of prescription drugs (NMUPD) is one of the fastest growing forms of illicit drug use, with research indicating that college students represent a particularly high risk population. The current study examined demographic characteristics, health/mental health, substance misuse, and rape experiences as potential risk correlates of NMUPD among a national sample of college women (N=2000). Interviews were conducted via telephone using Computer-Assisted Telephone Interviewing technology. NMUPD was assessed by asking if, participants had used a prescription drug non-medically in the past year. NMUPD was endorsed by 7.8% of the sample (n=155). Although incapacitated and drug–alcohol facilitated rape were associated with NMUPD in the initial model, the final multivariable model showed that only lifetime major depression and other forms of substance use/abuse were significantly uniquely associated with an increased likelihood of NMUPD. Implications for primary and secondary prevention and subsequent research are addressed. PMID:21356576

  19. Prescription Drug (Rx) and DEA Controlled Substance Order Worksheet PI/Researcher Name: Date of Order

    E-print Network

    Sura, Philip

    Prescription Drug (Rx) and DEA Controlled Substance Order Worksheet PI/Researcher Name: Date of Order: Budget Information: Vendor Name: (See below for vendor address) Rx/DEA Item Name: Rx/DEA Item Name: DEA Schedule (I-IV) or Rx: DEA Schedule (I-IV) or Rx: Catalog number: Catalog number: Number

  20. Association of prescription drug misuse with risky motor vehicle behaviors among low-income young women

    PubMed Central

    Laz, Tabassum H; Shemontee, Mirza O.; Rahman, Mahbubur; Berenson, Abbey B

    2013-01-01

    The purpose of this study was to examine the association between prescription drug misuse and risky motor vehicle behaviors among 16-24 year old women. A survey was conducted on misuse of four classes of prescription drugs (pain relievers, tranquilizers, stimulants, and sedatives) and past-month risky motor vehicle behaviors among these women during 2008-2010. Overall, 47.7% (1408/2952) of women reported risky motor vehicle behavior(s) in the past month. Misuse of one or more of the four classes was 30.1% (lifetime), 15.0% (past year), and 6.7% (past month). Misuse of one or more of these prescription drug classes was associated with risky motor vehicle behaviors in their lifetime (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.54-2.18), past year (OR 2.25, 95% CI 1.80-2.83), and past month (OR 2.70, 95% CI 1.94-3.78). Our finding that misuse of one or more of the four prescription drug classes, irrespective of when this last occurred, is associated with risky motor vehicle behaviors may help formulate awareness programs. PMID:24159912

  1. Measures such as interstate cooperation would improve the efficacy of programs to track controlled drug prescriptions.

    PubMed

    Deyo, Richard A; Irvine, Jessica M; Millet, Lisa M; Beran, Todd; O'Kane, Nicole; Wright, Dagan A; McCarty, Dennis

    2013-03-01

    In response to increasing abuse of prescription drugs, forty-four states have implemented--and five more states will soon adopt--monitoring programs to track prescriptions of controlled medications. Although these programs were originally designed to help law enforcement officials and regulatory agencies spot possible illegal activity, health care providers have begun to use data from them to help improve patient safety and quality of care. For this article we reviewed government documents, expert white papers, articles from the peer-reviewed medical literature, and reports of the experiences of local health officials. We found some evidence that prescription drug monitoring programs are a benefit to both law enforcement and health care delivery. However, the programs have strengths and weaknesses, and their overall impact on drug abuse and illegal activity remains unclear. We believe that improving the efficacy of prescription drug monitoring programs will require such changes as more standardization and interstate cooperation, better training of providers, more secure funding, and further evaluation. PMID:23406570

  2. 77 FR 1877 - Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Negotiated Pricing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-12

    ...more of these legal theories. We received comments...included advocacy groups representing the...Authority The third legal theory on which we invited...provides that employer group waiver provisions...employer-sponsored group prescription drug...more of those legal theories. One of the...

  3. Utilizing Business, University, and Community Resources to Target Adolescent Prescription Drug Abuse

    ERIC Educational Resources Information Center

    Wade-Mdivanian, R.; Anderson-Butcher, D.; Hale, K.; Kwiek, N.; Smock, J.; Radigan, D.; Lineberger, J.

    2012-01-01

    "Generation Rx" is a prescription drug abuse prevention strategy which includes a "toolkit" designed to be used with youth. Developed by Cardinal Health Foundation and the Ohio State University, it provides health care providers (especially pharmacists), parents, teachers, youth workers, and other community leaders with interactive tools and…

  4. New Drug Enforcement Administration guideline for communicating controlled substance prescriptions to pharmacies.

    PubMed

    2011-01-01

    The Drug Enforcement Administration (DEA) is issuing this statement of policy to provide guidance under existing law regarding the proper role of a duly authorized agent of a DEA-registered individual practitioner in connection with the communication of a controlled substance prescription to a pharmacy. PMID:21426229

  5. Polypharmacy: correlations with sex, age and drug regimenA prescription database study

    Microsoft Academic Search

    L. Bjerrum; J. Søgaard; J. Hallas; J. Kragstrup

    1998-01-01

    Objective: To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly\\u000a prone to PP.\\u000a \\u000a \\u000a \\u000a Methods: Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during\\u000a 1994 presented by inhabitants in the county of Funen (n= 466 567). The number of individuals concurrently using two to four drugs

  6. The Effect of Incentive-Based Formularies on Prescription-Drug Utilization and Spending

    Microsoft Academic Search

    Haiden A. Huskamp; Patricia A. Deverka; Arnold M. Epstein; Robert S. Epstein; Kimberly A. McGuigan; Richard G. Frank

    2009-01-01

    background Many employers and health plans have adopted incentive-based formularies in an at- tempt to control prescription-drug costs. methods We used claims data to compare the utilization of and spending on drugs in two employ- er-sponsored health plans that implemented changes in formulary administration with those in comparison groups of enrollees covered by the same insurers. One plan simul- taneously

  7. Misuse of Prescription and Illicit Drugs Among High-risk Young Adults in Los Angeles and New York

    PubMed Central

    Lankenau, Stephen E.; Schrager, Sheree M.; Silva, Karol; Kecojevic, Alex; Bloom, Jennifer Jackson; Wong, Carolyn; Iverson, Ellen

    2012-01-01

    Background Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available. Conclusion Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs. PMID:22798990

  8. Time trends of antidepressant drug prescriptions in men versus women in a geographically defined US population.

    PubMed

    Zhong, Wenjun; Kremers, Hilal Maradit; Yawn, Barbara P; Bobo, William V; St Sauver, Jennifer L; Ebbert, Jon O; Finney Rutten, Lila J; Jacobson, Debra J; Brue, Scott M; Rocca, Walter A

    2014-12-01

    The aim of this work was to study time trends of antidepressant drug (AD) prescriptions in a geographically defined US population between 2005 and 2011 for men and women separately. Using the Rochester Epidemiology Project medical records-linkage system, we identified all Olmsted County, MN residents who received AD outpatient prescriptions between 2005 and 2011 (7 years). We calculated the annual age- and sex-specific prevalence over 7 years and used generalized estimating equation models to test for time trends. The prevalence of subjects receiving at least one AD prescription was approximately two times higher in women than in men consistently across the 7 years of the study. The standardized annual prevalence increased from 10.8 % in 2005 to 14.4 % in 2011 overall, from 7.0 % in 2005 to 9.9 % in 2011 for men, and from 14.4 % in 2005 to 18.6 % in 2011 for women. The absolute percent increase was greater in women (4.2 vs. 2.9 %; standardized); however, the relative percent increase was greater in men (41.4 vs. 29.2 %; standardized). The relative percent increase was greater in the age group 65+ years for both men and women. AD prescriptions are increasing over time, especially in the elderly. Women receive more AD prescriptions than men. However, the relative increase in AD prescriptions over time is greater in men than women. PMID:25113318

  9. Direct-to-consumer prescription drug advertising and the public

    Microsoft Academic Search

    Robert A. Bell; Richard L. Kravitz; Michael S. Wilkes

    1999-01-01

    OBJECTIVE: Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied.\\u000a Consumers’ awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising\\u000a were examined.\\u000a \\u000a \\u000a DESIGN: Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates,\\u000a 58% and 69%, respectively).\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Respondents were interviewed while

  10. 76 FR 11790 - Drugs for Human Use; Drug Efficacy Study Implementation; Oral Prescription Drugs Offered for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-03

    ...Relief of Symptoms of Cough, Cold, or Allergy; Withdrawal of Hearing Requests; Final Resolution of Dockets AGENCY: Food and Drug Administration, HHS. ACTION...relief of symptoms of cough, cold, or allergy, Docket Nos....

  11. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study

    PubMed Central

    2014-01-01

    Objective To test the hypothesis that people taking anxiolytic and hypnotic drugs are at increased risk of premature mortality, using primary care prescription records and after adjusting for a wide range of potential confounders. Design Retrospective cohort study. Setting 273 UK primary care practices contributing data to the General Practice Research Database. Participants 34?727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69?418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years). Main outcome All cause mortality ascertained from practice records. Results Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription. Conclusions In this large cohort of patients attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding. PMID:24647164

  12. Forces Pushing Prescription Psychotropic Drugs in College Mental Health

    ERIC Educational Resources Information Center

    Whitaker, Leighton C.

    2007-01-01

    A complex of forceful influences is greatly accelerating the use of what are usually referred to as "psychiatric drugs," although most prescribing is not done by psychiatrists. Many other clinicians, including other kinds of physicians, and recently psychologists, prescribe these medications. The influences contributing to this dramatic surge…

  13. 21 CFR 202.1 - Prescription-drug advertisements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...NRC), Drug Efficacy Study Group, and for which no claim has been...The use of a single term for a group of side effects and contraindications (for...means of a general term for a group in place of disclosing each...established principles of statistical theory, methodology, applied...

  14. Management of drug overdose

    Microsoft Academic Search

    Jerrold Blair Leikin

    1996-01-01

    Routine poison management involves:oI.StabilizationII.Toxidrome recognitionIII.DecontaminationIV.Antidote administrationV.Enhanced elimination of toxinVI.Supportive care Stabilization involves airway, ventilation, and circulation support. In the patient with altered mental status, oxygen, naloxone, glucose, and thiamine should be administered. Specific symptom complexes that can be related to specific classifications of toxins are referred to as toxidromes. Emesis by means of ipecacsyrup is rarely used for in-hospital gastric

  15. Prescription drug monitoring program utilization in Kentucky community pharmacies

    PubMed Central

    Wixson, Sarah E.; Blumenschein, Karen; Goodin, Amie J.; Talbert, Jeffery; Freeman, Patricia R.

    2014-01-01

    Objective: Identify characteristics of Kentucky community pharmacists and community pharmacists’ practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). Methods: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists’ practice environment. Results: Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient’s controlled substance history since KASPER’s inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p<0.001). Multivariate regression results found utilization of KASPER varied significantly among practice environments of community pharmacists with those who practiced in an urban location (RR: 1.11; [1.01–1.21]) or at an independent pharmacy (RR: 1.27; [1.14–1.40]) having an increased likelihood of KASPER utilization. Conclusion: Utilization of KASPER differs by community pharmacists’ practice environment, predominantly by practice type and location. Understanding characteristics of community pharmacists and community pharmacists’ practice environment associated with PDMP use is necessary to remove barriers to access and increase utilization thereby increasing PDMP effectiveness. PMID:26131042

  16. Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance.

    PubMed

    Oser, Carrie B; Harp, Kathi L H

    2015-01-01

    This is the first known study to examine geographic discordance (traveling from one's home residence to a county with a different socio-cultural context to receive substance abuse treatment) as a predictor of clinical and social functioning treatment outcomes (i.e., relapse, self-help attendance, anxiety, and incarceration) among a sample of prescription drug misusers. Treatment entry and 12-month follow-up client-level survey data were collected from 187 clients who misused prescription drugs, and center-level survey data were collected from the supervisors at treatment centers attended by the clients. Multivariate models reveal that geographic discordance significantly increased the odds that prescription drug misusers would report relapse to prescription opioid misuse, anxiety, and any incarceration at follow-up. Moreover, geographically discordant clients were significantly less likely to have attended a self-help group, net of the effect of other individual- and center-level factors. Implications for clinical practice and substance abuse treatment policy are provided. PMID:25200740

  17. Medicare Part D and Its Effect on the Use of Prescription Drugs and Use of Other Health Care Services of the Elderly

    ERIC Educational Resources Information Center

    Kaestner, Robert; Nasreen Khan,

    2012-01-01

    We examine the effect of gaining prescription drug insurance, as a result of Medicare Part D, on use of prescription drugs and other medical services for a nationally representative sample of Medicare beneficiaries. Given the heightened importance of prescription drugs for those with chronic illness, we provide separate estimates for elderly in…

  18. 21 CFR 201.56 - Requirements on content and format of labeling for human prescription drug and biological products.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01 false...content and format of labeling for human prescription drug and biological products. 201.56 Section 201.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...

  19. 21 CFR 201.56 - Requirements on content and format of labeling for human prescription drug and biological products.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01 false...content and format of labeling for human prescription drug and biological products. 201.56 Section 201.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...

  20. 21 CFR 201.56 - Requirements on content and format of labeling for human prescription drug and biological products.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01 false...content and format of labeling for human prescription drug and biological products. 201.56 Section 201.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...

  1. 21 CFR 201.56 - Requirements on content and format of labeling for human prescription drug and biological products.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01 false...content and format of labeling for human prescription drug and biological products. 201.56 Section 201.56 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT...

  2. Researching Prescription Drug Misuse among First Nations in Canada: Starting from a Health Promotion Framework

    PubMed Central

    Dell, Colleen Anne; Roberts, Gary; Kilty, Jennifer; Taylor, Kelli; Daschuk, Mitch; Hopkins, Carol; Dell, Debra

    2012-01-01

    The intentional misuse of psychotropic drugs is recognized as a significant public health concern in Canada, although there is a lack of empirical research detailing this. Even less research has been documented on the misuse of prescription drugs among First Nations in Canada. In the past, Western biomedical and individual-based approaches to researching Indigenous health have been applied, whereas First Nations’ understandings of health are founded on a holistic view of wellbeing. Recognition of this disjuncture, alongside the protective influence of First Nations traditional culture, is foundational to establishing an empirical understanding of and comprehensive response to prescription drug misuse. We propose health promotion as a framework from which to begin to explore this. Our work with a health promotion framework has conveyed its potential to support the consideration of Western and Indigenous worldviews together in an ‘ethical space’, with illustrations provided. Health promotion also allots for the consideration of Canada’s colonial history of knowledge production in public health and supports First Nations’ self-determination. Based on this, we recommend three immediate ways in which a health promotion framework can advance research on prescription drug misuse among First Nations in Canada. PMID:22879752

  3. Thinking outside the medicine cabinet: a comparative content analysis of direct-to-consumer advertisements for prescription drug treatments.

    PubMed

    McKeever, Robert

    2014-01-01

    This study content analyzed online direct-to-consumer advertisements (DTCA) for prescription drug treatments to explore whether ads for prescription treatments for psychiatric conditions, which are commonly untreated, differ from other drug advertisements. Coded variables included the presence of interactive technological components, use of promotional incentives, and the social contexts portrayed in images shown on each site. Statistical analysis revealed ads for psychiatric medications contained fewer interactive website features, financial incentives, and calls to action than other types of prescription drug advertisements. Implications for health communication researchers are discussed. PMID:25405635

  4. Literacy demands of product information intended to supplement television direct-to-consumer prescription drug advertisements.

    PubMed

    Kaphingst, Kimberly A; Rudd, Rima E; DeJong, William; Daltroy, Lawren H

    2004-11-01

    The US Food and Drug Administration (FDA) allows television direct-to-consumer (DTC) prescription drug advertisements that do not fully disclose drug risks if the ads include "adequate provision" for dissemination of the drug's approved labeling. This requirement can be met in part by referring consumers to multiple text sources of product labeling. This study was designed to assess the materials to which consumers were referred in 23 DTC television advertisements. SMOG assessments showed that the average reading grade levels were in the high school range for the main body sections of the materials and college-level range for the brief summary sections. The Suitability Assessment of Materials (SAM) instrument identified specific difficulties with the materials, including content, graphics, layout, and typography features. Stronger plain language requirements are recommended. Health care providers should be aware that patients who ask about an advertised drug might not have the full information required to make an informed decision. PMID:15530767

  5. Prescription Drugs, Alcohol, and Illicit Substance Use and Their Correlations Among Medical Sciences Students in Iran

    PubMed Central

    Abbasi-Ghahramanloo, Abbas; Fotouhi, Akbar; Zeraati, Hojjat; Rahimi-Movaghar, Afarin

    2015-01-01

    Background: Substance use among young people is a major public health problem in Iran. Objectives: The aims of the present study were to determine the prevalence of substance misuse and its determinants in medical sciences students in Tehran, Iran. Patients and Methods: A cross-sectional study was performed on a randomly selected sample of 1992 medical sciences students during 2012-2013. Anonymous, structured questionnaires were distributed among the students in each selected class. Substance misuse was defined according to cultural and epidemiological features. Data analysis was performed using chi-squared test, Fisher’s exact test, and binary logistic regression. Results: The prevalence of prescription drug misuse, last year alcohol use, and ever illicit substance use was 4.9%, 6.9%, and 2.9%, respectively. The result of multiple logistic regression model showed that being a male (OR = 4.0), hookah use in the last year (OR = 3.2), prescription drug misuse (OR = 3.2), and alcohol use in the last year (OR = 3.3) were associated with the students’ illicit substance use. Last year alcohol use (OR = 5.3), ever illicit substance use (OR = 3.2), and illicit substance use in friends (OR = 2.6) were associated with prescription drug misuse. Conclusions: Our results suggested that the prevalence of prescription drugs, alcohol and illicit substance use was relatively low, though still significant, among Iranian students, which was strongly associated with family and friends’ use. The findings of this research can be used for planning and evaluating interventions by considering the risk factors and protective factors in Universities. PMID:25821750

  6. Perceived Harmfulness Predicts Nonmedical Use of Prescription Drugs Among College Students: Interactions with Sensation-Seeking

    Microsoft Academic Search

    Amelia M. Arria; Kimberly M. Caldeira; Kathryn B. Vincent; Kevin E. O’Grady; Eric D. Wish

    2008-01-01

    This study describes the level of perceived harmfulness of nonmedical prescription stimulant and analgesic use in a sample\\u000a of college students, and examines the prospective relationship between perceived harmfulness and subsequent nonmedical use.\\u000a In addition, we explore whether the association between perceived harmfulness and nonmedical use varies by level of sensation-seeking.\\u000a Personal interviews, including questions on sensation-seeking and drug use,

  7. Trend and variation of prescription drug cost in the veterans health-care system.

    PubMed

    Gao, Jian; Campbell, James

    2008-02-01

    Using descriptive statistics, this paper revealed that the prescription drug cost as a percentage of total health-care cost in Department of Veterans Affairs (VA) health-care system has outpaced the national trend. Given the fact that the national drug expenditure is the most fast-growing component in the health-care expenditure, the drug cost trend in VA commands further assessment for its financial and clinical impact. Furthermore, by applying simple log linear regression, we analysed the geographic variation in prescription drug use in the VA health-care system. We found a 30% deviation from the predicted drug cost at medical centre level and 15% deviation at Network level. Although this variation is relatively small compared with the variation in other medical service use, reduction of the variation has significant clinical and financial implications. Since the method used in this study is easy to implement, this paper provides a practical tool for large health-care systems such as VA, States and health maintenance organizations to identify those hospitals that over- or under-prescribe drugs. PMID:18275661

  8. Prescription of Kampo Drugs in the Japanese Health Care Insurance Program

    PubMed Central

    Katayama, Kotoe; Yoshino, Tetsuhiro; Munakata, Kaori; Yamaguchi, Rui; Imoto, Seiya; Miyano, Satoru; Watanabe, Kenji

    2013-01-01

    Kampo medicine or traditional Japanese medicine has been used under Japan's National Health Insurance scheme for 46 years. Recent research has shown that more than 80% of physicians use Kampo in daily practice. However, the use of Kampo from the patient perspective has received scant attention. To assess the current use of Kampo drugs in the National Health Insurance Program, we analysed a total of 67,113,579 health care claim records, which had been collected by Japan's Ministry of Health, Labour and Welfare in 2009. We found that Kampo drugs were prescribed for 1.34% of all patients. Among these, 92.2% simultaneously received biomedical drugs. Shakuyakukanzoto was the most frequently prescribed Kampo drug. The usage of frequently prescribed Kampo drugs differed between the youth and the elderly, males and females, and inpatients and outpatients. Kampo medicine has been employed in a wide variety of conditions, but the prescription rate was highest for disorders associated with pregnancy, childbirth, and the puerperium (4.08%). Although the adoption of Kampo medicine by physicians is large in a variety of diseases, the prescription rate of Kampo drugs is very limited. PMID:24550992

  9. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement

    Microsoft Academic Search

    James Zacny; George Bigelow; Peggy Compton; Kathleen Foley; Martin Iguchi; Christine Sannerud

    2003-01-01

    This position paper from the College on Problems of Drug Dependence addresses the issues related to non-medical use and abuse of prescription opioids. A central theme throughout is the need to strike a balance between risk management strategies to prevent and deter prescription opioid abuse and the need for physicians and patients to have appropriate access to opioid pharmaceuticals for

  10. The educational potential of direct-to-consumer prescription drug advertising.

    PubMed

    Kaphingst, Kimberly A; DeJong, William

    2004-01-01

    Food and Drug Administration (FDA) regulations for direct-to-consumer (DTC) prescription drug advertising allow broadcast advertisements with incomplete risk information if the ads refer consumers to physicians, pharmacists, and supplemental information sources. New research reveals several problems with both television advertisements and supplemental text materials that might compromise their ability to meet the FDA's requirement for "fair balance" in the presentation of risks and benefits. In response, we make several recommendations to improve the educational quality of DTC advertising, which can be implemented through either voluntary agreements or revised FDA regulations. PMID:15318574

  11. Impact of celebrity pitch in direct-to-consumer advertising of prescription drugs.

    PubMed

    Bhutada, Nilesh S; Menon, Ajit M; Deshpande, Aparna D; Perri, Matthew

    2012-01-01

    Online surveys were conducted to determine the impact of endorser credibility, endorser effectiveness, and consumers' involvement in direct-to-consumer advertising. In a randomized posttest only study, using the elaboration likelihood model, survey participants (U.S. adults) were either exposed to a fictitious prescription drug ad with a celebrity or a noncelebrity endorser. There was no significant difference in credibility and effectiveness between the celebrity and the noncelebrity endorser. High involvement consumers viewed the ad more favorably and exhibited significantly stronger drug inquiry intentions during their next doctor visit. Further, consumers' involvement did not moderate the effect of celebrity endorser. PMID:22416924

  12. Multifaceted determinants of online non-prescription drug information seeking and the impact on consumers' use of purchase channels.

    PubMed

    Holtgräfe, Catherine; Zentes, Joachim

    2012-06-01

    The growing importance of the Internet as an information and purchasing channel is drawing widespread attention from marketing decision makers. Nevertheless, the relevance of the Internet to the so-called self-medication market in Germany has been paid barely enough attention. Our study aims to contribute insights concerning the penetration of the Internet in this market, as well as to give an overview of the critical determinants of Internet use for non-prescription drug information seeking, such as the accessibility of professional information, trust in health professionals' opinion and the ability to search online, as well as the perceived usefulness and credibility of online non-prescription drug information. Furthermore, we demonstrate that the preferred use of the Internet as a non-prescription drug information source positively influences the choice of unconventional purchase channels for non-prescription drugs and negatively affects the use of stationary pharmacies. PMID:22733678

  13. Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

    PubMed Central

    2010-01-01

    Background Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM. Methods Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation. Results A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network. Conclusions A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users’ whose needs may not be being met by mainstream drug services, and issues of stigma in relation to ‘abusers’. PMID:20868516

  14. [Prescriptions and consumption of venotonic drugs in France (à propos of the report of the French National Institute for prescriptions and consumption of drugs)].

    PubMed

    Bouvenot, G

    1999-01-01

    In 1997, consumption of veinotonic drugs in France represented 3.8% of the sales of refundable patient medicines, that is to say nearly 3 Billion francs with a 2.8% mean annual increase in units sold from 1983 to 1997, whereas prices decreased and new presentations with stronger dosages and larger packagings appeared on the market. No French epidemiologic specificity could be evidenced as regards the prevalence of chronic venous insufficiency and its complications. In France, and in comparison with elastic support, veinotonic products are preponderant in the treatment of chronic venous insufficiency despite restrictive labelling of authorization (treatment of symptoms) and recommendations of good practice which consider them as a complementary treatment. They are the subject of 18 million prescriptions per year, by 69,000 doctors, mainly general practitioners. They are utilized over long periods, within a context of prescription rather than automedication. The number of patent medicines available (109), the status of refundable medicine, strong demand of patients and therapeutic habits have made France the world's foremost market for veinotonic products, with 70% of international sales. French particularism is indeed due to these factors and not to the prevalence of the condition to be treated. PMID:10464991

  15. 21 CFR 201.80 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    21 Food and Drugs 4 2014-04-01 2014-04-01 false Specific...requirements on content and format of labeling for human prescription drug and biological products; older drugs not described in § 201.56(b)(1). 201.80...

  16. 21 CFR 201.80 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    21 Food and Drugs 4 2011-04-01 2011-04-01 false Specific...requirements on content and format of labeling for human prescription drug and biological products; older drugs not described in § 201.56(b)(1). 201.80...

  17. 21 CFR 201.80 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    21 Food and Drugs 4 2012-04-01 2012-04-01 false Specific...requirements on content and format of labeling for human prescription drug and biological products; older drugs not described in § 201.56(b)(1). 201.80...

  18. 21 CFR 201.80 - Specific requirements on content and format of labeling for human prescription drug and...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 4 2010-04-01 2010-04-01 false Specific...requirements on content and format of labeling for human prescription drug and biological products; older drugs not described in § 201.56(b)(1). 201.80...

  19. 21 CFR 200.200 - Prescription drugs; reminder advertisements and reminder labeling to provide price information to...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...or suggestion concerning the drug product's safety, effectiveness...limited to, the cost of the drug product, professional fees...if any. Mailing fees and delivery fees, if any, may be stated...applicable to all prescription drug reminder labeling and...

  20. Trends in opiate overdose deaths in Australia 1979–1995

    Microsoft Academic Search

    Wayne Hall; Shane Darke

    1998-01-01

    Aims: to determine if there had been an increase in the rate of opioid overdose deaths between 1979 and 1995, and to describe the characteristics of persons who died of an opioid overdose. Method: opioid overdose deaths were defined according to ICD-9 as deaths due to drug dependence (codes 304.0 and 304.7) and accidental opiate poisoning (code E850.0). Data were

  1. Barbiturate intoxication and overdose

    MedlinePLUS

    Intoxication - barbiturates ... Symptoms of barbiturate intoxication and overdose include: Altered level of consciousness Difficulty in thinking Drowsiness or coma Faulty judgment Incoordination Shallow breathing Slowness ...

  2. Use of illicit and prescription drugs for cognitive or mood enhancement among surgeons

    PubMed Central

    2013-01-01

    Background Surgeons are usually exposed to high workloads leading to fatigue and stress. This not only increases the likelihood of mistakes during surgery but also puts pressure on surgeons to use drugs to counteract fatigue, distress, concentration deficits, burnout or symptoms of depression. The prevalence of surgeons taking pharmacological cognitive enhancement (CE) or mood enhancement (ME) drugs has not been systematically assessed so far. Methods Surgeons who attended five international conferences in 2011 were surveyed with an anonymous self-report questionnaire (AQ) regarding the use of prescription or illicit drugs for CE and ME and factors associated with their use. The Randomized Response Technique (RRT) was used in addition. The RRT guarantees a high degree of anonymity and confidentiality when a person is asked about stigmatizing issues, such as drug abuse. Results A total of 3,306 questionnaires were distributed and 1,145 entered statistical analysis (response rate: 36.4%). According to the AQ, 8.9% of all surveyed surgeons confessed to having used a prescription or illicit drug exclusively for CE at least once during lifetime. As one would expect, the prevalence rate assessed by RRT was approximately 2.5-fold higher than that of the AQ (19.9%; 95% confidence interval (CI), 15.9% to 23.9%, N = 1,105). An even larger discrepancy between the RRT and AQ was observed for the use of antidepressants with a 6-fold higher prevalence (15.1%; 95% CI, 11.3% to 19.0%, N = 1,099) as compared to 2.4% with the AQ. Finally, logistic regression analysis revealed that pressure to perform at work (odds ratio (OR): 1.290; 95% CI, 1.000 to 1.666; P = 0.05) or in private life (OR: 1.266; 95% CI, 1.038 to 1.543; P = 0.02), and gross income (OR: 1.337; 95% CI, 1.091 to 1.640; P = 0.005), were positively associated with the use of drugs for CE or ME. Conclusions The use of illicit and prescription drugs for CE or ME is an underestimated phenomenon among surgeons which is generally attributable to high workload, perceived workload, and private stress. Such intake of drugs is associated with attempts to counteract fatigue and loss of concentration. However, drug use for CE may lead to addiction and to overestimation of one’s own capabilities, which can put patients at risk. Coping strategies should be taught during medical education. PMID:23570256

  3. Life table methods applied to use of medical care and of prescription drugs in early childhood.

    PubMed Central

    Rasmussen, F; Smedby, B

    1989-01-01

    Life table methods were applied to analyses of longitudinal data on the use of medical care during the first 5 years of life among all 1701 children born in a Swedish semirural municipality. Cumulative proportions of the children who had used particular types of medical care or prescription drugs at least once by certain ages were estimated. By the fifth birthday, 98% had made at least one visit to any physician and 82% at least one visit to a paediatrician. By the fifth birthday at least one prescription for antibiotics had been purchased at a pharmacy by 82%; and 33% had been admitted to inpatient hospital care at least once (excluding immediate postnatal care). Acute conditions and more chronic diseases were also studied using these methods. At least one visit to a physician at a primary health care centre had been made for acute otitis media in 65% of 5 year olds and for atopic dermatitis in 8%. PMID:2592902

  4. Strategies used by adults to reduce their prescription drug costs: United States, 2013.

    PubMed

    Cohen, Robin A; Villarroel, Maria A

    2015-01-01

    Among U.S. adults aged 18-64, strategies for reducing prescription drug costs were more commonly practiced by those who were uninsured than those who had public or private coverage. Lack of health insurance coverage and poverty are recognized risk factors for not taking medication as prescribed due to cost. This cost-saving strategy may result in poorer health status and increased emergency room use and hospitalizations, compared with adults who follow their recommended pharmacotherapy. It is unknown whether adverse health outcomes and higher health care costs are also associated with the cost-reduction strategies of alternative therapy use or obtaining prescription drugs from abroad. Among adults aged 65 and over, those covered by both Medicare and Medicaid were more likely to have not taken their medication as prescribed to save money, but were less likely to have asked their doctor for a lower-cost prescription, than those who had private insurance coverage. Differences in cost-saving strategies by insurance coverage may be interrelated with socioeconomic and other patient characteristics. Belief that the recommended pharmacotherapy is needed, and an understanding of the recommended treatment, have been found to be lower among older adults who are economically vulnerable, compared with those with higher income. Income was also associated with the use of cost-reduction strategies. Among adults aged 65 and over, those living with incomes at 139%-400% FPL were more likely than adults living in lower or higher income thresholds to have asked their provider for a lower-cost prescription to save money. These patterns in the estimates by insurance status and poverty level are similar to those previously reported using the 2011 NHIS data. PMID:25633356

  5. Association between unemployment rates and prescription drug utilization in the United States, 2007–2010

    PubMed Central

    2012-01-01

    Background While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States. Methods Using a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class. Results Monthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics. Conclusion We found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces. PMID:23193954

  6. Prescription opioids and other medicines during pregnancy

    MedlinePLUS

    ... treatment is right for you. What is prescription drug abuse? Prescription drug abuse is when you use a prescription medicine in ... than ordered by your health care provider. Prescription drug abuse is a serious and growing problem in the ...

  7. Reducing Prescriptions of Long-Acting Benzodiazepine Drugs in Denmark: A Descriptive Analysis of Nationwide Prescriptions during a 10-Year Period.

    PubMed

    Eriksen, Sophie Isabel; Bjerrum, Lars

    2015-06-01

    Prolonged consumption of benzodiazepine drugs (BZD) and benzodiazepine receptor agonists (zolpidem, zaleplon, zopiclone; altogether Z drugs) is related to potential physiological and psychological dependence along with other adverse effects. This study aimed to analyse the prescribing of long-acting BZD (half-life >10 hr), compared to short-acting BZD in Denmark during a 10-year period. Descriptive analysis of total sales data from the Danish Register of Medicinal Product Statistics, to individuals in the primary healthcare sector, of all BZD and Z drugs in the period of 2003-2013. Prescription data derive from all community and hospital pharmacies in Denmark. The prescribing of long-acting BZD was reduced from 25.8 defined daily doses (DDD)/1000 inhabitants/day in 2003 to 8.8 DDD/1000 inhabitants/day in 2013, a relative reduction of 66%. The prescribing of short-acting BZD was reduced from 26.1 DDD/1000 inhabitants/day in 2003 to 16.4 DDD/1000 inhabitants/day in 2013, a relative reduction of 37%. Prescription data in this study did not include information about indications for initiating treatments. In addition, due to compliance problems, some of the prescribed drugs may not have been consumed according to the prescription. The observed reduction in BZD use was correlated to the introduction of new national guidelines on prescription of addictive drugs, but this study was not designed to detect a causal relationship. The prescribing of long-acting BZD decreased considerably more than the prescribing of short-acting BZD in the 10-year period. PMID:25382355

  8. Korean Americans' prescription drug information seeking and evaluation and use of different information sources.

    PubMed

    Huh, Jisu; Delorme, Denise E; Reid, Leonard N; Kim, Junga

    2013-01-01

    This study examined Korean Americans' prescription drug information seeking, evaluation and use of different information sources, and communication with physicians, and compared the findings with those from the White American population. The results suggest that although Korean and White Americans were similar in extent of drug information seeking, Korean Americans tended to experience relatively greater difficulty finding information. Regarding perceived source usefulness, Korean Americans were significantly more likely to perceive higher usefulness in mass media and direct-to-consumer advertising sources than were Whites. Korean Americans were also more likely to use fewer sources, and less likely to use mass media and printed materials in drug information seeking. However, the hypothesized in-group source preference by Korean Americans was not found. PMID:23472746

  9. Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women

    PubMed Central

    Tandon, Vishal R.; Sharma, Sudhaa; Mahajan, Shagun; Mahajan, Annil; Khajuria, Vijay; Mahajan, Vivek; Prakash, Chander

    2014-01-01

    Aim of Study: The aim of this study is to evaluate antihypertensive drug prescription patterns, rationality and adherence to Joint National Committee (JNC-7) hypertension (HT) treatment recommendations among Indian postmenopausal women (PMW). Materials and Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year. A total of 500 prescriptions prescribed to PMW for diagnosed HT, were identified for one point analysis. Drug prescription patterns/trends, and their adherence to JNC-7 report as well as rationality using WHO guide to good prescribing was assessed. Results: In the monotherapy, category angiotensin receptor blockers (ARBs) accounted (24.8%), calcium channel blockers (CCBs) (19.4%), angiotensin converting enzyme inhibitors (ACEIs) (11%), beta blockers (BBs) (2.8%), and diuretics (2%) of the total prescription. Individually, amlodipine was maximally prescribed in 16.4%. 31.6% had double combination, whereas 2.2% and 1% had triple and four drug combinations, respectively. About 3.6% of the prescription contained antihypertensive combination along with other class of drug. ARBs + diuretic were observed in 11%, CCBs + BB 10% and ACEI + diuretic in 2.6% of the total prescriptions. Among the combination therapy amlodipine + atenolol (8.4%), telmisartan + hydrochlorothiazide (6%) and losartan + hydrochlorothiazide (4.4%) were maximally prescribed. 84.21% (P < 0.001) of the prescription showed nonadherence as per recommendations for pre-HT. 100% and 43.25% adherence rates were noticed for Stage 1 HT (P < 0.001) and Stage 2 HT (P > 0.05) patients. Conclusion: Antihypertensive prescription trends largely adhere to existing guidelines and are rational except polypharmacy, generic and fixed dose combinations prescribing, were some of the common pharmacologically considered irrationality noticed. PMID:24970986

  10. Tylenol Extended Relief Overdose

    Microsoft Academic Search

    Edward W Cetarukcol; Richard C Dartcol; Katherine M Hurlbutcol; Rivka S Horowitzcol; Richard Shihcol

    1997-01-01

    In this report we describe the toxicokinetics of the Tylenol Extended Relief (TER) preparation of acetaminophen in human overdose. We collected 41 cases of TER overdose from five regional poison centers. Patients who met the following criteria were studied: a single ingestion of TER alone; confirmed time of ingestion; at least four acetaminophen determinations; and normal concentrations of liver function

  11. Subjective health literacy and older adults' assessment of direct-to-consumer prescription drug ads.

    PubMed

    An, Soontae; Muturi, Nancy

    2011-01-01

    Older adults are increasingly the intended target of direct-to-consumer (DTC) prescription drug ads, but limited evidence exists as to how they assess the educational value of DTC ads and, more importantly, whether their assessment depends on their level of health literacy. In-person interviews of 170 older adults revealed that those with low subjective health literacy evaluated the educational value of DTC ads significantly lower than did those with high subjective health literacy. The results prompt us to pay more scholarly attention to determining how effectively DTC ads convey useful medical information, particularly to those with limited health literacy. PMID:21951255

  12. A content analysis of direct-to-consumer television prescription drug advertisements.

    PubMed

    Kaphingst, Kimberly A; DeJong, William; Rudd, Rima E; Daltroy, Lawren H

    2004-01-01

    This article reports the results of a content analysis of 23 direct-to-consumer (DTC) product-specific television prescription drug advertisements broadcast during 2001. A majority of ads used both medical and lay terms to convey medical ideas. Most gave consumers somewhat more time to absorb facts about benefits than those about risks, which could have implications for the "fair balance" requirement. Complete references to additional product information were given only in text, casting doubt on whether these ads are making"adequate provision"for dissemination of detailed product information. Overall, our results call into question the potential of these ads to educate consumers. PMID:15764450

  13. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

    PubMed Central

    2015-01-01

    Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent. More serious adverse reactions after naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged hypoxia. One component of the new opioid harm reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. Patients or their close contacts receive a naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of naloxone by intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New naloxone delivery products are being developed for this prehospital application of naloxone in treatment of opioid overdose and prevention of opioid-induced mortality. PMID:25642320

  14. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access.

    PubMed

    Wermeling, Daniel P

    2015-02-01

    Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent. More serious adverse reactions after naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged hypoxia. One component of the new opioid harm reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. Patients or their close contacts receive a naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of naloxone by intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New naloxone delivery products are being developed for this prehospital application of naloxone in treatment of opioid overdose and prevention of opioid-induced mortality. PMID:25642320

  15. Extracorporeal circulation in the management of massive propranolol overdose.

    PubMed

    McVey, F K; Corke, C F

    1991-09-01

    A case of refractory hypotension following propranolol overdose is reported. Management included isoprenaline, glucagon and extracorporeal circulatory support using femoral vein-femoral artery bypass. The unreliability of neurological observations, especially unreactive pupils, in the presence of drug overdose is reiterated. PMID:1928675

  16. Acute opiate overdose in Tehran: The forgotten role of opium

    Microsoft Academic Search

    Mojgan Karbakhsh; Negar Salehian Zandi

    2007-01-01

    IntroductionThe global epidemic of opiate use continues to spread and is an increasing burden especially in developing countries. Acute opiate overdose (AOO) is one of the most dramatic complications of drug abuse. The purpose of this study is to examine the epidemiology of acute opiate overdose in a poisoning center in Tehran.

  17. Most primary care physicians are aware of prescription drug monitoring programs, but many find the data difficult to access.

    PubMed

    Rutkow, Lainie; Turner, Lydia; Lucas, Eleanor; Hwang, Catherine; Alexander, G Caleb

    2015-03-01

    State prescription drug monitoring programs are common tools intended to reduce prescription drug abuse and diversion, or the nonmedical use of a prescribed drug. The success of these programs depends largely upon physicians' awareness and use of them. We conducted a nationally representative mail survey of 1,000 practicing primary care physicians in 2014 to characterize their attitudes toward and awareness and use of prescription drug monitoring programs. A total of 420 eligible physicians (adjusted response rate: 58 percent) returned completed surveys. Among all physicians surveyed, 72 percent were aware of their state's prescription drug monitoring program, and 53 percent reported using one of the programs. We identified several barriers that may prevent greater use of the programs, including the time-consuming nature of information retrieval and the lack of an intuitive format for data provided by the programs. These results suggest that the majority of US primary care physicians are aware of and use prescription drug monitoring programs at least on occasion, although many did not access these programs routinely. To increase the use of the programs in clinical practice, states should consider implementing legal mandates, investing in prescriber education and outreach, and taking measures to enhance ease of access to and use of the programs. PMID:25732500

  18. Initiation into Prescription Drug Misuse: Differences between Lesbian, Gay, Bisexual, Transgender (LGBT) and Heterosexual High-Risk Young Adults in Los Angeles and New York

    PubMed Central

    Kecojevic, Aleksandar; Wong, Carolyn F.; Schrager, Sheree M.; Silva, Karol; Bloom, Jennifer Jackson; Iverson, Ellen; Lankenau, Stephen E.

    2012-01-01

    Objective Prescription drug misuse is an important public health problem in the U.S, particularly among adolescents and young adults. Few studies have examined factors contributing to initiation into prescription drug misuse, including sexual orientation and childhood abuse and neglect. The purpose of the present study is to investigate the relationship between initiation into the misuse of prescription drugs (opioids, tranquilizers, and stimulants), sexual identity, and individual and family determinants. Method Results are based upon data from a cross-sectional survey of 596 youth (polydrug users, homeless youth, and injection drug users) aged 16 to 25 who reported current prescription drug misuse. Participants were recruited in Los Angeles and New York City between 2009 and 2011. We compared initiation behaviors between sexual minority and heterosexual youth and examined factors modifying the relationship between sexual identity and earlier initiation into prescription drug misuse. Results Sexual minority youth were more likely to report histories of initiation into misuse of prescription opioids and tranquilizers. Further, they were more likely to report various types of childhood abuse than heterosexual youth. However, multivariate analyses indicated that age of first prescribed drug was the most significant factor associated with initiation into misuse of all three categories of prescription drugs. Conclusions The correlates of initiation into prescription drug misuse are multidimensional and offer opportunities for further research. Identifying additional factors contributing to initiation into prescription drug misuse is essential towards developing interventions that may reduce future drug use among young adults. PMID:22738887

  19. Association between prescription drug misuse and injection among runaway and homeless youth

    PubMed Central

    Al-Tayyib, Alia A; Rice, Eric; Rhoades, Harmony; Riggs, Paula

    2013-01-01

    Background The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, disproportionately impacting youth. Furthermore, the population prevalence of injection drug use among youth is also on the rise. This short communication examines the association between current prescription drug misuse (PDM) and injection among runaway and homeless youth. Methods Homeless youth were surveyed between October, 2011 and February, 2012 at two drop-in service agencies in Los Angeles, CA. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between current PDM and injection behavior were estimated. The outcome of interest was use of a needle to inject any illegal drug into the body during the past 30 days. Results Of 380 homeless youth (median age, 21; IQR, 17-25; 72% male), 84 (22%) reported current PDM and 48 (13%) reported currently injecting. PDM during the past 30 days was associated with a 7.7 (95% CI: 4.4, 13.5) fold increase in the risk of injecting during that same time. Among those reporting current PDM with concurrent heroin, cocaine, and methamphetamine use, the PR with injection was 15.1 (95% CI: 8.5, 26.8). Conclusions Runaway and homeless youth are at increased risk for a myriad of negative outcomes. Our preliminary findings are among the first to show the strong association between current PDM and injection in this population. Our findings provide the basis for additional research to delineate specific patterns of PDM and factors that enable or inhibit transition to injection among homeless and runaway youth. PMID:24300900

  20. Demographics, health behaviors, and past drug use as predictors of recall accuracy for previous prescription medication use

    Microsoft Academic Search

    Suzanne L. West; David A. Savitz; Gary Koch; Karen L. Sheff; Brian L. Strom; Harry A. Guess; Abraham G. Hartzema

    1997-01-01

    Drug data for pharmacoepidemiologic studies are often ascertained by self-report, but little research has addressed the factors influencing its accuracy. Stratified random sampling was used to select individuals for a study comparing interview data on past prescription drug use with dispensation information from the Group Health Cooperative of Puget Sound pharmacy database. The strata included age, gender, and recency of

  1. Risk factors of ?-hydroxybutyrate overdosing.

    PubMed

    Korf, Dirk J; Nabben, Ton; Benschop, Annemieke; Ribbink, Kim; van Amsterdam, Jan G C

    2014-01-01

    The aim of this study was to identify in recreational drug users the factors which increase the risk of overdosing (OD) with ?-hydroxybutyrate (GHB). A purposive sample of 45 experienced GHB users was interviewed, equally divided into three groups (never OD, occasional OD, and repeat OD). The repeat OD group scored highest on many risk factors regarding GHB use, the occasional OD group scored intermediate, and the never OD group scored lowest. Participants, whether or not they had overdosed on GHB, most often perceived GHB use (e.g. using more GHB than usual, using GHB doses too closely together) as the main reason for GHB OD, and many participants who had overdosed on GHB reported that they had taken more GHB than usual at their most recent occasion of GHB OD. No significant differences in co-use of GHB with other substances were found between the three groups. Our findings indicate that using GHB in the company of groups of friends probably reduces, but does not eliminate, the risk of OD. PMID:24080792

  2. Prescription Drug Monitoring Program Inquiry in Psychiatric Assessment: Detection of High Rates of Opioid Prescribing to a Dual Diagnosis Population

    PubMed Central

    Hackman, Daniel T.; Greene, Marion S.; Fernandes, Taya J.; Brown, Ashley M.; Wright, Eric R.; Chambers, R. Andrew

    2015-01-01

    Objective An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. Method In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. Results The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95% CI, 1.016–1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95% CI, 1.001–1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. Conclusions Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved prevention and treatment strategies for addictions as facilitated by more research and clinical use of prescription drug monitoring in psychiatric care are warranted. PMID:25093472

  3. Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

    PubMed Central

    Schmiedl, Sven; Fischer, Rainald; Ibáñez, Luisa; Fortuny, Joan; Klungel, Olaf H.; Reynolds, Robert; Gerlach, Roman; Tauscher, Martin; Thürmann, Petra; Hasford, Joerg; Rottenkolber, Marietta

    2014-01-01

    Respiratory drugs are widely used in children to treat labeled and non-labeled indications but only some data are available quantifying comprehensively off-label usage. Thus, we aim to analyse drug utilisation and off-label prescribing of respiratory drugs focusing on age- and indication-related off-label use. Patients aged ?18 years documented in the Bavarian Association of Statutory Health Insurance Physicians database (approx. 2 million children) between 2004 and 2008 were included in our study. Annual period prevalence rates (PPRs) per 10,000 children and the proportion of age- and indication-related off-label prescriptions were calculated and stratified by age and gender. Within the study period, highest PPRs were found for the fixed combination of clenbuterol/ambroxol (between 374–575 per 10,000 children) and the inhaled short acting beta-2-agonist salbutamol (between 378–527 per 10,000 children). Highest relative PPR increase was found for oral salbutamol (approx. 39-fold) whereas the most distinct decrease was found for oral long-acting beta-2-agonist clenbuterol (?97%). Compound classes most frequently involved in off-label prescribing were inhaled bronchodilative compounds (91,402; 37.3%) and oral beta-2-agonists (26,850; 22.5%). The highest absolute number of off-label prescriptions were found for inhaled salbutamol (n?=?67,084; 42.0%) and oral clenbuterol/ambroxol (fixed combination, n?=?18,897; 20.7%). Off-label prescribing due to indication was of much greater relevance than age-related off-label use. Most frequently, bronchodilative compounds were used off-label to treat respiratory tract infections. Highest off-label prescription rates were found in the youngest patients without relevant gender-related differences. Off-label prescribing of respiratory drugs is common especially in young children. Bronchodilative drugs were most frequently used off-label for treating acute bronchitis or upper respiratory tract infections underlining the essential need for a more rational prescribing in this area. PMID:25180704

  4. Age and the purchase of prescription drug insurance by older adults.

    PubMed

    Szrek, Helena; Bundorf, M Kate

    2011-06-01

    The Medicare Part D Prescription Drug Program places an unprecedented degree of choice in the hands of older adults despite concerns over their ability to make effective decisions and desire to have extensive choice in this context. While previous research has compared older adults to younger adults along these dimensions, our study, in contrast, examines how likelihood to delay decision making and preferences for choice differ by age among older age cohorts. Our analysis is based on responses of older adults to a simulation of enrollment in Medicare Part D. We examine how age, numeracy, cognitive reflection, and the interaction between age and performance on these instruments are related to the decision to enroll in a Medicare prescription drug plan and preference for choice in this context. We find that numeracy and cognitive reflection are positively associated with enrollment likelihood and that they are more important determinants of enrollment than age. We also find that greater numeracy is associated with a lower willingness to pay for choice. Hence, our findings raise concern that older adults, and, in particular, those with poorer numerical processing skills, may need extra support in enrolling in the program: they are less likely to enroll than those with stronger numerical processing skills, even though they show greater willingness to pay for choice. PMID:21534689

  5. Enrollment in prescription drug insurance: the interaction of numeracy and choice set size

    PubMed Central

    Szrek, Helena; Bundorf, M. Kate

    2015-01-01

    Objective To determine how choice set size affects decision quality among individuals of different levels of numeracy choosing prescription drug plans. Methods Members of an internet-enabled panel age 65 and over were randomly assigned to sets of prescription drug plans varying in size from 2 to 16 plans from which they made a hypothetical choice. They answered questions about enrollment likelihood and the costs and benefits of their choice. The measure of decision quality was enrollment likelihood among those for whom enrollment was beneficial. Enrollment likelihood by numeracy and choice set size was calculated. A model of moderated mediation was analyzed to understand the role of numeracy as a moderator of the relationship between the number of plans and the quality of the enrollment decision and the roles of the costs and benefits in mediating that relationship. Results More numerate adults made better decisions than less numerate adults when choosing among a small number of alternatives but not when choices sets were larger. Choice set size had little effect on decision making of less numerate adults. Differences in decision making costs between more and less numerate adults helped explain the effect of choice set size on decision quality. Conclusions Interventions to improve decision making in the context of Medicare Part D may differentially affect lower and higher numeracy adults. The conflicting results on choice overload in the psychology literature may be explained in part by differences across different types of people in their response to choice sets of varying sizes. PMID:23795708

  6. Associations between prescription opioid injection and Hepatitis C virus among young injection drug users

    PubMed Central

    Lankenau, Stephen E.; Kecojevic, Aleksandar; Silva, Karol

    2014-01-01

    Objective Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. Methods Young IDUs (n = 162) aged 18–25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009–2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. Results A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p<0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p<0.05), growing up in a lower social class (AIRR: 1.67, p<0.05), age (AIRR: 1.12, p<0.05), age of injection initiation (AIRR: 0.87, p<0.001), and history of being prescribed stimulants (AIRR: 0.64, p<0.05) were independently associated with HCV positivity. Conclusions Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US. PMID:25598589

  7. Strategic options for brand-name prescription drugs when patents expire.

    PubMed

    Mehta, S C; Mehta, S S

    1997-01-01

    Pharmaceutical companies face a very hostile competitive environment from generic drugs once the patents on their brand name drugs expire. Depending on the country, such patents usually last 10-15 years but no sooner do the patents expire then copies of off-patent brand name drugs, called generics, are introduced, generally by smaller-size and lesser known companies, at significantly lower prices. As health care costs escalate all over the world, efforts to control medication costs have created a major market for generic prescription drugs, particularly in government funded hospitals and in dispensing general practitioner markets of the Asia Pacific and the third world. The world market for generics is estimated at US$20 billion, doubling in only five years and capturing over 30% of the market share. Because of adverse effects on sales and profitability due to the launching of generics, most research based companies that produce original brand-name patented drugs are forced to take counter measures to overcome this problem, particularly when R&D costs for new patents are skyrocketing. This paper develops a brief perspective on this problem and then examines the experiences of many multinational companies in the Singapore market in dealing with the problem. While several different approaches are identified, only one company experience appeared to work successfully and this is discussed in relative detail. PMID:10167309

  8. Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Final rule.

    PubMed

    2014-12-01

    The Food and Drug Administration (FDA) is amending its regulations governing the content and format of the "Pregnancy," "Labor and delivery," and "Nursing mothers" subsections of the "Use in Specific Populations" section of the labeling for human prescription drug and biological products. The final rule requires the removal of the pregnancy categories A, B, C, D, and X from all human prescription drug and biological product labeling. For human prescription drug and biological products subject to the Agency's 2006 Physician Labeling Rule, the final rule requires that the labeling include a summary of the risks of using a drug during pregnancy and lactation, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy and lactation. The final rule eliminates the "Labor and delivery" subsection because information about labor and delivery is included in the "Pregnancy" subsection. The final rule requires that the labeling include relevant information about pregnancy testing, contraception, and infertility for health care providers prescribing for females and males of reproductive potential. The final rule creates a consistent format for providing information about the risks and benefits of prescription drug and/or biological product use during pregnancy and lactation and by females and males of reproductive potential. These revisions will facilitate prescriber counseling for these populations. PMID:25509060

  9. Direct-to-consumer advertising skepticism and the use and perceived usefulness of prescription drug information sources.

    PubMed

    DeLorme, Denise E; Huh, Jisu; Reid, Leonard N

    2009-01-01

    This study investigates advertising skepticism in the context of consumers' prescription drug information seeking behavior. Results of a telephone survey found that: (a) the overall level of direct-to-consumer advertising (DTCA) skepticism among consumers was neutral; (b) DTCA skepticism was unrelated to age, positively related to education and income, and varied by race; (c) however, when all the antecedent variables were considered concurrently, only education emerged as a significant predictor (consumers with higher education were more skeptical of DTCA); (d) DTCA skepticism was not significantly related to perceived importance of prescription drug information; (e) DTCA skepticism was not associated with use of advertising and interpersonal sources of prescription drug information; and (f) DTCA skepticism was negatively related to perceived usefulness of advertising sources but unrelated to perceived usefulness of professional interpersonal sources (i.e., physicians and pharmacists). The article concludes with a discussion of findings and directions for future research. PMID:19916096

  10. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

    PubMed Central

    Green, Traci C.; Heimer, Robert; Grau, Lauretta E.

    2011-01-01

    Aims This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose–response in the United States. Design and participants Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62). Setting US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico. Measurements Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics. Findings Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t60 = 3.76, P < 0.001) and instances where naloxone was indicated (t59 = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). Conclusions Results suggest that naloxone training programs in the United States improve participants’ ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality. PMID:18422830

  11. Guide to drug porphyrogenicity prediction and drug prescription in the acute porphyrias

    PubMed Central

    Thunell, Stig; Pomp, Erik; Brun, Atle

    2007-01-01

    What is already known about this subject Many drug safety lists for acute porphyrias, largely based on anecdotal evidence, are put forward, but no methods or rationale for the risk estimates are given. Many unexplained discrepancies between the lists exist. What this study adds A standardized method for assessment of the risk that a certain drug may activate these diseases has been developed. It also allows risk assessments for drugs lacking porphyria related clinical experience. About one thousand therapeutic drugs have been classified with regard to porphyrogenicity by the proposed method, which is most valuable for the care of porphyria patients. Aims This paper addresses two common problems in the care of carriers of acute porphyria: the choice of safe drugs for pharmacotherapy and the strategy to apply when potentially unsafe drugs cannot be avoided. Methods and results A technique is presented for prediction of risk that a certain drug may activate the disease in a gene carrier for acute porphyria. It is based on a model explaining the clinical manifestations as a result of the acute overloading of a deficient enzyme within the hepatic heme biosynthetic chain. The capacity of the drug for induction of the rate-limiting enzyme in heme biosynthesis, e.g. housekeeping 5-aminolevulinate synthase (ALAS1), is assessed by critical appraisal of reports of the outcomes of clinical use of the drug, and by theoretical criteria. The assessment occurs within the frame of a flow-scheme employing variables of increasing specificity, i.e. endocrine properties of the drug, structure and metabolism pointing to affinity to cytochrome P450, hepatic load in therapeutic use, recognized affinity to major CYP species, capacity for CYP-induction or irreversible inhibition, and capacity to activate or modulate the transduction mechanisms of nuclear receptors affecting ALAS1-gene transcription. It is proposed that in the absence of a safer alternative, an urgently needed drug not should be withheld on the grounds of potential porphyrogenicity. After risk-benefit analysis it should be prescribed, but individualized preventive measures adapted to patient vulnerability may be needed. Conclusions About 1000 therapeutic drugs categorized with regard to porphyrogenicity by the technique proposed are presented on the internet (http://www.drugs-porphyria.org). PMID:17578481

  12. Campho-Phenique overdose

    MedlinePLUS

    Campho-Phenique contains both camphor and phenol. For information on products containing camphor alone, see camphor overdose . ... The combination of camphor and phenol is found in Campho-Phenique. ... camphor and phenol may be found separately in other products.)

  13. Peppermint oil overdose

    MedlinePLUS

    ... oil is an oil made from the peppermint plant. Peppermint oil overdose occurs when someone accidentally or ... help, the better the chance is for recovery. Survival past 48 hours is usually a good sign ...

  14. Describing prescription opioid adherence among individuals with chronic pain using urine drug testing.

    PubMed

    Matteliano, Deborah; Chang, Yu-Ping

    2015-02-01

    Adherence monitoring for prescription opioid use is a clinical imperative for individuals prescribed opioids for chronic pain. Urine drug testing (UDT) provides objective evidence for prescription opioid adherence, as recommended by national guidelines to be part of adherence monitoring. The aim of this study was to describe prescription opioid adherence using UDT results in chronic pain patients and to examine the association between demographic characteristics and adherence to their prescribed opiate regimens. We used a retrospective chart review of 120 consecutive patients at an urban pain management clinic. Data collected included UDT results, pain level, and demographic characteristics. Descriptive and correlational statistics were used for data analysis. About 54% of the individuals appeared nonadherent to their prescribed opiate regimen as defined by absence or inappropriate level of prescribed controlled medication, presence of additional nonprescribed controlled substance(s), presence of illicit substance(s), or presence of adulterant in the urine sample. Of the participants, 23% had absence of one or more of their prescribed controlled medications and 12.5% had presence of one or more other opioids. Marijuana was the main illicit substance used (24.2%), followed by cocaine (11.7%). Patients' age, pain level, sex, ethnicity, and injury compensation were not associated with UDT results. UDT results could be useful to educate and guide patients on the proper use of controlled medications. Results from UDT are highly contextual and easily misinterpreted, requiring comparison with a variety of clinical indicators over time before deciding if there is adherence to a prescribed opiate regimen for individuals with chronic pain. PMID:24939349

  15. Ischaemic cardiovascular risk and prescription of non-steroidal anti-inflammatory drugs for musculoskeletal complaints

    PubMed Central

    Valkhoff, Vera E; Jong, Geert W't; Warlé-van Herwaarden, Margreet F; Bindels, Patrick Je; Sturkenboom, Miriam Cjm; Luijsterburg, Pim Aj; Bierma-Zeinstra, Sita Ma

    2014-01-01

    Abstract Objective. To determine the influence of ischaemic cardiovascular (CV) risk on prescription of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners (GPs) in patients with musculoskeletal complaints. Design. Cohort study. Setting. A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands. Patients. A total of 474 201 adults consulting their GP with a new musculoskeletal complaint between 2000 and 2010. Patients were considered at high CV risk if they had a history of myocardial infarction, angina pectoris, stroke, transient ischaemic attack, or peripheral arterial disease, and at low CV risk if they had no CV risk factors. Main outcome measures. Frequency of prescription of non-selective (ns)NSAIDs and selective cyclooxygenase-2 inhibitors (coxibs). Results. Overall, 24.4% of patients were prescribed an nsNSAID and 1.4% a coxib. Of the 41,483 patients with a high CV risk, 19.9% received an nsNSAID and 2.2% a coxib. These patients were more likely to be prescribed a coxib than patients with a low CV risk (OR 1.9, 95% CI 1.8–2.0). Prescription of nsNSAIDs decreased over time in all risk groups and was lower in patients with a high CV risk than in patients with a low CV risk (OR 0.8, 95% CI 0.7–0.8). Conclusion. Overall, patients with a high CV risk were less likely to be prescribed an NSAID for musculoskeletal complaints than patients with a low CV risk. Nevertheless, one in five high CV risk patients received an NSAID, indicating that there is still room for improvement. PMID:24931511

  16. Rapid Detection and Identification of Overdose Drugs in Saliva by Surface-Enhanced Raman Scattering Using Fused Gold Colloids

    PubMed Central

    Farquharson, Stuart; Shende, Chetan; Sengupta, Atanu; Huang, Hermes; Inscore, Frank

    2011-01-01

    The number of drug-related emergency room visits in the United States doubled from 2004 to 2009 to 4.6 million. Consequently there is a critical need to rapidly identify the offending drug(s), so that the appropriate medical care can be administered. In an effort to meet this need we have been investigating the ability of surface-enhanced Raman spectroscopy (SERS) to detect and identify numerous drugs in saliva at ng/mL concentrations within 10 minutes. Identification is provided by matching measured spectra to a SERS library comprised of over 150 different drugs, each of which possess a unique spectrum. Trace detection is provided by fused gold colloids trapped within a porous glass matrix that generate SERS. Speed is provided by a syringe-driven sample system that uses a solid-phase extraction capillary combined with a SERS-active capillary in series. Spectral collection is provided by a portable Raman analyzer. Here we describe successful measurement of representative illicit, prescribed, and over-the-counter drugs by SERS, and 50 ng/mL cocaine in saliva as part of a focused study. PMID:24310588

  17. Evidence based educational outreach visits: effects on prescriptions of non-steroidal anti-inflammatory drugs

    PubMed Central

    Bernal-Delgado, E; Galeote-Mayor, M; Pradas-Arnal, F; Peiro-Moreno, S

    2002-01-01

    Design: Randomised controlled simple blind trial, with randomisation into three groups: experimental (evidence based educational outreach visit), placebo (conventional education session), and control (without intervention). Setting: The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon, Spain. Participants: The 24 primary health care teams of the network, with 158 general practitioners (GPs). The teams were randomised into the groups, experimental (8 teams, 48 GPs), placebo (8 teams, 54 GPs), and control (8 teams, 56 GPs). Intervention: Experimental group: one group educational outreach visit, conveying data based on a systematic review of the literature that was reinforced with printed material; placebo group: one non-structured educational session; control group: no intervention. Both educational sessions emphasised that there are no differences in the effectiveness of the NSAIDs reviewed (diclofenac, piroxicam, and tenoxicam); a recommendation was made to prescribe diclofenac over tenoxicam because of price differences. Main outcome measures: Changes in the number of packages prescribed for each of the drugs and changes in the cost per package of NSAIDs prescribed during the six months before, and after the intervention. Results: There were no differences in the basal characteristics of the three groups, except for the number of prescriptions during the six months before the intervention. Prescriptions for NSAIDs decreased homogeneously in the three groups. For tenoxicam, the experimental group reduced prescriptions by 22.5% (95%CI: 34.42 to -10.76), compared with a reduction of 9.78% (95%CI: -17.70 to -1.86) in the placebo group and an increase of 14.44% (95%CI: 5.22 to 23.66) in the control group. The average cost per prescription decreased by 1.91% (95%CI: -0.33% to -3.49%) in the experimental group, 0.16% (95%CI: -0.27% to -2.93%) in the placebo group, and rose by 1.76% (95%CI: 0.35% to 3.17%) in the control group. Conclusions: Evidence based educational outreach visits are more effective than no intervention at all. Results suggest that evidence based educational outreach visits are incrementally more effective than conventional educational sessions, which in turn are more effective than no intervention at all. PMID:12177080

  18. Trust in prescription drug brand websites: website trust cues, attitude toward the website, and behavioral intentions.

    PubMed

    Huh, Jisu; Shin, Wonsun

    2014-01-01

    Direct-to-consumer (DTC) prescription drug brand websites, as a form of DTC advertising, are receiving increasing attention due to the growing number and importance as an ad and a consumer information source. This study examined consumer trust in a DTC website as an important factor influencing consumers' attitude toward the website and behavioral intention. Applying the conceptual framework of website trust, the particular focus of investigation was the effect of the website trust cue factor on consumers' perceived DTC website trust and subsequent attitudinal and behavioral responses. Results show a significant relation between the website trust cue factor and consumers' perceived DTC website trust. Perceived DTC website trust, in turn, was found to be significantly associated with consumers' attitude toward the DTC website and behavioral intention. PMID:24094133

  19. Evaluation, use, and usefulness of prescription drug information sources among Anglo and Hispanic Americans.

    PubMed

    Delorme, Denise E; Huh, Jisu; Reid, Leonard N

    2010-01-01

    This survey was conducted to determine and compare how Anglo and Hispanic Americans evaluate and use interpersonal, advertising, and mediated sources of prescription drug information. Findings suggest the following: (1) Hispanics rely on doctors, Internet advertising sources, and direct-to-consumer advertising (DTCA), while Anglos frequently use health-related websites and health care professionals; (2) Anglos are more likely to use health-related websites such as WebMD, although Anglos and Hispanics do not appear significantly different in Internet source usefulness evaluation; (3) Hispanics rely on television (TV) and DTC TV advertising more than Anglos, and this tendency is stronger for strong than weak Hispanic identifiers; (4) Hispanics evaluate TV news stories and TV advertising as more useful than Anglos; (5) Hispanics evaluate DTCA more positively and with less skepticism than Anglos; and (6) Hispanic ethnic identification level is positively related to preferences for Spanish-language media and health care professionals. PMID:20390975

  20. The unlicensed lives of antidepressants in India: generic drugs, unqualified practitioners, and floating prescriptions.

    PubMed

    Ecks, Stefan; Basu, Soumita

    2009-03-01

    Antidepressant uses have been rising rapidly over the past decades. Two main theories have been advanced to explain this. One claims that socio-economic change causes a global rise of depressive illness. The other holds that European and North American corporations are aggressively marketing antidepressants to expand their global reach. Both theories assume that multinational capitalism drives rising depression rates. Based on ethnographic data from India, this article shows that antidepressants are increasingly used in this country as well, but for reasons than have been little explored yet. Taking fluoxetine (Prozac) as the main example, it is argued that the spread of antidepressants in India is ;unlicensed' by Euro-American corporations in at least three ways: (i) drug marketing is driven by Indian generic producers; (ii) fluoxetine is given by practitioners who have no license to do so; and (iii) knowledge of fluoxetine is spread through unlicensed ;floating' prescriptions that patients take from one prescriber to another. PMID:19293281

  1. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    PubMed

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142

  2. Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

    PubMed Central

    Frosch, Dominick L.; Krueger, Patrick M.; Hornik, Robert C.; Cronholm, Peter F.; Barg, Frances K.

    2007-01-01

    PURPOSE American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. METHODS We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. RESULTS Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. CONCLUSIONS Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health. PMID:17261859

  3. Exposure to Prescription Drugs Labeled for Risk of Adverse Effects of Suicidal Behavior or Ideation among 100 Air Force Personnel Who Died by Suicide, 2006-2009

    ERIC Educational Resources Information Center

    Lavigne, Jill E.; McCarthy, Michael; Chapman, Richard; Petrilla, Allison; Knox, Kerry L.

    2012-01-01

    Prescription drugs for many indications are labeled with warnings for potential risk of suicidal ideation or behavior. Exposures to prescription drugs labeled for adverse effects of suicidal behavior or ideation among 100 Air Force personnel who died by suicide between 2006 and 2009 are described. Air Force registry data were linked to…

  4. Development and Reliability of Items Measuring the Nonmedical Use of Prescription Drugs for the Youth Risk Behavior Survey: Results Froman Initial Pilot Test

    ERIC Educational Resources Information Center

    Howard, Melissa M.; Weiler, Robert M.; Haddox, J. David

    2009-01-01

    Background: The purpose of this study was to develop and test the reliability of self-report survey items designed to monitor the nonmedical use of prescription drugs among adolescents. Methods: Eighteen nonmedical prescription drug items designed to be congruent with the substance abuse items in the US Centers for Disease Control and Prevention's…

  5. Unapproved prescription cough, cold, and allergy drug products: recent US Food and Drug Administration regulatory action on unapproved cough, cold, and allergy medications.

    PubMed

    Ostroff, Craig; Lee, Charles E; McMeekin, Judith

    2011-08-01

    The US Food and Drug Administration (FDA) drug approval and over-the-counter drug monograph processes play an essential role in ensuring that all drugs are both safe and effective for their intended uses. Manufacturers of drugs that lack required approval have not provided the FDA with evidence demonstrating that their products are safe and effective. Some of these prescription drugs have been marketed for many years and have remained on the market despite changes to the Federal Food, Drug, and Cosmetic Act, which requires approval for safety and efficacy purposes. Many health-care providers may be unaware that unapproved drugs exist because the product labels of these drugs do not disclose that they lack FDA approval. The FDA recently took action against unapproved prescription oral cough, cold, and allergy drug products because of concerns about the potential risks of these products, particularly some extended-release formulations that have not been reviewed for quality. There is a potential for medication errors because product names and labeling have not been reviewed for potential confusion, with some products inappropriately labeled for use in children aged ? 2 years. FDA-approved prescription drugs or drugs appropriately marketed as over the counter remain available for treatment of cough, cold, and allergy symptoms. Such products are of known efficacy, safety, identity, quality, and purity. Removing unapproved drugs from the marketplace and encouraging manufacturers of unapproved products to seek FDA review and approval is a top priority for the FDA. Since the initiation of the Unapproved Drugs Initiative in 2006, the FDA has removed ~1,500 unapproved products from the market and has worked with firms to bring other unapproved drugs into the approval process. The FDA remains committed to its mission of ensuring that safe and effective drugs are available to American consumers. PMID:21813527

  6. The international pharmaceutical market as a source of low-cost prescription drugs for U.S. patients.

    PubMed

    Kesselheim, Aaron S; Choudhry, Niteesh K

    2008-04-15

    In response to increasing prescription drug costs, more U.S. patients and policymakers are importing less-expensive pharmaceutical products from other countries. Large-scale prescription drug importation is currently illegal, but the U.S. Food and Drug Administration permits individuals to bring in 90-day supplies of drugs for personal use. As patient use of foreign-bought drugs has increased, federal legislators have continued to debate the full legalization of importation. Three factors help guide whether U.S. patients and policymakers can rely on other countries as sources of imported prescription drugs: whether the safety of the product can be ensured, how the import price compares with domestic prices, and how importation might affect the exporting country's pharmaceutical market. In wealthier countries with active regulatory systems, drug safety can be adequately ensured, and brand-name products are usually less expensive than in the United States (although generic drugs may be more expensive). However, implementing large-scale importation can negatively impact the originating country's market and can diminish the long-term cost savings for U.S. consumers. In low- and middle-income countries, prices may be reduced for both brand-name and generic drugs, but the prevalence of unauthorized products on the market makes ensuring drug safety more difficult. It may be reasonable for individual U.S. consumers to purchase essential medicines from certain international markets, but the most effective way to decrease drug costs overall is the appropriate use of domestic generic drugs, which are available for almost every major therapeutic class. PMID:18413623

  7. Opiate users' knowledge about overdose prevention and naloxone in New York City: a focus group study

    Microsoft Academic Search

    Nancy Worthington; Tinka Markham Piper; Sandro Galea; David Rosenthal

    2006-01-01

    BACKGROUND: Drug-induced and drug-related deaths have been increasing for the past decade throughout the US. In NYC, drug overdose accounts for nearly 900 deaths per year, a figure that exceeds the number of deaths each year from homicide. Naloxone, a highly effective opiate antagonist, has for decades been used by doctors and paramedics during emergency resuscitation after an opiate overdose.

  8. Increase in psychotropic drug use between 2006 and 2010 among adolescents in Norway: a nationwide prescription database study

    PubMed Central

    Steffenak, Anne Kjersti Myhrene; Wilde-Larsson, Bodil; Nordström, Gun; Skurtveit, Svetlana; Hartz, Ingeborg

    2012-01-01

    Background The purposes of this study were to investigate the prevalence of psychotropic (hypnotic, antidepressant, and anxiolytic) drug use among adolescents aged 15–16 years during the period 2006–2010 according to gender and subcategories of psychotropics, and to study psychotropic drug use over the period 2007–2010 among incident users in 2007. Methods This was a one-year prevalence and follow-up study based on information retrieved from the nationwide Norwegian prescription database for the period 2006–2010. The study population consisted of adolescents aged 15–16 years who had filled at least one prescription for a psychotropic drug in the study period. The main outcome measures were filling of hypnotic, antidepressant, and/or anxiolytic drug prescriptions. Results Overall use of psychotropic drugs increased from 13.9 to 21.5 per 1000 among boys and from 19.7 to 24.7 per 1000 among girls during the 2006– 2010 period. Hypnotic drugs, and melatonin in particular, accounted for most of the increase. For melatonin, the annual median amount dispensed was 180 defined daily doses through the period until 2010, at which time it decreased to 90 defined daily doses. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010. Conclusion This study shows an increase in hypnotic drugs dispensed for adolescents in Norway, mainly attributable to the increasing use of melatonin. The amount of melatonin dispensed indicates more than sporadic use over longer periods, despite melatonin only being licensed in Norway for use in insomnia for individuals aged 55 years or older. PMID:22936858

  9. Pharmaceutical penetration of new drug and pharmaceutical market structure in Taiwan: hospital-level prescription of thiazolidinediones for diabetes

    Microsoft Academic Search

    Yi-Wen Tsai; Yu-Wen Wen; Weng-Foung Huang; Ken N. Kuo; Pei-Fen Chen; Hsin-Wei Shih; Yue-Chune Lee

    2010-01-01

    This study used Taiwan’s National Health Insurance claim database (years 2000–2005) to examine how thiazolidinediones (TZD),\\u000a a new class of drugs for diabetes, penetrated into Taiwan’s hospitals, and its association with the concentration of all diabetes\\u000a drugs at the hospital level. We collected 72 monthly summaries of diabetes prescriptions from all hospitals in Taiwan. Hospital-level\\u000a pharmaceutical concentration was measured by

  10. The effects of North Carolina's prescription drug monitoring program on the prescribing behaviors of the state's providers.

    PubMed

    Ringwalt, Chris; Garrettson, Mariana; Alexandridis, Apostolos

    2015-04-01

    State-level prescription drug monitoring programs (PDMPs) show promise as a key strategy to respond to the epidemic of the misuse and abuse of controlled substances (CS), particularly opioid analgesics, in the United States. Undocumented concerns have been expressed that these PDMPs may have a "chilling effect" on providers' willingness to prescribe these substances to their patients. Using data from North Carolina's PDMP for the 3-year period from 2009 through 2011, we examined whether rapid increases in (1) the number of providers who queried the system, and (2) the number of days on which they queried it, would be related to their prescribing practices in regards to CS. We hypothesized that neither marker of PDMP utilization would be associated with a decrease in either patients receiving CS prescriptions or CS prescriptions filled. We found no association between either of these variables and the number of patients who filled prescriptions for CS or the number of prescriptions for CS filled. However, we did find a slight positive relationship between the growth in the utilization of the PDMP and the number of prescriptions filled for opioid analgesics. Concerns that PDMPs may constrain prescribing behavior with regards to CS are not supported. PMID:25466768

  11. Social and structural aspects of the overdose risk environment in St. Petersburg, Russia

    PubMed Central

    Grau, Lauretta E.; Blinnikova, Ksenia N.; Torban, Mikhail; Krupitsky, Evgeny; Ilyuk, Ruslan; Kozlov, Andrei; Heimer, Robert

    2009-01-01

    Background While overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility. Methods Twenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment. Results Several factors within St. Petersburg’s environment were identified as shaping illicit drug users’ risk behaviors and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviors. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone. Conclusion Local social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg. PMID:18774283

  12. Gender bias in clinical research, pharmaceutical marketing, and the prescription of drugs.

    PubMed

    Chilet-Rosell, Elisa

    2014-01-01

    This thesis is part of the studies of gender bias in health which together with the paradigm of evidence-based medicine shares the empirical assumption that there are inaccuracies in medical practice, in addition to a lack of rigour and transparency. It worked with the distinction between the concepts of sex and gender and between the concepts of sex-related differences and gender inequalities, in terms of applying a gender perspective in the study design and the subsequent analysis. This PhD review presents the research process conducted in Spain, which can provide an example for future research. Study I described a review of 58 clinical trials (CTs) of etoricoxib to assess its compliance with the Recommendations of Evaluation of Gender Differences in the Clinical Evaluation of Drugs. In Study II, key informants from professions related to different areas in drug development and pharmacovigilance held a working meeting to reach a consensus document on recommendations for the study and evaluation of gender differences in CTs in Spain. In Study III, the websites of the eight best-selling hormone replacement therapy drugs in Spain on Google first page of results were analysed. In Study IV, a logistic regression analysis was performed to compare analgesic prescription by sex in regions with a higher or lower Gender Development Index (GDI) than the Spanish average. Gender biases identified in this thesis limited the legitimacy of medicine, which is not based on the best possible evidence. The results also demonstrate the existence of inequalities between men and women that are not due merely to biological differences, but are gender inequalities stemming from the social differences that exist between both sexes. PMID:25498360

  13. Haggling for a patent: what a government would have to pay for prescription drug patents.

    PubMed

    Guell, R C

    1997-01-01

    In previous papers (Guell, R. and Fischbaum, M. The Milbank Quarterly 1995; 73: 2 and Applied Economics letters in press), we established that the allocative inefficiency in the prescription drug industry is so pervasive that some remedy is warranted. In the first paper, we estimated a lower bound on this inefficiency at approximately $3 billion, with an upper bound of approximately $30 billion; all on total industry sales of approximately $50 billion. In the second paper, on a narrower set of drugs for which sales were $8 billion, we more precisely estimated this dead weight loss to be $5 billion. From this we showed that a system could exist whereby a government would purchase a drug patent from a willing seller, freely distribute it and reap significant efficiency benefits. In those papers we considered the possibility that the innovating firm would not want to relinquish the patent, but we assumed that they would be indifferent between being paid the expected net present value of future monopoly profits and reaping those uncertain profits over time. While that may be the case, a more likely scenario would be that a negotiation would take place. In the current paper I show the bargaining range that would exist under different risk preference assumptions and show that this range widens as each side becomes more risk averse and narrows if the government threatens to use its power of eminent domain. Lastly, I acknowledge the risk of firms "capturing' the government agents doing the negotiation. To conclude, I present the circumstances under which the proposed agency would likely improve societal welfare and contrast that with the circumstances where the presently inefficient system would be made more so by government intervention. PMID:9158969

  14. Prescription Drug Misuse and Sexual Risk Behaviors Among Adolescents and Emerging Adults

    PubMed Central

    Bonar, Erin E; Cunningham, Rebecca M; Chermack, Stephen T; Blow, Frederic C; Barry, Kristen L; Booth, Brenda M; Walton, Maureen A

    2014-01-01

    Objective: The purpose of this study was to evaluate associations between prescription drug misuse (PDM) and sexual risk behaviors (SRBs) among adolescents and emerging adults. Method: In a hospital emergency department, 2,127 sexually active 14- to 20-year-olds (61% female) reported on past-year alcohol use severity (using the Alcohol Use Disorders Identification Test–consumption [AUDIT-C]), cannabis use, PDM (n = 422), and SRBs (inconsistent condom use, multiple partners, intercourse following alcohol/other drug use). Results: Bivariately, AUDIT-C score, cannabis use, and PDM of stimulants, opioids, and sedatives were positively associated with each SRB. Because many participants reported PDM for multiple drug classes (i.e., sedatives, stimulants, opioids), participants were categorized as (a) no PDM (n = 1,705), (b) PDM of one class (n = 251), (c) PDM of two classes (n = 90), or (d) PDM of three classes (n = 81). Three hierarchical logistic regression models evaluated the associations of number of classes of PDM with SRBs separately, after accounting for demographics (age, gender, race), AUDIT-C score, and cannabis use. Adding PDM statistically improved each model beyond what was accounted for by demographics, alcohol, and cannabis use. For inconsistent condom use and substance use before sex, PDM of one, two, or three classes was significantly associated with increased odds of these SRBs. PDM of two or three classes was associated with increased odds of reporting multiple partners. Conclusions: Findings suggest that PDM, especially poly-PDM, may be a pertinent risk factor for SRBs among youth. Event-based research could further evaluate how PDM, as well as other substance use, is related to SRBs at the event level in order to inform interventions. PMID:24650820

  15. Urine drug testing of chronic pain patients. II. Prevalence patterns of prescription opiates and metabolites.

    PubMed

    Heltsley, Rebecca; Zichterman, Anne; Black, David L; Cawthon, Beverly; Robert, Tim; Moser, Frank; Caplan, Yale H; Cone, Edward J

    2010-01-01

    This study of 20,089 urine specimens from chronic pain patients provided a unique opportunity to evaluate the prevalence of prescription opiates and metabolites, assess the usefulness of inclusion of normetabolites in the test panel, and compare opiate and oxycodone screening results to liquid chromatography with tandem mass spectrometry (LC-MS-MS) results. All specimens were screened by an opiate [enzyme-linked immunosorbent assay (ELISA), 100 ng/mL] and oxycodone assay [ELISA, 100 ng/mL or enzyme immunoassay (EIA), 50 ng/mL] and simultaneously tested by LC-MS-MS [limit of quantitation (LOQ) = 50 ng/mL] for 10 opiate analytes (codeine, norcodeine, morphine, hydrocodone, dihydrocodeine, norhydrocodone, hydromorphone, oxycodone, noroxycodone, and oxymorphone). Approximately two-thirds of the specimens were positive for one or more opiate analytes. The number of analytes detected in each specimen varied from 1 to 8 with 3 (34.8%) being most prevalent. Hydrocodone and oxycodone (in combination with metabolites) were most prevalent followed by morphine. Norcodeine was only infrequently detected whereas the prevalence of norhydrocodone and noroxycodone was approximately equal to the prevalence of the parent drug. A substantial number of specimens were identified that contained norhydrocodone (n = 943) or noroxycodone (n = 702) but not the parent drug, thereby establishing their interpretative value as biomarkers of parent drug use. Comparison of the two oxycodone screening assays revealed that the oxycodone ELISA had broader cross-reactivity with opiate analytes, and the oxycodone EIA was more specific for oxycodone. Specimens containing only norhydrocodone were best detected with the opiate ELISA whereas noroxycodone (only) specimens were best detected by the oxycodone EIA. PMID:20109300

  16. Gender bias in clinical research, pharmaceutical marketing, and the prescription of drugs

    PubMed Central

    Chilet-Rosell, Elisa

    2014-01-01

    This thesis is part of the studies of gender bias in health which together with the paradigm of evidence-based medicine shares the empirical assumption that there are inaccuracies in medical practice, in addition to a lack of rigour and transparency. It worked with the distinction between the concepts of sex and gender and between the concepts of sex-related differences and gender inequalities, in terms of applying a gender perspective in the study design and the subsequent analysis. This PhD review presents the research process conducted in Spain, which can provide an example for future research. Study I described a review of 58 clinical trials (CTs) of etoricoxib to assess its compliance with the Recommendations of Evaluation of Gender Differences in the Clinical Evaluation of Drugs. In Study II, key informants from professions related to different areas in drug development and pharmacovigilance held a working meeting to reach a consensus document on recommendations for the study and evaluation of gender differences in CTs in Spain. In Study III, the websites of the eight best-selling hormone replacement therapy drugs in Spain on Google first page of results were analysed. In Study IV, a logistic regression analysis was performed to compare analgesic prescription by sex in regions with a higher or lower Gender Development Index (GDI) than the Spanish average. Gender biases identified in this thesis limited the legitimacy of medicine, which is not based on the best possible evidence. The results also demonstrate the existence of inequalities between men and women that are not due merely to biological differences, but are gender inequalities stemming from the social differences that exist between both sexes. PMID:25498360

  17. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    PubMed Central

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n?=?1050) compared to IC patients (n?=?213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p?=?0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p?=?0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p?=?0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  18. Preventing Death Among the Recently Incarcerated: An Argument for Naloxone Prescription Before Release

    PubMed Central

    Wakeman, Sarah E.; Bowman, Sarah E.; McKenzie, Michelle; Jeronimo, Alexandra; Rich, Josiah D.

    2009-01-01

    PURPOSE Death from opiate overdose is a tremendous source of mortality, with a heightened risk in the weeks following incarceration. The goal of this study is to assess overdose experience and response among long-term opiate users involved in the criminal justice system. PROCEDURES 137 subjects from a project linking opiate-dependent individuals being released from prison with methadone maintenance programs were asked 73 questions regarding overdose. FINDINGS Most had experienced and witnessed multiple overdoses, 911 was often not called. The majority of personal overdoses occurred within one month of having been institutionalized. Nearly all expressed an interest in being trained in overdose prevention with Naloxone. CONCLUSIONS The risk of death from overdose is greatly increased in the weeks following release from prison. A pre-release program of overdose prevention education, including Naloxone prescription, for inmates with a history of opiate addiction would likely prevent many overdose deaths. PMID:19340674

  19. What Matters Most? Assessing the Influence of Demographic Characteristics, College-Specific Risk Factors, and Poly-Drug Use on Nonmedical Prescription Drug Use

    ERIC Educational Resources Information Center

    Lanier, Christina; Farley, Erin J.

    2011-01-01

    Objective: Although prior recent research has revealed a significant relationship between the nonmedical use of prescription drugs, demographic characteristics, college-specific risk factors, and other substance use among college students, there remains a need to conduct a comparative analysis on the differential impact these factors may have on…

  20. Trends and Determinants of Prescription Drug Use during Pregnancy and Postpartum in British Columbia, 2002–2011: A Population-Based Cohort Study

    PubMed Central

    Smolina, Kate; Hanley, Gillian E.; Mintzes, Barbara; Oberlander, Tim F.; Morgan, Steve

    2015-01-01

    Purpose To describe trends, patterns, and determinants of prescription drug use during pregnancy and postpartum. Methods This is a retrospective, population-based study of all women who gave birth between January 2002 and 31 December 2011 in British Columbia, Canada. Study population consisted of 225,973 women who had 322,219 pregnancies. We examined administrative datasets containing person-specific information on filled prescriptions, hospitalizations, and medical services. Main outcome measures were filled prescriptions during pregnancy and postpartum. We used logistic regressions to examine associations between prescription drug use and maternal characteristics. Results Approximately two thirds of women filled a prescription during pregnancy, increasing from 60% in 2002 to 66% in 2011. The proportion of pregnant women using medicines in all three trimesters of pregnancy increased from 20% in 2002 to 27% in 2011. Use of four or more different types of prescription drug during at least one trimester increased from 8.4% in 2002 to 11.7% in 2011. Higher BMI, smoking during pregnancy, age under 25, carrying multiples, and being diagnosed with a chronic condition all significantly increased the odds of prescription drug use during pregnancy. Conclusions The observed increase in the number of prescriptions and number of different drugs being dispensed suggests a trend in prescribing practices with potentially important implications for mothers, their neonates, and caregivers. Monitoring of prescribing practices and further research into the safety of most commonly prescribed medications is crucial in better understanding risks and benefits to the fetus and the mother. PMID:26011706

  1. Predictors of $4 Generic Prescription Drug Discount Programs use in the Low-income Population

    PubMed Central

    Hernandez, Mike; Sansgiry, Sujit; Paxton, Raheem; Jones, Lovell

    2013-01-01

    Background Generic drug discount programs (GDDPs) are an option to provide affordable prescription medication to low-income individuals. However, the factors that influence the use of GDDPs in low-income population are unknown. Objectives To evaluate factors associated with utilization of generic a drug discount program in a low-income population. Methods A survey was administered to adult participants at health centers and community based organizations in Houston, Texas, USA (n=525). Exploratory factor analysis was conducted to determine the construct validity of the survey instrument and to assess distinct factors associated with GDDP utilization. Descriptive statistics were used to summarize the distribution of patient socio-demographic characteristics and questionnaire responses. Multivariate logistic regression was used to compute adjusted odds ratios and to examine the strength of association with GDDP utilization after adjusting for participant socio-demographic features that were statistically significant at a priori level of p<0.05. Results In this study, 72% of respondents were aware of the GDDP, and 61% had utilized the GDDP. Participants were 4 times likely to use a GDDP when their physician (AOR: 4.0, 95% CI: 2.6 – 6.4, P < 0.001) or pharmacist (AOR: 4.0, 95% CI: 2.6 – 6.3, P < 0.001) talked to them about it. Participants indicated that the most important barriers to utilization of GDDPs were lack of awareness (44%), and lack of recommendation by a physician (19%). Conclusions Increased patient awareness and physician recommendation may increase the use of GDDPs, which may lead to improved compliance with medications, better health outcomes and reduced health care costs. PMID:23684716

  2. Charcoal hemoperfusion in the treatment of phenytoin overdose

    Microsoft Academic Search

    Chiyo Kawasaki; Reiko Nishi; Souichi Uekihara; Syunichi Hayano; Masaki Otagiri

    2000-01-01

    In the case of phenytoin, a drug that is generally highly protein bound, there is a lack of consensus on the use of charcoal hemoperfusion in cases of overdose. We performed charcoal hemoperfusion on a phenytoin-overdosed patient to assess the effectiveness of this treatment. The plasma concentrations of total and free phenytoin fell rapidly, from 40.0 ?g\\/mL and 3.6 ?g\\/mL

  3. Asymmetric responsiveness of physician prescription behavior to drug promotion of competitive brands within an established therapeutic drug class.

    PubMed

    Pedan, Alex; Wu, Hongsheng

    2011-04-01

    This article examines the impact of direct-to-physician, direct-to-consumer, and other marketing activities by pharmaceutical companies on a mature drug category which is in the later stage of its life cycle and in which generics have accrued a significant market share. The main objective of this article is to quantitatively estimate the impact of pharmaceutical promotions on physician prescribing behavior for three different statin brands, after controlling for factors such as patient, physician and physician practice characteristics, generic pressure, et cetera. Using unique panel data of physicians, combined with patient pharmacy prescription records, the authors developed a physician level generalized linear regression model. The generalized estimating equations method was used to account for within physician serial correlations and estimate physician population averaged effects. The findings reveal that even though on average the marketing efforts affect the brand share positively, the magnitude of the effects is very brand specific. Generally, each statin brand has its own trend and because of this, the best choice of predictors for one brand could be suboptimal for another. PMID:21590561

  4. Impact of Pharmacy Benefit Design on Prescription Drug Utilization: A Fixed Effects Analysis of Plan Sponsor Data

    PubMed Central

    Roebuck, M Christopher; Liberman, Joshua N

    2009-01-01

    Objective To study the impact of various elements of pharmacy benefit design on both the absolute and relative utilization of generics, brands, retail pharmacy, and mail service. Data Source Panel data on 1,074 plan sponsors covering 21.6 million individuals over 12 calendar quarters (2005–2007). Study Design A retrospective analysis of pharmacy claims. Statistical Methods To control for potential endogeneity, linear fixed effects models were estimated for each of six dependent variables: the generic utilization rate, the brand utilization rate, the generic dispensing rate (GDR), the retail pharmacy utilization rate, the mail service utilization rate, and the mail distribution rate. Principal Findings Most member cost-share variables were nonlinearly associated with changes in prescription drug utilization. Marginal effects were generally greater in magnitude for brand out-of-pocket costs than for generic out-of-pocket costs. Time dummies, as well as other pharmacy benefit design elements, also yielded significant results. Conclusions Prior estimates of the effect of member cost sharing on prescription drug utilization may be biased if complex benefit designs, mail service fulfillment, and unmeasured factors such as pharmaceutical pipelines are not accounted for. Commonly cited relative utilization metrics, such as GDR, may be misleading if not examined alongside absolute prescription drug utilization. PMID:19187183

  5. 21 CFR 310.305 - Records and reports concerning adverse drug experiences on marketed prescription drugs for human...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...or intentional; an adverse event occurring from drug abuse; an adverse event occurring from drug withdrawal...inpatient hospitalization, or the development of drug dependency or drug abuse. Unexpected adverse drug experience. Any...

  6. 21 CFR 310.305 - Records and reports concerning adverse drug experiences on marketed prescription drugs for human...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...or intentional; an adverse event occurring from drug abuse; an adverse event occurring from drug withdrawal...inpatient hospitalization, or the development of drug dependency or drug abuse. Unexpected adverse drug experience. Any...

  7. Who are the opinion leaders? The physicians, pharmacists, patients, and direct-to-consumer prescription drug advertising.

    PubMed

    Lee, Annisa Lai

    2010-09-01

    A popular perception holds that physicians prescribe requested drugs to patients influenced by mass mediated direct-to-consumer prescription drug advertising. The phenomenon poses a serious challenge to the two-step flow model, which emphasizes the influence of opinion leaders on their followers and their legitimating power over the informing power of the mass media. This study investigates a 2002 Food and Drug Administration (FDA) survey and finds that patients searching for drug information through mass and hybrid media in newspapers and magazines' small print, the Internet, and toll-free numbers are more likely to seek information through interpersonal communication channels like health care providers. Patients using small print, toll-free numbers, one's own physician, and other physicians are associated with influencing their physicians with various drug-requesting behaviors. But physicians only prescribe requested drugs to patients who are influenced by other health care providers, such as pharmacists and other physicians, not the mass media. The influence of expert opinion leaders of drugs is so strong that the patients even would switch from their own unyielding physicians who do not prescribe drugs as advised by the pharmacists. Physicians and patients all are influenced more by other expert opinion leaders of drugs than by the mass media and therefore still uphold the basic tenet of the two-step model. PMID:20812124

  8. 76 FR 1182 - Determination of System Attributes for the Tracking and Tracing of Prescription Drugs; Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ...products in the supply chain plays a significant...accountability in the drug supply chain. On September 27, 2007, the Food and Drug Administration...505D of the Federal Food, Drug, and Cosmetic...securing the drug supply chain against...

  9. Trust in online prescription drug information among internet users: the impact on information search behavior after exposure to direct-to-consumer advertising.

    PubMed

    Menon, Ajit M; Deshpande, Aparna D; Perri, Matthew; Zinkhan, George M

    2002-01-01

    The proliferation of both manufacturer-controlled and independent medication-related websites has aroused concern among consumers and policy-makers concerning the trustworthiness of Web-based drug information. The authors examine consumers' trust in on-line prescription drug information and its influence on information search behavior. The study design involves a retrospective analysis of data from a 1998 national survey. The findings reveal that trust in drug information from traditional media sources such as television and newspapers transfers to the domain of the Internet. Furthermore, a greater trust in on-line prescription drug information stimulates utilization of the Internet for information search after exposure to prescription drug advertising. PMID:12749596

  10. Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006

    PubMed Central

    2014-01-01

    Background It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity. Methods Data was collected on all individuals 20 years and older in the county of Östergötland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses. Results The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females. Conclusion Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders. PMID:24713023

  11. Decrease in rate of opioid analgesic overdose deaths - Staten Island, New York City, 2011-2013.

    PubMed

    Paone, Denise; Tuazon, Ellenie; Kattan, Jessica; Nolan, Michelle L; O'Brien, Daniella Bradley; Dowell, Deborah; Farley, Thomas A; Kunins, Hillary V

    2015-05-15

    From 2000 to 2011, the rate of unintentional drug poisoning (overdose) deaths involving opioid analgesics increased 435% in Staten Island, from 2.0 to 10.7 per 100,000 residents. During 2005-2011, disparities widened between Staten Island and the other four New York City (NYC) boroughs (Bronx, Brooklyn, Manhattan, and Queens); in 2011, the rate in Staten Island was 3.0-4.5 times higher than in the other boroughs. In response, the NYC Department of Health and Mental Hygiene (DOHMH) implemented a comprehensive five-part public health strategy, with both citywide and Staten Island-targeted efforts: 1) citywide opioid prescribing guidelines, 2) a data brief for local media highlighting Staten Island mortality and prescribing data, 3) Staten Island town hall meetings convened by the NYC commissioner of health and meetings with Staten Island stakeholders, 4) a Staten Island campaign to promote prescribing guidelines, and 5) citywide airing of public service announcements with additional airing in Staten Island. Concurrently, the New York state legislature enacted the Internet System for Tracking Over-Prescribing (I-STOP), a law requiring prescribers to review the state prescription monitoring system before prescribing controlled substances. This report describes a 29% decline in the opioid analgesic-involved overdose death rate in Staten Island from 2011 to 2013, while the rate did not change in the other four NYC boroughs, and compares opioid analgesic prescribing data for Staten Island with data for the other boroughs. Targeted public health interventions might be effective in lowering opioid analgesic-involved overdose mortality rates. PMID:25974633

  12. Reducing risk for illicit drug use and prescription drug misuse: High school gay-straight alliances and lesbian, gay, bisexual, and transgender youth.

    PubMed

    Heck, Nicholas C; Livingston, Nicholas A; Flentje, Annesa; Oost, Kathryn; Stewart, Brandon T; Cochran, Bryan N

    2014-04-01

    Previous research suggests that lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for using illicit drugs and misusing prescription drugs relative to heterosexual youth. Previous research also indicates that LGBT youth who attend high schools with a gay-straight alliance (GSA) report having fewer alcohol problems and lower levels of cigarette smoking. The present study investigates whether the absence of a GSA is associated with risk for illicit drug use and prescription drug misuse in a sample of 475 LGBT high school students (M age=16.79) who completed an online survey. After controlling for demographic variables and risk factors associated with illicit drug use, the results of 12 logistic regression analyses revealed that LGBT youth attending a high school without a GSA evidenced increased risk for using cocaine (adjusted odds ratio [adjOR]=3.11; 95% confidence interval [95% CI]=1.23-7.86), hallucinogens (adjOR=2.59; 95% CI=1.18-5.70), and marijuana (adjOR=2.22; 95% CI=1.37-3.59) relative to peers attending a high school with a GSA. Youth without a GSA also evidenced increased risk for the misuse of ADHD medication (adjOR=2.00; 95% CI=1.02-3.92) and prescription pain medication (adjOR=2.00; 95% CI=1.10-3.65). These findings extend the research base related to GSAs and further demonstrate the importance of providing LGBT youth with opportunities for socialization and support within the school setting. Important limitations of the present study are reviewed. PMID:24531638

  13. Prescription Drug Use During and Immediately Before Pregnancy in Hawai‘i — Findings from the Hawai‘i Pregnancy Risk Assessment Monitoring System, 2009–2011

    PubMed Central

    Hurwitz, Eric L

    2014-01-01

    There are relatively few population-based studies on prescription drug use during pregnancy. Hawai‘i Pregnancy Risk Assessment Monitoring System (PRAMS) survey data from 4,735 respondents were used to estimate statewide prevalence of overall non-vitamin prescription drug use during and in the month before pregnancy. Data were weighted to be representative of all pregnancies resulting in live births in Hawai‘i in 2009–2011. Of women with recent live births in Hawai‘i, 14.2% (95% CI: 13.0 – 15.5) reported prescription drug use before pregnancy and 17.6% (95% CI: 16.2 – 19.0) reported prescription drug use during pregnancy. Prevalence of prescription drug use both before and during pregnancy was highest among women who had a pre-pregnancy chronic disease, were White, and had a pregnancy-related medical problem. Pain relievers (2.82%; 95% CI: 2.28 – 3.47), psychiatric medications (2.34%; 95% CI: 1.85 – 2.95), and anti-infectives (1.91%; 95% CI: 1.46 – 2.48) were the most common types of medications used before pregnancy. The most commonly-reported prescription medication types taken during pregnancy were anti-infectives (4.00%; 95% CI: 3.34 – 4.79), pain relievers (3.18%; 95% CI: 2.56 – 3.94), and gastrointestinal drugs (3.08%; 95% CI: 2.47 – 3.83). Of women who reported prescription drug use during pregnancy and attended prenatal care, 10.3% (95% CI: 8.0 – 13.2) reported that their healthcare provider had not counseled them during prenatal care on which medicines are safe to use during pregnancy. PMID:25628970

  14. Comprehension of information in three direct-to-consumer television prescription drug advertisements among adults with limited literacy.

    PubMed

    Kaphingst, Kimberly A; Rudd, Rima E; Dejong, William; Daltroy, Lawren H

    2005-01-01

    Direct-to-consumer (DTC) television advertisements present a number of facts about prescription drug risks and benefits in a brief time. This study assessed comprehension of information in three advertisements among 50 adults with limited literacy. Participants correctly answered an average of 59% of comprehension questions. The percentage of respondents correctly answering individual comprehension questions ranged from 26% to 92%. A multivariate analysis suggested that type of information (risk vs. other) and channel (text vs. audio) predicted comprehension. There was a significant interaction effect for literacy and place of birth. Our results suggest key areas for future research on comprehension of DTC advertising. PMID:16278198

  15. Alcohol-Related Problems Among Younger Drinkers Who Misuse Prescription Drugs: Results from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC)

    Microsoft Academic Search

    J. Hermos; M. Winter; T. Heeren; R. Hingson

    2009-01-01

    The authors determined whether lifetime prescription drug misuse (PDM) associated with increased risks for alcohol-related problems among 18- to 34-year-old, NESARC respondents. Among 8222 “ever-drinkers,” 15.4% reported ever “misusing sedatives, tranquilizers, painkillers or stimulants … as prescriptions or from indirect sources.” Outcomes were within two alcohol-related problem domains, “risk-taking behaviors,” including driving while drinking, fights, injuries, and arrests, and “interpersonal

  16. PTSD, depression, prescription drug use, and health care utilization of Chinese workers affected by the WTC attacks.

    PubMed

    de Bocanegra, Heike Thiel; Moskalenko, Sophia; Kramer, Elizabeth J

    2006-07-01

    This study assessed the impact of the World Trade Center (WTC) attacks on emotional problems, prescription drug usage, and utilization of medical and mental health services within the Chinese community in lower Manhattan. We administered a survey to 148 randomly selected Chinese workers affected by the WTC attacks in March 2003. Although nearly half of the respondents had elevated PTSD and/or elevated depression scores, only a few (4.4%) had talked to a counselor. However, nearly all (86%) reported having visited a physician at least once since September 11, 2001. Individuals with elevated PTSD scores were significantly more likely to have gone to a physician after 9/11. They were also more likely to have received prescription drugs and to indicate an interest in counseling after 9/11 than individuals with low PTSD scores. The findings highlight the role of the primary care physician as gatekeeper for mental health symptoms after a disaster. They further suggest that primary care physicians should use screening tools for depression and posttraumatic stress after a major disaster and that they should be sensitive to potential emotional problems that are associated with somatic complaints. PMID:16791530

  17. Prescription Duration After Drug Copay Changes in Older People: Methodological Aspects

    Microsoft Academic Search

    Sebastian Schneeweiss; Malcolm Maclure; Stephen B. Soumerai

    2002-01-01

    OBJECTIVES: Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to healthcare planning for older people. Some cost-con- tainment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spuri- ous reductions in drug utilization measures after drug pol- icy changes when relying on pharmacy dispensing data. Reference pricing, a

  18. Calcium carbonate with magnesium overdose

    MedlinePLUS

    The combination of calcium carbonate and magnesium is commonly found in antacids, which are medicines that provide heartburn relief. Calcium carbonate with magnesium overdose occurs when someone accidentally or ...

  19. Health disparities and direct-to-consumer prescription drug advertising: a content analysis of targeted magazine genres, 1992-2002.

    PubMed

    Mastin, Teresa; Andsager, Julie L; Choi, Jounghwa; Lee, Kyungjin

    2007-01-01

    Health disparities exist in the United States based on race, gender, and socioeconomic status. One way to alleviate some of the disparities regarding certain diseases or conditions is to increase awareness among populations most affected. Physicians have suggested that direct-to-consumer advertising (DTCA) of prescription drugs could play a role in awareness. Social identity theory suggests that individuals are likely to attend messages if they can identify, often based on race or gender, with people portrayed in the messages. This study analyzed DTCA in 11 years of Black, women's, news, and entertainment magazines to determine whether models in the ads targeted specific populations. Black magazines were more likely to contain ads featuring Black models only than were other genres, which had more DTCA picturing White models only. Health conditions the drugs were intended for varied by genre and over time, with STD drugs appearing primarily in Black magazines, and DTCA for heart disease not published in Black magazines, despite cardiovascular diseases being the No. 1 cause of death for Blacks (and Whites). Women's magazines featured DTCA for a wide variety of drugs, reinforcing their roles as caretakers, with proportionally few ads for women's health. Implications for targeted use of magazine genres as a means of providing health information to specific populations are discussed. PMID:17617013

  20. Distributional consequences of the transition from age-based to income-based prescription drug coverage in British Columbia, Canada.

    PubMed

    Hanley, Gillian E; Morgan, Steve; Hurley, Jeremiah; van Doorslaer, Eddy

    2008-12-01

    In May, 2003, British Columbia transitioned from an age-based public drug program, with public subsidy primarily based on age, to an age-irrelevant income-based drug program, in which public subsidy is based primarily on household income. As one of the specific aims of the policy change was to improve fairness by increasing the extent to which payment for drugs is based on ability to pay, we measure the progressivity of pharmaceutical financing before and after the policy change in BC using Kakwani indices. Our results suggest that pharmaceutical financing became less regressive after the policy change. However, this decrease in regressivity arose primarily because high-income seniors were making greater direct contributions to pharmaceutical financing and not because low-income households were making smaller direct contributions. Our results also suggest that if the public financing of pharmaceuticals were maintained or increased, a change from age-based to income-based eligibility can unambiguously improve equity in finance. As populations in developed countries age, governments will increasingly consider reforms to publicly financed health-care programs with age-based eligibility. In assessing policy options, financial equity is likely to be a key consideration. These results suggest that income-based pharmacare can improve financial equity especially when implemented with a commitment to maintain or increase public funding for prescription drugs. PMID:18189226

  1. Strategic Options for Brand-Name Prescription Drugs When Patents Expire

    Microsoft Academic Search

    Subhash C. Mehta; Sanjay S. Mehta

    1997-01-01

    Pharmaceutical companies face a very hostile competitive environment from generic drugs once the patents on their brand name drugs expire. Depending on the country, such patents usually last 10-15 years but no sooner do the patents expire then copies of off-patent brand name drugs, called generics, are introduced, generally by smaller-size and lesser known companies, at significantly lower prices. As

  2. Enough to Make You Sick: Prescription Drug Prices for the Elderly

    NSDL National Science Digital Library

    2001-01-01

    Released on June 12, 2001 by Families USA, a national, nonprofit organization that advocates high-quality, affordable health and long term care for all Americans, this study finds that "last year and during the past 5 years, the prices of the 50 drugs most commonly used by older Americans have increased considerably faster than inflation." The report also demonstrates that the most expensive drugs are among the most commonly prescribed and that generic drugs are generally rising in price at much slower rates than brand-name drugs. Users may read the full text of the report in .pdf format at the FamiliesUSA site.

  3. ADVANCED TOOLS FOR ASSESSING SELECTED PRESCRIPTION AND ILLICIT DRUGS IN TREATED SEWAGE EFFLUENTS AND SOURCE WATERS

    EPA Science Inventory

    The purpose of this poster is to present the application and assessment of advanced technologies in a real-world environment - wastewater effluent and source waters - for detecting six drugs (azithromycin, fluoxetine, omeprazole, levothyroxine, methamphetamine, and methylenedioxy...

  4. Use of an online surveillance system for screening drug interactions in prescriptions in community pharmacies

    Microsoft Academic Search

    Tiina Heikkilä; Tuula Lekander; Hannu Raunio

    2006-01-01

    Objective  Computerised surveillance systems have become available for screening potential adverse drug interactions during drug prescribing and dispensing. The purpose of this study was to analyse the frequency and profile of alerts given by one such system in two community pharmacies in Finland.Methods  In a prospective study, all interaction alerts given by the surveillance system were collated during September–November 2004 in two

  5. Long-term, high-dose benzodiazepine prescriptions in veteran patients with PTSD: influence of preexisting alcoholism and drug-abuse diagnoses.

    PubMed

    Hermos, John A; Young, Melissa M; Lawler, Elizabeth V; Rosenbloom, David; Fiore, Louis D

    2007-10-01

    Databases from the New England Veterans Integrated Service Network were analyzed to determine factors associated with long-term, high-dose anxiolytic benzodiazepine prescriptions dispensed to patients with posttraumatic stress disorder (PTSD) and existing alcoholism and/or drug abuse diagnoses. Among 2,183 PTSD patients, 234 received the highest 10% average daily doses for alprazolam, clonazepam, diazepam, or lorazepam, doses above those typically recommended. Highest doses were more commonly prescribed to patients with existing drug abuse diagnoses. Among patients with PTSD and alcoholism, younger age, drug abuse, and concurrent prescriptions for another benzodiazepine and oxycodone/acetaminophen independently predicted high doses. Results indicate that for veteran patients with PTSD, alcoholism alone is not associated with high-dose benzodiazepines, but existing drug abuse diagnoses do increase that risk. PMID:17955537

  6. Medicare program; contract year 2016 policy and technical changes to the Medicare Advantage and the Medicare Prescription Drug Benefit programs. Final rule.

    PubMed

    2015-02-12

    This final rule amends the Medicare Advantage (MA) program (Part C) regulations and Medicare Prescription Drug Benefit Program (Part D) regulations to implement statutory requirements; improve program efficiencies; strengthen beneficiary protections; clarify program requirements; improve payment accuracy; and make various technical changes. Additionally, this rule finalizes two technical changes that reinstate previously approved but erroneously removed regulation text sections. PMID:25735051

  7. Characterization of Adolescent Prescription Drug Abuse and Misuse Using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS[R]) System

    ERIC Educational Resources Information Center

    Zosel, Amy; Bartelson, Becki Bucher; Bailey, Elise; Lowenstein, Steven; Dart, Rick

    2013-01-01

    Objective: To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS[R])) System. Method: Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all…

  8. Evaluation Design: Best Practices for Enrolling Low-Income Beneficiaries into the Medicare Prescription Drug Benefit Program. Princeton, NJ: Mathematica Policy Research, Inc

    Microsoft Academic Search

    Beth Stevens; Leslie Foster; James M. Verdier; Debra Lipson; Margaret Gerteis; Shanna Shulman; Mary Laschober; Sibyl Day; Kristen Kiefer

    2005-01-01

    The new Medicare Part D benefit, which began on January 1, 2006, expanded Medicare to include prescription drugs, and it required beneficiaries to change how they interact with the program. Past experience with low enrollment in a variety of programs designed to aid low-income Medicare beneficiaries suggests that there will be significant barriers to enrolling them into the Low-Income Subsidy

  9. ADVANCED TOOLS FOR ASSESSING SELECTED PRESCRIPTION AND ILLICIT DRUGS IN TREATED SEWAGE EFFLUENTS AND SOURCE WATERS

    EPA Science Inventory

    The purpose of this poster is to present the application and assessment of advanced state-of-the-art technologies in a real-world environment - wastewater effluent and source waters - for detecting six drugs [azithromycin, fluoxetine, omeprazole, levothyroxine, methamphetamine, m...

  10. Addiction and autonomy: can addicted people consent to the prescription of their drug of addiction?

    PubMed

    Foddy, Bennett; Savulescu, Julian

    2006-02-01

    It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural evidence purported to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict's apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will. PMID:16680876

  11. 21 CFR 250.108 - Potassium permanganate preparations as prescription drugs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...potassium permanganate in an effort to induce abortion. Reports from physicians who have...permanganate is not effective in producing abortion, but that instead the drug produces...would be used in an attempt to induce abortion. (4) Any preparation of...

  12. 21 CFR 250.108 - Potassium permanganate preparations as prescription drugs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...potassium permanganate in an effort to induce abortion. Reports from physicians who have...permanganate is not effective in producing abortion, but that instead the drug produces...would be used in an attempt to induce abortion. (4) Any preparation of...

  13. 21 CFR 250.108 - Potassium permanganate preparations as prescription drugs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...potassium permanganate in an effort to induce abortion. Reports from physicians who have...permanganate is not effective in producing abortion, but that instead the drug produces...would be used in an attempt to induce abortion. (4) Any preparation of...

  14. 21 CFR 250.108 - Potassium permanganate preparations as prescription drugs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...potassium permanganate in an effort to induce abortion. Reports from physicians who have...permanganate is not effective in producing abortion, but that instead the drug produces...would be used in an attempt to induce abortion. (4) Any preparation of...

  15. 21 CFR 250.108 - Potassium permanganate preparations as prescription drugs.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...potassium permanganate in an effort to induce abortion. Reports from physicians who have...permanganate is not effective in producing abortion, but that instead the drug produces...would be used in an attempt to induce abortion. (4) Any preparation of...

  16. 75 FR 52765 - Development and Distribution of Patient Medication Information for Prescription Drugs; Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

    ...are needed to ensure distribution of PMI? For example...we ensure adequate distribution of PMI while minimizing...situations where the distribution of PMI would not be...developers, publishers, industry, and any other interested...The Commissioner of Food and Drugs is...

  17. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial

    PubMed Central

    Walker, Ann F; Marakis, Georgios; Simpson, Eleanor; Hope, Jessica L; Robinson, Paul A; Hassanein, Mohamed; Simpson, Hugh CR

    2006-01-01

    Background Hawthorn (Crataegus laevigata) leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. Small-scale human studies support this approach. Aim To investigate the effects of hawthorn for hypertension in patients with type 2 diabetes taking prescribed drugs. Design of study Randomised controlled trial. Setting General practices in Reading, UK. Method Patients with type 2 diabetes (n = 79) were randomised to daily 1200 mg hawthorn extract (n = 39) or placebo (n = 40) for 16 weeks. At baseline and outcome a wellbeing questionnaire was completed and blood pressure and fasting blood samples taken. A food frequency questionnaire estimated nutrient intake. Results Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. Fat intake was lower and sugar intake higher than recommendations, and low micronutrient intake was prevalent. There was a significant group difference in mean diastolic blood pressure reductions (P = 0.035): the hawthorn group showed greater reductions (baseline: 85.6 mmHg, 95% confidence interval [CI] = 83.3 to 87.8; outcome: 83.0 mmHg, 95% CI = 80.5 to 85.7) than the placebo group (baseline: 84.5 mmHg, 95% CI = 82 to 87; outcome: 85.0 mmHg, 95% CI = 82.2 to 87.8). There was no group difference in systolic blood pressure reduction from baseline (3.6 and 0.8 mmHg for hawthorn and placebo groups, respectively; P = 0.329). Although mean fat intake met current recommendations, mean sugar intake was higher and there were indications of potential multiple micronutrient deficiencies. No herb–drug interaction was found and minor health complaints were reduced from baseline in both groups. Conclusions This is the first randomised controlled trial to demonstrate a hypotensive effect of hawthorn in patients with diabetes taking medication. PMID:16762125

  18. Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying

    PubMed Central

    Arria, Amelia M.; Wilcox, Holly C.; Caldeira, Kimberly M.; Vincent, Kathryn B.; Garnier-Dykstra, Laura M.; O'Grady, Kevin E.

    2012-01-01

    This study tested the hypothesis that college students’ substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories with NPS for studying was then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines. PMID:23254212

  19. Dispelling the myth of "smart drugs": cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying.

    PubMed

    Arria, Amelia M; Wilcox, Holly C; Caldeira, Kimberly M; Vincent, Kathryn B; Garnier-Dykstra, Laura M; O'Grady, Kevin E

    2013-03-01

    This study tested the hypothesis that college students' substance use problems would predict increases in skipping classes and declining academic performance, and that nonmedical use of prescription stimulants (NPS) for studying would occur in association with this decline. A cohort of 984 students in the College Life Study at a large public university in the US participated in a longitudinal prospective study. Interviewers assessed NPS; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cannabis and alcohol use disorders; and frequency of skipping class. Semester grade point average (GPA) was obtained from the university. Control variables were race, sex, family income, high school GPA, and self-reported attention deficit hyperactivity disorder diagnosis. Longitudinal growth curve modeling of four annual data waves estimated the associations among the rates of change of cannabis use disorder, percentage of classes skipped, and semester GPA. The associations between these trajectories and NPS for studying were then evaluated. A second structural model substituted alcohol use disorder for cannabis use disorder. More than one-third (38%) reported NPS for studying at least once by Year 4. Increases in skipping class were associated with both alcohol and cannabis use disorder, which were associated with declining GPA. The hypothesized relationships between these trajectories and NPS for studying were confirmed. These longitudinal findings suggest that escalation of substance use problems during college is related to increases in skipping class and to declining academic performance. NPS for studying is associated with academic difficulties. Although additional research is needed to investigate causal pathways, these results suggest that nonmedical users of prescription stimulants could benefit from a comprehensive drug and alcohol assessment to possibly mitigate future academic declines. PMID:23254212

  20. Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus.

    PubMed

    Vrecko, Scott

    2015-04-01

    This article investigates everyday experiences and practises that are associated with processes of pharmaceuticalization and with practices of 'drug diversion'--that is, the illicit exchange and non-medical use of prescription drugs. It reports results from a qualitative study that was designed to examine the everyday dimensions of non-medical prescription stimulant use among students on an American university campus, which involved 38 semi-structured interviews with individuals who used prescription stimulants as a means of improving academic performance. While discussions of drug diversion are often framed in terms of broad, population-level patterns and demographic trends, the present analysis provides a complementary sociocultural perspective that is attuned to the local and everyday phenomena. Results are reported in relation to the acquisition of supplies of medications intended for nonmedical use. An analysis is provided which identifies four different sources of diverted medications (friends; family members; black-market vendors; deceived clinicians), and describes particular sets of understandings, practices and experiences that arise in relation to each different source. Findings suggest that at the level of everyday experience and practice, the phenomenon of prescription stimulant diversion is characterised by a significant degree of complexity and heterogeneity. PMID:25455480

  1. Hepatitis C Viremia and Genotype Distribution among a sample of HCV-exposed Nonmedical Prescription Drug Users in Rural Appalachia

    PubMed Central

    Young, April M.; Crosby, Richard A.; Oser, Carrie B.; Leukefeld, Carl G.; Stephens, Dustin B.; Havens, Jennifer R.

    2012-01-01

    Research has demonstrated that hepatitis C (HCV) genotype distribution varies geographically and demographically. This exploratory study examines HCV viremia, viral concentration, and genotype distribution among anti-HCV positive, rural Appalachian nonmedical prescription drug users. The study population was randomly selected from a pool of 200 anti-HCV positive participants in a longitudinal study. Those randomly chosen were representative of the overall pool in terms of demographics, drug use, and other risk behaviors. Participants were tested serologically for HCV RNA, viral concentration, and genotype, and interview-administered questionnaires examined behavioral and demographic characteristics. Of the 81 participants, 69% tested RNA positive, 59% of which had viral loads exceeding 800,000 IU/mL. Approximately 66% of the RNA positive sample had genotype 1a; types 2b (16%) and 3a (13%) were less common. RNA positive participants were not significantly different than RNA negative participants demographically or behaviorally. Likewise, with the exception of education, genotype 1 participants were not significantly different than those with genotype 2 or 3. The prevalence of active HCV infection highlights a need for prevention and treatment in this population. However, the predominance of genotype 1 may present challenges due to its association with decreased responsiveness to drug treatment, although the novel class of direct-acting antivirals such as telaprevir and boceprevir offer new hope in this regard. The prevalence of genotype 1 may also foreshadow heightened burden of hepatocellular carcinoma and elevated healthcare expenditures. More research is needed to characterize HCV infection and genotype in this population. PMID:22825816

  2. Study of Natural Health Product Adverse Reactions (SONAR): Active Surveillance of Adverse Events Following Concurrent Natural Health Product and Prescription Drug Use in Community Pharmacies

    PubMed Central

    Vohra, Sunita; Cvijovic, Kosta; Boon, Heather; Foster, Brian C.; Jaeger, Walter; LeGatt, Don; Cembrowski, George; Murty, Mano; Tsuyuki, Ross T.; Barnes, Joanne; Charrois, Theresa L.; Arnason, John T.; Necyk, Candace; Ware, Mark; Rosychuk, Rhonda J.

    2012-01-01

    Background Many consumers use natural health products (NHPs) concurrently with prescription medications. As NHP-related harms are under-reported through passive surveillance, the safety of concurrent NHP-drug use remains unknown. To conduct active surveillance in participating community pharmacies to identify adverse events related to concurrent NHP-prescription drug use. Methodology/Principal Findings Participating pharmacists asked individuals collecting prescription medications about (i) concurrent NHP/drug use in the previous three months and (ii) experiences of adverse events. If an adverse event was identified and if the patient provided written consent, a research pharmacist conducted a guided telephone interview to gather additional information after obtaining additional verbal consent and documenting so within the interview form. Over a total of 112 pharmacy weeks, 2615 patients were screened, of which 1037 (39.7%; 95% CI: 37.8% to 41.5%) reported concurrent NHP and prescription medication use. A total of 77 patients reported a possible AE (2.94%; 95% CI: 2.4% to 3.7%), which represents 7.4% of those using NHPs and prescription medications concurrently (95%CI: 6.0% to 9.2%). Of 15 patients available for an interview, 4 (26.7%: 95% CI: 4.3% to 49.0%) reported an AE that was determined to be “probably” due to NHP use. Conclusions/Significance Active surveillance markedly improves identification and reporting of adverse events associated with concurrent NHP-drug use. Although not without challenges, active surveillance is feasible and can generate adverse event data of sufficient quality to allow for meaningful adjudication to assess potential harms. PMID:23028841

  3. Factors affecting trust in on-line prescription drug information and impact of trust on behavior following exposure to DTC advertising.

    PubMed

    Huh, Jisu; DeLorme, Denise E; Reid, Leonard N

    2005-12-01

    Despite growing concerns about the quality and accuracy of Internet-based prescription drug information, there has been very little empirical research on consumers' perceptions of the trustworthiness of on-line drug information. In this article, we report on a study modeled after that of Menon, Deshpande, Perri, and Zinkhan (2002) in Health Marketing Quarterly that reexamines how key demographic, predispositional, and media factors are associated with consumer trust in on-line prescription drug information and the impact of trust in on-line drug information on ad-promoted behavior following exposure to direct-to-consumer (DTC) advertising. Four major findings are reported: (1) on-line drug information is not highly trusted; (2) trust in on-line drug information is not differentially affected by consumer demographic or predispositional characteristics; (3) trust in the traditional media of DTC advertising is predictive of trust in on-line drug information; and (4) trust in on-line drug information is associated directly with specific types of ad-promoted behavior following exposure to DTC advertising. Implications and recommendations are offered based on the results. PMID:16316935

  4. Dialogue. Prescription for problems? Capitating mental health drugs--the great debate.

    PubMed

    Docherty, J P; Browne, R A; Farmer, M

    1998-10-01

    With the issue of physician capitation far from being resolved, mental health drug capitation is understandably up for debate. Those who deem it essential point to the rising cost of mental health drugs and urge management techniques which they believe can hold the delicate balance between a plan's budgetary limitations and a patient's appropriate care. They suggest that with an objectively calculated capitation rate, based not on expenditure alone, but on a defined population and their care needs, providers will not have to choose between profitability and optimal care. But others, responding to increasing quality concerns under capitation, worry that the increasing use of formularies will preclude patients and their providers from ready access to newer, more effective medications. With advocates still striving for nationwide parity for mental health benefits, capitating medications is not likely to assuage their concerns. Driving the debate is the fact that new technology drugs are expensive and most health plans are unable to anticipate the funding of breakthrough pharmaceuticals. With the advent of marketing to consumers directly through television and print media, plans and providers are increasingly pressured to provide these medications. The recent clamor for Viagra is an excellent example of how quickly the word can spread. New mental health medications may be even more expensive and offer patients and their families greater effectiveness with far fewer side effects. Plans, providers, and patients are caught in the middle, each holding their distinct view of the problems and solutions. This issue's dialogue brings our readers a discussion of capitation of pharmaceuticals as a primary answer to the sharp rise in mental health drugs. Three points of view lay out the viability and cautions of developing formularies and systems that could keep costs under control while still providing patient access. Without question, the debate will continue as legislative and consumer pressure continues to focus on managed care's techniques for cost savings and patient management. More sophisticated systems, designed for increasingly integrated and complex treatment plans, are certain to be required in the future. However, decisions about how to develop practice guidelines and integrate formularies with expensive new pharmaceutical technology, must begin to take shape now. PMID:10185199

  5. Asymmetric Responsiveness of Physician Prescription Behavior to Drug Promotion of Competitive Brands Within an Established Therapeutic Drug Class

    Microsoft Academic Search

    Alex Pedan; Hongsheng Wu

    2011-01-01

    This article examines the impact of direct-to-physician, direct-to-consumer, and other marketing activities by pharmaceutical companies on a mature drug category which is in the later stage of its life cycle and in which generics have accrued a significant market share. The main objective of this article is to quantitatively estimate the impact of pharmaceutical promotions on physician prescribing behavior for

  6. Prescription opioid injection and risk of hepatitis C in relation to traditional drugs of misuse in a prospective cohort of street youth

    PubMed Central

    Hadland, Scott E; DeBeck, Kora; Kerr, Thomas; Feng, Cindy; Montaner, Julio S; Wood, Evan

    2014-01-01

    Objective Despite dramatic increases in the misuse of prescription opioids, the extent to which their intravenous injection places drug users at risk of acquiring hepatitis C virus (HCV) remains unclear. We sought to compare risk of HCV acquisition from injection of prescription opioids to that from other street drugs among high-risk street youth. Design Prospective cohort study. Setting Vancouver, British Columbia, Canada from September 2005 to November 2011. Participants The At-Risk Youth Study (ARYS) is a prospective cohort of drug-using adolescents and young adults aged 14–26?years. Participants were recruited through street-based outreach and snowball sampling. Primary outcome measure HCV antibody seroconversion, measured every 6?months during follow-up. Risk for seroconversion from injection of prescription opioids was compared with injection of other street drugs of misuse, including heroin, cocaine or crystal methamphetamine, using Cox proportional hazards regression controlling for age, gender and syringe sharing. Results Baseline HCV seropositivity was 10.6%. Among 512 HCV-seronegative youth contributing 860.2 person-years of follow-up, 56 (10.9%) seroconverted, resulting in an incidence density of 6.5/100 person-years. In bivariate analyses, prescription opioid injection (HR=3.48; 95% CI 1.57 to 7.70) predicted HCV seroconversion. However, in multivariate modelling, only injection of heroin (adjusted HR=4.56; 95% CI 2.39 to 8.70), cocaine (adjusted HR=1.88; 95% CI 1.00 to 3.54) and crystal methamphetamine (adjusted HR=2.91; 95% CI 1.57 to 5.38) remained independently associated with HCV seroconversion, whereas injection of prescription opioids did not (adjusted HR=0.94; 95% CI 0.40 to 2.21). Conclusions Although misuse of prescription opioids is on the rise, traditional street drugs still posed the greatest threat of HCV transmission in this setting. Nonetheless, the high prevalence and incidence of HCV among Canadian street youth underscore the need for evidence-based drug prevention, treatment and harm reduction interventions targeting this vulnerable population. PMID:25052173

  7. Prescription practice of biological drugs in rheumatoid arthritis during the first 3 years of post-marketing use in Denmark and Norway: criteria are becoming less stringent

    PubMed Central

    Hjardem, E; Hetland, M; Ostergaard, M; Krogh, N; Kvien, T

    2005-01-01

    Objective: To investigate changes in prescription practice during the first 3 years of post-marketing use of biological drugs, and to determine the proportion of patients who would not have received tumour necrosis factor (TNF) blocking agents if the prescription guidelines of the UK and the Netherlands had been applied. Methods: Patients with rheumatoid arthritis (RA) receiving TNF blocking agents from Denmark (n = 823, median age 56.0, 72.2% women) and Norway (n = 371, median age 52.5, 75.4% women) were studied. Prescription guidelines in the UK and the Netherlands were applied to the data. Results: Baseline disease activity and number of previous DMARDs declined significantly during the 3 years (median baseline DAS28 decreased from 5.8 to 5.2 in Denmark (p<0.001) and from 6.0 to 5.6 in Norway (p<0.01)). 47.9% and 41.3% of the Norwegian and Danish patients, respectively, did not meet the UK criteria for using TNF blocking agents, and 10.5% and 5.7% did not meet the Dutch criteria. Conclusion: Danish and Norwegian prescription practices of biological treatments in RA were similar, and became less stringent from 2000 to 2003. Prescriptions agreed well with the Dutch guidelines, but almost half the patients did not meet the UK guidelines. PMID:15640272

  8. AnIndependentMemberoftheBlueShieldAssociation Note: This plan's prescription drug coverage is on average equivalent to or better than the standard benefit set by the federal government for Medicare Part D (also called

    E-print Network

    Ford, James

    Highlight: $0 Calendar-Year Brand-Name Drug Deductible $10 Formulary Generic/$20 Formulary Brand Name/$20 Non-Formulary Brand Name Drug - Retail Pharmacy $20 Formulary Generic/$40 Formulary Brand Name/$40 Non-Formulary Brand-Name Drug - Mail Service Covered Services Member Copayment DEDUCTIBLES (Prescription drug coverage

  9. Promotion of Prescription Drugs to Consumers and Providers, 2001–2010

    PubMed Central

    Kornfield, Rachel; Donohue, Julie; Berndt, Ernst R.; Alexander, G. Caleb

    2013-01-01

    Background Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies. Methods We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA) (Kantar Media) and provider-targeted promotion (IMS Health and SDI), including: (1) inflation-adjusted total promotion spending ($ and percent of sales); (2) distribution by channel (consumer v. provider); and (3) provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies. Results Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales). By 2010 it had declined to $27.7B (9.0% of sales). Between 2006 and 2010, similar declines were seen for promotion to providers and DTCA (both by 25%). DTCA’s share of total promotion increased from 12% in 2002 to 18% in 2006, but then declined to 16% and remains highly concentrated. Number of products promoted to providers peaked in 2004 at over 3000, and then declined 20% by 2010. In contrast to top-selling small molecule therapies having an average of $370 million (8.8% of sales) spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales) spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001–2010. Conclusions These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies. PMID:23469165

  10. Mirtazapine overdose is unlikely to cause major toxicity

    PubMed Central

    2014-01-01

    Objective. There is limited information on mirtazapine overdose, but cases of severe effects (seizures, serotonin toxicity and coma) have been reported. We aimed to investigate the clinical effects and complications of mirtazapine overdose. Methods. This was an observational case series of mirtazapine overdoses (> 120 mg) identified from admissions to a toxicology unit between January 1987 and August 2013. Demographic information, details of ingestion, clinical effects, ECG parameters (HR, QT and QRS), and length of stay were extracted from a clinical database. Results. From 267 mirtazapine overdoses, there were 89 single-agent mirtazapine ingestions and 178 cases where mirtazapine was taken with at least one other drug. The median age of the 89 single-agent mirtazapine ingestions was 36 years [interquartile range (IQR): 26–49 years; Range: 15–81 years]; 45 were female (51%). The median ingested dose was 420 mg (IQR: 270–750 mg; Range: 150–1350 mg) and 41 patients (46%) had a Glasgow coma score (GCS) < 15, but the minimum GCS was 10. There were no seizures, serotonin toxicity or delirium. Tachycardia occurred in 29 patients (33%) and hypertension in 32 patients (36%). The median QRS was 80 ms (Range: 80–120 ms) and there were no cases with QT prolongation. There were no arrhythmias and no deaths. The median length of stay was 14 h (IQR: 8.8–18.2 h; Range:2.2–75 h). No single-agent mirtazapine patient was admitted to intensive care. The 178 patients taking co-ingestants had more severe toxicity depending on the co-ingested drug. Conclusion. Mirtazapine appears to be relatively benign in overdose, associated with tachycardia, mild hypertension and mild CNS depression not requiring intervention. PMID:24228948

  11. Two cases of intranasal naloxone self-administration in opioid overdose

    PubMed Central

    Green, Traci C.; Ray, Madeline; Bowman, Sarah E.; McKenzie, Michelle; Rich, Josiah D.

    2013-01-01

    Background Overdose is a leading cause of death for former prisoners, exacting its greatest toll during the first 2 weeks post-release. Protective effects have been observed with training individuals at high risk of overdose and prescribing them naloxone, an opioid antagonist that reverses the effects of the opioid-induced respiratory depression that causes death. Cases We report two people with opiate use histories who self-administered intranasal naloxone to treat their own heroin overdoses following release from prison. Patient A is a 34-year-old male, who reported having experienced an overdose on heroin the day after he was released from incarceration. Patient B is a 29-year-old female, who reported an overdose on her first injection of heroin, 17 days post release from incarceration. Both patients self-administered the medication but were assisted at some point during the injury by a witness whom they had personally instructed in how to prepare and administer the medication. Neither patient experienced withdrawal symptoms following exposure to naloxone. Discussion Self-administration of naloxone should not be a goal of overdose death prevention training. A safer, more reliable approach is to prescribe naloxone to at-risk patients and train and also equip members of their household and social or drug using networks in overdose prevention and response. PMID:24821348

  12. Paliperidone overdose with delayed onset of toxicity.

    PubMed

    Levine, Michael; Lovecchio, Frank; Tafoya, Paul; Graham, Robert

    2011-07-01

    Paliperidone, or 9-hydroxy risperidone, is the newest atypical antipsychotic agent to be approved for use by the Food and Drug Administration. Despite being the primary active metabolite of risperidone, paliperidone differs in several ways from risperidone. The most notable difference is that paliperidone is formulated as an extended-release product. We present a case of a 14-year-old, 59-kg girl with a history of psychosis and major depressive disorder who developed toxicity after an ingestion of 180 mg (3.1 mg/kg) of paliperidone. This case is not only one of the first cases of paliperidone overdose described in the literature but also is unique in that it describes delayed onset of toxicity, as well as extended duration of symptoms. PMID:21376420

  13. Genetic and environmental risk factors for oral anticoagulant overdose

    Microsoft Academic Search

    C. Verstuyft; A. Robert; S. Morin; M. A. Loriot; A. Flahault; P. Beaune; C. Funck-Brentano; P. Jaillon; L. Becquemont

    2003-01-01

    Background. Cytochrome P450 2C9 (CYP2C9) allelic variant carriers have been shown to experience hyper-responsiveness to small doses of oral anticoagulants (OAs) (warfarin or acenocoumarol) and a higher bleeding rate. Objectives. To determine the relative frequencies of different risk factors for OA overdose including diet, concomitant diseases, drug interactions, recent increment of OA dose and CYP2C9 genetic polymorphism among hospitalised patients.

  14. Prescription diets for rabbits.

    PubMed

    Proença, Laila Maftoum; Mayer, Jörg

    2014-09-01

    Dietary management can be used with drug therapy for the successful treatment of many diseases. Therapeutic nutrition is well-recognized in dogs and cats and is beginning to increase among other pet species, including rabbits. The nutritional component of some rabbit diseases (eg, urolithiasis) is not completely understood, and the clinician should evaluate the use of prescription diets based on the scientific literature and individual needs. Long-term feeding trials are needed to further evaluate the efficacy of prescription diets in rabbits. Prescription diets are available for selected diseases in rabbits, including diets for immediate-term, short-term, and long-term management. PMID:25155667

  15. The Role of Traumatic Event History in Non-medical Use of Prescription Drugs among a Nationally Representative Sample of U.S. Adolescents

    PubMed Central

    McCauley, Jenna L.; Danielson, Carla Kmett; Amstadter, Ananda B.; Ruggiero, Kenneth J.; Resnick, Heidi S.; Hanson, Rochelle F.; Smith, Daniel W.; Saunders, Benjamin E.; Kilpatrick, Dean G.

    2009-01-01

    Background Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to Non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of lifetime non-medical use of prescription drugs. Method Nationally representative sample of 3,614 non-institutionalized, civilian, English speaking adolescents (aged 12-17 years) residing in households with a telephone. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if participants had ever used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of lifetime NMUPD. Results NMUPD was endorsed by 6.7% of the sample (n=242). Final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. Conclusions Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior should include treatment or prevention modules that specifically address NMUPD. PMID:19674194

  16. Molecular profiling of midbrain dopamine regions in cocaine overdose victims

    PubMed Central

    Tang, Wen-Xue; Fasulo, Wendy H.; Mash, Deborah C.; Hemby, Scott E.

    2013-01-01

    Chronic cocaine use in humans and animal models is known to lead to pronounced alterations in neuronal function in brain regions associated with drug reinforcement. To evaluate whether the alterations in gene expression in cocaine overdose victims are associated with specific dopamine populations in the midbrain, cDNA arrays and western blotting were used to compare gene and protein expression patterns between cocaine overdose victims and age-matched controls in the ventral tegmental area (VTA) and lateral substantia nigra (l-SN). Array analysis revealed significant up-regulation of numerous transcripts in the VTA, but not in the l-SN, of cocaine overdose victims including NMDAR1, GluR2, GluR5 and KA2 receptor mRNA (p < 0.05). No significant alterations between overdose victims and controls were observed for GluR1, R3 or R4 mRNA levels. Correspondingly, western blot analysis revealed VTA-selective up-regulation of CREB (p < 0.01), NMDAR1 (p < 0.01), GluR2 (p < 0.05), GluR5 (p < 0.01) and KA2 (p < 0.05) protein levels of cocaine overdose victims. The present results indicate that selective alterations of CREB and certain ionotropic glutamate receptor (iGluR) subtypes appear to be associated with chronic cocaine use in humans in a region-specific manner. Moreover, as subunit composition determines the functional properties of iGluRs, the observed changes may indicate alterations in the excitability of dopamine transmission underlying long-term biochemical and behavioral effects of cocaine in humans. PMID:12716423

  17. Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia

    PubMed Central

    Maher, Lisa; Ho, Hien T

    2009-01-01

    Background Ethnic Vietnamese injecting drug users (IDUs) in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory. Methods Observational fieldwork and in-depth interviews were conducted between 2001 and 2006 in neighbourhoods characterised by high proportions of Asian background IDUs and street-based drug markets. Eligibility criteria for the study were: 1) ethnic Vietnamese cultural background; 2) aged 16 years and over and; 3) injected drugs in the last 6 months. Results Participants commonly attempted to treat heroin overdose by withdrawing blood (rút máu) from the body. Central to this practice are cultural beliefs about the role and function of blood in the body and its relationship to illness and health. Participants' beliefs in blood were strongly influenced by understandings of blood expressed in traditional Chinese and Vietnamese medicine. Many participants perceived Western drugs, particularly heroin, as "hot" and "strong". In overdose situations, it was commonly believed that an excessive amount of drugs (particularly heroin) entered the bloodstream and traveled to the heart, making the heart work too hard. Withdrawing blood was understood to reduce the amount of drugs in the body which in turn reduced the effects of drugs on the blood and the heart. Conclusion The explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and discussed. PMID:19397811

  18. 75 FR 61621 - Charges Billed to Third Parties for Prescription Drugs Furnished by VA to a Veteran for a...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ...Domiciliary Care; 64.009, Veterans Medical Care Benefits; 64.010, Veterans...Home Care; 64.011, Veterans Dental Care; 64.012, Veterans Prescription...Health records, Homeless, Medical and dental schools, Medical devices, Medical...

  19. 76 FR 17137 - Pregnancy and Prescription Medication Use Symposium

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-28

    ...Docket No. FDA-2011-N-0002] Pregnancy and Prescription Medication Use Symposium...is announcing the following meeting: Pregnancy and Prescription Medication Use Symposium...discussed is ``Prescription Drug Use in Pregnancy.'' Date and Time: The meeting...

  20. Acute Sirolimus Overdose: A Multicenter Case Series

    PubMed Central

    Ceschi, Alessandro; Heistermann, Elja; Gros, Sonja; Reichert, Cornelia; Kupferschmidt, Hugo; Banner, Nicholas R.; Krähenbühl, Stephan; Taegtmeyer, Anne B.

    2015-01-01

    Background There are few data relating to sirolimus overdose in the medical literature. Our objectives were to describe all cases of overdose with sirolimus reported to Swiss, German and Austrian Poisons Centres between 2002-2013. Methods An observational case-series analysis was performed to determine circumstances, magnitude, management and outcome of sirolimus overdose. Results Five cases of acute sirolimus overdose were reported – three in young children and two in adults. Four were accidental and one was with suicidal intent. Two patients developed symptoms probably related to sirolimus overdose: mild elevation of alkaline phosphatase, fever and gastroenteritis in a 2.5-year-old male who ingested 3 mg, and mild changes in total cholesterol in an 18-year-old female after ingestion of 103 mg. None of these events were life-threatening. Serial blood concentration measurements were performed starting 24 h after ingestion of 103 mg in a single case, and these followed a similar pharmacokinetic time-course to measurements taken after dosing in the therapeutic range. Conclusions Acute sirolimus overdose occurred accidentally in the majority of cases. Even large overdoses appeared to be well-tolerated, however children might be at greater risk of developing complications. Further study of sirolimus overdose is needed. PMID:26020944

  1. Clinical outcomes in newer anticonvulsant overdose: a poison center observational study.

    PubMed

    Wills, Brandon; Reynolds, Penny; Chu, Eileen; Murphy, Christine; Cumpston, Kirk; Stromberg, Paul; Rose, Rutherfoord

    2014-09-01

    Clinicians have limited experience with assessment and treatment of overdose from newer anticonvulsant medications. The aim of this investigation was to evaluate clinical effects of newer anticonvulsant overdose, determine if a relationship exists between dose and clinical effect, and if a particular agent appears more toxic in overdose. This was a retrospective study using electronic poison center data, evaluating clinical outcomes from newer anticonvulsant overdose. The Toxicall™ database from January 1, 2002 to December 31, 2011 was queried using key words: "gabapentin," "lamotrigine," "levetiracetam," "tiagabine," "topiramate," "zonisamide," "pregabalin," and "oxcarbazine." Polypharmacy overdose and children less than 15 years of age were excluded. Charts were reviewed by two abstractors for pharmaceutical, self-reported dose, clinical effect score, and clinical signs, symptoms, and vital signs recorded in the chart. Ordinal logistic regression was used to evaluate the relationship between drug type, dose, age, and sex to clinical effect score. Out of 501 cases identified, 347 met the final inclusion criteria. There were 116 gabapentin, 67 lamotrigine, 15 levetiracetam, 15 tiagabine, 56 topiramate, 23 pregabalin, and 55 oxcarbazepine cases. Overdose of newer anticonvulsants frequently results in altered mental status. Seizures may be more common with tiagabine, lamotrigine, and oxcarbazepine. There was one death reported from intentional overdose of topiramate. An information index was created to rank drug toxicity based on reported signs and symptoms for each overdose. There was no significant effect of dose on severity of outcome (??=?0.12, p?=?0.23). However, the risk of a more severe outcome score was significantly increased with tiagabine relative to other drugs (??=?2.8, p?=?0.001). Lamotrigine ranked highest in terms of toxicity (HT?=?1.66) and number of interventions performed (HI?=?1.17), and levetiracetam the lowest (HT?=?0.98; HI?=?0.88). We could not identify a dose-effect in these data which likely reflects the limitations of self-reported doses. Despite limitations of these data, the risk of more severe outcome scores appear to be higher with tiagabine overdose while lamotrigine overdose appears to result in more reported signs, symptoms, and interventions. PMID:24515527

  2. HIV infection and risk of overdose: a systematic review and meta-analysis.

    PubMed

    Green, Traci C; McGowan, Samuel K; Yokell, Michael A; Pouget, Enrique R; Rich, Josiah D

    2012-02-20

    Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medications during their HIV care experience; others may continue to use illicit opioids despite their disease status. In either situation, there may be a heightened risk for nonfatal or fatal overdose. The potential mechanisms for this elevated risk remain controversial. We systematically reviewed the literature on the HIV-overdose association, meta-analyzed results, and investigated sources of heterogeneity, including study characteristics related to hypothesize biological, behavioral, and structural mechanisms of the association. Forty-six studies were reviewed, 24 of which measured HIV status serologically and provided data quantifying an association. Meta-analysis results showed that HIV seropositivity was associated with an increased risk of overdose mortality (pooled risk ratio 1.74, 95% confidence interval 1.45, 2.09), although the effect was heterogeneous (Q = 80.3, P < 0.01, I(2) = 71%). The wide variability in study designs and aims limited our ability to detect potentially important sources of heterogeneity. Causal mechanisms considered in the literature focused primarily on biological and behavioral factors, although evidence suggests structural or environmental factors may help explain the greater risk of overdose among HIV-infected drug users. Gaps in the literature for future research and prevention efforts as well as recommendations that follow from these findings are discussed. PMID:22112599

  3. HIV infection and risk of overdose: a systematic review and meta-analysis

    PubMed Central

    Green, Traci C.; McGowan, Samuel K.; Yokell, Michael A.; Pouget, Enrique R.; Rich, Josiah D.

    2012-01-01

    Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medications during their HIV care experience; others may continue to use illicit opioids despite their disease status. In either situation, there may be a heightened risk for nonfatal or fatal overdose. The potential mechanisms for this elevated risk remain controversial. We systematically reviewed the literature on the HIV–overdose association, meta-analyzed results, and investigated sources of heterogeneity, including study characteristics related to hypothesize biological, behavioral, and structural mechanisms of the association. Forty-six studies were reviewed, 24 of which measured HIV status serologically and provided data quantifying an association. Meta-analysis results showed that HIV seropositivity was associated with an increased risk of overdose mortality (pooled risk ratio 1.74, 95% confidence interval 1.45, 2.09), although the effect was heterogeneous (Q = 80.3, P <0.01, I2 = 71%). The wide variability in study designs and aims limited our ability to detect potentially important sources of heterogeneity. Causal mechanisms considered in the literature focused primarily on biological and behavioral factors, although evidence suggests structural or environmental factors may help explain the greater risk of overdose among HIV-infected drug users. Gaps in the literature for future research and prevention efforts as well as recommendations that follow from these findings are discussed. PMID:22112599

  4. 75 FR 61613 - Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ...Controlled Substance Prescriptions to Pharmacies AGENCY: Drug Enforcement Administration...controlled substance prescription to a pharmacy. FOR FURTHER INFORMATION CONTACT: Mark...communicating such prescriptions to a pharmacy in order to make the prescription...

  5. Hypothermic overdose, not all bad?

    PubMed

    Petterson, Timothy; Lyon, Lindsay; Peckler, Bradley

    2013-07-01

    A 51-year-old woman was brought into the Emergency Department (ED) following an intentional overdose of alcohol and her medication. Along with two bottles of wine it was estimated that she had taken 5800 mg of Quetiapine and 240 mg of Citalopram along with the wine. The ambient temperature in her flat was thought to be 10°C. On arrival to the ED her GCS was 8. She had agonal respirations with a pulse of 56/min, hypotensive 55/35 mmHg and a temperature 24°C. The patient was intubated and was given sodium bicarbonate, magnesium sulphate, calcium gluconate and an adrenaline infusion. She received active and passive rewarming measures. She had significant ECG findings related to her hypothermia and polypharmacy overdose which seemed to have been cumulative. The patient recovered and the only neurological deficit was numbness in her left leg which was thought to be related to prolonged immobility. Hypothermia may have contributed to her good outcome as hypothermia has been shown to improve both cardiac and neurological outcome. PMID:23960384

  6. Do Motives Matter?: Nonmedical Use of Prescription Medications among Adolescents

    ERIC Educational Resources Information Center

    McCabe, Sean Esteban; Boyd, Carol J.

    2012-01-01

    Adolescents' motives for engaging in nonmedical prescription drug use is somewhat different than their reasons for using other drugs, such as marijuana. For some youth, nonmedical prescription drug use is an attempt to self-treat a medical condition, for others it is an effort to get high, and some youth misuse prescription drugs for both reasons.…

  7. 21 CFR 1306.09 - Prescription requirements for online pharmacies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    21 Food and Drugs 9 2010-04-01...Prescription requirements for online pharmacies. 1306...Section 1306.09 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION...Prescription requirements for online pharmacies. (a...that is a prescription drug may be delivered,...

  8. The Misuse of Prescription Opioids: A Threat for Europe?

    PubMed

    van Amsterdam, Jan; van den Brink, Wim

    2015-01-01

    In the the past two decades the medical use of prescription opioids (POs), in particular oxycodone, increased up to 14-fold in the U.S. and Canada. The high consumption of these pain relievers also led to non-medical use and abuse of these substances which in turn resulted in a dramatic increase in the number of PO related fatalities and opioid dependent subjects. In the U.S. POs became the second most prevalent type of abused drug (4.5 million abusers; 1.7% of the population) after marijuana (8 million abusers) with currently 1.9 million (0.7% of the population) people dependent on opioid pain relievers. Pain relief was the leading motive for non-medical use in about 40% of the cases, but about half of non-medical PO users reported non-pain relief motives only, like to get high or to relax. Since 2011, there is a decline in the use and misuse of POs and reduction in painkiller overdose deaths in the U.S. probably due to the introduction of a variety of restrictive regulations. In Europe, the medical use of POs is increasing as well, but at a much slower rate than in the U.S. Moreover, in Europe non-medical use of POs and fatal PO incidents are (still) rare. The paper highlights and discusses the differences between Europe versus U.S. and Canada in an attempt to assess the risk of a PO abuse and overdose epidemic in Europe. It is concluded that the risk in Europe seems to be rather limited but vigilance is needed. PMID:26084418

  9. Liver transplantation after paracetamol overdose.

    PubMed Central

    O'Grady, J G; Wendon, J; Tan, K C; Potter, D; Cottam, S; Cohen, A T; Gimson, A E; Williams, R

    1991-01-01

    OBJECTIVE--To evaluate the role of liver transplantation after paracetamol overdose. DESIGN--Prospective study of consecutive candidates for transplantation and performance of transplantation over 18 months. SETTING--Liver unit, King's College Hospital, London. MAIN OUTCOME MEASURES--Fulfilment of indicators of poor prognosis, selection for transplantation, transplantation, survival. RESULTS--30 of 37 patients considered to have a reasonable prognosis with intensive medical care survived. Of 14 of 29 patients considered to have a very poor prognosis and registered for urgent liver transplantation, six received liver transplants, four of whom survived, while seven died and one survived without a transplant. Three of 15 patients with poor prognostic indicators but not selected for transplantation survived. CONCLUSION--Liver transplantation will have a definite but limited role in the management of fulminant hepatic failure induced by paracetamol. PMID:1884059

  10. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

    PubMed Central

    Lubana, Sandeep Singh; Genin, Dennis Iilya; Singh, Navdeep; De La Cruz, Angel

    2015-01-01

    Patient: Male, 20 Final Diagnosis: Asystolic cardiac arrest in profound hypothermia and poly-substance overdose Symptoms: Cardiac arrest • cardiac arrhythmia Medication: — Clinical Procedure: Endotracheal intubation • hemodialysis Specialty: Critical Care Medicine Objective: Unusual clinical course Background: Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest. Case Report: We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia. Conclusions: Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques. PMID:26054008

  11. Morphine concentrations in stomach contents of intravenous opioid overdose deaths.

    PubMed

    Duflou, Johan; Darke, Shane; Easson, Jennifer

    2009-09-01

    Death caused by heroin overdose is almost always the result of intravenous injection of the drug in Australia. We briefly describe a case where a heroin overdose was initially thought to be the result of oral ingestion of the drug, primarily as a result of higher concentrations of morphine in stomach contents than in blood. During the subsequent criminal trial and investigation, however, the issue of the entero-hepatic circulation of morphine was raised as a possible reason for the presence of morphine in the stomach contents. In this study, we report on the distribution of opioids in blood, stomach contents, urine, liver, and bile in 29 deaths caused by intravenous heroin overdose. The mean total and free blood morphine concentrations were 0.60 and 0.32 mg/L, respectively, and the mean stomach contents total morphine concentration was 1.16 mg/kg. All cases had detectable morphine in the stomach contents, and 24 of 29 cases (83%) had higher concentrations of total morphine in stomach contents than in blood. The mean total morphine concentration in bile was c. 100 times that in blood, and the liver total morphine concentration averaged twice that of blood levels. We conclude that the entero-hepatic circulation of morphine and subsequent reflux of duodenal contents back into the stomach can result in the deposition of morphine in gastric contents. Consequently, the relative levels of opioids in blood and stomach contents cannot be used to determine the site of administration of the drug. PMID:19674239

  12. A case of fatal felodipine overdose.

    PubMed

    Lota, Harpreet; Powell, Nick; Negus, Rupert; Leonard, Richard; Manikon, Maribel

    2008-01-01

    A 54 year gentleman was admitted to hospital within four hours of taking an overdose of modified release felodipine tablets, with a total dose of approximately 250 mg. The initial management comprised fluid resuscitation, calcium chloride and glucagon. He remained hypotensive and was commenced on hyperinsulinaemia-euglycaemic therapy. Hypotension persisted with the development of progressive metabolic acidosis despite increasing inotropic support, haemofiltration and high dose insulin-dextrose infusions. The patient died 60 hours post overdose. The case highlights the profound, refractory circulatory collapse and lethal consequences of significant calcium channel blocker overdose and also reviews potential management strategies to attempt to reverse these changes. Despite the lack of evidence of whole bowel irrigation in overdose per se, its role in the removal of modified release compounds has not been studied. We would strongly urge emergency departments to consider this therapeutic modality, especially in overdoses involving delayed release preparations of calcium channel blockers, which are extremely toxic in overdose and are associated with very high mortality. PMID:21607228

  13. Enhanced extracorporeal elimination of valproic acid in overdose.

    PubMed

    Engbersen, R; Kramers, C

    2004-10-01

    The treatment of the poisoned patient has been based on three main approaches: use of supportive nonspecific therapy, if available administration of antidotes and removal of the offending drug from the body. Gastric lavage and binding of nonabsorbed drug by activated charcoal are often used in an attempt to eliminate the intoxicating agent from the body. In addition, elimination of already absorbed drug can sometimes be enhanced by the induction of brisk diuresis coupled to manipulation of urine pH (e.g. alkalinise for salicylates) or applying extracorporeal techniques such as haemodialysis, haemofiltration or haemoperfusion. In this issue of the journal Meek et al. describe the application of haemodialysis in a patient with severe valproic acid (VPA) overdose and demonstrate an increased elimination after the start of haemodialysis. PMID:15635813

  14. Ginseng in Traditional Herbal Prescriptions

    PubMed Central

    Park, Ho Jae; Kim, Dong Hyun; Park, Se Jin; Kim, Jong Min; Ryu, Jong Hoon

    2012-01-01

    Panax ginseng Meyer has been widely used as a tonic in traditional Korean, Chinese, and Japanese herbal medicines and in Western herbal preparations for thousands of years. In the past, ginseng was very rare and was considered to have mysterious powers. Today, the efficacy of drugs must be tested through well-designed clinical trials or meta-analyses, and ginseng is no exception. In the present review, we discuss the functions of ginseng described in historical documents and describe how these functions are taken into account in herbal prescriptions. We also discuss the findings of experimental pharmacological research on the functions of ginseng in ginseng-containing prescriptions and how these prescriptions have been applied in modern therapeutic interventions. The present review on the functions of ginseng in traditional prescriptions helps to demystify ginseng and, as a result, may contribute to expanding the use of ginseng or ginseng-containing prescriptions. PMID:23717123

  15. Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada.

    PubMed

    Contoyannis, Paul; Hurley, Jeremiah; Grootendorst, Paul; Jeon, Sung-Hee; Tamblyn, Robyn

    2005-09-01

    The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a 'rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between -0.12 and -0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes. PMID:16127675

  16. Clinical translation of genotyping and haplotyping data: implementation of in vivo pharmacology experience leading drug prescription to pharmacotyping.

    PubMed

    Vizirianakis, Ioannis S

    2007-01-01

    The completion of the Human Genome Project has raised expectations for the translation of genomic knowledge into clinical forms that would lead to improved diagnosis of diseases and identification of new drug targets. Such an opportunity is quite challenging within science and society, although there is still uncertainty regarding its outcomes in new drug development and healthcare. Undoubtedly, however, the recent approval by the US FDA of the first two pharmacogenomic tests for genotyping drug-metabolising enzymes is expected to empower and eventually lead to general applicability of various genetic diagnostic tools to improve pharmacotherapy outcomes in the post-genomic era. To this end, the application of genomic knowledge and technologies in everyday clinical practice leads personalised medicine concepts towards the achievement of individualised drug selection and dosage profiling (i.e. pharmacotyping) for ensuring maximum drug effectiveness and safety. Within this framework, pharmacogenomic information can implement the existing clinical pharmacology experience in clinical diagnosis and drug delivery. The latter can be further advanced through the development of workflow information-based operating systems in healthcare to support the utilisation, assessment and outcome of engaged clinical and genomic information. Such a direction may help to suitably revise and adjust clinical regulatory guidelines as well as clinical pharmacology guidelines. This will further facilitate better designing of clinical trials for new drug development as well as pharmacovigilance registries and evaluation of these data. To critically describe the existing environment, this article comprehensively discusses scientific efforts aimed at making clinical translation of genotyping and haplotyping data more efficient and productive in forms that are readily applicable in everyday healthcare. In addition, specific and systematic pharmacogenomic and clinical attempts related to the development of new molecularly targeted drugs, as well as improvement of the efficacy and safety of commonly prescribed drugs, are presented. To this end, the clinical pharmacogenomic experience gained thus far in the use of tyrosine kinase inhibitors in oncology, as well as the process of empowerment through the use of genomic knowledge of the cardiac safety of drugs modulating the function of the human ether-à-go-go-related gene (HERG) potassium channel, represent examples of how the implementation of clinical experience with genomic information guides the development of new drugs and the improvement of pharmacotherapy outcomes. PMID:17854232

  17. Registration requirements for importers and manufacturers of prescription drug products containing ephedrine, pseudoephedrine, or phenylpropanolamine. Final rule.

    PubMed

    2010-02-01

    The Drug Enforcement Administration (DEA) is amending its registration regulations to ensure that a registration is obtained for every location where ephedrine, pseudoephedrine, or phenylpropanolamine, or drug products containing one of these chemicals, are imported or manufactured. These amendments will make it possible to establish the system of quotas and assessment of annual needs for the importation and manufacture of these chemicals that Congress mandated in the Combat Methamphetamine Epidemic Act of 2005. PMID:20352663

  18. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background One approach to preventing opioid overdose, a leading cause of premature, preventable mortality, is to provide overdose education and naloxone distribution (OEND). Two outstanding issues for OEND implementation include 1) the dissemination of OEND training from trained to untrained community members; and 2) the concern that OEND provides active substance users with a false sense of security resulting in increased opioid use. Methods To compare overdose rescue behaviors between trained and untrained rescuers among people reporting naloxone rescue kit use; and determine whether heroin use changed after OEND, we conducted a retrospective cohort study among substance users in the Massachusetts OEND program from 2006 to 2010. We used chi square and t-test statistics to compare the differences in overdose management characteristics among overdoses managed by trained versus untrained participants. We employed Wilcoxon signed rank test to compare median difference among two repeated measures of substance use among participants with drug use information collected more than once. Results Among 4,926 substance-using participants, 295 trained and 78 untrained participants reported one or more rescues, resulting in 599 rescue reports. We found no statistically significant differences in help-seeking (p =?0.41), rescue breathing (p =?0.54), staying with the victim (p =?0.84) or in the success of naloxone administration (p =?0.69) by trained versus untrained rescuers. We identified 325 OEND participants who had drug use information collected more than once. We found no significant overall change in the number of days using heroin in past 30 days (decreased 38%, increased 35%, did not change 27%, p =?0.52). Conclusion Among 4926 substance users who participated in OEND, 373(7.6%) reported administering naloxone during an overdose rescue. We found few differences in behavior between trained and untrained overdose rescuers. Prospective studies will be needed to determine the optimal level of training and whether naloxone rescue kits can meet an over-the-counter standard. With no clear evidence of increased heroin use, this concern should not impede expansion of OEND programs or policies that support them. PMID:24684801

  19. Frontline: Dangerous Prescription

    NSDL National Science Digital Library

    In the recent PBS broadcast Dangerous Prescriptions, Frontline "investigates the integrity of America's drug safety system." The documentary (viewable in its entirety online) explores "the FDA's handling of several drugs that were approved but later were pulled from the market after causing injuries and even deaths." The companion website offers a look at how the FDA works and details of its recent record, based on interviews with current and former FDA officials. Also, readers may share their thoughts on the issue with Frontline and a selection of readers' letters may be found under the Discussion heading.

  20. Alcohol Overdose: The Dangers of Drinking Too Much

    MedlinePLUS

    ... temperature), bluish skin color, paleness Although many people enjoy moderate drinking, defined as 1 drink per day for women or 2 for men, drinking too much can lead to an overdose. An overdose of ...

  1. N-acetylcysteine overdose after acetaminophen poisoning.

    PubMed

    Mahmoudi, Ghafar Ali; Astaraki, Peyman; Mohtashami, Azita Zafar; Ahadi, Maryam

    2015-01-01

    N-acetylcysteine (NAC) is used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning. Here we report a rare case of iatrogenic NAC overdose following an error in preparation of the solution, and describe its clinical symptoms. Laboratory results and are presented and examined. A 23-year-old alert female patient weighing 65 kg presented to the emergency ward with weakness, lethargy, extreme fatigue, nausea, and dizziness. She had normal arterial blood gas and vital signs. An excessive dosage of NAC over a short period of time can lead to hemolysis, thrombocytopenia, and acute renal failure in patients with normal glucose-6-phosphate dehydrogenase, and finally to death. Considering the similarity between some of the clinical symptoms of acetaminophen overdose and NAC overdose, it is vitally important for the administration phases and checking of the patient's symptoms to be carried out attentively and cautiously. PMID:25767408

  2. N-acetylcysteine overdose after acetaminophen poisoning

    PubMed Central

    Mahmoudi, Ghafar Ali; Astaraki, Peyman; Mohtashami, Azita Zafar; Ahadi, Maryam

    2015-01-01

    N-acetylcysteine (NAC) is used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning. Here we report a rare case of iatrogenic NAC overdose following an error in preparation of the solution, and describe its clinical symptoms. Laboratory results and are presented and examined. A 23-year-old alert female patient weighing 65 kg presented to the emergency ward with weakness, lethargy, extreme fatigue, nausea, and dizziness. She had normal arterial blood gas and vital signs. An excessive dosage of NAC over a short period of time can lead to hemolysis, thrombocytopenia, and acute renal failure in patients with normal glucose-6-phosphate dehydrogenase, and finally to death. Considering the similarity between some of the clinical symptoms of acetaminophen overdose and NAC overdose, it is vitally important for the administration phases and checking of the patient’s symptoms to be carried out attentively and cautiously. PMID:25767408

  3. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery.

    PubMed

    Singh Lubana, Sandeep; Genin, Dennis Iilya; Singh, Navdeep; De La Cruz, Angel

    2015-01-01

    BACKGROUND Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest. CASE REPORT We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia. CONCLUSIONS Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques. PMID:26054008

  4. Prescription-medication sharing among family members: an unrecognized cause of a serious drug adverse event in a patient with impaired renal function.

    PubMed

    Makówka, Agnieszka; Zawiasa, Anna; Nowicki, Michal

    2015-03-01

    Many medications need to be avoided in chronic kidney disease (CKD) because of increased toxicity. Metformin - an oral hypoglycemic drug universally recommended as the first-line treatment for type 2 diabetes mellitus (T2DM) - undergoes significant accumulation in advanced CKD that may ultimately lead to lactic acidosis. Recently, it has been found that side effects of the therapy may occasionally neither be linked to improper prescription nor lack of dose adjustment by the physician, but can result from borrowing and sharing of drugs with relatives and friends. This poorly recognized problem has never been studied in renal patients. This work contains a discussion on the diagnostic problems associated with proper diagnosis of the etiology of severe acidosis in an elderly woman with advanced CKD and diabetes. The patient developed severe lactic acidosis by taking metformin that was prescribed by another doctor to her son, who was also diabetic. The diagnosis of lactic acidosis was delayed since the initial laboratory assessments had focused mostly on dehydration and substance abuse. PMID:24691009

  5. CERTIFICATION OF DUAL UNIVERSITY COVERAGE FOR COORDINATION OF PRESCRIPTION BENEFITS

    E-print Network

    Provancher, William

    7/13 CERTIFICATION OF DUAL UNIVERSITY COVERAGE FOR COORDINATION OF PRESCRIPTION BENEFITS Coordination of Prescription Drug Benefits with a $0 coinsurance amount at the pharmacy is ONLY available when Plan Design Options. Coordination of Prescription Drug Benefits is not offered when either one or both

  6. Suicide by means of opioid overdose in patients with chronic pain.

    PubMed

    Madadi, Parvaz; Persaud, Nav

    2014-11-01

    Deaths from prescription opioid use continue to rise in North America. The main focus to date has been developing strategies to prevent nonintentional (accidental) fatalities, which constitute the majority of opioid deaths across all jurisdictions. Often overlooked is the complex group of individuals whose cause of death was suicide by opioid overdose. Although most opioid prescribing tools focus on identifying risk factors for potential abuse, diversion, and propensity for opioid addiction, physicians who consider prescribing opioids should also screen and optimize chronic pain treatment for patients at risk for suicide. PMID:25249422

  7. Now you see it. Now you don't: fair balance and adequate provision in advertisements for drugs before and after the switch from prescription to over-the-counter.

    PubMed

    Faerber, Adrienne E; Kreling, David H

    2012-01-01

    The objective of this study was to measure differences in fair balance (benefit and risk statements) and adequate provision (toll-free numbers, Internet URLs, print ad references, and medical professional references) in advertising content for drugs that have switched from prescription to over-the-counter (OTC). The Vanderbilt TV News Archive was used to select products to study, to measure the frequency and placement of ads for those products, and to view advertising content for those products. Unique advertisements (n?=?108) for loratadine (Claritin), citirizine (Zyrtec), and omeprazole (Prilosec) were analyzed for the presence of adequate provision statements and for the frequency of benefit, risk, and other statements. OTC ads were shorter than prescription ads by 10.6 seconds but contained the same total number of statements. Most prescription ads (n (RX)?=?31) contained toll-free numbers (97%), Internet URLs (94%), medical professional references (100%) and print ad references (68%). Few OTC ads (n (OTC)?=?77) contained adequate provision statements: 4% contained toll-free numbers and 10% contained Internet URLs. Prescription ads had similar numbers of benefits (1.5) and risks (1.8) per 30 seconds of ad time, and OTC ads had more benefits (6.6) than risks (1.2) per 30 seconds of ad time. Prescription drug ads contained risk statements that listed specific side effects and explicit harms from taking the product, but OTC ads contained nonspecific risk information and statements that implied risk rather than directly identifying risk. Differences in the Food and Drug Administration (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit information that appeared and the specificity of risk information available. PMID:21745037

  8. Non-life-threatening leukopenia in a renal transplant recipient with acute overdose of mycophenolate mofetil.

    PubMed

    Wu, S-W; Chang, H-R; Lai, Y-R; Lian, J-D

    2008-12-01

    Mycophenolate mofetil (MMF) is increasingly used as an immunosuppressant for organ transplantation and for treatment of autoimmune diseases. As yet, the experience with acute overdose of MMF in humans is limited. Herein we have reported a 40-year-old female kidney recipient with moderate leukopenia and lack of gastrointestinal toxicity following ingestion of 25 g MMF, which was confirmed by serum drug levels. We treated the patient with charcoal decontamination and oral cholestyramine. She recovered completely without sequelae. PMID:19100486

  9. The impact of direct-to-consumer advertising of prescription drugs on physician visits and drug requests: Empirical findings and public policy implications

    Microsoft Academic Search

    Qiang Liu; Sachin Gupta

    2011-01-01

    This study analyzes the effect of DTCA expenditures for anti-hyperlipidemia drugs on patient behaviors. The key findings are: (a) DTCA expenditures have a positive and long-term effect on the number of visits to physicians by newly diagnosed hyperlipidemia patients. (b) The effectiveness of DTCA in generating new patient visits varies substantially across patient sub-groups. (c) The effect of DTCA is

  10. Intranasal Naloxone for Treatment of Opioid Overdose

    Microsoft Academic Search

    Anne-Maree Kelly; Debra Kerr; Dietze Paul

    \\u000a In theory, intranasal (IN) naloxone should be effective and practical for the treatment of acute opioid overdose. To date,\\u000a evaluation of its effectiveness has been limited, but what is known is promising with reports that it is effective and safe,\\u000a can reduce the requirement for injected treatments and has comparable times to recovery with other routes of administration.\\u000a Unfortunately, naloxone

  11. Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s.

    PubMed Central

    Mårdh, Per-Anders; Wågström, Jolanta; Landgren, Maria; Holmén, Jan

    2004-01-01

    BACKGROUND: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. OBJECTIVES: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. METHODS: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. RESULTS: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. CONCLUSION: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions. PMID:15739824

  12. Nefopam Hydrochloride: A Fatal Overdose.

    PubMed

    Seetohul, L Nitin; De Paoli, Giorgia; Drummond, Gail; Maskell, Peter D

    2015-07-01

    Nefopam is a non-opiate analgesic commonly used for the treatment of moderate to severe pain. A case of a 37-year-old male who was found dead in the morning is presented. An autopsy was performed and femoral venous blood, heart blood, urine, and vitreous humor were submitted for toxicological analysis. A general drug screen detected the presence of nefopam, caffeine, nicotine, citalopram, gabapentin, amitriptyline, diazepam and paracetamol in cardiac blood. Nefopam was quantitated by high-performance liquid chromatography with diode-array detection. Nefopam was found at the following concentrations: 13.6 mg/L in unpreserved femoral blood; 14.7 mg/L in preserved (fluoride-oxalate) femoral blood; 21.2 mg/L in unpreserved cardiac blood and 4.5 mg/L in preserved vitreous. Citalopram was present at a concentration of 0.7 mg/L (femoral blood) and 0.9 mg/L (cardiac blood). Ethanol analyzed by headspace gas chromatography (GC-FID) was detected in preserved (fluoride-oxalate) vitreous (14 mg/100 mL) and preserved (fluoride-oxalate) urine 50 mg/100 mL. Death was attributed to atherosclerotic coronary artery disease and therapeutic drug toxicity. PMID:25855761

  13. Prescription of and Adherence to Non-Steroidal Anti-Inflammatory Drugs and Gastroprotective Agents in At-Risk Gastrointestinal Patients

    PubMed Central

    Lanas, Angel; Polo-Tomás, Mónica; Roncales, Pilar; Gonzalez, Miguel A; Zapardiel, Javier

    2012-01-01

    OBJECTIVES: Patients with gastrointestinal (GI) risk factors who take non-steroidal anti-inflammatory drugs (NSAIDs) should also take gastroprotective agents (GPAs). No studies have evaluated adherence and reasons for non-adherence to GPA and NSAID therapies. METHODS: This was a prospective, multicenter, observational, longitudinal study. Patients attending rheumatology/orthopedic clinics who were co-prescribed NSAID plus GPA for at least 15 days and had risk factors for GI complications were followed up by telephone call. Optimal adherence was defined as taking the drug for ?80% of prescribed days. Multivariate logistic regression analysis was used to determine factors associated with non-adherence. RESULTS: Of 1,232 patients interviewed, 192 were excluded because of inaccurate data. Of the remaining 1,040 patients, 74% were prescribed low-dose NSAIDs and 99.8% were prescribed a standard or high-dose GPA. In all, 70% of NSAIDs and 63.1% of GPA prescriptions were short term (<30 days). The majority of patients who were prescribed either an NSAID (92.5%) or GPA (85.9%) started therapy. Optimal adherence to GPA or NSAIDs was reported by 79.7% (95% confidence interval (CI): 76.9?82.2%) and 84.1% (95% CI: 81.7?86.3%) of patients, respectively. More adverse events occurred among patients who reported non-optimal adherence than among patients with optimal adherence to GPA (22.1 vs. 1.9%, P<0.0001). As reasons for non-adherence, patients most frequently cited infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Adverse events and short-term treatment were independent factors associated with poor adherence for both NSAIDs and GPAs. History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs. CONCLUSIONS: Most frequent reasons for non-adherence are infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Short-term treatment and adverse events were associated with poor adherence for both therapies. PMID:22334248

  14. Is 50 cent the price of the optimal copayment? - a qualitative study of patient opinions and attitudes in response to a 50 cent charge on prescription drugs in a publicly funded health system in Ireland

    PubMed Central

    2013-01-01

    Background A 50 cent prescription levy was introduced in 2010 on the General Medical Services (GMS) scheme (Irish public health insurance). This study sought to examine patient attitudes and opinions surrounding the 50 cent copayment. Given the small momentary value of the prescription fee, these results are of interest to policymakers internationally who wish to reduce copayments rather than abolish them. Methods A qualitative research design was used; semi structured interviews were carried out. Twenty four GMS eligible participants were interviewed in 23 interviews. Fifteen females and 9 males took part. Ages varied from 31- >70?years. Patients were invited to be interviewed in both independent and chain community pharmacies in three types of setting; 1) a socially deprived urban area, 2) a suburban affluent area and 3) a rural area. The Framework method was used for data management and analysis using QSR International’s NVivo 9.2 qualitative data analysis software. The “Francis method” was used to test for data saturation. Results Results are of interest to the Irish context and also at a broader international level. Patients were mostly accepting of the prescription levy with some reservations concerning an increased price and the way in which generated revenue would be used by government. Participants identified waste of prescription drugs at the hand of patients (moral hazard), but there was discordant opinion on whether the 50 cent copayment would halt this moral hazard. Interviewees felt the levy was affordable, albeit some may suffer a financial impact more than others. Conclusions This qualitative study gives important insights into the experiences of GMS patients with regard to the prescription levy. Information regarding the appropriateness of a 50 cent copayment as a symbolic copayment needs to be confirmed by quantitative analysis. Further insight is required from a younger population. PMID:23305316

  15. Serotonin syndrome due to an overdose of moclobemide and clomipramine. A potentially life-threatening association.

    PubMed

    François, B; Marquet, P; Desachy, A; Roustan, J; Lachatre, G; Gastinne, H

    1997-01-01

    The serotonin syndrome is frequently characterized by minor neurologic manifestations that regress rapidly (such as confusion, tremor, ...). Many medications including tricyclic antidepressants, serotonin reuptake inhibitors, tryptophan and the association of monoamine oxidase inhibitors together with a serotoninergic agent have been implicated in this syndrome. In certain cases, and for poorly understood reasons, clinical manifestations can include circulatory collapse, malignant hyperthermia, convulsions and rhabdomyolysis. These forms are often fatal. Treatment, other than the withdrawal of the offending drug, is symptomatic. Dialysis may be of value in withdrawing the drug from the circulatory system. We report a patient with the serotonin syndrome of favorable outcome due to an overdose of moclobemide and clomipramine. PMID:9037653

  16. Adolescents' Misperceptions of the Dangerousness of Acetaminophen in Overdose.

    ERIC Educational Resources Information Center

    Harris, Hope Elaine; Myers, Wade C.

    1997-01-01

    Assesses the generality and strength of nonclinical youths' (N=569) perceptions of the harmfulness and lethality of acetaminophen in overdose. Findings indicate that adolescents have ready access to acetaminophen and use it in suicide attempts but underestimate its potential for toxicity, lacking knowledge regarding side effects of overdose. (RJM)

  17. Treatment of cocaine overdose with lipid emulsion.

    PubMed

    Jakkala-Saibaba, R; Morgan, P G; Morton, G L

    2011-12-01

    We describe the management and recovery of a 28-year-old man following a history of overdose by nasal inhalation of cocaine. The patient was presented in a comatose state suffering from seizures and marked cardiovascularly instability. Intravenous lipid emulsion was administered following initial resuscitation and tracheal intubation, as a means of treating persistent cardiac arrhythmias and profound hypotension. Following lipid emulsion therapy, the patient's life-threatening cardiovascular parameters rapidly improved and he recovered well without any side effects, thus being discharged within 2 days. PMID:22074030

  18. Analysis Of Electronic Medication Orders With Large Overdoses

    PubMed Central

    Kirkendall, E.S.; Kouril, M.; Minich, T.; Spooner, SA.

    2014-01-01

    Summary Background Users of electronic health record (EHR) systems frequently prescribe doses outside recommended dose ranges, and tend to ignore the alerts that result. Since some of these dosing errors are the result of system design flaws, analysis of large overdoses can lead to the discovery of needed system changes. Objectives To develop database techniques for detecting and extracting large overdose orders from our EHR. To identify and characterize users’ responses to these large overdoses. To identify possible causes of large-overdose errors and to mitigate them. Methods We constructed a data mart of medication-order and dosing-alert data from a quaternary pediatric hospital from June 2011 to May 2013. The data mart was used along with a test version of the EHR to explain how orders were processed and alerts were generated for large (>500%) and extreme (>10,000%) overdoses. User response was characterized by the dosing alert salience rate, which expresses the proportion of time users take corrective action. Results We constructed an advanced analytic framework based on workflow analysis and order simulation, and evaluated all 5,402,504 medication orders placed within the 2 year timeframe as well as 2,232,492 dose alerts associated with some of the orders. 8% of orders generated a visible alert, with ¼ of these related to overdosing. Alerts presented to trainees had higher salience rates than those presented to senior colleagues. Salience rates were low, varying between 4–10%, and were lower with larger overdoses. Extreme overdoses fell into eight causal categories, each with a system design mitigation. Conclusions Novel analytic systems are required to accurately understand prescriber behavior and interactions with medication-dosing CDS. We described a novel analytic system that can detect apparent large overdoses (?500%) and explain the sociotechnical factors that drove the error. Some of these large overdoses can be mitigated by system changes. EHR design should prospectively mitigate these errors. PMID:24734122

  19. Office of National Drug Control Policy

    MedlinePLUS

    ... outbreak in Indiana in The Indianapolis Star. National Drug Control Strategy Drug use affects every sector of ... its consequences in America. Read more Topics Prescription Drug Abuse Prescription drug abuse is the Nation's fastest- ...

  20. Inter-country variations in anti-asthmatic drug prescriptions for children. Systematic review of studies published during the 2000–2009 period

    Microsoft Academic Search

    Marina Bianchi; Antonio Clavenna; Maurizio Bonati

    2010-01-01

    Objective  The objective of this study was to analyse inter-and intra-country quantitative and qualitative differences in anti-asthmatic\\u000a prescriptions to children and adolescents.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A literature search was performed in EMBASE and MEDLINE to identify pharmaco-epidemiological studies published from January\\u000a 1, 2000 to December 31, 2008 in which anti-asthmatic prescription prevalence in out-hospital children was measured. A meta-analytic\\u000a weighted average and 95% confidence

  1. Collaboration or coercion? Partnering to divert prescription opioid medications.

    PubMed

    Green, Traci C; Bowman, Sarah E; Ray, Madeline; Zaller, Nickolas; Heimer, Robert; Case, Patricia

    2013-08-01

    Diversion of prescription opioids is a widespread problem in the USA. While "doctor shopping" and pill brokering are well-described types of medication diversion, we sought to understand the social dynamic of diversion of prescription opioids and identify other diversion methods. Using qualitative data collected as part of a 12-week Rapid Assessment and Response study of prescription opioid overdose and abuse (the RARx Study) conducted in three communities in two New England states, we reviewed and thematically coded 195 interviews. Diversion took many forms: doctor shopping, pill brokering, and, most commonly, siphoning from the family medicine chest. Partnering-of patients with other "patients," of patients with "caregivers"- to obtain prescription opioids was also described. Motivations for partnering indicated doing so out of fear of violence, for financial benefit, or in exchange for transportation or other services. Partnering for prescription opioids exhibited a range of power differentials, from collaboration to coercion, and tended to involve vulnerable populations such as the elderly, disabled, or destitute. Increased awareness among health providers of the ease of access and diversion of prescription opioids is needed to promote patient safety and prevent interpersonal violence. PMID:23371052

  2. Identifying Errors in Handwritten Outpatient Prescriptions in Oman

    PubMed Central

    Al Shahaibi, Nadiya MS; Al Said, Lamya S; Kini, TG; Chitme, HR

    2012-01-01

    To evaluate and analyze the handwritten outpatient prescriptions and associated error of omissions from four different hospitals in Oman. The study designed was an observational, retrospective and analysis of prescriptions was carried out by table and chart method. A total of 900 prescriptions were collected between April 2009 to July 2010. The type of error of omissions considered in this analysis includes all three important parts of prescriptions, i.e. superscription, inscription, and subscription. The most common type of superscription error of omission was found to be age (72.44%) and gender (32.66%). More than 46% of prescriptions were incomplete on direction for use, more than 22% of prescriptions were not having the information on dose, and more than 23% of prescriptions omitted the dosage forms of prescribed drugs. The date of dispensing of medications was omitted in all the prescriptions and more than 44% of prescriptions were missing the signature of dispenser. It was also found that more than 4% of prescriptions omitted the prescriber's signature and more than 18% of prescriptions omitted the date of prescription. We conclude from this study that the handwritten prescriptions were associated with significant frequency of minor and major prescription error of omissions. PMID:23492857

  3. US Food and Drug Administration's Risk Evaluation and Mitigation Strategy for extended-release and long-acting opioids: pros and cons, and a European perspective.

    PubMed

    Mercadante, Sebastiano; Craig, David; Giarratano, Antonello

    2012-12-24

    Prescriptions for opioid analgesics to manage moderate-to-severe chronic non-cancer pain have increased markedly over the last decade. An unintentional consequence of greater prescription opioid utilization has been the parallel increase in misuse, abuse and overdose, which are serious risks associated with all opioid analgesics. In response to disturbing rises in prescription opioid abuse, the US Food and Drug Administration (FDA) has proposed the implementation of aggressive Risk Evaluation and Mitigation Strategies (REMS). While REMS could dramatically change the development, release, marketing and prescription of extended-release opioids, questions remain on how these programmes may influence prescribing practices, patient safety and ultimately patient access to these agents. The extent of the availability and misuse of prescription opioids in Europe is difficult to assess from the data currently available, due in large part to the considerable differences in prescribing patterns and regulations between countries. Balancing the availability of prescription opioids for those patients who have pain, while discouraging illicit use, is a complex challenge and requires effective efforts on many levels, particularly in Europe where policies are quite different between countries. PMID:23116252

  4. Buying Prescription Medicine Online: A Consumer Safety Guide

    MedlinePLUS

    ... Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Drugs Home Drugs Resources for You Section Contents Menu ... Internet Buying Medicines Over the Internet Buying Prescription Medicine Online: A Consumer Safety Guide Graphic version (PDF - ...

  5. A Combined Analysis of 48 Type 2 Diabetes Genetic Risk Variants Shows No Discriminative Value to Predict Time to First Prescription of a Glucose Lowering Drug in Danish Patients with Screen Detected Type 2 Diabetes

    PubMed Central

    Hornbak, Malene; Allin, Kristine Højgaard; Jensen, Majken Linnemann; Lau, Cathrine Juel; Witte, Daniel; Jørgensen, Marit Eika; Sandbæk, Annelli; Lauritzen, Torsten; Andersson, Åsa; Pedersen, Oluf; Hansen, Torben

    2014-01-01

    Objective To investigate the genetic influence of 48 type 2 diabetes susceptibility variants on disease progression measured as risk of early prescription redemption of glucose lowering drugs in screen-detected patients with type 2 diabetes. Methods We studied type 2 diabetes progression in 1,480 patients with screen-detected type 2 diabetes from the ADDITION-Denmark study using information of redeemed prescriptions from the Register of Medicinal Products Statistics from 2001–2009 in Denmark. Patients were cluster randomized by general practitioners, who were randomized to treat type 2 diabetes according to either a conventional or a multifactorial intensive treatment algorithm. We investigated the genetic influence on diabetes progression by constructing a genetic risk score (GRS) of all 48 validated type 2 diabetes susceptibility variants, a GRS of 11 variants linked to ?-cell function and a GRS of 3 variants linked to insulin sensitivity and assessed the association between number of risk alleles and time from diagnosis until first redeemed prescription of either any glucose lowering drug or an insulin drug. Results The GRS linked to insulin sensitivity only nominally increased the risk of an early prescription redemption with an insulin drug by 39% (HR [95% C.I.]?=?1.39 [1.09–1.77], p?=?0.009] in patients randomized to the intensive treatment group. Furthermore, the strongest univariate predictors of diabetes progression for the intensive treatment group (measured as time to first insulin) were younger age (HR [95% C.I.]?=?0.96 [0.93–0.99]), increased BMI (1.05 [1.01–1.09]), increased HbA1c (1.50 [1.36–.66]), increased TG (1.24 [1.11–1.39]) and reduced fasting serum HDL (0.37 [0.17–0.80]) at baseline. Similar results were obtained for the conventional treatment group. Conclusion Higher levels of HbA1c, fasting circulating levels of triglyceride, lower HDL, larger BMI and younger age are significant determinants of early pharmacological intervention in type 2 diabetes. However, known common type 2 diabetes-associated gene variants do not appear to significantly affect disease progression. PMID:25157406

  6. [Analysis on composition principles of prescriptions for stranguria in dictionary of traditional Chinese medicine prescription].

    PubMed

    Sun, Jing-Chang; Wang, Miao-Miao

    2014-03-01

    By using traditional Chinese medicine inheritance support system to analyze the dominant experience and recessive principles of the prescriptions for stranguria in the dictionary of traditional Chinese medicine prescription (DCMP), we aim to define the medication pattern and rule and to acquire new prescriptions. In dominant experience analysis, we were able to find 22 drugs used over 50 times, including drugs of clearing heat, diuresis and relieving stranguria which are the most used and drugs of clearing heat, cooling blood, benefiting Qi and nourishing Yin. In addition, drugs of activating Qi and Xue, eliminating phlegm and removing toxic are often used, including 34 herb pairs and 5 combinations of three-taste drugs are used more than 35 times. These results fully reflect the composition principles and compatibility characteristic of prescriptions for treating stranguria in DCMP. Thirteen new prescriptions by way of recessive principle excavating were acquired. These new prescriptions might be suitable to clinical treatments of variable syndromes. This article provides an useful clue to research and produce new drugs. PMID:24956864

  7. 76 FR 66235 - Bar Code Technologies for Drugs and Biological Products; Retrospective Review Under Executive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-26

    ...Dockets Management (HFA- 305), Food and Drug Administration, 5630...and Research (HFM-17), Food and Drug Administration, 1401...interactions, overdoses, and patient allergies) and retail pharmacy-based...section 505D of the Federal Food, Drug, and Cosmetic...

  8. Anticholinergic syndrome following an unintentional overdose of scopolamine.

    PubMed

    Corallo, Carmela E; Whitfield, Ann; Wu, Adeline

    2009-10-01

    Scopolamine hydrobromide (hyoscine) is an antimuscarinic drug which is primarily used in the prophylaxis and treatment of motion sickness and as a premedication to dry bronchial and salivary secretions. In acute overdosage, the main clinical problem is central nervous system (CNS) depression. In Australia, tablets containing scopolamine hydrobromide 0.3 mg are available over the counter in packs of ten. The recommended dose for adults is one to two tablets as a single dose, repeated four to six hours later, if required. The maximum dose stated on the pack is four tablets over a 24-hour period with a caution regarding drowsiness and blurred vision. We describe a patient who presented with symptoms of anticholinergic syndrome secondary to an unintentional overdose of scopolamine. Whilst at work, the patient noticed that he had forgotten his prescribed medication, domperidone, at home; a friend gave him some travel sickness medication which contained scopolamine for relief of nausea. On a previous occasion, he had experienced a similar, less severe reaction with another anticholinergic agent, loperamide. This report highlights the need to consider nonprescription products, ie, over the counter medications, herbal/nutritional supplements as causes of anticholinergic syndrome when a patient presents with symptoms suggestive of this diagnosis. PMID:19774213

  9. As the prescribing practices of emergency providers come under enhanced scrutiny, watch for red flags of drug-seeking behavior.

    PubMed

    2014-01-01

    With deaths from opioid medication-related overdoses reaching epidemic proportions, researchers at two academic medical centers in Boston have identified key characteristics or red-flags that patients may be exhibiting drug-seeking behavior. In a separate study, researchers note that the ED is a prime location for identifying and intervening with young people who are engaged in the non-medical use of opioid and sedative medications. Researchers have found that drug-seeking patients are more likely to request a narcotic by name, have multiple visits for the same complaint, report an allergy to non-narcotic drugs, have pain out of proportion to the exam, and visit the ED on weekends. When physicians compared their prescribing decisions based on their own impressions with data from a prescription drug monitoring program (PDMP), they changed their prescribing plan in 10% of cases. Physicians ended up writing more prescriptions for opioids once they had the PDMP data. Researchers at the University of Michigan in Ann Arbor found that one in 10 adolescents who presented to the ED between September 2010 and September 2011 reported that they engaged in non-prescription opioid or sedative use within the previous year. PMID:24432550

  10. Hemodialysis versus continuous veno-venous hemodiafiltration in the management of severe valproate overdose.

    PubMed

    Kay, T D; Playford, H R; Johnson, D W

    2003-01-01

    Valproate intoxication is a relatively common clinical problem that can result in coma, respiratory depression, pancytopenia, hemodynamic instability and death [Fernandez et al. 1996, Franssen et al. 1999]. The drug's relatively low molecular weight, small volume of distribution and saturable protein-binding render it potentially amenable to extracorporeal removal (hemofiltration, hemodialysis or hemoperfusion), but published experience is scarce. This report describes a woman with a potentially fatal sodium valproate overdose, who did not respond to continuous veno-venous hemodiafiltration, but was successfully treated with low-flux hemodialysis. Based on our experience, we recommend hemodialysis for serious valproate intoxication. PMID:12572932

  11. NHS prescription charges.

    PubMed

    2015-04-01

    In 2009, DTB published an editorial calling for the abolition of the NHS prescription charge.1 The article highlighted that from April 2011, England would be the only UK country that would tax patients for medicines through levying a prescription charge. In addition, it noted that the categorisation of medical and other exemptions is illogical and that the prescription charge is a poorly conceived, manifestly unfair tax. Of particular concern is the impact of the prescription charge on patients with chronic conditions that do not fall into the exemption categories. For many years the Prescription Charges Coalition, an alliance of more than 30 organisations concerned with the impact of prescription charges on people with long-term conditions, has campaigned to extend exemption from prescription charges to all those with long-term conditions.2 A subsequent DTB editorial, published in 2014, discussed anomalies associated with the prescription charge, including the cost of administering the bureaucracy needed to underpin the collection and checking of exemptions, and management of pre-payment certification.3 The editorial repeated the call for prescription charges to be abolished. Revisiting these themes, here we present an overview of the results of a survey conducted to explore the views of healthcare professionals on the NHS prescription charge. PMID:25858816

  12. The Ohio State University Office of Human Resources Page 1 of 1 Prescription Drug Benefit Summary Edited 02/06/14

    E-print Network

    , up to $75 $4 copay $10 copay Formulary Brand Name Drug 30% coinsurance, up to $100 30% coinsurance% coinsurance, up to $75 Non-Formulary Brand Name Drug 50% coinsurance, no maximum 50% coinsurance, no maximum Not available Formulary Brand Name Drug 15% coinsurance, up to $125 15% coinsurance, up to $38 Non

  13. Women's Dependency on Prescription Drugs; Hearing Before the Select Committee on Narcotics Abuse and Control, House of Representatives, Ninety-Sixth Congress, First Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House.

    This record of the Select Committee on Narcotics Abuse and Control contains testimonies addressing the problems facing drug abusing women. The extensive prescribing of legal drugs such as tranquilizers, sedatives, pain killers, and stimulants is examined. The problems of polydrug abuse and alcohol abuse in combination with other drugs are also…

  14. Drug Education: Is Ignorance Bliss?

    ERIC Educational Resources Information Center

    Zazzaro, Joanne

    1973-01-01

    Explains that drug education in schools has failed to work the way schoolmen expected, and may have cause more harm than good. Contends that just knowing about overdoses and chromosome damage hasn't convinced students to steer clear of drugs. Describes Boulder Valley Public Schools program for integrating drug information into broader mental…

  15. The Demand for Post-Patent Prescription Pharmaceuticals

    Microsoft Academic Search

    Judith K. Hellerstein

    1994-01-01

    This paper examines why physicians continue to prescribe trade- name drugs when less expensive generic substitutes are available. I utilize a data set on physicians, their patients, and the multi-source drugs prescribed to study the prescription habits of physicians in prescribing generic and trade-name drugs. The results indicate that almost all physicians prescribe both types of drugs to their patients.

  16. Typologies of Prescription Opioid Use in a Large Sample of Adults Assessed for Substance Abuse Treatment

    PubMed Central

    Green, Traci C.; Black, Ryan; Grimes Serrano, Jill M.; Budman, Simon H.; Butler, Stephen F.

    2011-01-01

    Background As a population, non-medical prescription opioid users are not well-defined. We aimed to derive and describe typologies of prescription opioid use and nonmedical use using latent class analysis in an adult population being assessed for substance abuse treatment. Methods Latent class analysis was applied to data from 26,314 unique respondents, aged 18-70, self-reporting past month use of a prescription opioid out of a total of 138,928 cases (18.9%) collected by the Addiction Severity Index-Multimedia Version (ASI-MV®), a national database for near real-time prescription opioid abuse surveillance. Data were obtained from November 2005 through December 2009. Substance abuse treatment, criminal justice, and public assistance programs in the United States submitted data to the ASI-MV database (n?=?538). Six indicators of the latent classes derived from responses to the ASI-MV, a version of the ASI modified to collect prescription opioid abuse and chronic pain experience. The latent class analysis included respondent home ZIP code random effects to account for nesting of respondents within ZIP code. Results A four-class adjusted latent class model fit best and defined clinically interpretable and relevant subgroups: Use as prescribed, Prescribed misusers, Medically healthy abusers, and Illicit users. Classes varied on key variables, including race/ethnicity, gender, concurrent substance abuse, duration of prescription opioid abuse, mental health problems, and ASI composite scores. Three of the four classes (81% of respondents) exhibited high potential risk for fatal opioid overdose; 18.4% exhibited risk factors for blood-borne infections. Conclusions Multiple and distinct profiles of prescription opioid use were detected, suggesting a range of use typologies at differing risk for adverse events. Results may help clinicians and policy makers better focus overdose and blood-borne infection prevention efforts and intervention strategies for prescription opioid abuse reduction. PMID:22087270

  17. Mobile Prescription: An NFC-Based Proposal for AAL

    Microsoft Academic Search

    M. Vergara; P. Di?az-Helli?n; J. Fontecha; R. Herva?s; C. Sa?nchez-Barba; C. Fuentes; J. Bravo

    2010-01-01

    Care-dependent people need assistance to carry out the normal daily activities. A situation that many of these people have to face up is going to the doctor in order to obtain the needed drugs' prescriptions. This work presents a proposal to enable patients getting prescriptions from home, avoiding going to the health-care center. With the aim of achieving a natural

  18. A generic system for critiquing physicians' prescriptions: usability, satisfaction and

    E-print Network

    Paris-Sud XI, Université de

    A generic system for critiquing physicians' prescriptions: usability, satisfaction and lessons a critiquing module that is automatically activated when the physician writes a drug prescription, and which support systems have been developed to help physicians to take clinical guidelines into account during

  19. Prescription Opioid Abuse and Dependence: Assessment Strategies for Counselors

    ERIC Educational Resources Information Center

    Weigel, Daniel J.; Donovan, Kimberly A.; Krug, Kevin S.; Dixon, Wayne A.

    2007-01-01

    The authors review the article "Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies" (J. H. Isaacson, J. A. Hopper, D. P. Alford, & T. Parran, 2005), which provides an overview of the recent increase in prescription opioid abuse and dependence from the physician's perspective. In the present article, the authors…

  20. Validity of parental-reported questionnaire data on Danish children’s use of asthma-drugs: A comparison with a population-based prescription database

    Microsoft Academic Search

    Pia Wogelius; Sven Poulsen; Henrik Toft Sørensen

    2005-01-01

    The aim of this study was to examine the validity – estimated as the sensitivity, specificity, and predictive values – of questionnaire-based parental reporting on Danish children’s use of asthma drugs. Within a population-based cross-sectional study on the association between asthma and dental anxiety, we compared parental answers on their children’s use of asthma drugs during the past 12 months

  1. Save on Drug Costs

    MedlinePLUS

    ... Medicare 2015 costs at a glance Save on drug costs If you meet certain income and resource ... call 711. Other ways to lower your prescription drug costs Look into generic drugs. Ask your doctor ...

  2. Beta blocker overdose with propranolol and with atenolol.

    PubMed

    Weinstein, R S; Cole, S; Knaster, H B; Dahlbert, T

    1985-02-01

    During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma. PMID:2857542

  3. Acute overdose with levodopa. Clinical and biochemical consequences.

    PubMed

    Hoehn, M M; Rutledge, C O

    1975-08-01

    A 61-year-old parkinsonian patient ingested up to 100 gm of levodopa during a period of 12 hours. Signs of parkinsonism were completely alleviated. Adverse effects included initial hypertension followed rapidly by hypotension of a few hours' duration, prolonged symptomatic postural hypotension, sinus tachycardia, mental confusion, insomnia, and anorexia. The effects of the overdose gradually subsided over 1 week. Analyses of serum and urine for dopa and its metabolites confirmed the overdose, which biochemically resulted in apparent saturation of two enzymatic pathways that inactivate dopamine: conjugation with sulfuric acid and O-methylation. PMID:1171416

  4. Prescriptions for home hemodialysis.

    PubMed

    Lockridge, Robert; Cornelis, Tom; Van Eps, Carolyn

    2015-04-01

    Prescribing a regimen that provides "optimal dialysis" to patients who wish to dialyze at home is of major importance, yet there is substantial variation in how home hemodialysis (HD) is prescribed. Geographic location, patient health status and clinical goals, and patient lifestyle and preferences all influence the selection of a prescription for a particular patient-there is no single prescription that provides optimal therapy for all patients, and careful weighing of potential benefit and burden is required for long-term success. This article describes how home HD prescribing patterns have changed over time and provides examples of commonly used home HD prescriptions. In addition, associated clinical outcomes and adequacy parameters as well as criteria for identifying which patients may benefit most from these diverse prescriptions are also presented. PMID:25925819

  5. Partnership for Prescription Assistance

    MedlinePLUS

    ... free or nearly free brand-name medicines. Our Partners We are proud to work with many amazing ... of the organizations that have partnered with the Partnership for Prescription Assistance since the inception of the ...

  6. Getting a prescription filled

    MedlinePLUS

    ... to get prescription filled; Pharmacy - mail order; Pharmacy - internet; Types of pharmacies ... stored at certain temperatures at a local pharmacy. INTERNET (ONLINE) PHARMACIES Internet pharmacies can be used long- ...

  7. 42 CFR 423.154 - Appropriate dispensing of prescription drugs in long-term care facilities under PDPs and MA-PD...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...sponsor must— (1) Require all pharmacies servicing long-term care facilities...defined in § 423.4, dispensed by the pharmacy to enrollees residing in a LTC facility...Part D sponsors for drugs dispensed by pharmacies that dispense both brand and...

  8. 42 CFR 423.154 - Appropriate dispensing of prescription drugs in long-term care facilities under PDPs and MA-PD...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...sponsor must— (1) Require all pharmacies servicing long-term care facilities...defined in § 423.4, dispensed by the pharmacy to enrollees residing in a LTC facility...Part D sponsors for drugs dispensed by pharmacies that dispense both brand and...

  9. 42 CFR 423.154 - Appropriate dispensing of prescription drugs in long-term care facilities under PDPs and MA-PD...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...sponsor must— (1) Require all pharmacies servicing long-term care facilities...defined in § 423.4, dispensed by the pharmacy to enrollees residing in a LTC facility...Part D sponsors for drugs dispensed by pharmacies that dispense both brand and...

  10. Prescription Opioid Abuse and Diversion in an Urban Community: The Results of an Ultra- Rapid Assessment

    PubMed Central

    Inciardi, James A.; Surratt, Hilary L.; Cicero, Theodore J.; Beard, Ronald A.

    2009-01-01

    Objective Prescription drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription drug abusers and dealers on the specific mechanisms of diversion is extremely limited. Design A pilot ultra-rapid assessment was carried out in Wilmington, Delaware, during December 2006 to better understand the scope and dynamics of prescription drug abuse and diversion. This involved focus groups with prescription drug abusers, and key informant interviews with police, regulatory officials, prescription drug dealers, and pill brokers. Results The primary sources of prescription drugs on the street were the elderly, pain patients, and doctor shoppers, as well as pill brokers and dealers who work with all of the former. The popularity of prescription drugs in the street market was rooted in the abusers’ perceptions of these drugs as: 1) less stigmatizing; 2) less dangerous; and, 3) less subject to legal consequences than illicit drugs. For many, the abuse of prescription opioids also appeared to serve as a gateway to heroin use. Conclusion The diversion of prescription opioids might be reduced through physician education focusing on: 1) recognizing that a patient is misusing and/or diverting prescribed medications; 2) considering a patient’s risk for opioid misuse before initiating opioid therapy; and, 3) understanding the variation in the abuse potential of different opioid medications currently on the market. Patient education also appears appropriate in the areas of safeguarding medications, disposal of unused medications, and understanding the consequences of manipulating physicians and selling their medications. PMID:19416440

  11. [Teaching students guidelines: prescription in the practice setting].

    PubMed

    Sommer, Johanna; Janjic, Danilo; Rieder, Arabelle; Girardin, François

    2013-05-15

    The aim of this article is to help primary care teachers to instruct students' recommendations for drug prescription. Teaching drug prescription covers many aspects of primary care physicians' profession: establishing the correct diagnosis, choosing the appropriate treatment for any individual patient, negotiating with the patient concrete ways of taking the treatment, handling the necessary pharmacologic knowledge or existing tools that help treatment choice and communicating efficiently with the patient. The WHO 6-step method is presented. It helps to clarify the complexity of medical prescription so as to make it understandable for the student. PMID:23745240

  12. A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process

    Microsoft Academic Search

    Jon C. Schommer; Marcia M. Worley; Andrea L. Kjos; Serguei V. S. Pakhomov; Stephen W. Schondelmeyer

    2009-01-01

    BackgroundTypically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be

  13. How to Read Drug Labels

    MedlinePLUS

    ... and alternative medicine Healthy Aging How to read drug labels Printer-friendly version How to Read Drug ... read drug labels How to read a prescription drug label View a text version of this picture. ...

  14. Polar organic chemical integrative sampling and liquid chromatography- electrospray/ion-trap mass spectrometry for assessing selected prescription and illicit drugs in treated sewage effluents

    USGS Publications Warehouse

    Jones-Lepp, T. L.; Alvarez, D.A.; Petty, J.D.; Huckins, J.N.

    2004-01-01

    The purpose of the research presented in this paper was twofold: (1) to demonstrate the coupling of two state-of-the-art techniques: a time-weighted polar organic chemical integrative sampler (POCIS) and microliquid chromatography-electrospray/ion-trap mass spectrometry and (2) to assess the ability of these methodologies to detect six drugs (azithromycin, fluoxetine, omeprazole, levothyroxine, methamphetamine, methylenedioxymethamphetamine [MDMA]) in a real-world environment, e.g., waste water effluent. In the effluent from three wastewater treatment plants (WWTPs), azithromycin was detected at concentrations ranging from 15 to 66 ng/L, which is equivalent to a total annual release of 1 to 4 kg into receiving waters. Detected and confirmed in the effluent from two WWTPs were two illicit drugs, methamphetamine and MDMA, at 2 and 0.5 ng/L, respectively. Although the ecotoxicologic significance of drugs in environmental matrices, particularly water, has not been closely examined, it can only be surmised that these substances have the potential to adversely affect biota that are continuously exposed to them even at very low levels. The potential for chronic effects on human health is also unknown but of increasing concern because of the multi-use character of water, particularly in densely populated, arid areas.

  15. Pharmaceutical promotion and GP prescription behaviour.

    PubMed

    Windmeijer, Frank; de Laat, Eric; Douven, Rudy; Mot, Esther

    2006-01-01

    The aim of this paper is to empirically analyse the responses by general practitioners to promotional activities for ethical drugs by pharmaceutical companies. Promotion can be beneficial as a means of providing information, but it can also be harmful in the sense that it lowers price sensitivity of doctors and it merely is a means of maintaining market share, even when cheaper, therapeutically equivalent drugs are available. A model is estimated that includes interactions of promotion expenditures and prices and that explicitly exploits the panel structure of the data, allowing for drug specific effects and dynamic adjustments, or habit persistence. The data used are aggregate monthly GP prescriptions per drug together with monthly outlays on drug promotion for the period 1994-1999 for 11 therapeutic markets, covering more than half of the total prescription drug market in the Netherlands. Identification of price effects is aided by the introduction of the Pharmaceutical Prices Act, which established that Dutch drugs prices became a weighted average of the prices in surrounding countries after June 1996. We conclude that GP drug price sensitivity is small, but adversely affected by promotion. Ltd. PMID:15945041

  16. Effectiveness of hemodialysis in a case of severe valproate overdose.

    PubMed

    Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

    2011-04-01

    A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. PMID:21814378

  17. Risk Factors Associated with Overdose among Bahraini Youth.

    ERIC Educational Resources Information Center

    Al Ansari, Ahmed M.; Hamadeh, Randah R.; Matar, Ali M.; Marhoon, Huda; Buzaboon, Bana Y.; Raees, Ahmed G.

    2001-01-01

    Study aimed to identify risk factors, such as family pathology and psychosocial stress, of overdose suicide attempts among Bahraini youth. Stresses from living in a non-intact family; interpersonal relationships mainly with the opposite sex; unemployment; and school performance emerged as main risk factors. Previously identified factors, such as…

  18. Methadone-induced rigid-chest syndrome after substantial overdose.

    PubMed

    Lynch, Robert E; Hack, Richard A

    2010-07-01

    We report here the case of an infant who developed life-threatening rigid-chest syndrome after receiving an accidental overdose of methadone. The child responded to narcotic reversal. Pediatric physicians should be aware of this possible complication. PMID:20587670

  19. Myocardial infarction resulting from caffeine overdose in an anorectic woman.

    PubMed

    Forman, J; Aizer, A; Young, C R

    1997-01-01

    A 20-year-old bulimic woman ingested 20 g of caffeine in a suicide attempt. After being evaluated and discharged from the emergency department, she was readmitted with ECG changes and ultimately found to have sustained a subendocardial infarction. This case highlights the wide-ranging health consequences of eating disorders and the toxicity of caffeine overdose. PMID:8998103

  20. Ten Tips to Prevent an Accidental Overdose

    MedlinePLUS

    ... different strengths, such as infant, children, and adult formulas. The dose and directions also vary for children ... in Children's Meds More in Consumer Updates Animal & Veterinary Children's Health Cosmetics Dietary Supplements Drugs Food Medical ...

  1. Patients Who Attend the Emergency Department Following Medication Overdose: Self-Reported Mental Health History and Intended Outcomes of Overdose

    ERIC Educational Resources Information Center

    Buykx, Penny; Ritter, Alison; Loxley, Wendy; Dietze, Paul

    2012-01-01

    Medication overdose is a common method of non-fatal self-harm. Previous studies have established which mental health disorders are commonly associated with the behaviour (affective, substance use, anxiety and personality disorders) and which medications are most frequently implicated (benzodiazepines, antidepressants, antipsychotics and non-opioid…

  2. Intentional low-molecular-weight heparin overdose: a case report and review.

    PubMed

    Byrne, Michael; Zumberg, Marc

    2012-12-01

    The reversal of low-molecular-weight heparins, particularly at supratherapeutic levels, remains challenging. The paucity of literature available to guide the treatment of these patients makes their management difficult for primary care providers, surgeons, and subspecialists alike. We report the case of a 34-year-old woman, who intentionally overdosed on enoxaparin (Lovenox) in a suicide attempt. Her initial antifactor Xa activity level was 8.3 IU/ml, the highest level reported in the literature to date. She was initially managed conservatively, however, within 24 h of admission she developed evidence of acute blood loss. Protamine sulfate and three doses of recombinant activated factor VII (rFVIIa) were administered in an effort to control bleeding. We report the effects of these measures and review the literature to date. Our study is one of the first to graph in-vivo antifactor Xa activity levels and to suggest a drug half-life of approximately 25 h. PMID:23135382

  3. Exercise by prescription.

    PubMed

    Browne, D

    1997-02-01

    General Practitioners (GPs) see over 90% of their practice population in three years. Over 50% of the adult population is below the perceived level of physical activity as recognised by the Allied Dunbar Physical Activity score (Allied Dunbar, Health Education Authority and Sports Council, 1992). Physical fitness levels in adolescents and children are declining, while the incidence of obesity is increasing. GPs, with their Primary Health Care Team, are in a unique position to be able to discuss the health benefits of regular physical activity with their patients during the consultation and offer, if appropriate, a prescription for a course of physical activity to a local leisure centre or community activity centre. Many communities have facilities for physical activity. These include leisure centres, schools, village and church halls, the home and the general practice surgery. A directory of resources for physical activity for all age groups should be available in the surgery waiting room area. A community co-ordinator can network community facilities and resources to meet individual need. The co-ordinator can be funded by the general practice surgery, Health Authority, Local Authority, Parish or District Council. An agreed protocol for exercise prescription referrals to suitable community facilities can benefit patient health care for a variety of medical, surgical, social and mental conditions. Auditing exercise prescriptions shows a health benefit, with improved quality of living and reduced prescription medicines. PMID:9050296

  4. Xylometazoline poisoning: A 40-fold nasal overdose caused by a compounding error in 3 children.

    PubMed

    Musshoff, Frank; Madea, Burkhard; Woelfle, Joachim; Vlanic, Dejan

    2014-05-01

    The imidazoline derivative xylometazoline, an alpha-2-adrenergic agonist, is used as non-prescription nasal preparation due to its vasoconstrictive and decongestive properties. Especially in children, an overdose can quickly cause severe central nervous system depression and cardiovascular adverse effects. In three 3-year-old boys (triplets) a xylometazoline intoxication was diagnosed by toxicological analysis. On admission to an emergency unit all three children were still unresponsive. One triplet showed respiration of 15-20 breaths/min and required oxygen support (3L/min) via face mask; his electrocardiogram revealed sinus bradycardia of 64 beats/min with supraventricular extrasystoles. However, no interventions were necessary except fluid management via intravenous lines. Eleven hours after the event, two of the triplets were awake but still not fully oriented. The third triplet woke up 20h after instillation of nose drops. Intoxication was caused by a compounding error in a pharmacy resulting in a concentration 40 times above the adequate dosage for children. In general, physicians, pharmacists and the public should be educated about the toxicity of over-the-counter preparations. PMID:24642023

  5. The Diversion of Prescription Opioid Analgesics

    PubMed Central

    Inciardi, James A.; Surratt, Hilary L.; Lugo, Yamilka; Cicero, Theodore J.

    2012-01-01

    Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process -- from the original manufacturing site, to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. Although a number of recent scientific papers have discussed the problems associated with diversion, empirical data on the scope and magnitude of diversion are limited in the literature. This paper presents findings from a national diversion survey being conducted as part of risk management initiatives supported by Denver Health and Hospital Authority, designed to monitor the abuse and diversion of a variety of prescription opioid analgesics. On a quarterly basis, diversion investigators in 300 jurisdictions distributed throughout the 50 states, the District of Columbia, and Puerto Rico are sent short questionnaires designed to elicit data on the extent of drug diversion in their areas. During the 20-quarter survey period reported in this paper, a total of 64,655 cases of prescription drug diversion were reported from all of the participating sites. The most widely diverted opioid was hydrocodone, in that it was mentioned in 38.2% of the cases, followed by oxycodone, mentioned in 24.3% of the cases. By contrast, the proportions of cases in which other opioids were mentioned were significantly smaller. The diversion of opioids appears in all 50 states, the District of Columbia, and Puerto Rico, with especially high concentrations in rural areas. How all of these prescription opioids are being diverted to the street, however, is not altogether clear, and in many ways, diversion is a “black box” requiring concentrated systematic study. PMID:25267926

  6. Pharmacy experience with facsimile prescriptions.

    PubMed

    Huntzinger, Paul E

    2010-11-01

    The purpose of this mixed qualitative/quantitative study was to review the impact of a policy to accept facsimile (fax) prescriptions as standard operating procedure. Between February and April 2009 the pharmacy processed 4,792 new prescriptions of which 363 (7.6%) were received through fax. Of the fax prescriptions, 19 (5.2%) concerned clarification of information, which took approximately 30 minutes to resolve. The fax prescription process allowed the pharmacy to adjust the distribution of its workload, provided quicker service for new prescriptions, and allowed more time for medication consultation that resulted in a high level of customer satisfaction. It appeared the policy allowing fax prescriptions was a "win-win" situation for both the pharmacy and its customers. Military pharmacies should consider running trials of accepting fax prescriptions to see whether it improves their prescription filling process. PMID:21121504

  7. Prescription for a pharmacyte.

    PubMed

    Hubbell, Jeffrey A

    2015-06-10

    The efficient homing capacity of T cells may be used to deliver cell-associated, drug-laden nanoparticles to lymphoma cells that are resident in lymph nodes, increasing drug efficacy compared with drug encapsulated in free nanoparticles or free drug (Huang et al., this issue). PMID:26062842

  8. New drugs of abuse.

    PubMed

    Rech, Megan A; Donahey, Elisabeth; Cappiello Dziedzic, Jacqueline M; Oh, Laura; Greenhalgh, Elizabeth

    2015-02-01

    Drug abuse is a common problem and growing concern in the United States, and over the past decade, novel or atypical drugs have emerged and have become increasingly popular. Recognition and treatment of new drugs of abuse pose many challenges for health care providers due to lack of quantitative reporting and routine surveillance, and the difficulty of detection in routine blood and urine analyses. Furthermore, street manufacturers are able to rapidly adapt and develop new synthetic isolates of older drugs as soon as law enforcement agencies render them illegal. In this article, we describe the clinical and adverse effects and purported pharmacology of several new classes of drugs of abuse including synthetic cannabinoids, synthetic cathinones, salvia, desomorphine, and kratom. Because many of these substances can have severe or life-threatening adverse effects, knowledge of general toxicology is key in recognizing acute intoxication and overdose; however, typical toxidromes (e.g., cholinergic, sympathomimetic, opioid, etc.) are not precipitated by many of these agents. Medical management of patients who abuse or overdose on these drugs largely consists of supportive care, although naloxone may be used as an antidote for desomorphine overdose. Symptoms of aggression and psychosis may be treated with sedation (benzodiazepines, propofol) and antipsychotics (haloperidol or atypical agents such as quetiapine or ziprasidone). Other facets of management to consider include treatment for withdrawal or addiction, nutrition support, and potential for transmission of infectious diseases. PMID:25471045

  9. Diltiazem overdose: a role for high-dose insulin.

    PubMed

    Abeysinghe, Neil; Aston, Jessica; Polouse, Sonia

    2010-10-01

    A 62-year-old man presented 6?h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. A bolus of high-dose insulin (Actrapid) was administered, followed by a continuous infusion. Glucose was administered to maintain a state of euglycaemia. Over the following 24?h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures. PMID:20660906

  10. Life-threatening valproate overdose successfully treated with haemodialysis.

    PubMed

    Mestrovi?, Julije; Filipovi?, Tomislav; Poli?, Branka; Stricevi?, Luka; Omazi?, Ante; Kuzmani?-Samija, Radenka; Marki?, Josko

    2008-12-01

    Valproate (VPA) poisoning is an increasing clinical problem. The most common finding in VPA overdose is the depression of the central nervous system, which may progress to coma and death. This type of poisoning is difficult to treat, as no antidote exists. This report describes a case with a 16-year-old girl who poisoned herself with valproate. Initial treatment included naloxone, but she did not respond. She became comatose, with serum VPA concentration of 1320 microg mL(-1). Three sessions of haemodialysis were performed, effectively eliminating VPA and decreasing the serum concentration. The patient regained consciousness and fully recovered.To our knowledge, this is the highest serum VPA concentration reported by now in children aged 16 or less. Haemodialysis has proved to be the treatment of choice for life-threatening acute VPA overdose in children. PMID:19064368

  11. Paper title: Citizens or Consumers? The politics of EU health policy and the case of direct-to-consumer advertising for prescription drugs. To be presented at the Politics of Health Group panel at the 2009 Political Studies Association Conference (please do not cite or quote this draft without permission from the author)

    Microsoft Academic Search

    Robert Geyer

    As the European Union (EU) has developed there has been a growing tension between its societal engendering (citizen) and market-making (consumers) roles. In health policy this is nowhere more evident than the struggle over the pharmaceutical industry's promotion of direct-to-consumer advertising for prescription drugs (DTCA- PD). DTCA-PD is currently banned in the EU. Since 2000 the industry has been trying

  12. Prescription loyalty behavior of physicians: an empirical study in India

    Microsoft Academic Search

    Kareem Abdul Waheed; Mohammad Jaleel; Mohammed Laeequddin

    2011-01-01

    Purpose – This paper seeks to empirically identify the major factors that influence physician loyalty behavior in prescribing certain brands of drugs. Design\\/methodology\\/approach – Testable hypotheses were developed with respect to physician loyalty behavior regarding drug prescription practices, and a survey questionnaire was designed to capture the data from 71 physicians, as a convenience sample. The hypotheses were tested by

  13. Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

    PubMed Central

    Doe-Simkins, Maya; Epstein, Andy; Moyer, Peter

    2009-01-01

    Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose. PMID:19363214

  14. The Hepatic Inflammatory Response after Acetaminophen Overdose: Role of Neutrophils

    Microsoft Academic Search

    Judy A. Lawson; Anwar Farhood; Robert D. Hopper; Mary Lynn Bajt; Hartmut Jaeschke

    2000-01-01

    Acetaminophen overdose induces severe liver injury and hepatic failure. There is evidence that inflammatory cells may be involved in the pathophysiology. Thus, the aim of this investigation was to characterize the neutrophilic inflammatory response after treat- ment of C3Heb\\/FeJ mice with 300 mg\\/kg acetaminophen. A time course study showed that neutrophils accumulate in the liver parallel to or slightly after

  15. Comparative toxicology of intentional and accidental heroin overdose.

    PubMed

    Darke, Shane; Duflou, Johan; Torok, Michelle

    2010-07-01

    The demographic and toxicological characteristics of deliberate (SUI, n = 50) and accidental (ACC, n = 927) fatal heroin overdose cases were examined. SUI cases were more likely to be female, had lower body mass indices, were more likely to be enrolled in treatment and less likely to have hepatic pathology. The median blood morphine concentration of SUI cases was significantly higher than that of ACC cases (0.70 vs. 0.40 mg/L, p < 0.001). Blood morphine concentrations of >1 mg/L were seen among 38.0% of SUI cases compared to 13.9% of ACC cases. Being a member of the SUI group remained a significant independent predictor of higher morphine concentrations after controlling for the effects of potential confounders (p < 0.001), other significant predictors being the absence of alcohol (p < 0.001), the presence of methadone (p < 0.05), and the presence of cocaine (p < 0.05). The current data are consistent with the view that suicide forms a small, but distinct, category of heroin overdose cases, rather than overdose being a parasuicidal phenomenon per se. PMID:20384920

  16. Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention

    Microsoft Academic Search

    Peter J. Davidson; Rachel L. McLean; Alex H. Kral; Alice A. Gleghorn; Brian R. Edlin; Andrew R. Moss

    2003-01-01

    Heroin-related overdose is the single largest cause of accidental death in San Francisco. We examined demographic, location,\\u000a nontoxicological, and toxicological characteristics of opiate overdose deaths in San Francisco, California. Medical examiner’s\\u000a case files for every opioid-positive death from July 1, 1997, to June 30, 2000, were reviewed and classified as overdose deaths\\u000a or other. Demographic variables were compared to two

  17. Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity

    Microsoft Academic Search

    Teresa Rivera-Penera; Roberto Gugig; Judy Davis; Sue McDiarmid; Jorge Vargas; Philip Rosenthal; William Berquist; Melvin B. Heyman; Marvin E. Ament

    1997-01-01

    Seventy-three medical records of pediatric patients admitted for acetaminophen overdose were reviewed. Twenty-eight patients (39%) had severe liver toxic effects, and six of them underwent liver transplantation. Multiple miscalculated overdoses given by parents, with delay in therapy, are risk factors and the major cause of overdose in children 10 years of age or younger. (J Pediatr 1997;130:300-4)

  18. Anesthetic propofol overdose causes endothelial cytotoxicity in vitro and endothelial barrier dysfunction in vivo

    SciTech Connect

    Lin, Ming-Chung [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China) [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan (China); Chen, Chia-Ling [Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China)] [Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Yang, Tsan-Tzu; Choi, Pui-Ching [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China)] [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Hsing, Chung-Hsi [Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan (China) [Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan (China); Department of Anesthesiology, College of Medicine, Taipei Medical University, Taipei, Taiwan (China); Lin, Chiou-Feng, E-mail: cflin@mail.ncku.edu.tw [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China) [Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China)

    2012-12-01

    An overdose and a prolonged treatment of propofol may cause cellular cytotoxicity in multiple organs and tissues such as brain, heart, kidney, skeletal muscle, and immune cells; however, the underlying mechanism remains undocumented, particularly in vascular endothelial cells. Our previous studies showed that the activation of glycogen synthase kinase (GSK)-3 is pro-apoptotic in phagocytes during overdose of propofol treatment. Regarding the intravascular administration of propofol, we therefore hypothesized that propofol overdose also induces endothelial cytotoxicity via GSK-3. Propofol overdose (100 ?g/ml) inhibited growth in human arterial and microvascular endothelial cells. After treatment, most of the endothelial cells experienced caspase-independent necrosis-like cell death. The activation of cathepsin D following lysosomal membrane permeabilization (LMP) determined necrosis-like cell death. Furthermore, propofol overdose also induced caspase-dependent apoptosis, at least in part. Caspase-3 was activated and acted downstream of mitochondrial transmembrane potential (MTP) loss; however, lysosomal cathepsins were not required for endothelial cell apoptosis. Notably, activation of GSK-3 was essential for propofol overdose-induced mitochondrial damage and apoptosis, but not necrosis-like cell death. Intraperitoneal administration of a propofol overdose in BALB/c mice caused an increase in peritoneal vascular permeability. These results demonstrate the cytotoxic effects of propofol overdose, including cathepsin D-regulated necrosis-like cell death and GSK-3-regulated mitochondrial apoptosis, on endothelial cells in vitro and the endothelial barrier dysfunction by propofol in vivo. Highlights: ? Propofol overdose causes apoptosis and necrosis in endothelial cells. ? Propofol overdose triggers lysosomal dysfunction independent of autophagy. ? Glycogen synthase kinase-3 facilitates propofol overdose-induced apoptosis. ? Propofol overdose causes an increase in peritoneal vascular permeability.

  19. Feedlot Pharmaceutical Documentation: Protocols, Prescriptions, and Veterinary Feed Directives.

    PubMed

    Apley, Michael D

    2015-07-01

    The days of oral treatment instructions and loosely associated authorizations for the use of drugs in food animals are gone. Treatment protocols should include case definitions for treatment eligibility, detailed regimens, case definitions for treatment success and failure, directions for animal disposition, and mechanisms to prevent animals entering the food chain with violative residues. Prescriptions and veterinary feed directives (VFDs) will soon be necessary for almost all uses of antimicrobials in food animals. Although VFDs have a regulatory format, prescriptions may vary, but there are basic inclusions that should be present in any prescription. PMID:26139195

  20. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse.

    PubMed

    Sehgal, Nalini; Manchikanti, Laxmaiah; Smith, Howard S

    2012-07-01

    Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self medication, use for reward, compulsive use because of addiction, and diversion for profit. Treatment approaches that balance treating chronic pain while minimizing risks for opioid abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic noncancer pain has increased dramatically in the past 2 decades in conjunction with a marked increase in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method of selecting patients for opioid therapy, predicting risk, and identifying problems once they arise could be of enormous benefit. Such an instrument could potentially curb the risk of iatrogenic addiction. Although several screening instruments and strategies have been introduced in the past decade, there is no single test or instrument that can reliably and accurately predict patients who are not suitable for opioid therapy or identify those who need increased vigilance or monitoring during therapy. At present screening for opioid abuse includes assessment of premorbid and comorbid substance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; and utilization of opioid screening tools. Multiple opioid assessment screening tools and instruments have been developed by various authors. In addition, urine drug testing, monitoring of prescribing practices, prescription monitoring programs, opioid treatment agreements, and utilization of universal precautions are essential. Presently, a combination of strategies is recommended to stratify risk, identify and understand aberrant drug related behaviors, and tailor treatments accordingly. This manuscript will review the current state of knowledge regarding the growing problem of opioid abuse and misuse; known risk factors; and methods of predicting, assessing, monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain. PMID:22786463

  1. Method of detoxifying animal suffering from overdose

    DOEpatents

    Mehlhorn, Rolf J. (Richmond, CA)

    1997-01-01

    A method for accumulating drugs or other chemicals within synthetic, lipid-like vesicles by means of a pH gradient imposed on the vesicles just prior to use is described. The method is suited for accumulating molecules with basic or acid moieties which are permeable to the vesicles membranes in their uncharged form and for molecules that contain charge moieties that are hydrophobic ions and can therefore cross the vesicle membranes in their charged form. The method is advantageous over prior art methods for encapsulating biologically active materials within vesicles in that it achieves very high degrees of loading with simple procedures that are economical and require little technical expertise, furthermore kits which can be stored for prolonged periods prior to use without impairment of the capacity to achieve drug accumulation are described. A related application of the method consists of using this technology to detoxify animals that have been exposed to poisons with basic, weak acid or hydrophobic charge groups within their molecular structure.

  2. Toxicology and circumstances of completed suicide by means other than overdose.

    PubMed

    Darke, Shane; Duflou, Johan; Torok, Michelle

    2009-03-01

    To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997-12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose. PMID:19220656

  3. Memory Impairment following Acute Tricyclic Antidepressants Overdose.

    PubMed

    Eizadi-Mood, Nastaran; Akouchekian, Shahla; Yaraghi, Ahmad; Hakamian, Mehrnazsadat; Soltani, Rasool; Sabzghabaee, Ali Mohammad

    2015-01-01

    Background. Psychiatric consultation is necessary for all patients with intentional poisoning and its reliability depends on the proper function of patients' memory performance. This study aimed to determine the possible memory impairment following acute TCAs' poisoning. Materials and Methods. In this cross-sectional study, patients with acute TCAs poisoning were allocated to two groups of severe poisoning (with coma, seizures, cardiac arrhythmias, hypotension, and a wide QRS complex) and mild-to-moderate poisoning according to their clinical presentation at the time of hospital admission. All patients underwent memory performance test both immediately and 24 hours after their initial consciousness after admission, using Wechsler Memory Scale (WMS-IV). Results. During the study period, 67 TCA-poisoned patients (aged, 20-64 years) were evaluated, of which 67.2% were female. The mean memory scores of patients immediately and 24 hours after the initial consciousness were 31.43 ± 9.02 and 50.62 ± 9.12, respectively (P < 0.001). Twenty-four hours after the initial consciousness, memory score was statistically correlated with the amount of ingested drug and the intoxication severity. Conclusion. Following the recovery from somatic symptoms of acute TCA poisoning, patients may still suffer from memory impairment and it seems that this time is not suitable for performing a reliable psychiatric consultation. PMID:25649497

  4. Memory Impairment following Acute Tricyclic Antidepressants Overdose

    PubMed Central

    Eizadi-Mood, Nastaran; Akouchekian, Shahla; Yaraghi, Ahmad; Hakamian, Mehrnazsadat; Sabzghabaee, Ali Mohammad

    2015-01-01

    Background. Psychiatric consultation is necessary for all patients with intentional poisoning and its reliability depends on the proper function of patients' memory performance. This study aimed to determine the possible memory impairment following acute TCAs' poisoning. Materials and Methods. In this cross-sectional study, patients with acute TCAs poisoning were allocated to two groups of severe poisoning (with coma, seizures, cardiac arrhythmias, hypotension, and a wide QRS complex) and mild-to-moderate poisoning according to their clinical presentation at the time of hospital admission. All patients underwent memory performance test both immediately and 24 hours after their initial consciousness after admission, using Wechsler Memory Scale (WMS-IV). Results. During the study period, 67 TCA-poisoned patients (aged, 20–64 years) were evaluated, of which 67.2% were female. The mean memory scores of patients immediately and 24 hours after the initial consciousness were 31.43 ± 9.02 and 50.62 ± 9.12, respectively (P < 0.001). Twenty-four hours after the initial consciousness, memory score was statistically correlated with the amount of ingested drug and the intoxication severity. Conclusion. Following the recovery from somatic symptoms of acute TCA poisoning, patients may still suffer from memory impairment and it seems that this time is not suitable for performing a reliable psychiatric consultation. PMID:25649497

  5. Your Guide to Medicare Prescription Drug Coverage

    MedlinePLUS

    ... is misusing your personal information, call the Federal Trade Commission’s ID Theft Hotline at 1-877-438- ... than in Original Medicare. 86 Definitions 9 Medigap policy —Medicare Supplement Insurance sold by private insurance companies ...

  6. Drug Abusers and Card 3BM of the TAT.

    ERIC Educational Resources Information Center

    Patalano, Frank

    1986-01-01

    Card 3BM of the Thematic Apperception Tests is valuable in assessing people with drug problems. Drug abusers often apperceive the lone figure in the picture as an addict, the revolver as a hyperdermic needle. Overdose situation themes are prevalent. Data concerning the individual's drug problems, attitudes, self-destructive tendencies, coping…

  7. Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants

    Microsoft Academic Search

    I. M. Whyte; A. H. DAWSON; N. A. BUCKLEY

    2003-01-01

    Summary Background: Selective serotonin reuptake inhibi- tors (SSRIs) and venlafaxine have been regarded as less toxic in overdose than tricyclic antidepressants (TCAs). Within the TCAs, dothiepin has greater toxicity. Venlafaxine may be more toxic than SSRIs. Aim: To assess the toxicity in overdose of venlafax- ine and SSRIs compared to TCAs, and of dothiepin compared to other TCAs. Design: Cohort

  8. Mathematical Modeling of Liver Injury and Dysfunction After Acetaminophen Overdose: Early Discrimination

    E-print Network

    Adler, Fred

    Mathematical Modeling of Liver Injury and Dysfunction After Acetaminophen Overdose: Early D. Box,3 and Norman L. Sussman4 Acetaminophen (APAP) is the leading cause of acute liver injury to describe acute liver injury due to APAP overdose. The Model for Acetaminophen-induced Liver Damage (MALD

  9. 21 CFR 203.33 - Drug sample forms.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 203.33 Section 203.33 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL PRESCRIPTION DRUG MARKETING Samples § 203.33 Drug sample forms. A sample...

  10. The Joint Commission and the FDA take steps to curb adverse events related to the use and misuse of opioid drugs.

    PubMed

    2012-10-01

    Alarmed by adverse events involving opioid drugs, the Joint Commission has issued a Sentinel Alert urging hospitals to take steps to improve safety in the prescribing of these powerful drugs. In addition, the Food and Drug Administration (FDA) has launched an initiative that will soon require the manufacturers of long-acting and extended-release opioids to offer education and training to physicians and others who prescribe these pharmaceuticals. The Joint Commission reports that of the opioid-related adverse events reported to the agency between 2004 and 2011, 47% involved wrong-dosage medication errors, 29% pertained to improper patient monitoring, and 11% were attributed to other factors such as excessive dosing, drug-drug interactions, and adverse reactions. The FDA reports that nearly 16,000 Americans died from overdoses involving opioids in 2009, and in 2011, there were nearly 23 million prescriptions written for extended-release and long-acting opioids. Some new guidelines on opioid prescribing in the ED urge providers to avoid prescribing extended-release or long-acting opioids altogether, and to consider measures that will limit opportunities for drug diversion. PMID:23045763

  11. Epidemiological trends in abuse and misuse of prescription opioids.

    PubMed

    Spiller, Henry; Lorenz, Douglas J; Bailey, Elise J; Dart, Richard C

    2009-01-01

    The authors evaluated trends between social, geographic, and demographic factors and cases of select scheduled drugs (buprenorphine, fentanyl, hydrocodone, hydromorphone, morphine, methadone, and oxycodone) using the Researched Abuse, Diversion and Addiction-Related Surveillance System poison center data and census data. Spontaneous calls from the public and healthcare professionals are recorded by poison centers using a standardized, electronic data collection system. We compared the annual incidence of total prescription opioid drug cases to annual data from the U.S. Department of Labor and U.S. Census Bureau by year and by state for unemployment rate, poverty rate, population density, high school graduation rate, and bachelor's degree proportion using the best least square fit in an evaluation for trends for 2003 to 2006. Two strong positive trends were found between poverty rate, unemployment rate, and prescription opioid drug rates, with prescription opioid drug rates increasing as poverty rate and unemployment rate increased. This trend was consistent over the 4 years of study and strongly influenced by the hydrocodone and methadone rates, with less influence from oxycodone rates. The high school graduation rate trend was consistent over the 4 years and was strongly influenced by the hydrocodone and methadone rate. No consistent trend was identified with population density and prescription opioid drug rates. Understanding trends may help guide distribution of scarce resources and prevention efforts to where they may have their greatest impact. PMID:19340675

  12. Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy

    PubMed Central

    Adrish, Muhammad; Duncalf, Richard; Diaz-Fuentes, Gilda; Venkatram, Sindhaghatta

    2014-01-01

    Patient: Male, 42 Final Diagnosis: Gluteal compartment syndrome • acute peripheral nauropathy Symptoms: — Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Management of emergency care Background: Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological complications. Conclusions: We present a 42-year-old male admitted after heroin use with heroin-related peripheral nervous system complication preceded by an acute gluteal compartment syndrome and severe rhabdomyolysis. Case Report: Early diagnosis and surgical intervention of the compartment syndrome can lead to full recovery while any delay in management can be devastating and can lead to permanent disability. The presence of peripheral nervous system injuries may portend a poor prognosis and can also lead to long term disability. Careful neurological evaluation for signs and symptoms of peripheral nervous system injuries is of paramount importance, as these may be absent at presentation in patients with opioid overdose. There is a potential risk of delaying a necessary treatment like fasciotomy in these patients by falsely attributing clinical symptoms to a preexisting neuropathy. Early EMG and nerve conduction studies should be considered when the etiology of underlying neurological weakness is unclear. PMID:24459539

  13. Cardiotoxicity and serotonin syndrome complicating a milnacipran overdose.

    PubMed

    Levine, Michael; Truitt, Carrie A; O'Connor, Ayrn D

    2011-12-01

    Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor, recently approved for use in the USA for treatment of fibromyalgia. This case report describes a 59-year-old woman who ingested 3,000 mg of milnacipran in a suicide attempt. Following the ingestion, she became obtunded and developed autonomic instability. She required mechanical ventilation, treatment for hypertension, and then ultimately vasopressor support for refractory hypotension. In addition, she developed a transient, acute cardiac dysfunction with global hypokinesis and an ejection fraction of 30%. Resolution of the cardiac dysfunction was documented on repeat echocardiogram 2 days after the initial study. This was confirmed by cardiac catheterization performed 4 days after the acute ingestion in which coronary arteriogram was normal and left ventricular ejection fraction was 70%. Acute overdose was confirmed by quantification of plasma milnacipran concentration of 8,400 ng/mL obtained 5 h post-ingestion. To our knowledge, this represents the first case of cardiac toxicity complicating a milnacipran overdose in the medical literature. PMID:21735310

  14. Escalation with overdose control using all toxicities and time to event toxicity data in cancer Phase I clinical trials.

    PubMed

    Chen, Zhengjia; Cui, Ye; Owonikoko, Taofeek K; Wang, Zhibo; Li, Zheng; Luo, Ruiyan; Kutner, Michael; Khuri, Fadlo R; Kowalski, Jeanne

    2014-03-01

    The primary purposes of Phase I cancer clinical trials are to determine the maximum tolerated dose (MTD) and the treatment schedule of a new drug. Phase I trials usually involve a small number of patients so that fully utilizing all toxicity information including time to event toxicity data is key to improving the trial efficiency and the accuracy of MTD estimation. Chen et al. proposed a novel normalized equivalent toxicity score (NETS) system to fully utilize multiple toxicities per patient instead of a binary indicator of dose limiting toxicity (DLT). Cheung and Chappell developed the time to toxicity event (TITE) approach to incorporate time to toxicity event data. Escalation with overdose control (EWOC) is an adaptive Bayesian Phase I design which can allow rapid dose escalation while controlling the probability of overdosing patients. In this manuscript, we use EWOC as a framework and integrate it with the NETS system and the TITE approach to develop an advanced Phase I design entitled EWOC-NETS-TITE. We have conducted simulation studies to compare its operating characteristics using selected derived versions of EWOC because EWOC itself has already been extensively compared with common Phase I designs [3]. Simulation results demonstrate that EWOC-NETS-TITE can substantially improve the trial efficiency and accuracy of MTD determination as well as allow patients to be entered in a staggered fashion to significantly shorten trial duration. Moreover, user-friendly software for EWOC-NETS-TITE is under development. PMID:24530487

  15. Qualitative Assertions as Prescriptive Statements

    ERIC Educational Resources Information Center

    Nolen, Amanda; Talbert, Tony

    2011-01-01

    The primary question regarding prescriptive appropriateness is a difficult one to answer for the qualitative researcher. While there are certainly qualitative researchers who have offered prescriptive protocols to better define and describe the terrain of qualitative research design and there are qualitative researchers who offer research…

  16. Application of computer vision to automatic prescription verification in pharmaceutical mail order

    NASA Astrophysics Data System (ADS)

    Alouani, Ali T.

    2005-05-01

    In large volume pharmaceutical mail order, before shipping out prescriptions, licensed pharmacists ensure that the drug in the bottle matches the information provided in the patient prescription. Typically, the pharmacist has about 2 sec to complete the prescription verification process of one prescription. Performing about 1800 prescription verification per hour is tedious and can generate human errors as a result of visual and brain fatigue. Available automatic drug verification systems are limited to a single pill at a time. This is not suitable for large volume pharmaceutical mail order, where a prescription can have as many as 60 pills and where thousands of prescriptions are filled every day. In an attempt to reduce human fatigue, cost, and limit human error, the automatic prescription verification system (APVS) was invented to meet the need of large scale pharmaceutical mail order. This paper deals with the design and implementation of the first prototype online automatic prescription verification machine to perform the same task currently done by a pharmacist. The emphasis here is on the visual aspects of the machine. The system has been successfully tested on 43,000 prescriptions.

  17. Stud Health Technol Inform . Author manuscript A generic system for critiquing physicians prescriptions: usability,'

    E-print Network

    Paris-Sud XI, Université de

    a critiquing module that is automatically activated when the physician writes a drug prescription, and whichStud Health Technol Inform . Author manuscript Page /1 5 A generic system for critiquing physicians prescriptions: usability,' satisfaction and lessons learnt Jean-Baptiste Lamy 1 * , Vahid Ebrahiminia 2

  18. A System For Secure Electronic Prescription Handling D.P.Mundy, D.W.Chadwick

    E-print Network

    Kent, University of

    A System For Secure Electronic Prescription Handling D.P.Mundy, D.W.Chadwick Contact Author Other a system for electronic prescribing of drugs should be available by 2004. The main objective our proposed electronic prescription processing system design, with the emphasis placed firmly

  19. Nonmedical Use of Prescription Stimulants: Age, Race, Gender, and Educational Attainment Patterns

    Microsoft Academic Search

    Melinda Pilkinton; Andrew Cannatella

    2012-01-01

    Illegal stimulant use has increased for several years in the U.S., particularly prescription stimulants prescribed for Attention Deficit Disorder. The propensity for youths to use medications sans prescription or to overuse for a ‘high’ has increased. This study analyzed data from the 2009 National Survey of Drug Use and Health. Of interest were age, race, and gender use rates, pointing

  20. Information Security and Privacy Concerns of Online Prescription Systems

    Microsoft Academic Search

    Stephan Poag; Xiaodong Deng

    This paper examines the effects of information sensitivity and information relevance on information security and privacy concerns (i.e., misuse, integrity, and breach to public) and the effect upon the customers' willingness to provide requested information in an online prescription drug management system setting. A sample of 1166 responses from 46 students relating to 26 information attributes to be collected for