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1

Treating Prescription Opioid Overdose  

MedlinePLUS

... Topics Drugs & Supplements Videos & Cool Tools NLM Director’s Comments Transcript Treating Prescription Opioid Overdose: 06/09/2014 ... information is available in 43 other languages. Your comments about this or any of our podcasts are ...

2

Apparent suicidal carbon monoxide poisonings with concomitant prescription drug overdoses.  

PubMed

We report four separate suicides by apparent motor vehicle-related carbon monoxide (CO) poisoning in which complete toxicological analysis showed the absence of, or lower than expected, percent carboxyhemoglobin saturation and high concentrations of concomitant prescription drugs. These cases, within a population of 71 apparent CO suicides from the Wayne County Medical Examiner's Office over 1998-2004, represent cases where additional factors are in play. Multiple modalities (CO poisoning and drug overdose) and/or undetectable carbon dioxide poisoning from the vehicle exhaust of cars manufactured after laws regulating vehicle emissions were enacted are examples of additional factors that require consideration in these selected cases. All four cases demonstrated some degree of decomposition, so the possible loss of CO could not be ruled out. The need for full toxicological analysis in apparent suicidal CO poisoning is emphasized. PMID:16419412

Gupta, Avneesh; Pasquale-Styles, Melissa A; Hepler, Bradford R; Isenschmid, Daniel S; Schmidt, Carl J

2005-10-01

3

Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics.  

PubMed

The misuse and abuse of prescription medications in the United States continues to increase despite interventions by health care professionals, regulatory, and law enforcement agencies. Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a 5-fold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression. Physician and pharmacy shopping by patients occurs, and prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage. Health care professionals need to inform patients and work closely with regulatory agencies and legislatures to stem the increasing fatalities from prescription drug unintentional overdoses. PMID:24436437

Jann, Michael; Kennedy, William Klugh; Lopez, Gaylord

2014-02-01

4

Suicidal attempts by prescription drug overdose in the elderly: a study of 44 cases  

PubMed Central

A series of 44 consecutive elderly, admitted to a busy general hospital following deliberate self-poisoning, is reviewed for associated medical and psychosocial factors. In all but 3 cases the act involved an overdose of drugs prescribed for the treatment of a chronic medical and/or psychiatric disorder. Women outnumbered men by 2.7 to 1. There was high proportion of chronic psychiatric (80%, mostly depressive) and medical (60%) conditions. Chronic stress from the physical illness, social isolation, or tacit family conflict were common and seemed instrumental in the self-poisoning act. Most attempts were carried out around the weekend and during winter. One man succumbed to complications of the overdose but the rest of the patients recovered. Psychosocial (especially depressive) and medical vulnerability, plus availability of prescribed drugs, were the most important determinants of suicidal behavior among these elderly attempters.

Gavrielatos, Gerasimos; Komitopoulos, Nikolaos; Kanellos, Petros; Varsamis, Efstratios; Kogeorgos, John

2006-01-01

5

CDC Vital Signs: Prescription Painkiller Overdoses in the US  

MedlinePLUS

... Prescription Painkiller Overdoses in the US November 2011 15,000 Nearly 15,000 people die every year of overdoses involving ... public health epidemic. Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This ...

6

Prescription Drugs  

MedlinePLUS

... Prescription Drug Abuse in Youth (August 2013) Featured Publications Cough and Cold Medicine Abuse (DrugFacts) Revised May ... Treatment Locator or 1-800-662-HELP . Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

7

Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco  

PubMed Central

Opiate overdose is a significant cause of mortality among injection drug users (IDUs) in the United States (US). Opiate overdose can be reversed by administering naloxone, an opiate antagonist. Among IDUs, prevalence of witnessing overdose events is high, and the provision of take-home naloxone to IDUs can be an important intervention to reduce the number of overdose fatalities. The Drug Overdose Prevention and Education (DOPE) Project was the first naloxone prescription program (NPP) established in partnership with a county health department (San Francisco Department of Public Health), and is one of the longest running NPPs in the USA. From September 2003 to December 2009, 1,942 individuals were trained and prescribed naloxone through the DOPE Project, of whom 24% returned to receive a naloxone refill, and 11% reported using naloxone during an overdose event. Of 399 overdose events where naloxone was used, participants reported that 89% were reversed. In addition, 83% of participants who reported overdose reversal attributed the reversal to their administration of naloxone, and fewer than 1% reported serious adverse effects. Findings from the DOPE Project add to a growing body of research that suggests that IDUs at high risk of witnessing overdose events are willing to be trained on overdose response strategies and use take-home naloxone during overdose events to prevent deaths.

Enteen, Lauren; Bauer, Joanna; McLean, Rachel; Wheeler, Eliza; Huriaux, Emalie; Kral, Alex H.

2010-01-01

8

Prescription Drug Abuse in Texas: Mortality and Its Economic Consequences.  

ERIC Educational Resources Information Center

Prescription drug overdose mortality is documented and its economic consequences estimated for Texas in 1978. Drug-related deaths (N=117 out of 397) were due to the use of barbiturates, tranquilizers, and anti-depressants; 85 to mixing drugs. The economic cost of mortality exceeded $43 million, 32 percent of prescription drug overdose. (Author)

Harlow, Kirk; Swint, J. Michael

1981-01-01

9

Treating Prescription Drug Addiction  

MedlinePLUS

... information about prescription drug abuse? Glossary References NIDA Publications By Audience By Drug of Abuse By Drug ... of national interest. View all ?Research Reports Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

10

Prescription Drug Abuse  

MedlinePLUS

... information about prescription drug abuse? Glossary References NIDA Publications By Audience By Drug of Abuse By Drug ... Unused Medicines: What You Should Know (FDA) Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

11

CDC Vital Signs: Prescription Painkiller Overdoses  

MedlinePLUS

... Administration - Drugs Information National Institute of Mental Health Mental health medications MotherToBaby PDMP Center of Excellence, Brandeis University Print page CDC on Facebook CDC on Twitter ...

12

Prescription Drugs Online  

NSDL National Science Digital Library

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.

Fox, Susannah

2007-04-03

13

Prescription Drugs Online  

NSDL National Science Digital Library

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.

14

Death by drug overdose: impact on families.  

PubMed

Death by overdose is loaded with social/moral stigmas, in addition to strong feelings of anger, helplessness, guilt and shame in the families. The objective of this study was to analyze the impact of these feelings on families facing death by overdose. Qualitative methodology was used to study six families with a history of death by overdose of one of their members. The interview was open, and guided by the question "What did you feel with the death of your family member by overdose and what was the impact of this death on your family as a whole?" The families were grouped into two categories: families who knew about the drug use of their family member, and families who were not aware of it. The reports show that secrecy regarding drug use followed by death by overdose arouses feelings of anger, guilt, helplessness, and deprives the family members of information that could allow them to take action. As regards families that were aware of the drug use, there seems to be a "veiled preparation" for a possible death by overdose, bringing about ambivalent situations of grief and relief. The report stresses how disturbing it is to lose a family member by overdose, and points to the need for psychological support for those families. PMID:18159785

da Silva, Eroy Aparecida; Noto, Ana Regina; Formigoni, Maria Lucia O S

2007-09-01

15

FDA OKs Quick-Acting Antidote for Prescription Painkiller Overdose  

MedlinePLUS

... health risks from abuse of drugs such as Oxycontin, Vicodin (*this news item will not be available ... opioids. Opioids include prescription narcotic painkillers such as Oxycontin, Vicodin and Percocet -- all of which have shown ...

16

Decline in drug overdose deaths after state policy changes - Florida, 2010-2012.  

PubMed

During 2003-2009, the number of deaths caused by drug overdose in Florida increased 61.0%, from 1,804 to 2,905, with especially large increases in deaths caused by the opioid pain reliever oxycodone and the benzodiazepine alprazolam. In response, Florida implemented various laws and enforcement actions as part of a comprehensive effort to reverse the trend. This report describes changes in overdose deaths for prescription and illicit drugs and changes in the prescribing of drugs frequently associated with these deaths in Florida after these policy changes. During 2010-2012, the number of drug overdose deaths decreased 16.7%, from 3,201 to 2,666, and the deaths per 100,000 persons decreased 17.7%, from 17.0 to 14.0. Death rates for prescription drugs overall decreased 23.2%, from 14.5 to 11.1 per 100,000 persons. The decline in the overdose deaths from oxycodone (52.1%) exceeded the decline for other opioid pain relievers, and the decline in deaths for alprazolam (35.6%) exceeded the decline for other benzodiazepines. Similar declines occurred in prescribing rates for these drugs during this period. The temporal association between the legislative and enforcement actions and the substantial declines in prescribing and overdose deaths, especially for drugs favored by pain clinics, suggests that the initiatives in Florida reduced prescription drug overdose fatalities. PMID:24990490

Johnson, Hal; Paulozzi, Leonard; Porucznik, Christina; Mack, Karin; Herter, Blake

2014-07-01

17

Prescription drug misuse and gender.  

PubMed

In recent years, prescription drug misuse has become a serious public health issue. A number of studies in this area have identified females to be at an increased risk for prescription drug misuse during adolescence. Guided by Agnew's general strain theory, the current research examined the relationship between prescription drug misuse and gender during adolescence. We used data from the 2010 National Survey on Drug Use and Health, a sample representative of the non-institutionalized population of the United States. Logistic regression models were estimated to examine the relationship between gender, prescription drug misuse, strain, and depression. The findings indicated that females were at an increased for prescription drug misuse. We also found support for general strain theory, as strain and depression were significantly related to prescription drug misuse. In addition, we found evidence that strain was gendered in that elements of general strain theory accounted for the relationship between prescription drug misuse and gender. PMID:24491149

Ford, Jason A; Reckdenwald, Amy; Marquardt, Briana

2014-06-01

18

Trends in Prescription Drug Abuse  

MedlinePLUS

... information about prescription drug abuse? Glossary References NIDA Publications By Audience By Drug of Abuse By Drug ... of national interest. View all ?Research Reports Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

19

Repeat Drug Overdoses Raise Risk for Hospitalization, Ventilator Care  

MedlinePLUS

... overdoses. These included having low income; Medicare or Medicaid coverage; and health problems such as alcohol or drug addiction, psychiatric or neurological conditions, and chronic pulmonary disease. The study is scheduled for publication ...

20

Overactive Bladder: Prescription Drug Therapy  

MedlinePLUS

... Prescription Drugs Search : Stay updated on the latest bladder health news! Share this site with a friend 1: Home 3: About NAFC 4: Bladder Health Information 6: Healthcare Providers 7: Contact 8: ...

21

Closing the Prescription Drug Coverage Gap  

MedlinePLUS

... does the coverage gap discount work for brand-name drugs? Companies that make brand-name prescription drugs ... the coverage gap, will all Medicare-covered brand-name prescription drugs be discounted? If a drug company ...

22

Initiation into Prescription Opioid Misuse among Young Injection Drug Users  

PubMed Central

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.

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

2011-01-01

23

Characteristics of Drug Overdose in Young Suicide Attempters  

PubMed Central

Objective Few studies have focused on the characteristic features of drug overdose in children and adolescents who have attempted suicide in Korea. The present study examined the characteristics of drug overdose in children and adolescents who visited the emergency room following drug ingestion for a suicide attempt. Methods The medical records of 28 patients who were treated in the emergency room following a drug overdose from January 2008 to March 2011 were analyzed. Demographic and clinical variables related to the suicide attempts were examined. Results The mean age of the patients was 16.6±1.7 years (range 11-19 years), and 20 of the patients (71.4%) were female. Most of the patients (n=23, 82.1%) overdosed on a single drug; acetaminophen-containing analgesics were the most common (n=12, 42.9%). Depression was the most common psychiatric disorder (n=22, 78.6%), and interpersonal conflict was the most common precipitating factor of the suicide attempts (n=11, 39.3%). This was the first suicide attempt for approximately 80% of the patients. About one fourth of the patients (n=7, 25%) had follow-up visits at the psychiatric outpatient clinic. Conclusion Early screening and psychiatric intervention for depression may be an important factor in preventing childhood and adolescent suicide attempts. Developing coping strategies to manage interpersonal conflicts may also be helpful. Moreover, policies restricting the amount and kind of drugs purchased by teenagers may be necessary to prevent drug overdose in this age group.

Kweon, Yong-Sil; Hwang, Sunyoung; Yeon, Bora; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Lee, Chung Tai

2012-01-01

24

Missed paracetamol (acetaminophen) overdose due to confusion regarding drug names.  

PubMed

Immediate management of drug overdose relies upon the patient account of what was ingested and how much. Paracetamol (acetaminophen) is involved in around 40% of intentional overdose episodes, and remains the leading cause of acute liver failure in many countries including the United Kingdom. In recent years, consumers have had increasing access to medications supplied by international retailers via the internet, which may have different proprietary or generic names than in the country of purchase. We describe a patient that presented to hospital after intentional overdose involving 'acetaminophen' purchased via the internet. The patient had difficulty recalling the drug name, which was inadvertently attributed to 'Advil', a proprietary non-steroidal anti-inflammatory drug. The error was later recognised when the drug packaging became available, but the diagnosis of paracetamol overdose and initiation of acetylcysteine antidote were delayed. This case illustrates the benefit of routinely measuring paracetamol concentrations in all patients with suspected poisoning, although this is not universally accepted in practice. Moreover, it highlights the importance of the internet as a source of medications for intentional overdose, and emphasises the need for harmonisation of international drug names to improve patient safety. PMID:23914754

Hewett, David G; Shields, Jennifer; Waring, W Stephen

2013-07-01

25

Preventing and Recognizing Prescription Drug Abuse  

MedlinePLUS

... information about prescription drug abuse? Glossary References NIDA Publications By Audience By Drug of Abuse By Drug ... Ebooks Brain Power Español PDF (7 MB) Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

26

What Are Some Commonly Abused Prescription Drugs?  

MedlinePLUS

... information about prescription drug abuse? Glossary References NIDA Publications By Audience By Drug of Abuse By Drug ... of national interest. View all ?Research Reports Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

27

Your Guide to Medicare Prescription Drug Coverage  

MedlinePLUS

... a plan that has a coverage gap: Ms. Smith joined the ABC Prescription Drug Plan. Her coverage ... card when she buys prescriptions. Monthly premium—Ms. Smith pays a monthly premium throughout the year. 1. ...

28

Source of prescription drugs used nonmedically in rural and urban populations.  

PubMed

Abstract Background: Unintentional overdose deaths due to nonmedical use of prescription drugs disproportionately impact rural over urban settings in the United States. Sources of these prescriptions may play a factor. Objective: This study examines the relationships between rurality and source of prescription drugs used nonmedically. Methods: Using data from the National Survey on Drug Use and Health 2008-2010 (n?=?10?693), we examined bivariate and multivariate associations of socio-demographic and clinical correlates and source (physician or non-physician) of prescription drugs (opioid, sedative, tranquilizer, or stimulant) used nonmedically among urban and rural residents. We also examined the type of prescription drugs used nonmedically among urban and rural residents by source. Results: Among respondents reporting past year nonmedical use of prescription medications, 18.9% of urban residents and 17.5% of rural residents had a physician source for drugs used nonmedically. Likelihood of physician source for urban and rural residents was increased in Hispanic, insured individuals and those with any prescription drug dependence. Rural residents who had a non-physician source were more likely than urban residents with a non-physician source to use hydrocodone (49% vs. 43.3%, p?=?0.05), morphine (17.7% vs. 14.0%, p?=?0.04), tramadol products (18.1% vs. 11.2%, p?=?0.003), and methadone (17.2% vs. 10.9%, p?=?0.001). Conclusion: Urban and rural individuals with nonmedical use of prescription drugs are equally likely to obtain these prescriptions from a physician source. Some factors associated with obtaining prescription drugs from a physician source differed between these populations, which may have implications for public health approaches to addressing problems such as overdose. PMID:24853143

Wang, Karen H; Fiellin, David A; Becker, William C

2014-07-01

29

Revisiting "the origins of compulsory drug prescriptions".  

PubMed Central

It has been argued that today's prescription drug market originated in the arbitrary acts of the US Food and Drug Administration (FDA), which in 1938 issued regulations creating a class of drugs that could be sold by prescription only. On the basis of the FDA's administrative records, I argue that the 1938 regulations on prescription drug labeling were initiated by industry and then agreed to by the FDA; that contemporaries understood and accepted the reasons for restricting the use of certain drugs; and that the subsequent evolution of these regulations is best understood as an FDA effort to limit industry abuses of the prescription labeling system. This decade-long war of position ended when drug manufacturers persuaded the US Congress to enshrine their version of prescription labeling in law in a highly politicized struggle over government's role in the economy. Images FIGURE 1

Marks, H M

1995-01-01

30

76 FR 51310 - Branded Prescription Drug Fee  

Federal Register 2010, 2011, 2012, 2013

...branded prescription drug fee imposed by the Affordable Care Act (ACA). The regulations affect persons engaged in the business of...or importing branded prescription drugs by section 9008 of the ACA. The text of those regulations also serves as the text of...

2011-08-18

31

Sources of prescription drugs for illicit use  

PubMed Central

Objectives This exploratory study investigated the sources of four classes of abusable prescription medications (sleeping, sedative/anxiety, stimulant, and pain medications) that were used illicitly by undergraduate students in the past year. The relationship between these sources and other substance use was examined. Methods In the spring of 2003, a random sample of 9,161 undergraduate students attending a large public Midwestern research university is selected to self-administer a Web-based survey. Results The respondents identified 18 sources of prescription drugs that were classified into three broad categories: peer, family, and other sources. The majority of respondents who were illicit users obtained their prescription drugs from peer sources. Undergraduate students who obtained prescription medication from peer sources reported significantly higher rates of alcohol and other drug use than students who did not use prescription drugs illicitly or students who obtained prescription medication from family sources. Conclusions The findings of the present study offer strong evidence that undergraduate students obtain abusable prescription drugs from their peers. Greater prevention efforts are needed to reduce the illicit use and diversion of prescription medication.

McCabe, Sean Esteban; Boyd, Carol J.

2006-01-01

32

42 CFR 423.159 - Electronic prescription drug program.  

Code of Federal Regulations, 2013 CFR

...HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements § 423.159 Electronic prescription drug program. (a) Definitions....

2013-10-01

33

Pharmacokinetic strategies for treatment of drug overdose and addiction  

PubMed Central

The pharmacokinetic treatment strategy targets the drug molecule itself, aiming to reduce drug concentration at the site of action, thereby minimizing any pharmacodynamic effect. This approach might be useful in the treatment of acute drug toxicity/overdose and in the long-term treatment of addiction. Phase IIa controlled clinical trials with anticocaine and antinicotine vaccines have shown good tolerability and some efficacy, but Phase IIb and III trials have been disappointing because of the failure to generate adequate antibody titers in most participants. Monoclonal antibodies against cocaine, methamphetamine and phencyclidine have shown promise in animal studies, as has enhancing cocaine metabolism with genetic variants of human butyrylcholinesterase, with a bacterial esterase, and with catalytic monoclonal antibodies. Pharmacokinetic treatments offer potential advantages in terms of patient adherence, absence of medication interactions and benefit for patients who cannot take standard medications.

Gorelick, David A

2012-01-01

34

Drug overdoses requiring temporary cardiac pacing; a study of six cases treated at Altnagelvin Hospital, Londonderry.  

PubMed Central

Drug overdoses in general are increasing and overdoses of cardiac medications are also increasing; some are associated with a high mortality. Temporary cardiac pacing has a valuable role in cases of hypotension related to dysrhythmia, or when it is necessary to provide overdrive pacing. However, despite technically successful and uncomplicated pacemaker insertion and restoration of cardiac electrical activity, patients developing bradyarrhythmia and hypotension after an overdose are in a high risk group.

McGlinchey, P. G.; McNeill, A. J.

1998-01-01

35

Do new prescription drugs pay for themselves?  

Microsoft Academic Search

During the last several years, spending on prescription drugs in the U.S. increased at a 15% annual rate, with the US$ 178 billion spent in 2002 accounting for more than 11% of health care expenditures in the U.S. This growth has been largely driven by a shift to new drugs, which are typically more expensive than earlier drugs within the

Mark Duggan

2005-01-01

36

Sale of prescription drugs over the Internet.  

PubMed

Online drugstores represent one of the hottest categories in electronic commerce. The Internet offers great promise in expanding access to prescription drugs for the disabled, the elderly, and people living in rural areas. But with this promise comes the danger of eliminating the safeguards that protect consumers from inappropriate use of medications and adverse drug events. This Issue Brief highlights two studies that investigate the availability of prescription drugs over the Internet, and focuses on the alarming ease with which consumers can obtain drugs without seeing a physician or a pharmacist. PMID:12523341

Armstrong, K; Bloom, B S

1999-01-01

37

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

PubMed

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

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

2013-05-01

38

Risk factors for recent nonfatal overdose among HIV-infected Russians who inject drugs.  

PubMed

Overdoses and HIV infection are common among Russians who inject drugs, yet risk factors have not been studied. We analyzed baseline data of 294 participants with 30-day injection drug use from an HIV secondary prevention trial for persons reporting "heavy" alcohol use (National Institute on Alcohol Abuse and Alcoholism [NIAAA] risky drinking definition) and risky sex in the past 6 months. The outcome was any self-reported overdose in the previous 3 months. We examined demographic, HIV-related, criminal justice, mental health, substance use, and injection risk factors. Participants' characteristics included median age 29 years, 117/294 (40%) female, and median CD4 cell count 345/µl. Over three quarters 223/294 (76%) reported a history of overdose and 47/294 (16%) reported overdose in the past 3 months. Past month injection frequency (adjusted odds ratio [AOR] 4.77, 95% confidence interval [CI]: 1.63-14.0 highest vs. lowest quartile; AOR 3.58, 95% CI: 1.20-10.69 second highest vs. lowest quartile) and anti-retroviral therapy (ART) at time of interview (AOR 3.96 95% CI: 1.33-11.83) were associated with 3-month overdose. Nonfatal overdose among HIV-infected Russians who inject drugs is common. Risk factors include injection frequency and anti-retroviral therapy (ART), which warrant further study. Overdose prevention efforts are needed among HIV-infected Russians who inject drugs. PMID:24382133

Walley, Alexander Y; Cheng, Debbie M; Coleman, Sharon M; Krupitsky, Evgeny; Raj, Anita; Blokhina, Elena; Bridden, Carly; Chaisson, Christine E; Lira, Marlene C; Samet, Jeffrey H

2014-08-01

39

America's Hidden and Ignored Drug Problem: Prescription Drug Abuse  

Microsoft Academic Search

This research attempts to gain better insight into one of the new epidemics in American society. This American epidemic, which started in the very late 1990's, is prescription drug abuse. This new epidemic not only affects the medical industry, but the criminal justice community as well. Further, in terms of prescription narcotics, primary research and media coverage into this topic

Brian Keith Simpkins

2004-01-01

40

Prescription patterns of hypolipidaemic drugs in a tertiary care teaching hospital of southern India.  

PubMed

Objective: To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. Materials and Methods: A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. Results: While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. Conclusion: This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs. PMID:24959461

Raja, Sangeetha; Mohapatra, Satyajit; Kumar, J S; Rani, R Jamuna

2014-04-01

41

Prescription Patterns of Hypolipidaemic Drugs in a Tertiary Care Teaching Hospital of Southern India  

PubMed Central

Objective: To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. Materials and Methods: A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. Results: While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. Conclusion: This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs.

Mohapatra, Satyajit; Kumar, J.S; Rani, R Jamuna

2014-01-01

42

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

Code of Federal Regulations, 2010 CFR

...providing other prescription drug coverage...providing other prescription drug coverage. (d) Cost management tools. The...from using cost management tools (including...of supplemental prescription drug...

2010-10-01

43

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

Code of Federal Regulations, 2010 CFR

...providing other prescription drug coverage...providing other prescription drug coverage. (d) Cost management tools. The...from using cost management tools (including...of supplemental prescription drug...

2009-10-01

44

Evaluation of Prescription Drug Monitoring Programs, September 1, 2006.  

National Technical Information Service (NTIS)

This research examines the effects of Prescription Drug Monitoring Programs (PDMPs) on the supply and abuse of prescription drugs. Information from the Automation of Reports and Consolidated Orders System (ARCOS) is used to develop measures of supply, and...

R. Simeone L. Holland

2006-01-01

45

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

Code of Federal Regulations, 2010 CFR

...drugs limited by new-drug applications to prescription sale. 310.201 Section...drugs limited by new-drug applications to prescription sale. (a) The prescription-dispensing...and containing no drug limited to prescription sale under the...

2009-04-01

46

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

Code of Federal Regulations, 2010 CFR

...drugs limited by new-drug applications to prescription sale. 310.201 Section...drugs limited by new-drug applications to prescription sale. (a) The prescription-dispensing...and containing no drug limited to prescription sale under the...

2010-04-01

47

Patterns of Prescription Medication Diversion among Drug Dealers  

ERIC Educational Resources Information Center

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…

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

2012-01-01

48

Resonant Messages to Prevent Prescription Drug Misuse by Teens  

ERIC Educational Resources Information Center

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…

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

2011-01-01

49

76 FR 59898 - Branded Prescription Drug Fee; Correction  

Federal Register 2010, 2011, 2012, 2013

...REG-112805-10] RIN 1545-BJ39 Branded Prescription Drug Fee; Correction AGENCY: Internal...provides guidance relating to the branded prescription drug fee imposed by the Affordable...the part heading PART 51--BRANDED PRESCRIPTION DRUGS, the last line of the...

2011-09-28

50

76 FR 59897 - Branded Prescription Drug Fee; Correction  

Federal Register 2010, 2011, 2012, 2013

...TD 9544] RIN 1545-BK34 Branded Prescription Drug Fee; Correction AGENCY: Internal...manufacturing or importing branded prescription drugs. This fee was enacted by section...2011 and applies to any fee on branded prescription drug sales that is due on or...

2011-09-28

51

ENHANCING PRESCRIPTION DRUG INNOVATION AND ADOPTION  

PubMed Central

The adoption and use of a new drug would ideally be guided by its Innovation and cost-effectiveness. The adoption and use of a new drug would ideally be guided by its innovation and cost-effectiveness. However, information about the relative efficacy and safety of a drug is typically incomplete even well after market entry, and various other forces create a market place in which most new drugs are little better than their older counterparts. Five proposed mechanisms are considered for promoting innovation and reducing the use of therapies ultimately found to offer poor value or have unacceptable risks. These changes range from increasing the evidence required for U.S. Food and Drug Administration approval to modifying the structure of drug reimbursement. Despite the challenges of policy implementation, the United States has a long history of successfully improving the societal value and safe use of prescription medicines.

Alexander, G. Caleb; O'Connor, Alec B.; Stafford, Randall S.

2014-01-01

52

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

NSDL National Science Digital Library

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."

2000-01-01

53

Combating the prescription painkiller epidemic: a national prescription drug reporting program.  

PubMed

Prescription painkiller abuse is the fastest growing drug problem in the United States. In the past year, approximately one out of twenty Americans reported misuse or abuse of prescription painkillers. Several factors contribute to the prescription painkiller epidemic. Drug abusers use various methods--such as doctor shopping, paying with cash, and filling prescriptions in different states--to avoid detection and obtain prescription painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by substantial profits, enable drug abusers by illegally prescribing or supplying controlled substances. Even ethical physicians rarely have adequate training to recognize and address prescription drug abuse, and as a result, prescribe painkillers to patients who are not using them for legitimate medical purposes. Similarly, although the majority of pharmacies have taken steps to combat drug abuse and reduce prescription painkiller dispensing, under current reporting systems, pharmacists lack visibility into several important indicators of drug abuse. As a result, even the most vigilant pharmacists find it extremely difficult to identify and detect drug abuse with certainty. While state governments have established prescription drug monitoring programs (PDMPs) to crack down on prescription drug abuse, these programs have proven to be inadequate. The programs currently suffer from inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and constraints on sharing data with law enforcement and state agencies. By contrast, third-party prescription payment systems run by pharmacy benefit managers (PBMs) or health insurers have been effective in detecting prescription drug abuse. This paper suggests that a national prescription drug reporting program building on existing PBM networks could be significantly more effective than existing state PDMPs in detecting prescription drug abuse. PMID:24844043

Shepherd, Joanna

2014-01-01

54

Propoxyphene overdose  

MedlinePLUS

... medicine (such as Darvocet) Fluids through a vein (IV) Medicine to block the effect of the overdose drug on the central nervous system (narcotic antagonist) Medicine (sodium bicarbonate) to help manage serious ...

55

Phencyclidine overdose  

MedlinePLUS

... is an illegal street drug that can cause hallucinations and severe agitation. This article discusses overdose due ... does not talk, move, or react) Coma Convulsions Hallucinations High blood pressure Nystagmus (side-to-side eye ...

56

Temporal differences in gamma-hydroxybutyrate overdoses involving injecting drug users versus recreational drug users in Helsinki: a retrospective study  

PubMed Central

Background Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) have been profiled as 'party drugs' used mainly at dance parties and in nightclubs on weekend nights. The purpose of this study was to examine the frequency of injecting drug use among GHB/GBL overdose patients and whether there are temporal differences in the occurrence of GHB/GBL overdoses of injecting drug and recreational drug users. Methods In this retrospective study, the ambulance and hospital records of suspected GHB- and GBL overdose patients treated by the Helsinki Emergency Medical Service from January 1st 2006 to December 31st 2007 were reviewed. According to the temporal occurrence of the overdose, patients were divided in two groups. In group A, the overdose occurred on a Friday-Saturday or Saturday-Sunday night between 11 pm-6 am. Group B consisted of overdoses occurring on outside this time frame. Results Group A consisted of 39 patient contacts and the remaining 61 patient contacts were in group B. There were statistically significant differences between the two groups in (group A vs. B, respectively): history of injecting drug abuse (33% vs. 59%, p = 0.012), reported polydrug and ethanol use (80% vs. 62%, p = 0.028), the location where the patients were encountered (private or public indoors or outdoors, 10%, 41%, 41% vs. 25%, 18%, 53%, p = 0.019) and how the knowledge of GHB/GBL use was obtained (reported by patient/bystanders or clinical suspicion, 72%, 28% vs. 85%, 10%, p = 0.023). Practically all (99%) patients were transported to emergency department after prehospital care. Conclusion There appears to be at least two distinct groups of GHB/GBL users. Injecting drug users represent the majority of GHB/GBL overdose patients outside weekend nights.

2012-01-01

57

Prevention of overlapping prescriptions of psychotropic drugs by community pharmacists.  

PubMed

The nonmedical use or abuse of prescription drugs, including psychotropic medicines, is a growing health problem in Japan. Patient access to psychotropic drugs, specifically from the oversupply of medications due to overlapping prescriptions, may increase the risk of drug abuse and dependence. However, very little is known about such overlapping prescriptions. Today, the dispensing of prescriptions is generally moving from inside to outside of hospitals, with psychotropic drugs mainly dispensed at community pharmacies. In this study, we used health insurance claims (i.e., receipts) for dispensing as the main source of information in an investigation of overlapping prescriptions of psychotropic drugs. A total of 119 patients were found to have received overlapping prescriptions, as identified by community pharmacists who were members of the Saitama Pharmaceutical Association, using patient medication records, followed by medication counseling and prescription notes for the patient. According to our findings, the most frequently overlapping medication was etizolam. Etizolam can be prescribed for more than 30 days since it is not regulated under Japanese law as a "psychotropic drug." Generally, when a drug can be prescribed for a greater number of days, it increases the likelihood of an overlapping prescription during the same period. As a result, the long-term prescription of etizolam increases the risk of overlapping prescriptions. We also found that the patients who received overlapping prescriptions of etizolam were mostly elderly and the most common pattern was prescription from both internal medicine and orthopedics physicians. Etizolam has wide range of indications that are covered by health insurance. Our results suggest that patients who received overlapping prescriptions of etizolam may receive prescriptions from different prescribers for different purposes. Therefore, it may be appropriate to regulate etizolam as a "psychotropic drug" under Japanese law, thus setting a limit on the period for which it can be prescribed in order to help prevent long-term and overlapping prescriptions. PMID:23393998

Shimane, Takuya; Matsumoto, Toshihiko; Wada, Kiyoshi

2012-10-01

58

Prescription drug abuse among ecstasy users in Miami.  

PubMed

This study examines the nature, extent and consequences of prescription drug abuse among 143 ecstasy users in Miami. Participants were recruited through nightclub and college campus outreach, and through respondent referrals. Instrumentation included the Risk Behavior Assessment, Substance Abuse Module and Center for Epidemiological Studies Depression Scale. Median age was 23, 42% were female and 50% Hispanic. An arrest history was reported by 44%, and 33% reported prior drug/alcohol treatment. Prescription drug abuse was reported by 87%; alprazolam (57%), oxycodone (36%), hydrocodone (32%) and diazepam (30%) were cited most often. Prescription drug abusers were more likely to report polydrug use, drug treatment histories, risky drug use behaviors, and symptoms of depression. They also reported numerous physical, psychological and social consequences of prescription drug abuse. Additional studies among larger samples are needed to understand the processes of prescription drug access and the extent of integration in club drug using cultures. PMID:16368653

Kurtz, Steven P; Inciardi, James A; Surratt, Hilary L; Cottler, Linda

2005-01-01

59

[Clinical practice guideline. Drug prescription in elderly].  

PubMed

The process of prescribing a medication is complex and includes: deciding whether it is indicated, choosing the best option, determining the dose and the appropriate management scheme to the physiological condition of the patient, and monitoring effectiveness and toxicity. We have to inform patients about the expected side effects and indications for requesting a consultation. Specific clinical questions were designed based on the acronym PICOST. The search was made in the specific websites of clinical practice guidelines, was limited to the population of older adults, in English or Spanish. We used 10 related clinical practice guidelines, eight systematic reviews and five meta-analyses. Finally, we made a search of original articles or clinical reviews for specific topics. The development and validation of clinical practice guidelines for "rational drug prescriptions in the elderly" is intended to promote an improvement in the quality of prescription through the prevention and detection of inappropriate prescribing in the elderly and, as a result of this, a decrease in the adverse events by drugs, deterioration of health of patients and expenditure of resources. PMID:23693115

Peralta-Pedrero, María Luisa; Valdivia-Ibarra, Francisco Javier; Hernández-Manzano, Mario; Medina-Beltrán, Gustavo Rodrigo; Cordero-Guillén, Miguel Angel; Baca-Zúñiga, José; Cruz-Avelar, Agles; Aguilar-Salas, Ismael; Avalos-Mejía, Annia Marisol

2013-01-01

60

Prescription drug abuse information in D.A.R.E.  

PubMed

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 within 14 categories. A two-dimensional coding system for context identified Use versus Abuse and Explicit versus Implicit references to prescription drugs. Results indicated that content and objectives found in D.A.R.E. represent a very narrow breadth of prescription drug topics. Moreover, all prescription-drug related content and objectives were presented in an Abuse-Implicit context. Although some educational material in D.A.R.E. modules potentially is related to prescription drugs, none of the content or objectives explicitly identify drugs discussed as prescription drugs. If elementary and middle schools rely on D.A.R.E. modules to teach students about drug abuse, students are likely to be underinformed about prescription drug risks. PMID:16981638

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

2006-01-01

61

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

PubMed Central

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.

2012-01-01

62

Medicare beneficiary knowledge of and experience with prescription drug cards.  

PubMed

Medicare beneficiaries used prescription drug discount cards, both Medicare and non-Medicare cards, to assist them in paying for the cost of prescription drugs. This article describes the beneficiary's awareness and understanding, sources of information, and experience with drug discount cards a year prior and during the implementation of the Medicare-Approved Prescription Drug Discount Card program. Also, it explores beneficiary characteristics that contribute to card ownership and knowledge about drug discount cards. Understanding these experiences and factors can inform future outreach and education campaigns for the Medicare Drug Coverage program. PMID:18624082

Rudolph, Noemi V; Williams, Sunyna S

2007-01-01

63

Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy  

PubMed Central

Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785). Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

Reisman, Richard M.; Shenoy, Pareen J.; Atherly, Adam J.; Flowers, Christopher R.

2009-01-01

64

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

ERIC Educational Resources Information Center

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.…

Office of National Drug Control Policy, 2007

2007-01-01

65

Non-Medical Prescription Drug Use among University Students  

ERIC Educational Resources Information Center

Background: Non-medical prescription drug use is an increasing problem among university students. Purpose: The present study investigated university students' involvement in non-medical prescription drug (NMPD) use and associations between use and other risky behaviors. Methods: A sample of 363 university students completed a four page survey…

Vidourek, Rebecca A.; King, Keith A.; Knopf, Ellen E.

2010-01-01

66

A Political History of Medicare and Prescription Drug Coverage  

Microsoft Academic Search

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

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

2004-01-01

67

Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach  

ERIC Educational Resources Information Center

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…

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

2012-01-01

68

How Can I End a Prescription Drug Habit Safely?  

MedlinePLUS

... Fitness Diseases & Conditions Infections Q&A School & Jobs Drugs & Alcohol Staying Safe Recipes En Español Making a change - ... MORE ON THIS TOPIC Dealing With Addiction Prescription Drug Abuse Alcohol School Counselors Talking to Your Doctor Talking to ...

69

26 CFR 51.6302-1T - Method of paying the branded prescription drug fee (temporary).  

Code of Federal Regulations, 2013 CFR

...CONTINUED) BRANDED PRESCRIPTION DRUG FEE § 51.6302-1T Method of paying the branded prescription drug fee (temporary). (a) Fee to...fee imposed on branded prescription drug sales by section 9008 and § 51.5T...

2013-04-01

70

Review of Medicare Payments to Prescription Drug Plans on Behalf of Deceased Enrollees.  

National Technical Information Service (NTIS)

Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Medicare Part D prescription drug benefit. Medicare Part D offers Medicare beneficiaries prescription drug options for health care coverage. The Centers ...

2011-01-01

71

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

Code of Federal Regulations, 2010 CFR

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

2009-10-01

72

21 CFR 201.22 - Prescription drugs containing sulfites; required warning statements.  

Code of Federal Regulations, 2010 CFR

... false Prescription drugs containing sulfites; required warning statements. 201...201.22 Prescription drugs containing sulfites; required warning statements. (a) Sulfites are chemical substances that are...

2009-04-01

73

21 CFR 201.22 - Prescription drugs containing sulfites; required warning statements.  

Code of Federal Regulations, 2010 CFR

... false Prescription drugs containing sulfites; required warning statements. 201...201.22 Prescription drugs containing sulfites; required warning statements. (a) Sulfites are chemical substances that are...

2010-04-01

74

Epidemic: Responding to America's Prescription Drug Abuse Crisis.  

National Technical Information Service (NTIS)

Prescription drug abuse is the Nation's fastest-growing drug problem. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people a...

2011-01-01

75

Community-Based Opioid Overdose Prevention Programs Providing Naloxone: United States, 2010. Morbidity and Mortality Weekly Report, Vol. 61, No. 6, February 17, 2012.  

National Technical Information Service (NTIS)

Drug overdose death rates have increased steadily in the United States since 1979. In 2008, a total of 36,450 drug overdose deaths (i.e., unintentional, intentional (suicide or homicide), or undetermined intent) were reported, with prescription opioid ana...

2012-01-01

76

Medicare program; Medicare Advantage and prescription drug benefit programs: negotiated pricing and remaining revisions; prescription drug benefit program: payments to sponsors of retiree prescription drug plans. Final rule.  

PubMed

This final rule implements and finalizes provisions regarding the reporting of gross covered retiree plan-related prescription drug costs (gross retiree costs) and retained rebates by Retiree Drug Subsidy (RDS) sponsors; and the scope of our waiver authority under the Social Security Act (the Act). PMID:22359793

2012-01-12

77

Alprazolam is relatively more toxic than other benzodiazepines in overdose  

PubMed Central

Aims To describe alprazolam poisoning and the relative toxicity of alprazolam compared with other benzodiazepines. Methods A database of consecutive poisoning admissions to a regional toxicology service was searched to identify consecutive benzodiazepine deliberate self poisonings, which were coded as alprazolam, diazepam or other benzodiazepine. Major outcomes used were length of stay (LOS), intensive care (ICU) admission, coma (GCS < 9), flumazenil administration and requirement for mechanical ventilation. Prescription data were obtained for benzodiazepines for the study period. Results There were 2063 single benzodiazepine overdose admissions: 131 alprazolam overdoses, 823 diazepam overdoses and 1109 other benzodiazepine overdoses. The median LOS for alprazolam overdoses was 19 h which was 1.27 (95% CI 1.04, 1.54) times longer compared with other benzodiazepines by multiple linear regression. For patients with alprazolam overdoses, 22% were admitted to ICU which was 2.06 (95% CI 1.27, 3.33) times more likely compared with other benzodiazepines after multivariate analysis adjusting for age, dose, gender, time to ingestion and co-ingested drugs. Flumazenil was administered to 14% of alprazolam patients and 16% were ventilated, which was significantly more than for other benzodiazepine overdoses (8% and 11%, respectively). Twelve percent of alprazolam overdoses had a GCS < 9 compared with 10% for other benzodiazepines. From benzodiazepine prescription data, total alprazolam prescriptions in Australia increased from 0.13 million in 1992 to 0.41 million in 2001. Eighty five percent of prescriptions were for panic disorder, anxiety, depression or mixed anxiety/depression. Conclusions Alprazolam was significantly more toxic than other benzodiazepines. The increased prescription of alprazolam to groups with an increased risk of deliberate self poisoning is concerning and needs review.

Isbister, Geoffrey K; O'Regan, Luke; Sibbritt, David; Whyte, Ian M

2004-01-01

78

The attitudes of consumers toward direct advertising of prescription drugs.  

PubMed Central

Attitudes about prescription drug advertising directed to consumers were assessed in 1,509 persons who had viewed prototypical advertisements for fictitious prescription drug products. Although many subjects were generally favorable toward the concept of drug advertising directed to consumers, strong reservations were also expressed, especially about television advertising. Prescription drug advertising did not appear to undermine the physician's authority, since respondents viewed the physician as the primary drug decision-maker. However, the physician was not perceived as the sole source of prescription drug information. Television advertising appeared to promote greater information-seeking about particular drugs; however, magazine ads were more fully accepted by subjects. Furthermore, magazine ads led to enhanced views of the patient's authority in drug decision-making. The greater information conveyed in magazine ads may have given subjects more confidence in their own ability to evaluate the drug and the ad. Ads that integrated risk information into the body of the advertisement were more positively viewed than ads that gave special emphasis to the risk information. The results suggest that consumer attitudes about prescription drug advertising are not firmly held and are capable of being influenced by the types of ads people view. Regulation of such ads may need to be flexed to adapt to the way different media are used and processed by consumers.

Morris, L A; Brinberg, D; Klimberg, R; Rivera, C; Millstein, L G

1986-01-01

79

Non-medical use of prescription drugs: implications for NPs.  

PubMed

Nurse practitioners are the first line of defense when combating the problem of nonmedical use of prescription drugs. This article outlines related clinical issues and provides tools and treatment options to use with patients and the community. PMID:22739464

Bettinardi-Angres, Kathy; Bickelhaupt, Ethan; Bologeorges, Stephanie

2012-07-10

80

Health, United States, 2013 Includes Special Section on Prescription Drugs  

MedlinePLUS

... Health Statistics 301-458-4800 Health, United States, 2013 includes special section on prescription drugs Most common ... five or more, according to Health, United States, 2013, the government’s annual, comprehensive report on the nation’s ...

81

Combating Misuse and Abuse of Prescription Drugs  

MedlinePLUS

... into serious trouble. Q: How big is this problem? A: The prevalence of misuse and abuse of prescription medications is concerning. The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal health agency, reports ...

82

Drug Shelving Plan Inside the Drug Prescription Center - A Case Study  

Microsoft Academic Search

This research studies drug shelving plan facing the prescription filling center. Since the prescription center is still in its infancy and the center itself has large amount of different kind of drugs, it needs further improvement in drug storage arrangement. It is found that current drug storage method based only on the alphabetical order to be inefficient and ineffective. From

Hen-Yi Jen; Hung-Chang Lin; Wan-Ching Chou; Shu-Ling Hsiao

2011-01-01

83

Prescription Drug Misuse among Young Adults: Looking Across Youth Cultures  

PubMed Central

Aims Youth cultures play a key role in the social organisation of drug trends among young people; the current prescription drug misuse trend is no different. The authors evaluated whether patterns of prescription drug misuse differed across several youth cultures. Methods Using field survey methods and time-space sampling during 2011, the authors assessed the patterns and prevalence of prescription drug misuse among young adults who are socially active in various urban youth cultures (n = 1781). Findings The prevalence of lifetime prescription drug misuse is highest within indie rock scenes (52.5%), electronic dance music scenes (52.1%), lesbian parties (53.8%) and alt scenes (50.9%). Prescription drug misuse was lowest among young adults in hip-hop scenes (25.0%). These findings were upheld in logistic regression analyses that accounted for demographic differences across youth cultures: indie rock scenes (adjusted odds ratio = 2.11), electronic dance music scenes (adjusted odds ratio = 2.20), lesbian parties (adjusted odds ratio = 2.30) and alt scenes (adjusted odds ratio = 2.65) all reported statistically significant (P < 0.05) higher odds of misuse than college bar scenes. Recent prescription drug misuse mirrored patterns for lifetime misuse. Conclusions: The differing prevalence of prescription drug misuse across distinct youth cultures suggests that the trend has not diffused equally among young people. The differing prevalence across youth cultures indicates that the most efficacious strategies for youth intervention may be targeted approaches that account for the subculturally rooted differences in attitudes and social norms.

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

2012-01-01

84

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

Code of Federal Regulations, 2013 CFR

...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...

2013-04-01

85

21 CFR 300.50 - Fixed-combination prescription drugs for humans.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Fixed-combination prescription drugs for humans. 300...CONTINUED) DRUGS FOR HUMAN USE GENERAL Combination Drugs § 300.50 Fixed-combination prescription drugs for humans....

2009-04-01

86

Prescription drug capitation: risk versus reward.  

PubMed

The unpredictable past and future of the prescription benefit business has resulted in an acute interest by plan sponsors in the concept of capitation. Capitation is effectively an insurance policy, offered by the provider, which will guarantee the cost of the prescription benefit. Such guarantees relative to the cost of the plan are attractive to the sponsor because they minimize risk and facilitate rate setting for HMOs and PPOs--and facilitate budgeting for corporate sponsors. Is capitation a cost-effective win-win alternative to traditional average wholesale price-based arrangements? PMID:10135997

Watt, G T

1994-07-01

87

Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs.  

PubMed

ABSTRACTColchicine has a low therapeutic index. Its toxic effects generally occur at doses ? 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited. PMID:24852590

Little, Anjuli; Tung, David; Truong, Christine; Lapinsky, Stephen; Burry, Lisa

2014-05-01

88

Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs.  

PubMed

ABSTRACTColchicine has a low therapeutic index. Its toxic effects generally occur at doses ? 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited. PMID:24063852

Little, Anjuli; Tung, David; Truong, Christine; Lapinsky, Stephen; Burry, Lisa

2013-01-01

89

[Drug prescriptions outside the marketing product license and its responsibilities].  

PubMed

In France, drugs are commercialized after obtaining marketing approval. There are some situations however in which clinicians are authorized to prescribe drugs outside the limits set by the approval document. Clinicians must comply with certain number of regulations. Compliance with prescription modalities, particularly precautions concerning prescription writing or the patient's informed consent, is mandatory. Although patients cannot be reimbursed for drugs prescribed outside the approval limitations, they may nevertheless benefit from special dispositions: temporary approval for use and experimentation within the framework of the Huriet law. We analyze here the question of liability in case of drug prescriptions outside approval limitations, discussing the issues of civil and penal law and patient reimbursement. PMID:10874916

Gromb, S; Maurain, C; Carbonnel, S

90

Prevalence of the prescription of potentially interacting drugs.  

PubMed

The use of multiple medications is becoming more common, with a correspondingly increased risk of untoward effects and drug-related morbidity and mortality. We aimed at estimating the prevalence of prescription of relevant potentially interacting drugs and at evaluating possible predictors of potentially interacting drug exposure. We retrospectively analyzed data on prescriptions dispensed from January 2004 to August 2005 to individuals of two Italian regions with a population of almost 2.1 million individuals. We identified 27 pairs of potentially interacting drugs by examining clinical relevance, documentation, and volume of use in Italy. Subjects who received at least one prescription of both drugs were selected. Co-prescribing denotes "two prescriptions in the same day", and concomitant medication "the prescription of two drugs with overlapping coverage". A logistic regression analysis was conducted to examine the predictors of potential Drug-Drug Interaction (pDDIs). 957,553 subjects (45.3% of study population) were exposed to at least one of the drugs/classes of the 27 pairs. Overall, pDDIs occurred 2,465,819 times. The highest rates of concomitant prescription and of co-prescription were for ACE inhibitors+NSAIDs (6,253 and 4,621/100,000 plan participants). Considering concomitance, the male/female ratio was <1 in 17/27 pairs (from 0.31 for NSAIDs-ASA+SSRI to 0.74 for omeprazole+clopidogrel). The mean age was lowest for methotrexate pairs (+omeprazole, 59.9 years; +NSAIDs-ASA, 59.1 years) and highest for digoxin+verapamil (75.4 years). In 13/27 pairs, the mean ages were ?70 years. On average, subjects involved in pDDIs received ?10 drugs. The odds of exposure were more frequently higher for age ?65 years, males, and those taking a large number of drugs. A substantial number of clinically important pDDIs were observed, particularly among warfarin users. Awareness of the most prevalent pDDIs could help practitioners in preventing concomitant use, resulting in a better quality of drug prescription and potentially avoiding unwanted side effects. PMID:24147143

Tragni, Elena; Casula, Manuela; Pieri, Vasco; Favato, Giampiero; Marcobelli, Alberico; Trotta, Maria Giovanna; Catapano, Alberico Luigi

2013-01-01

91

Comprehension of Prescription Drug Information: Overview of A Research Program  

Microsoft Academic Search

Both patients and healthcare professionals must understand information about prescription drugs to help them use medications in a safe and effective manner. However drug information materials can be difficult to understand - they can be long, detailed, technical, and complex. Comprehension problems can increase the chances that ineffective treatment or medication errors will occur. This paper presents an overview of

Ruth S. Day

92

78 FR 28862 - Announcement of Requirements and Registration for “Propose New Ideas For Prescription Drugs Oral...  

Federal Register 2010, 2011, 2012, 2013

...of Challenge Competition Prescription drugs are the second-most abused category of drugs in the United States, following marijuana. The most commonly misused prescription drugs fall into three classes: Opioids (pain relievers, analgesics) which...

2013-05-16

93

Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion.  

National Technical Information Service (NTIS)

The increasing diversion of prescription drugs for illegal use is a disturbing trend in the nation's battle against drug abuse. Prescription drug diversion is the channeling of licit pharmaceuticals for illegal purposes or abuse. It can involve activities...

2002-01-01

94

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

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Amyl nitrite inhalant as a prescription drug for human use...Specific Drugs § 250.100 Amyl nitrite inhalant as a prescription drug for human use. (a) Amyl nitrite inhalant has been available...

2010-04-01

95

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

Code of Federal Regulations, 2010 CFR

...2009-04-01 false Amyl nitrite inhalant as a prescription drug for human use...Specific Drugs § 250.100 Amyl nitrite inhalant as a prescription drug for human use. (a) Amyl nitrite inhalant has been available...

2009-04-01

96

Tricyclic antidepressant overdose: a review  

PubMed Central

Overdoses of tricyclic antidepressants are among the commonest causes of drug poisoning seen in accident and emergency departments. This review discusses the pharmacokinetics, clinical presentation and treatment of tricyclic overdose.

Kerr, G; McGuffie, A; Wilkie, S

2001-01-01

97

Commonly Abused Prescription Drug Abuse Chart  

MedlinePLUS

... and properly dispose of any unused medications. Featured Publications Cough and Cold Medicine Abuse (DrugFacts) Revised May ... Treatment Locator or 1-800-662-HELP . Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ...

98

Popping Pills: Prescription Drug Abuse in America  

MedlinePLUS

... Life Treatment Trends & Statistics PDF (2 MB) Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ... affects both brain and behavior. Read more NIDA's Publication Series NIDA Notes DrugFacts Research Reports Mind Over ...

99

Are You Shopping Smart for Prescription Drugs?  

MedlinePLUS

... National Library of Medicine, the Consumer Reports Best Buy Drugs program helps consumers discuss drug choices with their doctors and ... they are prescribed. Knowing what could happen can help prevent discomfort, ... magazine. Consumer Reports Best Buy Drugs™ can be found on the Internet at ...

100

Would legalizing illicit opioids reduce overdose fatalities? Implications from a natural experiment.  

PubMed

Overdose is the leading cause of premature mortality among heroin users. We examine whether the provision of regulated and quality-controlled heroin to users in specified doses would reduce heroin overdose rates. We also address this in the context of the epidemic of prescription opioid use and deaths seen in recent years in the United States and internationally. We explore the extent to which any change in legal access to heroin would affect overdose rates, and note that this depends upon the validity of the two main assumptions that variations in illicit drug purity and/or the presence of drug contaminants are major causes of overdose. Toxicological and demographic data from studies of heroin overdose deaths do not support these assumptions. The surge in the use of pharmaceutical opioids provides an example of the legal delivery of opioids of known dosage and free of contaminants, where overdose deaths can be examined to test these assumptions. Rates of fatal opioid overdose have escalated, with increased rates of prescribing of pharmaceutical opioids. On the basis of the experience with prescription opioids, unregulated legal heroin access would not reduce overdose rates. PMID:24456133

Darke, Shane; Farrell, Michael

2014-08-01

101

Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users  

PubMed Central

Background Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration. Methods Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months. Results One third of participants (n=829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently. Conclusions Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.

Kinner, Stuart A.; Milloy, M-J.; Wood, Evan; Qi, Jiezhi; Zhang, Ruth; Kerr, Thomas

2013-01-01

102

Prescription Drugs: FDA's Oversight of the Promotion of Drugs for Off-Label Uses.  

National Technical Information Service (NTIS)

The Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), regulates the promotion of prescription drugs to ensure that promotional materials are not false and misleading and that they comply with applicabl...

2008-01-01

103

Prescription Drug User Fee Act (PDUFA) IV Drug Safety Five-Year Plan 2008 - 2012.  

National Technical Information Service (NTIS)

The Prescription Drug User Fee Act (PDUFA) enacted in 1992 provided authority for FDA to collect additional resources (fees from industry) and enable FDA to accelerate its drug evaluation process without compromising review quality. Since 1992 PDUFA has s...

2008-01-01

104

Aminophylline overdose  

MedlinePLUS

Theophylline overdose; Xanthine overdose ... Aminophylline Theophylline ... Aminophylline Theophylline (Theo-Dur, Slo-Phyllin, Theolair, Slo-Bid) Various asthma medications Note: This list may not be all- ...

105

A New Prescription for Fighting Drug Abuse  

ERIC Educational Resources Information Center

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…

Schachter, Ron

2012-01-01

106

Prescription drug formularies in managed care: concerns for the elderly population  

Microsoft Academic Search

Prescription drug formularies are a key element in the rapidly growing trend of prescription drug benefit management. The use of formularies can increase the quality of prescribing and reduce the costs of prescription drug therapy. This is particularly important to older Americans, who represent about 13% of the population but consume roughly one third of the drugs prescribed in the

David J. Gross

1998-01-01

107

Rural Adolescents' Nonmedical Prescription Drug Use: Implications for Intervention  

ERIC Educational Resources Information Center

Rural communities often have distinct contextual factors that impact residents' substance abuse behavior. However, most studies to date have focused either exclusively on urban populations or neglected to analyze data in a way that allows any rural/urban comparison. This is especially true for research examining nonmedical prescription drug use…

Young, April M.; Glover, Natalie; Havens, Jennifer R.

2012-01-01

108

Justice Implications of a Proposed Medicare Prescription Drug Policy  

ERIC Educational Resources Information Center

Social justice is a core value to the mission of social work. Older people are among the most vulnerable populations for whom social workers are called on to advocate. Although Medicare prescription drug coverage has been a top legislative issue over the past few years, such a benefit expansion has yet to be implemented. This article examines the…

Larkin, Heather

2004-01-01

109

Prescription Drug Abuse Among Adolescent Arrestees: Correlates and Implications  

Microsoft Academic Search

This preliminary study examines the correlates of prescription drug abuse in a sample of adolescents in an urban juvenile detention center in Ohio. The study measures risk in 359 incarcerated females (20.1%) and 1,425 males (79.9%) by asking questions related to problems with alcohol, drug use, treatment history, mental and physical health problems, sexual behavior, anger management, physical violence, and

Sonia A. Alemagno; Peggy Stephens; Peggy Shaffer-King; Brent Teasdale

2009-01-01

110

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings  

PubMed Central

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.

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

2013-01-01

111

Health Outcomes in Patients Using No-Prescription Online Pharmacies to Purchase Prescription Drugs  

PubMed Central

Background Many prescription drugs are freely available for purchase on the Internet without a legitimate prescription from a physician. Objective This study focused on the motivations for using no-prescription online pharmacies (NPOPs) to purchase prescription drugs rather than using the traditional doctor-patient-pharmacy model. We also studied whether users of NPOP-purchased drugs had poorer health outcomes than those who obtain the same drug through legitimate health care channels. Methods We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. Using search engine marketing (SEM), we placed advertisements on search result pages stemming from the keyword “tramadol” and related terms and phrases. Participants, who either used the traditional doctor-patient-pharmacy model to obtain tramadol (traditional users, n=349) or purchased it on the Web without a prescription from their local doctor (ie, nontraditional users, n=96), were then asked to complete an online survey. Results Respondents in both groups were primarily white, female, and in their mid-forties (nontraditional users) to upper forties (traditional users). Nearly all nontraditional users indicated that their tramadol use was motivated by a need to treat pain (95%, 91/96) that they perceived was not managed appropriately through legitimate health care channels. A majority of nontraditional users (55%, 41/75) indicated they used NPOPs because they did not have access to sufficient doses of tramadol to relieve pain. In addition, 29% (22/75) of nontraditional users indicated that the NPOPs were a far cheaper alternative than seeing a physician, paying for an office visit, and filling a prescription at a local pharmacy, which is often at noninsured rates for those who lack medical insurance (37%, 35/96, of NPOP users). The remainder of participants (16%, 12/96) cited other motivations (eg, anonymity) for using NPOPs. In terms of health outcomes, nontraditional users experienced a significantly (P<.01) greater number and severity of adverse events, including life-threatening seizures: 7% (7/96) of nontraditional users reported seizures, while none of the traditional users reported seizures. Conclusions Although online pharmacies can offer distinct advantages in terms of convenience and cost, users of these “rogue” pharmacies that offer drugs with no prescription or doctor supervision do so at great risk to their health, as evidenced by much higher rates of adverse events. The most logical explanation for these findings is that the lack of physician oversight of dosage schedules, contraindicated conditions, and concomitant medications, were responsible for the increased intensity and frequency of adverse events in the nontraditional users. Although we only examined tramadol, it is logical to postulate that similar results would be observed with dozens of equally accessible prescription drugs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care.

2012-01-01

112

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

Code of Federal Regulations, 2013 CFR

...standing technical advisory committees for human prescription drugs. 14.160 Section...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PUBLIC HEARING BEFORE...ADVISORY COMMITTEE Advisory Committees for Human Prescription Drugs § 14.160...

2013-04-01

113

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

Code of Federal Regulations, 2010 CFR

...storage and handling of prescription drugs and for the...and maintenance of prescription drug distribution records...regulations that relate to prescription drug product salvaging...Approved by the Office of Management and Budget under...

2010-04-01

114

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

...General response to the public health problem of prescription drug abuse among youth. SUPPLEMENTARY INFORMATION: Scope of Problem: Prescription drug abuse \\1\\ remains...to address the prescription drug abuse problem, which included engaging the Office...

2011-05-03

115

Fatal heroin 'overdose': a review  

Microsoft Academic Search

The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and circumstances of such deaths. In particular, the dominance of the widely held belief that heroin-related fatalities are a consequence of overdose is challenged. Deaths attributed to overdose represented in the literature are typically older, heroin-dependent males not in drug treatment at the

SHANE DARKE; DEBORAH ZADOR

1996-01-01

116

Drug overdose due to malfunction of a patient-controlled analgesia machine -A case report-  

PubMed Central

Patient-controlled analgesia (PCA) provides excellent pain control and high stability, thereby minimizing the incidence of adverse effects. However, one of our patients experienced respiratory depression and hypotension within 30 minutes of initiation of PCA therapy. We discovered that machine malfunction caused continuous activation of the PCA button, resulting in a drug overdose. The PCA machine was sent to the manufacturer, who found an electrical short in the PCA button. All PCA units of the same make and model were immediately removed from hospitals and replaced with redesigned units without defects in the PCA button. We have used the improved machines without any problems. The purpose of this report is to raise awareness of this type of malfunction in PCA units in order to help prevent adverse events in the future.

Yi, Yuri; Kang, Seongsik

2013-01-01

117

Supply-side response to declining heroin purity: fentanyl overdose episode in new jersey.  

PubMed

The inelastic price demand observations characteristic of illegal drug markets have led to the conclusion that the burden of a negative supply shock would be completely reflected to consumers. This paper argues that the increasing availability of prescription opioids may threaten heroin sellers' profit margin and force them to find alternative methods to compensate buyers in the event of a supply shock. We investigate the 2006 fentanyl overdose episode in New Jersey and argue that the introduction of non-pharmaceutical fentanyl, its spatial distribution, and the timing of overdose deaths may have been related to trends in heroin purity. Using medical examiner data, as well as data from the Drug Enforcement Administration, Office of Diversion Control on retail sales of prescription opioids in a negative binomial specification, we show that month-to-month fluctuations in heroin purity have a significant effect on fentanyl-related overdoses, particularly in those areas where prescription opioids are highly available. PMID:23740651

Hempstead, Katherine; Yildirim, Emel O

2014-06-01

118

78 FR 53152 - Prescription Drug User Fee Rates for Fiscal Year 2014; Correction  

Federal Register 2010, 2011, 2012, 2013

...Docket No. FDA-2013-N-0007] Prescription Drug User Fee Rates for Fiscal Year...is correcting a notice entitled ``Prescription Drug User Fee Rates for Fiscal Year...Fiscal Year 2014 fee rates for the Prescription Drug User Fee Act. The document...

2013-08-28

119

On the demand for prescription drugs: heterogeneity in price responses.  

PubMed

This paper estimates the price elasticity of demand for prescription drugs using an exogenous shift in consumer co-payment caused by a reform in the Danish subsidy scheme for the general public. Using purchasing records for the entire Danish population, I show that the average price response for the most commonly used drug yields demand elasticities in the range of -0.36 to -0.5. The reform is shown to affect women, the elderly, and immigrants the most. Furthermore, this paper shows significant heterogeneity in the price response over different types of antibiotics, suggesting that the price elasticity of demand varies considerably even across relatively similar drugs. PMID:22899231

Skipper, Niels

2013-07-01

120

Prescription drug use in the elderly: a descriptive analysis.  

PubMed

In the current policy debate, pharmaceutical use in the elderly has been characterized largely by its economic impact, with little discussion of what drugs the elderly are taking. Based on data from the Medicare Current Beneficiary Survey (MCBS), this study defines subgroups of the community-dwelling elderly using health and functional status, and provides a comprehensive description of the composition of prescription drug use in this population. Drugs are classified into 16 primary therapeutic classes, with further breakdown into secondary classes and characterization by chronic versus acute use. Utilization is reported by age and health status categories. PMID:14628405

Moxey, Elizabeth D; O'Connor, John P; Novielli, Karen D; Teutsch, Steven; Nash, David B

2003-01-01

121

Development of a Patient-Centered Bilingual Prescription Drug Label  

PubMed Central

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.

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

2013-01-01

122

Development of a patient-centered bilingual prescription drug label.  

PubMed

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

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

2013-01-01

123

21 CFR 300.50 - Fixed-combination prescription drugs for humans.  

Code of Federal Regulations, 2013 CFR

... Fixed-combination prescription drugs for humans. 300.50 Section 300.50 Food and Drugs...DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE GENERAL Combination Drugs §...

2013-04-01

124

Growing internet use may help explain the rise in prescription drug abuse in the United States  

PubMed Central

The rise in availability of commonly abused prescription drugs through the internet has raised public health concerns. We examined whether U.S. prescription drug abuse growth may be explained by growth in internet use. We find that for every 10 percent increase in high-speed internet use at the state level, associated admissions for prescription drug abuse rose by 1 percent. Non-prescription drug related admissions bore no association with internet use. The results suggest that better surveillance of online prescription drug use is warranted, and aggressive efforts to curb illegitimate online pharmacies may be necessary.

Goldman, Dana P.; Jena, Anupam B.

2013-01-01

125

Amitriptyline and perphenazine overdose  

MedlinePLUS

Brush DE, Aaron CK. Tricyclic and other cyclic antidepressants. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose . 4th ed. Philadelphia, Pa: ...

126

Petroleum jelly overdose  

MedlinePLUS

Shannon MW. Emergency Management of Poisoning. In: Shannon, MW, Borron, SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 2.

127

Adrenergic bronchodilator overdose  

MedlinePLUS

... Rittenberger JC. Clinical neurotoxicology. In: Shannon MW, Borron SW, Burns MJ. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose . 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 10.

128

Prescription and Over-the-Counter Drug Abuse Admissions. The DASIS Report.  

National Technical Information Service (NTIS)

Prescription and over-the-counter (OTC) drug abuse accounted for a small fraction (3 percent) of the 1.6 million admissions reported to the Treatment Episode Data Set (TEDS) in 1999. Prescription drugs in TEDS are grouped as follows: prescription narcotic...

2002-01-01

129

21 CFR 300.50 - Fixed-combination prescription drugs for humans.  

Code of Federal Regulations, 2010 CFR

The Food and Drug Administration's policy in administering the new-drug, antibiotic, and other regulatory provisions of the Federal Food, Drug, and Cosmetic Act regarding fixed combination dosage form prescription drugs for humans is as...

2010-04-01

130

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

Code of Federal Regulations, 2013 CFR

...distribution of prescription drugs. (a) Identifying statement for sales by unauthorized distributors...identifying each prior sale, purchase, or trade of such drug. This identifying...identifying the previous sales of the component drug or drugs....

2013-04-01

131

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

Code of Federal Regulations, 2010 CFR

...2010-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2010-04-01

132

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

Code of Federal Regulations, 2010 CFR

...2009-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2009-04-01

133

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

Code of Federal Regulations, 2010 CFR

...1998-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

1998-04-01

134

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

Code of Federal Regulations, 2010 CFR

...1997-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

1997-04-01

135

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

Code of Federal Regulations, 2010 CFR

...1999-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

1999-04-01

136

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

Code of Federal Regulations, 2010 CFR

...2003-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2003-04-01

137

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

Code of Federal Regulations, 2010 CFR

...2007-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2007-04-01

138

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

Code of Federal Regulations, 2010 CFR

...2004-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2004-04-01

139

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

Code of Federal Regulations, 2010 CFR

...2000-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2000-04-01

140

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

Code of Federal Regulations, 2010 CFR

...2001-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2001-04-01

141

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

Code of Federal Regulations, 2010 CFR

...2005-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2005-04-01

142

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

Code of Federal Regulations, 2010 CFR

...2006-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2006-04-01

143

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

Code of Federal Regulations, 2010 CFR

...2008-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2008-04-01

144

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

Code of Federal Regulations, 2010 CFR

...2002-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2002-04-01

145

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

Code of Federal Regulations, 2010 CFR

...2011-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2011-04-01

146

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

Code of Federal Regulations, 2010 CFR

...2012-04-01 false Amphetamine and methamphetamine inhalers regarded as prescription...Drugs § 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

2012-04-01

147

National Estimates of Prescription Drug Utilization and Expenditures in Long-Term Care Facilities.  

National Technical Information Service (NTIS)

Although several studies have provided national estimates of prescription drug use by Medicare beneficiaries residing in nursing homes (NHs) and other long-term care facilities (LTCFs), there are no published estimates of expenditures for prescription med...

B. Stuart L. Simoni-Wastila T. Shaffer

2006-01-01

148

The New Medicare Part D Prescription Drug Benefit: An Estimation of Its Effect on Prescription Drug Costs in a Medicare Population with Atrial Fibrillation  

PubMed Central

OBJECTIVES To compare prescription drug cost savings under the most commonly selected Medicare Part D prescription plan in 2006 with savings under the Medicare standard benefit and with drug costs assuming no coverage in an elderly cohort of patients. DESIGN Inception cohort study. SETTING An academic medical center. PARTICIPANTS Four hundred seventy-two patients aged 65 and older who were followed as part of a larger study assessing stroke prevention in patients with atrial fibrillation. MEASUREMENTS Prescription drug expenditures were calculated for each patient in the cohort under three conditions: the 2006 AARP-endorsed prescription drug plan, the Medicare standard benefit, and no prescription drug coverage. RESULTS Total prescriptions drug costs were lower under the AARP plan, yet patients paid a similar percentage of total costs under the AARP plan and the Medicare standard benefit. Using different cost assessments, 27% to 46% of patients entered the “doughnut hole” in the AARP plan, and 3% to 11% emerged to receive catastrophic coverage. CONCLUSION Both the AARP-sponsored and standard Medicare Part D prescription drug benefit programs offer significant savings to enrollees. A greater savings is achieved under the private AARP drug insurance plan, largely due to greater discounts reflected in the negotiated drug prices. A substantial portion of enrollees enter but do not emerge from the coverage gap. J Am Geriatr Soc 55:1038–1043, 2007.

Evans-Molina, Carmella; Regan, Susan; Henault, Lori E.; Hylek, Elaine M.; Schwartz, Gregory R.

2014-01-01

149

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

PubMed Central

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.

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

2012-01-01

150

Methadone-Associated Overdose Deaths: Factors Contributing to Increased Deaths and Efforts to Prevent Them.  

National Technical Information Service (NTIS)

Prescription drug abuse is a growing public health problem. In particular, methadone-associated overdose deaths--those in which methadone may have caused or contributed to the death--have risen sharply. Before the late 1990s, methadone was used mainly to ...

2009-01-01

151

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

Microsoft Academic Search

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

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

2011-01-01

152

Licit, Illicit, and Non-medical Prescription Drug Abuse Among Pharmacists  

Microsoft Academic Search

The use of licit, illicit, and non-medical prescription drug abuse among pharmacists is a growing problem in the U.S. Studies and surveys have shown that health care professionals, including pharmacists, are more likely than the general population to abuse drugs, particularly prescription drugs. As pharmacists, this poses an ethical problem for all of us. As a pharmacist, we are one

Anna McDonald

153

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

Federal Register 2010, 2011, 2012, 2013

The Food and Drug Administration (FDA) is announcing the availability of a guidance for industry entitled ``Labeling for Human Prescription Drug and Biological Products--Implementing the PLR Content and Format Requirements.'' This guidance is intended to assist applicants in complying with the content and format requirements of labeling for human prescription drug and biological products. The......

2013-02-25

154

Suicide due to cyclizine overdose.  

PubMed

Cyclizine is an antihistamine with sedative effect used to treat motion sickness. A few studies have reported on cyclizine abuse among teenagers, and cyclizine abuse has been reported among opioid dependants receiving methadone, with the combination having been reported to produce strong psychoactive effects. Few reports exist on the possible toxic effects of cyclizine, and it is regarded as a safe drug most often sold as a non-prescription/over-the-counter drug. Very few cases of fatalities resulting from cyclizine overdose can be found in the literature. We present a case where a 22-year-old female was found unconscious and intoxication with drugs and alcohol was suspected. Whole blood from the femoral vein, urine and stomach content were collected during autopsy and screened for drugs of abuse and medicinal drugs. GC-MS screening of the stomach contents revealed presence of cyclizine and meclozine. Cyclizine and meclozine concentrations in blood were determined using a UPLC-MS-MS method. Quantification of femoral blood revealed a high concentration of cyclizine (16 mg/L), a low concentration of meclozine (0.2 mg/L) and ethanol 0.16 g/dL. No other medicinal drugs or drugs of abuse were detected. We report on a case of suicide where cyclizine was found to be the principal drug and question the safety of this drug. PMID:24324230

Arnestad, Marianne; Eldor, Kari Beate Boye; Stray-Pedersen, Arne; Bachs, Liliana; Karinen, Ritva

2014-03-01

155

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

Code of Federal Regulations, 2010 CFR

...Minimum requirements for the storage and handling of prescription...Minimum requirements for the storage and handling of prescription...for the receipt, security, storage, inventory, and distribution...prescription drug product is distributed first. The procedure may...

2009-04-01

156

Changing Effects of Direct-to-Consumer Broadcast Drug Advertising Information Sources on Prescription Drug Requests  

Microsoft Academic Search

This study tracks the changes of the effects of 4 information sources for direct-to-consumer drug advertising on patients' requests for prescription drugs from physicians since the inception of the “Guidance for Industry about Consumer-directed Broadcast Advertisements.” The Guidance advises pharmaceuticals to use four information sources for consumers to seek further information to supplement broadcast drug advertisements: small-print information, the Internet,

Annisa Lai Lee

2009-01-01

157

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

Code of Federal Regulations, 2010 CFR

...requirements on content and format of labeling for human prescription drug and biological products...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL...requirements on content and format of labeling for human prescription drug and biological...

2012-04-01

158

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

Code of Federal Regulations, 2010 CFR

...requirements on content and format of labeling for human prescription drug and biological products...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL...requirements on content and format of labeling for human prescription drug and biological...

2012-04-01

159

An Exploration of Social Circles and Prescription Drug Abuse Through Twitter  

PubMed Central

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.

2013-01-01

160

Nonmedical Use of Prescription ADHD Stimulants and Preexisting Patterns of Drug Abuse  

PubMed Central

Multidrug use is well documented among nonmedical users of prescription stimulants. We sought to provide insight into the drug use patterns of those reporting nonmedical use of prescription attention-deficit hyperactivity disorder (ADHD) stimulants in an attempt to discern whether such use is a first step in a pattern of drug-abusing behavior or, conversely, is a later development accompanied or preceded by a history of drug abuse. A cross-sectional, population-based survey of the U.S. civilian, non-institutionalized population aged 12 years and older was analyzed for lifetime nonmedical use of prescription ADHD stimulants, lifetime nonmedical use of another prescription drug, illicit drug use, and drug use initiation patterns. This included 443,041 respondents from the 2002–2009 National Survey on Drug Use and Health. Lifetime nonmedical use of prescription ADHD stimulants was reported by 3.4% of those aged 12 years and older. Of these, 95.3% also reported use of an illicit drug (i.e., marijuana, cocaine/crack, heroin, hallucinogens, inhalants) or nonmedical use of another prescription drug (i.e., tranquilizers, pain relievers, or sedatives), and such use preceded nonmedical use of prescription ADHD stimulants in 77.6% of cases. On average, 2.40 drugs were used prior to the first nonmedical use of prescription ADHD stimulants. These data suggest that nonmedical use of prescription ADHD stimulants is not commonly an initiating factor leading to the nonmedical use of other prescription medications or abuse of illicit drugs. Rather, nonmedical use of prescription ADHD stimulants appears to be adopted by individuals already engaged in broader patterns of drug abuse and misuse.

Sweeney, Christine T.; Sembower, Mark A.; Ertischek, Michelle D.; Shiffman, Saul; Schnoll, Sidney H.

2013-01-01

161

Nonmedical use of prescription ADHD stimulants and preexisting patterns of drug abuse.  

PubMed

Multidrug use is well documented among nonmedical users of prescription stimulants. We sought to provide insight into the drug use patterns of those reporting nonmedical use of prescription attention-deficit hyperactivity disorder (ADHD) stimulants in an attempt to discern whether such use is a first step in a pattern of drug-abusing behavior or, conversely, is a later development accompanied or preceded by a history of drug abuse. A cross-sectional, population-based survey of the U.S. civilian, non-institutionalized population aged 12 years and older was analyzed for lifetime nonmedical use of prescription ADHD stimulants, lifetime nonmedical use of another prescription drug, illicit drug use, and drug use initiation patterns. This included 443,041 respondents from the 2002-2009 National Survey on Drug Use and Health. Lifetime nonmedical use of prescription ADHD stimulants was reported by 3.4% of those aged 12 years and older. Of these, 95.3% also reported use of an illicit drug (i.e., marijuana, cocaine/crack, heroin, hallucinogens, inhalants) or nonmedical use of another prescription drug (i.e., tranquilizers, pain relievers, or sedatives), and such use preceded nonmedical use of prescription ADHD stimulants in 77.6% of cases. On average, 2.40 drugs were used prior to the first nonmedical use of prescription ADHD stimulants. These data suggest that nonmedical use of prescription ADHD stimulants is not commonly an initiating factor leading to the nonmedical use of other prescription medications or abuse of illicit drugs. Rather, nonmedical use of prescription ADHD stimulants appears to be adopted by individuals already engaged in broader patterns of drug abuse and misuse. PMID:23480243

Sweeney, Christine T; Sembower, Mark A; Ertischek, Michelle D; Shiffman, Saul; Schnoll, Sidney H

2013-01-01

162

Motivations for Non-Medical Prescription Drug Use: A Mixed Methods Analysis  

PubMed Central

Despite a dramatic increase in the non-medical use of prescription drugs among illicit drug users, their motives for abusing prescription drugs are still largely unknown. The objective of this study was to 1) determine the motivations for engaging in the non-medical use of prescription opioids and sedatives among street-based illicit drug users, methadone maintenance patients, and residential drug treatment clients, 2) examine associations between prescription drug abuse motivations and gender, age, race/ethnicity, and user group, and 3) examine associations between specific motivations and prescription drug abuse patterns. Quantitative surveys (n = 684) and in-depth interviews (n = 45) were conducted with a diverse sample of prescription drug abusers in South Florida between March 2008 and November 2009. The three most common motivations reported were “to get high”, “to sleep”, and “for anxiety/stress”. There were age, race/ethnicity, and gender differences by motives. Prescription drug abuse patterns were also found to be associated with specific motivations. While additional research is needed, these findings serve to inform appropriate prevention and treatment initiatives for prescription drug abusers.

Rigg, Khary K.; Ibanez, Gladys E.

2010-01-01

163

Perception of Generic Prescription Drugs and Utilization of Generic Drug Discount Programs  

PubMed Central

Objective Our study aimed to assess patient’s perceptions of generic drugs and utilization of generic drug discount programs. Design, Setting and Participants A survey was administered to adult participants at community health centers and community-based organizations in Houston, Texas, USA (n=525). Main Outcome Measures Multivariate logistic regression was used to quantify the strength of association between generic drug perception and utilization of generic drug discount programs. Results Respondents who agreed that “Generic prescription drugs are as effective as brand name prescription drugs,” were 3 times as likely to utilize generic drug discount programs (AOR: 3.0, 95% CI: 1.8–4.8, P<.001). Compared to non-Hispanic Whites, African Americans (OR: 10.2; 95% CI: 1.4–76.4) and Hispanics (OR: 10.3; 95% CI: 1.3–79.4) were 10 times as likely to agree that generic drugs have more side effects than brand name drugs. Conclusion Race/ethnicity had no impact in utilization of generic drug discount programs, despite racial disparities in perception toward generic drugs’ side effects and generic drugs being inferior to brand name drugs.

Omojasola, Anthony; Hernandez, Mike; Sansgiry, Sujit; Jones, Lovell

2012-01-01

164

New Medicare-approved prescription drug discount card.  

PubMed

Patients who are on Medicare and have income under 135% of Federal poverty level and are not on Medicaid probably should obtain one of the new Medicare discount cards that became available on June 1, 2004, because all these cards include $600 annual credit for prescription-drug purchases for persons within that income limit. Unfortunately this program is complex, no one yet knows how it will work in practice, and after choosing a card one is locked in and cannot change cards until November 15. The most difficult part of the choice of which card to get may involve how it interacts with other programs, including ADAP, and pharmaceutical company patient assistance programs. PMID:15241856

James, John S

2004-05-28

165

Oversight of the Prescriber Identifier Field in Prescription Drug Event Data for Schedule II Drugs.  

National Technical Information Service (NTIS)

Pursuant to section 1860D-15(c)(1)(C) and (d)(2) of the Act and 42 CFR Section 423.322(a), sponsors must submit the information necessary for CMS to carry out Part D payment provisions for the coverage year. Sponsors submit Prescription Drug Event (PDE) r...

2011-01-01

166

Epidemiologic Trends in Drug Abuse Advance Report: Prescription Drug Abuse. Community Epidemiology Work Group, June 2004.  

National Technical Information Service (NTIS)

This Advance Report is based on findings related to the nonmedical use or abuse of prescription drugs that were presented at the 56th semiannual meeting of the Community Epidemiology Work Group (CEWG) in Arlington, Virginia, on June 811, 2004, under spons...

2004-01-01

167

Heroin overdose: Research and evidence-based intervention  

Microsoft Academic Search

Drug overdose is a major cause of premature death and morbidity among heroin users. This article examines recent research\\u000a into heroin overdose to inform interventions that will reduce the rate of overdose death. The demographic characteristics\\u000a of overdose cases are discussed, including factors associated with overdose: polydrug use, drug purity, drug tolerance, routes\\u000a of administration, and suicide. Responses by heroin

Shane Darke; Wayne Hall

2003-01-01

168

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

ERIC Educational Resources Information Center

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.…

Keller, Mary Jane; Green, Monica A.

1981-01-01

169

Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients  

Microsoft Academic Search

BACKGROUND: Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce. METHOD: We used the ACE Score (an integer count of

Robert F Anda; David W Brown; Vincent J Felitti; Shanta R Dube; Wayne H Giles

2008-01-01

170

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

Microsoft Academic Search

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

Dhaval Dave; Henry Saffer

2010-01-01

171

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

Federal Register 2010, 2011, 2012, 2013

...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...

2011-09-19

172

CBO Study: Issues in Designing a Prescription Drug Benefit for Medicare.  

National Technical Information Service (NTIS)

One of lawmakers' highest health-related priorities is adding a prescription drug benefit to Medicare. Although that program gives older Americans broad insurance coverage for many health needs, it provides only limited coverage of drugs not dispensed dur...

2002-01-01

173

Review of Medicare Part D Prescription Drug Event Data for Schedule II Drugs at Health Net, Inc.  

National Technical Information Service (NTIS)

Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 amended Title XVIII of the Social Security Act (the Act) by establishing the Medicare Part D prescription drug program. Under Part D, which began January 1, 2006, indivi...

2011-01-01

174

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

Microsoft Academic Search

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:

Michelle Firestone; Benedikt Fischer

2008-01-01

175

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

PubMed

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

Gugelmann, Hallam; Perrone, Jeanmarie; Nelson, Lewis

2012-12-01

176

[Prescriptions for anorectic psychotropic drugs in the municipality of Juiz de Fora, Minas Gerais, Brazil].  

PubMed

Obesity is a serious public health issue of epidemic proportions. Although drug therapy is one of the therapeutic approaches, it should be preceded by a change in eating habits along with regular exercise. This study assessed prescription of such drugs in 2009, in Juiz de Fora, Minas Gerais, Brazil. Data were collected from consumption bulletins sent monthly to the municipal sanitary surveillance agency (VISA), and from the Brazilian National Management System of Controlled Products. Of the 7,759 notifications assessed, 93.3% were dispensed by prescription pharmacies and 6.7% by drugstores. Of that total, 55.4% were for amphepramone, 33.1% for femproporex, and 11.5% for mazindol. The three drugs had a larger consumption rate in the municipality (daily defined dose/1,000 inhabitants/day) than in the country as a whole, during the period under study. The professional with the highest prescription rate was responsible for 3,535 prescriptions. All of these were dispensed by prescription pharmacies, a single outlet being responsible for 99.5% of these prescriptions. This scenario shows that anorectic psychotropic drug prescription is a relevant public health issue and the criteria for monitoring the prescription and consumption of these drugs should be re-evaluated. PMID:23175409

Martins, Eduardo Luiz Mendonça; do Amaral, Maria da Penha Henriques; Ferreira, Maria Beatriz Cardoso; de Mendonça, Alessandra Ésther; Pereira, Mônica Cecília Santana; Pereira, Denise Campos; Ribeiro, Paula Maria; Brumano, Larissa Pereira

2012-12-01

177

Prescription and over-the-counter drug treatment admissions to the California public treatment system  

PubMed Central

Prescription and over-the-counter (OTC) drug abuse has become a focal point of public health policy, prevention, and control efforts. Adolescents represent one of the fastest growing segments of the general population abusing prescription and OTC drugs as represented by national surveys. This article reports on treatment admission data to the California addiction public system for prescription and OTC drugs among two age subgroups: adolescents 12–17 years and adults 18 years and older. Of the 6,841 admissions for primary abuse of prescription and OTC drugs in California (during 2006–2007), most adolescent admissions (12–17) were for stimulant prescription and OTC drugs (45.3% and 32.1%, respectively), whereas opioid prescription drugs (88.9%) were most common for adults 18 years and older. Differences in psychosocial, treatment, and substance use characteristics between these two age subgroups are described. Results from this study offer useful treatment admission information about prescription and OTC drug abuse within the California public addiction treatment system.

Gonzales, Rachel; Brecht, Mary-Lynn; Mooney, Larissa; Rawson, Richard A.

2014-01-01

178

The Impact of a Three-Tier Formulary on Demand Response for Prescription Drugs  

Microsoft Academic Search

A large number of health plans and employers have adopted three-tier prescription drug formularies in an effort to control rising prescription drug costs. We assessed the behavioral response to three-tier adoption by estimating econometric models of the probability of selecting drugs assigned to the third tier with the highest co-payment requirement and changes in expected out-of-pocket (OOP) spending. We concluded

Haiden A. Huskamp; Richard G. Frank; Kimberly A. McGuigan; Yuting Zhang

2005-01-01

179

A Computational Drug-Target Network for Yuanhu Zhitong Prescription  

PubMed Central

Yuanhu Zhitong prescription (YZP) is a typical and relatively simple traditional Chinese medicine (TCM), widely used in the clinical treatment of headache, gastralgia, and dysmenorrhea. However, the underlying molecular mechanism of action of YZP is not clear. In this study, based on the previous chemical and metabolite analysis, a complex approach including the prediction of the structure of metabolite, high-throughput in silico screening, and network reconstruction and analysis was developed to obtain a computational drug-target network for YZP. This was followed by a functional and pathway analysis by ClueGO to determine some of the pharmacologic activities. Further, two new pharmacologic actions, antidepressant and antianxiety, of YZP were validated by animal experiments using zebrafish and mice models. The forced swimming test and the tail suspension test demonstrated that YZP at the doses of 4?mg/kg and 8?mg/kg had better antidepressive activity when compared with the control group. The anxiolytic activity experiment showed that YZP at the doses of 100?mg/L, 150?mg/L, and 200?mg/L had significant decrease in diving compared to controls. These results not only shed light on the better understanding of the molecular mechanisms of YZP for curing diseases, but also provide some evidence for exploring the classic TCM formulas for new clinical application.

Lu, Peng; Zhang, Fangbo; Yuan, Yuan; Wang, Songsong

2013-01-01

180

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...

181

Deadly heroin or the death of heroin -- overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.  

PubMed

Rates of illicit drug use and drug-related deaths have continuously increased in developed countries since the 1960s even though the patterns of use and thus the related mortality differ from region to region. In Europe heroin is the drug most often implicated in overdoses. The decedents are most often male, between 20 and 30 years of age and have a long history of drug use. According to the majority of available studies a concomitant use of alcohol and benzodiazepines is one of the risk factors of heroin overdose. In our study we have examined the basic demographic and toxicological features of illicit drug related death cases in Budapest, Hungary between 1994 and 2012. Drug overdose death cases have been divided into two subgroups according to the substances responsible for the death of the subjects: an opioid group and a non-opioid group. The huge majority (87.9%) of decedents died due to heroin overdose and were male (87%). There has been a significant increase in the mean age of the opioid group for the past 19 years. The majority of heroin overdose cases (58%) has had no other psychofarmacons present at the toxicological examination. We have found a slight but significant positive correlation (p=0.0204, r=0.349) between the number of heroin overdose death cases and the mean concentration of street level purity heroin. Most of the examined demographic and toxicological features of the population studied have been in concordance with data previously reported. However, in contrast to other studies we report a strikingly high proportion of "pure" heroin overdose cases where no other psychoactive substances were found. The reason for this is currently unknown; we can only speculate that it can be related to the fact that heroin is used and abused differently from other countries. The remarkable phenomenon of the "ageing" of heroin users may also support a change in the drug use habits of the youngest population. The emergence and spread of new designer drugs also change the mortality characteristics of the youngest abusers and pose a new challenge for researchers. PMID:24380966

Horváth, Mónika; Dunay, György; Csonka, Renata; Keller, Éva

2013-12-01

182

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

PubMed Central

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.

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

183

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

PubMed Central

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.

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

2013-01-01

184

Injectable paracetamol in children: yet more cases of 10-fold overdose.  

PubMed

Intravenous paracetamol injection is associated with a risk of 10-fold overdose. This is due to confusion between normal dose prescription in milligrams and administration in millilitres of injectable solution (containing 10 mg per ml). Reports of overdose show that the consequences can be severe, due to the hepatic toxicity of paracetamol, which may be fatal if the error is not detected rapidly enough for antidote (acetylcysteine) administration. In practice, injectable paracetamol should only be prescribed when oral administration is not possible. Care must be taken when calculating the dose to be administered, and the calculation must be double checked before the drug is administered. PMID:23444503

2013-02-01

185

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

186

Physicians' Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities  

PubMed Central

Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a “take-home” dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

Ruthazer, Robin; Macalino, Grace E.; Rich, Josiah D.; Tan, Litjen; Burris, Scott

2006-01-01

187

Seizures after single-agent overdose with pharmaceutical drugs: Analysis of cases reported to a poison center.  

PubMed

Abstract Context. Seizures during intoxications with pharmaceuticals are a well-known complication. However, only a few studies report on drugs commonly involved and calculate the seizure potential of these drugs. Objectives. To identify the pharmaceutical drugs most commonly associated with seizures after single-agent overdose, the seizure potential of these pharmaceuticals, the age-distribution of the cases with seizures and the ingested doses. Methods. A retrospective review of acute single-agent exposures to pharmaceuticals reported to the Swiss Toxicological Information Centre (STIC) between January 1997 and December 2010 was conducted. Exposures which resulted in at least one seizure were identified. The seizure potential of a pharmaceutical was calculated by dividing the number of cases with seizures by the number of all cases recorded with that pharmaceutical. Data were analyzed using descriptive statistics. Results. We identified 15,441 single-agent exposures. Seizures occurred in 313 cases. The most prevalent pharmaceuticals were mefenamic acid (51 of the 313 cases), citalopram (34), trimipramine (27), venlafaxine (23), tramadol (15), diphenhydramine (14), amitriptyline (12), carbamazepine (11), maprotiline (10), and quetiapine (10). Antidepressants were involved in 136 cases. Drugs with a high seizure potential were bupropion (31.6%, seizures in 6 of 19 cases, 95% CI: 15.4-50.0%), maprotiline (17.5%, 10/57, 95% CI: 9.8-29.4%), venlafaxine (13.7%, 23/168, 95% CI: 9.3-19.7%), citalopram (13.1%, 34/259, 95% CI: 9.5-17.8%), and mefenamic acid (10.9%, 51/470, 95% CI: 8.4-14.0%). In adolescents (15-19y/o) 23.9% (95% CI: 17.6-31.7%) of the cases involving mefenamic acid resulted in seizures, but only 5.7% (95% CI: 3.3-9.7%) in adults (? 20y/o; p < 0.001). For citalopram these numbers were 22.0% (95% CI: 12.8-35.2%) and 10.9% (95% CI: 7.1-16.4%), respectively (p = 0.058). The probability of seizures with mefenamic acid, citalopram, trimipramine, and venlafaxine increased as the ingested dose increased. Conclusions. Antidepressants were frequently associated with seizures in overdose, but other pharmaceuticals, as mefenamic acid, were also associated with seizures in a considerable number of cases. Bupropion was the pharmaceutical with the highest seizure potential even if overdose with bupropion was uncommon in our sample. Adolescents might be more susceptible to seizures after mefenamic acid overdose than adults. "Part of this work is already published as a conference abstract for the XXXIV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 27-30 May 2014, Brussels, Belgium." Abstract 8, Clin Toxicol 2014;52(4):298. PMID:24844578

Reichert, C; Reichert, P; Monnet-Tschudi, F; Kupferschmidt, H; Ceschi, A; Rauber-Lüthy, C

2014-07-01

188

Measures Such As Interstate Cooperation Would Improve The Efficacy Of Programs To Track Controlled Drug Prescriptions  

PubMed Central

In response to increasing abuse of prescription drugs, 44 states have implemented -- and five more states will soon adopt -- monitoring programs to track prescriptions of controlled medications. Although these programs are primarily 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. We reviewed government documents, expert white papers, articles from the peer reviewed medical literature, and reports of the experiences of local health officials. Although we found some evidence that prescription drug monitoring programs are a benefit to both law enforcement and health care delivery, 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.

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

2013-01-01

189

78 FR 78367 - Draft Prescription Drug User Fee Act V Information Technology Plan; Availability for Comment  

Federal Register 2010, 2011, 2012, 2013

...Prescription Drug User Fee Act V Information Technology Plan; Availability for Comment...for public comment of the draft information technology (IT) plan entitled ``PDUFA V Information Technology Plan.'' This plan is...

2013-12-26

190

Effect of Cost-Sharing on the Utilization of Prescription Drugs for Chronically Ill Patients.  

National Technical Information Service (NTIS)

The purpose of the report is to understand the effect of cost-sharing on the initiation of pharmacological treatment for hypertension. Though much evidence suggests that increased cost-sharing is associated with reductions in prescription drug utilization...

D. P. Goldman J. J. Escarce M. D. Solomon R. H. Brook

2005-01-01

191

45 CFR 156.295 - Prescription drug distribution and cost reporting.  

Code of Federal Regulations, 2013 CFR

...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...

2013-10-01

192

77 FR 32407 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...  

Federal Register 2010, 2011, 2012, 2013

...entitled ``Medicare Program; Changes to the Medicare...Prescription Drug Benefit Programs for Contract Year 2013...with comment period entitled ``Medicare Program; Changes to the Medicare...Than 60 Days After Publication'' was...

2012-06-01

193

75 FR 71064 - Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug...  

Federal Register 2010, 2011, 2012, 2013

...0938-AQ00 Medicare Program; Proposed Changes...Prescription Drug Benefit Programs for Contract Year 2012...in the proposed rule entitled ``Medicare Program; Proposed Changes...days after date of publication in the Federal...

2010-11-22

194

Staff Report on Sales, Promotion, and Product Differentiation in Two Prescription Drug Markets.  

National Technical Information Service (NTIS)

The report presents new evidence on the concept of product differentiation and its relationship to brand promotion and sales. Focusing upon two therapeutic markets for prescription drugs, the analysis supports in part, and refutes in part, the notion that...

D. F. Lean R. S. Bond

1977-01-01

195

Detailed Description of CBO's Cost Estimate for the Medicare Prescription Drug Benefit.  

National Technical Information Service (NTIS)

The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) contains many provisions that affect the Medicare program specifically and the U.S. health sector more generally. This paper focuses on the provisions that e...

2004-01-01

196

Prescription drugs during pregnancy and lactation--a Finnish register-based study  

Microsoft Academic Search

Objective. To examine the use of prescription drugs in Finnish women before and during pregnancy and lactation.Methods. A register-based study linking four nation-wide registers in Finland: the Maternal Grants Register, the Drug Prescription Register, and the Special Refund Register (all maintained by the Social Insurance Institution in Finland; KELA), and the Finnish Population Register. The study included all women applying

Heli Malm; Jaana Martikainen; Timo Klaukka; Pertti J. Neuvonen

2003-01-01

197

Drug companies monitor prescriptions and sales to fine-tune their marketing strategies.  

PubMed

Market research companies analyse drug prescriptions and sales in community and hospital pharmacies, thus enabling drug companies to refine their marketing strategies. Some information of interest to drug companies is provided directly by healthcare professionals, sometimes unwittingly, and sometimes in return for small "favours". PMID:20738051

2010-06-01

198

Prescribing practices, knowledge, and use of prescription drug monitoring programs (PDMP) by a national sample of medical toxicologists, 2012.  

PubMed

Prescription opioid analgesic misuse and addiction are a significant public health concern in the USA. Through their concurrent roles as prescribers and public health stewards, medical toxicologists (MTs) have a unique perspective on this issue. They represent a physician group with a particular interest in prescription drug monitoring programs (PDMPs) because of their subspecialty knowledge of the negative consequences of opioid overprescribing in terms of misuse, diversion, addiction, and overdose death. This study surveyed a national sample of MTs about their opioid prescribing patterns and their knowledge and use of PDMPs. A link to a Web-based survey was disseminated by email to the physician membership of the American College of Medical Toxicology. The survey assessed the circumstances and details of the respondents prescribing practices for opioids and their knowledge and use of PDMPs. This included focused questions regarding their perceived limitation of their current PDMP. Responses were received from 205/445 surveys (46 %), representing responses from 35 states. The majority (78 %) of MTs responding to the survey reported that they primarily practice emergency medicine. Although awareness of PDMPs, in general, was high, approximately 25 % reported no knowledge of or did not have access to their state's PDMP. Barriers to use included time and complexity required to access relevant information. MTs prescribe opioids primarily to patients in the Emergency Department (ED) for acute pain or acute exacerbations of chronic pain. MTs are generally aware of PDMPs, although many were unaware of or not using their state-based PDMPs when prescribing opioids in clinical practice. PMID:22895794

Perrone, Jeanmarie; DeRoos, Francis J; Nelson, Lewis S

2012-12-01

199

Unusual abdominal complications of a suicidal overdose of analgesic and psychotropic drugs in an elderly patient.  

PubMed

A suicidal 67-year-old woman with manic-depressive psychosis took an overdose of asprin, amitriptyline and diazepam. The initial effects were pyrexia, tachycardia, hyperpnea, metabolic acidosis, electrocardiographic changes, hypoprothrombinemia, gastritis, and pancreatitis. Four to six weeks later, she was examined because of persistent abdominal pain with mausea, anorexia anemia, and possibly a malabsorption syndrome. An exploratory laparotomy was performed. The surgeon found several previous adhesions, a small intestinal volvulus, and a nodular pancreas. This suggested previous perforation of the small bowel from enteritis, causing a "blind-loop" syndrone. The invilved section of the small bowel was resected. With appropriate treatment, the patient is well three months after operation. PMID:618954

Mehta, D; Mehta, S; Mathew, P

1978-01-01

200

Paediatric drug use with focus on off-label prescriptions at Swedish hospitals - a nationwide study  

PubMed Central

Aim To perform a nationwide investigation of paediatric drug use at Swedish hospitals, including an analysis of off-label drug use. Methods All paediatric hospitals in Sweden were invited to register all prescriptions to children, aged between 0 and 18, during two separate 2-day-periods in 2008. Data were reported and analysed with respect to licence status and proportion of and reasons for off-label drug use. Results Data on 11 294 prescriptions to 2947 paediatric patients were received. Drugs associated with pain relief, infection, prematurity, nutrition and surgery or anaesthesia were most commonly used. Paracetamol was the most frequently used drug on-label and also among the most commonly used off-label drugs. Nearly half (49%) of all administered prescriptions concerned unlicensed drugs, off-label drugs or extemporaneously prepared drugs. The corresponding rate among neonates was 69%. Lack of paediatric information in the Summary of Product Characteristics was the main reason for off-label classification. Conclusions Paediatric off-label drug use is common at Swedish hospitals, and nearly half of all prescriptions were not documented for use in children. The findings emphasize a need for paediatric clinical studies as well as compilation of existing clinical experience and scattered evidence, particularly for drug treatment in infants and neonates.

Kimland, E; Nydert, P; Odlind, V; Bottiger, Y; Lindemalm, S

2012-01-01

201

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

PubMed Central

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.

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

2012-01-01

202

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

Microsoft Academic Search

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

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

2001-01-01

203

Clinical Factors Associated With Prescription Drug Use Disorder in Urban Primary Care Patients with Chronic Pain  

Microsoft Academic Search

This study examined characteristics associated with prescription drug use disorder (PDUD) in primary-care patients with chronic pain from a cross-sectional survey conducted at an urban academically affiliated safety-net hospital. Participants were 18 to 60 years old, had pain for >3 months, took prescription or nonprescription analgesics, and spoke English. Measurements included the Composite International Diagnostic Interview (PDUD, other substance use

Jane M. Liebschutz; Richard Saitz; Roger D. Weiss; Tali Averbuch; Sonia Schwartz; Ellen C. Meltzer; Elizabeth Claggett-Borne; Howard Cabral; Jeffrey H. Samet

2010-01-01

204

Classification of drug-related problems with new prescriptions using a modified PCNE classification system  

Microsoft Academic Search

Objectives To explore and classify drug-related problems (DRPs) with new prescriptions detected in community pharmacies using a modified\\u000a PCNE (Pharmaceutical Care Network Europe) classification system. Setting Sixty-four Swiss community pharmacies offering internships for pharmacy students. Main outcome measures Occurrence, nature and pharmacist’s management of DRPs. Methods Fifth-year pharmacy students collected consecutively hospital discharge and primary care prescriptions. After training, they

Patrick M. Eichenberger; Markus L. Lampert; Irene Vogel Kahmann; J. W. Foppe van Mil; Kurt E. Hersberger

2010-01-01

205

Prescription drug use during pregnancy: a population-based study in Regione Emilia-Romagna, Italy  

Microsoft Academic Search

Purpose  Drug utilization studies in pregnant women are crucial to inform pharmacovigilance efforts in human teratogenicity. The purpose\\u000a of this study was to estimate the prevalence of prescription drug use among pregnant women in Regione Emilia-Romagna (RER),\\u000a Italy.\\u000a \\u000a \\u000a \\u000a Methods  We conducted a retrospective prevalence study using data from the RER health care database. Outpatient prescription drug data\\u000a were reconciled for RER residents

Joshua J. Gagne; Vittorio Maio; Vincenzo Berghella; Daniel Z. Louis; Joseph S. Gonnella

2008-01-01

206

Study of Drug-Drug Interactions in Prescriptions of General Practitioners and Specialists in Iran 2007-2009  

PubMed Central

Prescriptions written by general practitioners and medical specialists were studied and compared to determine the type, time of onset and clinical importance of drug-drug interactions (DDIs) in an attempt to reduce further complications. In 2007, 28, 956, 638 prescriptions and 15, 610, 912 prescriptions in 2008 were filled by pharmacies affiliated with medical science universities. These prescriptions, prescribed by physicians from 33 Iranian medical universities nationwide were then evaluated with a prescription processing software named Pardazesh Nosakh. After processing and analyzing the data, DDIs were discovered in 14 different medical specialists consisting of internists, cardiologists, neurologists, psychiatrists, neurosurgeons, general surgeons, infectious diseases, urologists, dermatologists, ENT, ophthalmologists, orthopedists, and pediatrician. The results were then analyzed through methods applied in the book of Drug Interaction Facts. The results revealed that in 2007-2008, 0.77% of prescriptions had DDIs out of which 0.67% were with significant clinical importance. The percentage of interactions with significant clinical importance was higher in prescriptions of medical specialists and of those, cardiologists and internists ranked top on the list, while dermatologists ranked the lowest. The most common interacting combination prescribed was digoxin and furosmide in 2007-2008, and captopril and triamteren in 2008-2009. Moreover, this study showed that polypharmacy was an important factor which led to DDIs. Drug interactions were common among outpatients prescribed multiple medications and the rate of DDIs increased with the number of drugs prescribed. It is our opinion that by being up-to-date on drug information and participating in related educational classes and workshops, physicians can increase the chances of choosing the correct drug treatment and hence significantly decrease possible DDIs side effects.

Ahmadizar, Fariba; Soleymani, Fatemeh; Abdollahi, Mohammad

2011-01-01

207

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

PubMed Central

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.

2009-01-01

208

Low literacy impairs comprehension of prescription drug warning labels  

Microsoft Academic Search

BACKGROUND: Adverse events resulting from medication error are a serious concern. Patients’ literacy and their ability to understand\\u000a medication information are increasingly seen as a safety issue.\\u000a \\u000a \\u000a OBJECTIVE: To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret\\u000a commonly used prescription medication warning labels.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: In-person structured interviews with literacy assessment.

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

2006-01-01

209

Mechanisms of Prescription Drug Diversion Among Impaired Physicians  

PubMed Central

The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs.

Cummings, Simone Marie; Merlo, Lisa; Cottler, Linda B.

2014-01-01

210

70 FR 4194 - Medicare Program; Medicare Prescription Drug Benefit  

Federal Register 2010, 2011, 2012, 2013

...therefore not be a Part D drug when used in a heparin flush. Comment: One commenter recommended that Part D drugs should include liquid, chewable, transdermal and other special dosage forms and delivery mechanisms to accommodate swallowing limitations...

2005-01-28

211

21 CFR 201.100 - Prescription drugs for human use.  

Code of Federal Regulations, 2010 CFR

...CONTINUED) DRUGS: GENERAL LABELING Exemptions...the possession of a practitioner licensed by law to...precautions under which practitioners licensed by law to...preparations of insulin or antibiotic drugs. (d...precautions, under which practitioners licensed by...

2009-04-01

212

Abuse of Prescription (Rx) Drugs Affects Young Adults Most  

MedlinePLUS

... Life Treatment Trends & Statistics PDF (224 KB) Featured Publication Drugs, Brains, and Behavior - The Science of Addiction ... affects both brain and behavior. Read more NIDA's Publication Series NIDA Notes DrugFacts Research Reports Mind Over ...

213

Prescription Drugs Associated with Reports of Violence Towards Others  

PubMed Central

Context Violence towards others is a seldom-studied adverse drug event and an atypical one because the risk of injury extends to others. Objective To identify the primary suspects in adverse drug event reports describing thoughts or acts of violence towards others, and assess the strength of the association. Methodology From the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) data, we extracted all serious adverse event reports for drugs with 200 or more cases received from 2004 through September 2009. We identified any case report indicating homicide, homicidal ideation, physical assault, physical abuse or violence related symptoms. Main Outcome Measures Disproportionality in reporting was defined as a) 5 or more violence case reports, b) at least twice the number of reports expected given the volume of overall reports for that drug, c) a ?2 statistic indicating the violence cases were unlikely to have occurred by chance (p<0.01). Results We identified 1527 cases of violence disproportionally reported for 31 drugs. Primary suspect drugs included varenicline (an aid to smoking cessation), 11 antidepressants, 6 sedative/hypnotics and 3 drugs for attention deficit hyperactivity disorder. The evidence of an association was weaker and mixed for antipsychotic drugs and absent for all but 1 anticonvulsant/mood stabilizer. Two or fewer violence cases were reported for 435/484 (84.7%) of all evaluable drugs suggesting that an association with this adverse event is unlikely for these drugs. Conclusions Acts of violence towards others are a genuine and serious adverse drug event associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine, and antidepressants with serotonergic effects were the most strongly and consistently implicated drugs. Prospective studies to evaluate systematically this side effect are needed to establish the incidence, confirm differences among drugs and identify additional common features.

Moore, Thomas J.; Glenmullen, Joseph; Furberg, Curt D.

2010-01-01

214

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

PubMed Central

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.

Firestone, Michelle; Fischer, Benedikt

2008-01-01

215

Paediatric drug use with focus on off-label prescriptions in Lombardy and implications for therapeutic approaches.  

PubMed

The persistent lack of information on the paediatric use of most medicinal products is a major hindrance towards an optimal treatment of paediatric patients. Several studies have documented the high prevalence of off-label use in paediatric population. No comprehensive studies, however, exist that analyse in full all prescriptions for all dispensed drugs, especially in view of the recent intervention by the European Medicine Agency to tackle this issue. We have assessed the drug prescription pattern in the paediatric outpatient population of Lombardy, which has a reliable record of such prescriptions focusing on off-label drug use. We analysed all dispensed outpatient prescriptions to children aged 0-18 years and the proportion of off-label drug use in 2011, using data from the regional administrative prescriptions database. A total of 4,027,119 prescriptions were dispensed, of which 133,619 (3.3 %) were off-label. The anatomical therapeutic chemical classes most involved in off-label prescriptions were antibiotics for systemic use (33,629), alimentary tract and metabolism (31,739) and respiratory tract (31,458). The highest rate (8 %) of off-label drug prescriptions was observed in the age range 0-1. The study revealed also an inappropriate prescription pattern for fluoroquinolones and drugs targeting the cardiovascular and musculoskeletal systems. We identified inappropriate prescriptions for specific drug classes, highlighting the need of increasing pharmacological studies in the paediatric patients and specific critical drugs/drug classes in which such studies are particularly urgent. Depending on the region, inappropriate paediatric drug prescriptions may affect different drug classes, indicating the need of tailoring specific programmes of information. PMID:23913312

Carnovale, Carla; Conti, Valentino; Perrone, Valentina; Antoniazzi, Stefania; Pozzi, Marco; Merlino, Luca; Venegoni, Mauro; Clementi, Emilio; Radice, Sonia

2013-12-01

216

Pediatric ziprasidone overdose.  

PubMed

We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory depression in a child. H.C., a 30-month-old girl, presented to the emergency department approximately 30 minutes after an accidental ingestion of an adult family member's medication. The child was found on the floor surrounded by numerous pills and was witnessed to have ingested at least 1 tablet by a caregiver. After finding the child with the pills, the family observed the child for a brief period but transported her to the hospital after she became lethargic and unresponsive. The child received 2 doses of 0.4 mg of intravenous naloxone without change in her neurologic status. The child then underwent a rapid sequence intubation for airway protection and subsequently received gastrointestinal decontamination with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an atypical antipsychotic drug that was approved by the Food and Drug Administration in February 2001 for the general treatment of schizophrenia in adults. Previously reported pediatric ziprasidone overdoses describe a syndrome of sedation, tachycardia, hypotonia, and coma consistent with that of the patient described in this paper. In pediatric ziprasidone overdose, QTc prolongation and hypotension have also been illustrated, but seizures have not been reported. An interesting aspect of this case is the development of pinpoint pupils unresponsive to naloxone. This phenomenon has been reported before with overdose of olanzapine, a similar atypical antipsychotic. The mechanism of miosis associated with overdose of atypical antipsychotics is unclear but is likely related to interference with central innervation of the pupil. Pupil size is maintained by a balance between sympathetic and parasympathetic neurohumeral tones. We propose that an overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results in unopposed parasympathetic stimulation resulting in miosis. PMID:19369840

Fasano, Charles J; O'Malley, Gerald F; Lares, Claudia; Rowden, Adam K

2009-04-01

217

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

Federal Register 2010, 2011, 2012, 2013

...Containing Acetaminophen; Actions To Reduce Liver Injury From Unintentional Overdose AGENCY...increased margin of safety to help prevent liver damage due to acetaminophen overdosing...new safety information about the risk of liver damage. DATES: Sponsors of approved...

2011-01-14

218

Can Increases in CHIP Copayments Reduce Program Expenditures on Prescription Drugs?  

PubMed Central

Objective The primary aim is to explore whether prescription drug expenditures by enrollees changed in Alabama’s CHIP program, ALL Kids, after copayment increases in fiscal year 2004. The subsidiary aim is to explore whether non-pharmaceutical expenditures also changed. Data Sources Data on ALL Kids enrollees between 1999–2007, obtained from claims files and the state’s administrative database. Study Design We used data on children who were enrolled between one and three years both before and after the changes to the copayment schedule, and estimate regression models with individual-level fixed effects to control for time-invariant heterogeneity at the child level. This allows an accurate estimate of how program expenditures change for the same individual following copayment changes. Primary outcomes of interest are expenditures for prescription drugs by class and brand-name and generic versions. We estimate models for the likelihood of any use of prescription drugs and expenditure level conditional on use. Principal Findings Following the copayment increase, the probability of any expenditure decline by 5.8%, brand name drugs by 6.9%, generic drugs by 7.4%. Conditional on any use, program expenditures decline by 7.9% for all drugs, by 9.6% for brand name drugs, and 6.2% for generic drugs. The largest declines are for antihistamine drugs; the least declines are for Central Nervous System agents. Declines are smaller and statistically weaker for children with chronic health conditions. Concurrent declines are also seen for non-pharmaceutical medical expenditures. Conclusions Copayment increases appear to reduce program expenditures on prescription drugs per enrollee and may be a useful tool for controlling program costs.

Sen, Bisakha; Blackburn, Justin; Morrisey, Michael; Becker, David; Kilgore, Meredith; Caldwell, Cathy; Menachemi, Nir

2014-01-01

219

Fluoride overdose  

MedlinePLUS

... counter and prescription products, including: Certain mouthwashes and toothpastes Certain vitamins (Tri-Vi-Flor, Poly-Vi-Flor, ... for recovery. The amount of fluoride found in toothpaste is usually not swallowed in large enough amounts ...

220

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

Code of Federal Regulations, 2010 CFR

...content and format requirements in §§ 201.56...of prescription drug products are subject to the labeling requirements in paragraph (d...i) Prescription drug products for which...application (NDA), biologics license application...Administration (FDA) between June...

2010-04-01

221

AN EXPLORATORY STUDY OF RAPE SURVIVORS' PRESCRIPTION DRUG USE AS A MEANS OF COPING WITH SEXUAL ASSAULT  

Microsoft Academic Search

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

Marisa L. Sturza; Rebecca Campbell

2005-01-01

222

Strict Liability for Prescription Drugs: Which Shall Govern-Comment K or Strict Liability Applicable to Ordinary Products?  

Microsoft Academic Search

This Comment will review the history of strict products liability and the policies which have shaped its development. It will examine the state of the law today regarding strict liability for harm caused by prescription drugs, and demonstrate that comment k should continue to govern prescription drugs. Furthermore, it will point out that sound reasoning and public policy dictate that

Charlotte Smith Siggins

2010-01-01

223

Use of Antipsychotic Drugs in Individuals with Intellectual Disability (ID) in the Netherlands: Prevalence and Reasons for Prescription  

ERIC Educational Resources Information Center

Background: We investigated antipsychotic drug prescription practice of Dutch ID physicians, studying prevalence of antipsychotic drug use, reasons for prescription and the relationship between these reasons and patient characteristics. Methods: A cross-sectional study of medical and pharmaceutical records in a population living in residential…

de Kuijper, G.; Hoekstra, P.; Visser, F.; Scholte, F. A.; Penning, C.; Evenhuis, H.

2010-01-01

224

Ancillary Applications: Drug Prescription\\/Dispensing and Forensics  

Microsoft Academic Search

GENERAL INTRODUCTION Pharmacogenomics has been focused on enabling the tar- geted practice of drug selection by health care providers. However, other applications of PGx are evolving beyond that domain, such as applications in production of targeted drugs by pharmaceutical companies, forensics, safer distri- bution of medications by pharmacist, environmental toxi- cology, predicting addiction to substances, and multiple other applications. The

Saeed Jortani; Steven Wong

225

Prescription for Drug Abuse Education: Managing the Mood Changers  

ERIC Educational Resources Information Center

This article emphasizes the need to prepare youth to make decisions about drug use. To do this it is essential to eliminate hypocrisy about the use of marihuana, to "infuse" the curriculum with drug information and to provide students with realistic learning experiences. (Author)

Yolles, Stanley F.

1971-01-01

226

Appropriateness of timing of drug administration in electronic prescriptions  

Microsoft Academic Search

Introduction For a small number of drugs circadian variability has been shown to modify efficacy, safety, or pharmacokinetics. Objective of the study We aimed to develop a database containing optimum timing of drug administration and to test how well such information is\\u000a considered in daily practice. Setting University hospital providing primary and tertiary care. Methods We included data of randomised

Arwa Hassan; Walter E. Haefeli

2010-01-01

227

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

Federal Register 2010, 2011, 2012, 2013

...Agency's clinical, clinical pharmacology, and statistical capacity...Modernization of the FDA Drug Safety System The drug safety enhancements...segments of the health care system. Our experience with REMS...burdens on the health care system and, in some cases,...

2011-09-12

228

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

PubMed Central

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.

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

229

Prescription Drug Control: DEA Has Enhanced Efforts to Combat Division, but Could Better Assess and Report Program Results.  

National Technical Information Service (NTIS)

The Drug Enforcement Administration's (DEA) Diversion Control Program is responsible for enforcing the Controlled Substances Act (CSA) and ensuring the availability of prescription drugs such as pain relievers and stimulants while preventing their diversi...

2011-01-01

230

The impact of Wyeth v. Levine on FDA regulation of prescription drugs.  

PubMed

In Wyeth v. Levine, decided in March, 2009, the United States Supreme Court concluded that the plaintiff's failure to warn claim against the makers of the drug Phenergan was not impliedly preempted by the Food, Drug and Cosmetic Act. In doing so, the Court rejected the argument of the U.S. Food and Drug Administration (FDA) that tort claims of this nature stand as an obstacle to federal regulatory objectives. This Article evaluates the Court's opinion in Wyeth and examines that decision's impact on subsequent litigation in the area of prescription drug labeling. The Article first discusses the preemption doctrine and its application to state law tort claims against product manufacturers. It then reviews the history of implied preemption of tort claims against manufacturers of FDA-approved prescription drugs prior to Wyeth and then discusses the Wyeth decisions in the Vermont Supreme Court and the United States Supreme Court. Finally, the Article evaluates some of the prescription drug preemption cases that have been decided in the lower federal courts since Wyeth and suggests that these courts are now reluctant to preempt failure to warn claims unless a manufacturer affirmatively seeks permission from FDA to change a drug's labeling. PMID:24475542

Ausness, Richard C

2010-01-01

231

Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review  

Microsoft Academic Search

BACKGROUND: Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD). METHODS: A systematic review of intervention studies with a design according to research quality criteria and outcomes related to the effect of reduction of ASD medication retrieved from Medline, Embase and the Cochrane Library. Outcome measures were the

Hugo M Smeets; Arno W Hoes; Niek J de Wit

2007-01-01

232

The Relationship between Health Professionals and the Elderly Patient Facing Drug Prescription: A Qualitative Approach  

ERIC Educational Resources Information Center

Aiming at identifying the relationship between the elderly patient facing drug prescription and health professionals, an exploratory and descriptive study of a qualitative cut was carried out using semi-structured interviews. To this end, the Collective Subject Discourse analysis technique was employed. Thirty elderly patients living in the urban…

Lefevre, Fernando; Teixeira, Jorge Juarez Vieira; Lefevre, Ana Maria Cavalcanti; de Castro, Lia Lusitana Cardozo; Spinola, Aracy Witt de Pinho

2004-01-01

233

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

ERIC Educational Resources Information Center

"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…

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

2012-01-01

234

Beneficiary Cost Sharing Under Canadian Provincial Prescription Drug Benefit Programs: History and Assessment  

Microsoft Academic Search

Federal legislation outlined in the Medical Care Act of 1965 and the Canada Health Act of 1984 stipulates that Canadian provincial governments are to administer insurance programs for medically necessary services provided by hospitals and physicians. The legislation did not mandate provincial government coverage for prescription drugs taken outside of the hospital. Each province has, however, provided coverage to seniors

P Grootendorst

1999-01-01

235

Demand for Prescription Drugs: The Effects of Managed Care Pharmacy Benefits  

Microsoft Academic Search

This paper examines how demand for prescription drugs is influenced by different types of insurance. In order to understand demand characteristics and the competitiveness of pharmaceutical markets, both intermolecular (therapeutic) and intramolecular (generic) substitutions are studied in the antidepressant and beta blocker (anti-hypertensive) markets. Mixed logit and other discrete choice models are applied to national survey and product sales data.

Rika Onishi Mortimer

1997-01-01

236

The North Carolina Controlled Substances Reporting System: a valuable tool for combating prescription drug misuse.  

PubMed

Prescription drug misuse is a growing problem that is resulting in increased morbidity and mortality throughout the United States. The North Carolina Controlled Substances Reporting System has proven to be an effective tool that allows health care providers to make more informed decisions when they prescribe or dispense controlled substances. PMID:23940901

Bronson, William D

2013-01-01

237

Disclosures to participate in State Prescription Drug Monitoring Programs. Final rule.  

PubMed

This document adopts as final, without change, an interim final rule published in the Federal Register that amended the Department of Veterans Affairs' (VA) regulations concerning the sharing of certain patient information in order to implement VA's authority to participate in State Prescription Drug Monitoring Programs (PDMP). PMID:24696911

2014-03-14

238

Prescription drug abuse hits hospitals hard: tighter federal steps aim to deflate crisis.  

PubMed

Hospitals and their pharmacy departments are now at the epicenter of the prescription drug-abuse tsunami. The Obama administration is using regulatory agencies in an to attempt to crack down on physician-run "pill mills" and the pharmacies that support them. PMID:24273399

Barlas, Stephen

2013-09-01

239

[Drugs used for cognitive impairment. Analysis of 1.5 million prescriptions in Argentina].  

PubMed

Cognitive impairment and dementia treatment costs are significant for health systems. According to national and international guidelines, recommended drugs for treatment of dementias are cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine. Despite these guidelines recommendations, other nootropics, vasodilators and antioxidants are often used in Argentina. The purpose of this study was to describe and compare the prescription pattern of commonly used drugs for the treatment of cognitive disorders and dementia in different regions of Argentina. An observational, retrospective study of 1814108 recipes prescribed to National Institute of Social Services for Retired and Pensioners outpatients during the during the second half of 2008 and the first and second half of 2009 was performed, taking in count the whole country and also different Argentina's regions. Demographic variables, quantity and rate of prescriptions, dosage forms and strengths were analyzed. Considering the entire country, memantine was the most prescribed drug in these periods (570893 packages). An increase in the memantine, donepezil, rivastigmine and idebenone rates of prescription was observed. Prescription rate of memantine increased in the North-West and North-East regions, that of idebenone in the North-East region and Patagonia and donepezil in the North-East region. Non recommended drugs were highly prescribed in all the analyzed regions. Some of them were indicated to young and middle-aged patients. PMID:23732196

Rojas, Galeno; Demey, Ignacio; Arizaga, Raúl L

2013-01-01

240

Percentage of Medicare Beneficiaries with High Out-of-Pocket Prescription Drug Expenses  

MedlinePLUS

Skip to main content Skip to footer links ASPE.hhs.gov U.S. Department of Health & Human ... with High Out-of-Pocket Prescription Drug Expenses This measure reports the percentage of Medicare beneficiaries with high medical expenses for ...

241

Retail prescription drug spending in the National Health Accounts.  

PubMed

Recent rapid spending growth for retail drugs has largely arisen from increased use of new drugs, rather than from increasing prices of existing drugs. A sizable shift in the payment from consumers to third parties has also contributed to faster growth. Strategies such as negotiating for rebates and using tiered copayments have sought to slow spending growth but simultaneously have complicated the estimation of spending in the National Health Accounts (NHA). NHA estimates show that retail pharmaceuticals' share of health spending is not much different than it was in 1960, although its share of gross domestic product (GDP) has tripled. PMID:15002638

Smith, Cynthia

2004-01-01

242

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

PubMed

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. OBJECTIVES 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 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 acne vulgaris or rosacea in 2010. MAIN OUTCOMES AND 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 is correlated (r?=?0.92) 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 Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs. PMID:24740450

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

2014-05-01

243

Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York  

PubMed Central

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.

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

2012-01-01

244

Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York.  

PubMed

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

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

2012-02-14

245

21 CFR 201.100 - Prescription drugs for human use.  

Code of Federal Regulations, 2012 CFR

...injection it need not be named. (6) An identifying lot or control number from which it is possible to determine the complete...from certification requirements applicable to preparations of insulin or antibiotic drugs. (d) Any labeling, as...

2012-04-01

246

21 CFR 201.100 - Prescription drugs for human use.  

...injection it need not be named. (6) An identifying lot or control number from which it is possible to determine the complete...from certification requirements applicable to preparations of insulin or antibiotic drugs. (d) Any labeling, as...

2014-04-01

247

21 CFR 201.100 - Prescription drugs for human use.  

Code of Federal Regulations, 2010 CFR

...injection it need not be named. (6) An identifying lot or control number from which it is possible to determine the complete...from certification requirements applicable to preparations of insulin or antibiotic drugs. (d) Any labeling, as...

2010-04-01

248

21 CFR 201.100 - Prescription drugs for human use.  

Code of Federal Regulations, 2011 CFR

...injection it need not be named. (6) An identifying lot or control number from which it is possible to determine the complete...from certification requirements applicable to preparations of insulin or antibiotic drugs. (d) Any labeling, as...

2011-04-01

249

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 ... request it when you call. Printed on recycled paper Social Security Administration SSA Publication No. 05-10508 ...

250

Gender and Prescription Opioids: Findings from the National Survey on Drug Use and Health  

PubMed Central

Background Significant gender differences in drug and alcohol use have been reported, however little is known about gender differences in prescription opioid misuse and dependence. This study compared correlates, sources and predictors of prescription opioid non-medical use, as well as abuse or dependence among men and women in a nationally-representative sample. Methods Participants were 55,279 (26,746 men, 28,533 women) non-institutionalized civilians aged 12 years and older who participated in the National Survey on Drug Use and Health. Results Rates of lifetime and past year non-medical use of prescription opiates were 13.6% and 5.1%, respectively. Significantly more men than women endorsed lifetime (15.9% vs. 11.2%) and past year use (5.9% vs. 4.2%; ps < .0001). Among past year users, 13.2% met criteria for current prescription opiate abuse or dependence, and this did not differ significantly by gender. Polysubstance use and treatment underutilization were common among both men and women, however significantly fewer women than men had received alcohol or drug abuse treatment (p = .001). Women were more likely to obtain prescription opioids for free from family or friends, while men were more likely to purchase them (ps < .01). Gender-specific predictors of use as compared to abuse/dependence were also observed. Conclusions The findings highlight important differences between men and women using prescription opiates. The observed differences may help enhance the design of gender-sensitive surveillance, identification, prevention and treatment interventions.

Back, Sudie E.; Payne, Rebecca L.; Simpson, Annie N.; Brady, Kathleen T.

2010-01-01

251

What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries  

PubMed Central

As pharmaceutical expenditure continues to rise, third-party payers in most high-income countries have increasingly shifted the burden of payment for prescription drugs to patients. A large body of literature has examined the relationship between prescription charges and outcomes such as expenditure, use, and health, but few reviews explicitly link cost sharing for prescription drugs to efficiency and equity. This article reviews 173 studies from 15 high-income countries and discusses their implications for important issues sometimes ignored in the literature; in particular, the extent to which prescription charges contain health care costs and enhance efficiency without lowering equity of access to care.

Gemmill, Marin C; Thomson, Sarah; Mossialos, Elias

2008-01-01

252

Patients' Insight of Interpreting Prescriptions and Drug Labels - A Cross Sectional Study  

PubMed Central

Background Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events. Objective To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi. Methods A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure to health-care personnel as well as the basic knowledge and understanding of prescriptions and drug labels. Results Out of 181, majority 137(76%) had received graduate or post-graduate degrees. 16 (9%) had received no formal education; of which all were females and 89(84%) of the total females were housewives. Overall, 130(72%) followed only a single doctor’s prescription. Majority failed to understand various medical terminologies related to dosage. In the high literacy group, 45(33%) understood once daily OD (p?=?0.003), 27(20%) thrice daily TID (p?=?0.05), 29(21%) twice daily BD (p?=?0.01), 31(23%) thrice daily TDS (p?=?0.002) and 43(31%) as needed SOS (p?=?0.003) as compared to the group with no formal education, who were unable to comprehend the terms. The most common reason for using more than one prescription was decreased satisfaction with the doctor in 19(39%) and multiple co-morbids as responded by 17(35%) of patients. Knowledge regarding various medical terminologies used for dosage and routes of drug administration were also understood more frequently among the English medium respondents. The elderly identified medicine through color (47%, p<0.001), and were less likely to understand drug indications (p?=?0.05) compared to younger subjects. Conclusion Understanding of drug prescriptions is alarmingly low in the community, even amongst the educated. Care givers need to revisit this often ignored aspect of patient care.

Patel, Muhammad Junaid; Khan, Muhammad Shoaib; Ali, Farheen; Kazmi, Zehra; Riaz, Talha; Awan, Safia; Sorathia, Ayesha L.

2013-01-01

253

Utility of the Electrocardiogram in Drug Overdose and Poisoning: Theoretical Considerations and Clinical Implications  

PubMed Central

The ECG is a rapidly available clinical tool that can help clinicians manage poisoned patients. Specific myocardial effects of cardiotoxic drugs have well-described electrocardiographic manifestations. In the practice of clinical toxicology, classic ECG changes may hint at blockade of ion channels, alterations of adrenergic tone, or dysfunctional metabolic activity of the myocardium. This review will offer a structured approach to ECG interpretation in poisoned patients with a focus on clinical implications and ECG-based management recommendations in the initial evaluation of patients with acute cardiotoxicity.

Yates, Christopher; Manini, Alex F

2012-01-01

254

OxyContin: Prescription Drug Abuse. CSAT Advisory.  

ERIC Educational Resources Information Center

Recently, the media have issued numerous reports about the apparent increase in OxyContin abuse and addiction. OxyContin has been heralded as a miracle drug that allows patients with chronic pain to resume a normal life. It has also been called pharmaceutical heroin and is thought to have been responsible for a number of deaths and robberies in…

Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

255

Drug related problems identified by community pharmacists on hospital discharge prescriptions in New Zealand.  

PubMed

Background There can be a lack of transfer of information between hospitals and community pharmacies following patient discharge, which puts patients at a high risk of suffering drug related problems (DRPs). Community pharmacy plays a vital role in identifying and solving these discharge DRPs and taking action before these DRPs can lead to patient harm. Objective To identify the types and quantities of DRPs that community pharmacies detect within a single district health board (DHB) in New Zealand. Setting One DHB in New Zealand that contains 50 community pharmacies, which receive discharge prescriptions from two local hospitals. Method All community pharmacies in the DHB area (n = 50) were invited to participate in the 2 week study which involved documenting the number of hospital discharge prescriptions received, and then the number and type of DRPs identified and what interventions were required. Main outcome measure The number and type of DRPs identified as a proportion of all discharge prescriptions received during the 2 week study period. Results Initially a total of 38 pharmacies agreed to participate in this study, however only 32 pharmacies provided data for the entire 2 week period. Over a 2 week period a total of 1,374 hospital discharge prescriptions were presented to these pharmacies. From these prescriptions 344 (25 %) required further action to be taken by the pharmacist. These 344 prescriptions consisted of a total of 396 individual DRPs. Actions classified as "Supply and/or Funding" accounted for 43 % (171), which represented the largest class of all actions required from hospital discharge prescriptions. This class consisted of "Special Authority" problems, medications not being available, non-subsidised items on the prescription and other supply/funding problems. "Errors" accounted for 38 % (151) which included errors of omission (20 %) and errors of commission (18 %). Conclusion This study found a significant number of DRPs identified by community pharmacists on hospital discharge prescriptions. These included missing and incorrect information which required clarification with prescribers. Interventions need to be put in place to reduce the number of errors and improve clarity of hospital discharge prescriptions. Better information sharing and understanding of medications available in primary care will reduce the potential for DRPs. PMID:24700340

Braund, Rhiannon; Coulter, Carolyn V; Bodington, Amy Jane; Giles, Lauren Margaret; Greig, Anna-Marie; Heaslip, Larissa Jane; Marshall, Brooke Jane

2014-06-01

256

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

PubMed Central

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.

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

2013-01-01

257

National health spending in 2006: a year of change for prescription drugs.  

PubMed

In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years. The implementation of Medicare Part D caused a major shift in the distribution of payers for prescription drugs, as Medicare played a larger role in drug purchases than it had before. PMID:18180476

Catlin, Aaron; Cowan, Cathy; Hartman, Micah; Heffler, Stephen

2008-01-01

258

Barbicidal overdose  

PubMed Central

Acute severe methemoglobinaemia is an uncommon but life-threatening condition caused by a variety of oxidizing agents commonly used in both health care and industrial settings. Thus, recognition is important as it is readily treatable. The oxygen transport is compromised as a result of abnormal levels of oxidized haemoglobin, and this leads to skin discolouration and a variety of symptoms. Diagnostic confusion occurs as the oxygen saturations (SpO2) on the pulse oximeter are unreliable (Sharma V, Haber A. Acquired methaemoglobinaemia: a case report of benzocaine-induced methaemoglobinaemia and a review of the literature. Clin Pul Med. 2002;9(1):53–8). A case of severe methaemoglobinaemia due to self poisoning with barbicide is presented with a brief discussion of the patho-physiology and an overview of the treatment. A barbicidal overdose has never been reported before.

Nayeem, Asim; Elkhodair, Samer

2010-01-01

259

Prescription drug use among older adults in Italy: a country-wide perspective.  

PubMed

In Italy, prescription drug costs represent approximately 17% of total public health expenditures. Older adults commonly use multiple drugs and, for this reason, this population is responsible for a large portion of drug-related costs. In 2012, public expenditure for pharmaceuticals in primary care exceeded 11 billion Euros (approximately 15.2 billion US $), and older adults aged 65 or older accounted for more than 60% of these costs. Recently, increased attention has been focused on studies aimed at monitoring drug use and evaluating the appropriateness of drug prescribing in older adults. In this article, we examined studies that assessed these issues in different settings at a national level. Specifically, results of surveys of prescription drug use in primary care (OsMED), hospital (GIFA, CRIME, and REPOSI) and long-term care (ULISSE and SHELTER) settings are reviewed. Overall, these studies showed that the quality of drug prescribing in older patients is far from optimal. This leads to an increased risk of negative health outcomes and increased health care costs. Data from these studies are valuable, not only to monitor drug use, but also to target interventions aimed at improving the quality of prescribing. Translating the findings of clinical research and monitoring programs will be challenging, but it will lead to quantifiable improvements in the quality of drug prescribing at a national level. PMID:24878216

Onder, Graziano; Vetrano, Davide Liborio; Cherubini, Antonio; Fini, Massimo; Mannucci, Pier Mannuccio; Marengoni, Alessandra; Monaco, Alessandro; Nobili, Alessandro; Pecorelli, Sergio; Russo, Pierluigi; Vitale, Cristiana; Bernabei, Roberto

2014-07-01

260

Design of a RESTful web information system for drug prescription and administration.  

PubMed

Drug prescription and administration processes strongly impact on the occurrence of risks in medical settings for they can be sources of adverse drug events (ADEs). A properly engineered use of information and communication technologies has proven to be a promising approach to reduce these risks. In this study, we propose PHARMA, a web information system which supports healthcare staff in the secure cooperative execution of drug prescription, transcription and registration tasks. PHARMA allows the easy sharing and management of documents containing drug-related information (i.e., drug prescriptions, medical reports, screening), which is often inconsistent and scattered across different information systems and heterogeneous organization domains (e.g., departments, other hospital facilities). PHARMA enables users to access such information in a consistent and secure way, through the adoption of REST and web-oriented design paradigms and protocols. We describe the implementation of the PHARMA prototype, and we discuss the results of the usability evaluation that we carried out with the staff of a hospital in Florence, Italy. PMID:24107986

Bianchi, Lorenzo; Paganelli, Federica; Pettenati, Maria Chiara; Turchi, Stefano; Ciofi, Lucia; Iadanza, Ernesto; Giuli, Dino

2014-05-01

261

Do pharmacists have a right to refuse to fill prescriptions for abortifacient drugs?  

PubMed

Some pharmacists opposed to abortion on moral ground are concerned by having to fill prescriptions for abortifacient drugs like mifepristone (RU-486). The issue of the right of pharmacists to refuse to fill such prescriptions depends on the model of the physician-pharmacist-patient relationship. The libertarian model of pharmacy practice holds that physicians, pharmacists, and patients are bound only by the contract that they freely negotiate with one another, thus the pharmacist has no moral obligation to fill a prescription for mifepristone unless he or she has expressly contracted to do so. The American Pharmaceutical Association's 1981 Code of Ethics does not specify what a pharmacist ought to do in particular circumstances. The right to refuse is strongly supported by the principles of nonmaleficence and respect for autonomy. These are principles of the libertarian model of the pharmacist-patient relationship but are also present in the guild or societal models stressing the duty to avoid harming others. Justification for pharmacists right of refusal appeals to their autonomy rights as members of the moral community rather than the profession of pharmacy. Since the professional right to autonomy is not absolute, moral consideration circumscribe it: it is difficult to argue that a pharmacist who believes that homosexuality is immoral has the right to refuse to fill a prescription for AZT. Even if a person who presents such a prescription is homosexual there is no causal relationship between filling a prescription for AZT and participating in a homosexual act. At the opposite end the libertarians reject the notion of even a basic right to health care. A woman in the above situation would not have a right to the abortifacient drug, so a pharmacist has no duty to dispense it. According to the technician model of professionalism, the pharmacist's personal values do not matter, so a pharmacist has a duty to provide the service. PMID:1434764

Weinstein, B D

1992-01-01

262

Patterns of prescription of nonsteroidal antiinflammatory drugs and gastroprotective agents.  

PubMed

Peptic ulcer complications constitute the most important undesirable side effect of nonsteroidal antiinflammatory drugs (NSAID). The object of this study was to use the coprescription of a non-aspirin NSAID (NANSAID) and misoprostol or another antiulcer agent (AUA) as an endpoint to estimate the difference in the toxicity of ibuprofen compared to other available NANSAID. We also compared demographic characteristics of these 2 groups of patients. The study was done on the Quebec Health Insurance Board (RAMQ) database. The patients treated with ibuprofen are perceived by their physicians as having a lower need for AUA than those treated with other NANSAID. However, since patients treated with ibuprofen are younger, have fewer comedications, a lower frequency of medical visits, a lower frequency of arthritis, and a more occasional pattern of use, their lesser need for AUA might be due to a channelling of low risk patients toward this drug. PMID:7752128

LeLorier, J

1995-02-01

263

Is Access Sufficient?: An Examination of the Effects of the MedShare Program to Expand Access to Prescription Drugs for Indigent Populations  

ERIC Educational Resources Information Center

We conduct an evaluation of MedShare, a program designed to enhance access to prescription drugs for indigent patients in the Greater Cincinnati area. The program expands access to drugs by providing subsidies to reduce the costs paid by patients for their prescriptions. The assumption is that by expanding access to prescription drugs, participant…

Shaw, Thomas; Carrozza, Mark

2008-01-01

264

Medicare program; Medicare prescription drug discount card. Interim final rule with comment period.  

PubMed

Section 101, subpart 4 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, codified in section 1860D-31 of the Social Security Act, provides for a voluntary prescription drug discount card program for Medicare beneficiaries entitled to benefits, or enrolled, under Part A or enrolled under Part B, excluding beneficiaries entitled to medical assistance for outpatient prescription drugs under Medicaid, including section 1115 waiver demonstrations. Eligible beneficiaries may access negotiated prices on prescription drugs by enrolling in drug discount card programs offered by Medicare-endorsed sponsors. Eligible beneficiaries may enroll in the Medicare drug discount card program beginning no later than 6 months after the date of enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and ending December 31, 2005. After December 31, 2005, beneficiaries enrolled in the program may continue to use their drug discount card during a short transition period beginning January 1, 2006 and ending upon the effective date of a beneficiary's outpatient drug coverage under Medicare Part D, but no later than the last day of the initial open enrollment period under Part D. Beneficiaries with incomes no more than 135 percent of the poverty line applicable to their family size who do not have outpatient prescription drug coverage under certain programs--Medicaid, certain health insurance coverage or group health insurance (such as retiree coverage), TRICARE, and Federal employees Health Benefits Program (FEHBP)--also are eligible for transitional assistance, or payment of $600 in 2004 and up to $600 in 2005 of the cost of covered discount card drugs obtained under the program. In most cases, any transitional assistance remaining available to a beneficiary on December 31, 2004 may be rolled over to 2005 and applied toward the cost of covered discount card drugs obtained under the program during 2005. Similarly, in most cases, any transitional assistance remaining available to a beneficiary on December 31, 2005 may be applied toward the cost of covered discount card drugs obtained under the program during the transition period. The Centers for Medicare & Medicaid Services will solicit applications from entities seeking to offer beneficiaries negotiated prices on covered discount card drugs. Those meeting the requirements described in the authorizing statute and this rule, including administration of transitional assistance, will be permitted to offer a Medicare-endorsed drug discount card program to eligible beneficiaries. Endorsed sponsors may charge beneficiaries enrolling in their endorsed programs an annual enrollment fee for 2004 and 2005 of no more than $30; CMS will pay this fee on behalf of enrollees entitled to transitional assistance. To ensure that eligible Medicare beneficiaries take full advantage of the Medicare drug discount card program and make informed choices, CMS will educate beneficiaries about the existence and features of the program and the availability of transitional assistance for certain low-income beneficiaries; and publicize information that will allow Medicare beneficiaries to compare the various Medicare-endorsed drug discount card programs. PMID:14674398

2003-12-15

265

The impact of consumer-directed health plans on prescription drug use.  

PubMed

There has been much debate over the merits of consumer-directed health plans (CDHPs), yet there is little empirical evidence of their influence on health care use. We examined patterns in prescription drug use in the first year that CDHPs were offered alongside traditional plans. Using pharmacy claims data from one large company, we found that enrollees in high-deductible CDHPs were much more likely than those with other coverage to discontinue two of five drug classes. Enrollment in a CDHP did not, however, reduce adherence among those continuing their medication, nor did it greatly influence the use of generic drugs. PMID:18607045

Greene, Jessica; Hibbard, Judith; Murray, James F; Teutsch, Steven M; Berger, Marc L

2008-01-01

266

The role of bioethics in the international prescription drug market: economics and global justice.  

PubMed

In terms of health care access, bioethics has an important role to inform and shape policy issues and develop interdisciplinary ideas and interventions. The rising price of prescription drugs presents one of the most looming barriers to health care access in the world today. Including both theoretical and practical features of the pharmaceutical industry's behavior is necessary to find ethical solutions towards increasing access. Bioethics can evaluate global justice by weighing human rights theory and future innovation at the macro level, and by addressing market forces and responsibilities at the micro level. Inherent structural features of pharmaceuticals, such as its reliance on research and development, cause the industry to employ pricing strategies that seem counter-intuitive to conventional wisdom, but that result in producing a just allocation as defined by market forces. Parallel trade and drug exportation/reimportation threaten the saliency of the industry's differential pricing scheme; a case-study of a single "Euro-price" within the European Union illustrates how this will actually create harm to the most needy member states. This complex situation requires solutions weighing arguments from human rights theory with those from economic theory to arrive at the most globally just allocation of prescription drugs in the global marketplace, as well as to ensure future innovation and scientific progress. Bioethicists as well as economists need to partake urgently in this discourse for the betterment of the global injustices in the international prescription drug market. PMID:17146900

Newland, Shelby E

2006-01-01

267

To Dope or Not to Dope: Neuroenhancement with Prescription Drugs and Drugs of Abuse among Swiss University Students  

PubMed Central

Background Neuroenhancement is the use of substances by healthy subjects to enhance mood or cognitive function. The prevalence of neuroenhancement among Swiss university students is unknown. Investigating the prevalence of neuroenhancement among students is important to monitor problematic use and evaluate the necessity of prevention programs. Study aim To describe the prevalence of the use of prescription medications and drugs of abuse for neuroenhancement among Swiss university students. Method In this cross-sectional study, students at the University of Zurich, University of Basel, and Swiss Federal Institute of Technology Zurich were invited via e-mail to participate in an online survey. Results A total of 28,118 students were contacted, and 6,275 students completed the survey. Across all of the institutions, 13.8% of the respondents indicated that they had used prescription drugs (7.6%) or drugs of abuse including alcohol (7.8%) at least once specifically for neuroenhancement. The most frequently used prescription drugs for neuroenhancement were methylphenidate (4.1%), sedatives (2.7%), and beta-blockers (1.2%). Alcohol was used for this purpose by 5.6% of the participants, followed by cannabis (2.5%), amphetamines (0.4%), and cocaine (0.2%). Arguments for neuroenhancement included increased learning (66.2%), relaxation or sleep improvement (51.2%), reduced nervousness (39.1%), coping with performance pressure (34.9%), increased performance (32.2%), and experimentation (20%). Neuroenhancement was significantly more prevalent among more senior students, students who reported higher levels of stress, and students who had previously used illicit drugs. Although “soft enhancers”, including coffee, energy drinks, vitamins, and tonics, were used daily in the month prior to an exam, prescription drugs or drugs of abuse were used much less frequently. Conclusions A significant proportion of Swiss university students across most academic disciplines reported neuroenhancement with prescription drugs and drugs of abuse. However, these substances are rarely used on a daily basis and more sporadically used prior to exams.

Maier, Larissa J.; Liechti, Matthias E.; Herzig, Fiona; Schaub, Michael P.

2013-01-01

268

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

Microsoft Academic Search

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

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

2003-01-01

269

Doping in Gymnasiums in Amman: The other side of Prescription and Nonprescription Drug Abuse.  

PubMed

This study investigated the abuse of over-the-counter (OTC) products (e.g. proteins, dietary supplements) and prescription drugs (e.g. hormones) in gymnasiums in Amman by random distribution of a structured questionnaire to 375 gym clients (November 2012-February 2013). Data were analyzed using SPSS for Windows (version 17.0). A total of 31 (8.8%) clients admitted to using 21 products (mentioned 71 times) of anabolic steroids and other hormones (e.g., growth hormone and thyroxine) to increase muscular power at the gym or build muscle mass. Abuse of different prescription and OTC drugs among gymnasium clients is present in Jordan, but current methods for controlling the problem are ineffective. Better methods should be developed. The study's limitations are noted. PMID:24611822

Wazaify, Mayyada; Bdair, Ahmad; Al-Hadidi, Kamal; Scott, Jenny

2014-08-01

270

Preventing prescription drug misuse: field test of the SmartRx Web program.  

PubMed

Purpose of the project was to test a Web-based program designed to prevent prescription drug misuse. Study sample consisted of 346 working women randomized into either an experimental or wait-list control condition. Analysis of covariance and logistic regression were used to compare responses. Women receiving the intervention had greater knowledge of drug facts and greater self-efficacy in medication adherence and ability to manage problems with medications compared with controls. Women receiving the intervention also had reduced symptoms reported on the CAGE for prescription medications. Findings suggest that multimedia Web-based programs can be a beneficial addition to substance misuse prevention services. The study's limitations are noted. PMID:21043788

Deitz, Diane K; Cook, Royer F; Hendrickson, April

2011-01-01

271

Seniors' Uncertainty Management of Direct-to-Consumer Prescription Drug Advertising Usefulness  

Microsoft Academic Search

This study provides insight into seniors' perceptions of and responses to direct-to-consumer prescription drug advertising (DTCA) usefulness, examines support for DTCA regulation as a type of uncertainty management, and extends and gives empirical voice to previous survey results through methodological triangulation. In-depth interview findings revealed that, for most informants, DTCA usefulness was uncertain and this uncertainty stemmed from 4 sources.

Denise E. DeLorme; Jisu Huh

2009-01-01

272

Evaluation, Use, and Usefulness of Prescription Drug Information Sources Among Anglo and Hispanic Americans  

Microsoft Academic Search

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

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

2010-01-01

273

Prescription Drug Cost Reduction in Native Hawaiians After Laparoscopic Roux-en-y Gastric Bypass  

PubMed Central

Objective Native Hawaiians (NH) represent a unique population where socioeconomic factors have contributed to higher incidence rates of obesity and related comorbidities than in the general population resulting in substantial prescription medication costs. Studies demonstrate that laparoscopic Roux-en-y gastric bypass (LRYGB) surgery results in significant weight loss, improvement of comorbidities, and decreased costs for prescription medications in Caucasians. This study aimed to analyze the effects of LRYGB surgery on Native Hawaiians and their prescription drug costs. Methods Demographics, baseline body mass index (BMI), comorbidities, preoperative, and postoperative data were analyzed for NH patients who underwent LRYGB between January 2004 and April 2009. Medication costs were determined using the online pharmacy . Generic drugs were selected when appropriate, while vitamins and nutritional supplements were not included in this study. Results Fifty (14 Men, 36 women) NH patients had sufficient data and follow-up for analysis. Average preoperative BMI was 49 kg/m2, while at one year follow-up it decreased to 33 kg/m2 (P<.001). This correlates to an average of 61% excess body weight lost (P<.001). The average number of prescription medications decreased from 3.5/patient preoperatively to 1.1/patient at one year (P<.001), equating to a monthly cost savings of US $195.8/patient (P<.001). Conclusions LRYGB provided substantial weight loss for morbidly obese NH patients, resulting in significantly less prescription medication use and substantial cost savings. Thus, bariatric surgery for weight management has the potential to improve the overall well-being and lower the financial burden of medical care in socioeconomically disadvantaged communities such as the NH.

Lam, Edward CF; Murariu, Daniel; Takahashi, Edwin; Park, Chan W; Bueno, Racquel S

2013-01-01

274

Getting a prescription filled  

MedlinePLUS

... prescription filled; Drugs - how to get prescription filled; Pharmacy - mail order; Pharmacy - internet; Types of pharmacies ... paper prescription that you take to a local pharmacy Calling or e-mailing a pharmacy to order ...

275

Personal Social Network Factors Associated with Overdose Prevention Training Participation  

PubMed Central

We investigated social network factors associated with participation in overdose prevention training among injection drug users (IDUs). From 2008-2010, 106 IDUs who had witnessed an overdose in the past year from two syringe exchange programs in Los Angeles provided data on: overdose prevention training status (trained vs. untrained), social networks, history of overdose, and demographics. In multivariate logistic regression, naming at least one network member who had been trained in overdose prevention was significantly associated with being trained (Adjusted Odds Ratio 3.25, 95% Confidence Interval 1.09, 9.68). Using social network approaches may help increase training participation. Limitations are noted.

Iverson, Ellen; Wong, Carolyn F.; Jackson-Bloom, Jennifer; McNeeley, Miles; Davidson, Peter J.; McCarty, Christopher; Kral, Alex H.; Lankenau, Stephen E.

2013-01-01

276

Marketing drugs, marketing health care relationships: a content analysis of visual cues in direct-to-consumer prescription drug advertising.  

PubMed

Proponents and opponents of direct-to-consumer advertising (DTCA) of prescription drugs argue that it promotes greater participation in health care by consumers with significant implications for public health and health care outcomes. This article (a). proposes a social cognitive theoretical framework to explain DTCA's effects, and (b). reports the first in a series of studies on DTCA's observational learning functions that may influence consumer behavior and the physician-patient relationship. This investigation addresses visual features of print DTCA. Results focus on the prevalence and nature of models featured in the ads and how visual cues may offer identity and relational motivators while reinforcing the value of prescription drug treatments. Further, DTCA may market disenfranchising images that increase disparity in health care information and access, despite their argued educational function. PMID:15090282

Welch Cline, Rebecca J; Young, Henry N

2004-01-01

277

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

...LABELING Labeling Requirements for Prescription Drugs and/or Insulin § 201.57 Specific requirements on content and format...antidotes, gastric lavage, forced diuresis, or as per Poison Control Center). Such recommendations must be based on data...

2014-04-01

278

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

Code of Federal Regulations, 2011 CFR

...LABELING Labeling Requirements for Prescription Drugs and/or Insulin § 201.57 Specific requirements on content and format...antidotes, gastric lavage, forced diuresis, or as per Poison Control Center). Such recommendations must be based on data...

2011-04-01

279

Teens and the Misuse of Prescription Drugs: Evidence-Based Recommendations to Curb a Growing Societal Problem  

Microsoft Academic Search

The misuse of prescription drugs by teens in the United States is a growing public health problem. This article provides a\\u000a systematic synthesis of multiple strands of literature to recommend effective prevention methods. Using a social-ecological\\u000a framework, we review the scope of the problem of prescription drug use among teens. Then, we analyze the multiple factors\\u000a that may influence teen

Eric C. Twombly; Kristen D. Holtz

2008-01-01

280

Lomotil overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

281

Codeine overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

282

Merbromin overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

283

'He was like a zombie': off-label prescription of antipsychotic drugs in dementia.  

PubMed

This paper explores the legal position of the off-label prescription of antipsychotic medications to people with dementia who experience behavioural and psychological symptoms of dementia (BPSD). Dementia is a challenging illness, and BPSD can be very difficult for carers to manage, with evidence that this contributes to carer strain and can result in the early institutionalisation of people with dementia. As a result, the prescription of antipsychotic and other neuroleptic medications to treat BPSD has become commonplace, in spite of these drugs being untested and unlicensed for use to treat older people with dementia. In recent years, it has become apparent through clinical trials that antipsychotic drugs increase the risk of cerebrovascular accident (stroke) and death in people with dementia. In addition, these types of medication also have other risk factors for people with dementia, including over-sedation and worsening of cognitive function. Drawing on recent questionnaire (n = 185), focus group (n = 15), and interview (n = 11) data with carers of people with dementia, this paper explores the law relating to off-label prescription, and the applicability of medical negligence law to cases where adverse events follow the use of antipsychotic medication. It is argued that the practice of off-label prescribing requires regulatory intervention in order to protect vulnerable patients. PMID:23047844

Harding, Rosie; Peel, Elizabeth

2013-03-01

284

Prescription Drugs  

MedlinePLUS

... are also anonymous resources, such as the National Suicide Prevention Lifeline (1-800-273-TALK) and the Treatment Referral Helpline (1-800-662-HELP). The National Suicide Prevention Lifeline (1-800-273-TALK) is a crisis ...

285

Prescription Opioid Use, Misuse, and Diversion among Street Drug Users in New York City  

PubMed Central

Objective The use of heroin, cocaine, and other drugs is well researched in New York City, but prescription opioids (POs) have been overlooked. This study documents patterns of PO use, misuse, and diversion among street drug users, and begins to indicate how drug culture practices interact with the legitimate therapeutic goals of PO prescriptions (e.g. pain management). Methods Staff completed interviews inquiring about the reasons for use of POs and illicit drugs with 586 street drug users. Ethnographers wrote extensive field notes about subjects’ complex patterns of PO use. Results Methadone was used (71.9%) and sold (64.7%) at a higher level than OxyContin, Vicodin, and Percocet, used by between 34% and 38% of the users and sold by between 28% and 41% of the sellers. Recent PO use is associated with the recency of using heroin and cocaine (p<.001). Half of the heroin/cocaine sellers sold POs, and one quarter of the PO sellers only sold POs. Subjects were classified into four groups by whether they diverted POs or used POs to relieve pain or withdrawal rather than for euphoria. This classification was associated with frequency of PO use, whether POs were obtained from doctors/pharmacies or from drug dealers and family members, and those mostly likely to use POs for pain and withdrawal. Conclusions POs are an important component of street drug users’ drug-taking regimes, especially those who are Physically III Chemical Abusers (PICA). Future research is needed to model PO use, misuse, and diversion among this population.

Rees Davis, W.; Johnson, Bruce D.

2008-01-01

286

Physicians' decision process for drug prescription and the impact of pharmaceutical marketing mix instruments.  

PubMed

This paper provides an in-depth, qualitative analysis of the physicians' decision process for drug prescription. Drugs in the considered therapeutic classes are mainly prescribed by specialists, treating patients with obligatory medical insurance, for a prolonged period of time. The research approach is specifically designed to capture the full complexity and sensitive nature of the physician's choice behavior, which appears to be more hybrid and less rational in nature than is often assumed in quantitative, model-based analyses of prescription behavior. Several interesting findings emerge from the analysis: (i) non-compensatory decision rules seem to dominate the decision process, (ii) consideration sets are typically small and change-resistant, (iii) drug cost is not a major issue for most physicians, (iv) detailing remains one of the most powerful pharmaceutical marketing instruments and is highly appreciated as a valuable and quick source of information, and (v) certain types of non-medical marketing incentives (such as free conference participation) may in some situations also influence drug choices. PMID:16597584

Campo, Katia; De Staebel, Odette; Gijsbrechts, Els; van Waterschoot, Walter

2005-01-01

287

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

PubMed Central

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.

2013-01-01

288

Medicare Part D and the Federal Employees Health Benefits Program: A Comparison of Prescription Drug Coverage  

PubMed Central

Background There is much debate currently about how to restructure the Medicare program to achieve better value for the money. Many have cited the Federal Employees Health Benefits Program (FEHBP) as a model for reform. Objective To compare drug coverage and cost-sharing between Medicare Part D and the FEHBP plans. Methods A cross-sectional comparison was conducted of January 2009 data obtained from the Centers for Medicare & Medicaid Services, the Office of Personnel Management, and 3 health plan websites. Regression analysis and t-tests were used to examine drug coverage, copayment, and coinsurance amounts among Medicare Part D and FEHBP plans. The final study sample of Medicare Part D plans consisted of 19 formularies, covering 63% of total Part D enrollment. These 19 formularies represented 232 stand-alone prescription drug plans. In addition, 5 prescription drug plans or formularies in the FEHBP plans were included, which represents 70% of total FEHBP enrollment. Results The results of this study reveal that formulary coverage of the top drugs dispensed and sold in the United States in 2009 ranged from 72% to 94% (average, 84%) in Medicare Part D plans and from 85% to 99% (average, 94%) in the FEHBP plans (P <.01). The mean copayment for generic drugs in Medicare Part D plans was $4.53 compared with a mean of $7.67 (P <.05) in the FEHBP plans. The difference between the 2 programs in mean copayment for brand-name drugs was nonsignificant. For generic drugs, the mean coinsurance rate was 17% for Medicare Part D plans and a mean of 20% for the FEHBP plans (P <.05). Conclusions This analysis shows that there are differences in prescription drug coverage and cost-sharing among plans within Medicare Part D and the FEHBP. To avoid extreme increases in payroll taxes and other revenues or major cutbacks in services, Medicare must explore ways to change the healthcare system to achieve better value for the money. The experience of the FEHBP suggests a possible means of accomplishing this objective.

Lovett, Annesha

2013-01-01

289

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

PubMed Central

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.

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

2014-01-01

290

How Might the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Affect the Financial Viability of Rural Pharmacies? An Analysis of Preimplementation Prescription Volume and Payment Sources in Rural and Urban Areas  

ERIC Educational Resources Information Center

Passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) has created interest in how the legislation will affect access to prescription drugs among rural beneficiaries. Policy attention has focused to a much lesser degree on the implications of the MMA for the financial viability of rural pharmacies. This article…

Fraher, Erin P.; Slifkin, Rebecca T.; Smith, Laura; Randolph, Randy; Rudolf, Matthew; Holmes, George M.

2005-01-01

291

Public/Private Partnerships for Prescription Drug Coverage: Policy Formulation and Outcomes in Quebec's Universal Drug Insurance Program, with Comparisons to the Medicare Prescription Drug Program in the United States  

PubMed Central

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

2007-01-01

292

Intimate partner violence and prescription of potentially addictive drugs: prospective cohort study of women in the Oslo Health Study  

PubMed Central

Objectives To investigate the prescription of potentially addictive drugs, including analgesics and central nervous system depressants, to women who had experienced intimate partner violence (IPV). Design Prospective population-based cohort study. Setting Information about IPV from the Oslo Health Study 2000/2001 was linked with prescription data from the Norwegian Prescription Database from 1 January 2004 through 31 December 2009. Participants The study included 6081 women aged 30–60?years. Main outcome measures Prescription rate ratios (RRs) for potentially addictive drugs derived from negative binomial models, adjusted for age, education, paid employment, marital status, chronic musculoskeletal pain, mental distress and sleep problems. Results Altogether 819 (13.5%) of 6081 women reported ever experiencing IPV: 454 (7.5%) comprised physical and/or sexual IPV and 365 (6.0%) psychological IPV alone. Prescription rates for potentially addictive drugs were clearly higher among women who had experienced IPV: crude RRs were 3.57 (95% CI 2.89 to 4.40) for physical/sexual IPV and 2.13 (95% CI 1.69 to 2.69) for psychological IPV alone. After full adjustment RRs were 1.83 (1.50 to 2.22) for physical/sexual IPV, and 1.97 (1.59 to 2.45) for psychological IPV alone. Prescription rates were increased both for potentially addictive analgesics and central nervous system depressants. Furthermore, women who reported IPV were more likely to receive potentially addictive drugs from multiple physicians. Conclusions Women who had experienced IPV, including psychological violence alone, more often received prescriptions for potentially addictive drugs. Researchers and clinicians should address the possible adverse health and psychosocial impact of such prescription and focus on developing evidence-based healthcare for women who have experienced IPV.

Dyb, Grete; Tverdal, Aage; Jacobsen, Geir Wenberg; Schei, Berit

2012-01-01

293

Prescription drug coupons: evolution and need for regulation in direct-to-consumer advertising.  

PubMed

Pharmaceutical marketing in the United States had undergone a shift from largely exclusively targeting physicians to considerable efforts in targeting patients through various forms of direct-to-consumer advertising ("DTCA"). This includes the use of DTCA in prescription drug coupons ("PDCs"), a new form of DTCA that offers discounts and rebates directly to consumers to lower costs of drug purchasing. Our examination of PDCs reveals that the use and types of PDC programs is expanding and includes promotion of the vast majority of top grossing pharmaceuticals. However, controversy regarding this emerging form of DTCA has given rise to health policy concerns about their overall impact on prescription drug expenditures for consumers, payers, and the health care system, and whether they lead to optimal long-term utilization of pharmaceuticals. In response to these concerns and the growing popularity of PDCs, what we propose here are clearer regulation and regulatory guidance for PDC DTCA use. This would include review for appropriate disclosure of marketing claims, increased transparency in PDC use for pharmaceutical pricing, and leveraging potential positive benefits of PDC use for vulnerable or underserved patient populations. PMID:24120330

Mackey, Tim K; Yagi, Nozomi; Liang, Bryan A

2014-01-01

294

Effect of presentation modality in direct-to-consumer (DTC) prescription drug television advertisements.  

PubMed

Direct-to-consumer (DTC) drug advertising markets medications requiring a physician's script to the general public. In television advertising, risk disclosures (such as side effects and contraindications) may be communicated in either auditory (voice) or visual (text) or both in the commercials. This research examines presentation modality factors affecting the communication of the risk disclosures in DTC prescription drug television commercials. The results showed that risk disclosures presented either visually only or both visually and auditorily increased recall and recognition compared to no presentation. Risk disclosures presented redundantly in both the visual and auditory modalities produced the highest recall and recognition. Visual only produced better performance than auditory only. Simultaneous presentation of non-risk information together with risk disclosures produced lower recall and recognition compared to risk disclosures alone-without concurrent non-risk information. Implications for the design of DTC prescription drug television commercials and other audio-visual presentations of risk information including on the Internet, are discussed. PMID:24377979

Wogalter, Michael S; Shaver, Eric F; Kalsher, Michael J

2014-09-01

295

National health spending in 2004: recent slowdown led by prescription drug spending.  

PubMed

U.S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. Health spending accounted for 16 percent of gross domestic product (GDP), nearly the same as in 2003. The pace of health spending growth has slowed, compared with the 2000-2002 period, for both public and private payers. Hospital spending accounted for 30 percent of the aggregate increase between 2002 and 2004, and prescription drugs accounted for an 11 percent share-smaller than its share of the increase in recent years and much slower in absolute terms. PMID:16403753

Smith, Cynthia; Cowan, Cathy; Heffler, Stephen; Catlin, Aaron

2006-01-01

296

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

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.

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

2012-01-01

297

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

PubMed Central

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.

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

2009-01-01

298

78 FR 9589 - Disclosures To Participate in State Prescription Drug Monitoring Programs  

Federal Register 2010, 2011, 2012, 2013

...veteran population such as increased rates of homelessness, suicide attempts, and alcohol and other substance-abuse disorders...substances, are the most frequent form of medication used in suicide attempts via overdose. State PDMPs are effective in...

2013-02-11

299

Medicare--Use of Prescription Drugs by Aged Persons Enrolled for Supplementary Medical Insurance, 1967-1977.  

National Technical Information Service (NTIS)

The nation's elderly spent more than 2.3 billion dollars on prescription drugs in 1977, which were not covered by the Medicare program. This report evaluates drug usage by aged Medicare beneficiaries enrolled for Supplementary Medical Insurance (Part B) a...

G. Grindstaff B. Hirsch H. Silverman

1981-01-01

300

78 FR 26374 - An Evaluation of the Prescription Drug User Fee Act Workload Adjuster; Request for Comments  

Federal Register 2010, 2011, 2012, 2013

The Food and Drug Administration (FDA) is announcing an opportunity for public comment on an assessment of the Prescription Drug User Fee Act (PDUFA) Workload Adjuster conducted by an independent consulting firm. This assessment was conducted to fulfill FDA performance commitments made as part of the fifth authorization of PDUFA in section XV, ``Improving FDA Performance Management,'' subsection......

2013-05-06

301

Women Who Abuse Prescription Opioids: Findings from the Addiction Severity Index-Multimedia Version(R) Connect Prescription Opioid Database  

PubMed Central

Background Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Methods Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV® Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. Results 29,906 assessments from 220 treatment centers were included, of which 12.8% (N=3,821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, p< 0.001) and abuse of any prescription opioid (15.4% females vs. 11.1% males, p < 0.001) in the past month. Route of administration and source of prescription opioids displayed gender-specific tendencies. Women-specific correlates of recent prescription opioid abuse were problem drinking, age <54, inhalant use, residence outside of West US Census region, and history of drug overdose. Men-specific correlates were age <34, currently living with their children, residence in the South and Midwest, hallucinogen use, and recent depression. Women prescription opioid abusers were less likely to report a pain problem although they were more likely to report medical problems than women who abused other drugs. Conclusions Gender-specific factors should be taken into account in efforts to screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.

Green, Traci C.; Grimes Serrano, Jill M.; Licari, Andrea; Budman, Simon H.; Butler, Stephen F.

2009-01-01

302

Trends in opiate overdose deaths in Australia 1979–1995  

Microsoft Academic Search

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

Wayne Hall; Shane Darke

1998-01-01

303

Age and the purchase of prescription drug insurance by older adults  

PubMed Central

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.

Szrek, Helena; Bundorf, M. Kate

2011-01-01

304

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

Federal Register 2010, 2011, 2012, 2013

...the use of these products in pediatric populations. FDA also has concerns...minimize confusion and risks to patients. Modifications of product formulations...or overdose, particularly in pediatric patients. Finally, FDA has...

2011-03-03

305

Characterization of Adolescent Prescription Drug Abuse and Misuse Using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS®) System  

PubMed Central

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®) System. Method Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures. Results A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD ± 1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38%were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants. Conclusions Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents.

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

2013-01-01

306

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

PubMed

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

Koffeman, Aafke R; 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

2014-06-01

307

76 FR 71348 - Role of Naloxone in Opioid Overdose Fatality Prevention; Public Workshop; Request for Comments  

Federal Register 2010, 2011, 2012, 2013

...mu-opioid antagonist, is an injectable medicine that can rapidly reverse the overdose of either prescription (e.g., OxyContin) or illicit (e.g., heroin) opioids. It is currently the standard treatment for those who overdose on opioid...

2011-11-17

308

Effect of government and commercial warnings on reducing prescription misuse: the case of propoxyphene.  

PubMed Central

We analyzed trends in prescribing and overdose deaths related to propoxyphene (e.g., Darvon) before and after a 1978-80 informational campaign carried out by the US Food and Drug Administration and the drug's manufacturer through mailed warnings, face-to-face education of prescribers, press releases, and labeling changes. The goals included a reduction in propoxyphene use with alcohol or other CNS depressants, reduced prescribing of refills, and cessation of prescribing for patients at risk of abuse and misuse (suicide). We conducted time-series analyses of nationwide propoxyphene use data 1974-83 and analyzed data on drug overdose death rates covering a combined population of about 83 million. Segmented regression methods were used to determine if the informational program was associated with changes in trends of prescribing or overdose deaths. Comparison drug series were analyzed to control for other secular trends in prescribing. Nationwide propoxyphene use during the warnings continued a pre-existing decline of about 8 per cent per year, but this decline halted after the warnings. The no-refill recommendation had no impact on refill rates. The risk of overdose death per propoxyphene prescription filled has remained about constant since 1979. Sharper declines in misuse of such drugs will require stronger, more sustained regulatory or educational measures.

Soumerai, S B; Avorn, J; Gortmaker, S; Hawley, S

1987-01-01

309

Non-Steroidal Anti-Inflammatory Drugs and Antibiotics Prescription Trends at a Central West Bank Hospital  

PubMed Central

Objectives: We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. Methods: This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Results: Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. Conclusion: These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians’ knowledge of the rational prescription of these agents.

Tayem, Yasin I.; Qubaja, Marwan M.; Shraim, Riyad K.; Taha, Omar B.; Abu Shkheidem, Imadeddin A.; Ibrahim, Murad A.

2013-01-01

310

Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993-2009  

PubMed Central

The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of POD and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between POD and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in POD and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals POD predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years POD by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.

Unick, George Jay; Rosenblum, Daniel; Mars, Sarah; Ciccarone, Daniel

2013-01-01

311

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

PubMed

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

Ecks, Stefan; Basu, Soumita

2009-03-01

312

[Local straight line screening method for the detection of Chinese proprietary medicines containing undeclared prescription drugs].  

PubMed

The present paper constructs a new approach named local straight-line screening (LSLS) to detect Chinese proprietary medicines (CPM) containing undeclared prescription drugs (UPD). Different from traditional methods used in analysis of multi-component spectrum, LSLS is proposed according to the characteristics of original infrared spectra of the UPD and suspected CPM, without any pattern recognition or concentration model establishment. Spectrum-subtraction leads to the variance in local straight line, which serves as a key in discrimination of whether suspected CPD is adulterated or not. Sibutramine hydrochloride, fenfluramine hydrochloride, sildenafil citrate and lovastatin were used as reference substances of UPD to analyze 16 suspected CPM samples. The results show that LSLS can obtain an accurate quantitative and qualitative analysis of suspected CPM. It is possible for the method to be potentially used in the preliminary screening of CPM containing possible UPD. PMID:19445196

Li, Shu; Cao, Yan; Le, Jian; Chen, Gui-Liang; Chai, Yi-Feng; Lu, Feng

2009-02-01

313

Low-income Medicare beneficiaries and their experiences with the part D prescription drug benefit.  

PubMed

This study seeks to understand how much beneficiaries knew about the Medicare prescription drug benefit (Part D) and low-income subsidy (LIS) programs and what their experiences were with the programs. Part D enrollees who automatically qualified for the LIS were less likely to report awareness that they could switch among different plans, had lower knowledge scores, and were more likely to have medications not covered by the plan compared to beneficiaries who applied for the LIS and others who enrolled in Part D but did not receive the LIS. Communication efforts to the LIS population, particularly for beneficiaries deemed automatically eligible for the LIS, need to continually make them aware of their benefits and protections in Part D. PMID:20812464

Rudolph, Noemi V; Montgomery, Melissa A

2010-01-01

314

HIDDEN in PLAIN SIGHT Marketing Prescription Drugs to Consumers in the Twentieth Century  

PubMed Central

Although the public health impact of direct-to-consumer (DTC) pharmaceutical advertising remains a subject of great controversy, such promotion is typically understood as a recent phenomenon permitted only by changes in federal regulation of print and broadcast advertising over the past two decades. But today's omnipresent ads are only the most recent chapter in a longer history of DTC pharmaceutical promotion (including the ghostwriting of popular articles, organization of public-relations events, and implicit advertising of products to consumers) stretching back over the twentieth century. We use trade literature and archival materials to examine the continuity of efforts to promote prescription drugs to consumers and to better grapple with the public health significance of contemporary pharmaceutical marketing practices.

Herzberg, David

2010-01-01

315

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

Code of Federal Regulations, 2010 CFR

...Sec. 250.101 - Amphetamine and methamphetamine inhalers regarded as prescription... Sec. 250.101 Amphetamine and methamphetamine inhalers regarded as prescription...Recurring reports of abuse and misuse of methamphetamine (also known as...

1996-04-01

316

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

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…

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

2009-01-01

317

A prospective survey on drug choice for prescriptions for admitted patients with schizophrenia.  

PubMed

A survey on psychotropic drugs prescribed for the treatment of schizophrenia was implemented in order to obtain basic data required for revision of the Japanese Psychopharmacology Algorithm (1998). The subjects comprised 94 inpatients with schizophrenia (ICD-10) in seven public hospitals. A questionnaire was conducted to record age, gender, age at start of treatment, treatment period, compliance, frequency of admission and diagnostic classification. A mean dose of chlorpromazine base at 420 mg/day was prescribed to the subjects (six men vs four women; mean age: 32.4 years). The average number of psychotropic drugs prescribed together is 4.0 (1.8 for neuroleptics). The mean treatment period is 5.9 weeks. Antiparkinson drugs, hypnotics, anxiolytics, antimanics/antidepressants and antiepileptics are concurrently used in 92, 85, 25, 6.8 and 2.1% of cases, respectively. Prescriptions are changed 1.8 times on the average. In 84% of the patients, good response to the overall treatment is observed. Polypharmacy is carried out in more than 90% of the patients, although clinical psychopharmacological evidence for the benefits or disadvantages of polypharmacy are insufficient. A large-scale survey is required to revise the algorithm for treatment-refractory schizophrenia, because treatment-refractory and long-term hospitalized patients are rarely included in this survey. False intractable cases due to inadequate treatment such as long-term polypharmacy at a high dose may be included when the scope of subjects is enlarged. PMID:10560896

Ito, C; Kubota, Y; Sato, M

1999-10-01

318

Guidance for Industry: Labeling for Human Prescription Drug and Biological Products. Implementing the PLR Content and Format Requirements.  

National Technical Information Service (NTIS)

On January 24, 2006, FDA published a final rule that amended the requirements for the content and format of labeling for human prescription drug and biological products. The rule is commonly referred to as the Physician Labeling Rule (PLR) because it addr...

2013-01-01

319

Non-Medical Use of Prescription Drugs among Youth in an Appalachian Population: Prevalence, Predictors, and Implications for Prevention  

ERIC Educational Resources Information Center

This article examines prevalence of non-medical use of prescription drugs (NMUPD) in a sample of elementary and high school students in an Appalachian Tennessee county. We found that lifetime prevalence of NMUPD (35%) was higher than prevalence of cigarette use (28%) and marijuana use (17%), but lower than lifetime prevalence of alcohol use (46%).…

Collins, David; Abadi, Melissa Harris; Johnson, Knowlton; Shamblen, Steve; Thompson, Kirsten

2011-01-01

320

Doctors’ decision processes in a drug-prescription task: The validity of rating scales and think-aloud reports  

Microsoft Academic Search

The validity of rating scales and of think-aloud protocols were compared in a medical decision task (treatment of high cholesterol values). Twenty doctors were exposed to six case vignettes. All participants were asked to think aloud and 10 of them were also asked to rate their inclination to drug prescription during successive phases of the decision process. Both think-aloud data

Lars Backlund; Ylva Skånér; Henry Montgomery; Johan Bring; Lars-Erik Strender

2003-01-01

321

Introduction of a Self-Report Version of the Prescription Drug Use Questionnaire and Relationship to Medication Agreement Noncompliance  

Microsoft Academic Search

The Prescription Drug Use Questionnaire (PDUQ) is one of several published tools developed to help clinicians better identify the presence of opioid abuse or dependence in patients with chronic pain. This paper introduces a patient version of the PDUQ (PDUQp), a 31-item questionnaire derived from the items of the original tool designed for self-administration, and describes evidence for its validity

Peggy A. Compton; Stephen M. Wu; Beatrix Schieffer; Quynh Pham; Bruce D. Naliboff

2008-01-01

322

Design, Development, and Evaluation of Visual Aids for Communicating Prescription Drug Instructions to Nonliterate Patients in Rural Cameroon.  

ERIC Educational Resources Information Center

Culturally sensitive visual aids designed to help convey drug information to nonliterate female adults requiring antibiotics were developed. Researchers conceptualized the messages, and a local artist produced the visual aids. Comprehension and compliance with prescription instructions were evaluated (N=78). Results and practical implications are…

Ngoh, Lucy N.; Shepherd, Marvin D.

1997-01-01

323

Incidence of potential drug interactions in medication prescriptions for children and adolescents in the University Hospital Olomouc, Czech Republic.  

PubMed

Drug interactions are important potential causes of adverse drug reactions. However, studies of their occurrence in children are almost entirely lacking. This study evaluates the incidence of potential drug interactions (PDIs) in medication prescriptions for children. The study was performed at the University Hospital in Olomouc. PDIs in each patient's prescriptions were identified. Multivariate analysis was performed in order to assess the risk factors confounding the potential interactions. Univariate analysis was used to assess which diagnostic groups and medication groups significantly increase or lower the odds of a potential drug-drug interaction. A total of 6,078 patients meeting the inclusion criteria entered the study. They received 19,522 prescriptions. PDIs were identified in 3.83 % of patients (moderate-to-severe cases in 0.47 %). Patient age (p = 0.008), the average number of prescriptions per visit (p < 0.0001), and the number of visits per year (p < 0.0001) were found to increase the risk of drug interaction. The presence of epilepsy, leukemia, or rheumatoid arthritis and related disease diagnoses were discovered to increase the risk of PDIs significantly. Conclusion: The risk of PDIs in children is low, but it increases significantly with age and the number of drugs prescribed, particularly antiepileptics and immunosuppressants. The finding of a potential interaction in 0.47 % of all children in whom any medication was prescribed should not be underestimated since it means a significant risk for one child out of every 200, and it is also substantially higher in the chronically ill. Pediatricians should be aware of relevant interactions and should prevent them by therapeutic drug monitoring or appropriate clinical and laboratory monitoring. PMID:23334563

Langerová, Petra; Prokeš, Michal; Konvalinka, Martin; Fürstová, Jana; Urbánek, Karel

2013-05-01

324

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

Microsoft Academic Search

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

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

2010-01-01

325

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

PubMed

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

Kesselheim, Aaron S; Choudhry, Niteesh K

2008-04-15

326

Prescription painkillers and controlled substances: an appraisal of drug information provided by six US pharmacies  

PubMed Central

Background Health literacy impacts health outcomes. Health literacy is a measure of a person’s competence to find, access, contextualize, and understand the information needed to make health decisions. Low levels of health literacy have been associated with poor health status. Health literacy can be enhanced by improving the readability of health literature. Misuse and abuse of prescription medicines and controlled substances is rising. It could be argued that improving the readability of the drug-information documents associated with these medicines could serve to alleviate this situation in a small, albeit incremental, manner. This paper provides a readability assessment of 71 such documents. Methods The readability of drug-information documents associated with 12 commonly misused and abused painkiller medicines and controlled substances published by the top six US pharmacies was assessed. The Flesch-Kincaid Grade Level, Flesch Reading Ease, and Simple Measure of Gobbledygook (SMOG) indices were used to assess the readability of these drug-information documents. One-way analysis of variance (ANOVA) was used to compare the readability of the documents. Results The average Flesch-Kincaid Grade Level index score was found to be 11.16. The average Flesch Reading Ease index score was found to be 45.94. The average SMOG index score was found to be 13.60. Pharmacies C and E had the best average readability scores, whereas pharmacies A and B had the worst average readability scores. Conclusion Access, contents, and formatting of the documents were qualitatively analyzed to make recommendations to improve readability. Pharmacies C and E were used as benchmarks to identify the seven best practices. Good drug-information documents should have: (1) clear purpose, (2) limited scope, (3) summary/brief review, (4) well-placed graphics, (5) informative illustrations, (6) clean layout and lucid formatting relevant to the media, and (7) focus on the intended users.

Gill, Preetinder S

2013-01-01

327

Antipsychotic drug prescription rates among Dutch nursing homes: the influence of patient characteristics and the dementia special care unit.  

PubMed

Objectives: To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics.Method: As part of the Waalbed-II study, the data on antipsychotic drug use in 290 patients were collected and the Global Deterioration Scale (GDS) stage, type of dementia and behaviour (Cohen-Mansfield Agitation Inventory (CMAI)) were measured in 14 SCUs in nine nursing homes. A multilevel logistic regression model was used to assess the difference in antipsychotic drug prescription rates between dementia SCUs adjusted for age, gender, GDS stage, type of dementia and CMAI factor scores.Results: Two hundred and ninety residents met the inclusion criteria. Thirty-two per cent were prescribed an antipsychotic drug. Antipsychotic drugs were more often prescribed in patients with physically aggressive and non-aggressive behaviour and in patients with mixed dementia (vascular/Alzheimer's) than in patients with other types of dementia. Antipsychotic drug prescriptions significantly differed among the dementia SCUs. The odds of antipsychotic drug use for patients in the SCU with the highest prevalence of drug use were 2.76 (95% confidence interval (CI) 1.14-6.69) times as high as for the SCU with the lowest prevalence of drug use, taking the patient characteristics into account.Conclusion: Antipsychotic drug use in nursing home residents with dementia is not only predicted by the type of dementia and patient behaviour, but it is independently associated with the dementia SCU at which the patient resides. This result indicates that antipsychotic drugs are not only prescribed for their clinical indications (agitation/aggression) but are associated with environmental factors that may reflect a specific nursing home prescribing culture. PMID:24506695

van der Putten, M J G; Wetzels, R B; Bor, H; Zuidema, S U; Koopmans, R T C M

2014-09-01

328

Longitudinal Effects of Universal Preventive Intervention on Prescription Drug Misuse: Three RCTs with Late Adolescents and Young Adults  

PubMed Central

Objectives Examine long-term prescription drug misuse outcomes from three RCTs of brief universal preventive interventions conducted during middle school. Methods Study 1 tested the Iowa Strengthening Families Program (ISFP); 22 schools participated, with pretesting at grade 6 (1993) and outcomes measured at age 25. Study 2 evaluated a revised ISFP, renamed Strengthening Families Program: For Parents and Youth 10–14—SFP 10–14, plus the school-based Life Skills Training (SFP 10–14 + LST); 24 schools participated, with pretesting at grade 7 (1998) and outcomes at ages 21–25. Study 3 examined SFP 10–14 plus one of three school-based interventions selected from a menu (SFP 10–14 + School Program); 28 schools participated, with pretesting at grade 6 (2002) and outcomes at 12th grade. Self-reported outcomes were Prescription Opioid Misuse (POM) and Lifetime Prescription Drug Misuse Overall (PDMO). Results Study 1: ISFP showed significant effects on POM and PDMO, Relative Reduction Rates (RRRs) of 65%, and comparable benefits for higher- and lower-risk subgroups. Study 2: SFP 10–14 + LST showed significant or marginally-significant effects on POM/PDMO across all ages; higher-risk participants showed stronger effects (RRRs 43–79%). Study 3: significant results were found for POM/PDMO (RRRs 20–21%); higher-risk and lower-risk participants showed comparable outcomes. Conclusions Brief universal interventions have potential for public health impact by reducing prescription drug misuse among adolescents and young adults.

Spoth, Richard; Trudeau, Linda; Shin, Chungyeol; Ralston, Ekaterina; Redmond, Cleve; Greenberg, Mark; Feinberg, Mark

2013-01-01

329

Hydrocodone and acetaminophen overdose  

MedlinePLUS

... levels in the blood (N-acetylcysteine) Medicine to reverse the effect of the hydrocodone (narcotic antagonist) Tube ... for recovery. If you can receive medicines to reverse the overdose, you may get better within 1 - ...

330

Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians' prescription behavior  

Microsoft Academic Search

ABSTRACTBackground: The aim of the study was to examine whether staff distress and aspects of the nursing home environment were associated with psychotropic drug use (PDU) in patients with dementia.Methods: This was a cross-sectional study of 1289 nursing home patients with dementia from 56 Dementia Special Care Units (SCUs) in the Netherlands. The primary outcome was PDU. Potential correlates of

S. U. Zuidema; J. F. de Jonghe; F. R. J. Verhey; R. T. C. M. Koopmans

2011-01-01

331

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

PubMed Central

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.

2014-01-01

332

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

PubMed Central

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.

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

2014-01-01

333

Preventing death among the recently incarcerated: an argument for naloxone prescription before release.  

PubMed

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. One hundred thirty-seven subjects from a project linking opiate-dependent individuals being released from prison with methadone maintenance programs were asked 73 questions regarding overdose. Most had experienced and witnessed multiple overdoses; 911 was often not called. The majority of personal overdoses occurred within 1 month of having been institutionalized. Nearly all participants expressed an interest in being trained in overdose prevention with Naloxone. 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

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

2009-01-01

334

Drugs involved in drug-facilitated crimes--part II: Drugs of abuse, prescription and over-the-counter medications. A review.  

PubMed

In recent years, there has been a notable increase in the number of reports of drug-facilitated crimes. Usually, individuals report that they were robbed or assaulted while incapacitated by drugs. Most often, these cases have involved drugs that have the ability to produce an effect that leaves the victim in a semiconscious or unconscious state. It is reasonable to assume that the purpose of drug-induced incapacitation is probably largely unchanged with time. This covers the full range of property offences (particularly theft) and crimes against the person (often sexual assault). What have changed are the drugs themselves: the number; type; their accessibility; effects and detection. This review describes the different aspects related to the involvement and use of drugs of abuse, as well as prescription and over-the counter medications in drug-facilitated crimes, which may help people working in this field to expand their knowledge in order to better understand the nature of these crimes or offences. PMID:21073992

Shbair, M K S; Eljabour, S; Bassyoni, I; Lhermitte, M

2010-11-01

335

Digital Social Media, Youth, and Nonmedical Use of Prescription Drugs: The Need for Reform  

PubMed Central

The tragic death of 18-year-old Ryan Haight highlighted the ethical, public health, and youth patient safety concerns posed by illicit online nonmedical use of prescription drugs (NUPM) sourcing, leading to a federal law in an effort to address this concern. Yet despite the tragedy and resulting law, the NUPM epidemic in the United States has continued to escalate and represents a dangerous and growing trend among youth and adolescents. A critical point of access associated with youth NUPM is the Internet. Internet use among this vulnerable patient group is ubiquitous and includes new, emerging, and rapidly developing technologies—particularly social media networking (eg, Facebook and Twitter). These unregulated technologies may pose a potential risk for enabling youth NUPM behavior. In order to address limitations of current regulations and promote online safety, we advocate for legislative reform to specifically address NUPM promotion via social media and other new online platforms. Using more comprehensive and modernized federal legislation that anticipates future online developments is critical in substantively addressing youth NUPM behavior occurring through the Internet.

Liang, Bryan A; Strathdee, Steffanie A

2013-01-01

336

Amendments to regulations regarding eligibility for a Medicare prescription drug subsidy. Final rule.  

PubMed

This final rule adopts, without change, the interim final rule with request for comments we published in the Federal Register on December 29, 2010. The interim final rule incorporated changes to the Medicare prescription drug coverage low-income subsidy (Extra Help) program made by the Patient Protection and Affordable Care Act (Affordable Care Act) enacted in March 2010. Under our interpretation of section 3304 of the Affordable Care Act, if the death of a beneficiary's spouse would decrease or eliminate the subsidy provided by the Extra Help program, we will extend the effective period of eligibility for the most recent determination or redetermination until one year after the month following the month we are notified of the death of the spouse. The effective date of this provision was January 1, 2011. We also revised our regulations to incorporate changes made by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) which affect the way we account for income and resources when determining eligibility for the Extra Help program. The statute provides that we no longer count the value of any life insurance policy as a resource for Extra Help effective on and after January 1, 2010. As of that date, we also no longer count as income the help a beneficiary receives when someone else provides food and shelter, or pays household bills for food, mortgage, rent, electricity, water, property taxes, or heating fuel or gas. These revisions updated our rules to reflect these statutory changes. PMID:22359794

2012-01-18

337

Effects of Copayment Levels on the Quantities of Prescription Drugs Purchased: Methodology and Substantive Findings.  

National Technical Information Service (NTIS)

The contractor used data from their paid claims and enrollment files to determine the relative importance of such factors as age, sex, family size, days' supply per prescription, and copayment level on number of prescriptions filled per person per year. R...

1975-01-01

338

Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial  

PubMed Central

Background Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia. Methods/design The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out. Discussion This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. Trial registration Netherlands Trial Registry (NTR): NTR3569.

2013-01-01

339

Impacts of Generic Competition and Benefit Management Practices on Spending for Prescription Drugs: Evidence from Medicare's Part D Benefit  

PubMed Central

Objective This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs. Data and Methods We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor. Results We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007–2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs. Conclusion In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.

Sheingold, Steven; Nguyen, Nguyen Xuan

2014-01-01

340

Fatal overdoses associated with quetiapine.  

PubMed

Quetiapine (Seroquel) is an atypical antipsychotic drug belonging to a new chemical class, the benzothiazepine derivatives. We present three cases from the Provincial Toxicology Center of British Columbia, Canada in which suicidal overdose deaths were associated with quetiapine. The blood specimens were initially subjected to a thorough qualitative analysis. Basic drugs were screened for by liquid-liquid extraction followed by gas chromatography-nitrogen-phosphorus (GC-NPD) and gas chromatography-mass spectrometry-electron impact detection utilizing both in-house and commercial search libraries. Acidic and neutral drugs were screened for by liquid-liquid extraction followed by high-performance liquid chromatography-diode-array detection. Volatiles were assayed by gas chromatography-flame-ionization detection. Quetiapine was assayed in biological specimens by basic extraction with n-butyl chloride and derivatized with 50 microL of MTBSTFA and separation by GC-NPD. Linearity was observed up to 2.0 mg/L. Samples with concentrations exceeding the linearity were diluted. These cases were chosen for study because they were all deaths as a result of suicidal ingestion of drugs in which quetiapine was considered a significant factor. The concentrations of quetiapine in these cases are 6-16 times greater than the upper reported therapeutic range (0.1-1.0 mg/L). In case #1, the concentrations of quetiapine found were 7.20 mg/L (19 micromol/L) in blood and 0.93 mg/L (2.4 micromol/L) in vitreous fluid. In case #2, the concentrations of quetiapine found were 16 mg/L in blood (42 micromol/L), 120 mg/kg (310 micromol/kg) in liver, and 1.8 mg/L (4.6 micromol/L) in vitreous fluid. In case #3, the concentrations of quetiapine found in femoral blood was 5.90 mg/L (15 micromol/L). In all cases, drugs in addition to quetiapine were detected, but in cases #1 and #2, the cause of death was considered to be a quetiapine overdose and the other drugs were not considered to be contributory. Case #3 was considered a mixed drug overdose. PMID:15516308

Langman, Loralie J; Kaliciak, Henry A; Carlyle, Sheila

2004-09-01

341

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

ERIC Educational Resources Information Center

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…

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

2009-01-01

342

Regulations regarding income-related monthly adjustment amounts to Medicare beneficiaries' prescription drug coverage premiums. Final rule.  

PubMed

This final rule adopts, without change, the interim final rule with request for comments we published in the Federal Register on December 7, 2010, at 75 FR 75884. The interim final rule contained the rules that we apply to determine the income-related monthly adjustment amount for Medicare prescription drug coverage (also known as Medicare Part D) premiums. This new subpart implemented changes made to the Social Security Act (Act) by the Affordable Care Act. The interim final rule allowed us to implement the provisions of the Affordable Care Act related to the income-related monthly adjustment amount for Medicare prescription drug coverage premiums when they went into effect on January 1, 2011. PMID:22834072

2012-07-25

343

Primary care physicians’ attitudes toward direct-to-consumer advertising of prescription drugs: still crazy after all these years  

Microsoft Academic Search

Based upon a national random sample of primary care physicians, this study updates earlier investigations of direct-to-consumer (DTC) advertising of prescription pharmaceutical drugs, in light of the explosive growth of such advertising since the late 1990s. The attitudes of the majority of primary care physicians surveyed remain strongly negative, with particular concern about the overstatement of efficacy\\/exaggerated benefit claims and

David P. Paul; Amy Handlin; Angela D’Auria Stanton

2002-01-01

344

Combining user fees exemption with training and supervision helps to maintain the quality of drug prescriptions in Burkina Faso.  

PubMed

To improve access to health care services, an intervention was implemented in Burkina Faso granting full exemption from user fees. Two further components, staff training and supervision, were added to support the intervention. Our aim in this study was to examine how this tripartite intervention affected the quality of drug prescriptions. Using a mixed methodology, we first conducted an interrupted time series over 24 months. Nine health centres were studied that had previously undergone a process analysis. A total of 14 956 prescriptions for children 0-4 years old were selected by interval sampling from the visit registries from 1 year before to 1 year after the intervention's launch. We then interviewed 14 prescribers. We used three World Health Organization (WHO) indicators to assess drug prescription quality. Analysis was carried out using linear regression and logistic regression. The prescribers' statements underwent content analysis, to understand their perceptions and changes in their practice since the subsidy's introduction. One effect of the intervention was a reduced use of injections (odd ratio (OR) = 0.28 [0.17; 0.46]) in cases of acute lower respiratory tract infections (ALRTI) without comorbidity. Another was a reduction in the inappropriate use of antibiotics in malaria without comorbidity (OR = 0.48 [0.33; 0.70]). The average number of drugs prescribed also decreased (coefficient = -0.14 [-0.20; -0.08]) in cases of ALRTI without comorbidity. The prescribers reported that their practices were either maintained or improved. The user fees exemption programme, combined with health staff training and supervision, did not lead to any deterioration in the quality of drug prescriptions. PMID:23073891

Atchessi, Nicole; Ridde, Valéry; Haddad, Slim

2013-09-01

345

Influence of Creatinine versus Glomerular Filtration Rate on Non-Steroidal Anti-Inflammatory Drug Prescriptions in Chronic Kidney Disease  

Microsoft Academic Search

Background: Non-steroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 (COX-2) inhibitors, are generally contraindicated in chronic kidney disease (CKD). This investigation sought to identify the frequency of NSAID\\/COX-2 prescription and to determine the influence of serum creatinine (Cr) versus estimated glomerular filtration rate (eGFR) on this practice pattern. Methods: An established Veterans Health Administration CKD safety cohort (n = 70,154) was examined

Krupa Patel; Clarissa Diamantidis; Min Zhan; Van Doren Hsu; Loreen D. Walker; James Gardner; Matthew R. Weir; Jeffrey C. Fink

2012-01-01

346

Data for drugs available through low-cost prescription drug programs are available through pharmacy benefit manager and claims data  

PubMed Central

Background Observational data are increasingly being used for pharmacoepidemiological, health services and clinical effectiveness research. Since pharmacies first introduced low-cost prescription programs (LCPP), researchers have worried that data about the medications provided through these programs might not be available in observational data derived from administrative sources, such as payer claims or pharmacy benefit management (PBM) company transactions. Method We used data from the Indiana Network for Patient Care to estimate the proportion of patients with type 2 diabetes to whom an oral hypoglycemic agent was dispensed. Based on these estimates, we compared the proportions of patients who received medications from chains that do and do not offer an LCPP, the proportion trend over time based on claims data from a single payer, and to proportions estimated from the Medical Expenditure Panel Survey (MEPS). Results We found that the proportion of patients with type 2 diabetes who received oral hypoglycemic medications did not vary based on whether the chain that dispensed the drug offered an LCPP or over time. Additionally, the rates were comparable to those estimated from MEPS. Conclusion Researchers can be reassured that data for medications available through LCPPs continue to be available through administrative data sources.

2012-01-01

347

[Prescription drug in the elderly. Study of changes in treatment during a stay in 221 geriatric patients in the Lyon region].  

PubMed

Prescribe in the elderly has specifcities, with age-related pharmacologica modifications, polypharmacy, and risk of drug toxicity. At time of the prescription renewal, each drug must be re-evaluated. The objective of this study was to identify the nature and reasons of drugs modifications during a hospitalization in a geriatric ward, in order to optimize drug prescriptions in elderly and to limit iatrogenic diseases. A descriptive study was carried out with 221 patients hospitalized in 4 geriatrics wards of Lyon region, over a period of 2 months. Prescriptions modifications between admission and exit were studied. Among drugs the most often stopped, we found proton pump inhibitors and serotonin uptake inhibitors. All non steroidal anti inflammatory agents and anti-arthritis drugs, as neary al cerebra vasodilators which were prescribed, were stopped. The reasons for stop were no indication (37 % of cases), adverse effects (13.2 %), inappropriate medication (7.7 %), non demonstrated effectiveness (5.9 %). Drugs overuse concerned above all proton pump inhibitors and antihypertensive agents. Among drugs the most often started, we found paracetamol, morphine, benzodiazepines with short half-life, cholinesterase inhibitors, the most often for an acute pathology (61.7 % of cases). Drugs overuse is therefore predominant, more than inappropriate medication and drugs underuse. To stop needless drugs and drugs which didn't prove their effectiveness would already allow to improve drugs prescription in elderly. PMID:24422288

Ponson, Isabelle; Pechu, Audrey

2013-11-01

348

Acute myocarditis after massive phenelzine overdose  

Microsoft Academic Search

Background  Monoamine oxidase inhibitors (MAOIs) are uncommonly used due to their high frequency of adverse effects, including tachycardia\\u000a and hypertension. Recently, there has been renewed interest in the role of this class of drugs in treating a variety of psychiatric\\u000a disorders. The clinical features of MAOI overdose are poorly characterised. This paper describes a novel cardiac complication\\u000a of phenelzine toxicity in

W. Stephen Waring; William A. H. Wallace

2007-01-01

349

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Diagnosis of drug overdose by rapid reversal with naloxone.  

PubMed

A short-cut review was carried out to establish whether naloxone may have an awakening effect in patients who have not taken opiates, thereby clouding its use as a diagnostic manoeuvre. The clinical bottom line is that opioid antagonists are able to reverse symptoms such as altered consciousness in patients who have not taken an overdose of opiates. It is unclear in which conditions or circumstances this occurs. PMID:17057146

Barrie, Jenifer; May, Gabby

2006-11-01

350

Overuse, Overdose, Overdiagnosis... Overreaction?  

PubMed Central

When x-rays were first discovered, the harmful effects of radiation had to be manifest in the early users before they were known. Today, radiation protection and safety have been established and the effects of radiation, as well as its risks, are known. Even so, medical radiation, in particular the growth in the use of computed tomography (CT), has resulted in soaring radiation doses received by the population in general. Inappropriate use has resulted in overuse, overdose and, perhaps, overdiagnosis, especially when used in screening. In the quest to control and curb the use of procedures involving radiation, however, we must be careful not to provoke a pandemic of irrational fear of radiation. Overreaction to the overuse and overdose of radiation might deter patients from life-saving procedures.

Ho, ELM

2010-01-01

351

Overuse, overdose, overdiagnosis… overreaction?  

PubMed

When x-rays were first discovered, the harmful effects of radiation had to be manifest in the early users before they were known. Today, radiation protection and safety have been established and the effects of radiation, as well as its risks, are known. Even so, medical radiation, in particular the growth in the use of computed tomography (CT), has resulted in soaring radiation doses received by the population in general. Inappropriate use has resulted in overuse, overdose and, perhaps, overdiagnosis, especially when used in screening. In the quest to control and curb the use of procedures involving radiation, however, we must be careful not to provoke a pandemic of irrational fear of radiation. Overreaction to the overuse and overdose of radiation might deter patients from life-saving procedures. PMID:21611049

Ho, Elm

2010-01-01

352

21 CFR 201.22 - Prescription drugs containing sulfites; required warning statements.  

Code of Federal Regulations, 2013 CFR

...added to certain drug products to inhibit the oxidation of the active drug ingredient. Oxidation of the active drug ingredient may result...Examples of specific sulfites used to inhibit this oxidation process include sodium bisulfite,...

2013-04-01

353

Is access sufficient? An examination of the effects of the MedShare program to expand access to prescription drugs for indigent populations.  

PubMed

We conduct an evaluation of MedShare, a program designed to enhance access to prescription drugs for indigent patients in the Greater Cincinnati area. The program expands access to drugs by providing subsidies to reduce the costs paid by patients for their prescriptions. The assumption is that by expanding access to prescription drugs, participant health outcomes as measured by quality of life improve. Although the program appears outwardly successful, we found little difference between program participants and comparison groups. We feel that these findings point to a major flaw with existing health policy: access alone is not sufficient to improve health outcomes. Too often programs are created and, provided they show outwards signs of success (e.g., enrollment and utilization), are assumed to be improving the health of the community. Our findings indicate that one must look beyond just expanding access to ensure that programs are indeed achieving their overall objectives. PMID:18981334

Shaw, Thomas; Carrozza, Mark

2008-12-01

354

78 FR 15019 - Food and Drug Administration Prescription Drug User Fee Act V Benefit-Risk Plan; Request for...  

Federal Register 2010, 2011, 2012, 2013

...http://www.fda.gov/downloads...framework in its human drug and biologic review process...intended to fulfill the requirement in section 905 of...quality of human drugs is a complicated...task, requiring FDA's...

2013-03-08

355

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

...Drug Evaluation and Research, Food and Drug Administration...only to an individual patient. (3) Instead...addresses of individual patients; instead, the...received. Names of patients, individual reporters, health care professionals,...

2014-04-01

356

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

Code of Federal Regulations, 2011 CFR

...Drug Evaluation and Research, Food and Drug Administration...only to an individual patient. (3) Instead...addresses of individual patients; instead, the...received. Names of patients, individual reporters, health care professionals,...

2011-04-01

357

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

Code of Federal Regulations, 2012 CFR

...Drug Evaluation and Research, Food and Drug Administration...only to an individual patient. (3) Instead...addresses of individual patients; instead, the...received. Names of patients, individual reporters, health care professionals,...

2012-04-01

358

Rational prescription of drugs within similar therapeutic or structural class for gastrointestinal disease treatment: Drug metabolism and its related interactions  

Microsoft Academic Search

AIM: To review and summarize drug metabolism and its related interactions in prescribing drugs within the similar therapeutic or structural class for gastrointestinal disease treatment so as to promote rational use of medicines in clinical practice. METHODS: Relevant literature was identified by performing MEDLINE\\/Pubmed searches covering the period from 1988 to 2006. RESULTS: Seven classes of drugs were chosen, including

Quan Zhou; Xiao-Feng Yan; Zhong-Miao Zhang; Wen-Sheng Pan; Su Zeng; Zhou Q; Yan XF; Zeng S. Rational

2007-01-01

359

Nonmedical prescription drug use among US college students at a Midwest university: a partial test of social learning theory.  

PubMed

We estimate the prevalence of nonmedical prescription drug (NMPD) use and test social learning theory as an explanation for NMPD use based upon data from a large pilot study. Data were collected from 465 college students at a Midwestern university in the USA using a self-administered questionnaire. The sample was predominantly white (88%), 43% were female and the mean age was 22. Most participants (80%) were not members of social fraternities or sororities. A majority of students did not report NMPD use: 39.4% of respondents reported lifetime NMPD use, 31% reported past-year use, and 14.4% reported past-month use. Multivariate regression results partially supported social learning theory as an explanation for lifetime NMPD use. Limitations and suggestions for future research are suggested. PMID:20397873

Peralta, Robert L; Steele, Jennifer L

2010-05-01

360

Colleague interactions and new drug prescribing behavior: the case of the initial prescription of antidepressants in Taiwanese medical centers.  

PubMed

This research explores the social factors influencing hospital physicians' initial adoption of duloxetine hydrochloride, with a focus on colleague interactions. The study analyzes archival data compiled by the National Health Insurance Research Database of Taiwan to examine how the prescribing decisions made by psychiatrists' colleagues influence the likelihood of the psychiatrists' initial prescription. The results show that the adoption ratio of a physician's colleagues in a medical center is positively associated with the likelihood of a physician's adoption of the new drug. Specifically, colleague groups with similar and longer tenure as well as similar and older age have significantly positive effects. Colleague groups with the same and different gender also have positive effects. In summary, tenure and age, rather than gender, are vital sources of heterogeneous colleague interactions. PMID:21962150

Lin, Shu-Jou; Jan, Kuan-An; Kao, Jen-Tse

2011-10-01

361

Prescription for fairness: a new approach to tort liability of brand-name and generic drug manufacturers.  

PubMed

Over the past two decades, courts have consistently ruled that the manufacturer of a brand-name prescription drug cannot be liable for injuries suffered by those taking generic imitations of its product. This meant that a patient injured by a generic drug could have no remedy at all because in many instances the generic drug manufacturer would escape liability on the ground that it did not produce any information on which the patient's doctor relied. It was a perplexing dilemma. The generic drug manufacturer made the product that the plaintiff received, the brand-name manufacturer produced all of the information the patient's doctor saw, and neither manufacturer could be held liable even if each acted negligently. The California Court of Appeal recently issued a stunning decision in which it concluded that a brand-name drug manufacturer could be liable to a plaintiff who took a generic version of its product. The reaction to the decision has been overwhelmingly negative. Commentators have condemned the decision as one of the worst rulings made by any court in recent years. Judges around the country have dismissed it as a misguided aberration from the otherwise strong judicial consensus on the issue. Although the decision has been the subject of scathing criticism, this Article argues that the California court's ruling actually represents the first time that a court has properly examined this issue. In addition, the Article points out some weaknesses in the California court's reasoning and proposes a novel general framework for analyzing the liability of brand-name and generic drug manufacturers. PMID:21365961

Rostron, Allen

2011-02-01

362

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

NSDL National Science Digital Library

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.

2001-01-01

363

Competition in prescription drug markets: the roles of trademarks, advertising, and generic names.  

PubMed

We take on two subjects of controversy among economists-advertising and trademarks-in the context of the market for generic drugs. We outline a model in which trademarks for drug names reduce search costs but increase product differentiation. In this particular framework, trademarks may not benefit consumers. In contrast, the generic names of drugs or "International Nonproprietary Names" (INN) have unquestionable benefits in both economic theory and empirical studies. We offer a second model where advertising of a brand-name drug creates recognition for the generic name. The monopoly patent-holder advertises less than in the absence of a competitive spillover. PMID:22815099

Feldman, Roger; Lobo, Félix

2013-08-01

364

75 FR 71189 - Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug...  

Federal Register 2010, 2011, 2012, 2013

...facility. Brown CH, Am J Hosp Pharm. 1984 Apr; 41(4):698-702 Cost of discarded medication in Indiana LTC facilities. Parrott KA Am J Hosp Pharm 1980 Nov; 37(11);1531-4 Drug waste in LTC facilities: impact of drug distribution...

2010-11-22

365

The Role of Traumatic Event History in Non-Medical Use of Prescription Drugs among a Nationally Representative Sample of US Adolescents  

ERIC Educational Resources Information Center

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…

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.

2010-01-01

366

Medicare program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs. Final rule.  

PubMed

The final rule will revise the Medicare Advantage (MA) program (Part C) regulations and prescription drug benefit program (Part D) regulations to implement statutory requirements; improve program efficiencies; and clarify program requirements. The final rule also includes several provisions designed to improve payment accuracy. PMID:24855709

2014-05-23

367

38 CFR 58.18 - VA Form 10-0460-Request for Prescription Drugs from an Eligible Veteran in a State Home.  

Code of Federal Regulations, 2011 CFR

38 Ç Pensions, Bonuses, and Veterans' Relief Ç 2 Ç 2013-07-01 Ç 2013-07-01 Ç false Ç VA Form 10-0460-Request for Prescription Drugs from an Eligible Veteran in a State Home. Ç 58.18 Ç Section 58.18 Ç Pensions, Bonuses, and Veterans' Relief Ç DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) Ç FORMS Ç...

2013-07-01

368

Prescription Drugs for Children with Special Health Care Needs in Commercial Managed Care: Patterns of Use and Cost, 1999-2001. Washington, DC: Mathematica Policy Research  

Microsoft Academic Search

Although rapidly rising pharmaceutical costs have contributed to increased health expenditures nationwide, few studies have examined this trend in children with special health care needs. This study used data from two large commercial managed care plans in UnitedHealth Group to examine how many and what kinds of prescription drugs these children used, as well as their costs. The researchers found

Henry T. Ireys; Jennifer Humensky; Steven Wickstrom; Paula Rheault

2004-01-01

369

Medicare and state health care programs; fraud and abuse: OIG civil money penalties under the Medicare prescription drug discount card program. Final rule.  

PubMed

In accordance with section 1860D-31 of the Social Security Act, this rule finalizes OIG's new authority for imposing civil money penalties (CMPs) against endorsed sponsors under the Medicare prescription drug discount card program that knowingly engage in false or misleading marketing practices; overcharge program enrollees; or misuse transitional assistance funds. PMID:15597491

2004-12-14

370

Medicare and state health care programs; fraud and abuse: OIG civil money penalties under the Medicare prescription drug discount card program. Interim final rule with comment period.  

PubMed

In accordance with section 1860D-31 of the Social Security Act, this rule sets forth the OIG's new authority for imposing civil money penalties (CMPs) against endorsed sponsors under the Medicare prescription drug discount card program that knowingly engage in false or misleading marketing practices; overcharge program enrollees; or misuse transitional assistance funds. PMID:15151115

2004-05-19

371

Inhibitory potential of herbal medicines on human cytochrome P450-mediated oxidation: properties of umbelliferous or citrus crude drugs and their relative prescriptions.  

PubMed

To investigate the possible drug interaction with herbal medicine, hot water decoctions or 40% ethanol infusions of several Umbelliferous or Citrus crude drugs and their prescriptions were examined in vitro for their abilities to inhibit human cytochrome P450 3A (CYP3A). Addition of each decoction or infusion from Baizhi (Angelica dahurica and varieties), Qianghuo (Notopterygium incisum or N. forbesii), Duhuo (Angelica biserrata), Fangfeng (Saposhnikovia divaricata), Danggui (Angelicasinensis), Zhishi or Zhiqiao (Citrus aurantium) resulted in various degrees of human CYP3A inhibition as determined by microsomal testosterone 6beta-hydroxylation. The inhibitory potency was consistent with the abundance of the hydrophobic components for each sample. Experiments on the infusion of a Japanese Baizhi (BZ1) showed the major role of furanocoumarins on human CYP3A inhibition. Some of the crude drugs and a related prescription showed increased inhibition after the preincubation, suggesting the involvement of a mechanism-based inhibition. Some formulated prescriptions, however, showed intense inhibition with their hydrophobic fractions rather than with their hydrophobic fractions, suggesting that components other than furanocoumarins in herbal prescriptions may also cause CYP3A inhibition. These results indicate the necessity of intensive investigations on the possible drug interaction with traditional medicines. PMID:11388644

Guo, L Q; Taniguchi, M; Chen, Q Y; Baba, K; Yamazoe, Y

2001-04-01

372

38 CFR 1.515 - Disclosure of information to participate in state prescription drug monitoring programs.  

Code of Federal Regulations, 2013 CFR

...include the identification of the substance by a national drug code number, quantity dispensed, number...Department of Health and Human Services-issued National Provider Identifier number. (Authority: 5 U.S.C. 552a;...

2013-07-01

373

Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice.  

National Technical Information Service (NTIS)

In an October 2010 memorandum to all Medicare Part D sponsors, CMS said that sponsors may be paying for drugs that should be the responsibility of hospice organizations. Hospice beneficiaries generally experience common symptoms during the end of life, re...

2012-01-01

374

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

Federal Register 2010, 2011, 2012, 2013

...system and obtaining input from supply chain partners on attributes and standards...public health by securing the drug supply chain against the introduction of counterfeit...multi-layered approach to securing the supply chain and protecting consumers from...

2011-01-07

375

42 CFR 410.30 - Prescription drugs used in immunosuppressive therapy.  

Code of Federal Regulations, 2010 CFR

...includes the indication for preventing or treating the rejection of a transplanted...the specific purpose of preventing or treating the rejection of a patient's...drugs for the purpose of preventing or treating the rejection of a...

2010-10-01

376

42 CFR 410.30 - Prescription drugs used in immunosuppressive therapy.  

Code of Federal Regulations, 2010 CFR

...includes the indication for preventing or treating the rejection of a transplanted...the specific purpose of preventing or treating the rejection of a patient's...drugs for the purpose of preventing or treating the rejection of a...

2009-10-01

377

Getting Extra Help with Medicare Prescription Drug Plan Costs: Information for American Indians and Alaska Natives  

MedlinePLUS

... advances and refunds related to earned income tax credits and child tax credits; —Compensation you receive as a crime victim; and — ... treatment and drugs; • Disaster assistance; • Earned income tax credit payments; • Assistance from others to pay your household ...

378

Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem.  

National Technical Information Service (NTIS)

Amid heightened awareness that many patients with cancer and other chronic diseases suffer from undertreated pain, the Food and Drug Administration (FDA) approved Purdue Pharma's controlled-release pain reliever OxyContin in 1995. Sales grew rapidly, and ...

2003-01-01

379

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...

380

A Prescription for Drug Formulary Evaluation: An Application of Price Indexes  

PubMed Central

Existing economic approaches to the design and evaluation of health insurance do not readily apply to coverage decisions in the multi-tiered drug formularies characterizing drug coverage in private health insurance and Medicare. This paper proposes a method for evaluating a change in the value of a formulary to covered members based on the economic theory of price indexes. A formulary is cast as a set of demand-side prices, and our measure approximates the compensation (positive or negative) that would need to be paid to consumers to accept the new set of prices. The measure also incorporates any effect of the formulary change on plan drug acquisition costs and “offset effects” on non-drug services covered by the plan. Data needed to calculate formulary value are known or can be forecast by a health plan. We illustrate the method with data from a move from a two- to a three-tier formulary.

Glazer, Jacob; Huskamp, Haiden A.; McGuire, Thomas G.

2012-01-01

381

The rabbit in the hat: dubious argumentation and the persuasive effects of prescription drug advertising (DTCA).  

PubMed

There is an ongoing global debate over the potential benefits and risks of allowing direct-to-consumer advertising of prescription medicines (DTCA). The core of this debate concerns the identification of DTCA either as a beneficial procedure to be promoted or as a damaging procedure to be abolished. Economic data on DTCA suggest that this form of advertising has an impact on consumers. Based on this premise, we explore the use of argumentation theory to inquire into the reasons for this success. In particular, by combining perspectives from argumentation theory and marketing research this paper aims to test the hypothesis of whether DTCA presents information framed in potentially misleading, but persuasive, argumentative structures. We highlight and discuss the results of two studies designed to assess whether readers perceive DTCA as argumentative and, if so, which explicit and implicit elements provide groundings for the inference that consumers draw from the ads. The analysis highlights the presence in DTCA of dubious arguments (fallacies and distracting claims) that may go unnoticed. Also, it illustrates the nature of readers' wrong assumptions that arise independently from the contents of the ads. These factors seem to influence the level of the self-perceived persuasiveness of DTCA. PMID:19363879

Rubinelli, Sara; Nakamoto, Kent; Schulz, Peter J

2008-01-01

382

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 ...

383

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

PubMed

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

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

2013-03-01

384

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

PubMed Central

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.

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

2012-01-01

385

Acetaminophen overdose with fetal demise.  

PubMed

A case of fetal demise and maternal recovery after acetaminophen overdose is presented, to our knowledge the first reported. Fetal liver and maternal serum concentrations indicate overdose to be the cause of fetal death. Maternal disseminated intravascular coagulation (DIC) may have been related to maternal acetaminophen-induced liver disease alone or to a combination of liver disease and the presence of a dead fetus. PMID:6465090

Haibach, H; Akhter, J E; Muscato, M S; Cary, P L; Hoffmann, M F

1984-08-01

386

77 FR 22071 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...  

Federal Register 2010, 2011, 2012, 2013

...dispensed in amounts less than a 30 days' supply (for example, lotions and other drugs not in solid form). Therefore, we proposed...cost associated with prescriber ID validation has already been absorbed by the industry. Therefore, we assume that 80 percent...

2012-04-12

387

The relevance of marketing activities in the Swiss prescription drugs market : Two empirical qualitative studies  

Microsoft Academic Search

Purpose – The purpose of this paper is to identify the most relevant marketing factors and examine existing theories and to provide guidance for planning future studies. Since drug markets are very complex, this paper will focus on a particular market\\/country to reduce some of this complexity. Design\\/methodology\\/approach – A serial research study is undertaken to examine the essential marketing

Michael Stros; Juerg Hari; John Marriott

2009-01-01

388

Changes in Warnings and Contraindications in Prescription Drug Labeling Due to Liver Toxicity  

Microsoft Academic Search

Issuing labeling changes is a common practice to warn about important side effects after drug approval. Among the many safety concerns, liver toxicity is frequently a major cause for postapproval labeling changes. To examine labeling changes associated with liver toxicity, safety-related labeling changes due to liver toxicity were reviewed. They were categorized into labeling changes that clarified\\/emphasized existing safety information

Yeong-Liang Lin

2008-01-01

389

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...

390

015 How can we prevent overdoses and what works? a systematic review of interventions for non fatal poisonings  

Microsoft Academic Search

BackgroundDeaths from opiate overdose in the UK are among the highest in Europe. Drug related deaths in Wales are not reducing. Naloxone is administered to reverse overdose by paramedics and in emergency departments.AimTo describe interventions to treat overdoses in the pre-hospital setting and review their effectiveness.Method1—systematic literature search; 2—selection of comparative studies for qualitative synthesis; 3—meta-analysis of suitable studies.Results39 references

Helen Snooks; Daphne Russell; Christine Brown; Akshey Nair; Chris Moore; Alan Lewis; Gareth Thomas; Mohammed al-Sulaiti; Marie Thomas; Faye Griffith-Noble

2011-01-01

391

Bad medicine: prescription drugs, preemption, and the potential for a no-fault fix.  

PubMed

For decades, federal regulation of pharmaceutical drugs and medical devices has worked hand in hand with state tort claims to protect the health and safety of the American public. Now, a new trend toward preemption endangers this scheme. In recent years, the Supreme Court has given increasing deference to agency assertions about their preemptive authority and has found preemption in an increasing number of cases. In the process, the Supreme Court has preempted claims for medical device injuries and left claims for pharmaceutical harms in a precarious position. The elimination of common law claims for drug and device harms will leave holes in the FDA's regulatory scheme, endangering the health and safety of Americans. It will also prevent ordinary Americans from seeking compensation for their injuries--even those injuries caused by manufacturer malfeasance. This Article proposes that Congress create a no-fault compensation scheme for drugs and medical devices to close these gaps. Such a scheme could be both practical and politically possible, satisfying manufacturers, tort reformers, patients, and plaintiffs' lawyers alike. PMID:22363960

Smirniotopoulos, Amalea

2012-01-01

392

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

Code of Federal Regulations, 2013 CFR

...20705-1266. (1) Postmarketing 15-day âAlert reportsâ. (i) Any person whose...is not required to submit a 15-day âAlert reportâ for an adverse drug experience...experience. (2) Postmarketing 15-day âAlert reportsââfollowup. Each person...

2013-04-01

393

[On the rational exertion for the prescriptions and drugs of TCM in preventing and treating SARS].  

PubMed

Based on the main schemes of the prevention and therapy for SARS issued by the state and provincial administrations of traditional Chinese medicine (TCM), the characters and regulations for the application and performance of TCM in preventing and treating SARS were studied by cluster analysis. Some problems in the rational exertions of TCM in preventing and treating SARS were also discussed. Some proposals for the rational uses of traditional Chinese drugs (TCD) in preventing and treating SARS were offered finally in this article. PMID:15139117

Xiao, Xiao-he; Wang, Jia-bo; He, Cheng-han

2003-07-01

394

Unexpected frequent hepatotoxicity of a prescription drug, flupirtine, marketed for about 30 years  

PubMed Central

AIMS To determine efficacy of the analgesic flupirtine in the treatment of overactive bladder syndrome in a proof-of-concept study. METHODS Double-blind, double-dummy, three-armed comparison of flupirtine extended release (400 mg/day, titrated to 600 mg/day), tolterodine extended release (4 mg/day) and placebo for 12 weeks. RESULTS When major elevations of liver enzymes (more than three times the upper normal limit) were detected in several flupirtine-exposed patients, the study was prematurely discontinued. Based on study-end data, hepatotoxicity was detected in 31% of patients receiving flupirtine for ?6 weeks. CONCLUSIONS Unexpected frequent and relevant toxicity can occur when testing an established drug for a new indication.

Michel, Martin C; Radziszewski, Piotr; Falconer, Christian; Marschall-Kehrel, Daniela; Blot, Koenraad

2012-01-01

395

Making sense of differing overdose mortality: contributions to improved understanding of European patterns.  

PubMed

The European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, publishes statistics for overdose deaths giving a European mean number, and ranking nations in a national 'league table' for overdose deaths. The interpretation of differing national levels of mortality is more problematic and more complex than is usually recognised. Different systems are used to compile mortality data and this causes problems for cross-national comparisons. Addiction behaviour can only be properly understood within its specific social and environmental ecology. Risk factors for overdose, such as the type of drug consumed, and the route of administration, are known to differ across countries. This paper describes problems associated with ranking and suggests how mortality data might be used in high-level countries aiming at reduction in the number of overdose deaths. PMID:23921286

Waal, Helge; Gossop, Michael

2014-01-01

396

Management of type 2 diabetes and its prescription drug cost before and during the economic crisis in Greece: an observational study  

PubMed Central

Background The aim of the present study is to examine the clinical indices related to cardiovascular risk management of Greek patients with type 2 diabetes, before and after the major economic crisis that emerged in the country. Methods In this retrospective database study, the medical records of patients with type 2 diabetes treated at three diabetes outpatient centers of the national health system during 2006 and 2012 were examined. Only patients with at least six months of follow-up prior to the recorded examination were included. The prescription cost was calculated in Euros per patient-year (€PY). Results A total of 1953 medical records (938 from 2006 and 1015 from 2012) were included. There were no significant differences in adjusted HbA1c, systolic blood pressure and HDL-C, while significant reductions were observed in LDL-C and triglycerides. In 2012, a higher proportion of patients were prescribed glucose-lowering, lipid-lowering and antihypertensive medications. Almost 4 out of 10 patients were prescribed the new incretin-based medications, while the use of older drugs, except for metformin, decreased. A significant increase in the adjusted glucose-lowering prescription cost (612.4 [586.5-638.2] €PY vs 390.7 [363.5-418.0]; p?prescription cost (1306.7 [1264.6-1348.7] €PY vs 1122.3[1078.1-1166.5]; p?prescriptions declined, while no difference was observed for lipid-lowering and antiplatelet agents. Conclusions During the economic crisis, the cardiovascular risk indices of Greek patients with type 2 diabetes being followed in public outpatient diabetes clinics did not deteriorate and in the case of lipid profile improved. However, the total prescription cost increased, mainly due to the higher cost of glucose-lowering prescriptions.

2014-01-01

397

Potential of prescription registries to capture individual-level use of aspirin and other nonsteroidal anti-inflammatory drugs in Denmark: trends in utilization 1999-2012  

PubMed Central

Background Due to over-the-counter availability, no consensus exists on whether adequate information on nonsteroidal anti-inflammatory drug (NSAID) use can be obtained from prescription registries. Objectives To examine utilization of aspirin and nonaspirin NSAIDs in Denmark between 1999 and 2012 and to quantify the proportion of total sales that was sold on prescription. Method Based on nationwide data from the Danish Serum Institute and the Danish National Prescription Registry, we retrieved sales statistics for the Danish primary health care sector to calculate 1-year prevalences of prescription users of aspirin or nonaspirin NSAIDs, and to estimate the corresponding proportions of total sales dispensed on prescription. Results Both low-dose aspirin and nonaspirin NSAIDs were commonly used in the Danish population between 1999 and 2012, particularly among elderly individuals. The 1-year prevalence of prescribed low-dose aspirin increased throughout the study period, notably among men. Nonaspirin NSAID use was frequent in all age groups above 15 years and showed a female preponderance. Overall, the prevalence of prescribed nonaspirin NSAIDs decreased moderately after 2004, but substantial variation according to NSAID subtype was observed; ibuprofen use increased, use of all newer selective cyclooxygenase-2 inhibitors nearly ceased after 2004, diclofenac use decreased by nearly 50% after 2008, and naproxen use remained stable. As of 2012, the prescribed proportion of individual-level NSAID sales was 92% for low-dose aspirin, 66% for ibuprofen, and 100% for all other NSAIDs. Conclusion The potential for identifying NSAID use from prescription registries in Denmark is high. Low-dose aspirin and nonaspirin NSAID use varied substantially between 1999 and 2012. Notably, use of cyclooxygenase-2 inhibitors nearly ceased, use of diclofenac decreased markedly, and naproxen use remained unaltered.

Schmidt, Morten; Hallas, Jesper; Friis, S?ren

2014-01-01

398

The Views of Healthcare Professionals, Drug Developers and Regulators on Information about Older People Needed for Rational Drug Prescription  

PubMed Central

Background The ICH E7 guideline intends to improve the knowledge about medicines in geriatric patients. As a legislative document, it might not reflect the needs of healthcare professionals. This study investigated what information healthcare professionals, regulatory agencies and pharmaceutical industries consider necessary for rational drug prescribing to older individuals. Methods and Findings A 29-item-questionnaire was composed, considering the representation in trials, pharmacokinetics, efficacy, safety, and convenience of use in older individuals, with space for additions. Forty-three European professionals with an interest in medication for older individuals were included. In order to investigate their relevance, five items were included in a second questionnaire, with 11 control items. Median scores, differences between clinical and non-clinical respondents and response consistency were analysed. Consistency was present in 10 control items. Therefore, all items of the first questionnaire and the five additional items were analysed. Thirty-seven (86%) respondents returned the first questionnaire; 31/37 (84%) the second. Information about age-related differences in adverse events, locomotor effects, drug-disease interactions, dosing instructions, and information about the proportion of included 65+ patients was considered necessary by most respondents. Clinicians considered information significantly more important than the non-clinical respondents about the inclusion of 75+, time-until-benefit in older people, anticholinergic effects, drug-disease interactions, and convenience of use. Main study limitations are the focus on information for daily practice, while the ICH E7 guideline is a legislative document focused on market approval of a new medicine. Also, a questionnaire with a Likert scale has its limitations; this was addressed by providing space for comments. Conclusions This study reveals that items considered necessary are currently not included in the ICH E7 guideline. Also, clinicians’ and non-clinicians’ opinions differed significantly in 15% of the items. Therefore, all stakeholders should collaborate to improve the availability of information for the rational prescribing to older individuals.

Beers, Erna; Egberts, Toine C. G.; Leufkens, Hubert G. M.; Jansen, Paul A. F.

2013-01-01

399

Zinc oxide overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

400

Calcium channel blocker overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

401

Sassafras oil overdose  

MedlinePLUS

... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ... In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug ...

402

Use of anti-asthmatic drugs in Italy: analysis of prescriptions in general practice in the light of guidelines for asthma treatment  

Microsoft Academic Search

Our aim was to analyse anti-asthmatic drug utilisation in primary health care in a Northern Italian region in the light of guidelines for asthma treatment. Methods: We collected all prescriptions for anti-asthmatic agents reimbursed in 1998 in six local health authorities (overall population: 1,909,192 inhabitants) of Emilia Romagna (Northern Italy). The asthmatic cohort was defined as the population of subjects

E. Poluzzi; D. Resi; P. Zuccheri; D. Motola; F. De Ponti; A. Vaccheri; N. Montanaro

2002-01-01

403

History and current perspectives on the use of drug formulations to decrease the abuse of prescription drugs.  

PubMed

This article is part of a supplemental issue of the journal devoted entirely to papers on how abuse liability of medications is affected by their formulation for medical use. This article reviews the history of abuse and addiction to medications in the United States and the legislation designed to control these problems. The provisions in legislation related specifically to formulations of medications designed to decrease their abuse potential will be noted. In addition, the role of the College on Problems of Drug Dependence (CPDD) as an organization initially founded to develop analgesic medications with less abuse potential than morphine is briefly reviewed. Examples of current approaches to the development of formulations of medications to decrease their abuse potential discussed in detail in the articles to follow are outlined. Finally, the use of behavioral economic analyses to better delineate the relative abuse potential of new medication formulations is discussed. PMID:16483729

Schuster, Charles R

2006-06-01

404

76 FR 17137 - Pregnancy and Prescription Medication Use Symposium  

Federal Register 2010, 2011, 2012, 2013

...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...

2011-03-28

405

National Trends in Pharmaceutical Opioid Related Overdose Deaths Compared to other Substance Related Overdose Deaths: 1999-2009  

PubMed Central

Background: Pharmaceutical opioid related deaths have increased. This study aimed to place pharmaceutical opioid overdose deaths within the context of heroin, cocaine, psychostimulants, and pharmaceutical sedative hypnotics, examine demographic trends, and describe common combinations of substances involved in opioid related deaths. Methods: We reviewed deaths among 15-64 year olds in the US from 1999-2009 using death certificate data available through the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Database. We identified International Classification of Disease-10 codes describing accidental overdose deaths, including poisonings related to stimulants, pharmaceutical drugs, and heroin. We used crude and age adjusted death rates (deaths/100,000 person years [p-y] and 95% confidence interval [CI] and multivariable Poisson regression models, yielding incident rate ratios (IRRs), for analysis. Results: The age adjusted death rate related to pharmaceutical opioids increased almost 4-fold from 1999 to 2009 (1.54/100,000 p-y [95% CI 1.49-1.60] to 6.05/100,000 p-y [95% CI 5.95-6.16; p<0.001). From 1999 to 2009, pharmaceutical opioids were responsible for the highest relative increase in overdose death rates (IRR 4.22, 95% CI 3.03-5.87) followed by sedative hypnotics (IRR 3.53, 95% CI 2.11-5.90). Heroin related overdose death rates increased from 2007 to 2009 (1.05/100,000 persons [95% CI 1.00-1.09] to 1.43/100,000 persons [95% CI 1.38-1.48; p<0.001). From 2005-2009 the combination of pharmaceutical opioids and benzodiazepines was the most common cause of polysubstance overdose deaths (1.27/100,000 p-y (95% CI 1.25-1.30). Conclusion: Strategies, such as wider implementation of naloxone, expanded access to treatment, and development of new interventions are needed to curb the pharmaceutical opioid overdose epidemic.

Calcaterra, Susan; Glanz, Jason; Binswanger, Ingrid A.

2014-01-01

406

Prescription Nonsteroidal Anti-Inflammatory Medicines  

MedlinePLUS

... Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body ... What are some common prescription NSAIDs? There are 2 classes of prescription NSAIDs. Traditional NSAIDs include the ...

407

Prescription Pain Medicines - An Addictive Path?  

MedlinePLUS

... more than the number of people abusing cocaine, heroin, hallucinogens, and inhalants, combined. "The abuse of prescription ... on the receptors in the brain affected by heroin, morphine, and prescription painkillers. The tablets relieve drug ...

408

Concealed paracetamol overdose treated as HELLP syndrome in the presence of postpartum liver dysfunction.  

PubMed

Paracetamol is the most frequently used analgesic during pregnancy and the most common drug involved in suicidal overdose in the UK. Manifestation of toxicity classically occurs over four phases with clinical and laboratory features resembling HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We report a case that was erroneously managed as HELLP syndrome before a paracetamol overdose was diagnosed. This case highlights current practice in managing paracetamol overdose and focuses on the importance of addressing mental health issues to mitigate the risk of self-harm in pregnancy. PMID:24631060

Mills, A T; Davidson, M E; Young, P

2014-05-01

409

Effects of risperidone in overdose  

Microsoft Academic Search

This study was a 13-month prospective, descriptive case series of risperidone overdose reported by telephone to a regional poison control center (PCC) serving Philadelphia, PA. Patients were seen in local Philadelphia-area emergency departments. The variables examined were medical history, therapeutic use of risperidone, time postingestion, reported coingestants, clinical findings, decontamination and treatment, electrocardiograph results, laboratory data, standard toxicologic screen results,

Allison A Acri; Fred M Henretig

1998-01-01

410

75 FR 61613 - Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies  

Federal Register 2010, 2011, 2012, 2013

...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...

2010-10-06

411

Mirtazapine overdose is unlikely to cause major toxicity  

PubMed Central

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.

2014-01-01

412

Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011.  

PubMed

Objectives. We sought to collect and characterize all laws governing the operation of prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information, which have been suggested as a tool for reducing prescription drug overdose fatalities. Methods. We utilized a structured legal research protocol to systematically identify, review, and code all PMP statutes and regulations effective from 1998 through 2011. These laws were then abstracted along eleven domains, including reporting provisions, data sharing, and data access. Results. PMP characteristics vary greatly among states and across time. We observed an increase in the types and frequency of data required to be reported, the types of individuals permitted to access PMP data, and the percentage of PMPs authorized to proactively identify outlier prescribers and patients. As of 2011, 10 states required PMPs to report suspicious activity to law enforcement, while only 3 required reporting to the patient's physician. None required linkage to drug treatment or required all prescribers to review PMP data before prescribing. Few explicitly address data retention. Conclusions. State PMP laws are heterogeneous and evolving. Future studies of PMP effectiveness should take these variations into account. PMID:24922132

Davis, Corey S; Pierce, Matthew; Dasgupta, Nabarun

2014-08-01

413

APAMAT: A Prescription Algebra for Medication Authoring Tool  

Microsoft Academic Search

We describe here the prescription algebra and its implementation for medication authoring tools. The tools are parts of medication use process, which consists of prescription entry systems, medication authoring tool, medication scheduling specification, medication scheduler, and programmable pill dispenser. A medication authoring tool aids the pharmacists to collect and integrate prescriptions, to verify drug-drug interactions amongst prescriptions one took for

Han-Chun Yeh; Pi-Cheng Hsiu; Chi-Sheng Shih; Pei-Hsuan Tsai; J. W. S. Liu

2006-01-01

414

Do Motives Matter?: Nonmedical Use of Prescription Medications among Adolescents  

ERIC Educational Resources Information Center

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.…

McCabe, Sean Esteban; Boyd, Carol J.

2012-01-01

415

Prescription Patterns of General Practitioners in Peshawar, Pakistan  

PubMed Central

Objectives: To find out prescription patterns of general practitioners in Peshawar. Methods: Cross-sectional survey of drug prescriptions was done at six major hospitals and pharmacies of Peshawar between April and May 2011. A total of 1097 prescriptions that included 3640 drugs, were analyzed to assess completeness, average number of drugs, prescription frequency of various drug classes, and number of brands prescribed. Results: No prescription contained all essential components of a prescription. Legibility was poor in 58.5% prescriptions. Physician’s name and registration number were not mentioned in 89% and 98.2% prescriptions respectively. Over 78% prescriptions did not have diagnosis or indication mentioned. Dosage, duration of use, signature of physician and directions for taking drugs were not written in 63.8%, 55.4%, 18.5% and 10.9% of prescriptions respectively. On average each prescription included 3.32 drugs. Most frequently prescribed drug classes included analgesics (61.7%), anti-infective agents (57.2%), multi-vitamins (37.8%) and gastrointestinal drugs (34.4%). We found 206, 130, 105 and 101 different brands of anti-infective agents, gastrointestinal drugs, analgesics and multivitamins being prescribed. Conclusion: We observed a high number of average drugs per prescription mostly using brand names, and over-prescription of analgesics, antimicrobials, multivitamins and anti-ulcer drugs. Quality of written prescriptions was poor in terms of completeness.

Raza, Usman Ahmad; Khursheed, Tayyeba; Irfan, Muhammad; Abbas, Maryam; Irfan, Uma Maheswari

2014-01-01

416

Prescription patterns of general practitioners in peshawar, pakistan.  

PubMed

Objectives: To find out prescription patterns of general practitioners in Peshawar. Methods: Cross-sectional survey of drug prescriptions was done at six major hospitals and pharmacies of Peshawar between April and May 2011. A total of 1097 prescriptions that included 3640 drugs, were analyzed to assess completeness, average number of drugs, prescription frequency of various drug classes, and number of brands prescribed. Results: No prescription contained all essential components of a prescription. Legibility was poor in 58.5% prescriptions. Physician's name and registration number were not mentioned in 89% and 98.2% prescriptions respectively. Over 78% prescriptions did not have diagnosis or indication mentioned. Dosage, duration of use, signature of physician and directions for taking drugs were not written in 63.8%, 55.4%, 18.5% and 10.9% of prescriptions respectively. On average each prescription included 3.32 drugs. Most frequently prescribed drug classes included analgesics (61.7%), anti-infective agents (57.2%), multi-vitamins (37.8%) and gastrointestinal drugs (34.4%). We found 206, 130, 105 and 101 different brands of anti-infective agents, gastrointestinal drugs, analgesics and multivitamins being prescribed. Conclusion: We observed a high number of average drugs per prescription mostly using brand names, and over-prescription of analgesics, antimicrobials, multivitamins and anti-ulcer drugs. Quality of written prescriptions was poor in terms of completeness. PMID:24948959

Raza, Usman Ahmad; Khursheed, Tayyeba; Irfan, Muhammad; Abbas, Maryam; Irfan, Uma Maheswari

2014-05-01

417

Prevalence and Patterns of Commonly Abused Psychoactive Prescription Drugs in a Sample of University Students from Lebanon: An Opportunity for Cross-Cultural Comparisons  

PubMed Central

Background Concerns about psychoactive prescription drug abuse among youth are growing worldwide, but the majority of published studies remain from the US and Canada impeding cross-cultural comparisons. This study examines the prevalence, sources, motivations and substance-use correlates of commonly abused medications among youth from Lebanon. Methods An IRB-approved cross-sectional study was conducted (May 2010) at the American University of Beirut. Proportionate cluster sampling was used to generate a representative sample of AUB students (n=570). A self-filled anonymous questionnaire was administered. Results Lifetime medical and nonmedical prevalence of medications were (respectively): pain (36.9%, 15.1%), anxiety (8.3%, 4.6%), sleeping (6.5%, 5/8%) and stimulants (2.6%, 3.5%). Gender differences were not observed. Lebanese were least likely to report non-medical use. Nonmedical users mostly used the drugs for their intended purpose (e.g., sleeping to help in sleep, stimulants to increase alertness). Parents and pharmacists (without a doctor’s prescription) were the top two sources of all medications but stimulants whereby friends predominated. Diversion was observed in about 20% of the medical users. Lifetime marijuana users and past year alcohol abusers were three times as likely to use any prescription drug nonmedically. Conclusions In Lebanon, as in Western cultures, a considerable proportion of youth may be self-medicating. The absence of medical supervision coupled with motivations such as “to get high” renders this issue a high priority on the national youth agenda. Besides larger more comprehensive surveys, the findings signal the immediate need to raise awareness among youth, parents, health professionals and other stakeholders, as well as to reinforce relevant policies.

Ghandour, Lilian A.; El Sayed, Donna S.; Martins, Silvia S.

2013-01-01

418

Lamotrigine childhood overdose  

Microsoft Academic Search

A 2-year-old male developed generalized tonic-clonic seizure activity, tremor of limbs, muscle weakness, ataxia, and hypertonia after he swallowed 16 50-mg tablets of lamotrigine. His vital signs were normal, as were electroencephalography and laboratory investigation tests. The urine toxicologic screen revealed no other drugs. Treatment included midazolam and gastric lavage followed by activated charcoal and fluid loads. Symptoms resolved within

George Briassoulis; Panajiotis Kalabalikis; Maria Tamiolaki; Tassos Hatzis

1998-01-01

419

Relative mortality from overdose of antidepressants  

Microsoft Academic Search

AbstractObjective: To compare the fatal toxicities of antidepressant drugs in 1987–92.Design: Retrospective epidemiological review of prescription data of the Department of Health, Scottish Office Home and Health Department, and Welsh Health Common Services Authority (excluding data from most private general practices and most hospitals), and mortality data from the Office of Population Censuses and Surveys and General Register Office in

John A Henry; Carol A Alexander; Ersin K Sener

1995-01-01

420

Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia  

PubMed Central

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.

Maher, Lisa; Ho, Hien T

2009-01-01

421

21 CFR 369.3 - Warnings required on drugs exempted from prescription-dispensing requirements of section 503(b)(1...  

Code of Federal Regulations, 2013 CFR

...HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE INTERPRETATIVE STATEMENTS RE WARNINGS ON DRUGS AND DEVICES FOR OVER-THE-COUNTER SALE Definitions and Interpretations...369.3 Warnings required on drugs exempted from...

2013-04-01

422

21 CFR 369.3 - Warnings required on drugs exempted from prescription-dispensing requirements of section 503(b)(1...  

Code of Federal Regulations, 2010 CFR

...HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE INTERPRETATIVE STATEMENTS RE WARNINGS ON DRUGS AND DEVICES FOR OVER-THE-COUNTER SALE Definitions and Interpretations...369.3 Warnings required on drugs exempted from...

2010-04-01

423

21 CFR 369.3 - Warnings required on drugs exempted from prescription-dispensing requirements of section 503(b)(1...  

Code of Federal Regulations, 2010 CFR

...HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE INTERPRETATIVE STATEMENTS RE WARNINGS ON DRUGS AND DEVICES FOR OVER-THE-COUNTER SALE Definitions and Interpretations...369.3 Warnings required on drugs exempted from...

2009-04-01

424

Discovery of potent, selective multidrug and toxin extrusion transporter 1 (MATE1, SLC47A1) inhibitors through prescription drug profiling and computational modeling.  

PubMed

The human multidrug and toxin extrusion (MATE) transporter 1 contributes to the tissue distribution and excretion of many drugs. Inhibition of MATE1 may result in potential drug-drug interactions (DDIs) and alterations in drug exposure and accumulation in various tissues. The primary goals of this project were to identify MATE1 inhibitors with clinical importance or in vitro utility and to elucidate the physicochemical properties that differ between MATE1 and OCT2 inhibitors. Using a fluorescence assay of ASP(+) uptake in cells stably expressing MATE1, over 900 prescription drugs were screened and 84 potential MATE1 inhibitors were found. We identified several MATE1 selective inhibitors including four FDA-approved medications that may be clinically relevant MATE1 inhibitors and could cause a clinical DDI. In parallel, a QSAR model identified distinct molecular properties of MATE1 versus OCT2 inhibitors and was used to screen the DrugBank in silico library for new hits in a larger chemical space. PMID:23241029

Wittwer, Matthias B; Zur, Arik A; Khuri, Natalia; Kido, Yasuto; Kosaka, Alan; Zhang, Xuexiang; Morrissey, Kari M; Sali, Andrej; Huang, Yong; Giacomini, Kathleen M

2013-02-14

425

Discovery of Potent, Selective Multidrug And Toxin Extrusion Transporter 1 (MATE1, SLC47A1) Inhibitors Through Prescription Drug Profiling and Computational Modeling  

PubMed Central

The human multidrug and toxin extrusion (MATE) transporter 1 contributes to the tissue distribution and excretion of many drugs. Inhibition of MATE1 may result in potential drug-drug interactions (DDIs) and alterations in drug exposure and accumulation in various tissues. The primary goals of this project were to identify MATE1 inhibitors with clinical importance or in vitro utility and to elucidate the physicochemical properties that differ between MATE1 and OCT2 inhibitors. Using a fluorescence assay of ASP+ uptake in cells stably expressing MATE1, over 900 prescription drugs were screened and 84 potential MATE1 inhibitors were found. We identified several MATE1 selective inhibitors including four FDA-approved medications that may be clinically relevant MATE1 inhibitors and could cause a clinical DDI. In parallel, a QSAR model identified distinct molecular properties of MATE1 versus OCT2 inhibitors and was used to screen the DrugBank in silico library for new hits in a larger chemical space.

Kido, Yasuto; Kosaka, Alan; Zhang, Xuexiang; Morrissey, Kari M.; Sali, Andrej; Huang, Yong; Giacomini, Kathleen M.

2014-01-01

426

Excess drug prescriptions during influenza and RSV seasons in the Netherlands: Potential implications for extended influenza vaccination  

Microsoft Academic Search

Influenza and respiratory syncytial virus (RSV) infections are responsible for considerable morbidity, mortality and health-care resource use. For the Netherlands, we estimated age and risk-group specific numbers of antibiotics, otologicals and cardiovascular prescriptions per 10,000 person-years during periods with elevated activity of influenza or RSV, and compared these with peri-season rates. Data were taken from the University of Groningen in-house

M. D. M. Assink; J. P. Kiewiet; M. H. Rozenbaum; P. B. Van den Berg; E. Hakb; E. J. Buskens; J. C. Wilschut; A. C. M. Kroes; M. J. Postma

2009-01-01

427

Medicare program; revisions to the Medicare Advantage and Part D prescription drug contract determinations, appeals, and intermediate sanctions processes. Final rule with comment period.  

PubMed

This rule with comment period finalizes the Medicare program provisions relating to contract determinations involving Medicare Advantage (MA) organizations and Medicare Part D prescription drug plan sponsors, including eliminating the reconsideration process for review of contract determinations, revising the provisions related to appeals of contract determinations, and clarifying the process for MA organizations and Part D plan sponsors to complete corrective action plans. In this final rule with comment period, we also clarify the intermediate sanction and civil money penalty (CMP) provisions that apply to MA organizations and Medicare Part D prescription drug plan sponsors, modify elements of their compliance plans, retain voluntary self-reporting for Part D sponsors and implement a voluntary self-reporting recommendation for MA organizations, and revise provisions to ensure HHS has access to the books and records of MA organizations and Part D plan sponsors' first tier, downstream, and related entities. Although we have decided not to finalize the mandatory self-reporting provisions that we proposed, CMS remains committed to adopting a mandatory self-reporting requirement. To that end, we are requesting comments that will assist CMS in crafting a future proposed regulation for a mandatory self-reporting requirement. PMID:18064773

2007-12-01

428

Survival following intentional massive overdose of 'Ecstasy'.  

PubMed Central

A case of intentional overdose with 18 'Ecstasy' tablets is described. 'Ecstasy' is a semi-synthetic hallucinogenic amphetamine and acute adverse reactions follow from the effects of sympathetic stimulation. To our knowledge this is the first reported case of massive intentional overdose reported in the literature.

Roberts, L; Wright, H

1994-01-01

429

Isolated atomoxetine overdose resulting in seizure  

Microsoft Academic Search

Background: Atomoxetine (Strattera™), has recently been approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adolescents and adults. Atomoxetine acts by inhibiting the reuptake of norepinephrine. There are limited reports of the effects of atomoxetine in overdose. We report a case of isolated atomoxetine overdose resulting in seizure and mild cardiac toxicity. Case Report: A 17-year-old female ingested

John Kashani; Anne-Michelle Ruha

2007-01-01

430

Treatment Approaches for Drug Addiction  

MedlinePLUS

... Drugged Driving HIV/AIDS and Drug Abuse: Intertwined Epidemics Understanding Drug Abuse and Addiction Survey Data Drug- ... What Can We Do About the Heroin Overdose Epidemic? National Longitudinal Study of the Neurodevelopmental Consequences of ...

431

Ginseng in Traditional Herbal Prescriptions  

PubMed Central

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.

Park, Ho Jae; Kim, Dong Hyun; Park, Se Jin; Kim, Jong Min; Ryu, Jong Hoon

2012-01-01

432

A Population-Based Prescription Study of Asthma Drugs during Pregnancy: Changing the Intensity of Asthma Therapy and Perinatal Outcomes  

Microsoft Academic Search

Background: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered ‘safe’ during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during pregnancy, and no population-based studies concerning gestational asthma therapy exist. Objectives: To examine whether asthma

Charlotte Olesen; Nana Thrane; Gunnar Lauge Nielsen; Henrik Toft Sørensen; Jørn Olsen

2001-01-01

433

Hypothermic overdose, not all bad?  

PubMed Central

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.

Petterson, Timothy; Lyon, Lindsay; Peckler, Bradley

2013-01-01

434

Hypothermic overdose, not all bad?  

PubMed

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

Petterson, Timothy; Lyon, Lindsay; Peckler, Bradley

2013-07-01

435

Alcohol and Illegal Drug Use Behaviors and Prescription Opioids Use: How do Nonmedical and Medical Users Compare, and Does Motive to Use Really Matter?  

PubMed Central

Background/Aims The study compared illegal drug and alcohol use behaviors between medical and nonmedical users of prescription opioids (PO) and nonmedical users with distinct motives to use. Method An ethically-approved cross-sectional study (2010) was conducted on a representative sample of private university students (n=570), using a self-filled anonymous questionnaire. Results About 25% reported using PO only medically and 15% nonmedically. The prevalence of alcohol and illegal drug use was consistently higher among nonmedical than medical PO users. Adjusting for age and gender, lifetime medical users of PO were more likely to use marijuana only (OR=1.8, 95%CI= 1.1, 2.8), while nonmedical users were at higher odds of using marijuana, ecstasy, cocaine/crack, and alcohol problematically. Compared to non-users, students who took PO nonmedically for non-therapeutic reasons were more likely to use various illegal drugs, but nonmedical users who took PO to relieve pain/help in sleep were only more likely to use marijuana (OR=2.5, 95%CI=1.1, 5.4) and alcohol (e.g., alcohol abuse, OR=3.8, 95%CI= 1.4, 10.1). Conclusion Youth who use PO nonmedically to self-treat have a different alcohol and illegal drug-using profile than those who take it for non-therapeutic reasons.

Ghandour, Lilian A.; El Sayed, Donna S.; Martins, Silvia S.

2013-01-01

436

No increase in new users of blood glucose-lowering drugs in Norway 2006-2011: a nationwide prescription database study  

PubMed Central

Background National estimates for the occurrence of diabetes are difficult to obtain, particularly time trends in incidence. The aim was to describe time trends in prevalent and incident use of blood glucose-lowering drugs by age group and gender in Norway during 2005–2011. Methods Data were obtained from the nationwide Norwegian Prescription Database. We defined prevalent users of “insulins only” as individuals having no oral antidiabetic drugs (OAD) dispensed from a pharmacy during the previous 24 months or in the subsequent 12 months. Incident users had no blood glucose-lowering drugs dispensed in the previous 24 months; incident “insulins only” users also had no OAD in the subsequent 12 months. Results In 2011, 3.2% of the population had blood glucose-lowering drugs dispensed, and the incidence rate was 313 per 100,000 person years. The prevalence of OAD use increased from 1.8% in 2005 to 2.4% in 2011; however a decreasing trend in incidence of OAD use was observed, particularly in those aged 70 years and older. In 2010, 0.64% of the population had insulins only dispensed, with an overall incidence rate in the total population of 33 per 100,000 person years which was stable over time. Conclusions In this nationwide study, we found that although the prevalent use of OAD had increased in recent years, incident use was stable or had decreased. This may indicate that the increase in diabetes occurrence in Norway is levelling off, at least temporarily.

2014-01-01

437

A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray  

PubMed Central

Opioid overdose morbidity and mortality is recognized to have epidemic proportions. Medical and public health agencies are adopting opioid harm reduction strategies to reduce the morbidity and mortality associated with overdose. One strategy developed by emergency medical services and public health agencies is to deliver the opioid antidote naloxone injection intranasally to reverse the effects of opioids. Paramedics have used this route to quickly administer naloxone in a needle-free system and avoiding needle-stick injuries and contracting a blood-born pathogen disease such as hepatitis or human immunodeficiency virus. Public health officials advocate broader lay person access since civilians are likely witnesses or first responders to an opioid overdose in a time-acute setting. The barrier to greater use of naloxone is that a suitable and optimized needlefree drug delivery system is unavailable. The scientific basis for design and study of an intranasal naloxone product is described. Lessons from nasal delivery of opioid analgesics are applied to the consideration of naloxone nasal spray.

Wermeling, Daniel P.

2012-01-01

438

Review of prehospital sodium bicarbonate use for cyclic antidepressant overdose  

PubMed Central

Methods: A three year retrospective observational review of records was performed using the San Diego County Quality Assurance Network database for prehospital providers. All adult patients who were treated with NaHCO3 by paramedics for a CA overdose were included. Demographic data, presenting cardiovascular and neurological symptoms, paramedic treatments, and any changes in status were reviewed. Results: Twenty one patients were treated by paramedics with NaHCO3 for CA overdose. Seventeen patients (80%) presented with mental status changes, including 11 presenting with a GCS<8. Seven of the 21 (33%) presented with a cardiac arrhythmia expected to possibly respond to NaHCO3 treatment. Seven of the 21 (33%) were hypotensive, and five (24%) patients had reported seizure activity. Only 2 of the 21 patients (10%) treated with NaHCO3 had recorded improvements after administration of the drug, while the other 19 remained stable without any deterioration. Sixteen of 21 patients (76%) were given NaHCO3 for indications on standing order, while five patients were treated outside the standing order indications by base physician order with none of the five patients having any change in status ater treatment. Conclusions: After prehospital NaHCO3 use in patients with CA overdose, there were no complications reported, two patients improved in status and the others remained unchanged. Base hospital physician orders of NaHCO3 for indications beyond the standing orders were not associated with changes in patient status.

Calkins, T; Chan, T; Clark, R; Stepanski, B; Vilke, G

2003-01-01

439

Safe prescription recommendations for non steroidal anti-inflammatory drugs: consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG).  

PubMed

This article outlines key recommendations for the appropriate prescription of non steroidal anti-inflammatory drugs to patients with different musculoskeletal problems. These recommendations are based on current scientific evidence, and takes into consideration gastrointestinal and cardiovascular safety issues. The recommendations have been agreed on by experts from three scientific societies (Spanish Society of Rheumatology [SER], Spanish Association of Gastroenterology [AEG] and Spanish Society of Cardiology [SEC]), following a two-round Delphi methodology. Areas that have been taken into account encompass: efficiency, cardiovascular risk, gastrointestinal risk, liver risk, renal risk, inflammatory bowel disease, anemia, post-operative pain, and prevention strategies. We propose a patient management algorithm that summarizes the main aspects of the recommendations. PMID:24462644

Lanas, Angel; Benito, Pere; Alonso, Joaquín; Hernández-Cruz, Blanca; Barón-Esquivias, Gonzalo; Perez-Aísa, Ángeles; Calvet, Xavier; García-Llorente, José Francisco; Gobbo, Milena; Gonzalez-Juanatey, José R

2014-01-01

440

[Safe prescription recommendations for non steroidal anti-inflammatory drugs: Consensus document ellaborated by nominated experts of three scientific associations (SER-SEC-AEG)].  

PubMed

This article outlines key recommendations for the appropriate prescription of non steroidal anti-inflammatory drugs to patients with different musculoskeletal problems. These recommendations are based on current scientific evidence, and takes into consideration gastrointestinal and cardiovascular safety issues. The recommendations have been agreed on by experts from three scientific societies (Spanish Society of Rheumatology [SER], Spanish Association of Gastroenterology [AEG] and Spanish Society of Cardiology [SEC]), following a two-round Delphi methodology. Areas that have been taken into account encompass: efficiency, cardiovascular risk, gastrointestinal risk, liver risk, renal risk, inflammatory bowel disease, anemia, post-operative pain, and prevention strategies. We propose a patient management algorithm that summarizes the main aspects of the recommendations. PMID:24529572

Lanas, Angel; Benito, Pere; Alonso, Joaquín; Hernández-Cruz, Blanca; Barón-Esquivias, Gonzalo; Perez-Aísa, Angeles; Calvet, Xavier; García-Llorente, José Francisco; Gobbo, Milena; Gonzalez-Juanatey, José R

2014-03-01

441

Tretinoin overdose: A first case report  

Microsoft Academic Search

Introduction  Tretinoin (Vesanoid) is an all-trans-retinoic acid, and is related to retinol (Vitamin A). To date, there have been several case reports on overdose with its\\u000a isomer isotretinoin, but none involving overdose of tretinoin. We report the first known case of a patient who ingested a\\u000a massive overdose of tretinoin.\\u000a \\u000a \\u000a \\u000a Case Report  A 31-year-old man ingested 1000 mg of tretinoin (100 pills

Adeline Ngo Su-Yin; Joyce Ann Wong; Timothy J. Wiegand; Kent R. Olson

2009-01-01

442

Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature  

PubMed Central

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

Shah, Shiwan K.; Goswami, Sanjeev Kumar; Babu, Rajesh V.; Sharma, Gulshan; Duarte, Alexander G.

2012-01-01

443

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.

444

Association between Prescription of Conventional or Atypical Antipsychotic Drugs and Mortality in Older Persons with Alzheimer’s Disease  

Microsoft Academic Search

Background\\/Aims: To evaluate whether dementia patients prescribed antipsychotic drugs have a higher mortality compared to unexposed patients, and to investigate whether there are differences in mortality associated with exposure to conventional versus atypical antipsychotic drugs. Methods: Retrospective population cohort study with information gathered from the Italian Health Information System. All 4,369 residents of Milan (Italy) aged 60 years or older

Massimo Musicco; Katie Palmer; Antonio Russo; Carlo Caltagirone; Fulvio Adorni; Carla Pettenati; Luigi Bisanti

2011-01-01

445

Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada.  

PubMed

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

Contoyannis, Paul; Hurley, Jeremiah; Grootendorst, Paul; Jeon, Sung-Hee; Tamblyn, Robyn

2005-09-01

446

Overdose of vincristine: experience with a patient.  

PubMed

Vincristine, referred to as a vinka alkaloid, has been used as a component of the various chemotherapeutic regimens. The major side effects of the usual dosage of vincristine are bone marrow suppression, gastrointestinal disorder, and neurotoxicity. A 53-year-old cervical cancer patient received 14 mg (4 mg/m2/day for 2 days) of vincristine instead of vinblastine because of the similarity between the two names. Then life threatening toxicities including paresthesias, bone marrow depression, severe oral mucositis, paralytic ileus, bladder atony, myalgia, muscle weakness, high fever, derangements of various organs (liver, heart), hypertension, and insomnia were encountered. But hypotension and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) were not observed. Other than paresthesias in the extremities, the patient recovered completely from toxic impairments with intensive symptomatic and supportive care. In order to prevent the administration of the overdosed drug, it would be advisable for chemotherapy to be administered only by an experienced physician who is able to check the dose and concentration. PMID:9681818

Chae, L; Moon, H S; Kim, S C

1998-06-01

447

Lantus overdose: case presentation and management options.  

PubMed

Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. We present a case of a 37-year-old male insulin-dependent diabetic presenting with refractory hypoglycemia secondary to an intentional overdose of Lantus insulin to illustrate the varied management concerns in overdoses of long-acting insulins. The patient was managed with oral intake, intravenous dextrose bolus, peripheral 10% dextrose solution, 25% dextrose sliding scale via central line, and psychiatry evaluation for suicide attempt. Other potential treatments discussed for possible use with long-acting insulin overdoses include incision and drainage of the injection site, glucagon, and octreotide. PMID:17976762

Fuller, Everett T; Miller, Michael A; Kaylor, David W; Janke, Cliff

2009-01-01

448

Lantus Overdose: Case Presentation and Management Options  

Microsoft Academic Search

Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. We present a case of a 37-year-old male insulin-dependent diabetic presenting with refractory hypoglycemia secondary to an intentional overdose of Lantus insulin to illustrate

Everett T. Fuller; Michael A. Miller; David W. Kaylor; Cliff Janke

2009-01-01