Tag Archives: ‘prescribe’

Pharmacists want to prescribe more medication for minor ailments

At a drugstore in downtown Toronto recently, pharmacist Michael Demian was doing what he typically does on any given day — dispensing health care advice to a regular customer. On this day, it was about how to treat a stubborn skin rash.

The customer, 71-year-old Brian Rhodes, was also picking up a refill of a prescription to treat his allergies. He says he appreciates the advice he gets, and the quick and easy convenience of coming here.

“They are strategically placed in our communities, they’re close by, and they have capabilities that go well beyond what we are using them for,” Rhodes says of his pharmacist.

Demian, a pharmacist for nine years agrees. “All of the pharmacists I know in my graduating class always say how we don’t use what we learned in school. I think pharmacists are just excited for the opportunity to use more of our education and help our patients, besides, here’s your prescription, here’s how to take it.”

But that may be about to change as pharmacists across Canada are stepping up and into a bigger role in health care. From prescribing birth control to providing instant strep throat tests, they’re taking over the care of minor ailments from an overtaxed system.  

Relieving stress on health-care system

“To see a physician, wait times are very long,” says Nardine Nakhla, a community pharmacist, and professor at the School of Pharmacy at the University of Waterloo. “To go to your ER, you’re waiting a long time as well. So we’re hoping to relieve some of the stress on that formal health-care system by diverting some patients to access some of our services in the pharmacy, rather than their traditional physicians.

University of Waterloo’s Nardine Nakhla believes doctors and pharmacists can collaborate. (Jon Castell/CBC News)

For now, what pharmacists in Ontario can do is limited. “We currently can extend prescriptions. We’re able to refill prescriptions that don’t have any refills for a certain period of time. We’re able to do flu shots and certain immunizations — that came a few years ago. And that’s pretty much it,” says Demian.

He says pharmacists in Ontario can also renew medication for chronic conditions like high blood pressure and cholesterol. 

The Pharmacists Advisory Board for Ontario will be making recommendations to the provincial government of what additional services pharmacists in the province should be providing. They hope to have additional powers to prescribe drugs for so called “minor ailments” by summer.

Across Canada, the scope of what pharmacists can and can’t do depends on where you live. For example, in Nova Scotia they can prescribe for minor ailments like acne and cold sores. British Columbian pharmacists can give strep throat tests. Saskatchewan pharmacists can prescribe birth control and bladder infection medication.  In Alberta, they can authorize antibiotics.

Carlene Oleksyn, left, in her Stony Plain, Alta., pharmacy can already assess minor ailments and even prescribe antibiotics. (Terry Reith/CBC News)

Alberta has been at the forefront when it comes to additional prescribing authority, says Stony Plain, Alta., pharmacist Carlene Oleksyn. She’s been assessing minor ailments for the past seven years. It’s in the best interest of patients, she says.

“It really is working collaboratively with our physician colleagues because we can take care of the minor things that don’t require a physical assessment by the physician and then we can prescribe if necessary for that patient.”

Most doctors agree treating patients with chronic illnesses like high blood pressure is well suited for pharmacists. But some are worried, calling it a slippery slope. They say if pharmacists do more diagnosing, mistakes can happen. 

Doctors push back

“There is some potential risk,” says Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta.

“Some things are really not suited to be done in a pharmacy. I think the skills of a pharmacist are really strongest in therapeutics. In medicine, we spend a lot of time learning how to diagnose and treat common illnesses. A big part of that is figuring out when a common illness is actually an uncommon manifestation of something dangerous. That depth is something that would be hard to replicate in a community pharmacy and with the training that people have.”

She says what would be helpful is some form of evaluating the impact of the changes that have already happened in the provinces where pharmacists have had additional prescribing authority.

But School of Pharmacy’s Nardine Nakhla believes doctors and pharmacists can collaborate. “This is no way shape or form stepping on physicians’ toes. We want to optimize patients’ outcomes. And if it can free up the system a little bit more and remove some of that stress or burden on the system, then, we’re here for them.”

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Should nurses be allowed to prescribe certain drugs? Ontario wants to know

The Ontario government is looking for public feedback on a proposal that would give registered nurses the power to prescribe certain medications including contraceptives, immunizations and smoking cessation drugs.

Under the plan proposed by the College of Nurses of Ontario, which regulates the profession, nurses would also be permitted to prescribe drugs related to wound care and travel health.

A spokeswoman for provincial Health Minister Christine Elliott said the change could improve convenience for patients and help free up physicians to do more complex work.

“This is a basic change that can save time and money, and get Ontarians healthier quicker,” Hayley Chazan said in a statement.

In 2017, the previous Liberal government amended the law to allow registered nurses to prescribe some medications, but then tasked the college with researching and designing the necessary regulatory changes.

The college said it spent two years consulting with the public, nurses and other stakeholders in the field to develop a plan. That feedback found nurse prescribing would lead to quicker access and shorter wait times for certain services, the college said in a statement.

“Our priority is that RN prescribing will be safe for patients, and we will provide the regulatory oversight needed to promote safe and ethical prescribing,” college spokeswoman Angela Smith said.

Under the plan proposed by the College of Nurses of Ontario, which regulates the profession, nurses would have the power to prescribe certain medications, including contraceptives. (Rich Pedroncelli/Associated Press)

The Registered Nurses’ Association of Ontario has been calling on the provincial government to expand the scope of practice for the profession since 2012. CEO Doris Grinspun said the change could make the most of limited resources in the health-care system.

“This will move us in the direction of people being cared for in the right place and time by the right professionals,” she said.

The RNAO has pressed the government to go further than the proposed regulations and align with the scope of practice granted to nurses in other jurisdictions, Grinspun said.

“We hope this will open the door to in the future to ordering more lab testing and prescribing first-line antibiotics,” she said. “This has been happening in the UK for 15 years.”

Nurses initial point of contact for patients, NDP MPP says

NDP health critic Frances Gelinas said the proposed changes are important because nurses are often the initial point of contact for many patients in the health-care system.

“If you take young women, for example, there is a good chance their first talk about contraception will be with a nurse,” she said.

“Nurses are available in so many places … as opposed to making an appointment and seeing a family physician. It’s not how life always unfolds for young women.”

Gelinas said the changes are long overdue, but worries the government may not fully commit to them because it could fear having to pay a new class of nurse-prescribers more for their skills.

“There always been this elephant in the room,” she said. “You’ll now have more professionals with these tools in their toolbox to help you. On the flip side, if you have more responsibilities usually you are compensated for those responsibilities.”

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Why is Shoppers Drug Mart training doctors to prescribe medical cannabis?

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven't subscribed yet, you can do that by clicking here.

"Shoppers Drug Mart presents: 'Medical Cannabis: The Future is Now.'"

That was the notice sent to Canadian doctors who were invited to register for "an exciting educational event" that would give them tools "to capably and confidently authorize medical cannabis for your patients."

Interested doctors could sign up for one of four sessions being held across Canada.

Why is Shoppers Drug Mart holding education sessions for doctors on how to prescribe cannabis for their patients?

"Somebody has to do it," said one family doctor on his way into the Vancouver event on Thursday evening. "On the whole for me I am confused. Who do I listen to? Who do I send my patients to, because I know I do not have adequate knowledge?"

Who should train doctors on prescribing medical cannabis?

But Toronto family doctor Sharon Cirone questions whether this medical education should be offered by a drug store chain that wants to get into the business of selling medical cannabis.

"It's not appropriate and it's not necessary" she said, adding that there are resources being developed by the College of Family Physicians of Canada, and other medical associations that don't have a vested financial interest in cannabis.

The issue brings into sharp focus two increasingly controversial questions — how should a product that has not been approved through the normal drug approval process be used in medical practice? And who should be selling it?

Some doctors say they have no idea how to properly prescribe a product patients ingest though smoking. (Livia Manywounds/CBC)

Right now, pharmacies are not allowed to dispense medical cannabis. Instead patients must get it through the mail, after first getting authorization from a doctor and then registering with a licensed producer.

(Last week CBC News reported that medical cannabis users are facing supply disruptions in the first rush to supply newly legalized recreational market.)

National pharmacy chains are lobbying for legislation that would let them sell medical cannabis.

"This is basically the only product for medicinal purposes that does not go through a pharmacy," said Justin Bates, CEO of The Neighbourhood Pharmacy Association of Canada which represents major drugstore chains and large retailers with in-store pharmacies.

The Canadian Pharmacists Association (CPhA) said patients would be better served if pharmacists were the ones dispensing medical cannabis.

"Typically the patients who are using cannabis for medical purposes are not using it as first line," said CPhA spokesperson Shelita Dattani. "They're on other medications which may have drug interactions with cannabis, they may be experiencing adverse effects, and we'd like to make sure we're helping to keep patients safe."

Lack of evidence still a concern, says CMA

But the professional pharmacist licensing agencies are not as keen for their pharmacists to jump into the medical cannabis field. The National Association of Pharmacy Regulatory Associations outlines that hesitation in a position statement.

There is similar hesitation from the Canadian Medical Association about doctors embracing cannabis use in their practices.

"The CMA remains concerned about the lack of clinical research, guidance and regulatory oversight for cannabis as a potential medical intervention," the CMA states on its website.

"Physicians [are] being asked to prescribe something that is not approved, and that is largely ingested by smoking," said Cirone. "Physicians have never been put in the position to prescribe a smoked product before and expose the lungs to disease."

Right now, some doctors avoid dealing with the problem and instead direct patients to the recreational cannabis market, even though medical users might have different medical cannabis needs, such as achieving pain relief without getting high.  

Canada has two separate cannabis markets— recreational and medical. (CBC)

Is there a conflict of interest?

"Now with it being legal, many patients are going forward and getting a product and asking afterwards for guidance on how to use it," said Winnipeg oncologist Dr. Paul Daeninck. He routinely gives talks to doctors about his experience using cannabis to treat cancer pain and other palliative conditions. He's one of the panelists involved in the Shoppers Drug Mart seminars.

Is there a potential conflict of interest?

"I feel that a company or a group that's providing education and trying to do it in an unbiased manner is really doing the right thing, and bringing in experts to talk about it is important," Daeninck said. 

This is the first step in our journey to provide medical cannabis to our patients,"– Catherine Thomas, Loblaw Companies Limited

"The sessions, developed and presented by key opinion leaders from top Canadian universities and hospitals, cover the most up to date information about research into medical cannabis, including its use for a variety of disease states," said Catherine Thomas, spokesperson for Loblaw Companies Limited, which owns the Shoppers Drug Mart chain.

In September, Shoppers Drug Mart received a licence from Health Canada to purchase and store pre-packaged cannabis products from existing licensed producers.

"This is the first step in our journey to provide medical cannabis to our patients," Thomas said in an email.

Health Canada confirmed that Shoppers Drug Mart pharmacies cannot sell cannabis even through the mail, until the company receives a second Health Canada licence.

"There is no licence under the Cannabis Regulations that would allow Shoppers Drug Mart, or its subsidiary companies, to sell cannabis in its stores,"  Health Canada spokesperson Tammy Jarbeau said in an email.

With files from Manjula Defresne in Vancouver.

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Doctors to prescribe museum visits to help patients 'escape from their own pain'

A group of Canadian physicians will be writing a new kind of prescription starting next month — a trip to the museum.

The Montreal Museum of Fine Arts and a Montreal-based doctors' association are launching a pilot project Nov. 1 to treat patients to a day of paintings, sculpture and relaxation.

One of the doctors behind the initiative says a trip to the museum can benefit people with conditions from mental illness and eating disorders to diabetes and high blood pressure, as well as those in palliative care.

"It's so rare in medicine that you prescribe something and you do not need to worry about all those side-effects or interactions with other medication," said Dr. Hélène Boyer, vice-president of Médecins francophones du Canada.

Under the pilot project, association members will be able to issue up to 50 prescriptions granting free admission to the Montreal Museum of Fine Arts for a family of four. (A single ticket for an adult can normally cost as much as $ 31.) 

Releases hormones, distracts from chronic pain

Nathalie Bondil, the museum's director general and chief curator, made her pitch to the association at their annual meeting. The physicians were intrigued by the idea.

"We know that art stimulates neural activity," said Bondil, whose museum already employs a full-time art therapist to hold creative workshops for those with chronic illness.

"What we see is that the fact that you are in contact with culture, with art, can really help your well-being."

Dr. Hélène Boyer says she's excited to prescribe a trip to the museum to patients. (Sean Henry/CBC Montreal)

Doctors who are members of the association will be able to prescribe a free trip to the museum.

The prescription is good for two adults and two children under 17.

Taking in the art with loved ones is key to the treatment, said Bondil.

MMFA director general and chief curator Nathalie Bondil made her pitch to the association at its annual meeting.

Boyer admits they're treading on uncharted ground, but the simple act of getting out and focusing on something other than their condition can work wonders on a patient's outlook.

It can cause a release of hormones, she said, that is otherwise difficult to attain for those with chronic pain who have trouble maintaining regular physical activity.

'Modern cathedral'

The museum visits complement, don't supplement, more traditional treatment.

"What is most important is to have this experience which is to help them escape from their own pain," said Bondil.

"When you enter the museum, you escape from the speed of our daily life. It's a kind of modern cathedral."

While only doctors who are part of the association can participate in the pilot project, Boyer encourages anglophone physicians to join so that they can also take part.

Doctors will follow up with patients to see if there are any changes in their conditions, and after the project runs for one year, they will prepare a report with their cumulative findings.

The museum is already involved in 10 clinical trials assessing the impact of art on health. It is looking to help a broad range of patients, including people with eating disorders, breast cancer, epilepsy, mental illness and Alzheimer's disease.

With files from Sean Henry and The Canadian Press

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Ottawa making it easier for doctors to prescribe methadone and heroin

The federal government will announce this morning that it is taking steps to make it easier for doctors to prescribe methadone and pharmaceutical grade heroin.

Health Minister Ginette Petitpas Taylor will make the announcement at the Shepherds of Good Hope in Ottawa, a homeless shelter that offers programs for drug addicts.

CBC News has obtained some of the details in advance.

Right now health care providers, from physicians to pharmacists, must apply for an exemption to prescribe, sell or provide methadone with approval from Health Canada.

Now, the federal government will introduce regulatory amendments to lift this requirement and allow health care providers to administer methadone treatment without an exemption.

The federal government is also planning to loosen restrictions around how to, and who can, prescribe pharmaceutical heroin, or diacetylmorphine, a drug often used to treat pain in a hospital setting.

But it has also been known to help people with addictions who do not respond to other types of treatment, such as methadone and naloxone.

Currently, diacetylmorphine can only be administered in a hospital. People with addictions who may need more than one dose a day find it difficult to make several trips to a hospital, especially if they are working.

The federal government plans to introduce changes to the regulations that will allow heroin to be prescribed outside of a hospital, perhaps in treatment facilities or substance use disorder clinics.

The changes will also allow nurse practitioners to prescribe the drug if they are allowed to under provincial laws.

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U.S. drug company founder charged with bribing doctors to prescribe addictive opioid

The founder of U.S. drug company Insys Therapeutics has been charged with leading a nationwide conspiracy to bribe doctors and pharmacists to widely prescribe an opioid cancer pain drug for people who didn’t need it. 

John N. Kapoor was charged along with group of his colleagues on Thursday with pushing prescriptions for the highly addictive drug. It was the same day that President Donald Trump declared the opioid crisis a nationwide public health emergency.

Trump Opioids

President Donald Trump declared the opioid crisis a national public health emergency in the U.S. on Thursday. (Evan Vucci/Associated Press)

Kapoor, 74, of Phoenix, was listed by Forbes several years ago as having a worth of $ 2.4 billion US. That worth has fallen amid the indictments of numerous fellow Insys executives, but Forbes still listed Kapoor’s worth at $ 1.75 billion US on Thursday as he went to U.S. federal court in the fraud and racketeering case.

The case naming Kapoor follows indictments against the company’s former CEO and other executives and managers on allegations that they provided kickbacks to doctors to prescribe a potent opioid spray called Subsys amid a drug epidemic that is claiming thousands of lives each year.

The new indictment alleges Kapoor and the other defendants offered bribes to doctors to write large numbers of prescriptions for the fentanyl-based pain medication that is meant only for cancer patients with severe pain. Most people who received prescriptions did not have cancer.

It also alleges that they conspired to mislead and defraud insurance providers who were reluctant to approve payment for the drug when it was prescribed for patients without cancer.

Federal prosecutors in Boston brought the case as part of “ongoing efforts to attack the opioid crisis from all angles,” said Boston-based Acting U.S. Attorney William D. Weinreb.

A judge set bail at $ 1 million US for Kapoor, saying he must wear electronic monitoring and surrender his passports. Kapoor, who was arrested earlier Thursday, entered court in basketball shorts, tennis shoes and a T-shirt, his long, grey hair disheveled.

“He is not guilty of these charges, he intends to fight it vigorously,” defence attorney Brian T. Kelly said outside court. Kelly is a high-profile Boston lawyer and former federal prosecutor who successfully tried imprisoned gangster James “Whitey” Bugler.

In Massachusetts, former Insys CEO Michael L. Babich and five other former executives and managers are set to go to trial in October 2018 and have pleaded not guilty. The latest indictment brings new charges against Babich and others.

Several former Insys employees and health care providers have pleaded guilty to felony charges around the country, including in Alabama and Connecticut. A Rhode Island doctor pleaded guilty Wednesday to accepting kickbacks in return for prescribing the fentanyl spray.

A spokesman for Insys said this week that the company is under new management and has replaced nearly all its original sales staff. It says it takes responsibility for the actions of its former employees.

“We have taken necessary and appropriate steps to prevent past mistakes from happening in the future, and are committed to conducting business according to high ethical standards and the interests of patients,” the company said in a statement Wednesday. “We also continue to work with relevant authorities to resolve issues related to the misdeeds of former employees.”

After immigrating from India decades ago, Kapoor earned a Ph.D. in medicinal chemistry from the University of Buffalo, where the pharmacy school is named for him and his wife to honour their longtime philanthropy. He initially founded Akorn Pharmaceuticals, an Illinois-based generics drug manufacturer, then later Insys Therapeutics in Chandler, Arizona, which went public in 2013. Kapoor also has a company that operates seven restaurants including the Japanese eatery Roka Aker in Scottsdale, and several establishments in Chicago.

Kapoor was named Insys president and CEO in November 2015 after Babich resigned without explanation. He stepped aside in January, a month after six former Insys executives including Babish were arrested and charged in the ongoing federal probe.

U.S. authorities apparently have been investigating the company for some time. In late 2013, Insys said it received a subpoena from the Department of Health and Human Services asking for documents tied to the commercialization of Subsys. Nearly a year later, it received a subpoena from U.S. prosecutors in Boston for documents connected with sales and marketing practices for the drug.

In addition to the criminal charges, states have been suing Insys over its marketing practices.

The company has been active in politics, donating $ 500,000 US last year to an Arizona campaign to defeat a ballot measure to legalize marijuana.

Insys’ stock price has taken a big tumble in recent months amid the legal issues. Its stock plunged more than 20 per cent Thursday.

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