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Rx drug abuse rises in high school students

BY Alaric DeArment

News broke last month that officials in the South American nation of Uruguay were planning to possibly legalize marijuana. Meanwhile, activists in Colorado have sought to legalize the drug in that state, while Chicago’s city council decriminalized possession of small amounts of marijuana and reduced the penalty to a ticket.


Supporters of legalization or at least liberalization of marijuana laws argue that it would take control of the marijuana trade out of the hands of drug cartels. But in recent years, one of the most rapidly growing problems with drug abuse hasn’t involved cannabis or heroin or cocaine, but prescription drugs — a trend that has been implicated in both drug overdoses and pharmacy crime.


According to the National Institute on Drug Abuse, part of the National Institutes of Health, Abbott’s opioid painkiller, Vicodin (hydrocodone and acetaminophen), and Teva’s attention deficit hyperactivity disorder drug, Adderall (amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate and dextroamphetamine sulfate), are the most commonly abused drugs after marijuana among 12th-graders, while the National Education Association Health Information Network estimated that 1-in-5 high school students have used a prescription drug without a doctor’s prescription. This includes 1-in-12 high school seniors who have abused Vicodin and 1-in-20 who have abused Purdue Pharma’s painkiller, OxyContin (oxycodone). Meanwhile, between 1999 and 2008, opioid painkillers were the leading cause of unintentional drug overdose deaths, dwarfing the rates of cocaine and heroin, according to the institute.


Still, several policy-makers and companies have sought ways to confront the problem. Last month, New York Gov. Andrew Cuomo announced a plan — calling it the first in the country — to create an all-
electronic registry that would enable doctors, pharmacists and law enforcement to track controlled substances to prevent excessive prescription and refill requests. “This landmark agreement will help put a stop to the growing number of fatalities resulting from overdoses on prescription drugs,” Cuomo said. “We have seen too many untimely deaths as a result of prescription drug abuse, and today New York state is taking the lead in saying enough is enough.”


But in addition to preventing drug abusers from illegally getting their hands on prescription medicines, another step to combatting the problem involves education. At the end of last month, the NEA HIN and Purdue Pharma announced the release of a set of cross-curricular lessons aimed at middle-school students designed to discourage prescription drug abuse. “We know that 20% of high school students have reported that they have taken a prescription drug without a doctor’s prescription,” NEA HIN executive director Jerry Newberry said. “This behavior endangers student health and can interfere with academic success. NEA HIN welcomes our partnership with Purdue Pharma to help teachers inform students about the risks of misusing prescription medication.”

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Will you define health reform?

BY Rob Eder

“I can’t hear you; I have a banana in my ear!”

-Ernie the Muppet


There is so much noise out there about the Patient Protection and Affordable Care Act and what it means for America that at times I wish I could just stick a banana in my ear — actually, make that two bananas, one for each ear.


I don’t want to waste any space here lamenting over what has become of a profession I gave my life to, but the sad fact is we live in a world where pundits blab and spin, and reality and truth — the facts — take a back seat to whatever a bunch of jerks tell you it is.


But you really can’t blame the media even — this thing has been going on for as long as people preferred to be sheep whose opinions are hand-fed to them like kibble at a petting zoo. Plato wrote about it more than 2,400 years ago in his “Allegory of the Cave,” a recap of a discussion between Socrates and Plato’s brother. Basically, Socrates believed that people choose to watch shadows projected on the wall in front of them, and attach meaning to them rather than turning around to see things for what they really are. I think if the ancient Greeks had TV, Socrates would have referred to CNN and Fox.


I do my best to screen out all the noise — like the July 5 Gallup Poll that came out in the wake of the Supreme Court’s decision to let the ACA stand. Forty-six percent believe that the law will hurt the economy versus 37% who believe it will help the economy. That’s like asking someone in Plato’s allegorical cave, “What color are the shadows?”


If you ask some people, they’ll tell you the ACA will bankrupt America. If you ask others, they’ll tell you that you can’t only look at rising costs — you have to consider the savings that investment will deliver. Will states really go broke expanding Medicaid? What will they save by not having to pay for the cost of uncompensated care when poor people end up in the emergency room and can’t afford to pay they bill? How will prices adjust when hospitals and doctors no longer charge the insured more to make up for the cost to treat the uninsured? Economists at the Urban Institute estimated that 21 to 45 states would save money by expanding Medicaid.


A lot of this is politics. Many worry that America will become a welfare state, when the reality is we have long been a country that doesn’t refuse care to those who can’t afford it — we just pay too much the way we do it now and get little in return.


As a result of the Supreme Court’s ruling, “incentives for collaboration are quickening the convergence of hospitals, insurers, drug makers, physicians and technology companies,” wrote PricewaterhouseCoopers Health Research Institute in its June 2012 white paper, “Implications of the U.S. Supreme Court ruling on health care.” “Creation of new state and private insurance exchanges, greater pricing transparency, mobile technology and nontraditional competitors are turning the health business into a retail operation. … The crucial question now is: Will health reform define your organization, or will your organization define the post-reform landscape?”


To be sure, the report is aimed more at large- and small-business owners that may have been putting off addressing the new requirements of the ACA. According to a poll of more than 4,000 employers conducted in late June/early July by the human resource consulting firm Mercer, more than half said they were waiting for the Supreme Court’s decision. In all, 16% will wait to see how the November elections pan out.


But if you’re a provider on any level, particularly in community pharmacy or retail clinics, PwC asks a valid question: Will health reform define your organization, or will your organization define the post-reform landscape? Is your company ready? That’s the key sound bite in all of this. Everything else is just noise. 



Rob Eder is the editor in chief of The Drug Store News Group, publishers of Drug Store News, DSN Collaborative Care, and Specialty Pharmacy magazines. You can contact him at [email protected].

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Alliance Boots deal changes the game for WAG

BY Michael Johnsen

Walgreens and Alliance Boots — it’s a trans-Atlantic retail pharmacy game-changer. 


As the largest single purchaser of prescription drugs in the world, with 11,000 retail pharmacies in 12 countries that currently dispense more than 260 million prescriptions a year, and a global pharmaceutical wholesale operation to match, serving more than 180,000 healthcare outlets worldwide, the new company will have a whole lot more leverage on that side of the business. 


And the area in which Walgreens will benefit immediately is private brands. While Walgreens has beefed up its private-brand development in recent years with brands like Delish and Nice!, it will benefit greatly from the 400-plus associates Boots currently has dedicated to private-brand innovation. Boots has long been acknowledged for private brands, most notably the venerable No7 beauty brand, but also Soltan (sun care), Botanics (natural skin care) and Boots Labs (anti-age partnership with Procter & Gamble).


And given the market for multisource generic pharmaceuticals and future projections, having an in-house generic pharmaceutical manufacturing capability — Alliance Boots’ Almus division currently makes generic pharmaceuticals in five European countries — could be a decided advantage for a drug store operator.


Two more areas where Walgreens might be able to learn from Boots: optical — Boots operates some 625 optical stores in the U.K.; and loyalty cards — approximately two-thirds of U.K. women are members of Boots’ program, and Walgreens is expected to roll out its own card in September. 


How transformational is this deal? Consider Walgreens’ revenue mix today and how it expects that to change over the next five years. Currently, about two-thirds of Walgreens’ $73 billion in sales is in pharmacy. In 2016, sales of the combined companies are projected to top $130 billion, with only about one-third coming from the U.S. pharmacy business. 


As an encore, Walgreens celebrated Independence Day by buying USA Drug’s 144 stores for $438 million.

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