Towards Safe

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Towards Safe Appropriate Medicine Use Looking
Back / Moving Ahead

• William Ray Bullman
• Executive Vice President
• National Council on
• Patient Information and Education
• Bethesda, MD
• bullman_at_ncpie.info

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Pleased to be here --- 21st National Talk About
Prescriptions Month
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About NCPIE

• Nonprofit 501 (c)(3) formed in 1982
• Over 110 member organizations (diverse)
• Mission Stimulate/improve communication of
  information on safe and appropriate medicine use
  to consumers and healthcare providers.

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NCPIE Members

• Consumer patient groups
• Healthcare professional organizations
• Businesses (some pharma cos. and pharma trade
  associations
• Government agencies / non-govt. standard-setting
  organizations

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About NCPIE

• Produces educational messages materials to
  promote better consumer provider dialogue about
  medicines
• Major Activities Consumer Medicine Information
  (CMI) Initiative Talk About Rx Month Be
  MedWise about OTCs National Brown Bag Medicine
  Review Program.
• Medication Use Safety Training for Older Adults
  (MUST for Seniors). launch 2007.

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Remember when Farming was just farming.?
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Pharming Today
Kids getting high using Rx or OTC drugs
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Changing Face of Drug Abuse

• of Teens Who Have Ever Tried (in millions)
• Marijuana 8.6 million
• Inhalants 4.7 million
• Rx Medicine 4.5 million
• Cough Medicine 2.4 million
• Crack/Cocaine 2.4 million
• Ecstasy 1.9 million
• Meth 1.9 million
• LSD 1.3 million
• Heroin 1.1 million
• Ketamine 1 million
• GHB 1 million
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study)

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Rx Abuse Where on the Continuum

• Abuse of Rx medicines falls in middle of the
  teen drug use continuum less common than
  marijuana more common than other drugs
• Lifetime Use
• Marijuana 37
• Inhalants 30
• Prescription Medicine 19 (not their own Rx)
• Cough Medicine 10
• Cocaine / Crack 10
• Methamphetamine 8
• Ecstasy 8
• LSD 6
• Heroin 5
• Ketamine (Special K) 4
• GHB 4
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study)

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"Generation Rx

• 1 in 4 teens report having a friend who abuses
  medicines to get high
• 1 in 3 report being offered an Rx or OTC medicine
  for the purpose of abuse
• Teen abuse of Rx OTC medicines is greater than
  the combined abuse of ecstasy, meth, and heroin.
• Every day, 2,700 teens try an Rx medicine to get
  high for the first time
• This suggests that Rx OTC abuse has penetrated
  teen culture and become normalized.
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study 2004
  National Survey on Drug Use and Health)

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Q What cough medicines are target for abuse
(contain dextromethorphan, or DXM?)

• 100 OTC medicines contain DXM, either as only
  active ingredient or in combination w/other
  active ingredients, including
• -Alka-Seltzer Plus Cold  Cough Medicine -Vicks
  NyQuil LiquiCaps
• -Dayquil LiquiCaps -Coricidin HBP
  Cough/Cold
• -Dimetapp DM -Robitussin cough
  Products
• -Sudafed cough products -Triaminic
  cough syrups
• -Tylenol Cold products -Vicks 44
  Cough Relief products
• There also are a number of store brands
• that contain DXM.

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Q What types of Rx medications are teens
abusing?

• National Survey on Drug Use and Health
  identifies 4 types of Rx medications that are
  commonly abused
• ?Pain relievers
• ?Stimulants
• ?Sedatives
• ?Tranquilizers
• 11 of teens aged 12-17 reported lifetime
  non-medical use of pain relievers and 4 reported
  lifetime non-medical use of stimulants.

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Theyre Getting Them From Somewhere

• 04 05
• Use Rx pain relievers such as Vicodin, 37 37
• Oxycontin, Tylox, that a doctor did not
• prescribe for them
• Use the Rx drugs Ritalin or Adderall 29 29
• that a doctor did not prescribe for them
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study)

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Meet Willie Sutton

• Willie Sutton (aka "The Actor" "Slick Willie)
  for his ingenuity in executing robberies in
  various disguises. Although a bank robber, he
  had the reputation of a gentleman people present
  at his robberies said he was quite polite. One
  victim said witnessing one of Sutton's robberies
  was like being at the movies, except the usher
  had a gun. When asked why he robbed banks, Sutton
  simply replied, "Because that's where the money
  is.

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Excuse me Mr. Bullman, may I use your bathroom?

• The source of drugs is now the family medicine
  cabinet more than any dealer.
• PD-FA found 62 of teens said Rx pain relievers
  are easy to find at home. And 52 say Rx pain
  relievers are "available everywhere."
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study)

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Because thats where medicines with abuse
potential are

• Easy to get from parents medicine cabinet 62
• Are available everywhere 52
• They are not illegal drugs 51
• Easy to get through other peoples Rxs 50
• Teens can claim they have a prescription if
  caught 49
• They are cheap 43
• Safer to use than illegal drugs 35
• Less shame attached to using 33
• Easy to buy over Internet 32
• (Partnership for a Drug-Free America, 2005
  Partnership Attitude Tracking Study)

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Looking Back Whats different now than
then?

• More medicines available
• Number of prescriptions has increased
  dramatically (nearly four billion per year)
• ? Access to Rx medicines with /Medicare Part D
• ? in DTC advertising
• ? switches -- Rx to OTC status
• ? Focus on safety, risk communication, error
  reduction
• Other things.???

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Looking Back/ Moving Ahead Some things have
changed / others havent

• Medication misuse is still Americas Other Drug
  Problem
• Patients still must be motivated, equipped, and
  able to use medicines properly
• Medication counseling slow to gain momentum
• Medication Therapy Mgmt limited within MMA Part
  D
• Medication therapy management for all?

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Medication Therapy Management Services (A
Pharmacist Definition)

• A. Performing/obtaining necessary assessments of
  patients health status.
• B. Formulating a medication treatment plan.
• C. Selecting, initiating, modifying, or
  administering medication therapy.

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MTM Services

• D. Monitoring evaluating patients response to
  therapy, including safety effectiveness.
• E. Performing comprehensive medication review to
  identify, resolve, and prevent medication-related
  problems, including adverse drug reactions
  (ADRs).
• F. Documenting care delivered communicating
  essential information to other primary care
  providers. (connecting the dots.)

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MTM Services

• G. Providing verbal education and training
  designed to enhance patient understanding
  and appropriate use of his/her medications.
• H. Providing information, support services and
  resources designed to enhance patient
  adherence with his/her therapeutic regimens.
  
• I. Coordinating integrating MTM services
  w/in the broader health care management
  services being provided to the patient.

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Looking Back / Looking Ahead 1996 2006

• Quality Improvements to Written Rx Information
  (pharmacy leaflets)
• 10-Year Action Plan for Provision of Useful Rx
  Info. (Public Law 104-180)
• Plan includes criteria for content, design,
  layout and readability
• FDA has authority to monitor progress of private
  sector for meeting Action Plan targets
• 95 of written information to meet Action Plan
  criteria of usefulness by December 31, 2006

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If You Cant Read It, You Cant Heed It.. 1
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If You Cant Read It, You Cant Heed It.. 2
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Medication Counseling Looking Back 1992 - 1998

• FDA Survey Consumers Reported Receipt of Rx
  Info
• Physicians Office 92 94 96 98 04
• How much to take 55 59 61 60 ?
• How often to take 56 61 62 63 ?
• Refills 32 35 34 33 ?
• Precautions 33 35 37 37 ?
• Side effects 29 33 37 35 ?
• Any Information 61 65 67 69 ?
• Pharmacy 92 94 96 98 04
• How much to take 28 32 36 34 ?
• How often to take 27 33 37 34 ?
• Refills 16 15 19 15 ?
• Precautions 18 25 26 24 ?
• Side effects 11 19 23 23 ?
• Any Information 37 42 47 43 ?

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Medication Error ReductionLooking Back 1999

• To Err is Human (Institute of Medicine)

• Medical errors kill between 44,000 98,000
  people in U.S. hospitals each year. Even using
  lower estimate, more people die from medical
  mistakes each year than from highway accidents,
  breast cancer, or AIDS.
• Errors afflict every health care setting
  day- surgery and outpatient clinics, retail
  pharmacies, nursing homes, as well as home care.
  
• Deaths from medication errors that take place
  both in and out of hospitals more than
  7,000 annually exceed those from workplace
  injuries.

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Communication ImprovementsLooking Back/Looking
Ahead... 2000-2010

• Healthy People 2010 Chapter 17 Medical Product
  Safety, (OHPDP,HHS, 2000)
• 17-3. Increase proportion of primary care
  providers, pharmacists, other hcps who
  routinely review with their patients aged 65
  years and older and patients with chronic
  illnesses or disabilities all new prescribed and
  OTC medicines. -- Deleted mid 2004 due to no
  data source)
• 17-4. Increase proportion of patients receiving
  information that meets Action Plan guidelines for
  usefulness when their new prescriptions are
  dispensed.
• 17-5. Increase proportion of patients who
  receive verbal counseling from prescribers and
  pharmacists on the appropriate use potential
  risks of medications.

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Medication Errors Moving Ahead . July 2006

• Preventing Medication Errors, (Committee on
  Identifying and Preventing Medication Errors,
  Institute on Medicine, July 2006)
• Four out of five U.S. adults will use
  prescription or over-the-counter (OTC)
  medications or dietary supplements, and nearly
  one-third of adults will take five or more
  different medications.
• Hospitalized patients can expect to be subjected
  to more than one medication error each day.
• There are at least 1.5 million preventable
  adverse drug events (ADEs) in the U.S. each year
  and it may even be much higher.

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Medication CommunicationMoving Ahead . Sept.
2006

• Doctors Prescribe More Than They Explain,
• Many doctors prescribe medicine without
  explaining its purpose, side effects,
  instructions for use, or even mentioning its
  name. (Archives of Internal Medicine, Sept. 25,
  2006)
• 74 mentioned name of medicine
• 87 mentioned its purpose
• 66 did not mention how long to take the medicine
• 45 did not say what dosage to take
• 42 failed to mention the timing or frequency of
  doses
• 65 did not mention adverse side effects

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Reducing Adverse EventsMoving Ahead Oct. 2006

• Adverse Drug Events Cause 700,000 Emergency
  Visits
• (JAMA, Oct. 18, 2006)
• The five most common drug classes implicated in
  ADE-connected hospitalizations were
  anticoagulants, insulins, opioid-containing
  analgesics, oral hypoglycemic agents, and
  anti-neoplastic agents.
• Of the 18 medications most commonly involved in
  an ADE that led to an ED visit, 16 have been in
  clinical use for more than 20 years.
• More than 80 of the population in 04 reported
  using at least one prescription medication,
  nonprescription drug, or a dietary supplement and
  30 reported using five or more of those products.

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How Can We Better Equip Enable (Safeguard)
Consumers?

• Recognize key role that the pt. plays on the
• Medicine Education Team (NCPIE, circa 1985).
• Train consumers for this role
• Pre-prescribing (at home, before you even make an
  appt medication record for each provider)
• Prescribing (Do Ask, Do Tell about your
  medicines).
• Post-prescribing (fill Rx read/heed Rx leaflet
  side effects recognition management know
  what/when tests or monitoring required to assess
  how medicine is working when in doubt, call
  doctor or pharmacist

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How Can We Better Equip Enable (Safeguard)
Consumers?

• At Home
• KEEP an updated list of the prescription and
  nonprescription medicines other products like
  vitamins and minerals, you are taking.
• TAKE your medicine list with you every time you
  visit a healthcare provider and have him or her
  review it.
• (Institute of Medicine, Preventing Medication
  Errors, July, 2006)

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How Can We Better Equip Enable (Safeguard)
Consumers?

• At the Doctors Office
• HAVE the doctor, PA, NP, DDS write down the name
  of the medicine (brand generic, if available),
  what it is for, its dosage, and how often to take
  it, or provide other written material with this
  information.
• HAVE the prescriber explain how to use the
  medicine properly.
• ASK about side effects and what to do if you
  experience a side effect.
• (Institute of Medicine, Preventing Medication
  Errors, July, 2006)

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How Can We Better Equip Enable (Safeguard)
Consumers?

• At the Pharmacy
• KNOW that you can review your list of medications
  with the pharmacist for additional safety.
• KNOW that you have the right to counseling by the
  pharmacist if you have any questions. For
  example, you can ask the pharmacist to explain
  how to properly take the medicine, the side
  effects of the medicine, and what to do if you
  think you are starting to develop a side effect.
• (Institute of Medicine, Preventing Medication
  Errors, July, 2006)

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How Can We Better Equip Enable
(Safeguard) Consumers?

• At the Hospital (Inpatient Care)
• ASK the doctor or nurse what medicines you are
  being given.
• DO NOT take a medicine without being told the
  purpose for doing so.
• EXERCISE your right to have someone with you
  whenever you are being given medicine and are not
  able to carefully follow the medication-use
  process yourself.
• (Institute of Medicine, Preventing Medication
  Errors, July, 2006)

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How Can We Better Equip Enable
(Safeguard) Consumers?

• At the Hospital (Inpatient Care)
• BEFORE SURGERY, ASK whether there are
  medications, especially prescription antibiotics,
  that you should take or any that you should stop
  taking.
• BEFORE YOU GO HOME, ASK for a list of the
  medications that you should be taking at home,
  have a healthcare provider review the medicines
  with you, and be sure you understand how to take
  these medicines.
• (Institute of Medicine, Preventing Medication
  Errors, July, 2006)

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Contact Information
Wm. Ray Bullman, M.A.M. Executive Vice
President National Council on Patient Information
and Education 4915 Saint Elmo Ave., Suite
505 Bethesda, MD 20814-6082 [phone] -
Phone bullman_at_ncpie.info - Email www.talkaboutrx.o
rg www.bemedwise.org