Update on Pharmacy News

During January 1 to April 26, 2019, a total of 704 cases of measles were reported, the highest number of cases reported since 1994. Outbreaks in close-knit communities accounted for 88% of all cases, according a report received by WVPA from the CDC.

How good is your measles vaccine? It might not be working as well as you think. “Up to 10 percent of the cases in the current outbreak occurred in people who received one or two doses of the vaccine,” said the CDC. So if you got your vaccination before 1989, you might want to consider getting a …. let’s call it a refresher.

The FDA is stressing the safety of the measles vaccine amid the biggest outbreak in 25 years. Cases have spiked in 22 states, mostly areas with low immunization rates. What can pharmacists do? Educate your workers and patients about the safety and importance of vaccination.

According to the lawsuit filed by West Virginia-based hospitals against several pharmaceutical companies and distributors and reported by WVDA on April 30, between 2001 and 2015, 7,209 people died from overdoses in West Virginia. The number dying from overdose in the State in 2016 (884) is more than four times the number of people who died in 2001 (212). The percentage of overdose deaths involving an opioid increased from 70% in 2001 to 87% in 2015. In each of 2015, 2016 and 2017, West Virginia has the highest opioid drug overdose rate in the country.

A study in the Journal of the American Medical Association found that 93% of the unintentional overdose deaths attributed to prescription drugs in West Virginia involved opioids, and that 63% of the overdose deaths were associated with pharmaceutical diversion.

The U.S. Senate has held hearings into pharmacy benefit managers (PBMs), and several states are undertaking steps to investigate and possibly eliminate managed care care from their Medicaid pharmacy operations, as did West Virginia Medicaid almost two years ago.

CDC cautions against misapplication of 2016 guidelines for prescribing opioids for chronic pain. In a new commentary published in the New England Journal of Medicine on April 24, 2019, authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain cautioned against policies and practices that misinterpret and misapply its recommendations.

The authors stressed that the guideline’s recommendations on opioids should not be used for purposes outside of chronic pain management in adults aged 18 years and older. The guideline’s misapplication to other patient populations, such as those undergoing active cancer treatement, acute sickle cell crises, or postsurgical pain, could risk the patient’s health and safety.

The authors also advised against “hard limits”or “cutting off” opioids. When first starting treatment, “clinicians should prescribe the lowest effective dosage and avoid increasing dosage to 90 morphine milligram equivalents (MME)/day,” unless there is a justified reason to do so. However, the guideline strongly recommends against “abrupt tapering or sudden discontinuation of opioids,” especially when already prescribed long-term at higher doses.

Doing so can lead to severe withdrawal symptoms such as “pain and psychological distress,” which may drive some patients to seek opioids from other sources.

CDC commended health care providers in their efforts to reduce opioid misuse and improve opioid prescribing, and urged clinicians to continue using their clinicalljudgment when prescribing opioids for chronic pain. The agency stated that is important to assess each each patient’s unique needs and circumstances and determine if the benefits of opioid treatment outweigh the risks.

Providers should first consider and maximize nonpharmacologic and ononopioid therapies for chronic pain before prescribing opioids. In addition, collaboration and follow-up are important to ensure patient’s health and safety.