Communication. The Voice of Pharmacists in Manitoba. A Publication of the Manitoba Society of Pharmacists Inc.

Transcription

1 Communication A Publication of the Manitoba Society of Pharmacists Inc. Continuing Education: Therapeutic Options Focus on the Influenza and Influenza Vaccine ( Season) The Last Word: Drug Ads: The Hard Sell Behind High Public Purpose November/December 2005 Vol. 31, No. 2 The Voice of Pharmacists in Manitoba Publication Mail Agreement No Return Undeliverable Canadian Addresses To: The Manitoba Society of Pharmacists Garry St., Winnipeg, MB R3C 4H1

2 SAFEWAY PHARMACY CANADA SAFEWAY has current CAREER OPPORTUNITIES for both FULL TIME PHARMACISTS AND PHARMACY MANAGERS in Thunder Bay, ON and Thompson, MB Are you looking to work in a patient focused care setting? Do you want to work for a company which provides a strong team environment? Are you looking for a company that can provide you room to expand your skills and future opportunities? Do you want to feel secure and work for a company that will provide you an outstanding benefits package as well as bonus potential for your skills? We offer a Full Compensation and Benefits Package with industry-leading components. Our Bonus Plan allows you to participate and receive benefits as a full time Pharmacist/Pharmacy Manager every year. In addition, we believe in reimbursement for cognitive services and have developed positions in many practicing specialties including: Long Term Care Clinical Pharmacists Certified Menopause Educating Pharmacists Asthma Certified Pharmacists Certified Diabetes Educating Pharmacists Men s and Women s Health Specialty Pharmacists Together, the Safeway family is one of the largest employers of retail pharmacists in North America, and in Canada operates pharmacies in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario. If you are a pharmacist who is licensed to practice in Canada and looking to provide patient-focused care within a strong team environment, then this opportunity may be for you. If you would like to pursue this opportunity further, please send a cover letter and resumé by or fax to the address below: CHRISTINE LEE, B.Sc. Pharm Pharmacy Recruiter CANADA SAFEWAY LTD., 7280 Fraser Street, Vancouver, BC V5X 3V9 Phone: (604) Cell: (604) Fax: (604) christine.lee@safeway.com Web Site:

3 THIS ISSUE N O V E M B E R/DECEMBER 2005 Manitoba Society of Pharmacists Board of Directors Brent Havelange, President, Economics Chair Nancy Remillard, Vice President, Professional Relations Chair Wayne Hogaboam, Honourary Secretary Treasurer, Finance Chair Bonnie Coombs, Bylaws Chair Joe Piotrowski, Pharmacare Chair Jay Rich, Communication Chair Mel Baxter Michelle Glass Lisa Zaretzky Liaisons Chuck Narvey, Insurance Liaison Ron Guse, MPhA Liaison Elmer Kuber, CPhA Liaison Angela Arran, Student Liaison Marian Kremers, Government Relations Chair Scott Ransome, Executive Director & Editor Jill Ell, Assistant to the Executive Director & Editorial Assistant Editor/Publisher Manitoba Society of Pharmacists 90 Garry Street, Suite 202, Winnipeg, MB R3C 4H1 Telephone: (204) or info@msp.mb.ca COMMUNICATION is published six times a year. The subscription rate is $12.00 per issue, $77.04 per annum (including GST). The inclusion of proprietary names in this publication is for reference only. The inclusion of brand names does not imply that the brands listed are in any way preferable to those not listed. The sources of information are published articles in pharmaceutical and medical journals, private communications, etc. Incorrect quotations or interpretations are possible but not intentional. The views expressed in COMMUNICATION do not necessarily reflect the views of the Manitoba Society of Pharmacists Inc. The Society assumes no responsibility for the statements and opinions advanced by contributors in COMMUNICATION. Material from COMMUNICATION may be copied provided that the source is acknowledged. The deadline for submission of material for inclusion in COMMUNICATION is the 15th of February, April, June, August, October and December. ISSN Printed in Canada by: Leech Printing (204) Publication Mail Agreement No Return Undeliverable Canadian Addresses to: Manitoba Society of Pharmacists Garry Street Winnipeg, MB R3C 4H1 info@msp.mb.ca Up Front Pharmacy Customer Loyalty Programs 4 Let s talk loyalty. A loyal customer is a great thing. Statistics show that it takes 10 new customers to replace just one regular customer in regards to your pharmacy business. Sounding Board Feedback on Drive Thru Pharmacies & Incentive Programs 5 Tracy Lelond-Young, Kim Bright, Barbara Cinnamon Feature Article Chronic Idiopathic Urticaria 7 Chronic idiopathic urticaria is defined as the occurrence of daily or almost daily, wheals and itching (hives) for at least six weeks with no obvious cause. Feature Article Work and Professional Environment 11 A total of 87% of respondents said they are satisfied with their current work arrangement and almost half of the respondents strongly agreed with that statement. Feature Article abc s of Amphetamines 15 The amphetamines (uppers, bennies, pep pills) are a group of artificial stimulants. The original drug is called amphetamine, but the group includes dextroamphetamine (dexies), methamphetamine (speed, crystal, meth, crank), and smokable methamphetamine (ice). Classifieds Pharmacists Wanted 16 Q&A: Getting to Know your Manitoba Pharmacists Alison Desjardins 17 The Last Word Drug Ads: The Hard Sell Behind High Public Purpose 18 There is a correlation between spending on prescription drugs and reduction of mortality and morbidity within populations that consume the drugs. The simple conclusion from observing the correlation is that more drugs lead to better health. M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 3

4 UP FRONT Pharmacy Customer Loyalty Programs Let s talk loyalty. A loyal customer is a great thing. Statistics show that it takes 10 new customers to replace just one regular customer in regards to your pharmacy business. But at what means did you go to get that loyal customer? Did you dazzle them with service? Did you slash your price? Or maybe, just maybe, they became hooked on your in-store loyalty program. So when we are talking loyalty, that s the hot topic of the day (and as with all great stories, there are always two sides to it ). Pharmacy is a business, and businesses like to make money. What better way to make money than have a customer that will only fill his/her prescriptions at your store because of the loyalty points? In a world of scraping to find competitive edges to one-up the guy down the street, it has to be considered a sledgehammer. Not only does it bring your regular people into the store to fill their prescriptions, but they will also shop more in the front store, often up to 40% more. It s a win-win situation for a pharmacy s overall bottom line. JAY RICH Communication Chair But pharmacy is also a health-care profession, and at what point does offering loyalty points cross our ethical boundaries? Many people feel the line has been crossed with bonus days. Bonus days encourage people to refill their prescriptions during a certain time frame (whether they need them or not), so they can cash in on huge rewards offered by the loyalty program. There are reports of patients not refilling medications on time so they could wait for the next bonus day to pick up their prescriptions. To compound that dilemma, you get the loading up phenomenon, as the customer attempts to squeeze every last loyalty point out of the promotion that they can. When used in this manner, loyalty programs turn pharmacy into a commodity, and after years of stressing compliance and proper use of medications, can certainly be viewed as a step backwards for the profession. So, those are my thoughts what about yours? Do you think that loyalty programs offer great value to your pharmacy and see no harm in them, or do you feel they are a burden on the profession and should be restricted to the front store? Take a few minutes to fill out the survey located in this month s journal and let us hear your voice. It s our profession, so when we are talking loyalty, it s your opinion that counts. Editorial Note: I would like to thank everyone who took the time to write in to the Sounding Board this issue. Keep those letters coming. Problems or more appropriately personal problems. We all experience them, and work them out most of the time. Some problems might involve Marital issues Financial issues Family issues Chemical use (including alcohol) Emotional/psychological/physical issues Gambling Because we are all unique as individuals, we respond differently to problem situations. At times, however, these problems may seem next to impossible to resolve on our own. We may need HELP! The Pharmacists-At-Risk committee is dedicated to the care and assistance of pharmacists in need of Physical, Psychological, Social and Spiritual Support. If you or a colleague are experiencing personal problems, no matter what the issue may be, the Pharmacists-At-Risk Committee can HELP. All calls and inquiries are CONFIDENTIAL. To access the At-Risk Program please call and leave a message. Your call will be returned within 24 hours. Manitoba Pharmacist-At-Risk Program let us help you keep it together The Medication Information Line for the Elderly (MILE) is now located at the University of Manitoba Please visit us at Room 111 University Centre (204) :30am to 2:30pm Monday to Thursday mile_resource@umanitoba.ca 4 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

5 SOUNDING BOARD The Sounding Board is here for members to speak up and speak out on issues that are of interest to pharmacy. The Sounding Board is not intended to be an expression of the opinions of the Manitoba Society of Pharmacists, but rather is meant to be a forum for opinions and thoughts. We encourage you, our members, to write in with your opinions on the topical issues of the day. To: The Manitoba Pharmaceutical Association Sent: April 29th, 2005 Hi Ron, I did receive a questionnaire on the impact of pharmacy promotions, coupons etc. but I ignored it b/c it doesn t affect us. (At least I didn t think it affected us.) But, after attending the conference and speaking to others I learned things I hadn t known before that really surprised and upset me. I was informed that even a customer that doesn t pay for a prescription because they have met their deductible or have other 3rd party coverage still receive air miles for the amount of that Rx. So people are getting very expensive medications, not paying for them and receiving the air miles. That means that Pharmacare is paying for these people to fly for free which means in turn that we the tax payers are footing the bill. I cannot believe this is allowed and if it isn t too late my comments can be added to the survey that was sent out. I was also informed that people will get an unnecessary Rx filled since they get their Rx free and get the air miles. What a waste! Thank you for taking the time to read this. Sincerely, Tracy Lelond-Young To: The Manitoba Society of Pharmacists Sent: Oct. 13th, 2005 To whom it may concern: Several months ago I had ed Ron Guse my opinions about the several problems I see with incentive programs such as the air miles given by certain pharmacies. In addition to my previous comments another problem has come to my attention. A customer was given an antibiotic Rx but did not fill it for several days so they could get in on the double air miles day. I m not sure if this is a dead issue but it has been on my mind. I am also concerned about the amount of monetary waste we are encountering in our store alone (which isn t a big store) with people having very expensive meds prescribed for 3 months and after a week of getting the med filled they are d/c. One day last week, just as an example I had 84 Plavix worth $247 and another gentleman with approx $500 dollars worth of d/c meds returned to me. We cannot re-dispense these meds so they are garbage. That is one day in one store! Can you imagine how much that is provincially? No wonder our health care system is in dire straits. What can we do about it, I m not sure but I would like to be part of the solution. Please let me know where we can go from here or any suggestions. Sincerely, Tracy Lelond-Young Oct. 8, 2005 Dear Jay, So many of our patients love using our Drive-Thru Pharmacy. I find I do exactly the same counseling at the window as I do a few steps down in the counseling area. The many people who really appreciate this service are elderly people who have trouble walking from their cars and harried mothers with sick kids. Of course others love the convenience and we even have our favorite walk-thru dogs (and drive-thru dogs) that we give treats to! If you could just imagine for a minute that you have 3 children. The baby and toddler both have ear infections and are crying. The three year old is very busy and likes to touch things. Do you unload the whole gang from their car seats, walk through the deep snow and go into the store? Or do you drive up to the window, have a quick chat with the very sympathetic female pharmacist (who has been there, done that) and have the RX delivered? I m very happy to provide this service to our patients. Sincerely, Kim Bright Super Thrifty Pharmacy Richmond Centre, Brandon M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 5

6 SOUNDING BOARD The Sounding Board is here for members to speak up and speak out on issues that are of interest to pharmacy. The Sounding Board is not intended to be an expression of the opinions of the Manitoba Society of Pharmacists, but rather is meant to be a forum for opinions and thoughts. We encourage you, our members, to write in with your opinions on the topical issues of the day. 6 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

7 Chronic Idiopathic Urticaria FEATURE ARTICLE What is chronic idiopathic urticaria (CIU)? Chronic idiopathic urticaria is defined as the occurrence of daily or almost daily, wheals and itching (hives) for at least six weeks with no obvious cause. 1 Epidemiological data is scarce but it is estimated that about 1% of the population suffer from this condition. This figure does not seem to vary greatly across different regions of the world. 2 MEERA B. THADANI M.Sc.(Pharm.) There are two subgroups of patients with this condition: Autoimmune chronic idiopathic urticaria (ACIU) about 30 50% of patients Non-autoimmune chronic idiopathic urticaria (CIU) remaining patients The most relevant advance in understanding this condition has been the discovery that there is an autoimmune process responsible in 30 50% of patients. Therefore, in these patients, the condition is not strictly idiopathic. In these patients circulating IgG autoantibodies react specifically with the α-chain of the highaffinity IgE receptor on dermal mast cells and basophils, resulting in the release of histamine and other mediators that cause urticaria and angioedema. 3 Patients who suffer from autoimmune chronic idiopathic urticaria (AICU) are more treatment resistant than those with non-autoimmune CIU. The remaining patients with non-autoimmune CIU remain truly idiopathic. How do you distinguish autoimmune chronic idiopathic urticaria (AICU) from non-autoimmune chronic idiopathic urticaria (CIU)? Unfortunately, there are no specific sensitive tests for AICU. A skin biopsy is essential to make the diagnosis of CIU. Thyroid function is also checked because Hashimoto s thyroiditis and Graves disease are positively associated with CIU. Clinical features Patients present with pruritis and urticaria. The wheals may remain small (1 to 5 mm) or cm or larger; sometimes confluent. Crops of hives appear and subside. A lesion can remain in one site for several hours; then disappear, only to appear elsewhere (Figures 1 and 2). If a lesion persists for more than 24 hours the possibility of a more serious condition called urticaria vasculitis can be considered. Other skin conditions that can be confused with CIU and ACIU are listed in Table 1. The patient should be referred to a specialist for differential diagnosis. 4 Figure 1 Hives on the upper torso. Figure 2 Hives covering the legs. M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 7

8 Skin condition Location of lesion(s) Contact allergic dermatitis Hands, feet, face Dermatomyositis Mainly face Cellulits Mainly limbs and face Lymphoedema Mainly limbs and face Recurrent erythema multiforme Mainly limbs and face Hypoalbuminaemia (e.g. nephrotic syndrome) Angioedema of face and limbs Polymorphous light eruption Mainly face Fixed drug eruption Mucocutaneous junctions Crohn s disease Angioedema of lips Table 1 Disorders that can be incorrectly diagnosed as CIU Short-term corticosteroid therapy is considered if the condition does not go into remission. Long-term corticosteroid therapy is not recommended. In most patients, CIU can be well controlled with routine antihistamines. The specialist monitors the patient with CIU and if there is an indication of ACIU or other conditions are suspect, then treatment is adjusted accordingly. In chronic idiopathic urticaria, spontaneous remissions occur within 1 to 2 years in about half of the cases. Control of stress often helps to reduce the frequency and severity of episodes. Certain drugs, for example aspirin can aggravate symptoms, as well as alcohol, coffee and tobacco smoking. It is therefore best to avoid triggers that can make the condition worse. When urticaria is brought on by aspirin, sensitivity to NSAIDS and to tartrazine (a food and drug coloring additive) should be investigated. 5 How is CIU treated? Second generation non-sedating antihistamines (H 1 blockers) are drugs of first choice. Cetirizine has a rapid onset of action and 10 mg twice daily in the morning and at night can be effective for some patients. The dose can be safety increased to 20 mg in the morning and 20 mg at bedtime to control the lesions. For some patients a sedating antihistamine such as hydroxyzine can be used instead of cetirizine at bedtime to help relieve nocturnal itching. The patient must be warned that continuing impairment of cognitive function during the following day can occur. Ranitidine, an H 2 blocker can be added to cetrizine if the H 1 blocker alone is not sufficient. The patient must be warned that dizziness and drowsiness are possible side effects of ranitidine. Another possibility is the addition of montelukast to an H 1 blocker. It is a selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene receptor. Cysteinyl leukotrienes and leukotriene receptor occupation have been correlated with the pathophysiology of cellular activity associated with the inflammatory process. The Pharmacist s role Pharmacists can ask about: Antihistamine and other medication use Duration of urticaria (>6 weeks) Exacerbation of urticaria or initiation of urticaria by pressure, cold, heat, vibration, water, or sunlight Duration of urticarial lesions (<24 to 36 hours) Frequency and timing of hives (e.g., daily, perimenstrual, nocturnal) Presence of angioedema (described as nonpruritic swelling of the lips, eyes, hands) Presence of pruritus with the lesions Personal history of allergic disease Personal history of acute urticaria induced by aspirin or NSAIDs Exacerbation concurrent with aspirin or NSAID use Family history of hives 6 Pharmacists frequently see the results of bee stings, poison ivy, contact allergic dermatitis and drug related skin reactions. These typically subside with treatment and upon the discontinuation of the offending agent. Crops of hives that persist, enlarge and have a diurnal pattern are indicative of chronic idiopathic urticara. The patient must be referred to a physician. Once the diagnosis has been made and drug therapy initiated, it becomes important to monitor therapy for efficacy and side effects. Patients should be encouraged to report any unwanted side effects and to seek help if selecting medications for self-treatment. Effective symptomatic treatment until the condition goes into remission is the goal of treatment. 8 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

9 Drug Metabolism/excretion Cetirizine Limited hepatic/urine Desloratidine Hepatic/urine and feces Fexofenadine ~5% mostly by gut flora; up to 1.5% hepatic/feces 80%, urine 11% Loratidine CYP2D6 and 3A4/urine and feces Montelukast Hepatic CYP3A4 and 2C8/feces 86% Ranitidine Hepatic/urine Prednisone Hepatic/urine as glucuronides, sulfates and unconjugated metabolites Table 2 Metabolism and excretion 7 Glossary of terms continued Urticarial vasculitis painful, purpuric cutaneous lesions resembling urticaria but lasting more than 24 hours, with biopsy findings for leukocytoclastic (breaking up of leukocytes) vasculitis and variable systemic changes often with hypocomplimentemia. Table 2 provides the metabolism and excretion of the medications mentioned. This information is useful when assessing potential drug-drug interactions. Glossary of terms 1 Angioedema is a deeper swelling due to edematous areas in the deep dermis and subcutaneous tissue and may also involve mucous membranes. Edema an accumulation of an excessive amount of watery fluid in cells or intercullar tissues. Erythema redness due to capillary dilation. Hypocomplimentemia a condition in which one or another component of complement is lacking or reduced in amount; associated with immune complex diseases. Urticaria is local wheals and erythema in the superficial dermis. References: 1. Dirckx JH, Stedman s Medical Dictionary, Williams & Wilkins, O Donnell BF, Lawlor F, Simpson J, et al The impact of chronic urticaria on quality of life. British Journal of Dermalology, 136: , Tong LJ, Balakrishnan G, Kochan JP et al Assessment of autoimmunity in patients with chronic urticaria, J Allergy Clin Immunol., 99, , Curr Opin Allergy Clin Immunol., Lippincott Williams & Wilkins, Beers MH and Berkow R, editors, The Merck Manual, 17th edition, Merck & Co., New Jersey, Griffith s 5MCC, PDA version 2005 and StatREF! Accessed through University of Manitoba Libraries, 10 October Lexi-Drugs PDA version, Be exceptionally well taken care of. Paul Milton Financial Advisor Phone: (204) pmilton@assante.com Reno Augellone, B.Sc., CFP Financial Planning Advisor Phone: (204) raugellone@assante.com What can you expect from you Assante advisor? Expertise. Insight. Attentiveness. And an integrated wealth management strategy that incorporates investment objectives, cash and credit flexibility, capital preservation, estate planning In short, everything you need to make more, keep more and be more secure. Please call for a private consultation. Assante Financial Management Ltd Taylor Avenue Winnipeg, Manitoba R3M 3Y9 The Assante symbol and Assante Wealth Management are trademarks of Assante Corporation, used under licence. M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 9

10 CORRECTION Hernia Errata Please note the following correction to the Hiatal Hernia Article published in Vol. 31 No.1 on Page 11. MANITOBA PHARMACY What is a hiatal hernia? A hiatal hernia is when a part of the stomach protrudes through the esophageal hiatus. There are two kinds of hiatal hernia. 1. Sliding hernia where the esophagus and stomach slide up into the chest through the hiatus. This is the more common type of hiatal hernia (Figure 2a). 2. Paraesophageal (next to the esophagus) where the esophagus and stomach stay in their normal locations but part of the stomach squeezes through the hiatus to become lodged next to the esophagus (Figure 2b).2 CONFERENCE Save the Dates! April 7 th, 8 th, and 9 th, 2006 The Clarion Hotel 1445 Portage Ave., Winnipeg, MB Announcing the 2006 Honorary Conference Chair Sliding hernia Figure 2a Sliding hernia Paraesophageal hernia Figure 2b Paraesophageal hernia Carey Lai Carey graduated from the Faculty of Pharmacy, University of Manitoba in the spring of He is currently practicing at Safeway Pharmacy in St. Vital. Over his four years in the faculty, Carey was involved with both local and national pharmacy student groups. He served as the President of the Canadian Association of Pharmacy Students and Interns and is currently finishing his term as Past President. Carey has also played an active role in the University of Manitoba Pharmacy Student Association and was the 4th year Co-stick from He has been a member of various faculty committees such as the curriculum review and student appeals committee. In 2004, Carey was the recipient of the CPhA Centennial Scholarship and the Doreen Ash Memorial Award. In 2005, Carey was the recipient of the Manitoba Society of Pharmacists A. Langley Jones Leadership Award and the CPhA Future Leaders Award for his commitment to the profession of Pharmacy. 10 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

11 FEATURE ARTICLE Work and Professional Environment Reprinted with the permission of: Trends & Insights 2004, The Pharmacy Group, Rogers Publishing Sponsored by Novopharm Ltd. and McKesson Canada A total of 87% of respondents said they are satisfied with their current work arrangement and almost half of the respondents strongly agreed with that statement. The level of agreement didn t change very much according to gender, type of employment or location but the degree of passion did. Fifty-eight percent of independents strongly agreed that they are satisfied, compared with only 44% for chains, 46% for supermarkets and 46% for franchise operations. Quebeckers were least likely to be satisfied with their work arrangement, at 32%, compared with a high of 57% in B.C. and Ontario. What will you be doing one year from now? Pharmacists who have been in their jobs the shortest amount of time are also the ones with the itchiest feet: 34% of those who have worked one year or less at their primary location said they are planning to look for another job within the next year, compared with a national average of 21%. Although Ontario pharmacists are among the most likely to voice satisfaction with their current job, they are also among the most likely to look for brighter horizons: 23% say they ll be looking for a job soon, compared with Alberta (27%), Manitoba (25%) and, at the end of the scale, Saskatchewan (12%). Hospital pharmacy may be the beneficiary of any job changes: 42% of those who plan to work in a hospital pharmacy within the next five years say they are planning to look for that other job within the next year (compared with 22% of respondents overall). Dissatisfaction with a job doesn t always translate into a decision to move, however. Although Quebeckers were least likely (at 32%) to express strong satisfaction with their current employment arrangement, they were among the least likely to plan a job move. Saskatchewan, meanwhile, is a field of stability compared to its neighbours: only 12% of the province s Only 38% of those who have been in their current job for one year or less said they would still be doing what they do now, compared to 58% of those with six to 10 years in the same job pharmacists plan a job move, compared with a high of 27% in Alberta and 25% in Manitoba. That s despite the fact that 4% of Saskatchewan pharmacists say they re working longer hours than they d like to (compared to a national average of 29%). Where will you be in five years? One in 10 (11%) pharmacists say they expect to retire by 2009.That number is even higher among pharmacists working in chains (17%) and independent pharmacies (16%).The picture isn t any better on the owner/manager side, where 25% say they plan to retire within the next five years. Again, stability seems to reign in pharmacy: roughly half (52%) of all pharmacists said that in five years, M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 11

12 they expect to be where they are right now. That figure rises to almost two of three for chain pharmacists (62%). If employees stay in a job at least a year, it seems, they re hooked: only 38% of those who have been in their current job for one year or less said they would still be doing what they do now, compared with 55% of those with two to five years, and 58% of those with six to 10 years in the same job. Four in 10 pharmacy consultants said they expect to have an office-based practice within a community pharmacy within the next five years. Another 11% said they would probably be working for pharmaceutical companies, compared with only 2% of staff pharmacists. Foreign-trained pharmacists are far more likely to move into nontraditional roles: 13% of U.S.-trained pharmacists and 14% of those trained outside of North America say they plan to be working in a community pharmacy as an office-based pharmacy consultant, compared with only 2% of Canadian-trained individuals. On the other side of the coin, slightly more than half (53%) of Canadiantrained pharmacists say they expect to be doing the same thing they are now, compared with only 36% of foreign-trained, and 38% of U.S.-trained pharmacists. What would make your job better? The number one request, mentioned by 30% of 26% of those paid over $150,000 annually say they spend too much time on drug plan issues respondents, was to reduce the amount of time spent on nonpharmacy activities. The percentage was even higher among chains (44%) and banners (36%). Sixteen percent of pharmacists pointed to the need for a change in their hours. When broken down in another question, 29% said they were working more hours than they d like to every week and 6% said they are working less than they d like. Those earning the big bucks are paying the price: a whopping two-thirds of those earning $150,000 or more said they are working longer hours than they d like, and 37% of them said a change in work hours was #1 on their wish list. Only 6% of pharmacists nationwide said they really wished they could have more professional responsibilities. It looks like hospitals are still the magnet for these people: 20% of those who plan to be in hospital in the next five years say that s what they want, compared with only 9% of those who expect to be in community pharmacy in Interestingly, although Saskatchewan pharmacists were the least likely to say they re planning a job change in the near future, they were also by far the province that most frequently mentioned changing their boss: 10% fingered their boss as their prime irritant, compared with 4% nationally. U.S.-trained pharmacists were even more vocal, with one-quarter (26%) saying the thing they d like to change most in their current position is their boss. What s best and worst about your job? Forget that image of the lonely pharmacist hidden behind the dispensary counter. By an overwhelming margin, pharmacists pointed to their interaction with patients as the thing that makes them come into work every morning. Forty-two percent of respondents said the best part of their job is the interaction they have with people, while another 28% named the pharmaceutical care and counselling they provide. Interestingly, they re willing to give without expecting a return: only 8% named the appreciation they get from customers as the best part of their job, while only 2% named their wages. Twenty-nine percent of chain and 26% of supermarket pharmacists said interaction with patients was the best part of their job (compared with 42% nation- 12 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

13 ally). Pharmacists in chain pharmacies seem to put more emphasis on pharmaceutical care and counselling (40%), while 27% of supermarket pharmacists said the same; another 20% of supermarkets voted for their fellow staff members. They ve got the money, but not the time. As a result of the pharmacist shortage, Canadian pharmacists are seeing the green. But higher wages come with a price longer hours, increased stress and less time off. In these days of professional drought, pharmacists are increasingly being called upon to do more with less, in some cases drawing on technicians and technology to fill the gaps. Is there really a shortage of pharmacists? Canadian pharmacists are divided right down the middle when asked if they re experiencing a pharmacist shortage at their own site. Half of respondents agreed there is a staffing shortfall, with 24% stating they strongly agree and 25% saying they somewhat agree. Interestingly, managers/ owners were more likely than staff pharmacists to strongly agree they didn t have Whether pharmacists believe in the pharmacist shortage or not, they all agree that they need more time to do their job enough pharmacists at their store (29% vs. 22%). While only half of respondents said there was a shortage at their own site, more than two-thirds (67%) said the pharmacist shortage has had a personal impact on them. Broken down provincially, Manitoba pharmacists (78%) were more likely to feel the effects of the pharmacist shortage, compared with Ontario and B.C. at the other end (64%). When asked how the shortage was affecting them personally, 62% of these respondents said their wages had increased as a result.while that rise in salary is a bonus, it does not come without its drawbacks. Almost two-thirds (65%) said the pharmacist shortage meant they had less time off, and 56% said they were under more stress. Would an increased role for technicians help you? Longer hours, more stress and fewer colleagues to shoulder the load whatever is a pharmacist to do? The majority of respondents (75%) said it would really help them do their job better if technicians were to take on an expanded role.that idea had the most support in Manitoba and Ontario, where 82% thought technicians could give them more help. Pharmacists in Quebec, B.C. and Saskatchewan were the least optimistic about technicians being able to help ease their workload, although most agreed with the concept (67, 68 and 69%, respectively). What does your average day look like? In addition to dispensing and counselling patients, many pharmacists find themselves doing tasks someone else could probably handle (ringing in purchases, entering refill orders) or things they simply don t want M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 13

14 to do (haggling with third-party payers). If they could write their own ticket, it s clear they d do less of the actual dispensing of product and more counselling of patients. And it goes without saying that dealing with third-party payers and administration would go into someone else s inbasket. When it comes to specific tasks, 72% of respondents said they ring in purchases at the cash register, 89% enter new prescriptions into the computer, and 88% enter refill prescriptions into the computer. Those numbers were far higher in supermarket/ mass merchandise pharmacies, where 89% said they work the cash register, and 97% enter prescriptions into the computer. By contrast, only two-thirds of banner pharmacists (62%) work the cash register. The survey found that nationally, pharmacists spend an average of 37.5 hours per week at their jobs, although 25% of respondents said they work more than 40 hours a week. Pharmacists in Saskatchewan and Manitoba appear to be the real workhorses of the country: 32 and 37% in those provinces, respectively, said they work more than 40 hours a week. 14 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

15 FEATURE ARTICLE As the most accessible health care professional, you are likely increasingly being asked questions about Crystal Meth. As the media spotlight intensifies on the emerging issue of crystal meth use, it may be helpful to have an uncomplicated explanation readily available. For this reason we have enclosed the following article entitled abc s of Amphetamines. We hope you find the article useful in your practice. Look for a more detailed article, entitled Beyond the abc s in the next issue of Communication. abc s of Amphetamines Reprinted with the Permission of the Alberta Alcohol and Drug Abuse Commission The amphetamines (uppers, bennies, pep pills) are a group of artificial stimulants. The original drug is called amphetamine, but the group includes dextroamphetamine (dexies), methamphetamine (speed, crystal, meth, crank), and smokable methamphetamine (ice). These drugs all have similar effects. Even experienced users may be unable to tell which drug they have taken. These drugs come in tablets and capsules that can be taken orally. They can also appear as off-white crystals, chunks and powders, which may be sniffed or injected. Smokable methamphetamine looks like shaved glass slivers or clear rock salt. Amphetamines may be prescribed for narcolepsy (attacks of uncontrollable sleepiness) and hyperactivity. They are no longer used medically to treat depression and obesity because of their dangerous side effects. Because amphetamines increase alertness, energy, and a sense of well-being, they are sometimes used illicitly by truck drivers, shift workers, students, athletes and body builders. But possessing, manufacturing, trafficking in, and prescription shopping for amphetamines can result in fines, prison sentences and criminal records. Some methamphetamine users repeatedly take the drug over several days in order to maintain the euphoria. These binges or runs often continue even when agitation and frightening hallucinations replace the feelings of exhilaration. Effects of short-term use Small doses of amphetamines can make you feel alert and energetic. They can increase your breathing and heart rates, decrease your appetite, and dilate your pupils. They can cause a dry mouth and sleeping problems. At higher doses, you can experience euphoria. Smoking and injecting amphetamines can produce an extremely pleasurable rush or flash that lasts a few minutes. Side effects include restlessness, shakiness, sweating, anxiety, headache, blurred vision, dizziness, irregular heartbeat and chest pain. Some users experience feelings of power and superiority. Some become hostile and aggressive. Overdose can cause delusions, hallucinations, high fever, delirium, seizures, coma, stroke, heart failure and death. Use with alcohol and other drugs is especially dangerous. Amphetamine users who inject the drug with shared needles risk getting hepatitis and AIDS. Injected particles, which do not dissolve in water, damage blood vessels, kidneys, lungs, and brain tissue. Effects of long-term use If you use amphetamines regularly, you can have chronic sleep problems, mood swings, irregular heartbeat, high blood pressure, weight loss, constipation or diarrhea, and nutritional problems. High doses of the drug can result in nerve damage, chronic psychosis, paranoia, and hallucinations. Most of these problems disappear a few days or weeks after drug use stops. There is evidence, however, that methamphetamine can cause lasting brain damage. If you use drugs often, you can develop serious personal problems. Using drugs can become more important than family and friends. You may continue using even when your job or schoolwork is suffering, or when you run into financial, spiritual or legal problems. Young people who frequently abuse drugs may not learn how to solve problems, handle their emotions and become mature, responsible adults. Babies born to amphetamine users are more likely to be born prematurely, have low birth weight, and experience withdrawal symptoms like agitation and drowsiness. They may also have an increased risk of birth defects. The drug passes to nursing babies through the mothers milk. Amphetamines and Addiction Regular amphetamine users develop tolerance. As their body adapts to the drug, they need larger doses to feel the same effects. After chronic use, even at low doses, users can develop dependence. Cravings can get very intense, and users may go to great lengths to obtain more. They continue to use the drug to avoid the crash they experience when the drug s effects wear off. Withdrawal from amphetamine use can result in extreme tiredness, disturbed sleep, anxiety, hunger, depression, and suicidal thoughts. M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 15

16 CLASSIFIEDS FULL TIME PHARMACIST WANTED: Pharmasave in Roblin, MB offers a great position as head pharmacist. Medium volume business with technician and capable, friendly staff. Excellent opportunity for patient care in a virtually stressfree environment. Terry Fraser (204) PHARMACIST WANTED: Pharmacy has immediate opening for licensed pharmacist. We require excellent pharmaceutical care and communication skills. We offer competitive rates and a very flexible schedule, unique arrangement. For more information contact Tony at (204) RELIEF PHARMACIST REQUIRED for independent pharmacy. Daily hours are 10:00am to 6:00 pm. No evenings or holidays. Contact Donna at Opportunities available for licensed pharmacists Full-time Pharmacists in Manitoba: Brandon, Dauphin, Flin Flon, Selkirk, Steinbach, Swan River, The Pas, Winkler, Winnipeg Please contact: DRUGStore Pharmacy National Recruitment Centre Phone NATL JOB Fax NATL FAX ( ) ( ) jobs@drugstorepharmacy.ca Online PHARMACIST WANTED: Part/Full-time pharmacist for friendly independent pharmacy. We are located in four season cottage country 75 mins. NE of Winnipeg. Contact or ingham.pharmacy@mts.net. Pharmacist required for rural pharmacy in Manitou, MB. Full time or part time available. Hours are 9-5 no weekends or evenings. Very generous remuneration with potential for ownership or profit sharing. Please call Steve at (204) Full colour advertisement rates range from 1/8 page to full page. Save more with multiple issue ad placement. MSP members are entitled to place one free classified ad per membership year. Contact MSP for classified rates for non-msp members and business (corporate) classified ads (priced according to size). All rates are subject to GST. Space is limited. Call MSP today at (204) for the full current 2005 ad rate schedule. As a service to members, MSP maintains a list of employment opportunities. This list is updated every week and is available by fax or on our website at Pharmacy is the most important part of our business at Shoppers Drug Mart / Pharmaprix, and we want you to be a part of it. As Canada s leading pharmacy, we have tremendous career opportunities. We offer competitive salaries and benefits and, if you have an entrepreneurial spirit, the chance to become a Pharmacist Owner. You will also have access to rewarding professional practice opportunities, career development and leading-edge technology. Achieve your full potential while providing top patient care. We are currently looking for Licensed Pharmacists for the following locations: Brandon, Manitoba Assiniboia, Saskatchewan Winnipeg, Manitoba North Battleford, Saskatchewan Steinbach, Manitoba Calgary, Alberta Thompson, Manitoba Fort McMurray, Alberta Shoppers Drug Mart has opportunities available across Canada! to receive a current listing of opportunities in other provinces! For the experience of a lifetime, please contact in strict confidence: Samantha Beaudry, Recruitment Coordinator Phone: (306) sbeaudry@shoppersdrugmart.ca Medicine Hat Co-op Ltd. The Medicine Hat Co-op is a diverse co-operative organization with over 25,000 active members in the South-Eastern Alberta and Western Saskatchewan Area. We are currently recruiting for PHARMACISTS (Full Time or Flexible Part Time) We are: A progressive pharmacy working out of new, modern facilities A pharmacy with a separate compounding area, a private consultation room, ample work area and current technology A pharmacy that utilizes technicians with over 25 years of combined experience and knowledge A patient-focused pharmacy providing an environment where pharmacists can utilize and expand their personal areas of interest A company that focuses on a healthy work-life balance, with competitive wages, comprehensive benefit and pension plans, bonuses and other incentives You have: An interest in the challenge and satisfaction that a community pharmacy can offer for continuing patient care, long-term monitoring and possible research initiatives Eligibility for licensure with the Alberta College of Pharmacists The desire to spend some time away from dispensing and in direct patient care (YES, in a community pharmacy!) Whether you are a recent graduate looking for your first pharmaceutical position (and to pay off some student loans!) or a veteran pharmacist looking to broaden your horizons we want you to fit into our team. Licensing Assistance and other incentives available with signed employment contract. Please apply to: Human Resources Manager, Medicine Hat Co-op Ave SE, Medicine Hat, AB T1B 1E3 Fax (403) humanresources@medicinehatcoop.ca (Word Format) For more information, please visit our website at 16 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

17 Q&A: GETTING TO KNOW YOUR MANITOBA PHARMACISTS Name: Alison Desjardins Place/Year of Graduation: University of Manitoba, 1995 Years in Practice: 10 Currently Working: I am co-owner of Birtle Pharmacy, along with Tracy Lelond-Young. Our pharmacy is a fairly typical rural pharmacy that employs five people in addition to the two pharmacists/owners. We provide pharmacy services to Sunnyside Manor (the nursing home in Birtle) and also do considerable blister-packaging of medications for community residents. Our front shop has a good mix of retail items, as well as liquor (note to Jay Rich: this is quite common in rural MB) and lottery tickets. At present, my family is my first priority, and therefore I have chosen to limit my committee involvement. However, in the past I have been a board member of MSP, a member of Faculty Council and the Curriculum Committee at the U. of M. Faculty of Pharmacy, and locally an active member of Birtle in Bloom. I expect to have more time for committee work again in the future, once my children are older. Accomplishments in pharmacy: Creating what I feel is the ideal practice situation! Tracy and I are equal partners in the business. We each work half-time, a week on and a week off. When we are at work, we have a whole week to immerse ourselves in our work. The best part, though, is having every other week at home to spend quality time with our young families. Family: Husband Steve, sons Mason (5) & Miles (1&1/2), baby #3 due in March Hobbies: With 2, soon to be 3 young children, there s not a lot of time for hobbies. I do try to curl regularly, and I enjoy scrapbooking if I can stay awake after the kids go to bed. Community activities: I m the co-chair of the Birtle Health Centre Focus Group, and a member of both the local palliative care committee and the board of the local day care/nursery school. As well, this will be my first winter as a hockey mom, which I expect to shock my system! Favorite thing about **rural** Manitoba: The civilized lifestyle. Daytime shifts, no commute (I walk 1&1/2 blocks to work), low cost of living (enables Steve and I to work part-time and care for our own children). Most relaxing vacation choice: An all-inclusive beach resort in Cuba. Pet peeves: Part 2 EDS. Favorite fictional character and why: Dilbert, because he helps me see the humour in my common stressors (bureaucracy, computer difficulties, employee relations, etc.). What could you do without forever: Rx & OTC drug abuse. What couldn t you do without for even a day: My family. What you love about pharmacy: Retail pharmacy provides a great way to become part of a new community. Do you know someone who is making a difference in the pharmacy community? We would like to highlight them in this article! Please contact the MSP office at (204) or info@msp.mb.ca. M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 17

18 THE LAST WORD Drug Ads: The Hard Sell Behind High Public Purpose There is a correlation between spending on prescription drugs and reduction of mortality and morbidity within populations that consume the drugs. The simple conclusion from observing the correlation is that more drugs lead to better health. That result is superficial; however, for a substantial part of drug spending is frivolous and even perverse. Big pharmaceutical companies have been culprits in promotion of overuse of some drugs. The question, however, is not one of guilt, but of what can be done to control promiscuous drug advertising. ANDREW ALLENTUCK Recently, while watching NBC News in the evening, I saw ads for drugs for restless leg syndrome, toenail fungus, sleeplessness, loose skin cells of the upper eyelid and general nervousness. Mostly trivial, for sure. Defenders of the drug ads, which run in the U.S. with explanations of the conditions they are intended to treat, is that information can help patients make informed choices. Critics say that the drugs are just medicalizing conditions that need nothing more than exercise or soap and water. The problem is that the ads convey more than information. They extend the uses of drugs to populations that may be perfectly healthy. Example: Psychoactive drugs that may be prescribed for the travails of daily life. Though it may be argued that the tragedy of Sept. 11, 2001 was not daily life as people are accustomed to it, GlaxoSmithKline ran an ad using the event to promote Paxil. Barely a month after the planes brought down the World Trade Center GSK touted its brand of paroxetine with an image of a woman walking in a crowd with evident strain in her face. The caption on the ad read, Millions suffer from chronic anxiety. Millions could be helped by Paxil. Preaching Illness: Turning the normal conditions of life into diseases is not a new tradition in medicine. At the urging of insurance companies that like to know what they are paying for, psychiatrists have expanded their once-slim set of illnesses into a list of several hundred conditions. Likewise, the medicalization of life has grown the list of treatable illnesses into a drug marketer s garden of delights. Women are told to have bone density tests and perhaps then to be candidates for alendronic acid. The stuff can produce oesophageal ulcers. Moreover, bone density alone is not a predictor of fractures, reported the online journal, bmj.com. Drug ads sell pills. In one remarkable marketing coup in the United States, ads for finasteride (Propecia) mobilized hordes of bald men and others who feared they might become less hirsute. Following the ads, visits to physicians for treatments for baldness rose by 79% compared with 1997 levels, bmj.com noted. In a hectic world, it could be said that consumers need to be given memorable messages and starting images. But hustling pills may go too far. A year ago, Merck took its arthritis drug Vioxx off the market after reports of incidents of heart attack and stroke. Vioxx had been the most heavily advertised drug in the U.S. and the 10th most heavily advertised in Canada, reported the Canadian Health Services Research Foundation. Vioxx was more heavily advertised than Pepsi and Budweiser, said Globe and Mail health reporter André Picard in a Feb. 24, 2005 article on hearings on the safety of Vioxx and other cox-2 inhibitors. The Vioxx case raises the issue of risk management. A potent drug may indeed cause unwanted illness. So do we blame an efficacious drug, physicians who prescribe it, or the marketers who want to push the pill into ever more mouths? Those who damn drug ads are in the position of shooting the messenger. Canada, like most countries, limits the advertising of prescription drugs directly to consumers. Direct to consumer advertising, DTCA for short does exist, though on a limited basis. As David M. Gardner, Barbara Mintzes and Aleck Ostry noted in the September 2, 2003 issue of the Canadian Medical Association Journal, drug ads may be 1. Product claims that make claims of therapeutic value for specific diseases. 2. Reminder ads that name a product without claiming a use for it. 3. Help-seeking statements that suggest that there are new but unspecified ways to treat certain conditions. While category 1 DTCA ads are still illegal in Canada, ads that fall into categories 2 and 3 are considered acceptable under revised Health Canada regulations. Drug companies have managed to get around controls on DTCA by what amounts to imaginative display. Thus ads for drugs for erectile dysfunction show men jumping for joy or walking into their offices with fresh confidence on their faces. Everybody understands. Drug companies protest that if they can legally associate conditions with drugs, as they do for compounds that supposedly help smokers to switch to nicotine substitutes, why should 18 C O M M U N I C AT I O N N O V E M B E R/DECEMBER 2005

19 they not be able to tout the benefits of any drug? The answer is perhaps that prescription drugs are more potent than OTC compounds. That s the rationale suggested by Gardner et al., but it is feeble. Prescription drugs could be more potent than OTC drugs, but in the hands of certain imaginative cooks, OTC cold remedies can be turned into very toxic substances such as methamphetamines. Indeed, in August, 2005, Oregon became the first U.S. state to require a prescription to purchase designated cold and flu pills that contain precursor substances used in making crystal meth. What then can be said of the official case against product claims in drug advertising? 1. Canadian prohibitions against the association of a condition with a prescription drug are weak, not because of clinical potency or toxicity, but because drug marketers can tell people what a pill can fix through suggestion rather than statement or though origination of messages outside of Canada. And if suggestion is not enough, broadcast and magazine ads that associate drugs will illness flow across the border with the United States where such promotions are lawful. 2. There is still good reason to discourage the modern version of medicine men taking their wagons of nostrums to potential patients. Drumming up more demand for any drug can increase its cost to patients and insurers. The genuinely ill are vulnerable, even desperate for relief. The healthy patient may be convinced the he or she needs a checkup or a drug for merely preventative reasons. 3. There is a compromise position which Health Canada could use as a means of satisfying the public policy view that DTCA category 1 ads are counterproductive and even dangerous and the drug industry view that folks are entitled to know what drugs exist and what they treat. A Modest Proposal: Just as Health Canada requires warnings and disclosures on cigarette packages, it could establish a template for drug ads. In words as large in print as those that lure consumers, drug makers would be required to disclose side effects and contraindications. In television broadcast form, the size of words on screen and the speed of scrolling of such information would have to be readable. In radio ads, the script would have to devote equal time to the downside of drugs as they do to the hustle. Canada can attempt to limit information passing to consumers, but censors at Health Canada do not have the powers of customs inspectors who can seize what they like. The best that can be done is to shape what consumers read, hear and see. Compromise may not be the best way to control ads that associate diseases with drugs; it is the only way. Corporate Membership Program Corporate Membership Program Exclusive Membership Package for the Manitoba Society of Pharmacists. Exclusive All of these Membership facilities under one Package roof for the Manitoba o Hockey and Society Figure of Skating Pharmacists. o Tennis All o of Squash these facilities under one roof oo Hockey Badminton and Figure Skating oo Tennis Fitness Center o Squash Lap Pool o Badminton Five-Pin Bowling o Fitness Babysitting and Center much more! o Lap Pool This is where you belong! o Five-Pin Bowling o 6 Babysitting and month Family Memberships much more! Primary $105/month* Spouse $39/month Student (18-24) $29/month Child (3-17) 6 month Family $25/month Memberships Primary *Food Assessment is $105/month* $200 per 6 months (per family) Spouse 6-month Single $39/month Memberships Student Individual (18-24) $90/month* $29/month Child *Food(3-17) Assessment is $200 $25/month per 6 months *Food Assessment is $200 per 6 months (per family) Day Passes (For Rural Members Only) Single 6-month $10 Single Couple $20 Memberships Family $25 Individual 200 River $90/month* Avenue, Winnipeg, MB *Food Assessment is $200 per 6 months For Membership Information Call: Janet Thorpe Single Phone: $10 Couple $20 ext. Family 102 $ River Avenue, Winnipeg, MB This is where you belong! Day Passes (For Rural Members Only) Visit our website today! For Membership Information Call: Janet Thorpe Phone: ext. 102 Visit our website today! M A N I TO B A S O C I E T Y O F P H A R M A C I S T S C O M M U N I C AT I O N 19

20 Leech Printing, Brandon