tag:theconversation.com,2011:/us/topics/pharmacies-8173/articlesPharmacies – The Conversation2024-03-08T19:16:00Ztag:theconversation.com,2011:article/2252452024-03-08T19:16:00Z2024-03-08T19:16:00ZOpill, the first over-the-counter birth control pill, will be on shelves soon − here are some key things to know<figure><img src="https://images.theconversation.com/files/580646/original/file-20240308-25-jut003.jpg?ixlib=rb-1.1.0&rect=9%2C9%2C6325%2C4213&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Within weeks, for the first time in the U.S. consumers will be able to find a birth control pill on retail shelves. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-shopping-for-health-and-beauty-supplies-royalty-free-image/528571278?phrase=grocery+store+pharmacy">Bill Oxford/iStock via Getty Images</a></span></figcaption></figure><p><em>The Food and Drug Administration’s 2023 approval of the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive">first over-the-counter birth control pill</a>, called Opill, <a href="https://theconversation.com/fda-approves-first-daily-over-the-counter-birth-control-pill-opill-a-pharmacist-and-public-health-expert-explain-this-new-era-in-contraception-204230">broadened the options</a> for people seeking to prevent pregnancy.</em> </p>
<p><em>On March 4, 2024, the pill’s manufacturer, Perrigo Company, <a href="https://www.prnewswire.com/news-releases/perrigo-commences-shipments-of-opill-to-retailers-nationwide-empowering-millions-to-enter-a-new-era-of-reproductive-health-access-in-the-united-states-302077710.html">announced that it has started shipping Opill</a> and that consumers can expect to see it on shelves by the end of the month.</em></p>
<p><em>The Conversation asked Sarah Lynch, a <a href="https://www.binghamton.edu/pharmacy-and-pharmaceutical-sciences/departments/pharmacy-practice/profile.html?id=selynch">pharmaceutical expert</a> from Binghamton University, State University of New York, to answer some of the key questions people have about the new over-the-counter contraceptive.</em></p>
<h2>How does Opill work to prevent pregnancy?</h2>
<p>Opill contains norgestrel, which is a synthetic form of the hormone progesterone. Progesterone works in several ways to <a href="https://doi.org/10.1016/j.contraception.2022.03.022">prevent pregnancy</a>. First, it thickens the mucus in the cervix, which makes it challenging for sperm to enter the uterus and fertilize an egg. Second, it thins the lining of the uterus, making it less hospitable for a fertilized egg to implant. And third, it can prevent ovulation, or release of the egg, in most people.</p>
<p>Opill, like many other progestin-only birth control pills, must be <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">taken at the same time each day</a> to prevent pregnancy. This is because progestin levels must remain high in order to be effective. </p>
<p>If an Opill dose is taken even three hours late, or if vomiting or diarrhea occurs within four hours of taking the dose, a person should avoid intercourse or use some form of nonhormonal contraception for two days. Even though it only takes about two days for the drug to build up to an effective level, sperm can remain fertile in the female reproductive tract for <a href="https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/pregnancy/faq-20058504#">up to five days</a> after intercourse, meaning that it is important to take this medication regularly both before and after unprotected intercourse.</p>
<h2>How effective is Opill?</h2>
<p>When used exactly as instructed, Opill is <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/opill-0075mg-oral-norgestrel-tablet-information#">98% effective</a>. This makes it the most effective nonprescription contraceptive option. </p>
<p>Effectiveness rates of contraceptives are measured in contraceptive failure. If 100 women use a birth control that is 91% effective over one year, it is estimated that nine women using that method will become pregnant over that year. </p>
<p>It is important to differentiate between “perfect use” and “typical use” when discussing effectiveness. “<a href="https://www.guttmacher.org/fact-sheet/contraceptive-effectiveness-united-states">Perfect use</a>” applies to using a method consistently and correctly, while “typical use” represents effectiveness among all people who use the method, including those who do not use it consistently or correctly. The <a href="https://www.fda.gov/media/167893/download">98% effectiveness</a> occurred under the “perfect-use” conditions of a clinical trial. Birth control pills generally have an <a href="https://doi.org/10.1016%2Fj.contraception.2011.01.021">effectiveness of between 91% to 93%</a> under “typical-use” conditions. </p>
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<a href="https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Front view of a box of Opill." src="https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=601&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=601&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=601&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580643/original/file-20240308-29-prhzxy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When used as instructed, Opill is highly effective.</span>
<span class="attribution"><a class="source" href="https://mma.prnewswire.com/media/2153138/Perrigo_Company_plc_Opill.jpg?p=original">Perrigo Company</a></span>
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<h2>Is Opill safe to be sold over the counter?</h2>
<p>Prior to Opill’s approval in the United States, birth control pills were already available without a prescription in <a href="https://freethepill.org/otc-access-world-map">more than 100 countries</a> around the world. The same drug in Opill, norgestrel, has been used safely and effectively for birth control <a href="https://www.federalregister.gov/documents/2017/10/25/2017-23125/determination-that-ovrette-norgestrel-tablet-0075-milligrams-was-not-withdrawn-from-sale-for-reasons">since 1973</a>.</p>
<p>In order for a drug to be sold without a prescription in the U.S., it must first be reviewed and <a href="https://www.fda.gov/media/140598/download#">approved by the Food and Drug Administration</a>. The FDA ensures that the product can meet several conditions for safe use: Consumers must be able to use it appropriately for self-diagnosed conditions; they should not need guidance from a health practitioner to use it safely and effectively; and the drug must have a low potential for misuse and abuse. The FDA also requires that over-the-counter <a href="https://www.fda.gov/drugs/information-consumers-and-patients-drugs/otc-drug-facts-label">drug manufacturers follow specific labeling requirements</a> and include information about the drug’s use, warnings, purpose and directions. </p>
<p>Norgestrel <a href="https://doi.org/10.1001/jama.2023.10825">has been shown to be safe</a> for most women. However, it should not be used by those who currently have or have ever had breast cancer, because <a href="https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet">some breast cancers are hormone-sensitive</a> and in some cases, hormones lead to increased growth of tumors. People should also not use Opill if they are pregnant or are taking <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">certain medications</a> used for seizures, tuberculosis, HIV/AIDs or pulmonary hypertension because norgestrel may not work as effectively when taken with these medications.</p>
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<figcaption><span class="caption">Opill will be about as easy to find in stores and online as Advil.</span></figcaption>
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<h2>Shouldn’t a doctor be involved in choosing birth control?</h2>
<p>Getting a prescription for any type of hormonal contraceptive product has traditionally required a medical examination with a health care provider. Screenings may include pap test, pelvic examination, clinical breast examination and testing for sexually transmitted diseases. Although important, leading medical organizations such as the American College of Obstetricians and Gynecologists <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception">state that these screenings are not required</a> before safely using hormonal contraception.</p>
<p>Even before the approval of Opill, people had the option to uncouple their screening examinations from prescription access. One way has been through telehealth. A 2018 review of several online telehealth platforms found that these companies are <a href="https://doi.org/10.1177/1357633X18824828">still able to screen for safe use</a> and provide safe birth control recommendations without an in-person examination. In addition, <a href="https://doi.org/10.3390%2Fpharmacy8040176">more than 20 states currently allow pharmacists</a> to provide prescription contraceptive based on a self-assessment questionnaire and blood pressure screening.</p>
<p>People who want to use any type of nonprescription medication should ensure that they know their medical history and what medications they take. They should carefully review the labeling information and, if they have questions, ask their pharmacist or reach out to their primary care provider. </p>
<h2>Does Opill have any side effects?</h2>
<p>Some of the <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">most common side effects of Opill</a> include nausea, breast tenderness, increased appetite, acne, fatigue and headaches, which are similar to the side effects of other hormonal birth control products. With most hormonal contraceptive products, these side effects diminish over time. </p>
<p>Opill does not contain estrogen, as some other hormonal birth control pills do. Estrogen plays a role in menstrual regularity, so people who use Opill may experience more irregular vaginal bleeding. But some individuals who use Opill <a href="https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection">may have less bleeding</a> or stop bleeding altogether while taking the pills. </p>
<p>A commonly raised concern regarding safety of hormonal birth control is the risk of blood clots, such as <a href="https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557">deep vein thrombosis</a> or <a href="https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism">pulmonary embolism</a>. This risk is mainly associated with products that contain <a href="https://health.clevelandclinic.org/yes-your-birth-control-could-make-you-more-likely-to-have-a-blood-clot/#">estrogen in addition</a> to progestin. </p>
<p>Progestin-only pills such as Opill carry <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">no or minimal risk of blood clots</a>. However, even products that contain estrogen <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception">still have a lower risk</a> of blood clot than the risk during pregnancy or the postpartum period. </p>
<h2>How affordable will it be?</h2>
<p>Opill <a href="https://www.prnewswire.com/news-releases/perrigo-commences-shipments-of-opill-to-retailers-nationwide-empowering-millions-to-enter-a-new-era-of-reproductive-health-access-in-the-united-states-302077710.html">will be available for purchase</a> from many major retailers by the end of March. The manufacturer’s suggested retail price is US$19.99 for a one-month supply, or $49.99 for a three-month supply. The company will provide options for online purchasing of a one-, three- or six-month supply and will also offer subscription services.</p>
<p>Over-the-counter availability of Opill will undoubtedly increase access to those who are looking to prevent pregnancy without access to, interest in or time to see a health care provider. </p>
<p>However, there is concern that the cost <a href="https://www.kff.org/health-costs/press-release/three-charts-the-cost-and-coverage-of-opill-the-first-fda-approved-over-the-counter-daily-oral-contraceptive-pill-in-the-united-states/">may be prohibitive</a> for some. The Affordable Care Act <a href="https://www.healthcare.gov/coverage/birth-control-benefits/">currently mandates insurance coverage</a> of certain FDA-approved prescription birth control products, but it does not require coverage of nonprescription options. A group of governors and reproductive health advocates issued a <a href="https://news.bloomberglaw.com/health-law-and-business/first-otc-birth-control-fuels-push-for-federal-coverage-rule">joint statement</a> calling for an expansion of the ACA to include over-the-counter contraceptives. </p>
<p>Some people may be able to use health savings accounts and flexible spending accounts to purchase Opill. Perrigo has also announced that it plans to offer a patient-assistance program.</p>
<h2>Is Opill right for me?</h2>
<p>Opill represents only one type of birth control. In <a href="https://www.cdc.gov/reproductivehealth/contraception/index.htm">addition</a> to other nonprescription options such as condoms and spermicide, there are also prescription options including hormonal pills, vaginal rings and transdermal patches. Some individuals may prefer a long-acting reversible contraceptive, such as an intrauterine device or an implant, that lasts for several years. </p>
<p>Opill does not prevent sexually transmitted infections, so people looking to further protect themselves should still use some sort of barrier method during intercourse. </p>
<p>People looking for options that don’t need to be taken daily and as precisely, that include different hormones, or that provide other noncontraceptive benefits will need to continue to rely on prescription products at this time. </p>
<p><em>This is an updated version of an <a href="https://theconversation.com/how-does-the-new-over-the-counter-birth-control-pill-opill-work-to-prevent-pregnancy-5-questions-answered-209801">article originally published</a> on July 19, 2023.</em></p><img src="https://counter.theconversation.com/content/225245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Lynch does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Once available, Opill will be the most effective form of nonprescription birth control on the market. But you should still speak with your health care provider about any questions.Sarah Lynch, Clinical Associate Professor of Pharmacy Practice, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2192802023-12-13T13:36:15Z2023-12-13T13:36:15ZBig-box retail chains were never a solution for America’s downtowns − and now they’re fleeing back to suburbia<figure><img src="https://images.theconversation.com/files/564994/original/file-20231211-89932-pedkqb.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C2032%2C1529&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Merchandise is locked in cases to guard against theft in a Target store in New York City on Sept. 23, 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/target-retail-stores-in-new-york-city-have-installed-locked-news-photo/1726478336">Deb Cohn-Orbach/UCG/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Holiday shopping is in full swing, but city dwellers may have fewer options for buying in person than they did a few years ago. That’s because many large chain stores are pulling out of central cities. </p>
<p>This trend has been building for several years. Target made national headlines in 2018 when it closed its store in a <a href="https://www.nytimes.com/2021/06/30/business/target-baltimore-store-closings.html">predominantly Black Baltimore neighborhood</a> after just 10 years of operation. COVID-19 sped things up by cutting foot traffic in city centers and boosting online commerce. </p>
<p>Target has <a href="https://www.cnn.com/2023/10/12/business/target-closing-us-cities-crime-dg/index.html">closed additional stores</a> in Chicago, Milwaukee, New York, San Francisco, Seattle and Portland, Oregon. <a href="https://www.businessinsider.com/walmart-store-closings-2023-full-list">Walmart</a>, <a href="https://www.thestreet.com/retailers/cvs-is-permanently-closing-hundreds-of-stores-for-a-surprising-reason">CVS</a>, <a href="https://www.usatoday.com/story/money/shopping/2023/11/29/rite-aid-store-closures-grow/71744831007/">Rite Aid</a> and Walgreens have also closed many urban stores.</p>
<p>Closures have spread to many suburbs and small towns. Retailers saddled with high debt, overexpansion, <a href="https://nrf.com/research/national-retail-security-survey-2023">shoplifting losses</a>, slumping sales and <a href="https://www.jpmorganchase.com/institute/research/cities-local-communities/post-covid-consumer-spending-in-new-york-city">online competition</a> are shedding stores fast. But this contraction lopsidedly affects city dwellers, who often lack the shopping options and price competition suburbanites enjoy. </p>
<p>Many news reports, particularly from conservative outlets, have <a href="https://www.nationalreview.com/corner/manhattan-retail-is-getting-destroyed-by-shoplifting/">blamed lawlessness</a> and <a href="https://www.wsj.com/articles/the-root-causes-of-san-franciscos-disorder-crime-homeless-911-auto-theift-public-disorder-a45b170c">weak leadership by progressive city governments</a>. In my view, however, there’s another important factor: flawed corporate strategies.</p>
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<figcaption><span class="caption">As big-box chain drugstores close in St. Louis, an independent pharmacy works to fill the gap with more personal service.</span></figcaption>
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<h2>The self-service revolution</h2>
<p>The concept of letting shoppers serve themselves dates back to 1879, when Frank W. Woolworth <a href="https://guides.loc.gov/this-month-in-business-history/february/woolsworth">opened his first store in Utica, New York</a>. Its successors grew into the F.W. Woolworth chain of “five-and-dime” discount dry goods stores, which became fixtures of hundreds of cities, suburbs and small towns in the early 20th century. </p>
<p>Food stores followed suit in the early 1900s, beginning with the <a href="https://www.supermarketnews.com/archive/early-stores-pioneer-self-service-concept">Alpha Beta chain</a> in California in 1914 and <a href="https://mypigglywiggly.com/aboutus/">Piggly Wiggly</a> in Tennessee in 1916. Instead of having clerks gather customers’ orders from store shelves, these stores let shoppers loose in the aisles, then allowed them to pay at the end of their visit.</p>
<p>This approach seeded the meteoric rise of “big box” stores like <a href="https://www.thestreet.com/markets/history-of-walmart-15092339">Walmart</a> and <a href="https://corporate.target.com/about/purpose-history/history-timeline?era=2">Target</a> in the mid-20th century. With their low manufacturing costs, streamlined logistics, minimally staffed stores, national advertising and vast inventories, big-box chains <a href="https://www.npr.org/2012/11/19/165295840/the-past-and-future-of-americas-biggest-retailers">drove many small retailers out of business</a> – and most Woolworth stores, too. </p>
<p>Self-service came to rule the suburbs, where big chains could build mega-stores with plenty of parking. But they were rare in central cities for most of the 20th century, except for a few affluent enclaves, such as West Los Angeles or Chicago’s North Side. Generally, these chains avoided poor neighborhoods and many downtowns altogether. </p>
<p>As shoppers increasingly gravitated to suburban malls, many urban neighborhoods became <a href="https://www.city-journal.org/article/the-return-of-urban-retail-deserts">retail deserts</a>, with few vendors meeting local needs. Those that endured, often run by small-scale entrepreneurs, typically were businesses that offered a single type of product, such as grocery stores, delicatessens or pharmacies. </p>
<h2>Chains discover downtowns</h2>
<p>Harvard management professor <a href="https://www.hbs.edu/faculty/Pages/profile.aspx?facId=6532">Michael Porter</a> drew attention to the lack of retail services in densely populated urban neighborhoods in a seminal 1995 article, “<a href="https://hbr.org/1995/05/the-competitive-advantage-of-the-inner-city">The Competitive Advantage of the Inner City</a>.” Economic development, Porter argued, was key to revitalizing inner cities – and these zones housed a lot of potential customers.</p>
<p>“Even though average inner city incomes are relatively low, high population density translates into an immense market with substantial purchasing power,” Porter wrote. “Ultimately, what will attract the inner city consumer more than anything else is a new breed of company that is not small and high-cost but a professionally managed major business employing the latest in technology, marketing, and management techniques.” </p>
<p>Chains of many kinds began to <a href="https://www.npr.org/2010/12/21/132231472/big-box-retailers-move-to-smaller-stores-in-cities">rediscover the central city market</a> in the early 2000s. <a href="https://nyc-business.nyc.gov/nycbusiness/article/reduce-operating-expenses">Tax breaks</a> and subsidized redevelopment projects often greased the wheels. Urban gentrifiers were reliably drawn to new urban chain stores like Target, Walmart and Whole Foods.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/cLCAmoR6BL/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Many small retail shops now faced a juggernaut of national chains. One example was <a href="http://dx.doi.org/10.1001/jamainternmed.2019.4588">independent pharmacies</a>: Between 2009 and 2015, 1 in 4 urban pharmacies in low-income neighborhoods closed.</p>
<p>And chain stores often failed to generate major benefits for their new neighborhoods. Employees had few chances for advancement beyond <a href="https://www.epi.org/press/new-company-wage-tracker-shows-low-wages-are-the-norm-at-large-retail-and-food-service-employers/">minimum-wage hourly work</a>. Clustering of chain stores in prosperous neighborhoods and business districts failed to address “food deserts” <a href="https://www.ers.usda.gov/amber-waves/2011/december/data-feature-mapping-food-deserts-in-the-u-s/">in impoverished areas</a>.</p>
<h2>Broken big boxes</h2>
<p>Certain qualities that made chains so successful – national sales strategies, self-service stores and brand awareness – are proving to be liabilities in today’s more complicated and divided urban context. </p>
<p>Retail executives and their <a href="https://nrf.com/advocacy/policy-issues/organized-retail-crime">trade associations</a> have cited excessive shoplifting losses and weak law enforcement as factors in urban store closures, even though they have conspicuously <a href="https://www.theatlantic.com/health/archive/2021/12/shoplifting-holiday-theft-panic/621108/">failed to provide shoplifting data</a> by location. There are signs, moreover, that <a href="https://www.nytimes.com/2023/12/08/business/organized-shoplifting-retail-crime-theft-retraction.html">shoplifting is receding</a>, except for in a few large cities like New York.</p>
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<p>In my opinion, there are three reasons why city chain stores are closing at such a high rate compared with those in suburbs.</p>
<p>First, despite job recovery in many cities since the pandemic, low-income urban households remain in crisis, with <a href="https://www.nytimes.com/2023/01/25/realestate/rent-burdened-american-households.html">high rents</a> and inflation driving up the cost of essentials. According to the nonprofit Brookings Institution, 9.6% of suburban residents lived in poverty in 2022, compared with about <a href="https://www.brookings.edu/articles/post-pandemic-poverty-is-rising-in-americas-suburbs/">16.2% in primary cities</a>. Widespread poverty in a city like Baltimore, for instance, is reflected in the <a href="https://mdfoodbank.org/hunger-in-maryland/maryland-hunger-map/">concentration of food banks</a> on the west and east sides. </p>
<p>Less disposable income, compounded by shoplifting losses, can lead to store closures – especially since national chains like Target and Walmart expect the dollar value of sales from stores that have been open for more than a year to <a href="https://www.wallstreetmojo.com/same-store-sales/">increase steadily over time</a>. </p>
<p>Second, urban chains clustered too many of their own branches close together or too near other chains – usually in high-income residential or business districts. <a href="https://www.nytimes.com/2009/07/09/business/media/09adco.html">Manhattan below 96th Street</a> is a clear example of this pattern. With affluent customers shifting to online shopping, and reduced foot traffic overall thanks to remote work, this aggressive strategy has failed. </p>
<p>Third, widely distributed <a href="https://www.cnn.com/2023/12/07/business/shoplifting-surge-hype-nightcap/index.html">media images of rampant shoplifting</a> send a message at odds with these chains’ powerful brand images of order, safety and standardization. A <a href="https://counciloncj.org/shoplifting-trends-what-you-need-to-know/">small but rising share</a> of shoplifting incidents since 2019 have involved assaults or other crimes. These events have the potential to <a href="https://www.vox.com/money/23938554/shoplifting-organized-retail-crime-walmart-target-theft-laws">scare executives</a> concerned about employee lawsuits. Chains want urban locations but not “urban” reputations. </p>
<h2>Retail flight</h2>
<p>Large retail chains have finally figured out that cities aren’t suburbs. Those that remain are adding staff, scaling back self-checkout, checking receipts at exits and <a href="https://www.kqed.org/news/11949025/why-are-retail-stores-locking-up-basic-necessities">locking down higher-priced goods</a> – essentially, abandoning the self-service model. However, these costly measures won’t bring back online-addicted shoppers or daily commuters, nor will they put more money in struggling consumers’ pockets.</p>
<p>Responding to retail association pressure, some city and state governments are imposing <a href="https://www.cnbc.com/2023/08/11/organized-retail-crime-nine-states-pass-laws-to-crack-down-on-theft.html">stricter punishments for shoplifting</a> and cracking down on <a href="https://www.youtube.com/watch?v=5RIjWTO2Yz4">black-market vending</a> on sites like Amazon and eBay. However, it isn’t clear that this get-tough approach can or should rescue the big-box model, since these stores failed to create safe, secure shopping environments in the first place.</p>
<p>As I see it, the urban chain store implosion raises questions about whether suburban-style retail really does much for cities. These stores are mediocre job creators, undercut local entrepreneurs, often <a href="https://www.strongtowns.org/journal/2022/9/13/mainstreet-vs-chain-stores-a-western-north-carolina-analysis">pay relatively low property taxes</a> and build ugly parking lots. They also don’t provide the kind of “<a href="https://medium.com/i-cities/eyes-on-the-street-ab12b39b960b">eyes on the street</a>” local security that small-scale shopkeepers do. In fact, their parking lots and open aisles seem to <a href="https://www.cbsnews.com/newyork/news/yonkers-shoplifting-big-box-stores/">attract disorder</a>.</p>
<p>Shoehorning suburban-style stores into urban neighborhoods now looks like a Band-Aid for much deeper urban problems. In my view, city leaders would do better to focus on <a href="https://www.recastyourcity.com/">building local capacity</a> and protecting smaller stores that usually have greater local wealth-building potential, more reasonable growth expectations and the kind of personal service that <a href="https://www.sfgate.com/bayarea/article/how-retail-crime-impacts-business-16720683.php">naturally deters shoplifting</a>.</p><img src="https://counter.theconversation.com/content/219280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Dagen Bloom does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Shoplifting has been hyped as a driver of chain-store closures, but did these companies ever really understand urban environments in the first place?Nicholas Dagen Bloom, Professor of Urban Policy and Planning, Hunter CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2145542023-11-01T19:24:51Z2023-11-01T19:24:51ZWhat makes an ideal main street? This is what shoppers told us<figure><img src="https://images.theconversation.com/files/551115/original/file-20230929-19-vfuzaw.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5639%2C3759&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Irina Grotkjaer/Unsplash</span></span></figcaption></figure><p>A lot of dedication and effort goes into making main streets attractive. Local governments, planners, place makers, economic development managers, trade associations and retailers work hard to design, improve and revitalise main streets. The goal is to make them attractive places to increase shopper numbers, provide pleasant places for communities, and boost local economies.</p>
<p>Despite the efforts that go into planning, maintaining and marketing local shopping areas, the people who use these places are often not consulted about what they actually want and need on their main street. <a href="https://www.shopology.com.au/resources">Our research</a> is the only-known Australian study to ask shoppers about the key elements, and shops and services, they regard as contributing to the ideal main street. </p>
<p>So what types of stores and services do they want?</p>
<p>Pharmacies are the top choice. Intriguingly, four types of stores/services that are disappearing from main streets around Australia – the post office, bank, department store and newsagent – are in the top ten (out of 45 choices in our survey). </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1715480716900012399"}"></div></p>
<h2>What are the key shops and services?</h2>
<p>We wanted to find out what consumers see as their ideal local shopping street. What kinds of shops and services matter most for them? Which other elements of local shopping places do they want?</p>
<p>Curiously, users are often not asked these questions. Yet their answers are essential if we are to design new towns, suburbs and regional centres, and improve existing ones, so more people want to work, shop and visit them.</p>
<p>We surveyed a representative sample of 655 shoppers from around Australia about their local shopping preferences. </p>
<p>We provided a list of 45 different stores and services. Participants were asked to rank them in order of importance from one to 45.</p>
<p>Overwhelmingly, participants considered the <a href="https://drugstorenews.com/study-consumers-shop-drug-stores-grocery-household-items-much-pharmacy">pharmacy the most important store or service</a> for an ideal main street. Across gender, age and location, pharmacies were consistently number one.</p>
<p>Similarly, four types of stores and services – the <a href="https://www.afr.com/policy/economy/australia-post-risks-death-spiral-without-urgent-change-ceo-20230427-p5d3nh">post office</a>, <a href="https://www.abc.net.au/news/2023-10-06/regional-bank-branches-at-risk-of-closing-population-analysis/102937120">bank</a>, <a href="https://www.abc.net.au/news/2023-03-16/qld-myer-to-close-brisbanes-queen-street-mall/102106162">department store</a> and <a href="https://thewest.com.au/politics/state-politics/wa-government-to-provide-39m-to-aid-500-newsagents-as-industry-battles-the-internet-c-10085316">newsagent</a> – appeared in the top ten most important, regardless of demographics. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551133/original/file-20230929-29-q50xs9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The top ten stores and services in an ideal main street.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<h2>What other key elements are important?</h2>
<p>We then asked participants about the importance of different elements of main streets. We provided 21 elements and participants were asked to rate each on a <a href="https://www.simplypsychology.org/likert-scale.html">Likert scale</a> from 1, “not at all important”, to 7, “extremely important”. </p>
<p>Shoppers rated “cleanliness” as the most important element for their ideal shopping area. It was followed by “safety and security” and “parking”. </p>
<p>Aside from the “retail mix”, in most areas local councils have control over nine of the ten top elements. “Safety and security” also involves police and individual security services that centres and some stores employ.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552684/original/file-20231009-31-adta9o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The top ten elements of an ideal main street.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<h2>Motivation for shopping affects choices</h2>
<p>We also tested for shoppers’ levels of hedonic and utilitarian orientation. <a href="https://www.sciencedirect.com/science/article/pii/S0022435903000071">Hedonic</a> shoppers really enjoy the act of shopping. They experience euphoria and pleasure and they buy so they can go shopping, rather than shopping so they can buy.</p>
<p><a href="https://www.jstor.org/stable/2489765">Utilitarian shoppers</a>, on the other hand, are rational and cognitive and they view shopping as a task or chore. Buying products they need is simply a “means to an end”. They get no great satisfaction from the activity. </p>
<p>Hedonic shoppers are more often <a href="https://www.tandfonline.com/doi/full/10.1080/09593960802113877">women</a>. Men tend to be more utilitarian. We tend to become more utilitarian as we get older.</p>
<p>We were interested to find out if people’s responses to our questions were different depending on whether they were hedonic (shop for pleasure) or utlilitarian (shop for practical needs) shoppers. </p>
<p>For the most important store or service, hedonic and utilitarian shoppers both rated a pharmacy as number one. And they ranked similar stores and services in their top ten. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552679/original/file-20231009-20-n4119g.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Top ten stores and services for hedonic shoppers.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<p>But there were some differences. Hedonic shoppers included a lifestyle/gift store and department store in their top ten. Utilitarian shoppers did not. Instead they rated the post office and the newsagent as important. </p>
<p>This finding makes sense. Lifestyle stores, gift shops and department stores offer the hedonic shopper the chance to browse and enjoy quality surroundings and service. The post office and newsagent allow the utilitarian shopper to complete tasks quickly and easily – no browsing required.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552681/original/file-20231009-31-k7gykf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Top ten stores and services for utilitarian shoppers.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<p>Despite similarities in their top-ranked shops and services, hedonic and utilitarian shoppers’ rankings of the most important elements of local shopping areas were starkly different.</p>
<p>For hedonic shoppers, the complete visitor experience, including the surroundings and atmosphere, is an important aspect of their ideal shopping area. Their top ten elements reflected this. They selected a combination of tangible elements, including public art, aesthetics, greenery and lighting, to complement the more ephemeral such as events and activities, night-time economy, sustainability and history and culture. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552682/original/file-20231009-17-5u8syd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The top ten elements for hedonic shoppers.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<p>Utilitarian shoppers rated elements that help make a task-oriented shopping trip easier. <a href="https://wayfoundvictoria.vic.gov.au/what-is-wayfinding/">Wayfinding</a> (all the ways to help people navigate a space), signage and information, walkability, retail mix, and services and amenities were important for them. </p>
<p>The only two elements both groups agreed should be in the top ten were lighting, and seating and tables.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552686/original/file-20231009-24-2cbsrx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The top ten elements for utilitarian shoppers.</span>
<span class="attribution"><span class="source">Louise Grimmer</span></span>
</figcaption>
</figure>
<h2>Making main streets the best they can be</h2>
<p>There is an increasing understanding that retailing will not continue to be the main or sole reason people visit town centres. While still important, retail will more often complement services, attractions and “experiences” as the major factors that entice visitors. </p>
<p>This requires local councils, chambers of commerce and marketing organisations to perform a juggling act. They need to market shopping precincts as being attractive for shoppers while showcasing a range of services and attractions in these areas that appeal to other types of visitors.</p>
<p>Making shopping areas the best they can be is challenging work. Different people want different things from main streets. </p>
<p>Our findings provides insights for local councils, which have a primary policy responsibility for main streets, as well as developers, investors and individual store owners. This knowledge can help them better plan and improve the retail and service mix for everyone.</p><img src="https://counter.theconversation.com/content/214554/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Different shoppers have different priorities, but some shops and services are ranked as important across the board.Louise Grimmer, Retail Scholar, University of TasmaniaMartin Grimmer, Pro Vice-Chancellor and Professor of Marketing, University of TasmaniaPaul J. Maginn, Interim Director, UWA Public Policy Institute; Associate Professor & Programme co-ordinator (Masters of Public Policy), The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114122023-08-31T21:39:50Z2023-08-31T21:39:50ZHere’s what new 60-day prescriptions mean for you and your hip pocket<figure><img src="https://images.theconversation.com/files/545417/original/file-20230829-19-mvx2g4.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/customer-paying-bill-by-cell-phone-623126426">Shutterstock</a></span></figcaption></figure><p>From today, there are significant <a href="https://www.health.gov.au/our-work/60-day-prescriptions">changes</a> to how some common medicines are prescribed and dispensed in Australia. This means you could walk away from the pharmacy with 60-days’ worth of your usual medicine from a single prescription.</p>
<p>Until now, most long-term medicines were only available for 30 days at a time. So the price of these medicines for some patients may effectively halve. </p>
<p>You would also need fewer trips to the GP for a prescription and fewer visits to the pharmacy to have your medicine dispensed.</p>
<p>But not all medicines are yet eligible for 60-day scripts and not everyone is prescribed 60-days’ worth of medicine at a time. Here’s what the changes mean for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Can I get a 60-day script today?</h2>
<p>If you have a current prescription, you need to use this prescription first before you get a new one. To be eligible for a prescription that provides medicine for 60 days your medication needs to be on the <a href="https://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2022-12/Increased-Dispensing-Quantities-List-of-Medicines.pdf">approved list</a>.</p>
<p>Your doctor also needs to assess if you are stable on it. This is to avoid wastage. We know new treatments can result in frequent changes to medication regimens, which would result in wasted medicines if they don’t end up being used.</p>
<p>Your doctor may also give you “repeat” prescriptions for 60-days’ worth of medicines at a time. Under the new rules, this could mean up to <a href="https://www.health.gov.au/resources/publications/60-day-prescriptions-information-kit-for-prescribers?language=ha">12 months’ supply</a> of medicine (the initial script plus five “repeats”). You would have to pay for each of these repeat scripts when your medicine is dispensed every 60 days.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-time-of-day-should-i-take-my-medicine-125809">What time of day should I take my medicine?</a>
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</em>
</p>
<hr>
<h2>Is my medicine on the list?</h2>
<p>The roll-out of 60-day scripts will be in three stages. The first stage, which begins today, <a href="https://www.health.gov.au/our-work/60-day-dispensing/pbs-medicines-current-item-codes">includes</a> medicines for cardiovascular disease (such as heart disease and stroke), heart failure, high cholesterol, gout, osteoporosis, and the gut conditions Crohn’s disease and ulcerative colitis.</p>
<p>This includes some of the most common medicines prescribed in Australia, such as atorvastatin for lowering cholesterol, and perindopril for lowering blood pressure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person adding medications to pill organizer" src="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Not all your medicines may be affected by the changes.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/1TL8AoEDj_c">Laurynas Mereckas/Unsplash</a></span>
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<p>The following stages, set to be rolled out over the coming 12 months, include medicines for diabetes, epilepsy, glaucoma, asthma and Parkinson’s disease. </p>
<p>When fully implemented, these changes will affect more than 300 prescription medicines available on the Pharmaceutical Benefits Scheme (PBS).</p>
<p>These medicines have been chosen because they are appropriate treatments for people living with stable, chronic health conditions, they meet clinical safety criteria, and are considered cost-effective.</p>
<p>Medicines not available for 60-day dispensing are those only for short-term use and medicines known to be at risk of overuse. These <a href="https://www.nps.org.au/australian-prescriber/articles/pharmaceutical-drug-misuse-in-australia#information-sources-for-prescribers">include</a> pain medicines and some medicines for mental health conditions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-pharmacists-are-angry-at-script-changes-and-why-the-government-is-making-them-anyway-204028">Here's why pharmacists are angry at script changes – and why the government is making them anyway</a>
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<h2>Will I save money?</h2>
<p>The government has brought in these changes mainly to try to make medicines more affordable. We know people do not seek medical care or fill prescriptions <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">due to cost</a>. </p>
<p>The <a href="https://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee">maximum price you pay</a> at the pharmacy for a PBS script (known as the co-payment) is not changing. <a href="https://www.pbs.gov.au/info/about-the-pbs">It’s still</a> A$7.30 for concession card holders and $30 for non-concession card holders. But by having 60-day dispensing, you’ll only be charged this every two months instead of every month.</p>
<p>But not everyone will save money from a 60-day prescription because in some cases your pharmacy may already be discounting your medicine. If the price for 60-days’ supply would not take the price over $30, you may not be getting two scripts for the price of one. </p>
<p>For example, a commonly discounted medicine is atorvastatin. In Australia, a non-concession patient generally pays between $8 and $22 for 30-days’ supply. But it’s likely that a 60-day supply would cost between $15 and $30.</p>
<p>The amount you or your family need to pay to reach the <a href="https://www.pbs.gov.au/info/general/faq#WhatisthePBSSafetyNet">PBS safety net</a> is also not changing. This is the threshold you need to reach before medicines become free (for concession card holders) or discounted (non-concession card holders) for the rest of the calendar year. In some instances, 60-day dispensing may result in you or your family reaching the safety net threshold later, or not at all.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman looking into purse, holding coin" src="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The changes are meant to make medicines more affordable.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-old-person-senior-hold-wallet-1844510152">Shutterstock</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-pbs-safety-net-and-is-it-really-the-best-way-to-cut-the-cost-of-medicines-180315">What is the PBS safety net and is it really the best way to cut the cost of medicines?</a>
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</em>
</p>
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<h2>How should I store my medicine?</h2>
<p>If you don’t store your medicines correctly at home they can become degraded and not work so well. With a 60-day supply, correct storage is even more important. </p>
<p>As a general rule of thumb, never store your medicines in hot rooms or your car (even in winter) and don’t store them in direct sunlight. If your medicine needs to be stored in the fridge, your pharmacist will let you know.</p>
<p>One example is <a href="https://media.healthdirect.org.au/medicines/GuildLink_Information/58775/CMI/ujcxalae10320.pdf">latanoprost</a>, which are drops for the eye condition glaucoma. You can keep the bottle you are using in the cupboard but you need to store the unopened, second bottle in the fridge.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Remember, 60-day dispensing is only available for new prescriptions. When you next see your doctor, if your condition is stable and your medicine is suitable, you will be provided a 60-day script. Your pharmacist will then dispense a 60-day supply.</p>
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<p><em>If you have any questions about the new rules, ask your local pharmacist. Information is also available from the <a href="https://www.health.gov.au/our-work/60-day-prescriptions">Commonwealth health department</a> and the <a href="https://www.60dayscripts.com.au/">Consumers Health Forum</a>.</em></p><img src="https://counter.theconversation.com/content/211412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bartlett is a member of the Pharmaceutical Society of Australia, a previous director of Blooms the Chemist management services and remains a shareholder.</span></em></p><p class="fine-print"><em><span>Associate Professor Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p>The price you pay at the pharmacy for your long-term medicines may effectively halve. But not all medicines or patients qualify.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2098012023-07-19T12:24:57Z2023-07-19T12:24:57ZHow does the new over-the-counter birth control pill, Opill, work to prevent pregnancy? 5 questions answered<figure><img src="https://images.theconversation.com/files/537887/original/file-20230717-20840-u0w4rp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Food and Drug Administration has approved the first nonprescription daily birth control pill.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-holding-the-pill-on-her-lap-royalty-free-image/88186275?phrase=birth+control&adppopup=true">Dimitri Otis/Stone via Getty Images</a></span></figcaption></figure><p><em>The Food and Drug Administration’s July 13, 2023, approval of the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive">first over-the-counter birth control pill</a>, called Opill, <a href="https://theconversation.com/fda-approves-first-daily-over-the-counter-birth-control-pill-opill-a-pharmacist-and-public-health-expert-explain-this-new-era-in-contraception-204230">broadens the options</a> for people seeking to prevent pregnancy. When Opill becomes available, presumably in the first quarter of 2024, it will be sold in grocery and convenience stores, in pharmacies and through online retailers.</em></p>
<p><em>The Conversation asked Sarah Lynch, a <a href="https://www.binghamton.edu/pharmacy-and-pharmaceutical-sciences/departments/pharmacy-practice/profile.html?id=selynch">pharmaceutical expert</a> from Binghamton University, State University of New York, to answer some of the key questions people have about the new over-the-counter contraceptive.</em></p>
<h2>1. How does Opill work to prevent pregnancy?</h2>
<p>Opill contains norgestrel, which is a synthetic form of the hormone progesterone. Progesterone works in several ways to <a href="https://doi.org/10.1016/j.contraception.2022.03.022">prevent pregnancy</a>. First, it thickens the mucus in the cervix, which makes it challenging for sperm to enter the uterus and fertilize an egg. Second, it thins the lining of the uterus, making it less hospitable for a fertilized egg to implant. And third, it can prevent ovulation, or release of the egg, in most people.</p>
<p>Opill, like many other progestin-only birth control pills, must be <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">taken at the same time each day</a> to prevent pregnancy. This is because progestin has to stay at a certain level in the body in order to effectively prevent pregnancy. </p>
<p>If an Opill dose is taken even three hours late, or if vomiting or diarrhea occurs within four hours of taking the dose, a person should avoid intercourse or use some form of nonhormonal contraceptive method for two days. Even though it only takes about two days for the drug to build up to an effective level, sperm can remain fertile in the female reproductive tract for <a href="https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/pregnancy/faq-20058504#">up to five days</a> after intercourse, meaning that it is important to take this medication regularly both before and after unprotected intercourse.</p>
<p>When used exactly as instructed, Opill is <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/opill-0075mg-oral-norgestrel-tablet-information#">98% effective</a>. This makes it the most effective contraceptive option available for use without a prescription. Opill does not prevent sexually transmitted infections, so people looking to further protect themselves should still use some sort of barrier method during intercourse. </p>
<h2>2. Is Opill safe to be sold over the counter?</h2>
<p>Prior to Opill’s approval in the United States, birth control pills were already available without a prescription in <a href="https://freethepill.org/otc-access-world-map">more than 100 countries</a> around the world. The same drug in Opill, norgestrel, has been used safely and effectively for birth control <a href="https://www.federalregister.gov/documents/2017/10/25/2017-23125/determination-that-ovrette-norgestrel-tablet-0075-milligrams-was-not-withdrawn-from-sale-for-reasons">since 1973</a>. It has been available by prescription under the brand name Ovrette.</p>
<p>In order for a drug to be sold without a prescription in the U.S., it must first be reviewed and <a href="https://www.fda.gov/media/140598/download#">approved by the Food and Drug Administration</a>. The FDA ensures that the product can meet several conditions for safe use: It must be able to be used appropriately by consumers for self-diagnosed conditions, it should not need a health practitioner for safe and effective use, and it must have a low potential for misuse and abuse. The FDA also requires that over-the-counter <a href="https://www.fda.gov/drugs/information-consumers-and-patients-drugs/otc-drug-facts-label">drug manufacturers follow specific labeling requirements</a> and include information about the drug’s use, warnings, purpose and directions. </p>
<p>Norgestrel <a href="https://doi.org/10.1001/jama.2023.10825">has been shown to be safe</a> for most women. However, it should not be used by those who currently have or have ever had breast cancer, because <a href="https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet">some breast cancers are hormone-sensitive</a> and in some cases, hormones lead to increased growth of tumors. People should also not use Opill if they are pregnant or are taking <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">certain medications</a> used for seizures, tuberculosis, HIV/AIDs or pulmonary hypertension because norgestrel may not work as effectively when taken with these medications.</p>
<p>Several studies have looked at whether women can accurately evaluate their own ability to safely use birth control. The studies show that <a href="https://doi.org/10.1136%2Fbmjgh-2019-001402">women are accurate in their evaluations</a> and may take birth control pills for a longer period of time when compared to having a doctor evaluate and prescribe for them.</p>
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<figcaption><span class="caption">Doctors still recommend speaking to a physician or pharmacist before taking Opill, once it’s available.</span></figcaption>
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<h2>3. Shouldn’t a doctor be involved in choosing birth control?</h2>
<p>Getting a prescription for any type of hormonal contraceptive product has traditionally required a medical appointment and a screening examination with a health care provider. Screenings may include pap test, pelvic examination, clinical breast examination and testing for sexually transmitted diseases. Although important, leading medical organizations such as the <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception">American College of Obstetricians and Gynecologists</a> state that these screenings are not required before safely using hormonal contraception.</p>
<p>Even before the approval of Opill, people had the option to uncouple their screening examinations from prescription access. One way has been through telehealth. A 2018 review of several online telehealth platforms found that these companies are <a href="https://doi.org/10.1177/1357633X18824828">still able to screen for safe use</a> and provide safe birth control recommendations without any type of in-person examination. In addition, <a href="https://doi.org/10.3390%2Fpharmacy8040176">more than 20 states currently allow pharmacists</a> to provide prescription contraceptive based on a self-assessment questionnaire and blood pressure screening.</p>
<p>People who want to use any type of nonprescription medication should ensure that they know their medical history and what medications they take. They should carefully review the labeling information and, if they have questions, ask their pharmacist or reach out to their primary care provider. </p>
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<figcaption><span class="caption">Once Opill is available over the counter, presumably in early 2024, anyone of reproductive age will be able to get it without a prescription or parental approval.</span></figcaption>
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<h2>4.Does Opill have any side effects?</h2>
<p>Some of the <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">most common side effects of Opill</a> include nausea, breast tenderness, increased appetite, acne, fatigue and headaches, which are similar to the side effects of other hormonal birth control products. With most hormonal contraceptive products, these side effects diminish over time. </p>
<p>Opill does not contain estrogen, as some other hormonal birth control pills do. Estrogen plays a role in menstrual regularity, so people who use Opill may experience more irregular vaginal bleeding. But some individuals who use Opill <a href="https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection">may have less bleeding</a> or stop bleeding altogether while taking the pills. </p>
<p>A commonly raised concern regarding safety of hormonal birth control is the risk of blood clots, such as <a href="https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557">deep vein thrombosis</a> or <a href="https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism">pulmonary embolism</a>. This risk is mainly associated with products that contain <a href="https://health.clevelandclinic.org/yes-your-birth-control-could-make-you-more-likely-to-have-a-blood-clot/#">estrogen in addition</a> to progestin. </p>
<p>Progestin-only pills such as Opill carry <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf">no or minimal risk of blood clots</a>. However, even products that contain estrogen <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception">still have a lower risk</a> of blood clot than the risk during pregnancy or the postpartum period. </p>
<h2>5. Will OTC status truly increase accessibility to birth control?</h2>
<p>Over-the-counter availability of Opill will undoubtedly increase access to those who are looking to prevent pregnancy without access to, interest in or time to see a health care provider. </p>
<p>However, cost constraints may still be an issue with Opill. The cost is unknown at this time. The Affordable Care Act <a href="https://www.healthcare.gov/coverage/birth-control-benefits/">currently mandates insurance coverage</a> of certain FDA-approved prescription birth control products, but it does not require coverage of nonprescription options. In May 2023, lawmakers reintroduced <a href="https://pressley.house.gov/wp-content/uploads/2023/05/Affordability-is-Access-Act-2023.pdf">legislation requiring coverage of over-the-counter options</a>, which would require that private health insurance plans cover FDA-approved over-the-counter contraceptives without a prescription. </p>
<p>Lastly, Opill represents only one type of birth control. While Opill was <a href="https://www.fda.gov/media/167893/download">98% effective</a> under “perfect-use” conditions in the clinical trials of the drugs, birth control pills generally have an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">effectiveness of between 91% to 93%</a> under “typical-use” conditions. “<a href="https://www.guttmacher.org/fact-sheet/contraceptive-effectiveness-united-states">Perfect use</a>” applies to using a method consistently and correctly, while “typical use” represents effectiveness among all people who use the method, including those who do not use it consistently or correctly. Effectiveness rates of contraceptives are measured in contraceptive failure. If 100 women use a birth control that is 91% effective over one year, it is estimated that nine women using that method will become pregnant over that year. </p>
<p>People looking for options that don’t need to be taken daily and as precisely, include different hormones or provide other noncontraceptive benefits will need to continue to rely on prescription products at this time.</p><img src="https://counter.theconversation.com/content/209801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Lynch does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new over-the-counter pill is highly effective at preventing pregnancy but must be taken at the same time daily, which can be a limitation for some people.Sarah Lynch, Clinical Associate Professor of Pharmacy Practice, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042302023-07-13T22:34:32Z2023-07-13T22:34:32ZFDA approves first daily over-the-counter birth control pill, Opill – a pharmacist and public health expert explain this new era in contraception<figure><img src="https://images.theconversation.com/files/537358/original/file-20230713-15-64cjm9.jpg?ixlib=rb-1.1.0&rect=49%2C35%2C4643%2C3067&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The progestin-only pill Opill could be available in early 2024.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/empty-shopping-basket-on-pharmacy-drugstore-counter-royalty-free-image/1013458454">Kwangmoozaa/iStock via Getty Images</a></span></figcaption></figure><p>On July 13, 2023, the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive">U.S. Food and Drug Administration approved</a> a drugmaker’s application for the first daily over-the-counter birth control pill for people seeking to prevent pregnancy.</p>
<p>The pill, called Opill – the brand name for the tablet formulation of norgestrel – is an oral contraceptive containing only progestin hormone, which helps prevent pregnancy by thickening cervical mucus, preventing ovulation or both. Opill was initially approved <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/opill-0075mg-oral-norgestrel-tablet-information">by the FDA for prescription use in 1973</a>. Its approval for nonprescription use may spark other manufacturers of prescription-only birth control to follow. This highlights the importance of pharmacies as destinations for health care and pharmacists as facilitators of contraceptive care.</p>
<p>Opill is expected to be available through pharmacies, supermarkets, convenience stores and online retailers in early 2024. The FDA’s approval of an over-the-counter birth control pill can further expand options for people seeking hormonal contraception to all 50 states and U.S. territories. This expanded access could be a significant development in the post-Roe era as <a href="https://theconversation.com/one-year-after-the-fall-of-roe-v-wade-abortion-care-has-become-a-patchwork-of-confusing-state-laws-that-deepen-existing-inequalities-207390">individual states further restrict</a> women’s access to abortion. </p>
<p>Prior to the FDA’s approval of this pill, many U.S. states have allowed pharmacists to prescribe hormonal contraception. The process begins <a href="https://birthcontrolpharmacist.com/">with a pharmacist consultation</a> to screen patients for eligibility, collect a medical history and measure blood pressure. If the patient qualifies, the pharmacist can provide a prescription to the patient; if not, the pharmacist refers the patient to a physician. </p>
<p>We are a <a href="https://scholar.google.com/citations?user=9Np7_DYAAAAJ&hl=en">pharmacist</a> and a <a href="https://scholar.google.com/citations?hl=en&user=OIT2K2oAAAAJ">public health expert</a>. We see the move toward over-the-counter birth control as an important step toward accessible and equitable reproductive health care for all Americans. Even though this product will be over-the-counter, pharmacists will play an indispensable role in that effort.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/X7YqBIXDB3U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The FDA’s approval of the first-ever over-the-counter daily birth control pill means that people could soon get them from the same aisles as aspirin, eye drops or condoms.</span></figcaption>
</figure>
<h2>Making birth control more accessible</h2>
<p><a href="https://doi.org/10.1016/j.japh.2022.07.003">With more than 60,000 pharmacies nationwide</a>, pharmacists are the most accessible members of the health care workforce. Nearly 90% of Americans live within <a href="https://doi.org/10.1016/j.japh.2022.07.003">5 miles of a pharmacy</a>. Throughout the COVID-19 pandemic, pharmacies have provided testing, vaccination and treatment for millions of people in the U.S., <a href="https://theconversation.com/how-the-test-to-treat-initiative-aims-to-get-ahead-of-the-next-wave-of-covid-19-179607">proving their worth</a> in supporting and sustaining initiatives that are important to public health. </p>
<p>Traditionally, hormonal contraception – also known as birth control, or when taken orally, “the pill” – has only been accessible after a comprehensive medical evaluation by a physician, physician assistant or nurse practitioner. </p>
<p>But in 2016, California and Oregon changed their legislation to allow pharmacists to prescribe birth control. That quickly expanded to 20 states, plus Washington, D.C., that now <a href="https://naspa.us/resource/contraceptives/">allow pharmacists to prescribe</a> some form of birth control, whether it be the pill, patch, ring or shot.</p>
<p>However, the move toward over-the-counter birth control is important because it will lessen some of the known barriers to birth control, especially if the products are offered at an affordable price point. These barriers include the inability to pay for medical office visits required to obtain a prescription, lack of insurance to cover the cost of prescription birth control or lack of access to pharmacist-prescribed contraception.</p>
<p>Over-the-counter birth control can also reduce access barriers by preventing the need for a scheduled appointment with a primary care physician during work hours, the need for a pharmacist to be present to dispense prescription birth control or the need to travel long distances to access these professionals. </p>
<p>But it is important to note that over-the-counter access to hormonal birth control does not replace the importance of regular office visits or discussion about reproductive health with physicians.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WZ7fp8j1uUU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The use of contraception was illegal in the U.S. from the late 1800s until the 1960s.</span></figcaption>
</figure>
<h2>Addressing remaining barriers</h2>
<p>Even in states where pharmacists are currently allowed to prescribe birth control, over-the-counter hormonal birth control can make a difference.</p>
<p>For example, if state policies do not create payment pathways to reimburse pharmacists for their time to counsel and prescribe, pharmacists may choose not to participate in prescribing birth control. Additionally, pharmacist availability and time may be limited and more restricted than the hours a pharmacy is advertised as open to the public to sell over-the-counter birth control products.</p>
<p>Finally, there are notable cases of pharmacists who have denied patients access to emergency contraception, also known as the “morning-after pill,” and <a href="https://www.npr.org/2018/06/25/623307762/walgreens-pharmacist-denies-drug-for-woman-with-unviable-pregnancy">prescriptions for medication abortion</a> on the grounds of moral, ethical and religious beliefs. </p>
<p>For instance, in 2019, a pharmacist in Minnesota <a href="https://www.nbcnews.com/news/us-news/minnesota-pharmacist-trial-refusing-dispense-morning-pill-beliefs-rcna41030">denied a patient emergency contraception</a>, citing personal beliefs. As a result, the patient drove 50 miles <a href="https://www.washingtonpost.com/nation/2022/08/03/minnesota-pharmacist-contraception-lawsuit/">to gain access to the medication</a>. Ultimately, a jury found that the pharmacist did not discriminate against the woman by denying to fill her prescription.</p>
<p>This precedent suggests that pharmacists who object to the use of reproductive medications may further choose not to participate in prescribing hormonal contraception even when permitted to do so by state law. Individuals may also choose not to stock over-the-counter birth control when it becomes available.</p>
<h2>Pharmacist ‘conscience clauses’</h2>
<p>Notably, many states give pharmacists autonomy when dispensing medications. Currently, 13 states have laws or regulations known as “conscience clauses” that <a href="https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871">permit pharmacists to refuse to dispense a medication</a> when it conflicts with their religious or moral beliefs. </p>
<p>The American Pharmacists Association also recognizes an individual pharmacist’s right to conscientiously refuse to dispense a medication; however, the organization supports a system to <a href="https://aphanet.pharmacist.com/policy-manual?key=Pharmacist+Conscience+Clause&op=Search">ensure patient access to medications</a> without compromising the pharmacist’s right of refusal. In other words, pharmacists are encouraged to “step aside” but should not “step in the way” of dispensing or selling medications that conflict with their personal beliefs. </p>
<p>Some states with conscience clauses legally require pharmacists to refer patients elsewhere when they decline to dispense a medication for ethical and/or moral beliefs. In addition, company policies may require pharmacists with objections to arrange for another pharmacist – who does not have objections – to provide the medication and care requested by the patient. However, some states do not require a system to ensure this patient access as the American Pharmacists Association suggests.</p>
<p>Pharmacist conscience clauses are unlikely to interfere with over-the-counter birth control availability at large pharmacy chains, supermarkets and mass merchandisers due to top-down decision-making structures of these organizations. However, national pharmacy chains have recently faced <a href="https://www.nytimes.com/2023/03/07/business/walgreens-abortion-pill.html">complicated legal and political situations</a> when it comes to offering prescription abortion pills in the post-Roe era.</p>
<p>Ongoing <a href="https://www.guttmacher.org/state-policy">legislation seeking to reduce abortion access</a> in the post-Roe era across the U.S. only increases the importance of patient access to contraception. Geographical spatial analyses have found that people of low socioeconomic classes and of color <a href="https://read.dukeupress.edu/jhppl/article/46/2/277/166722/Affordable-but-Inaccessible-Contraception-Deserts">disproportionately reside in contraception deserts</a>, which are areas with low access to family planning resources. These contraception deserts could be reduced or eliminated altogether now that retailers may sell over-the-counter hormonal birth control at an affordable price. </p>
<h2>Pharmacists’ role in providing contraceptive</h2>
<p>Although patients may seek and purchase over-the-counter hormonal birth control at locations other than community pharmacies, when patients come to a pharmacy, pharmacists can help them understand how to use the product correctly, safely and effectively prior to purchase. Pharmacists are trained as medication experts and acquire unique knowledge and skills of self-care products and nonprescription medications. When a pharmacist feels it is necessary, they can refer patients who do not qualify for over-the-counter birth control use back to their primary care providers for further evaluation and care.</p>
<p>In our view, pharmacists can positively contribute to the safe, effective and accessible use of contraception across the country.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/with-over-the-counter-birth-control-pills-likely-to-be-approved-pharmacists-and-pharmacies-could-play-an-ever-increasing-role-in-reproductive-health-care-189216">article originally published</a> on Oct. 28, 2022.</em></p><img src="https://counter.theconversation.com/content/204230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Berenbrok is part owner of the consulting company, Embarx, LLC.</span></em></p><p class="fine-print"><em><span>Marian Jarlenski does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With the approval of the first over-the-counter oral contraceptive, pharmacists stand to play an ever-increasing role in helping expand access to reproductive health care in the post-Roe era.Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of PittsburghMarian Jarlenski, Associate Professor of Health Policy and Management, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892162022-10-28T12:32:36Z2022-10-28T12:32:36ZWith over-the-counter birth control pills likely to be approved, pharmacists and pharmacies could play an ever-increasing role in reproductive health care<figure><img src="https://images.theconversation.com/files/487887/original/file-20221003-22-rx39dq.jpg?ixlib=rb-1.1.0&rect=395%2C0%2C5595%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The over-the-counter birth control pill will not require medical examinations or prescriptions prior to purchase.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cheerful-woman-in-modern-pharmacy-royalty-free-image/1360043428?phrase=pharmacy&adppopup=true">Sergey Mironov/Moment via Getty Images</a></span></figcaption></figure><p>The U.S. Food and Drug Administration is <a href="https://www.reuters.com/legal/us-fda-review-perrigos-birth-control-pill-otc-use-november-2022-09-12/">set to review</a> a drugmaker’s application for the <a href="https://www.statnews.com/2022/07/11/drugmaker-seeks-fda-approval-of-over-the-counter-birth-control-pill/">first over-the-counter birth control pill</a> in November 2022, with a decision expected in the first half of 2023. </p>
<p>An approved over-the-counter hormonal birth control product would not require a prescription and <a href="https://www.selfcarefederation.org/what-is-self-care">would be considered self-care</a>, defined as “the practice of individuals looking after their own health using the knowledge and information available to them.” </p>
<p>Currently, in many U.S. states, pharmacists can already prescribe hormonal contraception that requires a prescription. The process begins <a href="https://birthcontrolpharmacist.com/">with a pharmacist consultation</a> to screen patients for eligibility, collect a medical history and measure blood pressure. If the patient qualifies, the pharmacist can provide a prescription to the patient; if not, the pharmacist refers the patient to a physician. </p>
<p>The FDA’s approval of an over-the-counter birth control pill will further expand options for people seeking hormonal contraception to all 50 states. The first such over-the-counter pill – <a href="https://www.reuters.com/legal/us-fda-review-perrigos-birth-control-pill-otc-use-november-2022-09-12/">a non-estrogen, progestin-only contraceptive</a> – could become available by mid-2023. </p>
<p>We are a <a href="https://scholar.google.com/citations?user=9Np7_DYAAAAJ&hl=en">pharmacist</a> and a <a href="https://scholar.google.com/citations?hl=en&user=OIT2K2oAAAAJ">public health expert</a>. We see the move toward over-the-counter birth control as an important step toward accessible and equitable reproductive health care for all Americans, and pharmacists will play an indispensable role in that effort.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0gzbFP09Eww?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The FDA will consider the application from HRA Pharma in November 2022.</span></figcaption>
</figure>
<h2>Making birth control more accessible</h2>
<p><a href="https://doi.org/10.1016/j.japh.2022.07.003">With more than 60,000 pharmacies nationwide</a>, pharmacists are the most accessible members of the health care workforce. Nearly 90% of Americans live within <a href="https://doi.org/10.1016/j.japh.2022.07.003">5 miles of a pharmacy</a>. Throughout the COVID-19 pandemic, pharmacies provided testing, vaccination and treatment for millions of people in the U.S., proving their worth in supporting and sustaining initiatives that are important to public health.</p>
<p>Traditionally, hormonal contraception – also known as birth control, or when taken orally, “the pill” – has only been accessible after a comprehensive medical evaluation by a physician, physician assistant or nurse practitioner. </p>
<p>But in 2016, California and Oregon became the first states to allow pharmacists to prescribe birth control. That quickly expanded to 20 states plus Washington, D.C. that now <a href="https://naspa.us/resource/contraceptives/">allow pharmacists to prescribe</a> some form of birth control, whether it be the pill, patch, ring or shot.</p>
<p>However, the move toward nonprescription-based, over-the-counter birth control is important because it will greatly lessen some of the known barriers to birth control. These barriers include the inability to pay for medical office visits required to obtain a prescription, lack of insurance to cover the cost of prescription birth control or lack of accessibility to pharmacist-prescribed contraception.</p>
<p>Over-the-counter birth control can also reduce access barriers by preventing the need for a scheduled appointment with a primary care physician during work hours or the need to travel long distances to get such care.</p>
<p>But it is important to note that over-the-counter access to hormonal birth control does not replace the importance of regular office visits or discussion about reproductive health with physicians.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WZ7fp8j1uUU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The use of contraception was illegal in the U.S. from the late 1800s until the 1960s.</span></figcaption>
</figure>
<h2>Addressing remaining barriers</h2>
<p>Even in states where pharmacists are currently allowed to prescribe birth control, patients may still face barriers. </p>
<p>For example, if state policies do not create payment pathways to reimburse pharmacists for their time to counsel and prescribe, pharmacists may choose not to participate. Additionally, pharmacist availability and time may be limited and more restricted than the hours a pharmacy is advertised as open.</p>
<p>Finally, there are notable cases of pharmacists who have denied patients access to emergency contraception, also known as the “morning-after pill,” and <a href="https://www.npr.org/2018/06/25/623307762/walgreens-pharmacist-denies-drug-for-woman-with-unviable-pregnancy">prescriptions for medication abortion</a> on the grounds of moral, ethical and religious beliefs. </p>
<p>For instance, in 2019, a pharmacist in Minnesota <a href="https://www.nbcnews.com/news/us-news/minnesota-pharmacist-trial-refusing-dispense-morning-pill-beliefs-rcna41030">denied a patient emergency contraception</a>, citing personal beliefs. As a result, the patient drove 50 miles <a href="https://www.washingtonpost.com/nation/2022/08/03/minnesota-pharmacist-contraception-lawsuit/">to gain access to the medication</a>. Ultimately, a jury found that the pharmacist did not discriminate against the woman by denying to fill her prescription.</p>
<p>This precedent suggests that pharmacists who object to the use of reproductive medications may further choose not to participate in prescribing hormonal contraception even when permitted to do so by state law. They may also choose not to sell over-the-counter birth control when it becomes available.</p>
<h2>Pharmacist ‘conscience clauses’</h2>
<p>Notably, many states give pharmacists autonomy when dispensing medications. Currently, 13 states have laws or regulations known as “conscience clauses” that <a href="https://www.nbcnews.com/news/us-news/can-pharmacist-legally-deny-patient-prescription-it-depends-n894871">permit pharmacists to refuse to dispense a medication</a> when it conflicts with their religious or moral beliefs. </p>
<p>The American Pharmacists Association also recognizes an individual pharmacist’s right to conscientiously refuse to dispense a medication; however, the organization supports a system to <a href="https://aphanet.pharmacist.com/policy-manual?key=Pharmacist+Conscience+Clause&op=Search">ensure patient access to medications</a> without compromising the pharmacist’s right of refusal. In other words, pharmacists are encouraged to “step aside” but should not “step in the way” of dispensing or selling medications that conflict with their personal beliefs. </p>
<p>Some states with conscience clauses legally require pharmacists to refer patients elsewhere when they decline to dispense a medication for ethical and/or moral beliefs. In addition, company policies may require pharmacists with objections to arrange for another pharmacist – who does not have objections – to provide the medication and care requested by the patient. However, some states do not require a system to ensure this patient access as the American Pharmacists Association suggests.</p>
<h2>Contraception deserts</h2>
<p>Ongoing <a href="https://www.guttmacher.org/state-policy">legislation seeking to reduce abortion access</a> in the post-Roe era across the U.S. only increases the importance of patient access to contraception. Geographical spatial analyses have found that people of low socioeconomic classes and of color <a href="https://read.dukeupress.edu/jhppl/article/46/2/277/166722/Affordable-but-Inaccessible-Contraception-Deserts">disproportionately reside in contraception deserts</a>, which are areas with low access to family planning resources. These contraception deserts could be reduced or eliminated altogether in states that authorize pharmacists to prescribe contraception, or in areas with access to community pharmacies carrying hormonal birth control when available.</p>
<p>In our view, pharmacists can positively contribute to the safe, effective and accessible use of contraception across the country.</p><img src="https://counter.theconversation.com/content/189216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some states already allow pharmacists to provide birth control to patients with a prescription. But FDA approval of an over-the-counter birth control pill could greatly expand access.Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of PittsburghMarian Jarlenski, Associate Professor of Health Policy and Management, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1787102022-07-26T12:01:00Z2022-07-26T12:01:00ZThe opioid crisis isn’t just the Sacklers’ fault – and making Purdue Pharma pay isn’t enough on its own to fix the pharmaceutical industry’s deeper problems<figure><img src="https://images.theconversation.com/files/474172/original/file-20220714-17678-rvc47r.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5234%2C3387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many companies have sold dangerous prescription drugs.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/large-capsule-of-dangerous-medicine-royalty-free-image/1175215967?adppopup=true">Peter Dazeley/The Image Bank via Getty Images</a></span></figcaption></figure><p>You may have heard of the <a href="https://theconversation.com/how-the-purdue-opioid-settlement-could-help-the-public-understand-the-roots-of-the-drug-crisis-166701">Sackler family</a> and the role that they and their privately held company, <a href="https://www.cbsnews.com/news/purdue-pharma-sackler-family-wealth-where-did-the-sacklers-shift-cash-from-opioid-maker/">Purdue Pharma</a>, played in the opioid crisis. One TV series depicting the family as a villainous clan <a href="https://www.emmys.com/shows/dopesick">earned 14 Emmy nominations</a>, winning two. Another is in the works.</p>
<p>Purdue is infamous for its <a href="https://www.jstor.org/stable/45345199">hard-sell marketing of its powerful, long-acting opioid OxyContin</a>. Among its troubling tactics: co-opting legitimate medical organizations to spread messages overstating the drug’s effectiveness and understating its addiction risks. Sales boomed, <a href="https://www.dirt.com/more-dirt/heirs-heiresses/oxycontin-david-sackler-house-bel-air-11220/">making its owners</a> <a href="https://oversight.house.gov/news/press-releases/committee-releases-documents-showing-sackler-family-wealth-totals-11-billion">fabulously wealthy</a> and building what journalist Patrick Radden Keefe memorably calls an “<a href="https://www.penguinrandomhouse.com/books/612861/empire-of-pain-by-patrick-radden-keefe/">empire of pain</a>.” </p>
<p>Purdue’s profit-seeking became a <a href="https://www.washingtonpost.com/investigations/2022/07/07/american-cartel-book/">model for other drugmakers</a>, <a href="https://ncdoj.gov/attorney-general-josh-stein-announces-26-billion-agreement-with-opioid-distributors-manufacturer/">distributors</a> and <a href="https://doi.org/10.1136/bmj.n2893">pharmacy chains</a>. The ensuing sales frenzy led to skyrocketing rates of opioid addiction and related harms by the early 2000s – <a href="https://www.cdc.gov/opioids/basics/epidemic.html">perhaps the worst pharmaceutical crisis</a> in U.S. history.</p>
<p>So when Purdue Pharma’s bankruptcy settlement was revised in March 2022 to <a href="https://www.npr.org/2022/03/03/1084163626/purdue-sacklers-oxycontin-settlement">make the family pay US$6 billion</a>, mostly to local and state governments, the news was greeted with at least <a href="https://slate.com/news-and-politics/2022/03/sacklers-oxycontin-opioid-crisis-purdue-pharma-bankruptcy-settlement.html">some satisfaction</a>. Although it looks as though no members of that family will go to prison, the people often <a href="https://www.npr.org/2021/11/12/1051811415/dopesick-opioids-purdue-pharma-sacklers">regarded as the saga’s primary villains</a> were at least paying a price for their misdeeds.</p>
<p>But as a <a href="https://scholar.google.com/citations?user=bQa5NtoAAAAJ&hl=en">historian of addictive pharmaceuticals</a>, I see a danger in associating the opioid crisis too closely with the Sackler family. My research has shown that the crisis isn’t an aberration caused by the individual misdeeds of bad actors. Punishing people who broke the law, and making business leaders pay to repair the harms they caused, surely helps. Yet broad reforms are also needed to prevent similar disasters from happening again.</p>
<h2>Who are ‘the Sacklers’?</h2>
<p>Despite the many individuals and companies involved, the Sacklers became the public face of the opioid crisis. In part this acknowledged their status as pioneers: They were the first to hypermarket strong opioids, and they led the pack in <a href="https://www.cbsnews.com/news/purdue-executive-richard-sackler-cast-blame-on-opioid-victims-old-emails-show/">blaming the resulting catastrophe on consumers who became addicted</a> to those prescription painkillers.</p>
<p>But who are they? Their story began with <a href="https://www.theguardian.com/us-news/2018/feb/13/meet-the-sacklers-the-family-feuding-over-blame-for-the-opioid-crisis">Arthur, Mortimer and Raymond Sackler</a>, three brothers who were all doctors and made a collective fortune in medical marketing. They acquired what was then called Purdue Frederick Co. in 1952.</p>
<p>After Arthur died in 1987, <a href="https://www.propublica.org/article/sacklers-who-disavow-oxycontin-may-have-benefited-from-it">Mortimer and Raymond bought their brother’s stake</a> in the company from his family for $22 million. For that reason, <a href="https://apnews.com/article/museums-lawsuits-us-news-business-opioids-f69d14706030450da26dd6b0f5466eb8">Arthur Sackler’s heirs</a> aren’t involved in opioid-related litigation that’s on track to be resolved through Purdue’s bankruptcy settlement.</p>
<p>“The Sacklers” I refer to here – and when you read about them elsewhere – are Mortimer and Raymond and their heirs who benefited from Purdue’s profit machine, <a href="https://www.stamfordadvocate.com/business/article/Sacklers-quit-Purdue-Pharma-board-signaling-13742946.php">many of whom worked there, served on its board</a> – or both.</p>
<p>Richard Sackler ran the company for years and subsequently became a micromanaging board member. His cousin Kathe Sackler, another former Purdue executive, repeatedly claimed that <a href="https://www.theguardian.com/us-news/2021/apr/09/kathe-sackler-oxycontin-empire-of-pain-book">OxyContin was her idea</a>, Patrick Radden Keefe has reported. Pinpointing exactly how much money they collectively extracted from Purdue is impossible, but in 2021 those two branches of the Sackler family were estimated to hold about <a href="https://oversight.house.gov/news/press-releases/committee-releases-documents-showing-sackler-family-wealth-totals-11-billion">$11 billion in assets</a>.</p>
<h2>Pop culture villainy</h2>
<p>The Sacklers used their profits to protect the family’s reputation through <a href="https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain">lavish charitable donations</a> to museums like the Guggenheim and the Louvre, and several universities – <a href="https://www.wgbh.org/news/local-news/2019/12/05/tufts-university-severs-ties-with-sacklers-the-family-behind-oxycontin">including Tufts</a> and <a href="https://yaledailynews.com/blog/2022/03/09/university-quietly-severs-sackler-ties/">Yale</a>.</p>
<p>Their philanthropy produced an aura of respectability but also made them highly visible. Eventually journalists connected the dots, leading to a cottage industry of <a href="https://www.simonandschuster.com/books/Pharma/Gerald-Posner/9781501151897">books</a> and <a href="https://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/">media</a> <a href="https://www.hbo.com/documentaries/the-crime-of-the-century">coverage</a> of the opioid crisis casting the Sacklers as the bad guys responsible for historic levels of addiction and overdose.</p>
<p>The Sacklers-as-comic-book-villains story is on full display in actor <a href="https://www.emmys.com/events/74th-emmy-nominations-announcement">Michael Stuhlbarg’s</a> <a href="https://www.emmys.com/shows/dopesick">Emmy-nominated performance</a> as a remarkably creepy Richard Sackler in the Hulu series “<a href="https://press.hulu.com/shows/dopesick/">Dopesick</a>,” based on <a href="https://www.littlebrown.com/titles/beth-macy/dopesick/9780316551281/">Beth Macy’s book</a> by the same name. The show won <a href="https://www.emmys.com/shows/dopesick">two Emmys in 2022</a>.</p>
<p>Viewers can probably expect similar fare from <a href="https://www.whats-on-netflix.com/news/painkiller-netflix-limited-series-everything-we-know-so-far/">Michael Broderick</a>, who will play Richard Sackler in “<a href="https://www.netflix.com/title/81095069">Painkiller</a>,” an upcoming Netflix limited series about how the opioid crisis began.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EzrLrUG2QVk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘Dopesick,’ a Hulu series, dramatizes Purdue’s role in bringing about the opioid epidemic.</span></figcaption>
</figure>
<h2>‘White market drugs’</h2>
<p>As satisfying as it may be, focusing on the Sacklers’ misdeeds can obscure as much as it reveals about the deeper causes of the opioid crisis.</p>
<p>Purdue did not invent the tactics it used to sell OxyContin. Pharmaceutical companies discover and sell genuinely miraculous products, but they also routinely wield troubling influence over every step of the <a href="https://www.matteringpress.org/books/ghost-managed-medicine">production and circulation of knowledge about drugs</a>, which can make it difficult to understand the true value of a medicine. They oversee the research that demonstrates drug effectiveness. They write or help write the publications based on the research.</p>
<p>Drugmakers script or influence the professional guidelines that encourage prescribing. They underwrite professional organizations and pay medical experts to spread the word. They fund and channel patient advocacy organizations into supporting the medicines they manufacture.</p>
<p>And then they lobby for legislation, regulations and anything else that can gin up more demand for their drugs.</p>
<p>Until the <a href="https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-opioid-misuse-and-abuse">Food and Drug Administration approved OxyContin in 1995</a>, these marketing techniques <a href="https://press.uchicago.edu/ucp/books/book/chicago/W/bo58927880.html">were forbidden for opioids</a>, which authorities considered to be too dangerous for them.</p>
<p>As I explain in my book, “<a href="https://press.uchicago.edu/ucp/books/book/chicago/W/bo58927880.html">White Market Drugs</a>,” federal regulators, supported by cautious medical authorities, appointed leading pharmacologists to test the addictiveness of new opioid products. They scrutinized advertisements to make sure the risks were fully and accurately conveyed.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Old-fashioned article warns readers to be wary when the 'Prescription says 'DOPE''" src="https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=878&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=878&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=878&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1103&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1103&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475888/original/file-20220725-14-z4hx12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1103&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This 1944 article decried the dangers of prescribed opioids.</span>
<span class="attribution"><span class="source">David Herzberg/National Archives</span></span>
</figcaption>
</figure>
<p>Pharmaceutical companies tried to outfox regulators with a parade of now-forgotten “miracle opioids” long before OxyContin. Indeed, one of these would-be wonder drugs was none other than oxycodone, OxyContin’s main ingredient.</p>
<p>Oxycodone, <a href="https://doi.org/10.1016/j.jpainsymman.2005.01.010">discovered in 1916</a>, had been sold in the U.S. for most of the 20th century. </p>
<p>In 1949, Endo Products claimed that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1515192/">Percodan, its new oxycodone product</a>, shouldn’t face strict federal controls because it was chemically <a href="https://www.addictioncenter.com/opiates/codeine/">similar to codeine</a>, a relatively weak opioid used in cough syrups. The company insisted it wasn’t addictive when used as prescribed.</p>
<p>Expert pharmacologists working with federal regulators pushed back. Noting that oxycodone produced an “intense” addiction, they pointed out that people did not always follow doctors’ orders – especially with addictive drugs.</p>
<p>Purdue’s real innovation with OxyContin was commercial, not scientific. The company was the first to market a powerful opioid using the most aggressive strategies other drug companies regularly used to get pharmaceutical innovations into bodies with great speed and efficiency – while maximizing profits.</p>
<p>Once Purdue showed it could be done, competitors quickly followed suit. The industry replaced U.S. medicine’s century-old habits of opioid precautions with a reckless boosterism. </p>
<h2>Complicity of many industries</h2>
<p>Purdue, that is, didn’t act alone.</p>
<p>Other drugmakers such as <a href="https://ag.ny.gov/opioidsettlement">Endo</a> and <a href="https://apnews.com/article/business-health-lawsuits-epidemics-west-virginia-8ba921c65638ea7d2260c4111d35ab59">Janssen</a> imitated and even surpassed Purdue’s example once the taboo had been broken. </p>
<p>Generic manufacturers such as <a href="https://www.sfcityattorney.org/2022/07/12/city-attorney-announces-54-million-settlement-with-opioid-defendants-allergan-and-teva">Allergan and Teva</a> then profited by expanding and prolonging the boom, as did <a href="https://ag.ny.gov/opioidsettlement">wholesale drug distributors</a> and <a href="https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid-lawsuit-verdict.html">retail chain pharmacies</a>. Even the prestigious <a href="https://www.nytimes.com/2021/02/03/business/mckinsey-opioids-settlement.html">McKinsey consulting firm</a> got into the game, advising others how to maximize sales.</p>
<p>The complicity of so many industries makes opioid litigation complex and hard to follow. Cities, states and other plaintiffs didn’t just sue Purdue. They turned to the legal system to make sure that all the other companies pay to repair the harms they caused in building the historic opioid boom that has contributed to more than <a href="https://www.cdc.gov/opioids/data/analysis-resources.html">500,000 overdose deaths</a> since 1996.</p>
<p>To date the largest national opioid settlement is with the three main opioid distributors and Johnson & Johnson, manufacturer of the <a href="https://www.jnj.com/johnson-johnson-reaches-opioid-settlement-agreement-with-new-york-state-consistent-with-terms-of-previously-announced-broader-settlement-agreement-in-principle">Duragesic and Nucynta</a> opioids. It totals <a href="https://www.washingtonpost.com/health/2022/02/25/opioid-settlement-final/">$26 billion</a>, significantly more than what Purdue and the Sacklers are paying.</p>
<p>But financial settlements cannot solve every problem that made this crisis possible. Purdue and its competitors were able to put profits over consumer safety for so long, in part, because their marketing strategies closely approximated how other medicines are sold in the U.S. </p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK448203/">opioid crisis</a>, in other words, revealed in an exaggerated fashion problems prevalent in the pharmaceutical industry more generally. Until those broader problems are resolved, the unhappy <a href="https://press.uchicago.edu/ucp/books/book/chicago/W/bo58927880.html">history of addictive prescription drugs</a> will keep repeating itself.</p>
<p><em>This article was updated on Sept. 13, 2022, to include the two Emmys “Dopesick” won in 2022.</em></p><img src="https://counter.theconversation.com/content/178710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Herzberg has served as a paid consultant and expert witness for plaintiffs in U.S. opioid litigation. He has received funding from the National Institute of Health.</span></em></p>Making them pay is important but it’s not going to stop drugmakers from endangering public health.David Herzberg, Associate Professor of History, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1819982022-04-28T12:17:46Z2022-04-28T12:17:46ZWhat is Paxlovid and how will it help the fight against coronavirus? An infectious diseases physician answers questions on the COVID-19 pill<figure><img src="https://images.theconversation.com/files/459834/original/file-20220426-18-d63m4y.jpeg?ixlib=rb-1.1.0&rect=11%2C11%2C7423%2C4793&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paxlovid may help prevent severe illness in patients at highest risk for COVID-19 complications.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/march-2022-berlin-the-drug-paxlovid-against-covid-19-from-news-photo/1238868638">picture alliance/picture alliance via Getty Images</a></span></figcaption></figure><p><em>The Biden administration <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/26/fact-sheet-biden-administration-increases-access-to-covid-19-treatments-and-boosts-patient-and-provider-awareness/">announced plans</a> on April 26, 2022, to <a href="https://www.npr.org/2022/04/26/1094735822/biden-will-make-paxlovid-a-highly-effective-covid-drug-available-to-more-pharmac">increase the availability</a> of the COVID-19 drug Paxlovid, vowing to get more of the treatment pills into the hands of Americans.</em></p>
<p><em>An oral antiviral, Paxlovid has proved successful at reducing the chances of hospitalization among COVID-19 sufferers, but has suffered from a <a href="https://apnews.com/article/coronavirus-pandemic-science-business-health-pandemics-b2d1051842df779dfa6122f824bd0377">slow rollout to pharmacies</a> across the U.S.</em></p>
<p><em>Patrick Jackson, an <a href="https://uvahealth.com/findadoctor/profile/patrick-e-jackson">infectious diseases physician</a> <a href="https://scholar.google.com/citations?user=NAnp8WsAAAAJ&hl=en">and scientist</a> at the University of Virginia, has helped care for hundreds of COVID-19 patients and assisted in Paxlovid clinical trials. The Conversation asked him to explain what the drug does and what impact greater availability may have in the fight against the coronavirus.</em></p>
<h2>What is Paxlovid and how does it work?</h2>
<p>Paxlovid is a made up of two protease inhibitors, including one used in treating HIV as a booster medicine. Protease inhibitors are synthetic drugs that block enzymes that viruses need to replicate. The combination in Paxlovid basically prevents the coronavirus from completing its life cycle.</p>
<p>If left uninterrupted, SARS-Cov-2 would normally <a href="https://doi.org/10.1016/j.bbadis.2020.165878">create the proteins it needs</a> by making a polyprotein, or long strings of amino acids. Then protease, <a href="https://doi.org/10.1016/j.bmcl.2020.127377">a viral enzyme</a>, activates the polyprotein strings by cutting them into smaller parts. Paxlovid <a href="https://doi.org/10.1126/science.abl4784">blocks the protease</a> from doing this, thereby preventing the virus from becoming active. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A thumb and forefinger holding a COVID-19 testing tray and strip." src="https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/459836/original/file-20220426-24-7ndf0q.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Doctors prescribe Paxlovid after a positive test for COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/detail-of-a-hand-holding-a-lateral-flow-test-that-shows-a-news-photo/1240227986">Richard Baker/In Pictures via Getty Images</a></span>
</figcaption>
</figure>
<h2>How much of a game-changer could it be in fighting COVID-19?</h2>
<p>It’s kind of limited. It could be beneficial for those at <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-who-is-at-risk/art-20483301">high risk of severe disease and possibly death</a>, such as people who are older or who have hypertension, diabetes, obesity, heart disease or who are immunocompromised. And that’s the population that we’re really the most worried about when it comes to COVID-19. </p>
<p>But the more medically complicated a person is – by which I mean the more health conditions they have and medications they take – the more likely it is that Paxlovid will <a href="https://hivinfo.nih.gov/understanding-hiv/fact-sheets/what-drug-interaction">interact with one of their drugs</a>. That means that one drug could alter or interfere with how another drug works, which can be dangerous.</p>
<p>Some of the really important Paxlovid interactions are with anti-rejection medications for people who have transplants. A lot of blood thinners have interactions with it that can be very serious. Medications that treat heart rhythm abnormalities can be a major issue if patients on those medications take Paxlovid. And there’s a whole range of other things that it just doesn’t mix well with in the body.</p>
<p>Some who could most benefit from Paxlovid are also at highest risk for <a href="https://labeling.pfizer.com/ShowLabeling.aspx?id=16474">drug interaction with Paxlovid</a>. That makes it somewhat less useful.</p>
<p>And Paxlovid was studied only in <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2118542">unvaccinated patients</a>. So it’s not clear how well it will work in a vaccinated population – that is, we don’t know what additional benefit it gives on top of vaccination. I think it would work, but we don’t know how much. And I do wonder how much of a game-changer this is when we can just vaccinate more people and probably get more benefit on a population level. </p>
<h2>Is Paxlovid available to everyone?</h2>
<p>It is a prescription drug, so you have to talk to your doctor. You have to have symptoms of COVID-19 and test positive for the virus – not necessarily with a PCR test; it can be with a home test. But you have to actually have a diagnosis. </p>
<p>And this drug has an <a href="https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization">emergency use authorization</a> from the Food and Drug Administration, which has more restrictions than simply having full FDA approval. Pharmacies are responsible for making sure that the prescribed use is appropriate for this medication. So a lot of pharmacies will require some information from doctors who prescribe it – things like documentation of symptoms. So depending on the pharmacy, Paxlovid can be a little bit more complicated to get.</p>
<p>The No. 1 issue is probably going to be the hesitancy of physicians to prescribe it. I think part of that comes down to a lack of awareness, and part is the result of the complexity of making sure that you’re using it appropriately and not hurting your patient through the drug interactions.</p>
<p>I will certainly prescribe it for my patients when appropriate. But I have to go through their whole list of medications and check for drug interactions and double-check myself with another resource. </p>
<h2>Why has there been a problem in delivering the drug to pharmacies?</h2>
<p>Initially, I think the manufacturer and distributors were kind of trying to spread it around. So doctors and patients had to figure out which pharmacies had the drug and get to them early to secure Paxlovid. But pharmacies would run out even though they might have been listed on a website as having received a supply. </p>
<p>But that is becoming less of a concern, now that there is more drug supply. </p>
<h2>What has the White House said it will do to speed things along?</h2>
<p>The government is <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/26/fact-sheet-biden-administration-increases-access-to-covid-19-treatments-and-boosts-patient-and-provider-awareness/">purchasing more supplies</a> of the drug and distributing it into more pharmacies – that has helped to a certain extent. And the Biden administration has made some noises about trying to make the drug more readily available at test-to-treat sites and clinics – something that to date has been challenging.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/181998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Jackson receives funding from the National Institutes of Health. He is affiliated with Indivisible Charlottesville.</span></em></p>An infectious disease doctor discusses the use, benefits and availability of a drug to prevent severe COVID-19.Patrick Jackson, Assistant Professor of Infectious Diseases, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1796072022-04-05T12:29:10Z2022-04-05T12:29:10ZHow the ‘test to treat’ initiative aims to get ahead of the next wave of COVID-19<figure><img src="https://images.theconversation.com/files/455661/original/file-20220331-20-adg2b6.jpg?ixlib=rb-1.1.0&rect=87%2C58%2C6403%2C4252&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacies could play an increasingly important role in testing and treatment of COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/help-from-a-pharmacist-a-female-pharmacist-with-royalty-free-image/1318290439?adppopup=true">dusanpetkovic/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>Going into the third year of the pandemic, public health experts are developing strategies to work within communities to have a more nimble and rapid response to COVID-19 infection rates.</em> </p>
<p><em>C. Michael White, a professor of pharmacy practice, and Adrian V. Hernandez, a clinical epidemiologist, both from the University of Connecticut, explain how the Biden administration’s new “test to treat” initiative will make use of pharmacies in this effort. The strategy is to quickly identify those who are positive for COVID-19 and to provide oral antiviral treatments in the early days of illness when it is deemed necessary – all through the easy access of a local pharmacy. And they discuss how the strategy falls short of addressing the needs of underserved communities.</em></p>
<h2>1. What is the premise behind the initiative?</h2>
<p>In his March 2022 State of the Union address, President Joe Biden introduced the “<a href="https://www.hhs.gov/about/news/2022/03/08/fact-sheet-biden-administration-launches-nationwide-test-treat-initiative-ensuring-rapid-on-spot-access-lifesaving-covid-treatments.html#">test to treat” initiative</a>, a program designed to help reduce barriers to getting COVID-19 treatments in the early stages of illness. The goal is for people to be able to walk into a pharmacy with a health clinic staffed by nurse practitioners, physician assistants or physicians and to be tested for COVID-19 free of charge; if a person tests positive and treatment is deemed appropriate, oral antiviral therapy can be prescribed on the spot at no cost. </p>
<p>The premise is that the sooner people are tested, the sooner they can self-isolate to limit the spread of the disease while simultaneously receiving <a href="https://theconversation.com/could-oral-antiviral-pills-be-a-game-changer-for-covid-19-an-infectious-disease-physician-explains-why-these-options-are-badly-needed-169919">oral antiviral medications</a> to help prevent hospitalization and death from COVID-19.</p>
<h2>2. How might this initiative help curb the next wave of COVID-19?</h2>
<p>As of March 31, 2022, more than <a href="https://www.worldometers.info/coronavirus/country/us/">1 million</a> out of <a href="https://www.census.gov/popclock/">332.6 million people</a> or 3 in 1,000 people living in the U.S., have died from COVID-19. In contrast, <a href="https://www.worldometers.info/coronavirus/country/south-korea/">16,230 people</a> out of <a href="https://www.census.gov/popclock/world/ks">51.8 million</a> or 3 in 10,000 South Koreans have died from COVID-19.</p>
<p>Some countries, such as <a href="https://www.healthaffairs.org/do/10.1377/forefront.20210521.255232/full/">South Korea</a> and New Zealand, invested heavily in COVID-19 testing and <a href="https://ourworldindata.org/coronavirus-testing">contact tracing</a> early in the pandemic so those at higher risk of infection could be tested immediately and isolated early. And they implemented contract tracing – the process of identifying friends, family and co-workers who may have come into contact with the infected person – early on to help slow the spread of infection. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A medical worker takes samples from a man during COVID-19 testing at a makeshift clinic." src="https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455844/original/file-20220401-27-3ko9r7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Early on in the COVID-19 pandemic, South Korea implemented strategies to quickly test for COVID-19, isolate those who tested positive and trace people who may have come into contact with the infected person.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/APTOPIXVirusOutbreakSouthKorea/c572e19e09624d6cbefd71d4bc51c7a0/photo?Query=south%20korea%20covid&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=3879&currentItemNo=12">AP Photo/Ahn Young-joon</a></span>
</figcaption>
</figure>
<p>Another advantage of early COVID-19 testing is that infected people can be treated much sooner. A new meta-analysis of oral antiviral therapies found that such treatments reduced the <a href="https://dx.doi.org/10.1080%2F07853890.2022.2034936">risk of hospitalization and death from COVID-19 by nearly 67%</a>. </p>
<p><a href="https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-covid-19-oral-antivirals#">Starting therapy early</a> is key. Early studies with the injectable antiviral remdesivir found that people <a href="https://doi.org/10.1371/journal.pone.0258643">did not benefit</a> from the treatment at later stages of illness. Clinical trials for the newest oral antiviral therapies against SARS-CoV-2, the virus that causes COVID-19, required that patients be treated within <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19">five days of the beginning of their symptoms</a>. So combining early testing with immediate access to free oral antiviral therapy could make a huge difference, especially for those with limited access to traditional health care services. </p>
<p>A more rigorous and proactive testing program in the U.S. could especially benefit underserved communities with limited health care access. For instance, in the first half of the pandemic, a study found that for every 10,000 people who tested positive for COVID-19, more than <a href="https://doi.org/10.1001/jama.2020.26443">30 Hispanic patients and nearly 25 Black patients were hospitalized</a>, compared with only 16 Asian patients and seven white patients. </p>
<h2>3. What are the limitations of the initiative?</h2>
<p>Only about 2,800 of the <a href="https://doi.org/10.1371/journal.pone.0183172">approximately 50,000 retail pharmacies</a> in the U.S. <a href="https://www.rand.org/pubs/research_briefs/RB9491-2.html">have health clinics</a> staffed by nurse practitioners, physician assistants or physicians, and about a third of them are located in California, Florida, Illinois, Minnesota and Texas. And <a href="https://www.rand.org/pubs/research_briefs/RB9491-2.html">only 12.5%</a> of these retail clinics are located in medically underserved areas. </p>
<p>This leaves much of the country, and especially populations who suffer disproportionately from health disparities, left out of the “test to treat” initiative. But <a href="http://rximpact.nacds.org/pdfs/nacds-fact-sheet.pdf">95% of Americans</a> live within 5 miles (8 kilometers) of one of more than 41,000 community pharmacies. If those settings were part of the initiative, access and impact would be much more widespread and equitable. The pharmacy is often the sole health care setting that can alleviate the problem of <a href="https://assets.ctfassets.net/4f3rgqwzdznj/1XSl43l40KXMQiJUtl0iIq/ad0070ad4534f9b5776bc2c41091c321/GoodRx_Healthcare_Deserts_White_Paper.pdf">health care deserts</a> – areas that <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1612">lack sufficient access</a> to medical offices in inner-city and rural communities.</p>
<p>At the height of the omicron surge, between <a href="https://www.worldometers.info/coronavirus/country/us/">890,000 and 904,000 people</a> in the U.S. were diagnosed with COVID-19 daily. <a href="https://www.ama-assn.org/practice-management/physician-health/omicron-pushed-doctors-brink-3-keys-get-them-back">Physicians’ offices</a> and <a href="https://www.npr.org/sections/health-shots/2022/01/13/1072902744/ers-are-overwhelmed-as-omicron-continues-to-flood-them-with-patients">emergency departments</a> were highly stressed. So adding only 2,800 retail health clinics – which are also dealing with heavy demands outside of COVID-19 – to rapidly test and disseminate oral antiviral drugs across the nation is unlikely to make a major dent in handling a COVID-19 surge. And there would be virtually no impact on COVID-19 outcomes in underserved communities, which would continue to have limited access.</p>
<h2>4. Could pharmacists play a bigger role in the initiative?</h2>
<p><a href="https://doi.org/10.1177/10600280211036160">Our research</a> shows <a href="https://doi.org/10.1177/1060028013511786">great variations</a> in how pharmacists are allowed to practice in the U.S. In hospitals across the country as well as federal health clinics run by the <a href="https://jcpp.net/wp-content/uploads/2015/09/Improving-Patient-and-Health-System-Outcomes-through-Advanced-Pharmacy-Practice.pdf">Department of Veterans Affairs, Indian Health Service and Department of Defense</a>, pharmacists are fully integrated health professionals who can order lab tests and interpret their results, order or alter drug therapy and actively monitor a patient’s drug response. </p>
<p>The data supporting the positive impact that <a href="https://doi.org/10.1177%2F1060028013511786">pharmacist-provided services</a> have on <a href="https://doi.org/10.1177%2F10600280211036160">patient health</a> is <a href="http://docplayer.net/395611-Improving-patient-and-health-system-outcomes-through-advanced-pharmacy-practice.html">undeniable</a>. For example, <a href="https://doi.org/10.1177%2F0897190020926841">pharmacist-run hypertension</a> and <a href="https://doi.org/10.2147/PPA.S180256">diabetes</a> clinics help patients achieve their blood pressure and blood sugar goals better than the standard treatment provided in physicians’ offices.</p>
<p>But pharmacists are not currently recognized as <a href="https://www.medicare.gov/coverage/doctor-other-health-care-provider-services">Medicare Part B providers</a> – health professionals allowed to bill Medicaid for clinical services. So pharmacists are limited in their ability to provide clinical services in the community.</p>
<h2>5. What can be done to address access issues?</h2>
<p>To broaden access, the Department of Health and Human Services authorized pharmacists to provide COVID-19 vaccines in community pharmacies or long-term care facilities in <a href="https://www.hhs.gov/sites/default/files/licensed-pharmacists-and-pharmacy-interns-regarding-covid-19-vaccines-immunity.pdf">September 2020</a>. Since that time, pharmacists from more than 41,000 pharmacies have administered <a href="https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html">233.4 million vaccine doses</a> as of early April 2022. This includes <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7110a4.htm?s_cid=mm7110a4_w#">46% of all COVID-19 vaccinations</a> in children ages 5-11.</p>
<p>A similar authorization could be granted to allow <a href="https://www.ashp.org/news/2022/03/07/ashp-applauds-administrations-focus-on-covid-test-to-treat-opioid-treatment-in-state-of-the-union?loginreturnUrl=SSOCheckOnly#">pharmacists to provide oral antiviral drugs</a> to patients with positive COVID-19 tests who meet the criteria. </p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-likethis">Sign up for The Conversation’s daily newsletter</a>.]</p>
<p>Alternatively, a bill that has been proposed with bipartisan support in the <a href="https://www.pharmacist.com/Advocacy/Issues/Provider-Status/Equitable-Community-Access-to-Pharmacist-Services-Act-ECAPS">House of Representatives</a> aims to ensure that all communities have access to testing and drug treatment by a pharmacist.</p>
<p>However, the <a href="https://www.ama-assn.org/press-center/press-releases/ama-statement-administration-s-test-treat-covid-19-plan">American Medical Association</a> has taken a stand against “test to treat” in pharmacies, whether or not they have a health clinic with nurse practitioners and physician assistants in them. The organization states that the large number of drug interactions with these antivirals, the complexities of COVID-19 disease and the lack of full access to patients’ medical records suggests that patients testing positive for COVID-19 should solely contact their physician to discuss treatment options. </p>
<p>But this position does not take into consideration the <a href="https://doi.org/10.1177%2F10600280211036160">medical conditions pharmacists</a> already <a href="https://doi.org/10.1002/jac5.1051">successfully manage</a>, such as <a href="https://doi.org/10.1016/j.cardfail.2019.07.455">heart failure</a> and <a href="https://doi.org/10.18433/J3SQ0B">blood clotting</a>. And it does not address how to care for the <a href="https://creakyjoints.org/doctor-patient/americans-with-primary-care-doctor-declining/#">25% of patients</a> – largely in underserved communities – who do not have a primary care physician or access to a health clinic within a pharmacy.</p><img src="https://counter.theconversation.com/content/179607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Earlier detection and treatment of COVID-19 by health care providers in pharmacies could help prevent surges in infection rates and severe illness.C. Michael White, Professor of Pharmacy Practice, University of ConnecticutAdrian V. Hernandez, Associate Professor of Comparative Effectiveness and Outcomes Research, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783002022-03-03T07:29:34Z2022-03-03T07:29:34ZGetting urgent medicines in a flood zone can be a life or death challenge<p>I’m writing this from the flooded far north coast of New South Wales, where all around me people are contending with the awful and unexpected consequences of a catastrophic flood. </p>
<p>I have worked in rural health for a long time and this has been the worst I have experienced it. It is well <a href="https://link.springer.com/article/10.1007/s11069-020-03887-z">established</a> that those living in flood-prone areas often already have more financial and health issues than others.</p>
<p>Among those consequences is the need to manage medicines safely, and sometimes urgently find and acquire medicines you need to stay alive and healthy or keep pain at manageable levels.</p>
<p>The far north coast has a high population of older people, many of whom need daily medicines such as insulin to survive.</p>
<p>While I was picking up medicines for a family member this morning, another older person turned up at the pharmacy with a script. She was running out of her medicine today but the pharmacy did not have the required medicines left. She continued her hunt for medicines at the last pharmacy in the area we have access to.</p>
<p>These are just some of the challenges people face when it comes to medicines in a disaster zone.</p>
<h2>From ordinary errand to a life or death challenge</h2>
<p>A week ago, if you needed to top up your medicine supplies, you could pop down to the local chemist. The script would be filled, and supplies plentiful. It would be an easy trip.</p>
<p>Today during floods, an errand like that means confronting challenges such as:</p>
<ul>
<li><p>many chemists being underwater or badly flooded</p></li>
<li><p>the chemists that are open are contending with a surge of demand as people flock there to buy medicines</p></li>
<li><p>power is down in many places, meaning online systems for managing scripts are impossible to access and fridges used to store medicines such as insulin at home are not working</p></li>
<li><p>phone and internet is down or patchy in many places</p></li>
<li><p>petrol is very hard to get and running out, so many people cannot drive to the chemist</p></li>
<li><p>many people have lost their cars too or have water damaged cars</p></li>
<li><p>some people cannot leave home due to landslides or floodwaters</p></li>
<li><p>roads are being cut off and supply lines disrupted because the highway is blocked off</p></li>
<li><p>getting a new script is not as easy as heading to the doctor’s office; some GPs are also flooded in, their practices inundated or not-operational and many are unable to get to work and/or stuck without power, phone or internet.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498798439643361280"}"></div></p>
<p>These challenges are not unique to our area nor are they unique to floods. People who have survived <a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">bushfires</a> and other disasters have faced similar issues.</p>
<p>But with disasters predicted to become more frequent and more intense as the climate changes, it does raise the question what systems we can put in place to deal with these challenges in future without putting people at risk.</p>
<h2>What can be done?</h2>
<p>Firstly, if you are in an emergency, depending on your circumstances, please call 000 or contact the SES on 132 500.</p>
<p>When preparing your evacuation plan, ensure you have a list of all your medicines, care plans, scripts, Medicare and other health-care cards details and other important medical information ready. </p>
<p>If an evacuation warning is out for your area, ensure all your information and medicines are packed. Store medicines that need to remain cold in an esky with ice bricks, so you are ready when you need to evacuate. The esky is important; power may not be available for a while when you leave home.</p>
<p>Several apps are available to help in preparing for a disaster and <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">taking your medicines safely</a>, such as the Red Cross’ <a href="https://www.redcross.org.au/prepare">RediPlan</a> emergency survival plan or the <a href="https://www.nps.org.au/consumers/medicinewise-app?c=getting-started-5cfff60c#what-is-the-medicinewise-app?">MedicineWise app</a>.</p>
<p>If you know a flood is heading your way, it’s also handy to have extra cash at hand. During this flood disaster, electronic payment systems were not working in many places in the Northern Rivers. Having some cash can further reduce already very stressful circumstances.</p>
<p>If you’re flood-affected, in need of medicines and can get yourself to a pharmacy, it may be OK even if you have lost your scripts in the floods. The pharmacist may be able to call <a href="https://www.australianpharmacist.com.au/mick-fanning-takes-pharmacist-to-work-during-floods/?fbclid=IwAR01BothXjaztpxWs2Y2zt--fnH_3BYbhMZS6C7MwF_YJrRRbtLY6mHtvVQ">the GP on their mobile</a>. </p>
<p>If you have internet access, use social media to see if others can help with transport or delivery of medicines. Many people feel powerless during disasters and will be keen to help. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498537920180862980"}"></div></p>
<p>And there may be some <a href="https://www.health.nsw.gov.au/pharmaceutical/pharmacists/Pages/faq-supply-of-medicines.aspx#owing">strictly limited circumstances</a> under which a pharmacist can provide a small emergency supply of certain medicines <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">without a script</a>. </p>
<p><a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">According</a> to Queensland Health:</p>
<blockquote>
<p>In an emergency situation where you are not able to reach a community pharmacy, your GP’s prescription can be filled by a Queensland Health public hospital pharmacy. However, please be aware that hospitals may not stock the full range of medicines prescribed by your GP, as the needs of hospital and community patients are different.</p>
</blockquote>
<p>You can use <a href="https://www.myhealthrecord.gov.au/">My Health Record</a> to get certain key details on your medicines and health details, if you’ve got internet access.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498450313879199745"}"></div></p>
<p>After the floods, it is important to look at <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/after-a-flood/faq-20058421#:%7E:text=Any%20medications%20%E2%80%94%20pills%2C%20liquids%2C,contaminated%20water%20should%20be%20discarded">replacing medicines</a> that have been in contact with flood water or other contaminated water. This includes pills, liquids, injections, inhalers or creams. Contact your doctor or pharmacist as soon as possible and organise replacement medications.</p>
<p>You can also contact the NPS Medicines Line 1300 MEDICINE (1300
633 424) or the healthdirect helpline (1800 022 222 or <a href="https://www.healthdirect.gov.au/nurse-on-call#:%7E:text=Call%20NURSE%2DON%2DCALL%20on,apply%20from%20anywhere%20in%20Victoria.">Nurse on Call</a> in Victoria) if you are unsure or have <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">questions about your medicines</a>.</p>
<p>More broadly, access to medicines during a natural disaster is complex, and we need to continue strong partnerships and collaboration between organisations to ensure access during disasters.</p>
<p>Having a good spread of chemists around different parts of a town or rural areas helps boost the chances that even if some are hit by disasters, others are able to operate and provide people with medicines (which is what we have seen in the 2022 floods in some areas).</p>
<p>Privately owned and hospital-run helicopters have been used to get medicines to residents in flood-affected areas of Brisbane; ensuring disaster-prone regions have the infrastructure and machines needed for this kind of help is important.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498836780203741189"}"></div></p>
<p>COVID forced us to think creatively about delivering medical supplies to people who need them but are <a href="https://www.ppaonline.com.au/programs/covid-19-programs/covid-19-home-medicine-service">unable to visit a pharmacy</a>. This shows what’s possible when needs must be met. </p>
<p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring uninterrupted supplies, extra support for vulnerable people and access to medicines is a core part of that goal.</p><img src="https://counter.theconversation.com/content/178300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabrina Pit has received funding in the past from NHMRC.</span></em></p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring access to medicines is a core part of that goal.Sabrina Pit, Honorary Senior Research Fellow at the University of Sydney, Honorary Adjunct Research Fellow, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1723992021-12-13T19:06:52Z2021-12-13T19:06:52ZIt’s legal to buy over-the-counter cannabis in Australia – but it’s still a long way from your local chemist<figure><img src="https://images.theconversation.com/files/436029/original/file-20211207-19-1schdva.jpg?ixlib=rb-1.1.0&rect=17%2C17%2C5734%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/cbd-hemp-oil-hand-holding-260nw-1507445519.jpg">Shutterstock</a></span></figcaption></figure><p>Since <a href="https://www.news.com.au/lifestyle/health/cbd-oil-cannabidiol-now-available-over-the-counter-in-australian-pharmacies/news-story/c5e516bdc8bd6639163d5e39453a7927">early 2021</a>, the Therapeutic Goods Administration (TGA) has allowed the sale of low-dose cannabidiol (CBD) preparations over the counter at Australian pharmacies. But you won’t find any at your local chemist.</p>
<p>The situation is <a href="https://www.sciencedirect.com/science/article/pii/S0955395920302747">different overseas</a>. In the United States, although <a href="https://www.raps.org/news-and-articles/news-articles/2021/8/fda-reaffirms-that-cbd-products-cant-be-marketed-a">not approved</a> at a federal level, it is possible to buy over-the-counter products such as sweets <a href="https://www.healthline.com/health-news/cvs-to-sell-cannabidiol-products-over-the-counter">containing CBD</a> in several states. In the United Kingdom, low-dose CBD oil can be sold as a dietary supplement, but not a medicine. </p>
<p>CBD is a chemical found in the cannabis plant. Like tetrahydrocannabinol (THC), also found in cannabis, it does have psychoactive effects. It can make people sleepy and affect the brain’s electrical signals. Unlike THC, it won’t get you “high” or induce other psychotic effects.</p>
<p>Getting a medicine to market in Australia, even a non-prescription one, requires extensive research and investment. It might be too much for small cannabis producers to take on, and a turn-off for big pharmaceutical companies if that investment is at the expense of upcoming blockbuster drugs. And the process might not be worth it if research shows the benefit of cannabinoids is small compared with other therapies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-smoking-marijuana-affect-academic-performance-two-researchers-explain-how-it-can-alter-more-than-just-moods-168158">How does smoking marijuana affect academic performance? Two researchers explain how it can alter more than just moods</a>
</strong>
</em>
</p>
<hr>
<h2>Setting high standards</h2>
<p>In Australia, it became legal to purchase products containing low-dose (less than 150 milligrams a day) CBD over the counter after the TGA <a href="https://www.tga.gov.au/media-release/over-counter-access-low-dose-cannabidiol">down-scheduled the substance</a> from a Schedule 4 (prescription medicine) to a Schedule 3 (pharmacist-only medicine). </p>
<p>But so far, no product containing CBD has been approved by the Australian Register of Therapeutic Goods (ARTG), which is a requirement of pharmacist sale. ARTG approval means regulatory quality data on its safety, contaminants, microbial content, shelf-life and efficacy meet the TGA standards and is known and tested in regulatory grade laboratories. </p>
<p>The time and financial costs for drug development to meet the ARTG standards can be significant. Aspiring cannabis companies may not anticipate the difference between selling a product like cannabidiol compared to other products such as toys or clothing. </p>
<p>Expert clinical groups including physicians, psychiatrists, the <a href="https://ama.com.au/sites/default/files/documents/AMA_submission_to_the_TGA_proposed_amendments_to_the_Poisons_Standard_interim_decision_on_CBD.pdf">Australian Medical Association</a> and Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists opposed the down-scheduling, citing the lack safety data, lack of efficacy data, issues with product labelling and the potential for interactions with prescription medicines. </p>
<p>In fact there is only one regulatory-grade CBD product approved for use in Australia, <a href="https://www.tga.gov.au/sites/default/files/auspar-cannabidiol-210115.pdf">Epidyolex</a>, which is approved for treating forms of severe childhood epilepsy, and only available on prescription. (A drug called Sativex is also approved that contains both CBD and THC.)</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctor with oil dropper in hand" src="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436030/original/file-20211207-23-1rhd6jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Low-dose cannabinoids provide less than 150 mg per day to the user.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/cbd-hemp-oil-doctor-holding-260nw-1433210075.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>From a patient-safety perspective, regulating formulation and ensuring safety and quality data has met the TGA bar is imperative. Proving effectiveness is reasonable too. By down-scheduling and yet insisting on ARTG approval, the use of illicit CBD products may decrease – a win for population health if it transpires.</p>
<p>For industry, the TGA’s decision to down-schedule but require ARTG approval could be seen helpful to ensure quality and restrict supply. It has been estimated there is a <a href="https://www.grandviewresearch.com/industry-analysis/australia-legal-cannabis-market">potential</a> for hundreds of millions of dollars of market in Australia and crop development is <a href="https://www.abc.net.au/news/rural/2021-02-17/medical-cannabis-crop-facility-approval-in-gascoyne-wa/13160764">already underway</a>. So, major investment into drug development by a CBD company could be financially rewarding, as long as the standards are met.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-its-time-to-treat-medicinal-cannabis-as-an-alternative-therapy-not-a-pharmaceutical-169458">Why it's time to treat medicinal cannabis as an alternative therapy, not a pharmaceutical</a>
</strong>
</em>
</p>
<hr>
<h2>What could low dose CBD be good for?</h2>
<p>There are currently no recommended medical uses for low-dose CBD. <a href="https://pubmed.ncbi.nlm.nih.gov/31290177/">Clinical trial data</a> suggests a benefit of higher dose CBD for some children with a severe form of epilepsy who haven’t responded to other drugs. But it’s not clear whether the benefits could also have been explained by the fact patients <a href="https://pubmed.ncbi.nlm.nih.gov/31290177/">also took Valium</a>. And there were significant side effects reported that were higher in the CBD group.</p>
<p>With some high-profile proponents including <a href="https://www.abc.net.au/news/2021-12-06/basketball-legend-lauren-jackson-medicinal-cannabis-chronic-pain/100672048">basketballer Lauren Jackson</a>, there are increasing calls in many countries for patients, particularly those with chronic pain, to legally use cannabinoids. There are also <a href="https://www.news.com.au/lifestyle/health/cbd-oil-cannabidiol-now-available-over-the-counter-in-australian-pharmacies/news-story/c5e516bdc8bd6639163d5e39453a7927">claims</a> low-dose CBD could help people with anxiety, insomnia, arthritis or inflammatory issues, but this has yet to be backed by research into effectiveness or safety. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="oil capsules and dropperf" src="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436031/original/file-20211207-17-au9qly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Over-the-counter CBD products must be approved for registration to be sold in Australian. So far, none have passed those tests.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/joliet-illinois-usa-december-9-260nw-1253672308.jpg">Shutterstock</a></span>
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<p>We don’t know whether any cannabis business has applied to the TGA to have its product registered and been rejected due to failures on the safety, efficacy and quality side. </p>
<p>However, due to cannabis’ complicated extraction, synthesis, combinations, drug interactions and side-effects profile, it seems unlikely many non-medical companies would have the facilities, systems and people available in Australia to be able to achieve the required standards. </p>
<p>So far, big pharmaceutical companies have not shown significant interest in low-dose CBD. They may not be sure low-dose drugs will be recommended by doctors, or be waiting for more research. They may not judge CBD to be a potential blockbuster compared with other therapies in their pipelines. </p>
<p>There are some <a href="https://www.afr.com/companies/healthcare-and-fitness/local-medical-cannabis-company-scores-92m-deal-20210120-p56vhv">local producers exporting cannabis</a> and embarking on clinical trials. Federal health minister Greg Hunt has <a href="https://www.afr.com/companies/healthcare-and-fitness/local-medical-cannabis-company-scores-92m-deal-20210120-p56vhv">said</a> Australia is “poised to become a recognised leader in the global supply of the highest-quality medicinal cannabis products”. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-products-are-being-sold-as-sleep-remedies-heres-the-evidence-about-their-effectiveness-168166">Cannabis products are being sold as sleep remedies – here's the evidence about their effectiveness</a>
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<h2>Coming to a chemist soon?</h2>
<p>If we are using cannabis as a medicine, we should <a href="https://www.tga.gov.au/scheduling-decision-final/notice-final-decision-amend-or-not-amend-current-poisons-standard-cannabidiol">make the same demands</a> we do of other medicines to protect patient safety. This requires good manufacturing practice, good laboratory standards of measurement, appropriate labelling, and sufficient clinical information for informed patient consent.</p>
<p>Medical professionals should know what they are prescribing or recommending and be able to refer to dose-response data for each compound. They need to know the pharmacology and the drug interactions, the evidence for their use in specific conditions and any negative effects.</p>
<p>They also need to understand the legal, professional and regulatory obligations placed on prescribers and dispensers. If products are being bought at the chemist, they may interfere with other drugs or foods. Companies who want to sell such products in Australia will need to focus on bringing their drug development into line with regulatory standards. Time will tell how many can do that.</p><img src="https://counter.theconversation.com/content/172399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J Martin is the Chief Investigator for the NHMRC funded Centre for Research Excellence, Australian Centre for Cannabinoids Research Excellence.J. Martin has a family member who is a shareholder in a cannabis start‐up company in Australia. This has been fully declared to the funding agency and is subject to a governance order from the University of Newcastle regarding management of this potential conflict.</span></em></p><p class="fine-print"><em><span>Catherine Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The TGA gave low-dose cannabis sales without prescription the green light in February. But no product has jumped through all the regulatory hoops to market yet.Jennifer Martin, Professor of Medicine and Chair of Clinical Pharmacology, University of NewcastleCatherine Lucas, Clinical pharmacologist, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671782021-09-02T05:27:41Z2021-09-02T05:27:41ZThinking of trying ivermectin for COVID? Here’s what can happen with this controversial drug<figure><img src="https://images.theconversation.com/files/419019/original/file-20210902-18-njx5bl.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/clamart-france-august-22-2021-box-2028959327">Shutterstock</a></span></figcaption></figure><p>Westmead Hospital in Sydney’s west says it has treated a patient <a href="https://www.news.com.au/lifestyle/health/health-problems/westmead-hospital-patient-overdoses-on-online-cure-for-covid19/news-story/d5cc0998a98791af3b43bcaef42578b9">who overdosed</a> after taking the drug ivermectin, an unproven and potentially dangerous treatment for COVID-19.</p>
<p>The person went to hospital seeking treatment for diarrhoea and vomiting side-effects, after taking the drug, which is usually used to treat parasites. The person had ordered this and other unproven COVID “cures” online.</p>
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<p>While the patient did not die, <a href="https://www.tga.gov.au/covid-19-treatments-information-consumers-and-health-professionals">health authorities are concerned</a> at the number of people taking ivermectin, and warn against it for anyone else who may have COVID symptoms or has been diagnosed with the virus.</p>
<p>Other known ivermectin side-effects range from mild to the life-threatening, including seizures and coma.</p>
<h2>Why are people taking it?</h2>
<p>Ever since researchers showed ivermectin could kill SARS-CoV-2 (the virus that causes COVID-19) in the laboratory, there has been interest in whether the drug would also work to kill the virus <a href="https://theconversation.com/head-lice-drug-ivermectin-is-being-tested-as-a-possible-coronavirus-treatment-but-thats-no-reason-to-buy-it-135683">in the human body</a>.</p>
<p>So far, there is <a href="https://theconversation.com/a-major-ivermectin-study-has-been-withdrawn-so-what-now-for-the-controversial-drug-164627">no clinical evidence</a> it works to treat or prevent COVID-19. And there is widespread consensus people should not take ivermectin at home for COVID-19. </p>
<p>Organisations that recommend against it include: the <a href="https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials">World Health Organization</a>, Australia’s <a href="https://covid19evidence.net.au/faqs/#Ivermectin">National COVID-19 Clinical Evidence Taskforce</a> and <a href="https://www.nps.org.au/ivermectin-and-covid-19">NPS Medicinewise</a>, the United State’s <a href="https://www.fda.gov/animal-veterinary/animal-health-safety-and-coronavirus-disease-2019-covid-19/cvm-letter-veterinarians-and-retailers-help-stop-misuse-animal-ivermectin-prevent-or-treat-covid-19">Food and Drug Administration</a>, and the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full">Cochrane Library</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-major-ivermectin-study-has-been-withdrawn-so-what-now-for-the-controversial-drug-164627">A major ivermectin study has been withdrawn, so what now for the controversial drug?</a>
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</p>
<hr>
<h2>How are people getting hold of it?</h2>
<p>Despite this, <a href="https://www.theguardian.com/australia-news/2021/sep/01/australian-pharmacists-report-rise-in-customers-refusing-to-say-what-ivermectin-prescription-is-for">community pharmacists</a> have reported increased demand for ivermectin, with people seeking the drug as a possible COVID treatment.</p>
<p>In Australia, ivermectin is <a href="https://www.tga.gov.au/covid-19-treatments-information-consumers-and-health-professionals">approved to treat parasite infections in humans</a>. It’s also widely used in veterinary medicine to treat and prevent parasite infections.</p>
<p>However, as a prescription-only human medicine (known as <a href="https://www.healthdirect.gov.au/medicines/brand/amt,3069011000036101/stromectol">schedule 4</a>), you can only access ivermectin legally in Australia after approval from a doctor.</p>
<p>This is because, like all medicines, ivermectin is not 100% safe. It does have possible harmful side-effects and a doctor’s judgement is necessary to decide if ivermectin is safe and appropriate for each patient.</p>
<p>So ivermectin is currently only recommended to treat and prevent COVID-19 when used <a href="https://covid19evidence.net.au/faqs/#Ivermectin">as part of a clinical trial</a>, where patients can be more safely selected and carefully monitored.</p>
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<p>As well as more patients presenting to pharmacies with scripts, the Therapeutic Goods Administration <a href="https://www.tga.gov.au/media-release/risks-importing-ivermectin-treatment-covid-19">warns</a> about the danger of importing ivermectin products of unknown quality, bought over the internet.</p>
<p>This is risky because products may not contain the stated drug, may contain dangerous contaminants or much more of the drug than thought, which may result in an overdose.</p>
<p>Of most concern are reports from <a href="https://www.abc.net.au/radio/programs/worldtoday/warnings-against-ivermectin/13524184">Australia</a> and <a href="https://www.theguardian.com/commentisfree/2021/aug/31/a-human-is-not-a-horse-so-why-is-a-livestock-drug-sweeping-america-covid-ivermectin">overseas</a> of people buying and taking ivermectin products intended for animal use. People may be resorting to these types of products where they have been unable to access a script for human formulations of ivermectin.</p>
<h2>What does it do to your body?</h2>
<p>We know very little about what the drug does to humans, and the little we do know mostly comes from <a href="https://pubmed.ncbi.nlm.nih.gov/34149064/">its use in animals</a>.</p>
<p>When taken at the recommended dose, the drug is generally well tolerated. But ivermectin is known to cause mild side-effects such as diarrhoea, nausea, dizziness and sleepiness. Less common, but serious, side-effects include severe skin rashes and effects on the nervous system (causing tremor, confusion and drowsiness). </p>
<p>In higher doses, and overdose cases, these side-effects can be <a href="https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19">more severe</a>. These include low blood pressure, problems with balance, seizures, liver injury, and it can even <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1917344">induce comas</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-misinformation-is-a-global-issue-but-which-myth-you-fall-for-likely-depends-on-where-you-live-143352">Coronavirus misinformation is a global issue, but which myth you fall for likely depends on where you live</a>
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<h2>The take-home message</h2>
<p>The public is understandably interested in medicines to treat and prevent COVID-19. However, <a href="https://theconversation.com/au/topics/covid-misinformation-103292">misinformation about ivermectin and others continues to circulate</a>. </p>
<p><a href="https://theconversation.com/how-well-do-covid-vaccines-work-in-the-real-world-162926">COVID-19 vaccination</a> remains the best way to reduce the risk of serious illness and death from COVID-19. Australia’s <a href="https://covid19evidence.net.au/">National COVID-19 Clinical Evidence Taskforce</a> provides the most up-to-date information about COVID-19 treatments and is a reliable source of information as new knowledge emerges.</p>
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<p><em>If you or a family member take ivermectin and have strong side-effects you should seek medical advice. Call the <a href="https://www.health.gov.au/contacts/poisons-information-centre">Poisons Information Centre</a> on 131 126. For life-threatening symptoms, call 000 for an ambulance.</em></p><img src="https://counter.theconversation.com/content/167178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Andrew McLachlan receives research funding from the NHMRC and the Sydney Pharmacy School receives research scholarship funding from GSK for a PhD student under his supervision. Andrew has served as a paid consultant on Australian government committees related to medicines regulation. Andrew does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article.</span></em></p><p class="fine-print"><em><span>Slade Matthews has served the Australian Therapeutic Goods Administration as an external evaluator for the Therapeutic Goods Evaluation Panel. He also serves on the NSW Poisons Advisory Committee as the pharmacologist member. Slade does not work for, consult or own shares in or receive funding from any company of organisation that would benefit from this article.</span></em></p>Side-effects for this unproven and potentially dangerous treatment range from vomiting and diarrhoea to seizures and a coma.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyAndrew McLachlan, Head of School and Dean of Pharmacy, University of SydneySlade Matthews, Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1618942021-06-10T20:09:05Z2021-06-10T20:09:05ZHere’s how pharmacies could boost Australia’s COVID vaccine rollout<p>Under Australia’s original COVID-19 vaccination rollout plan, community pharmacies were meant to be involved in administering vaccines <a href="https://www.health.gov.au/sites/default/files/documents/2021/01/community-pharmacy-covid-19-vaccine-rollout-from-phase-2a-community-pharmacy-covid-19-vaccine-rollout-from-phase-2a-may-2021-onwards.pdf">from phase 2a</a>. </p>
<p>Phase 2a includes <a href="https://www.health.gov.au/sites/default/files/documents/2021/01/covid-19-vaccination-australia-s-covid-19-vaccine-national-roll-out-strategy.pdf">all adults over 50</a>, among other priority groups, and began <a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-is-the-astrazeneca-vaccine-safe-does-it-work-what-else-do-i-need-to-know-159814">at the beginning of May</a> via mass vaccination hubs, followed by <a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-can-i-talk-to-the-gp-first-do-i-need-a-painkiller-what-else-do-i-need-to-know-160357">GP clinics</a>. </p>
<p>We’re now technically into phase 2b, with certain age groups <a href="https://www.abc.net.au/news/2021-06-03/act-vaccination-expansion-makes-thousands-40-49-eligible/100186728">under 50</a> newly eligible, depending on the state or territory. </p>
<p>Pharmacists have been found to be capable, willing and ready to help with Australia’s vaccine rollout. But with the exception of <a href="https://www.psa.org.au/a-day-to-celebrate/">Queensland</a>, where 49 regional and remote community pharmacies are now allowed to deliver the vaccine, we have yet to see the government engage pharmacists in a meaningful way. </p>
<h2>A bit of background</h2>
<p>On <a href="https://www.ppaonline.com.au/vaccine-eoi">February 5</a> this year, the federal government called for expressions of interest from community pharmacies to be involved with the vaccine rollout. Approximately 3,900 of the <a href="https://www.guild.org.au/__data/assets/pdf_file/0020/12908/Vital-facts-on-community-pharmacy.pdf">5,700 pharmacies nationwide</a> were deemed “suitable”.</p>
<p>The Pharmacy Guild of Australia <a href="https://www.theaustralian.com.au/nation/pharmacy-guild-asks-for-right-to-give-jab/news-story/02ac953ce406c76a200c810bb167bf17">has estimated</a> allowing these pharmacies to administer the vaccine would accelerate Australia’s vaccination rollout by three months. Their modelling also suggested involving the pharmacy sector would save the government A$77 million.</p>
<p>In April, <a href="https://www.pm.gov.au/media/national-cabinet-4">National Cabinet</a> agreed pharmacies could be engaged in the states’ and territories’ rollout plans in locations where there are no or limited other places for people to be vaccinated.</p>
<p>In May, Federal Health Minister Greg Hunt <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/further-strengthening-the-covid-19-vaccine-rollout-through-primary-care">announced</a> up to 56 community pharmacies in regional Queensland would be approved to administer COVID vaccines, following a proposal from the Queensland government. </p>
<p>We’ve seen that <a href="https://www.psa.org.au/a-day-to-celebrate/">begin this week</a>, and it’s great news for those Queensland communities with no medical practice. It’s expected jurisdictions with large hinterlands including <a href="https://www.theage.com.au/politics/federal/end-vaccine-frustration-and-let-pharmacies-join-the-rollout-pharmacy-guild-20210609-p57zkr.html">New South Wales and Western Australia</a> will follow soon.</p>
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<p>But we haven’t seen engagement of pharmacies more broadly, beyond filling the gaps that exist outside city centres (and even that we’ve only seen in Queensland so far). At the Australian Pharmacy Professional Conference in May, <a href="https://www.greghunt.com.au/transcript-speech-australian-pharmacy-professional-conference-gold-coast/">Minister Hunt stated</a> the pharmacy sector would need to wait until “the latter part of the year” to be involved.</p>
<p>In personal communications with the department of health, inadequate supplies of vaccines at the state and territory level has been cited as the reason for delayed implementation of pharmacy-based vaccination, even in a “filling the gap” role.</p>
<p>This doesn’t help those Australians living in towns or in outer suburbs of the cities where there is an approved pharmacy but no GP. Nor does it help people whose GPs don’t provide COVID-19 vaccinations, or who are elderly or frail and unable to travel to mass vaccination hubs.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pay-pharmacists-to-improve-our-health-not-just-supply-medicines-124641">Pay pharmacists to improve our health, not just supply medicines</a>
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</em>
</p>
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<h2>Pharmacists are well-placed to deliver vaccines</h2>
<p>Pharmacists have been a fundamental part of Australia’s vaccination workforce <a href="https://www.psa.org.au/pharmacist_administered_vaccinations/">since 2014</a>. Depending on the state, pharmacists can administer influenza, whooping cough, measles, mumps, rubella, meningococcal, diphtheria and COVID-19 vaccines.</p>
<p>Approval for pharmacies to offer vaccination requires training to the same skill level as other vaccinators (such as nurses and doctors), appropriate private space within the pharmacy, and the capacity to upload patients’ vaccination records to the Australian Immunisation Register.</p>
<p>Once pharmacies get the green light for greater involvement, the lead time for the profession to come on board will be short as these factors are largely already in place.</p>
<p>With the expectation of assisting with the COVID-19 vaccination program, we’ve seen an upsurge in pharmacists completing vaccination training this year.</p>
<figure class="align-center ">
<img alt="A young female pharmacist uses a tablet computer." src="https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405578/original/file-20210610-27-sau218.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many pharmacists are trained in vaccination.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Storage changes will make it easier</h2>
<p>The Therapeutic Goods Administration recently <a href="https://www.tga.gov.au/behind-news/tga-approves-more-flexible-storage-conditions-pfizer-biontech-covid-19-vaccine">approved changes</a> to the storage requirements of the Pfizer-BioNTech vaccine. </p>
<p>This COVID vaccine belongs to a family of a new technology called mRNA vaccines, and initially required storage at around -60°C. During development of the mRNA vaccines, scientists didn’t know whether the vaccines would be <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/biontech-nearing-request-approval-longer-lasting-version-covid-vaccine-2021-05-04/">stable in a refrigerator</a>, but testing has since demonstrated they can be stored safely for one month at a normal fridge temperature of 2-8°C. </p>
<p>The capability to store vaccine in unopened vials in normal fridges, as opposed to ultra-cold freezers, will allow greater flexibility in vaccine delivery. This will be particularly useful for remote communities where deliveries can be complicated. </p>
<p>The storage change also enables administration of COVID-19 mRNA vaccines in community pharmacies which all have fridges with temperature monitors.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-gathering-data-on-covid-vaccine-side-effects-in-real-time-heres-what-you-can-expect-158945">We're gathering data on COVID vaccine side effects in real time. Here's what you can expect</a>
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<h2>Addressing vaccine hesitancy</h2>
<p>With Australia starting COVID-19 vaccination later than many places and <a href="https://ourworldindata.org/covid-vaccinations">slipping further behind</a> comparable countries, all available resources should be brought to bear in assisting the population to accept and access vaccination.</p>
<p>We can look overseas to see government programs which engage community pharmacy in COVID-19 vaccination. </p>
<p>In the United States, for example, a <a href="https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html">collaboration</a> between national and state governments and 40,000 pharmacies makes it easier for people to access COVID-19 vaccination locally, improving vaccine uptake and decreasing the logistical and operational burden on health departments.</p>
<p>Also in the US, the <a href="https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships.html">Pharmacy Partnership for Long-Term Care Program</a> involves community pharmacies vaccinating residents and staff on-site at more than 62,000 residential aged-care facilities.</p>
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<img alt="A male pharmacist talks with a female customer." src="https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405576/original/file-20210610-25-19pgvj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacists may be able to allay the concerns of some people who are hesitant about COVID vaccination.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>While issues of global supply and vaccine storage have affected distribution, public concern about efficacy and side effects have contributed to vaccine hesitancy and affected uptake. </p>
<p>Public health messaging is important but these are complex and personal matters. Many people have questions, like “which vaccine is best for me taking into account my medical situation?” and “what are the potential side effects?”. Pharmacists are well-placed to answer these sorts of questions. </p>
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Read more:
<a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">4 ways Australia's COVID vaccine rollout has been bungled</a>
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<p class="fine-print"><em><span>John Jackson is President of the Victorian Branch of the Pharmaceutical Society of Australia and has been engaged in negotiation within the profession and with the Victorian government on how and when pharmacists may be engaged in COVID-19 vaccination. </span></em></p><p class="fine-print"><em><span>Harry Al-Wassiti received funding from Monash University and The Medical Research Future Fund (MRFF) to develop mRNA Covid19 vaccine. He collaborates, consults for or and receives funding from Pharmaceutical industry collaborators biotechnology and government bodies involved in the technological development of vaccines. No affiliation with Pharmacy councils or assoications.
</span></em></p>Community pharmacies and pharmacists are important resources in Australia’s vaccine rollout, and right now they’re being under-utilised.John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityHarry Al-Wassiti, Bioengineer and Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1409622020-06-24T16:50:23Z2020-06-24T16:50:23ZNon-medical use of prescription drugs among skilled workers: a pilot study in Nigeria<figure><img src="https://images.theconversation.com/files/343198/original/file-20200622-55021-wqrrxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A pharmacy store in Ogun State, southwest Nigeria. </span> <span class="attribution"><span class="source">Photo by Pius Utomi Ekpei /AFP via Getty Images</span></span></figcaption></figure><p>More than ever, the world is facing a challenge of non-medical use of prescription drugs among people of all ages, genders and occupations. <a href="https://pubmed.ncbi.nlm.nih.gov/24654550/">Evidence shows</a> that pharmaceutical opioids (tramadol, codeine, or morphine), barbiturates such as pentobarbital sodium, benzodiazepines (diazepam and alprazolam), and amphetamines are the most common types of prescription medication used in a non-medical context. </p>
<p>According to the International Narcotics Control Board there was a <a href="https://www.incb.org/incb/en/publications/annual-reports/annual-report-supplement-2018.html">tripling</a> in the consumption of pharmaceutical opioids between 2014 and 2016. </p>
<p>Unfortunately, abuse of pharmaceutical drugs is as <a href="http://www.ulifeline.org/articles/390-the-dangers-of-misused-prescription-drugs">dangerous and deadly</a> as any other psychoactive substance. And the chemical components and effects of many pharmaceutical drugs make them particularly addictive. </p>
<p>In Nigeria, we conducted <a href="https://www.tandfonline.com/doi/full/10.1080/14659891.2020.1760375">research</a> into the non-medical use of pharmaceutical drugs among hairstylists and mechanics in Osogbo, a southwest region of the country. </p>
<p>My findings showed that tramadol and codeine were the most common drugs used for non-medical purposes. They also showed that prevalence was higher than the 4.7% use of non-medical drugs among adult Nigerians as reported in a nationwide survey on drug use by <a href="http://www.unodc.org/documents/data-and-analysis/statistics/Drugs/Drug_Use_Survey_Nigeria_2019_BOOK.pdf">the United Nations Office on Drugs and Crime</a> in 2018.</p>
<p>For <a href="https://www.samhsa.gov/data/sites/default/files/report_3210/ShortReport-3210.html">many reasons</a> more people are shifting from the use of conventional psychoactive drugs such as cannabis, cocaine and heroin to pharmaceutical drugs for a non-medical purpose. These reasons include sensation seeking, energy boost, to feel better and to cope with stress, frustration and unpleasant life events. </p>
<h2>Findings</h2>
<p>The study population for the research was made up of 64 hairstylists and 54 mechanics. Ninety four were males and 24 females. Their ages ranged between 18 and 45 years.</p>
<p>About 20% of the participants reported non-medical use of tramadol in the previous 12 months, 18% used codeine, 10.1% used other unnamed painkillers, and 1.7% used Rohypnol. A further 3.2% reported the use of other tranquilisers for a non-medical purpose within a one year period.</p>
<p>The results also showed that the non-medical use of pharmaceutical drugs was more prevalent among mechanics. For instance, 10.2% of the mechanics compared to 6.6% of the hair stylists reported non-medical use of tramadol within a period of one month. </p>
<p>We found that participants’ level of education and living situation was associated with their non-medical use of pharmaceutical drugs. This usage was most prevalent among participants who had received formal education at a higher level. These were participants with either complete or incomplete tertiary education (55.6%).</p>
<p>And we found that drug use was more prominent among persons living with friends (66.7%). We recorded 54.1% among people living alone and 50% of those living with their children alone, compared to people living with spouse and children, parents, and other relatives. </p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/14659891.2020.1760375">research</a> was a pilot study. We intend to conduct a follow-up study with wider coverage among the target population to reinforce the findings of the present study.</p>
<h2>Solutions</h2>
<p>Drug abuse, including the non-medical use of pharmaceutical drugs at the workplace, exacts a <a href="https://www.verywellmind.com/substance-abuse-in-the-workplace-63807">heavy price</a>. </p>
<p>As a result a <a href="https://www.shrm.org/resourcesandtools/hr-topics/risk-management/pages/nsc-prescription-drug-abuse-at-work.aspx">lot of effort</a> has been put into reducing drug abuse. </p>
<p>Over time different solutions have been proposed. </p>
<p>Based on experience garnered from my clinical practice and research, I would recommend three solutions.</p>
<p>The first is primary intervention. This involves effort aimed at protecting an individual from becoming exposed and vulnerable to drug use. Activities at this level also include reducing environmental stressors and building people’s abilities to cope with life events that may particularly make them susceptible to drug use. </p>
<p>The main aim of the primary intervention is, therefore, to prevent drug use from occurring. For instance, we found that among the hairstylists and mechanics we studied, their work, leisure and other activities are not well balanced. </p>
<p>Intervention at the secondary level involves putting in place a functioning system that can assist individuals who are already using drugs to cut down and eventually quit. </p>
<p>The secondary intervention also involves preventing drug users from progressing to a harmful level of use which compromises or impairs their health, relationships, finance, academics or work and overall mental well-being. </p>
<p>At a secondary level of intervention, institutions and organisations are encouraged to provide an environment that enables well-being and discourages drug use. </p>
<p>Irrespective of the preventive or intervention measure put in place for any problem behaviour such as drug abuse, it is evident that some people will always be caught up in the web. </p>
<p>At this level, the aim is to minimise the impact of drug use on an individual and organisation. </p>
<p>Lastly, there is relapse prevention. People who have been to treatment are assisted not to return to drug use. Several forms of rehabilitating strategies are also employed at this level to help people regain their well-being and possibly become optimally productive at work again.</p><img src="https://counter.theconversation.com/content/140962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samson Femi Agberotimi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For many reasons, drug users are shifting from the use of conventional psychoactive drugs such as cannabis, cocaine and heroin to pharmaceutical drugs for non-medical purposes.Samson Femi Agberotimi, Postdoctoral Research Fellow, North-West UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1342212020-03-25T12:26:27Z2020-03-25T12:26:27ZReaching out to isolated older adults is essential during coronavirus – here are 7 specific things you can do, just for starters<figure><img src="https://images.theconversation.com/files/322212/original/file-20200323-22606-1yoqjt1.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C4913%2C3245&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Seniors may need help shopping, picking up prescriptions, and connecting with others.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-elderly-woman-covers-her-face-with-a-scarf-on-a-near-news-photo/1207933992?adppopup=true">Getty Images / NurPhoto</a></span></figcaption></figure><p>Older adults always need social connection, but they need it now more than ever. The novel coronavirus brings with it <a href="https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html">unprecedented fear and uncertainty</a>. Vulnerable seniors need help. With face-to-face encounters discouraged, our society must develop creative strategies to help them connect. </p>
<p><a href="https://nursing.uw.edu/person/basia-belza/">As professors</a> at <a href="https://nursing.uw.edu/person/anita-souza/">the University of Washington</a>, which is near the epicenter of the coronavirus outbreak, <a href="https://nursing.uw.edu/person/tatiana-sadak/">we study aging</a> and the health concerns of older adults. There are a number of reasons they are more vulnerable: Those over 65 typically have more chronic conditions than younger people. An <a href="https://theconversation.com/older-people-are-at-more-risk-from-covid-19-because-of-how-the-immune-system-ages-133899">aging immune system</a> makes it harder to fight off diseases, infections and viruses. Recoveries are usually slower and more complicated. Older adults – perhaps living alone, on a fixed income, no longer driving, unfamiliar with using public transportation, and with undiagnosed or poorly managed depression – might already be socially isolated. For millions of them, the risk of COVID-19 may amplify already-existing problems. </p>
<p>With that in mind, here are some ways to <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">safely connect</a> during this crisis with older family members, friends and neighbors.</p>
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<img alt="" src="https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/322215/original/file-20200323-22622-876ija.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">During the COVID-19 crisis, social support for seniors is particularly critical.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/resident-at-the-leonard-florence-center-for-living-watches-news-photo/1207965747?adppopup=true">Getty Images / Boston Globe</a></span>
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<h2>1. Help with social support</h2>
<p>Check in with older adult neighbors. Send a text or email, phone them, or leave a note on their front door – whatever they prefer. Just let them know you’re thinking about them, and ask if they need anything. If you’re cooking, make a little extra and offer a dish to them; put it in a disposable container, use a disinfectant wipe to sanitize the outside of the container, and leave a thoughtful note. </p>
<h2>2. Help with food and essentials</h2>
<p>Lots of nonperishable items have disappeared from stores, especially hand sanitizers and toilet paper. Seniors risking a trip to the store might find mostly empty shelves anyway. Consider shopping for them while doing yours, or help them set up a revolving delivery from the grocery store. </p>
<h2>3. Help with medications</h2>
<p>Again, you could make the trip to the pharmacy yourself, or set up ongoing delivery. The latter might require a three-way call to the drug store, and maybe a follow-up call to their health insurance. Some of the elderly have trouble remembering to take medications; you can ask the pharmacy to pre-package medications in blister packs with designations for morning and evening. You can also call to remind them to take their medications. </p>
<h2>4. Help with health care appointments</h2>
<p>Most clinics now offer phone or video conference appointments. In the time of COVID-19, it’s a safe way to visit. Particularly if you are a family member, or have power of attorney for medical decision-making, you could participate in these appointments. Should the older person urgently need an in-person evaluation, phone ahead for them, report symptoms and ask for instructions as to next steps. </p>
<h2>5. Engage the grandchildren</h2>
<p>With school closed for the time being, your children could help an older adult learn something new about today’s technology, whether it be a laptop or a TV remote. Or they might send emails to grandparents or elderly neighbors to chat about what they’re doing, or ask them to participate online in virtual classrooms, symphonies or museums. Best of all: Your children could use this time to record some family history. </p>
<h2>6. Connect with trusted organizations</h2>
<p>Remote-volunteer for local organizations serving older adults. Many of these agencies, stretched thin, may prefer financial support. Many provide meals for seniors, and most of those are providing home delivery during the COVID-19 crisis. Consider helping out by purchasing pre-paid gas cards to support the drivers. </p>
<h2>7. For dementia care partners</h2>
<p>If you know someone caring for an <a href="https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care">older person with dementia</a>, reach out to them. Many of them occasionally use adult day care, but during this outbreak, these facilities are unavailable. Any support groups they normally attend might not be in session either. The lack of services may increase their stress. So help them set up phone or video conferencing with other dementia care partners to strategize on ways to cope. </p>
<p>Also, music is a powerful way to elicit positive emotions from the elderly. Help grandchildren or neighbors make playlists that resonate with them. </p>
<p>These ideas are only a starting point. <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">With the Centers for Disease Control and Prevention recommendations</a> in hand, engage in a dialogue with your family, friends and neighbors to generate your own action plan. Through communication and collaboration, we can reduce the social isolation of our older adults by reaching out.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/134221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Basia Belza receives funding from Centers for Disease Control and Prevention (CDC) and the Alzheimer's Association. </span></em></p><p class="fine-print"><em><span>Tatiana Sadak works for the University of Washington School of Nursing. He/she receives funding from NIH. </span></em></p><p class="fine-print"><em><span>Anita Souza does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Look out for your elderly parents, family members, friends and neighbors. It could save their lives.Basia Belza, The Aljoya Endowed Professor of Aging, Director of the de Tornyay Center for Healthy Aging, University of WashingtonAnita Souza, Clinical Associate Professor, Nursing, University of WashingtonTatiana Sadak, Associate Professor of Nursing, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1208852019-08-01T20:04:43Z2019-08-01T20:04:43ZExpanding pharmacy services increases both health-care and profit outcomes<figure><img src="https://images.theconversation.com/files/285991/original/file-20190729-43109-1m1njms.jpg?ixlib=rb-1.1.0&rect=66%2C0%2C6384%2C4536&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Legislation that expands the types of services offered by pharmacies may also benefit their profits.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Unlike many other health-care professions, pharmacists have both professional and business objectives. The majority of Canadian pharmacies are located in <a href="https://napra.ca/national-statistics">communities as opposed to in hospitals</a>, selling retail products, like cosmetics and food, in addition to filling prescriptions. </p>
<p>Despite their dual professional and business responsibilities, Canadian research suggests <a href="https://doi.org/10.1016/j.sapharm.2009.11.001">pharmacy managers demonstrate high levels of professionalism</a> and the retail setting does not compromise their ability to serve their patients.</p>
<p>Today, Canadian pharmacists’ professional roles are expanding and broadening to further emphasize their professional scope. Pharmacists are taking on expanded roles and are increasingly being recognized as the medication management experts of the health-care team. The comprehensive list of the expanded service offering by province and territory can be found on the <a href="https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada/">Canadian Pharmacists Association’s website</a>.</p>
<p>My original interest in this topic started when I was a PhD student at the University of Saskatchewan. Now, as a faculty member in the Department of Management and Marketing at the Edwards School of Business, this continues to be one of my active research areas. In a forthcoming paper in the <em><a href="https://www.tandfonline.com/toc/rsbe20/current">Journal of Small Business & Entrepreneurship</a></em>, my University of Saskatchewan co-authors — <a href="https://pharmacy-nutrition.usask.ca/research/spotlight-profiles/spotlight-on-dr.-jason-perepelkin-.php">Jason Perepelkin</a> and <a href="https://www.edwards.usask.ca/faculty/David%20Di%20Zhang/index.aspx">David Di Zhang</a> — and I find that when retail pharmacies implement expanded services, they ultimately achieve both better professional and financial outcomes.</p>
<h2>Regulation changes</h2>
<p>Recent regulatory changes have allowed pharmacists in Canada to <a href="https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada/">expand their professional services</a> and play a more active role as health-care providers. Depending on the province or territory in Canada, pharmacists have some prescriptive authority, can adapt prescriptions or make therapeutic substitutions, provide flu and travel vaccines and order and interpret lab results.</p>
<p>A pharmacy’s decision to offer expanded services depends on where the pharmacy is located, its organizational strategy and capabilities. Despite the varying degrees of legislation, <a href="http://www.canadianhealthcarenetwork.ca/files/2017/02/2017Trends_Order_Form_Feb10-1.pdf">81 per cent of Canadian pharmacists have intentionally expanded their role</a>. Both the legislation and corresponding publicly funded remuneration programs have been implemented. Moreover, <a href="http://www.canadianhealthcarenetwork.ca/files/2017/02/2017Trends_Order_Form_Feb10-1.pdf">45 per cent of Canadian pharmacists plan to further expand their role as legislation changes permit</a>.</p>
<p>Although <a href="https://doi.org/10.1016/j.sapharm.2014.09.004">pharmacists have evaluated their implementation of expanded services as successful</a>, it remains to be seen how these new services impact patient health and the profitability — dual objectives — of retail pharmacies.</p>
<h2>Outcomes of expanded services</h2>
<p>Using data from 259 western Canadian retail pharmacies, we found that entrepreneurial pharmacies were the most likely to participate in the expanded services. Entrepreneurial pharmacies were those that were self-described by their owners and managers as actively innovating, willing to take some business risks and making proactive business decisions.</p>
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<a href="https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285988/original/file-20190729-43126-1672wv4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Patients are benefiting from the new activities performed by pharmacists.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>We also found that the implementation of expanded services was related to favourable patient health outcomes. Favourable patient health outcomes included overall quality of care, patient prescription knowledge and prescription error reduction as reported by the pharmacy owner or manager. This suggests the expansion of pharmacy services is working as intended and patients are benefiting from the new activities performed by pharmacists. </p>
<p>For example, the ability to get an emergency refill from a pharmacist resulted in better medication management by patients. Although this relationship was one of the study’s most noteworthy findings, it is unclear if the addition of services would also have positive impacts for patients. It will be interesting to see if the industry regulatory bodies advance the scope of practice and if these services have the same outcomes.</p>
<p>In addition to patient health outcomes, our research suggested that retail pharmacies financially benefited from the implementation of expanded services. Specifically, pharmacies that implemented new services reported higher levels of revenues, margins and profits over the previous year. While pharmacies’ motivation to implement expanded services is related to advancing the profession, it is evident from these findings that it supports the financial objectives too.</p>
<h2>Expanding services and profits</h2>
<p>Given the dual objectives of retail pharmacy, our research suggests that the implementation of expanded services can help achieve both. Faced with such opportunities, retail pharmacies should look to implement at least some of the permitted services in their province or territory, as it appears to be a win-win.</p>
<p>Unfortunately, because the implementation of such services is completely voluntary and an individual pharmacy decision, it creates some market confusion for patients. Therefore, which pharmacies and how many services they engage in is highly ambiguous. As the implementation is clearly effective, perhaps efforts should shift to communicating clearly which pharmacies provide which services.</p>
<p>Overall, the findings of our study are beneficial to patients, pharmacists, technicians, managers and owners and highlight the effectiveness of the industry’s expansion of care offerings. The results suggest the expansion of expanded services improves patient access to care and ultimately improves their health. At the same time, these new services offer new revenue streams to retail pharmacies and increase their profits. It is this combination that yields the greatest benefit overall and achieves the dual objectives of retail pharmacy. </p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/120885/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grant Alexander Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Expanding the services offered by pharmacies can have positive effects on health outcomes — and profits.Grant Alexander Wilson, Department of Management & Marketing, Edwards School of Business, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/935222018-04-13T13:49:21Z2018-04-13T13:49:21ZRepeat prescriptions are expensive and time consuming – it’s time for an NHS rethink<figure><img src="https://images.theconversation.com/files/211738/original/file-20180323-54863-99b0bv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">And repeat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-prescription-treatment-medication-pharmaceutical-medicament-544348294?src=Pt2C-eiYews1VpI5kIYHZA-1-33">Shutterstock</a></span></figcaption></figure><p>Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a <a href="https://digital.nhs.uk/catalogue/PUB23631">cost of over £9 billion</a>. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.</p>
<p>The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment. </p>
<p>The <a href="http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4892136">UK Department of Health advises</a> that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”. </p>
<p>However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by the UK’s <a href="http://psnc.org.uk/services-commissioning/psnc-briefings-services-and-commissioning/psnc-briefing-05416-medicines-wastage-and-prescription-duration-october-2016/">Pharmaceutical Services Negotiating Committee</a>.</p>
<p>One of the key reasons for issuing monthly supplies is the opportunity to reduce medication waste, which has been previously estimated to cost the NHS <a href="https://www.bristolccg.nhs.uk/media/medialibrary/2016/02/Report_Medicines_Waste_in_Bristol.pdf">around £300m a year</a> in England alone. If patients have fewer pills in their possession, it is harder to mislay or stockpile them. </p>
<p>It is also possible that fairly frequent contact with the doctor may aid the discovery of potential drug intolerance, and provide more chances for medication review.</p>
<p>But is this approach the right one? From the perspective of patients, shorter prescriptions also mean more opportunities to forget to reorder supplies, and often necessitate additional trips to the GP and pharmacy. </p>
<p>Time and effort spent dispensing pills in community pharmacies is also considerable, and arguably an inefficient use of pharmacists’ valuable skills. Shorter prescription time frames exacerbate this. The workload for GPs authorising further prescriptions can also be substantial.</p>
<p>Our <a href="https://njl-admin.nihr.ac.uk/document/download/2011885">recent research</a> challenges the current practice of shorter repeat prescriptions. We identified evidence from <a href="https://bjgp.org/content/early/2018/03/12/bjgp18X695501">nine reports</a> suggesting that longer duration prescriptions are associated with better adherence by patients to their medications (in other words, patients are more likely to take their pills the way the doctor intended). </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534845/">single American study</a> of statins, a drug commonly prescribed to patients with cardiovascular disease, even found improvements in lipid control with longer term prescriptions. (However, other studies examining health outcomes or patient experience were lacking.)</p>
<p>In analysing 11 years of UK <a href="http://bmjopen.bmj.com/content/7/12/e019382">GP prescribing data</a>, we found that shorter prescriptions were indeed associated with reduced medication waste. But those savings were more than offset by greater costs due to the additional work required by GPs and pharmacists. </p>
<p>Consider, for example, the impact of switching statins – the most widely prescribed drugs in UK primary care – to longer durations of around three months. This has the potential to save over £500m per year in doctor and pharmacist time – precious GP time which could be ploughed back into a struggling health service, seeing patients rather than signing bits of paper. </p>
<p>One could argue that the growth of electronic repeat dispensing, where GPs can authorise multiple repeat prescriptions at a time, could help deal with this issue. But there is still the opportunity for over £60m in savings through reduced dispensing costs for these drugs alone. </p>
<p>An <a href="https://link.springer.com/article/10.1007%2Fs40258-018-0383-9">economic modelling exercise</a> found longer term prescriptions to be more cost-effective than shorter ones, driven primarily through health gains due to better medication adherence. </p>
<p>Medications are a daily part of the lives of millions, and in many cases unavoidable. Yet the current recommendations that require patients to make monthly trips to pick up more pills are simply not justified by the evidence. </p>
<p>There is the potential for longer prescriptions to lead to important benefits, by improving patients’ adherence and thus the effectiveness of the drugs, lessening workload for health care professionals, and reducing inconvenience and costs to patients.</p>
<h2>A bitter pill?</h2>
<p>News that issuing longer prescriptions is more cost effective is likely to be welcomed by most GPs. But pharmacists may be less enthusiastic. </p>
<p>Community pharmacies receive dispensing fees for each NHS prescription, so reducing the frequency could lead to a large reduction in income. The NHS may save money, but critical pharmacy services could suffer. Changes to national policy around the length of repeat prescriptions would therefore need to consider how pharmacies are reimbursed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214249/original/file-20180411-570-819oki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">What if the drugs don’t work?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newbury-berkshire-england-november-3-2017-755878630?src=pTc5K-y3YVlW_UbMQZXYIQ-1-4">Shutterstock</a></span>
</figcaption>
</figure>
<p>Simply increasing the dispensing fee will not be straightforward, as some drugs may be more suitable for switching to longer prescriptions than others. It may not be possible, either, to recommend a new, standardised, longer prescription length. </p>
<p>Further research is likely to show that the one-size-fits-all model of 28 day blanket prescription policy is unsustainable. Different conditions, drugs and patient profiles may require different prescription lengths. </p>
<p>There are undoubtedly limitations to the work we have carried out so far, and it is necessary to make assumptions about the degree to which improvements in adherence lead to health gains – although evidence <a href="http://www.nejm.org/doi/full/10.1056/NEJMra050100">suggests a clear link</a>. </p>
<p>The only way to provide a definitive answer to this question is to conduct a clinical trial. This is a potentially significant challenge that would require strong support from practices and service commissioners. Given patients frequently report irritation in the process of ordering regular medications, a trial would also offer the opportunity to compare and contrast the “customer” experience.</p>
<p>Until then, we must accept that the evidence does not support the current 28 day prescribing policy. The NHS needs to reconsider its approach – both to reduce costs and improve patient care.</p><img src="https://counter.theconversation.com/content/93522/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rupert Payne receives funding from the National Institute for Health Research. </span></em></p><p class="fine-print"><em><span>Céline Miani was involved in research projects funded by the National Institute for Health Research.</span></em></p>Current guidance is not leading to cost-effective practice.Rupert Payne, Consultant Senior Lecturer in Primary Health Care, University of BristolCéline Miani, Junior research group leader, Social epidemiology, Bielefeld UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/824052017-08-15T09:41:56Z2017-08-15T09:41:56ZPharmacies could do more to help improve everyone’s health<figure><img src="https://images.theconversation.com/files/181953/original/file-20170814-28437-huljts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacies could be doing more for public health</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Most people aren’t aware that high street pharmacies offer much more than dispensing and selling medicines. Many also provide a wide range of services designed to improve public health, like supporting people to stop smoking, providing emergency contraception and testing for sexually transmitted diseases. Some also offer the national <a href="http://www.healthcheck.nhs.uk/">NHS Health Check</a>, which identifies people with high blood pressure diabetes and chronic kidney disease and gives them information about the risk of having a heart attack or stroke. This gives people the opportunity to make changes to protect their health. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/2dfrz7SvhmQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>These services are free to use because they are commissioned and paid for by local government. But not every pharmacy offers the full range of services. It might be surprising but there has been no data collected on the range of these services. We think it is important to know which services are offered in different pharmacies, and how many people have access to each of the services. So <a href="http://bmjopen.bmj.com/content/bmjopen/7/7/e015511.full.pdf">we carried out a study</a> to find out.</p>
<h2>Our results</h2>
<p>We found that between April 2014 and May 2015, pharmacies provided over 200,000 consultations for emergency contraception, over 30,000 free condoms and almost 16,000 chlamydia screening kits. More than 55,000 people registered to stop smoking in a pharmacy, almost 30,000 were screened for alcohol use and over 26,000 had an NHS Health Check. </p>
<p>We also found that not all services are offered in all areas of England. Some are offered in most areas, including emergency contraception – almost half of all pharmacies offer this. Smoking cessation is commissioned by nine out of ten local authorities, but in some areas where smoking rates are higher than the national average only a few pharmacies provide support. Studies show these <a href="http://bmjopen.bmj.com/content/6/2/e009828">“stop smoking” services have good quit rates</a> and are preferred by many people to other types of support. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181955/original/file-20170814-28430-qok2zv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Quitting with the help of a pharmacy is more popular.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>Just under a third of local authorities commissioned pharmacies to provide the NHS Health Check, although people think having a one of these in a pharmacy <a href="https://kar.kent.ac.uk/52701/">is more convenient than going to a general practice</a>. So you may live in an area where you can get a free NHS Health Check at your local pharmacy, but it’s much more likely that you don’t. Around half of the areas which do offer this are in London. If you live in an area with a high rate of diabetes, or a high number of deaths from cardiovascular disease, its unlikely that you can get an NHS Health Check at your local pharmacy. </p>
<p>Some areas pay pharmacies to provide lots of different services, while others can offer only a few. For example, pharmacies were paid to provide free emergency contraception and support to stop smoking in Birmingham and Wolverhampton, and in Walsall a small number were also paid to offer free NHS Health Checks. But not too far away in Dudley, pharmacies were paid to provide all these plus free Chlamydia screening tests, screening for excess alcohol use, weight management and testing for HIV. Many of the local authorities which commissioned lots of different services are in London, so people elsewhere are less likely to have access to these from a pharmacy.</p>
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<img alt="" src="https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181973/original/file-20170814-23252-12fkedb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Going to a pharmacy is considered easier than going to see your GP.</span>
<span class="attribution"><a class="source" href="http://www.geograph.org.uk/photo/2822735">Mike Quinn</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>What our study shows is that the extent to which services are offered doesn’t match up with what people need. So in some areas where local people could potentially benefit, pharmacies can’t provide these services because they aren’t commissioned by local authorities. But, we didn’t find out why there are such big differences between areas of England in the range and extent of services that pharmacies are commissioned to provide. </p>
<p>In 2015, NHS England decided to allow community pharmacies to offer free flu vaccinations to people at high risk. Pharmacies in all areas did this, so anyone could take advantage of the greater convenience this offers. Almost 600,000 people did so from 2015 to 2016 and over 950,000 the following year. </p>
<p>Pharmacy services are popular, so perhaps local authorities could be making better use of them to help improve public health.</p><img src="https://counter.theconversation.com/content/82405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Krska has received funding from Public Health England. </span></em></p>It depends where you live whether pharmacies can offer services like emergency contraception and health checks.Janet Krska, Professor of Clinical & Professional Practice, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/510152016-01-05T11:09:16Z2016-01-05T11:09:16ZCan pharmacists help fill the growing primary care gap?<p>By 2020 <a href="http://content.healthaffairs.org/content/28/1/64.full">157 million</a> people in the US will be living with at least one chronic health condition. As the number of Americans managing diseases such as diabetes, hypertension and high cholesterol increases, the ranks of primary care providers (PCPs) who currently perform the majority of chronic disease management are dwindling. </p>
<p>Within the next 10 years, there is estimated to be a <a href="http://dx.doi.org/10.1377/hlthaff.27.w232">27% shortage of PCPs in the US</a> – about 90,000 fewer PCPs than the US health care system requires. </p>
<p>But there are approximately 300,000 pharmacists in the US, and the number of pharmacists is going up. Between 2003 and 2013, the number of pharmacists in the US <a href="http://dpeaflcio.org/programs-publications/issue-fact-sheets/pharmacists-and-pharmacy-technicians-facts-and-figures/">increased</a> by approximately 19%.</p>
<p>Pharmacists are trained to do much more than dispense medication, and they could help plug the growing gaps in chronic care management in the United States. </p>
<p>The trouble is that state pharmacy practice statutes were written in a different era, and haven’t caught up with the training pharmacists receive today. There’s a chasm between what pharmacists are trained to do and what they are allowed to do by law.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106306/original/image-20151216-30110-vkrrxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A child has her blood pressure checked by a pharmacist at the Mayor’s Back to School Fair in Dallas, Texas, August 2009.</span>
<span class="attribution"><span class="source">Jessica Rinaldi/Reuters</span></span>
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<h2>What does your pharmacist know how to do?</h2>
<p>Your local pharmacist is a highly trained medical professional. Before pharmacy students even start school, they have to take and pass the standardized Pharmacy College Admissions Test (PCAT), which covers topics like chemistry and biology and mathematics. Before entering pharmacy school (which is a four-year program), most students will have completed a bachelor’s degree or a rigorous two-year program of prerequisites. That means graduates of pharmacy schools have doctoral-level training. </p>
<p>Before they can practice, students have to pass a licensure exam (North American Pharmacist Licensure Examination, NAPLEX). Some will go on to receive board certification in cardiology, pediatrics, infectious disease or other specialties by the Board of Pharmaceutical Sciences (BPS). </p>
<p>Of course, pharmacists receive extensive training in drug therapy management – medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients, and the subtle differences between medications. </p>
<p>But pharmacists are also well-versed in preventative care, patient counseling, and health and wellness. They know how to manage chronic diseases, including high blood pressure, diabetes and high cholesterol. A pharmacist can manage a treatment plan initiated by a physician, order basic laboratory tests and adjust medication dosages, adding or subtracting medications as needed. These are things that many patients with chronic disease need to schedule an appointment with their PCP to do.</p>
<p>Pharmacists are often more accessible to patients than PCPs. No appointments are needed and in general pharmacists are available for consultation at hours during the day and night that most physician offices are closed. </p>
<p>But in most states, pharmacists stick with drug therapy management and don’t get to use the rest of the skills that they learn throughout their pharmacy education. </p>
<p>In some states, pharmacists are allowed to participate in administration of certain immunizations or are allowed to participate in preventative care or wellness. But it is the <a href="http://lawatlas.org/query?dataset=pharmacist-scope-of-practice">minority of states</a> that have progressive pharmacy statutes allowing pharmacists to interact with patients, take medical histories and order appropriate laboratory tests under certain conditions. </p>
<h2>Why aren’t pharmacists doing more?</h2>
<p>Outdated pharmacy statues aren’t the only thing blocking pharmacists from doing more than dispensing medication. </p>
<p>Pharmacists are often assisted by pharmacy technicians who perform routine tasks, like counting pills and labeling bottles, so they can devote more time to patients. Despite that division of labor, <a href="http://content.healthaffairs.org/content/28/1/64.abstract">almost 70% of a pharmacist’s time</a> is still spent on tasks that can be performed by technicians.</p>
<p>Pharmacists are paid based on the number of prescriptions filled. Even though they can do a lot more than dispense medication, that’s what they get paid to do, with a few exceptions. </p>
<p>For instance, Medicare reimburses pharmacists for medication therapy management – where a pharmacist manages and adjusts a the medication to suit an individual patient’s needs. </p>
<p>Because pharmacists don’t get paid for other services they provide, the end result is that patients receive less care than they could and should when visiting the pharmacy.</p>
<h2>Letting pharmacists play a bigger role in care is a boon for patients</h2>
<p>Even if there were enough PCPs to take care of the explosion in chronic diseases, there is evidence that PCPs aren’t doing a good job at managing their patients’ chronic diseases. </p>
<p><a href="http://content.healthaffairs.org/content/28/1/64.full.pdf+html">Fifty percent of patients</a> walk out of appointments not understanding what they were told by their physician. Patients actively participate in their own clinical decision-making less than <a href="http://personcentredcare.health.org.uk/sites/default/files/resources/bodenheimer_clinicalcrossroadsjama.pdf">10% of the time</a>. Just <a href="http://content.healthaffairs.org/content/28/1/64.full.pdf+html">one-third of US patients</a> with diabetes, hypertension and elevated cholesterol have their conditions under good control. </p>
<p>And patients are taking more medication than ever. The number of prescriptions written in the US has increased from 700 million in 1989 to <a href="https://www.youtube.com/watch?v=ajmT93H2RpA&feature=player_detailpage">4 billion in 2014</a>. Since 2002 there has been a <a href="http://www.cdc.gov/nchs/data/hus/hus14.pdf">15% increase</a> in the number of 55-64-year-olds taking five or more medications. Ninety percent of adults over the age of 65 years take <a href="http://www.webmd.com/news/20140514/prescription-drug-use-continues-to-climb-in-us">at least one</a> prescription drug.</p>
<p>Taking more medication makes it more likely that a person won’t take them as directed. This can lead to medical complications, higher costs and even death. And more medication means a greater likelihood of harmful interactions. </p>
<p>But research shows that when pharmacists are part of patient care teams they can help avoid these problems and result in better patient care. This is called a collaborative care model. </p>
<p>For example, the physician in charge of the care team would assign activities to a pharmacist, like monitoring blood pressure, ordering lab tests, evaluating and changing medication or doses. This lets the pharmacist act more independently while still working closely with the physician who is leading the care. </p>
<p>Collaborative care models have been shown <a href="http://www.cdc.gov/dhdsp/pubs/docs/Translational_Tools_Pharmacists.pdf">to improve outcomes</a> in patients with hypertension, diabetes, clotting disorders and high cholesterol. Putting a pharmacist on the care team can reduce adverse drug reactions and lower costs. If patients can go to a pharmacist for day-to-day management of their condition, physicians can spend more time seeing the patients that really need their expertise.</p>
<h2>Change is happening…slowly</h2>
<p>There are bills in both the House and Senate proposing an amendment to the Social Security Act authorizing the secretary of health and human services to develop <a href="https://www.congress.gov/bill/114th-congress/house-bill/592/text">pharmacist-specific</a> codes for insurance reimbursement. </p>
<p>These efforts are necessary and long overdue, but even if these bills are passed and signed into law, what pharmacists can do is still restricted by antiquated state statutes that have little connection to how pharmacists are trained today.</p>
<p>Once laws catch up to what pharmacists are really trained to do, it will be the patients who benefit the most.</p><img src="https://counter.theconversation.com/content/51015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Gums does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pharmacists are trained to do far more than dispensing medicine, but outdated policies keep them from taking on a greater role in patient care.John Gums, Associate Dean for Clinical Affairs and Professor of Pharmacy and Medicine , University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/208232013-12-01T19:30:20Z2013-12-01T19:30:20ZDo we really need prescriptions for the contraceptive pill?<figure><img src="https://images.theconversation.com/files/36507/original/h2tmdbn9-1385699872.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Why should women not be in charge of their own contraception if it's safe for them to do so?</span> <span class="attribution"><span class="source">anoldent/Flickr</span></span></figcaption></figure><p>Women using <a href="http://www.fpnsw.org.au/713867_8.html">the contraceptive pill</a> currently require a prescription from a doctor and to return once a year to renew it. But recent research suggests the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837145/">relative safety</a> of this oral contraceptive means we should consider making it more freely available.</p>
<p>For <a href="http://www.biomedcentral.com/content/pdf/1478-4491-10-1.pdf">many women</a> the current model can involve a fair bit of effort – significant forward planning to get an appointment before the prescription runs out, an often lengthy wait to see the doctor and a hefty consultation fee – for a few minutes in the doctor’s surgery to have a prescription renewed.</p>
<p>A <a href="http://www.sciencedirect.com/science/article/pii/S0002937813020358">recent research article</a> has stimulated debate about the value of providing women with oral contraceptives, without having to go through all this.</p>
<p>While the position is <a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives">supported</a> by the American College of Obstetricians and Gynecologists, the Australian Medical Association <a href="http://www.medicalobserver.com.au/news/experts-back-ocp-on-prescription">has spoken out</a> against the suggestion, even for experienced pill users.</p>
<p>But why shouldn’t women be in charge of their own contraception if it’s safe for them to do so? Let’s consider some of the arguments for and against providing oral contraceptive pills over the counter.</p>
<h2>Why it’s a good idea – access</h2>
<p>The requirement to keep returning to the doctor for repeat prescriptions can be expensive, and time consuming. </p>
<p>For young women, those who are socioeconomically disadvantaged, and others who find it difficult to access the health system, these barriers can be considerable. Both <a href="http://fampra.oxfordjournals.org/content/20/1/11.short">doctors</a> and <a href="http://jfprhc.bmj.com/content/34/4/213.short">patients</a> can be embarrassed about discussing sexual matters.</p>
<p>Without easy access to effective hormonal contraception women may not use any birth control at all, or they may rely on less effective methods (such as condoms or the withdrawal method). </p>
<p>And anyway, the emergency contraceptive pill is already <a href="http://www.fpnsw.org.au/422437_8.html">available over the counter</a> at pharmacies in Australia, so why not include other oral contraceptives as well?</p>
<p>In the United States, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23664627">up to 30% of women</a> who don’t currently use contraception, or use a less effective method say they would probably start taking the pill if they could get it without a prescription. </p>
<p>For some women, the doctor’s visit is a significant barrier to using hormonal contraception, so making it available in pharmacies will lead to more, and more effective, contraceptive use, and fewer unintended pregnancies.</p>
<h2>Why it’s a bad idea – health risks</h2>
<p>Taking combined oral contraceptive pills has potentially serious health <a href="http://www.fpnsw.org.au/713867_8.html">consequences</a>. </p>
<p>The most dangerous of these is blood clots. Although rare, the sudden death of a healthy young woman because of a blood clot is <a href="http://www.cbc.ca/news/canada/british-columbia/yaz-yasmin-birth-control-pills-suspected-in-23-deaths-1.1302473">shocking</a>. Sadly this can happen even with the current requirement for a doctor’s prescription. </p>
<p>Although many doctors thoroughly screen women and inform them about oral contraceptive use, the quality of consultations is <a href="http://www.sciencedirect.com/science/article/pii/S0010782404002690">variable</a>. Reasons why a woman shouldn’t take the pill can be missed, or simply be unknown, particularly for young women.</p>
<p>Thorough <a href="http://www.racgp.org.au/afp/2012/october/contraception/">Medical Eligibility Criteria</a> have been developed to minimise the risk of serious adverse events from using oral contraceptives. Women with hypertension, migraines with aura, a history of venous thromboembolism, or smokers at age 35 years or older, for instance, are at higher risk of adverse events and should not take the combined oral contraceptive pill. </p>
<p>Without proper screening by a doctor, there’s a risk that factors that should stop women from taking the pill will be missed. </p>
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<img alt="" src="https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/36508/original/xr3rpzk7-1385700024.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Gnarls Monkey/Flickr</span></span>
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<h2>Why it’s good – availability</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23664627">Many women wish</a> they could purchase their contraceptive pills over the counter. </p>
<p>In the United Kingdom, <a href="http://ocsotc.org/wp-content/uploads/2012/04/NHS-2012_Evaluation-of-pharmacy-provision-of-OCs-in-London-1-2012.pdf">a pilot program</a> evaluated the feasibility of community pharmacy providing combined oral contraceptives, <a href="http://www.fpnsw.org.au/936515_8.html">progesterone-only (“mini”) pills</a> as well as information on and referral to long-acting reversible contraception. </p>
<p>Women participating in the study said they valued the convenience, anonymity, drop-in system, long opening hours and lack of waiting time. </p>
<p>Appropriately trained health-care professionals, including <a href="http://rcnpublishing.com/doi/abs/10.7748/phc2013.07.23.6.16.e713">nurses</a> and <a href="http://ocsotc.org/wp-content/uploads/2012/04/NHS-2012_Evaluation-of-pharmacy-provision-of-OCs-in-London-1-2012.pdf">pharmacists</a>, could effectively assist women with contraception. And they could do this using current eligibility criteria, just as doctors do.</p>
<p>Could concern about maintaining professional territories be denying women better access to contraception?</p>
<p>There’s no reason why women couldn’t get advice about their contraceptive options from pharmacies or other community settings. This advice could include referral to see a doctor or specialist as required</p>
<h2>Why it’s bad - sexual health screening</h2>
<p>Doctors argue that having women visit them for a new pill prescription ensures they have a regular Pap test, breast examination and sexual health check. </p>
<p>While all these checks are undoubtedly important, there are many women who don’t take the oral contraceptive pill, so the logic of this argument is not entirely satisfying. It’s akin to the suggestion that condoms or aspirin should be provided by prescription so men visit a doctor for prostate examinations!</p>
<p>What’s more, in Australia, women are advised to have a Pap test every two years and those guidelines are currently under <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/ncsp-renewal">review</a> in light of the <a href="http://www.biomedcentral.com/1741-7015/11/227">effectiveness</a> of the HPV vaccination program on cervical abnormalities. And we have <a href="http://www.ncbi.nlm.nih.gov/pubmed/22520645">evidence</a> that rates of sexual health screening remain high among women who get oral contraceptive pills over the counter. </p>
<p>It’s also worth noting that the <a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/Over-the-Counter_Access_to_Oral_Contraceptives">American College of Obstetricians and Gynecologists</a> states screening for cervical cancer or sexually-transmitted infections is not medically required to provide hormonal contraception.</p>
<h2>There’s more</h2>
<p>The uptake of the very effective long-acting reversible contraceptives (such as IUDs and implants) is <a href="https://www.mja.com.au/journal/2011/194/6/intrauterine-contraception-why-are-so-few-australian-women-using-effective-method">low in Australia</a>. Evidence from the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21508749">CHOICE project</a> indicates women choose long-acting methods when offered good information and cost-effective access. </p>
<p>The low uptake in Australia may be an indicator that doctors are not able to spend time with women discussing all the contraceptive options available. </p>
<p>We need to provide easy access to contraception and contraceptive information, while balancing the potential risk for side effects and adverse events.</p>
<p>Perhaps the way forward is to trial providing the <a href="http://www.fpnsw.org.au/936515_8.html">progesterone only pill</a> over the counter for a start because most women can take it with <a href="http://www.ncbi.nlm.nih.gov/pubmed/22364816">little risk</a>.</p>
<p>What do you think?</p><img src="https://counter.theconversation.com/content/20823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayne Lucke receives funding from the Australian Research Council. She is Chief Investigator on an ARC Linkage Grant that involves cash and in-kind support from Family Planning New South Wales and Bayer Australia</span></em></p>Women using the contraceptive pill currently require a prescription from a doctor and to return once a year to renew it. But recent research suggests the relative safety of this oral contraceptive means…Jayne Lucke, Principal Research Fellow in Health Ethics and Policy, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.