PharmacyForward
Marijuana Use - Medical, Health, and Legal Issues (III)

Marijuana Use - Medical, Health, and Legal Issues (III)

August 15, 2019

William J Stilling, BS Pharm, JD - Founding Partner, Stilling & Harrison, PLLC and Clinical Associate Professor, Department of Pharmacy Practice at the University of Utah College of Pharmacy - talks to us about some of the legal issues related to the medical and recreational use of marijuana.

Key Lessons:

  • Marijuana (in its raw form) is a schedule I substance under Federal Law.  However, the US Congress has prohited the Department of Justice from using its funds to enforce Federal law superceding State laws related to marijuana.
  • Medical marijuana is typically legal to use under State laws only in specific "use cases" or "qualifying conditions."  Physicians and other prescribers can't legally prescribe marijuana because it would violate their DEA issued license but may "recommend" or "authorize" the use of marijuana.
  • Healthcare instutitions need to consider the use of marijuana for therapeutic purposes by their patients and develop clear policies and procedures on how marijuana use will be accommodated in their facility.
  • Pharmacists and pharmacies are subject to oversight by the board of pharmacy and most state boards require pharmacists to abide by Federal laws.  Thus, pharmacists who use marijuana, even for "legal" therapeutic purposes, may be subject to sanctions and lose their license to practice.
  • Employers may terminate a pharmacist or health professional for marijuana use because it is a violation of Federal law.
  • The FDA is unlikely to approve marijuana (in its raw form) for medical indications because it can not be easily studied or standardized.
  • The legal status of marijuana in the years to come will be significantly impacted by political and economic forces.

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Marijuana Use - Medical, Health, and Legal Issues (II)

Marijuana Use - Medical, Health, and Legal Issues (II)

July 18, 2019

Laura Borgelt, Pharm.D., BCPS - Professor, Departments of Pharmacy Practice and Family Medicine at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the recreational use of marijuana and its potential health consequences.

Key Lessons:

  • Cannabis (marijuana) use has increased substantially in the past decade.  Young adults are the most likely to report using marijuana in the past year or month but use among older adults (age > 65 years) is growing as well.
  • Its important to ask patients in a non-judgmental, open-ended manner about their cannabis use including the intended purpose(s), frequency of use, and forms used.
  • Numerous cannabis products are available. Inhaling (smoking or vaping) remains the most common method for use.  Edible products are available in a wide variety of food-like delivery systems (e.g. baked goods, candies).  Topical products are more commonly used for medical purposes.
  • The THC concentrations found in cannabis products today are much higher than years ago. This has resulted in higher rates of unintentional overdoses leading to paranoia and psychotic symptoms. Overdosing is most common with edible products due their delayed absorption.
  • There are several short-term and long-term health consequences related to marijuana use. Regular cannabis use can lead to neurocognitive effects including impaired memory. Cannabis use is more likely to have a detrimental impact for adolescents and young adults. Cannabis use during pregnancy also appears to have detrimental neurocognitive effects on children.
  • There are several potential drug-drug interactions with THC and medications metabolized through CPY2C9 and CPY3A4 as well as receptor interactions.
  • Pharmacists have an important public health role by screening for cannabis use, educating patients about the potential risks associated with marijuana use, and identifying potential drug-drug interactions.

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Marijuana Use - Medical, Health, and Legal Issues (I)

Marijuana Use - Medical, Health, and Legal Issues (I)

June 18, 2019

Kari Franson, Pharm.D., Ph.D., BCPP - Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the medical use of marijuana, THC, and CBD.

Key Lessons:

  • Cannabis plants have been used for medical, recreational, and industrial purposes for thousands of years.
  • The two active ingredients in cannabis plants include tetrahydrocannabinol (THC) and cannabidiol (CBD) - collectively known as cannabinoids.  They have distinctly different pharmacological properties.
  • Cannabis plants that contain less than 0.3% of THC by dry weight are legally classified as hemp.  Cannabis plants can be cultivated to have more (or less) THC and CBD content.
  • Prescription products containing THC have been available for more than 30 years. A buccal spray containing THC + CBD has been approved (but not in the United States) for the treatment of muscle spasms/stiffness associated with multiple sclerosis.  A purified CBD product was approved by the FDA for the treatment of rare childhood seizure disorders in 2018.
  • There is a long list of claimed medical uses of marijuana (typically contains high concentrations of THC).  Not all claims are supported by sufficient evidence and some have been refuted by the evidence.  Far less is known about the medical uses of CBD.
  • Cannabinoids are erratically and slowly absorbed from the GI tract.
  • There are substantial legal barriers to studying cannabis and its health consequences in the United States.

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Credentialing & Privileging (III)

Credentialing & Privileging (III)

May 15, 2019

Brandon Shank, PharmD, BCOP - Clinical Pharmacy Specialist at the University of Texas MD Anderson Cancer Center - talks to us about credentialing & privileging from a front-line clinician's point of view.

Key Lessons:

  • Building rapport and trust with your team is an essential first step from which clinical privileges follow.
  • State laws vary.  Some authorize privileging of pharmacists at the institutional level.
  • Obtaining and maintaining clinical privileges requires additional training ... and paperwork.
  • Pharmacists have a unique understanding of the dosing and available dosage forms of drugs - this brings value to the patient care team.
  • Privileging pharmacists to take on advanced clinical responsibilities can increase team efficiency and effectiveness.

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Credentialing & Privileging (II)

Credentialing & Privileging (II)

April 16, 2019

Julie Groppi, PharmD - National Program Manager, Clinical Pharmacy Practice Policy and Standards, Department of Veteran's Affairs and Todd Nesbit, PharmD, MBA - Director of Pharmacy Patient Care Services, the Johns Hopkins Hospital - discuss the credentialing and privileging of pharmacists.

Key Lessons

  • Credentialing is the process of verifying someone education, training, certifications, and experience. 
  • Privileging is the process of determining an appropriate scope of practice based on the practitioner's credentials and granting authority to carry out specific patient care services/decisions.
  • All health systems should credential the pharmacists they employ.
  • Pharmacists can be privileged to initiate, modify, continue, or discontinue medication therapies as well as order tests and referrals as needed to achieve treatment goals.
  • A pharmacist's privileges may be restricted to specific drugs and disease (e.g. collaboratory drug therapy management agreement) or may be service-specific (e.g. all patients enrolled in or assigned to a specific clinical service unit).
  • The credentials necessary to be privileged to carry out advanced patient care services typically include residency training and board certification.

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Credentialing & Privileging (I)

Credentialing & Privileging (I)

March 13, 2019

Joseph Saseen, Pharm.D., BCPS, BCACP, CLS - Professor of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - discusses the various credentials pharmacists can earn following graduation and licensure.

Key Lessons

  • Credentials include degrees, licensure, post-graduate training, and board certification.
  • Earning a certificate is not synonymous with becoming board certified.
  • Board certification requires candidates to meet specific eligibility criteria and pass a comprehensive examination to validate the breadth and depth of knowledge in the area of specialization.
  • Board certification can give pharmacists a competitive advantage for employment and open doors to new opportunities.
  • Candidates should consider preparing for a board certification exam either through a formal, structured program or forming a study group ... or both.
  • Obtaining advanced credentials is ultimately about improving the quality of care pharmacists provide to patients.

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Opioid Overdose Crisis (III)

Opioid Overdose Crisis (III)

January 16, 2019

Carol Ott, Pharm.D., BCPP - Clinical Professor of Pharmacy Practice, Purdue University College of Pharmacy and Residency Program Director for the Eskenazi Health/Purdue University PGY2 Psychiatric Pharmacy Residency Program - discusses how sigma adversely impacts patients with opioid use disorder and how the BoilerwoRx program is helping to address the opioid crises at the community level.

Key Lessons

  • Health professionals too often use stigmatizing language when describing patients with a substance use disorder and their behaviors.
  • We need to critically examine our unconscious biases toward patients with substance use disorder.
  • Substance use disorders are most often co-morbid with other mental health conditions.
  • Needle exchange programs are an evidence-based intervention that can reduce harm by preventing the spread of infectious diseases and be an important touchpoint to get people into treatment.
  • There are numerous ways pharmacists can help patients with substance use disorders - approaching them with empathy, volunteering, and using evidence-based resources to guide care and combat misinformation.

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Opioid Overdose Crisis (II)

Opioid Overdose Crisis (II)

December 13, 2018

Suzanne Nesbit, Pharm.D., BCPS - Clinical Pharmacy Specialist in Pain and Palliative Care at the Johns Hopkins Health System - and Lucas Hill, Pharm.D., BCPS, BCACP - Clinical Assistant Professor at the University of Texas at Austin and Director of Operation Naloxone - discuss how to improve patient safety by implementing opioid stewardship and harm-reduction strategies.

Key Lessons

  • Opioid stewardship requires multiple components starting first with a commitment to change and includes opioid prescribing guidelines, provider feedback, and patient education.
  • Discussing the goals of therapy, intended treatment duration, and realistic expectations with patients when opioids are prescribed is critical.
  • Patients at high risk of opioid overdose should receive naloxone and trained how to use it.
  • Naloxone standing orders or collaborative practice agreements can facilitate access.
  • Information from prescription drug monitoring programs can be helpful during the medication review process but providers must recognize their limitations.
  • Pain relief requires a patient-specific approach. Patients with a substance use disorder deserve to have their pain addressed too.

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Opioid Overdose Crisis (I)

Opioid Overdose Crisis (I)

November 14, 2018

Jeffrey Bratberg, Pharm.D., BCPS - Professor of Pharmacy Practice at the University of Rhode Island talks with us about the opioid overdose crisis - it's causes and potential solutions.

Key Lessons

  • The causes of the opioid overdose crisis are multifactorial but rooted in hopeless and despair
  • Illicitly obtained synthetic opioids are very potent and the leading cause of opioid overdose deaths today
  • Opioid use disorder is a brain disease and all patients deserve compassionate care
  • The response to the opioid overdose crisis (to date) has been anemic due to societal stigma and unconscious bias
  • Supply-side solutions (e.g. prescription drug monitoring programs) to the problem may seem helpful but have unintended consequences
  • Naloxone should be widely available and all health professionals should carry it

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Pharmacists Patient Care Process (III)

Pharmacists Patient Care Process (III)

October 18, 2018

Kristina Butler, Pharm.D., BCPS, BCACP - Manager of Clinical Pharmacy Specialists in Primary at the Providence Medical Group in Portland, Oregon talks with us about implementing a consistent patient care practice model across multiple sites.

Key Lessons: Implementing a consistent model of care begins with hiring people who have the appropriate training & experience followed by a robust orientation process and supplemented by ongoing peer review; high-quality clinical pharmacy services need to be consistently available; more experienced practitioners may need to reframe their thinking and update their terminology in order to consistently teach learners about the pharmacists patient care process.

Helpful Resources:  Check out the Patient Care Process chapter in Pharmacotherapy: A Pathophysiologic Approach and the Patient Care Process for Delivering Comprehensive Medication Management report.