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Patients who used psychotropic drugs in suicide attempts were more likely to have had prescriptions for them

As prescriptions for psychotropic drugs increase, researchers at the University of Colorado Anschutz Medical Campus have found that prescribed access to anti-anxiety and anti-psychotic medications may make it easier for some patients to use the drugs in attempted suicides.

“In a study focused on people who attempted suicide, those who used a psychotropic drug in an attempt were 70 percent more likely to have prescribed access than patients who used other methods in their attempt,” said Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health at CU Anschutz.

Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health
Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health.

The study was published last week in the Journal of Clinical Psychiatry.

Suicide is the 10th leading cause of death in the nation with 45,000 fatalities in 2016, more than 200,000 hospitalizations and 500,000 emergency department visits.

Survival often depends on the method used and the method usually depends on having physical access to it. Intentional poisoning accounts for 15 percent of all fatal suicides and between 54-68 percent of nonfatal suicide attempts. Drugs make up the vast majority of those poisonings.

The study investigated the association between prescribed access to psychotropic drugs and using them in a suicide attempt. The researchers used a large, nationally representative insurance claims dataset of 27,876 people who had attempted suicide at least once.

They found that 10,158 of them had used psychotropic drugs in their attempt. The most commonly used were antianxiety medications, followed by antidepressants, antipsychotics or mood stabilizers and stimulants. About 13 percent used more than one drug.

Overall, some 23 percent of those in the study who used psychotropic drugs in a suicide attempt had filled prescriptions for the drugs within 90 days before their suicide attempt. That led researchers to ask how so many other people who attempted suicide gained access to the medications they took.

Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

“The most likely options were from family and friends, previous prescriptions filled prior to our exposure period, medications purchased outside of insurance plans or on the black market,” the study said.

Brown said it was important to safely store all over-the-counter and prescription drugs, not just the most toxic, especially when there is a friend or family member at risk of suicide.

The findings offer a number of lessons and insights into prescribing these drugs, said the study’s senior author Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

“Restricting or modifying access to psychotropic drugs will require increased attention by all healthcare professionals, particularly pharmacists who are well-positioned to talk to their patients about safe medication use and storage,” she said. “It is important to stay on top of a patient’s depression, stay on top of their prescriptions and monitor suicidal ideation.”

Providing medicine in blister packs has been successful in other countries in reducing deaths because it requires time and effort to remove enough of the drug for an overdose. And people can change their minds during that time.

Ultimately, Brown said, those at high risk for suicide with prescriptions for psychotropic drugs should be closely monitored for potential safety interventions.

The study co-authors include: Peter M. Gutierrez, PhD; Gary K. Grunwald, PhD; Carolyn DiGuiseppi, MD, PhD; Robert J. Valuck, PhD.

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CU Pharmacy earns national awards for community service, excellence in assessment

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences was recently recognized with two national awards at the American Association of Colleges of Pharmacy’s (AACP) annual meeting.

“I am very happy that we were recognized on a national stage for the good work we and our students do at our school and in our community,” said Dean Ralph Altiere.

The school received the 2017 Lawrence C. Weaver Transformative Community Service Award along with the AACP Award for Excellence in Assessment.

Transformative Community Service Award

The Transformative Community Service Award is presented annually to a school of pharmacy that demonstrates a commitment to addressing unmet community needs through education, practice, and research. This should be demonstrated through the development of exceptional programs that go beyond the traditional service role of academic pharmacy.

During a site visit with AACP, CU Pharmacy showcased several programs, they refer to as their Colorado Commitment, including prescription drug abuse prevention and the combatting the opioid epidemic, rural health programs, commitment to community health centers and Federally Qualified Health Centers through faculty positions, student rotations, and scholarly work, the Aurora Elementary Schools Nutrition Program – in which over 1,500 pharmacy students and 8,000 elementary students have participated since program inception, and finally their work with the Community Campus Partnership and the work of Robert McGranaghan, MPH.

CU Pharmacy faculty member, Gina Moore, PharmD, gathered all the elements needed for the award submission, “Thanks to Dr. Moore’s commitment and persistence over the years in preparing our award application and arranging our site visits and the great work of our faculty and students,” said Dean Altiere.

“Gina and everyone at the School of Pharmacy – congratulations! The School of Pharmacy has been a great champion and leader on the campus for community engagement and this award gives further evidence of that,” added Robert McGranaghan.

The award consists of a commemorative sculpture honoring the institution’s extraordinary social commitment and $5,000 to distribute to community partners to support continuation or expansion of their collaboration.

Excellence in Assessment

The school received the AACP Award for Excellence in Assessment thanks to work by faculty members Eric Gilliam, PharmD, Jason Brunner, PhD, Wesley Nuffer, PharmD, Toral Patel, PharmD and Megan Thompson, PharmD.

The award recognizes outstanding Doctor of Pharmacy assessment programs for their progress in developing and applying evidence of outcomes as part of the ongoing evaluation and improvement of pharmacy professional education. The manuscript CU Pharmacy faculty submitted was titled: Unique Assessments for Unique Experiences: Content Validation of Three Assessment Tools for Advanced Pharmacy Practice Experience Rotations.

“The Experiential Education Committee at CU Pharmacy used a data-driven validation and assessment plan to guide the design, testing, and implementation of five high-stakes advanced pharmacy practice experience (APPE) student assessments,” explained Jason Brunner, PhD.

The use of a four-year validation plan to guide the design, testing, and implementation of new final APPE student performance evaluations resulted in significant and positive changes to the experiential education program.

“Students must demonstrate a readiness to practice pharmacy prior to graduation, and we are now better able to document each student’s level of skill during each experiential program. Compared to our prior performance evaluations, the value of the feedback to the student has much improved. We trust when a preceptor indicates a student is ready to practice, that the student truly is ready to advance in their career,” said Eric Gilliam, PharmD.

Ultimately, the five new APPE assessment tools, each unique to its own practice setting and designed by input of active preceptors,  have proven to be effective in providing reliable and meaningful feedback for students.

Congratulations to the CU Skaggs School of Pharmacy on both awards and the national recognition!

Guest contributor: This story was written by Stephanie Carlson, content producer, Skaggs School of Pharmacy and Pharmaceutical Sciences.

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Rapping his way through the Curriculum

Lee Amaya, stage name SouLeePharmD, is our very own rapping pharmacist.

Amaya fell in love with rap music and poetry during high school. “I became infatuated with the flow and rhyme schemes of songs while listening to my favorite artists. The raw passion displayed and the topics they rapped about resonated with me,” says Amaya.

Inspired, he began writing and producing his own rap music that he shared over the Internet. “Rap provided me with an outlet to voice my grief and frustrations with the world. Being a science nerd, this allowed me to express a side of me that I rarely revealed.”

One of his first live performances was in front of his entire high school.  “No pressure there!” says Amaya.

The performance was part of a Senior Project that was required to graduate from the Skaggs School of Pharmacy and Pharmaceutical Sciences. Consisting of an internship, mentorship, faculty-run seminar or independent project of the student’s design, the project is quite the undertaking. Instead of the usual fare, Amaya asked if he could compose a rap album and the school agreed — of course with the oversight of his honors English teacher. Most would choose creating and producing one song in five weeks, but Amaya chose an album!  Then, he selected one song to perform at a school-wide assembly. That project solidified his interest in the art form and he’s been writing, performing and producing ever since.

“Because my time was extremely limited during pharmacy school, I didn’t have a lot of time to be creative and write raps during the program,” says Amaya. He did, however, write and record one rap during his fourth year for a reflection project.  The song, which highlights his experiences as a pharmacy student, is the basis for a music video that is currently in development at the school.

Future goals for Amaya include creating educational raps about pharmacy-related topics in a similar fashion to ZDoggMD, who raps about medical issues and conditions and releases them to the public through social media.

“I would love nothing more than to be able to combine my musical talents with my pharmacy knowledge by writing songs about various healthcare topics to educate those who learn in an auditory manner,” says Amaya.

In the meantime, Amaya has lined up a PGY-1 residency at Nebraska Medicine in Omaha, which is sure to consume a lot of his time. ”Once I’m finished with residency and have more free time on my hands, I will definitely try to become the rapping pharmacist!”

Mic drop.

Reflections of  a P-4

Verse 1:

Let’s take a trip down memory lane

To recognize the school that left me better than I came

Now professionalism is steady flowing through the veins

And infected with wisdom to analyze gram stains

 

At the University of Colorado

Leadership in pharmacy has always been the motto

Faculty members have set examples we can follow

Phi Delta Chi Sigma Brothers yelling “bravo!”

 

Now looking back to first year

I get real sense of what I learned here

Communication skills, how to make the pills

And a genuine devotion to reshape the field

 

Through interprofessional education

Got to work with students of different healthcare occupations

Determining the plan of patient simulations

And giving way too many case presentations

 

Hook 1:

And now I’m dosing Vanco

Pharmacokinetics is a pharmacy staple

Ensuring safety, and our patients are stable

Crash cart filled and the meds are labeled

 

We do more than count by fives

Always taking time saving patient lives

Looking over DDI’s

And the prodrugs that need to hydrolyze

 

(Break)

 

Verse 2:

We are the Skaggs School of Pharmacy

In the mile-high city where it’s hard to breathe

Whether asthma, infection, or heart disease

We stay monitoring meds in the chart with ease

 

In addition to creatinine clearance

Calling all our patients to verify their adherence

Giving education so that they can understand

That they’re taking Synthroid for their thyroid gland

 

And with so many doses

Always gotta remain focused

Learning pharmacotherapy from respected professors

Authors to guidelines every semester

 

They helped me become independent practitioner

When pharmacy training required analyzing literature

And working with a team to improve patient outcomes

All my APPEs, couldn’t’ve done it without ‘em

 

Hook 2:

And I sit here grateful

For every teacher that was willing to provide me

Guidance, education ‘til I got a brain full

Can’t contain appreciativeness inside me

 

And let’s not forget my peers

Who throughout the years gave me lots of cheer

I am ready for my career

And to practice at the pharmacy frontier

Guest contributor: Dana Brandorff

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Answering the call: Line9 partnership puts pharmacy school to action

As soon as Bayli Larson hung up the phone, it rang again. She closed her eyes. It rang again. On the third ring, Larson took a deep breath, exhaled slowly and picked up the receiver.

Larson, a fourth-year graduate student in the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, wasn’t facing a harassing caller. A firm believer in the benefits of volunteering, Larson was staffing the phones for Pharmacist Line9.

Although the 90-minute phone marathon can offer a crash course in stress control and mental cleansing, it provides CU, volunteers and Channel 9 viewers so much more, participants say.

“It gave me a sense of the needs of the community members, and it helped me learn how to think on the spot,” Larson said. “As a pharmacist, it’s really important to be able to communicate effectively and respond accurately in a way that the patients understand. It was great practice.”

Fulfilling a growing need

Because of the popularity of the service (no volunteer’s phone ever sits quiet) coupled with serious medical matters taxing the community, Channel 9 recently boosted the airings, making Pharmacist Line9 a monthly event, said Lynne Valencia, Channel 9 vice president of community relations.

Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event. — Briana Williams

From an opioid-addiction crisis gripping the state to a severe flu season lingering on, critical issues have heightened the need for the partnership, said Valencia, an alumna of CU Denver. “CU students and faculty members supply the expertise that people are looking for, and we provide the platform. They offer our viewers sound advice and a great service.”

Volunteering ranks high on the priority list of CU’s pharmacy school, recently named the recipient of the 2017 Lawrence C. Weaver Transformative Community Service Award from the American Association of College of Pharmacy (AACP). While fulfilling unmet needs in the community, volunteer events move CU students’ education beyond the textbook.

“It really can help supplement what you are learning in class,” said third-year graduate student Briana Williams, an active volunteer, including with Line9, and an intern at University of Colorado Hospital. “You definitely get questions right off the bat that you are like: I have no idea how to answer this. But you have to think on your feet and use the resources that you are taught in pharmacy school.”

Briana Williams on 9Line desk
Briana Williams, left, takes a rare break to smile for the camera. Her colleagues, from left to right: Liza Wilson Claus, Emily Zadvorny and Peter Rice.

Facing tough questions

Armed with Centers for Disease Control guidelines and other medical and prescription directives, Williams and Larson quickly fell into the groove of the call-ins, which generally include two students and two faculty members. Apprehensive her first time, when she was a second-year student, Larson said she remembered a lesson from school: It’s OK to say I don’t know.

Calls can run the gamut from the simple — Where can I get a flu shot? — to the moderate — How do I dispose of addictive medications? — to the complicated — What will I do if I can’t refill my pain-pill prescription?

With new regulations threatening opioid access, many calls relate to the crisis, including from fearful patients who rely on the drugs, Larson said. “I found those questions kind of challenging. A lot of these people have been living with chronic pain for years, and it’s the only thing that can get them out of bed in the morning.”

The anonymity factor can embolden callers to ask more complicated and sensitive questions, Williams said.  “Without having to actually go to a physician or pharmacist and see them face to face, they can ask these questions without thinking in the back of their minds that somebody is judging them,” she said.

Volunteers can confer with their colleagues on the Line9 desk, or, when a question falls outside of their expertise, refer the callers to their physicians, Williams said. “You have to know your boundaries and your scope of practice.”

Educating the pubic

Regardless of whether they can answer the question, the volunteers educate patients and urge them to use their physicians and pharmacists as resources. “I don’t know a pharmacist who wouldn’t provide any patient a phone consultation, but a lot of people don’t know that,” Larson said.

I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals. — Briana Williams

Williams, who said she chose the CU Anschutz Medical Campus for graduate school partly because of the state’s progressiveness in the pharmaceutical field and the school’s emphasis on multidisciplinary teamwork, said taking part in events like Line9 also helps educate people about her profession.

“I think it really gets out to the public that pharmacists are not just pill-pushers; that we really have a lot of education that we go through to provide more services. And we are typically one of the more accessible health care professionals.”

‘A greater purpose’

A lot of people don’t know where to go for help, Williams said. “Many of the questions I answered I felt really made a difference in their lives, whether it was preventing drugs from falling into the wrong hands or averting a serious health event.”

In today’s competitive world, volunteering can also boost student’s chances at jobs and residency programs, said Williams and Larson, who both work in pharmacies and have their eyes on residencies post-graduation. Larson recently learned that she matched to a PGY1 residency with UCHealth Memorial in Colorado Springs.

Residencies are not required, but they can help set pharmacy students up for careers in hospitals and clinical settings after graduation. This year’s residency numbers for CU Pharmacy are on par with previous years, with 64 percent of those who applied matching, tying the national average.

“I just can’t stress it enough how important work and volunteering is,” Larson said.  It also helps students stay focused on what comes at the end of their heavy college load. “I remember going to work after an exam and being grateful to see there’s a lot to look forward to,” she said. “It’s all for a greater purpose.”

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Expensive new cancer therapy may be cost effective

Researchers from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, selected to estimate the cost-effectiveness of the newly approved CAR-T therapies, have found the clinical benefit may justify the expensive price.

The treatments involve removing immune cells known as T-cells from the patient, genetically engineering them to kill cancer cells and then putting them back in the body. The therapy is known as CAR-T or chimeric antigen receptor T-cell therapy and is FDA approved for some B-cell cancers, including acute lymphoblastic leukemia in pediatric and young adult patients and those with adult lymphoma.

Jon Campbell, PhD, associate professor of pharmacy.
Jon Campbell, PhD, associate professor of pharmacy.

The evidence suggests a potentially great benefit from these therapies, but the treatments are costly. The leukemia therapy, known as Kymriah, costs $475,000 while the lymphoma treatment, Yescarta, costs $373,000. So the non-profit Institute for Clinical and Economic Review (ICER) enlisted the help of pharmaceutical outcomes research faculty Melanie Whittington, R. Brett McQueen, and Jon Campbell from the CU Skaggs School of Pharmacy to generate evidence on whether the treatments, already approved by the FDA, are cost-effective.

The draft report of their findings was published Wednesday on the ICER website. After a public comment period, the researchers in collaboration with ICER, will finalize the report and present the findings at a public forum on March 2, 2018.

In the draft report, they compared CAR-T therapies to chemotherapy, taking into account patient survival, quality of life and health care costs from the health care system perspective over the lifetime of a patient receiving the therapies.
“We take into account the clinical evidence, quality of life data, and health system costs to generate cost-effectiveness evidence,” said Whittington, PhD, research instructor at the CU School of Pharmacy.

According to Jon Campbell, PhD, associate professor of pharmacy, the cost-effectiveness findings for both CAR-T therapies were `promising’ and suggested that they may be a good use of our health care resources toward improving health. They significantly extended the lives of some patients, much more on average, than traditional chemotherapy.

“The CAR-T science is beyond whether the therapies work for certain patients and is now questioning its value,” he said. “CAR-T is promising on the clinical side but there is some feeling of sticker shock related to the price. Is it worth it? Yes, it seems to be.”

Does the cost-effectiveness of therapies matter in the U.S.?

“The straightforward answer to that question is yes,” said McQueen, PhD, assistant professor of pharmacy. “Insurance companies have a higher likelihood of providing access and payment for therapies that are considered good value for money.”

Campbell, who is director of pharmaceutical outcomes research graduate track at the Center for Pharmaceutical Outcomes Research at CU Anschutz, noted that cost-effectiveness doesn’t mean cheapest and it doesn’t mean denying access.

“It’s about ensuring patients have access to high value care while sustaining our health system for future generations,” he said.

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Pharmacy school enrollment numbers up despite drops nationally

Skaggs brags:

There’s good news to share from the Skaggs School of Pharmacy and Pharmaceutical Sciences (CU Pharmacy). Applicant numbers at CU Pharmacy have risen 30 percent, even as applications to pharmacy programs nationwide are down 3 percent.

While the number of pharmacy schools in the U.S. has increased from 80 in 2009 to 143 today, the number of students applying to pharmacy programs seems to have plateaued. In the resulting competition for pharmacy students, CU Pharmacy is faring well – and the school’s leaders credit high-quality academic programs and enhanced recruitment efforts for this success.

“We are a top-tier school,” said  CU Pharmacy Dean Ralph J. Altiere, PhD. “We recognize that competition for students has increased considerably over the past few years, and that led us to undertake a reorganization to establish a marketing unit last year.”

Stellar faculty and students

A growing reputation and top-notch academic and professional programs are motivating students to apply to and attend CU Anschutz’s No. 22-ranked pharmacy school.

Hartsfield family
CU Pharmacy student Eric Hartsfield and his family

“Skaggs has a reputation within the profession that is nationally and even internationally recognized,” said Hawaii native and second-year CU Pharmacy student Ryan Sutherlan. “Other schools that I considered also had strong reputations, but I worried that they may not be able to challenge me in the way I felt CU would.”

Both Sutherlan and first-year pharmacy student Eric Hartsfield noted the campuswide Interprofessional Practice & Education program as a driver for their interest in the school.

“I believe the future of medicine is based in collaborative care and want to learn as much about it as I can,” Hartsfield said. “I have really appreciated the stellar faculty and high-quality facilities of the campus.”

And as students express satisfaction with the pharmacy school, CU Pharmacy leadership express pride in both the students and faculty.

“Our students consistently outperform other schools by winning national competitions,” Altiere said, “and our faculty are lauded nationally with education and clinical awards.”

Strategic outreach and recruitment

To build on its reputation and promote its successful programs, CU Pharmacy has centralized and fortified its recruiting, marketing and communications efforts into a six-person team led by Dana Brandorff, director of marketing, communications and alumni affairs.

The team is implementing several new tactics to reach prospective students, including a strategic database management system, a multi-pronged advertising campaign and a live chat feature on the school’s website. To complement these traditional and digital approaches, the marketing team has had in-person interactions with more than 3,000 prospective students, advisors and influencers at conferences and other pharmacy events.

These efforts have led to that 30-percent application increase, as well as a completely full 2017 incoming class for the school’s PharmD program. And now the challenge, Brandorff said, is not just attracting students but changing the perception of what pharmacists do.

“The perception is that pharmacists only dispense medications,” said Brandorff, who came to CU Pharmacy in 2009. “Today, pharmacists are on the front lines of health care – in the ER collaborating with nurses and doctors, in clinics managing diabetes or heart disease patients and at independent pharmacies compounding medications or vaccinating patients. Our job is to help the general public understand the vital role pharmacists play in health care.”

To that end, the group engages in various community outreach activities, including volunteer days at health fairs and other events; a new Speakers’ Bureau showcasing faculty, alumni and students; and a new education initiative focusing on academic advisors, faculty members, administrators and students at Colorado universities. The school also conducts live, once-a-month call-ins on 9News and creates and distributes its own video content that is regularly aired by local and national television outlets.

Ryan Sutherlan
CU Pharmacy student Ryan Sutherlan

CU Pharmacy is also helping change Colorado laws to allow pharmacists to be reimbursed for pharmacy services other than dispensing. Altiere believes this would create more opportunities for pharmacy practice and help change how the public values pharmacists.

Top-choice pharmacy school

Although changing perceptions takes time, many student perceptions are right where CU Pharmacy wants them to be.

“At CU Anschutz, I am consistently impressed and humbled to be among the ranks of the amazing student body, who are so wildly unique, brilliant, compassionate and welcoming,” Sutherlan said. “It’s like being a part of a large, extended family.”

And Sutherlan said this positive experience began before he even enrolled as a student.

“CU Pharmacy always reached out to me … which stood in contrast to other schools’ carbon-copy communications,” Sutherlan said. “I don’t regret my choice of schools at all.”

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Despite efforts, barriers to emergency contraceptives remain

Efforts to win greater access to emergency contraceptives (EC) saw some success in 2013 after the U.S. Food and Drug Administration removed age restrictions on over-the-counter sales of the levonogestrel drug Plan B.

But a new study shows those needing EC can still encounter cost and availability barriers.

Laura Borgelt, PharmD, professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences
Laura Borgelt, PharmD, professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences

Researchers at the University of Colorado School of Medicine discovered this when they asked 633 Colorado pharmacies in 2014 about EC access. They found EC completely accessible to just 23 percent of those who use them.

They report their findings in the latest issue of the journal Women’s Health Issues, “Barriers to Single-Dose Levonorgestrel-Only Emergency Contraception Access in Retail Pharmacies.” The study was selected by the editor of Women’s Health Issues as an Editor’s Choice article for the September/October 2017 edition.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Study author Van (Mimi) Chau, a student at CU School of Medicine, under the mentorship of Carol Stamm, MD, along with colleagues that included Laura Borgelt, PharmD,  a professor at the  University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences  used the Little Blue Book 2014, which physicians use for referrals, to identify Colorado pharmacies, and then had three researchers call the pharmacies posing as women seeking levonogestrel-only emergency contraception (LNG-EC). Chau was part of the University’s Leadership, Education, Advocacy and Development (LEADS) track while she worked on the project.

Study says barriers to emergency contraceptives remain
Study says barriers to emergency contraceptives remain

They asked each pharmacy whether they had LNG-EC in stock, whether it was located on the shelf or had to be requested from the pharmacy, whether a generic version was available, how much the product cost, and whether any additional documentation — such as proof of age or a prescription — was required to purchase the drug. The authors defined EC as being “completely accessible” at a pharmacy if the responding employee reported having it available on store shelves that day for purchase without presenting an ID or prescription. Accessibility is important because EC must be taken within 120 hours of intercourse, and research suggests it is most effective within the first 24 hours.

Chau and her colleagues found that 87 percent of pharmacies reported having LNG-EC in stock, but it was only completely accessible at 23 percent of the stores surveyed. Of the stores with the drug in stock, 42 percent reported it was behind the counter — i.e., had to be requested from a pharmacy employee — and 56 percent told callers an ID or prescription was required for purchase. Independent pharmacies were significantly less likely to have EC in stock (58 percent of independent stores vs. 90 percent of chain stores and 100 percent of 24-hour stores) or demonstrate complete access (10 percent vs. 25 percent and 15 percent), the authors report.

Requiring EC purchasers to request the drug from a pharmacy employee and present additional documentation are potentially substantial barriers, the authors note, because people may find it embarrassing to interact with an employee about reproductive healthcare and may lack the requested documents. Adolescents may not have identification or may not meet the age limit pharmacy employees believe to be in place.

When considering why pharmacy employees report outdated policies for documentation and behind-the-counter access, the authors point out that the age cutoff for LNG-EC products changed four times before being lifted completely, and suggest “delays in updating store policies or lag in information dissemination may explain the variability in knowledge among pharmacy staff about FDA regulations and requirements.”

“Although federal policy restrictions on LNG-EC have been removed, this study demonstrates that retail pharmacy-level policies can still create tangible hindrances in obtaining appropriate health care,” Chau and her co-authors write.

The study, “Barriers to Single-Dose Levonorgestrel-Only Emergency Contraception Access in Retail Pharmacies,” has been published in the September/October issue of Women’s Health Issues.

Guest contributor: Contact for this story is Jackie Brinkman.

 

 

 

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Pharmacy professor teaches personalized medicine in Egypt

Christina Aquilante, PharmD, was struck by many things during a recent trip to Egypt. Foremost was the profound thirst for knowledge displayed by health providers and students who enrolled in Aquilante’s intensive weeklong training program on clinical pharmacogenomics.

Group of students at Egypt hospital
About 90 attendees participated in the pharmacogenomics program taught by Christina Aquilante in Cairo, Egypt, in January.

“It was one of the best experiences of my career. The folks just wanted to learn so much,” said, Aquilante, associate professor in the Department of Pharmaceutical Sciences at the CU Anschutz Medical Campus. “I could have stayed probably 10 hours a day and they would have kept asking questions. They have such dedication and passion for taking care of their pediatric patients.”

Christina Aquilante of CU Anschutz
Christina Aquilante, PharmD, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

The 90 attendees included practicing pharmacists and physicians as well as medical and pharmacy students. Aquilante taught at Children’s Cancer Hospital Egypt (CCHE), which partnered with the CU Skaggs School of Pharmacy and Pharmaceutical Sciences on the clinical course. Sherif Abouelnaga, MD, and a few other leaders from CCHE, visited CU Anschutz last October and learned about Aquilante’s online certificate program on pharmacogenomics – the use of a person’s genetic makeup to inform the safe and effective use of medications. Abouelnaga asked if Aquilante would be interested in delivering the program live in Egypt.

Threefold purpose for visit

Pyramids of Egypt
Christina Aquilante did some sightseeing while in Egypt, including an excursion to see the pyramids outside Cairo.

“I said sure – I love to teach. They have a sophisticated hospital there and they’d just bought a new machine to do genotyping,” she said. “They are highly motivated to start incorporating genetic makeup into patient care at their institution.”

Aquilante arrived in Cairo in early January and, while enjoying a crash course in Egyptian culture, she launched the live training program, which had a threefold purpose:

  • Educate providers on pharmacogenomics.
  • Serve as the first program for CCHE’s new Health Care Sciences Academy.
  • Introduce active and practice-based learning to the Egyptian participants.

A team effort

Christina Aquilante, PharmD, was assisted with her pharmacogenomics course in Egypt by these health care professionals in Cairo and faculty at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences: Sherif Kamal, RPh, MSc; Mohamed Nagy, RPh, MSc; Jodie Malhotra, PharmD; Kari Fransom, PharmD, PhD; Manal Zamzam, MD; and Sherif Abouelnaga, MD.

While active learning is the norm in CU Anschutz classrooms, Egyptian education is still centered around didactic lectures, Aquilante discovered. “To change the dynamic, I’d give a lecture and then the attendees did exercises in teams and then we talked about answers to the case-based scenarios,” she said. “It was really an introduction of interactive and practice-based learning for them.”

Because world-class clinical personalized medicine and pharmacogenomics education – Aquilante’s course is required for all third-year PharmD students – is deeply rooted at CU Anschutz, the expertise of our campus’s researchers and educators is often helpful in developing countries where precision medicine is in its early stages. But it’s not always the case that these nations are short on resources, Aquilante said. In Egypt, for example, the hospital is equipped with sophisticated technology, she said, but the providers lack formal education on pharmacogenomics.

CU reaches out to all

“I think my trip speaks to how CU reaches out to all cultures and regions, promoting diversity and education across the world,” Aquilante said. She hopes the groundwork has been laid for an ongoing partnership between Skaggs School of Pharmacy and Pharmaceutical Sciences and the Cairo pediatric hospital.

Online class coming up

Christina Aquilante’s online course on Pharmacogenomics is so popular that she had to offer another session, which begins May 3. For more information or to register visit www.ucdenver.edu/pharmacy/continuingeducation

Aquilante submitted an abstract about her experience to an education symposium – Pharmacy Education and Collaboration for Global Practice – taking place in Italy this summer. The abstract, which is under consideration for acceptance, details how her trip “not only fostered clinical collaborations with health care providers in Egypt, but it fostered potential research collaborations, too.”

Aquilante returned to Colorado with gifts from appreciative attendees, photos of the pyramids and other sights around the ancient city of Cairo, as well as 90 new Facebook friends. One of the attendees said this about Aquilante’s class: “You were fantastic at explaining this course, making it easy for us to have new knowledge that we can use in our research and clinical implementation for our patients.”

A formal graduation ceremony was held for the attendees at the end of the 30-hour, five-day program. Participants literally jumped for joy, Aquilante said, and they celebrated with music, disco lights and even some dancing. “I wish more people had the opportunity to experience what I, personally, think Egyptian culture is all about,” she said. “They were really lovely people – extremely kind and hospitable.”

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CU Pre-Health Scholars Program’s Community Strengthening Project

CUPS high-school student
CUPS high school student

A select group of young adults with an interest in pursuing health careers receive an introduction to the many diverse opportunities available to them through the CU Pre-Health Scholars Program (CUPS) at the University of Colorado Anschutz Medical Campus in Aurora while they’re still in middle school and high school. The program often takes the students beyond the classroom into the community providing some highly impactful experiences. A Community Strengthening Project provided by the CUPS students to the Comitis Crisis Center near CU Anschutz, in conjunction with the CU Anschutz Medical Campus Office of Inclusion and Outreach, CU School of Dental Medicine’s American Student Dental Association Colorado Chapter, CU Skaggs School of Pharmacy and Pharmaceutical Sciences and Walgreens Pharmacy, included a pancake breakfast, along with free flu shots and take-care bags for center clients. The Comitis Crisis Center provides a safe shelter for individuals and families that find themselves homeless. In addition, the center offers visitors ways to rebuild their lives, support with family emergency housing shelter, daily meals, emergency cold weather shelter 24/7, mental health and substance abuse treatment.

The CUPS junior & senior high school students from around the Denver/Aurora metro area had the opportunity to serve pancakes, sausage, and orange juice to over 40 guests from the Comitis Crisis Center. CUPS participants played volleyball, football, and did crafts with the children.

A Walgreens pharmacist, along with two CU Pharmacy students, administered over 25 free flu shots to guests 7 years old or older.

CUPS high-school students
CUPS high school students
CUPS high-school students
CUPS high school students

Daisy Chapa, a senior from Overland High School and the CUPS class president, said, “It’s incredibly rare that students get an opportunity to sit down with homeless individuals and learn about their background and experiences.” The primary objective for the CUPS participants is to engage them in community service while learning more about the health disparities among the homeless population. In addition to flu shots and pancakes, CUPS participants gathered and donated hygiene items and created take-care bags for children, men, and women. Bags included items such as winter socks, feminine products, soap, lotion, toothbrushes and toothpaste.

Chapa continues, “I had envisioned middle-aged men with drug problems or mentally ill dependents; instead, we met families with tiny children and single parents. Some of these children were happy with their lives despite not having a home to live in or any material goods. They improvised with what they had and saw themselves as no less than anyone else, which is a mindset that even many grown adults fail to adapt to. Having the opportunity to meet with and interact with these individuals showed me to be grateful for what I have and, one day, I will work towards helping those who have fallen on hard times.”

CUPS Program Director Abenicio Rael said, “This was an eye opening experience for many of our students as well as our staff and myself. It reminded me of my own privileges and how to be aware of them before imposing them on others unconsciously.”

“The Anschutz Medical Campus Office of Inclusion and Outreach has done many wonderful things for my pre-collegiate group from exposing us to cadaver-based anatomy to professionalism in the academic world”, said Chapa. “But, the greatest thing they have ever done is remind us to be humble and human by not getting carried away with ignorance or selfishness. The pancake breakfast served as a reality check for some of us, for others, it was a reminder that we are all humans struggling to find one thing- happiness.”

Guest Contributor: Dominic F. Martinez, Ed.D., Senior Director of the CU Anschutz Medical Campus Office of Inclusion and Outreach

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Cherry Creek High student does nanoparticle research at CU Anschutz

Hariatbench

When 16-year-old Hari Sowrirajan says, “You can’t just buy nanoparticles at the supermarket,” you realize quickly that this down-to-earth high school student is doing some out-of-this-world science.

What you don’t know is that Sowrirajan has been working with researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences since he was a 13-year-old middle schooler—too young to step inside a CU Anschutz laboratory—all because he wrote a single email to a researcher he had never met.

How he got a foot in the door

Like many younger brothers, Sowrirajan was inspired by watching his older sister enter science fairs. By seventh grade, he decided to tackle his first project, manipulating carbon dioxide in water with cyanobacteria. Ready for new challenges in the eighth grade, he found an “intriguing” article about researchers introducing nanoparticles—particles between 1 and 100 nanometers in size—into water, focusing sunlight on the water and discovering that it boiled at a lower temperature.

“So much of our energy is generated by using fossil fuels to heat water,” Sowrirajan said. “If we could focus sunlight on nanoparticle-filled water, and the water produced steam at a lower temperature, the implications are profound.”

The eighth grader decided to spin his research off the article, trying to determine the optimal conditions for the process to work. Getting access to sunlight was not a problem, but the nanoparticles presented a far greater challenge. Undaunted, Sowrirajan did a Google search. The name Jared Brown, PhD, and the Nanotoxicology Laboratory popped up. With the help of his mother, Sowrirajan wrote an email to Brown.

“I have had young students in my lab before and it’s always fun,” said Brown. “Hari was the youngest, but his email was impressive because he already had a project outline, and so I wrote him back.”

“I was surprised and thrilled,” said Sowrirajan. “To this day, I don’t know why they responded and agreed to help.”

HariJonathan

Hari Sowrirajan and Jonathan Shannahan discuss Hari’s current science fair project.

Hariresearch

Conclusions from Hari’s current science fair project, which looks at how nanoparticles influence the epithelium.

What he learned at CU Anschutz

After Brown gave Sowrirajan a green light, Jonathan Shannahan, PhD, research assistant instructor in the Nanotoxicology Laboratory, took over as chief mentor to the young student.  Shannahan acquired the nanoparticles and prepared the samples. “We handled them for him in a safe manner to mitigate any danger,” Shannahan said. “It was a very ambitious project but he had the desire to succeed.”

Too young to work inside the lab, Sowrirajan picked up the materials and received guidance at CU Anschutz, did the experiments at home and then returned to the pharmacy school to discuss experimental design, look at the data and assess results with Shannahan.

Sowrirajan described that experiment as “a lot of trial and error,” but his fascination with nanoparticles—which can be found in car tires, printer toner, lotion and drug delivery systems—kept him going. His science project placed first in the Environmental Science category in the Denver metro-area science fair; he went on to the state fair where he again placed first in his category.

A year later, in ninth grade, Sowrirajan advanced even further to the International Science Fair in Pittsburgh with a project looking at how nanoparticles influence cardiovascular disease development.

This year, Sowrirajan tackled an even tougher project, studying how nanoparticles influence the epithelium, the thin tissue lining the lung. With few resources to guide his work, he found himself venturing into the unknown and collecting massive amounts of data.

“I learned so much about the scientific process,” he said. “You aren’t going to always know what’s going to happen.”

“When he started, I was always looking over his shoulder, but now we have developed trust,” Shannahan added. “At the beginning, he just wanted to work with nanoparticles because they are cool. Now, he is a functioning scientist and a part of our lab family.”

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What he forgot to mention

Despite his scientific success at such a young age, Sowrirajan remains well-rounded. He is in the math club at Cherry Creek High School, where he also plays on the soccer team and runs track. He also plays the guitar and violin. Even with those accomplishments, he remains unassuming, so much so that during an interview he failed to mention one of his most significant accomplishments. Along with PhDs from CU Anschutz and Clemson University, he is listed as one of the authors on a scientific paper published by Brown’s lab, “Impact of silver and iron nanoparticle exposure on cholesterol uptake by macrophages.”

“Not too many high school students in the country have a published paper,” Brown said. “What he has accomplished is not unheard of, but he is unusual because he has done everything so well at such a young age.”

Sowrirajan also submitted an abstract of his work to the National Society of Toxicology for its annual meeting. He was accepted but he couldn’t go because of school commitments. Rather than drop him, the conference set him up on Skype, making him the first scientist in the history of the society to do a virtual presentation.

Sowrirajan has not yet decided what direction his career will take him after high school, but wherever he lands, he will bring with him years of professional research training thanks to Brown and Shannahan, and for that he is very grateful.

“When I was in elementary school, science was just glamorous explosions and test tubes filled with colorful solutions,” Sowrirajan said. “For better or for worse, I now know what it’s really like to work in a lab doing research that has the potential to impact millions of lives.”

 

 

 

 

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