Pharmacies may not stock naloxone, despite statewide orders

[ad_1]

(Reuters Health) - More than three years after Pennsylvania issued a statewide order expanding access to the life-saving opioid antidote naloxone, the product was still hard to purchase in Philadelphia pharmacies, researchers found.

In 2017, two-thirds of pharmacies in Philadelphia either did not stock naloxone, or they still insisted on a physician’s prescription, which the law said was no longer required.

In the wake of the opioid addiction crisis that has claimed thousands of lives, many U.S. states have passed laws like Pennsylvania’s, which allow the drug to be dispensed without a prescription and mandate that every drugstore carry it.

Laws that let pharmacists sell naloxone without prescription have been associated with a nearly 30% drop in the number of opioid overdose deaths, a separate team of researchers reported last month. (reut.rs/2WM3qMa)

Yet this study is not the first to find that drugstores are slow to comply. Research has shown that most pharmacies in California and Texas, for example, do not carry the drug or make it readily available.

The new results add to the growing body of evidence that these laws are not being enforced, experts said.

“While policy can be put in place, it’s not sufficient and has to be followed up with education, and reinforcement at the county and pharmacy level, and not just assume that the policy itself will ensure access to anyone who needs it,” Dr. Michael Lynch, a toxicologist and emergency medicine physician who was not involved in the study, told Reuters Health.

For the current study, Dima Qato of the University of Illinois, Chicago and colleagues contacted 418 drugstores in Philadelphia between February and August 2017 and found that only about 34% had naloxone in stock - and 38.5% of those drugstores required a physician’s prescription to dispense the drug.

People living in communities with elevated rates of opioid overdose deaths were the least likely to have access to naloxone without a prescription and had to pay more to buy the drug, the researchers wrote in JAMA Network Open.

“Areas that need this policy enforced the most are areas that lack it and that’s a concern,” Qato told Reuters Health by phone.

An overdose of opioids like morphine or heroin slows breathing, reducing the supply of oxygen to the body. Naloxone helps reverse the effects of an overdose and saves lives.

Lynch, who is also the medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center, notes that the high importance of naloxone may not necessarily translate to high demand.

“If patients or individuals are not coming in and asking for it, pharmacies, especially a local independent pharmacy with pretty narrow margins, may not continue to stock a medication that isn’t being dispensed,” he added.

However, Mel Brodsky, executive director of PARD, an association of community pharmacies in Philadelphia, disputes the study’s findings.

“It is from 2 years ago - a lot has changed. Philadelphia mandates that every pharmacy have 2 doses of naloxone in stock. As I travel to my stores, I see 95% having naloxone in stock,” he told Reuters Health by email.

Dr. Michael Fingerhood, of Johns Hopkins Bayview Medical Center in Baltimore, Maryland, told Reuters Health that the low numbers in the study may be partly due to a shortage of naloxone in 2017.

“I would do a similar study now, (when) we don’t have a shortage of naloxone, and see if there has been any difference, two years later,” he said.

SOURCE: bit.ly/2IEd5LZ JAMA Network Open, online June 7, 2019

Our Standards:The Thomson Reuters Trust Principles.

[ad_2]

Source link

Prosecutors drop Flint, Michigan water charges over 'flawed' probe

[ad_1]

(Reuters) - Michigan prosecutors on Thursday dropped all criminal charges over the deadly contamination of the city of Flint’s water, saying a more thorough investigation was needed before they could proceed with the case.

FILE PHOTO: Volunteers distribute bottled water to help combat the effects of the crisis when the city's drinking water became contaminated with dangerously high levels of lead in Flint, Michigan, March 5, 2016. REUTERS/Jim Young/File Photo

The charges were brought by the Office of Special Counsel (OSC), a federal prosecutorial agency, and were based on an investigation that state prosecutors described as “flawed.”

“Dismissing these cases allows us to move forward according to the non-negotiable requirements of a thorough, methodical and ethical investigation,” Michigan’s Solicitor General Fadwa Hammoud and Wayne County Prosecutor Kym Worthy said in a statement.

Eight former state and city officials, including Michigan’s chief medical officer Eden Wells, faced criminal charges for their roles in the water crisis which killed 12 people and sickened over 70, one of the worst man-made environmental disasters in U.S. history.

According to the prosecutors, the OSC made agreements that gave law firms representing state agencies and officials a role in deciding what information would be turned over to law enforcement during their investigation. As a result, not all evidence was pursued, they said.

Additional investigation by the prosecution team has already identified more individuals of interest in the case, they said.

Flint’s troubles began in 2014 after the city switched its water supply to the Flint River from Lake Huron to cut costs. Corrosive river water caused lead to leach from pipes, contaminating the drinking water and causing an outbreak of Legionnaires’ disease.

Prosecutors said they dropped charges “without prejudice,” meaning they could be brought again once a new investigation is completed.

“Justice delayed is not always justice denied,” Michigan Attorney General Dana Nessel said in a statement.

But Michigan Senate Minority Leader Jim Ananich, a Democrat who represents Flint, expressed his disappointment.

“Months of investigation have turned into years, and the only thing to show for it is a bunch of lawyers who have gotten rich off the taxpayers’ dime,” he said in a statement. “The people of Flint believe that they will never see justice, and sadly, so far they’ve been proven right.”

The U.S. Supreme Court in March allowed two class-action lawsuits filed by Flint residents, who are pursuing civil rights claims against local and state officials.

Reporting by Andrew Hay in Taos, New Mexico; Editing by Bill Tarrant and James Dalgleish

Our Standards:The Thomson Reuters Trust Principles.

[ad_2]

Source link

Female soldiers wanting to suppress periods face barriers

[ad_1]

(Reuters Health) - Military women wanting to stop menstruating while they are deployed may face a number of barriers, a new commentary suggests.

The majority of surveyed military women say they would like to suppress menstruation during deployment but very few are doing so, according to the paper in Obstetrics & Gynecology that explores why more military women are not accessing that option.

One answer may be that not enough military women and their health providers even know that hormonal contraceptives used continuously will suppress menstruation.

“Women are counseled to stop taking contraceptives before deployment and that negates all the valuable health benefits, including suppression, that come with them,” said the commentary’s author, Sheena Eagan, an assistant professor at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and a specialist in military medicine ethics. “There’s a recurring theme in surveys: women want to access cycle control and they want to suppress menstruation before they are deployed.”

Unfortunately, there are many barriers blocking women’s access to menses suppression in the military, Eagan said, including the instructions to stop taking contraceptives before deployment because there is a rule against sexual intercourse while deployed. “I wanted to highlight the misconception I saw throughout the literature that equates contraceptive use with pregnancy prevention,” she said.

After reviewing the medical literature on the topic of menses suppression in the military, Eagan found that 66% to 86% of women surveyed wanted the ability to stop menstruating during deployment. In contrast, a mere 7% reported having done so.

Part of the problem may be lack of education among both the women and their health providers, Eagan said. A 2009 report found that only a third of service women had received any pre-deployment counseling on menstrual regulation and suppression. Moreover, nearly 70% of women reported that their primary healthcare providers were medics or corpsmen. Although training varies depending on the branch of service, these types of providers normally do not hold professional or graduate degrees, Eagan noted.

Eagan said she isn’t suggesting that menses suppression be mandated for all female soldiers, but “it should be part of women’s autonomous choice.”

The issues of menses regulation and control aren’t limited to military women, said Dr. Charles Ascher-Walsh, director of gynecology for the Mount Sinai Health System in New York City. “Obviously, when women are deployed it’s more convenient not to be menstruating,” he said. “But there are many women who would have the same kinds of benefits, such as when they are traveling for work.”

In general, Ascher-Walsh said, “there’s a lack of education among women and their doctors that this is a possibility - and a safe possibility. And doctors don’t offer it as much as I think they should.”

Still, the article may have made the process sound more straightforward than it sometimes is, Ascher-Walsh said. “It’s not as simple as: do this and you are guaranteed not to bleed,” he explained.

That’s because not all women will stop cycling on hormonal contraceptives, Ascher-Walsh said. With some methods, “you can end up with spotting every day and that’s worse than having your period,” he added. “So you don’t want to do it right before you are deployed since that can make it worse rather than better.”

The best option if a female soldier wants to try a method to halt menstruation is to experiment with it well before deployment, Ascher-Walsh said. Among the possible options, continuous birth control is “the most likely to stop a woman’s periods and be reliable,” Ascher-Walsh said.

SOURCE: bit.ly/2F89nsS Obstetrics & Gynecology, online June 11, 2019.

Our Standards:The Thomson Reuters Trust Principles.

[ad_2]

Source link

New review suggests proven ways to cut back on sugary drinks

[ad_1]

(Reuters Health) - With sugary sodas and other sweetened drinks considered a key driver of the obesity epidemic worldwide, a new research review evaluates how well various measures work to reduce consumption of these calorie laden drinks.

Strategies including limited availability of sodas in schools, removal from children’s menus at restaurants and better labeling could help reduce consumption, according to the analysis published in The Cochrane Database of Systematic Reviews.

The authors of the new report did not respond to requests for an interview. Study coauthor Hans Hauner said in a statement, “Rates of obesity and diabetes are rising globally, and this trend will not be reversed without broad and effective action.” Hauner, a professor of nutritional medicine at the Technical University Munich, added, “Governments and industry in particular must do their part to make the healthy choice the easy choice for consumers. This review highlights key measures that can help accomplish this.”

The researchers pored through the literature seeking studies that evaluated so-called environmental strategies for reducing sugary drink consumption - meaning interventions that change the physical or social setting in which a person chooses what drink to consume or buy. Fifty-eight studies involving a total of more than 1 million adults, teens and children met their criteria. Most lasted about a year and were done in schools, stores or restaurants.

Some of the studies were less well designed, the researchers allowed, simply asking participants how much sugary soda they consumed, for example.

Ultimately, the researchers found moderate-to-low-certainty evidence supporting a number of measures that appeared to help people cut back on sugary drinks. These included: labels that were easy to understand and that rated the healthfulness of beverages; limits on availability of sugary sodas in schools; price increases on sugary sodas in restaurants, stores and leisure centers; inclusions of healthier beverages in children’s menus; and promotion of healthier beverages in supermarkets.

Strategies that raise the price of sugar-sweetened drinks were also supported by moderate-quality evidence while lowering prices on low-calorie drinks was not as well supported.

The new study “lays out evidence that there are things that actually do work,” said Dr. Bruce Y. Lee, executive director of the Global Obesity Center and an associate professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

What makes these sugary beverages especially bad for health is the fact that they represent “empty calories,” said Lee, who was not involved in the review. “So you’re essentially drinking sugar.”

While these strategies may not be the entire solution, “we are clearly having an obesity and diabetes epidemic,” said Dr. Robert Rapaport, a professor of pediatrics and director of the division of pediatric endocrinology and diabetes at the Kravis Children’s Hospital at Mount Sinai in New York City. “Anything that can be done to improve that would certainly be welcome.”

Rapaport welcomes strategies such as removing sugary drinks from schools and making labels easier to read. In general, he said, it makes sense to “tell children to drink water. If they want it with carbonation and flavors that’s fine. All are preferred to having drinks that contain high calories.”

The new study highlights the importance of education, especially for kids, said Shelly Kendra, clinical nutrition manager at the Magee-Womens Hospital of the University of Pittsburgh Medical Center, who also wasn’t involved in the review. “What we learn as kids is what we’re going to carry with us into adulthood,” Kendra said. “Having an environment to help support that is potentially creating the building blocks to healthier choices.”

SOURCE: bit.ly/2IbuoVp The Cochrane Database of Systematic Reviews, online June 12, 2019.

Our Standards:The Thomson Reuters Trust Principles.

[ad_2]

Source link