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Pharmacists as part of medical team make patients healthier and reduce costs, study says

A hospital bed.
How can doctors keep patients healthier and out of the hospital? By having pharmacists on the medical team, a new study says.
By Christian Ruiz
Auxiliary Label Staff

Pharmacists working in collaboration with other health-care providers can improve the quality and cost of care for patients, according to a recent study.

A recent article in the American Journal of Health-System Pharmacy makes the case that pharmacists working as part of the primary-care team can be crucial life savers for their patients. In the case of the study, having pharmacists on the team reduced hospitalizations by 23.4 percent and reduced costs by approximately $5 million.

The study — of six hospitals from the Carilion Clinic health system in southwest Virginia in conjunction with 22 patient-centered medical homes associated with Carilion Clinic — was led by VCU School of Pharmacy’s Gary Matzke, Pharm.D.; Leticia Moczygemba, Pharm.D., Ph.D.; Karen Williams, Pharm.D.; Michael Czar, Pharm.D., Ph.D.; and William Lee. The study took place from January 2013 to June 2015. Funding sources for the study included the CMS Center for Medicare and Medicaid Innovation and the Carilion Clinic health system.

A total of 2,480 patients in the study had two or more of these seven chronic health conditions: heart failure, high blood pressure, high cholesterol, diabetes, asthma, chronic obstructive pulmonary disease (COPD) and depression. In addition, the patients were taking at least four medications and had a primary care physician in the Carilion Clinic health system.

The researchers studied the difference between collaborative care, in which pharmacists were members of the primary care team and worked closely with physicians, and “usual care,” in which pharmacists were not part of the primary care team, on the progress of their patients’ chronic health conditions and on their patients’ use of hospital resources.

The collaborative-care pharmacists called patients within 72 hours after their hospital stay to see if those patients had any medication-related problems or issues. Additionally, these pharmacists met the patients face-to-face or by phone to address patient-specific problems or concerns, which encouraged patients to self-manage their medications and health conditions.

Patients in the usual-care group did not interact with pharmacists in these ways.

Patients in the group working more closely with pharmacists showed better improvement in each of their health conditions compared to the usual-care group in terms of their diabetes, high blood pressure and high cholesterol.

In addition, the number of patients who were treated with the collaborative-care group experienced a 23.4 percent decrease in hospitalizations, from 1,675 hospitalizations before treatment by the collaborative-care group to 1,283 hospitalizations after treatment by the collaborative-care group.

The usual-care group, in comparison, experienced an 8.7 percent decrease in hospitalizations, from 355 hospitalizations before treatment and 324 hospitalizations after treatment.

Along with the health improvements, pharmacists in the collaborative-care group helped reduce the cost of hospitalizations overall by $5,156,675 — $2,619 less per patient than standard procedures would have been expected to cost. In comparison, the usual-care group recorded a cost reduction of $475,071, or $241 less per patient than standard procedures would have been expected to cost. This means that pharmacists in the collaborative-care group helped save $4,681,604 more than the usual-care group — or $2,378 more per patient than standard procedures would have been expected to cost — over the course of the study.

This study demonstrates that pharmacists can contribute far more to health care in the community than just serving as “pill counters” – a perceived role that immensely underestimates and undervalues the impact they can have on both the health of their patients and the cost of health care. Additionally, when health care providers work together as a team, our jobs as life savers can be worth so much more to our patients.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

How to Be an Entrepreneur, Lesson 2: Find a niche

A rooftop sign reads "fountain."
A sign on the roof of Midlothian Apothecary. The restaurant inside the pharmacy acts much like advertising, says pharmacist Janet Darby. Photo by Nicole Carter.
By Nicole Carter
Auxiliary Label Staff

Midlothian Apothecary is an independent pharmacy in Chesterfield County, just outside Richmond, that has survived under the same management since 1990. Auxiliary Label’s Nicole Carter met with Janet Darby, a VCU School of Pharmacy alumna, to talk about the business of independent pharmacy today.

Auxiliary Label: What is your biggest revenue source?

Darby: It’s not drugs any more. With generics, I almost have to give them away for free. Brand-name drugs are still profitable. We do vaccinations and they pay well on those. Also, home health-care products such as durable medical equipment, but we don’t bill Medicare for that. Medicare has a designated location for patients to buy DME [durable medical equipment] but a lot of people don’t want to go through the hassle so we just sell it straight to the customer.

What do you think has the biggest growth potential out of all the services you offer?

We’re starting to do point-of-care testing for flu, strep throat, cholesterol and blood glucose. We can charge for that. The problem is, though, in Virginia I can’t write a prescription if I find out somebody is positive for flu. … We are setting up a collaborative practice agreement so that after I get the test result, I can call the doctor and then get the prescription.

How do you bill for the point-of-care testing?

It’s out of pocket. In Virginia we can’t bill insurance unless we are the one who writes the prescription. Last year, with the big flu epidemic, no doctor could see anyone [because they were too busy] — people were having the flu and couldn’t get any medications. The doctors are looking for help too because they can’t see everybody.

How is having the fountain in the pharmacy an asset to the business?

It’s always busy. It’s kind of like paying for advertising: A lot of people come in here [for the fountain] not knowing about the pharmacy, and some people come in not knowing about the fountain. So it brings in people and kind of keeps things hopping all the time. You can’t say it’s a moneymaker because you have to sell a lot of food to make money. But we see the money that goes toward the fountain as money we would have otherwise spent on advertising.

What is the biggest threat to independent pharmacy?

PBMs, the processors for insurance companies, right now they are ruining pharmacy. They mandate how much we get paid. And the insurance company pays them one thing and then they pay us something else. Now for generics they are using the average for the year. So if they think they paid us too much for the first six months of the year then they take money back. But they don’t give us a reason. It’s really crooked.

Competition isn’t a threat because I offer something entirely different. We provide individualized care that other pharmacies just don’t.

What is the biggest opportunity for independent pharmacy?

There is a niche. You got to want to do customer service. You’ve got to want to do a lot more than just fill a prescription. And you’ve got to answer question upon question. There are people out there that want that individual service.

What advice do you have for pharmacy students?

You’ve got to want to work. And you’ve got to want to work hard. If you can’t multitask you can’t be a pharmacist. And you’ve got to want to work long hours. It’s a great profession if you like people. You’ve just got to know what niche you want and what you want to do.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

Auxiliary Label: Antibiotic stewardship research in a community outpatient setting

An image of a purple C. dificile bacterium.
An image of C. dificile bacterium, based on photomicrographic data. (Centers for Disease Control).
By Victoria Hammond
Auxiliary Label Staff

Antibiotic resistance — when bacteria are untreatable by current antibiotics — is a growing public health concern.

To reduce antibiotic resistance, prescribers use antibiotics only when necessary. In hospital settings, experts called antibiotic stewards monitor trends in resistance, prescribing, costs and adverse effects. Prescribing trends are compared to current treatment guidelines.

Stewards in an antibiotic stewardship have a goal to “enhance patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs,” according to the Society of Healthcare Epidemiology of America.

In 2015, about  269 million antibiotic prescriptions were dispensed in outpatient settings — at least 30 percent of which were unnecessary, according to the U.S. Centers for Disease Control. Unnecessary treatment of antibiotics can increase the risk of side effects or opportunistic infections such as C. difficile.

Settings with high volumes of antibiotics being prescribed would benefit from an antibiotic stewardship program to prevent side effects and opportunistic infection.

To improve patient outcomes in outpatient settings, VCU School of Pharmacy faculty members John Bucheit, Pharm.D.,  Teresa Salgado, M.Pharm., Ph.D., and Amy Pakyz, Pharm.D., Ph.D., have been implementing an antibiotic stewardship program in a free outpatient health clinic in the Richmond area. (They asked that the clinic’s name not be published.)

The faculty members’ first focus targets the prescribing trends of uncomplicated urinary-tract infections, or UTIs. Bucheit, Pakyz and Salgado are developing an antibiogram — a profile of antibiotic susceptibility for a specific practice site — based on prescribing trends from the past two years.

The antibiogram will provide information about which antibiotics are providing beneficial therapy to patients based on the clinic’s antibiotic susceptibility to resistant or nonresistant bacteria. This antibiogram will then be compared with current therapy guidelines to develop clinic specific guidelines for practitioners to use at the clinic. The project was made possible by a grant from the VCU School of Pharmacy’s Center for Pharmacy Practice Innovation.

“We are excited about this project to not only improve patient care at our clinic,” Bucheit said, “but also to provide an example for other outpatient offices interested in improving antibiotic prescribing for uncomplicated UTI.”

After the guideline is developed, Bucheit, Pakyz, Salgado and their team will educate the staff and reevaluate in a year.

The goal of this project is to provide prescriber education and improve patient health outcomes in a setting where high volumes of antibiotics are prescribed.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

 

Auxiliary Label: Lessons from pharmacy school

A glass mortar and pestle.
A mortar and pestle in the VCU School of Pharmacy collection.

by Victoria Hammond
Auxiliary Label Staff

In my third year of pharmacy school, as I am beginning to think about choices for Advanced Pharmacy Practice Experiences rotations, I am reflecting on my experience here.

When I started, I remember thinking how thriving in pharmacy school was going to be impossible. When classes began I was overwhelmed by the amount of coursework.

Now in my new shoes as a third-year student, or P3, I look back and realize that while pharmacy school can be stressful, success is possible.

Here is the story of how I learned to succeed in pharmacy school. I hope some readers may find it helpful.

When I began, I saw pharmacy school as a reservoir of knowledge and opportunity. I wanted to take steps to gain a variety of experiences but still perform well academically. More importantly, I wanted to prove that I belonged in my seat. My first year and a half of pharmacy school was a competition between myself. I was my own worst enemy.

I was applying for outreach programs, working 12 hours a week, involved in committees and training for a marathon while studying for all my tests. All in a grand gesture for me to feel confident in my ability to be a pharmacist.

As you can imagine, this schedule put my time management to the test. I quickly felt the pressure from managing my life in pharmacy school and my life at home. I was constantly stressed and did not believe in myself.

In my P2 year of pharmacy school I had better self-confidence but I was in the battle. I was perpetually clouded in self doubt.

It was not until elections for organizations where I finally broke my bad habit. I had nominated myself for the secretary position in my class and had been nominated for an executive position in Phi Delta Chi, one of several active pharmacy fraternities. To my surprise, I was elected to both.

Breaking outside my comfort zone and being chosen for these leadership positions broke my spell. I found that my new confidence improved my academic standing and social savvy. I soon realized I wasn’t the only one who had faced this battle.

The hardest aspect of pharmacy school for me hasn’t been from content taught in the classroom. The hardest aspect is finessing time management skills while maintaining mental health. The amount of coursework can be worrisome but it is manageable. Your involvement in an organization will enhance your knowledge from the classroom. Pharmacy school is a lifestyle and with everything you do you have support from friends and faculty.

To all pharmacy students, I have a few pieces of advice:

  1. Even if it scares you, sign up for that position or go to the volunteer event. It could change your whole outlook.
  2. Focus on the present moment; if you don’t it’s easy for your mind to get cloudy with self doubt.
  3. Don’t forget to have some fun outside of studying whether it be running or playing the banjo (the choice is yours!).
  4. Be confident. You will be a pharmacist.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

Dr. Rx: Steps you can take to avoid hospital-related infections

Dr. Rx: How to avoid hospital infections

Dr. Rx: How can I avoid getting an infection while I am in the hospital?

Posted by VCU School of Pharmacy on Tuesday, October 16, 2018

By Christian Ruiz
Pharm.D. Candidate 2020

Q: I’m getting a procedure done at the hospital soon, and I’m afraid of getting an infection while I’m there. Is there anything I can do?

A: Infections you can develop while inside hospitals or other medical settings — including doctors’ offices, rehab facilities or nursing homes — are called healthcare-associated infections, or HAIs. They could come from germs that enter your body at a surgical site or germs that travel on medical equipment such as a catheter or an IV line.

Common HAIs include:

  • Infections caused by the bacteria C. diff (Clostridium difficile or C. difficile) or MRSA (methicillin-resistant Staphylococcus aureus)
  • Infections at the site where you’ve had surgery or where a catheter or an IV line has been placed into your body
  • Pneumonia or other respiratory infections from using a ventilator

There are many ways you can prevent HAIs. People using ventilators or recovering from surgeries have to take special precautions and should follow doctor’s orders. But below are some general recommendations to prevent HAIs while you are in the hospital.

  • Sanitize your own hands often with soap and water, especially after using the bathroom.
  • When coughing or sneezing, cover your mouth and nose with a tissue and throw away the tissue as soon as possible. Then wash your hands.
  • Ensure that your doctors and nurses sanitize their hands before and after they leave your room. Also be sure they are wearing any necessary personal protective equipment such as gloves, gowns and/or masks while in your room. This is to protect you and them from HAIs. Don’t be afraid to speak up!
  • Ensure that visitors sanitize their hands before and after they leave your room. Also, ensure they follow any special instructions from doctors and nurses while they visit you, which may include wearing gloves, gowns or masks.
  • If you do need a catheter, ask your doctors and nurses why it is needed and when it will be removed. Your risk of getting a HAI increases with the number and duration of catheters placed into your body.

You might have a HAI if you have recently been in the hospital and experience:

  • Fever
  • Nausea
  • Unexpected pain, tenderness, redness, or swelling at the site where you’ve had surgery or where a catheter or an IV line has been placed into your body

If you think you have any of these symptoms, tell your doctors or nurses immediately. Having any of these symptoms does not necessarily mean you have a HAI, but if you do have a health-care-related infection you want to be treated for it as soon as possible in order to prevent further complications.

If your doctor does determine that you have a HAI, he/she will likely prescribe you an antibiotic. However, be sure to take the antibiotic exactly as prescribed in order to prevent another HAI or an even worse one.

Christian Ruiz is a third-year Pharm.D. student at VCU School of Pharmacy. He majored in chemistry and minored in music and biology at Virginia Commonwealth University. Upon graduation he currently hopes to pursue a career in emergency medicine, critical care or internal medicine.

Dr. Rx is a monthly community-health column provided as a public service by VCU School of Pharmacy. It can be read in Fifty Plus magazine as well as online. 

Auxiliary Label: Pharmacy students take part in community care

A pharmacy student in a V C U shirt sits at a table with a woman.
Katie Jones, a second-year pharmacy student, prepares to take a fair attendee’s blood glucose.

By Michael Ong
Auxiliary Label Staff

I arrived for my afternoon shift at the Charles City County Fair around 1 p.m. With the forecast of rain later on in the day, I hadn’t expected many people to attend. But the large parking lot was full.

As I was getting out of my car, a mother pushing a stroller waved at me. She was walking away from a row of tents toward their own car parked just spaces from mine.

I had driven to Charles City County, about 40 miles from Richmond, to participate in a health booth. The prevalence of health disparity in the access and availability of care is a rapidly growing problem. Urban centers such as Richmond boast a nationally renowned medical center, yet pockets of disparity can be found across the city. Into the surrounding counties and municipalities, health access further diminishes.

Rural areas like Charles City County have some of the highest rates of rural poverty and lack of available healthcare. Through partnerships and opportunities such as the Charles City County Fair, VCU, through its educators and student volunteerism, is addressing this vast community need.

As I walked to the fair, I saw a row of tents pitched on the practice field, filled with food and homemade jewelry, soaps, and other sundries. Under a large white tent, families sat entertained by a performer juggling on top of a unicycle. Nearby was another tent selling boxes of Krispy Kreme donuts and raffles to be drawn at end of the day.

The VCU booth at the Charles City County Fair is a long tradition and work of dedication anchored by Patricia Slattum, Pharm.D., herself a Charles City County resident. The health outreach and preventative services are great resources for a smaller county with limited health-awareness opportunities for its residents.

The fair-goers proved the perfect target population for the group organizing the event, the VCU chapter of the Student National Pharmaceutical Association (SNPhA). Its motto for serving the underserved is well lived in the variety of events at which its students volunteer. From rural fairs like the Charles City County Fair to back-to-school immunization events with Crossover Clinic in downtown Richmond to advocating for safe HIV testing at the annual VA PrideFest on Richmond’s Brown’s Island, SNPhA engages its student members to be invested in its greater Richmond community.

A pharmacy student sits with a woman. The woman has a blood-pressure cuff on her arm.
Jiro Morales, a second-year pharmacy student, checks a patient’s blood pressure using a mechanical cuff.

Partnering with Slattum, SNPhA is able to provide blood-pressure readings and blood-glucose checks for fair attendees. Alongside these point-of-care services, we had another full table littered with a library of education pamphlets available for anyone to pick up.

While I was at the health booth we had a variety of people visit our tables. Some, like an older lady, chose not to get a reading but chatted with several of our volunteers about her recent hospital stay. She even had a small photo album with her pictures of the during the stay.

Others, like a tribal dancer from the local Chickahominy tribe, asked for everything we could provide. All were open to casual conversations about their lives, their health and were open ears to the information we provided.

As a student, volunteer experiences like these form a fundamental aspect of the overall education VCU School of Pharmacy offers. Being able to take traditional lecture learning into a more clinical setting multiplies student learning. In first year we learn how to take vitals such as blood pressure. In our second year we are trained on how to read glucose meters. All for just this situation — providing front-line care to our neighbors.

Late in the afternoon, a father and son stopped by the tables. The father had wanted to get his blood pressure checked and the son, a high school student, sat down with him. After some cajoling from his father, the son let one of our student volunteers take his blood pressure.

The father’s reading was elevated, which after talking with him we were expecting. However, the son’s was slightly above the normal range for his age. This was a wonderful teaching moment for the VCU student to reinforce what she learned in her cardiology module and suggest some lifestyle choices for the pair.

After handing them some informational pamphlets on hypertension, it was endearing to hear them bicker about exercise; the dad telling his son they were going running in the morning from now on and the son rebutting with how he gets enough exercise with the football team.

Near the end of the day, after having seeing and helping several dozen people, I took the time to do one last run outside to indulge in a warm plateful of funnel cake. The line was long and the wind had picked up significantly while I was inside the gym. But it wasn’t a fair until I enjoyed the fried dough and powdered sugar.

And in between bites, while putting away our excess brochures and other supplies, I smiled and waved back at a lady we had helped earlier in the afternoon.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

“Failure shouldn’t stop you”: an interview with healthcare innovator Hilton Bennett

How to Be an Entrepreneur, Lesson One: Time Commitment

By Nicole Carter
Auxiliary Label Staff

Hilton Bennett is a young man to admire. While studying at VCU, he has been a husband and a father of three. Now 38, he is pursuing a master’s in product innovation.

VCU has filed for four patents in the past year for technology on which he has been the primary mechanical engineer. One of these patents is for a device that can digitally tell an anesthesiologist the pressure difference in the spinal column. This allows for more precise epidurals with fewer side effects.

Hilton Bennett
Bennett

An avid rock climber, as a freshman in the VCU Engineering program Bennett wanted a safe way to practice traditional climbing indoors. He started building a device to solve his problem. Two years ago, Bennett started Native Heights Climbing Solutions, a company with the goal of simulating traditional rock climbing for indoor climbing gyms. VCU’s Cary Street Gym will be his first client; he says it will be the first indoor climbing gym in the world to have a device that allows practicing and training for traditional climbing indoors.

I had the opportunity to chat with Bennett over pizza after he spoke at the Entrepreneurship in Healthcare Series at VCU School of Pharmacy, coordinated by faculty member Dayanjan Wijesinghe, Ph.D.

Auxiliary Label: What do you think is unique or challenging about innovating in the healthcare industry?

Hilton Bennett: [Laughs] Challenging first: It’s the time. The time commitment is longer for medical devices. If you only consider the FDA process, minimum it’s going to be two to five years, averages can be longer depending on what class the device falls in, what it’s being used for, and who’s going to use it. It’s kind of daunting to think about.

There’s an argument that technology is growing at a speed that we can’t keep up with. We could design a device but then the technology advances beyond it before it even comes to market.

I assume it takes a lot of money to run trials. Do you raise money or partner with a bigger institution?

For our epidural device, we partnered with VCU Health’s Anesthesiology Department, as the problem for ideation originated from their ranks. Three former anesthesiology residents, now all anesthesiologists, and current instructor Michael Kammerman taught us the epidural procedure and we practiced the procedure with the regular epidural needle and syringe. Once we had a prototype, we were able to use their simulation models for testing. It was an invaluable resource to test in their lab. I mean, normally, to get to that level of testing, you’d have to spend several thousand dollars. For us, it was free, and I think the experience is what we really hope for as engineering students.

What have you done when you’ve been faced with an obstacle?

After I get feedback … I decide if it’s meant to be overcome. Then it’s time to make the next iteration to the design. I usually take time throughout the week to focus on higher priority projects and just everything else. Then I’ll start back — not to square one, but to a specific point, and think back though how it’s designed and how someone would use it. We’ll make very small changes. We look at the shape and the size, how it fits in your hand, the screw placement, and how the electronics fit inside. Most obstacles were; in my opinion, meant to be overcome, but also to create a check and balance in what shouldn’t be an easy process.

What advice do you have for other entrepreneurs?

Know that it will take time. Every device is not going to work, and failure shouldn’t stop you; it should encourage you to continue working. And make sure that you’re passionate about it in a way that drives you to work at it in your spare time, but not in a way that prevents you from being open to changes or to scrapping everything and starting over.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

VCU agrees to automatically accept eligible Randolph-Macon College students into pharmacy school

V C U and Randolph-Macon College school logos

VCU and Randolph-Macon College have signed an agreement to automatically grant admission into VCU’s Pharm.D. program to eligible Randolph-Macon students.

Randolph-Macon sophomores who meet VCU’s requirement for health-care shadowing and who successfully complete an on-site interview will be given provisional acceptance into the doctor of pharmacy program under the articulation agreement. If they maintain their grades and score well on the PCAT pharmacy entrance exam they will be automatically accepted into VCU’s pharmacy school upon completing their undergraduate programs.

Students who do not qualify for provisional or guaranteed acceptance can apply through the standard application process.

Criteria for guaranteed admission under the articulation agreement include:

  • PCAT composite scores in the 70th percentile or greater for students with GPAs of 3.25 and in the 60th percentile or greater for students with GPAs of 3.4
  • Completion of VCU’s required prerequisite courses and credits with grades of C or better
  • A completed PharmCAS application submitted by Oct. 1
  • Two favorable letters of recommendation from Randolph-Macon faculty
  • One letter of recommendation from a health-care provider
  • Meeting all graduation requirements from Randolph-Macon

VCU is a major urban research institution in Richmond. Randolph-Macon is a private liberal-arts college with more than 1,400 students in the town of Ashland, about 20 miles from Richmond.

For more information, see the School of Pharmacy’s Pharm.D. admissions page.

Contact VCU School of Pharmacy Director of Communications Greg Weatherford at goweatherfor@vcu.edu.

Auxiliary Label: Working to build better opioids

Molecular model of hydrocodone.
A molecular model of hydrocodone. (Credit)

By Christian Ruiz
Auxiliary Label Staff

Opioids are a class of highly addictive pain-relieving drugs derived from the opium in poppy plants. These drugs are at the center of today’s opioid-overdose crisis, in which at least 115 people per day in the United States die after opioid overdoses.

If you have ever had your wisdom teeth removed, you might be familiar with opioid drugs that are not available over the counter but are prescribed by your doctor or dentist: Percocet (oxycodone/acetaminophen), Vicodin (hydrocodone/acetaminophen) or Tylenol No. 3 (codeine with acetaminophen). The widespread availability of these and similar drugs have caused many people to become addicted to opioids. 

At least 33,000 people in this country died in 2015 alone from overdosing on opioids. Overall, misuse of opioid drugs has cost the United States $78.5 billion per year, including the costs of healthcare, lost productivity, addiction treatment and legal system involvement.

However, the major FDA-approved treatments for opioid abuse and addiction — methadone (Dolophine, Methadose), buprenorphine (Belbuca, Buprenex), naloxone (Narcan) and naltrexone (Vivitrol) — are not fully effective in treating opioid abuse and addiction. They have many of the side effects that the opioids themselves have, such as mood disorders.

For several years, Yan Zhang, Ph.D., and his laboratory in VCU School of Pharmacy’s Medicinal Chemistry Department have been working on modifying the chemical structures of drugs used to treat opioid abuse and addiction. In doing so, they hope to reduce the opioids’ addictive potential and their other harmful side effects such as sedation, decreased ability to breathe and constipation.

To do this, they use organic chemistry to synthesize these potential new drugs and then use biochemical techniques to examine how these drugs interact with different, specific proteins in cells.

Proteins: More Than Just for Bodybuilding

To understand how Zhang and his team are working to build better, safer opioids, we need to take a step back and talk about proteins.

Proteins are large molecules that are responsible for many survival functions in the human body. For example, they protect the body against viruses and bacteria, speed up chemical reactions within cells, and provide structure and support for cells. An important function that proteins play, particularly in terms of many drugs and their actions, is to relay biological messages throughout the body.

In essence, the way most drugs work is by binding to these receptor proteins (proteins that “receive” these drugs), which causes these proteins to send biochemical or electrical signals throughout the cells in the body. These signals in turn tell the body to reduce inflammation, relieve a headache or even decrease heart rate, for example.

G protein-coupled receptors are a superfamily of these receptors; opioids bind to a specific group within this superfamily of receptors, called opioid receptors.

The three major types of opioid receptors are named for the Greek letters mu, kappa and delta. For simplicity, these opioid receptors often are abbreviated MOR, KOR and DOR.  

The mu opioid receptor, or MOR, is primarily responsible for relaying signals causing pain relief. The KOR is primarily responsible for relaying signals causing depression and anxiety. The DOR is primarily responsible for relaying signals causing mood-related disorders.

Notably, several studies have shown that the MOR is responsible for relaying other signals, particularly the addictive potential and other harmful side effects of opioids mentioned previously.

These effects on mood are due to opioids’ interactions with the KOR and/or the DOR rather than just the MOR.

Hence, selectively blocking only the MOR should be able to block the signals for addiction, sedation, constipation and the other side effects without relaying the signals for mood disorders caused by interacting with the KOR and/or the DOR. This could mean new treatments for opioid addiction could be developed that avoid these unpleasant side effects. 

With this hypothesis in mind, Zhang’s laboratory group is working on producing new chemical compounds that selectively target the MOR without targeting the KOR and the DOR. After synthesizing these potential, new drugs, the group uses a series of biochemical tests to examine these drugs’ abilities to bind to and to relay biological messages through the MOR, the KOR and the DOR.

Through their hard work, we might one day have a drug to more effectively help those in need during this opioid-overdose crisis.

Auxiliary Label is a student-created blog examining pharmacy life, education and research at the VCU School of Pharmacy from a student perspective. It is overseen by Greg Weatherford, the school’s director of communications. Contact him here.

Confronting a crisis, VCU School of Pharmacy shifts curriculum on opioids

A pill bottle is surrounded by pills and a syringe.
Future pharmacists are learning how to better manage issues around opioid addiction and overdose.
By Karolina Blaziak
Communications Associate, VCU School of Pharmacy

With thousands of Virginians affected by the opioid crisis, the VCU School of Pharmacy has added to its curriculum material about how pharmacists can respond.

An article about these curriculum changes has been accepted by the American Journal of Pharmaceutical Education. The article, “Preparing pharmacy students to manage the opioid crisis,” also discusses the background of opioid prescriptions and pain management, and the rise of opioid misuse to an epidemic in the United States.

Opioid overdoses have killed more Virginians each year than car crashes or guns, with more than 4,000 deaths between 2012 and 2017, according to the Virginia Department of Health. That has made overdoses the No. 1 cause of unnatural death in the state.

In 2016, Virginia’s health commissioner declared opioid addiction a public-health emergency. The commissioner issued a standing order authorizing pharmacists via a statewide standing order to dispense naloxone to any person requesting the drug.

To prepare pharmacy students for this responsibility, a number of activities were added to the pharmacy curriculum. In the fall 2017 semester the VCU School of Pharmacy offered a new laboratory activity in opioid-overdose management to its third-year pharmacy students.

With the statewide reach of the problem there has been “a new change in culture and awareness about opioid overdoses,” said Krista Donohoe, Pharm.D., an associate professor in the Department of Pharmacotherapy and Outcomes Science at the VCU School of Pharmacy.

The laboratory course taught 130 VCU pharmacy students what to do in the event of a patient overdose, along with a discussion of the Prescription Drug Monitoring Program, and how to do opioid calculations. The instructors — Donohoe and fellow VCU School of Pharmacy Pharmacotherapy and Outcomes Science faculty members Laura Morgan, Pharm.D., and Kacie Powers, Pharm.D. — wanted to prepare the pharmacy students to counsel patients and their families on opioid overdoses using naloxone.

Pharmacists can play a critical role in combating the opioid crisis. They have regular contact with patients and track their prescriptions through a database called the Prescription Drug Monitoring Program that lists medications prescribed and how frequently they are being dispensed.

The pharmacy students practiced with different prescription-monitoring database scenarios to learn how to identify red flags for opioid misuse.

For example, if a patient’s records show multiple visits to doctors or pharmacies, the pharmacist should recognize this as a possible red flag, and contact the prescriber to warn about potential opioid misuse, said Morgan, an associate professor in the VCU School of Pharmacy’s Department of Pharmacotherapy & Outcomes Science who served on a statewide Task Force on Prescription Drug and Heroin Abuse for then-Gov. Terry McAuliffe.

Students also practiced calculations needed to safely switch patients from one opioid to another such as from oral administration to intravenous.

In a survey conducted at the end of the course, students gave the curriculum changes high marks and said the class gave them the knowledge and confidence needed to care for their patients in the community.

“We’re going to continue it. Definitely,” Donohoe said.

Additional listed authors for the journal article are Thuy T. Tran, Pharm.D.; Ph.D. candidate Fawaz M. Alotaibi, Pharm.D.; and Archana Raghavan, Pharm.D.

For more information: Greg Weatherford, VCU School of Pharmacy director of communications

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