SCP Volume 26 - saskpharm.ca

NewsletterVOLUME 28 NUMBER 1 MARCH 2007

700 - 4010 PASQUA STREET, REGINA, SK S4S 7B9TEL: 306-584-2292 FAX: 306-584-9695EMAIL: [email protected]

Counterfeit Health ProductsThe following information was

provided by Health Products andFood Branch (HPFB) Inspectoratewith a request to disseminate to ourmembers.

Recently, counterfeit health prod-ucts have been found in the Cana-dian supply chain. In response, theHPFB Inspectorate is developing ananti-counterfeit strategy to increaseour capacity to mitigate the healthand safety risks posed to Canadiansby counterfeit health products. Partof the strategy will be developingand maintaining strategic partner-ships with other enforcement andregulatory organizations to reducethe potential for counterfeit healthproducts to enter the supply chain,increase awareness, and increasethe capacity for detection and identi-fication.

Counterfeiting of health productsoccurs within the larger context ofhealth fraud. Counterfeit healthproducts are forgeries, imitationsmade without right and with theintent to deceive. Although data onthe magnitude of the issue variesbetween studies, all indications sub-stantiate that the issue is extensiveand global, penetrating well regu-lated supply chains of developedcountries, and is compounded bythe increasing expertise and sophis-tication of counterfeiters.

Counterfeit health products andassociated activities constitute viola-tions of the Food and Drugs Act(FDA) and its Regulations. Withoutmarket authorization, counterfeithealth products fall within thescope of unapproved products. It isimportant to note that, while coun-terfeit health products are always

unapproved for sale in Canada, allunapproved products are not neces-sarily counterfeit.

Counterfeit health products posean unacceptable risk to the healthand safety of Canadians. Not adher-ing to market authorization require-ments, counterfeit health productslack any assurance of safety, quality,and efficacy. Counterfeiters supplypotentially unsafe, unregulated, mis-labelled, repackaged, co-minglesand toxic products to unsuspectingconsumers, risking serious adversereactions or events, serious harm ordeath. As a result, public health isseverely endangered and consumerconfidence in the supply chain isdiminished.

The sale of counterfeit healthproducts is a violation of the Crimi-nal Code and therefore incidents ofsuspected counterfeit products arealso referred to the Royal CanadianMounted Police (RCMP) for furtherinvestigation. However, HealthCanada is responsible for promotingthe integrity of the health productsupply chain, including addressingthe health risks posed by counterfeithealth products. As such, we workin conjunction with the RCMP tocomplement their expertise by pro-viding investigative and laboratoryexpertise, as well as advice, pertain-ing to the FDA.

Due to the scope and nature ofthe issue, a collaborative approachis essential. Health Canada, theRCMP, Canada Border ServicesAgency (CBSA), provincial and terri-torial regulatory authorities, and themanufacturers of health products allhave a role to play in combatingcounterfeiting.

continued on page 3

Inside This IssueCouncil Highlights ................... 2

Fee Schedule .......................... 3

Budget Highlights ................... 4

Bylaw Amendments ............... 5

From the Desk of the Dean .... 6

Prescription Transfersand Privacy ............................. 7

Role forHealth Professionals

Protecting the health andsafety of Canadians from therisks posed by health products isa responsibility shared betweenfederal, provincial and territorialauthorities, and health care pro-fessionals. In order to minimizethe potential risk of counterfeitproducts, health professionalsare encouraged to:• Request a drug establishment

license (DEL) or a medicaldevice establishment licence(MDEL) from importers, distri-butors, and wholesalers, etc.

• Look for a drug identificationnumber (DIN), natural productnumber (NP), or drug identifi-cation number – homeopathicmedicine (DIN-HM) on all rele-vant products.

• Report to provincial or territo-rial regulatory authorities anyinstances where counterfeitproducts have been offeredsupplied or suspected. Coun-terfeit products may be sus-pect due to lack of therapeuticeffect or other reasons.

2 • Saskatchewan College of Pharmacists Volume 28 Number 1

Council Highlights – March 1, 2007From the meetings held in Regina March 1, 2007:• Received an update on the next phase of the Pharmaceutical Information

Program (PIP) “E-Prescribing”• Approved the summer hiring of a pharmacy student to undertake

research regarding the development of an educational campaign to thepublic.

• Approved a bylaw amendment to lower quorum at the annual generalmeeting from 50 to 30 members. Attendance at the AGM has beendecreasing and should the required 50 eligible members not be presentaccording to the bylaws the official transaction of business would beinvalid. Attempts to increase attendance to date have unsuccessful andso this bylaw amendment was approved.

• Received an update on the Joint Conference with the College of Physi-cians and Surgeons and the Saskatchewan Registered Nurses’ Associa-tion to be held September 14-15, 2007. The Conference will commencewith separate Council meetings the morning of September 14, then anafternoon joint Council meeting, education and development. The remain-der of the two days will be joint social, networking and educationsessions for our respective members. The theme of the Conference is“Collaborative Care Models to Advance Patient Safety”. Please see sepa-rate notice in this issue for registration information.

• Approved 2007 award recipients to be announced at the Friday eveningWelcoming Reception at the RBSP Annual Conference (for further detailsrefer to separate notice in this issue).

• Appointed George Furneaux as the incoming Chair of the ComplaintsCommittee replacing Bill Paterson who has held that position on the com-mittee for a number of years. We take this opportunity to thank Bill for hisgood humour and stewardship of the Committee: it is a thankless job buta necessary function of the College’s public protection mandate.

• Received a report from the Registrar in his capacity as Returning Officer,the constitution of Council for the 2007-2008 membership year: Coun-cillors in Division 3, 5 and 7 were re-elected by acclamation, leavinga vacancy in Division 1 and Division 6 [George Furneaux had held theDivision 6 seat on Council as a member-at-large. With his election inDivision 5 (Regina), a vacancy in Division 6 (Swift Current) occurs as ofJuly 1, 2007.]SCP Council for the 2007-2008 membership year is:Division 1 VacantDivision 2 Teri Bromm, TisdaleDivision 3 Randy Wiser, Prince AlbertDivision 4 Bev Allen, SaskatoonDivision 5 George Furneaux, ReginaDivision 6 VacantDivision 7 Janet Harding, SaskatoonPast President Jeannette Sandiford, WeyburnEx-Officio Dean Dennis GoreckiPublic Members Ken Hutchinson and Joseph Jeerakathil

• Reappointed Gary Groves to the University of Saskatchewan Senate for asecond term effective July 1, 2007.

• Approved continuation of work underway regarding consultation processfor the regulatory initiative to enhance the pharmacist’s authority to pre-scribe drugs.

• Approved administrative drug schedule amendments for ranitidine andfamotidine (see separate notice in this issue).

• Approved the budget for the 2007-2008 membership year. Please referto the detailed Fee schedule and 2008 Budget highlights included in thisissue.

SCP Council 2006-07Division 1

Jeannette Sandiford, Weyburn(term expires June 30, 2007)

President

Division 2

Terri Bromm, Tisdale(term expires June 30, 2008)

Vice-President

Division 3

Randy Wiser, Prince Albert(term expires June 30, 2007)

Division 4

Bev Allen, Saskatoon(term expires June 30, 2008)

President-Elect

Divison 5

Bill Paterson, Regina(term expires June 30, 2007)

Division 6

George Furneaux, Regina(term expires June 30, 2008)

Division 7

Debbie McCulloch, Rosetown(term expires June 30, 2007)

Past-President

Division 8

Janet Harding, Saskatoon(term expires June 30, 2008)

Ex Officio

Dean Dennis GoreckiCollege of Pharmacy and Nutrition,

Saskatoon

Public

Ken Hutchinson, Fort Qu’AppelleJoseph Jeerakathil, Saskatoon

Student Observer

Kim Sparrowhawk

SCP StaffConnie Borsa

Administrative Assistant

Jeanne Eriksen,Assistant Registrar

Paulette Francis,Reception/Accounting Clerk

Pat Guillemin,Administrative Assistant

Ray Joubert,Registrar

Cheryl Klein,Senior Administrative Assistant

Heather Neirinck,Administrative Assistant

Lori Postnikoff, Field Officer

Volume 28 Number 1 Saskatchewan College of Pharmacists • 3

Fee Schedule 2007-08On March 1, 2007 Council approved the fee schedule for the upcoming

membership year as follows:

Membership and %

Licence Fee Schedule 2007-08 2006-07 Change

Membership FeesPractising $630.00 $610.00 3.28%Non-practising $525.00 $505.00 3.96%Associate $130.00 $125.00 4.0%Retired $65.00 $65.00 0%

Permit Fee Schedule

Pharmacy Permit (Traditional) $975.00 $945.00 3.17%Pharmacy Permit (International

Prescription Service operations) $13,500.00 $13,350.00 1.12%Satellite Pharmacy $487.50 $472.50 3.17%

Fees – Registration and Other

Registration (U of S Intern) $250.00 $245.00 2.04%Out of Province Registration $670.00 $665.00 .75%Dispensing Physicians $770.00 $765.00 .65%Locum Tenens $250.00 $245.00 2.04%Intern $105.00 $100.00 5.0%Appraisal Training

Application Fee $205.00 $200.00 2.5%Assessment Fee $655.00 $650.00 .77%

Reinstatement $250.00 $245.00 2.04%Jurisprudence Exam $250.00 $245.00 2.04%Lock and Leave $405.00 $400.00 1.25%Permit Amendment $230.00 $225.00 2.22%Late Payment $185.00 $180.00 2.78%

Membership/Licensure Renewal 2007-08Membership renewal time is nearing for the 2007 – 2008 year. Eligibility

for re-licensure includes submission of:• Application for Membership• Fees and any arrears• Declaration that Professional Development Log with minimum 15 CEUs• Declaration of Malpractice Insurance (refer to SCP Bylaw 4.4.4)

The new on-line membership renewal system is currently being

finalized. Your invoice and information package regarding instructions

for submission of the application form on the system will be sent

directly to the address you have provided to the office.

Eligibility for relicensure in the 2007-08 membership year includes com-pleting the “Professional Development Log” with a minimum 15 CEUs(please do not submit these to the office at this time – you will be contactedshould your portfolio be required for auditing purposes).

As well, all malpractice insurance requirements must be met and ap-

plication forms, fees, and any arrears must be received in the office on

or before June 1, 2007. A penalty of $180.00 + GST will be assessed forrequirements received after June 1.

Date of approval is assigned only when a completed application formaccompanied by the fees and requirements are received.

*Practising Membership does not include Malpractice Liability Insurance

If you have concerns regardingan EL licensee, verify with the listof EL holders available on theHealth Canada website at:

DEL: http://www.hc-sc.gc.ca/d h p - m p s / c o m p l i - c o n f o r m /l icences/drugs-drogues/del_lepp_tc-tm_e.html

MDEL: http://www.hc-sc.gc.ca/dhp-mps/compl-conform/licences/md-im/mdel_leim_10-07-2006_cp-pc_e.html

Or contact the Health CanadaEstablishment Licensing Unit at:

[email protected] OR [email protected]

Health professionals shouldbe alert to variations in packag-ing, labelling, and physicianappearance of products. Com-mon indicators of potential coun-terfeit drugs and devices, ofwhich health professionalsshould be aware, include:• Cost of the product is much

lower than average• Product normally in bulk pack-

aging is sold individually• Spelling mistakes on the prod-

uct or package• Shoddy appearance of the

product or package• Inadequate storage conditions

by seller.A checklist for visual inspec-

tion of medicines, in order toidentify suspected counterfeitproducts for further examination,has been developed by the Inter-national Pharmaceutical Federa-tion. The tool is designed to helphealth professionals carry out aninspection for signs of counter-feiting such as improper pack-aging labelling, or descriptionof dosage. The Tool for VisualInspection for Medicines is avail-able at: http://www.fip.orgwww2/subsections/index.php?page+menu_counterfeitmedicines&menu_counterfeitmedicines+menu_counterfeit medicines_ infofor

An informational sheet forConsumers is available from theSCP office.

Role for Health Professionals

continued from page 1


2007 Budget Highlights1.0 Inflationary increases are based upon the Con-

sumer Price Index increase of 1.3% at November2006.

2.0 Predicts a surplus of $10.00

3.0 Regulatory Priorities

3.1 Statutory obligations and programs:• Registration and licensing with staggered

licence (June 30) and permit November 30renewal deadlines

• Revised permit issuance, renewal and phar-macy inspection process

• Complaints management and discipline, includ-ing special investigations with alternative dis-pute resolution

• Implement and enforce NAPRA Model Stand-ards of Practice for Canadian Pharmacists

3.2 Preliminary revisions to learning portfolio and earlyphases of continuing competency program.

3.3 Continue developing the primary care role of thepharmacist and pharmacist prescribing.

3.4 Continue to refine policy governance.3.5 Continue CPDP grant and resume audits of learn-

ing portfolio.3.6 Continue the subsidy for the Structured Practice

Experiences Program funded from insurance re-serves.

3.7 Continues Council priorities on primary care andquality, to include implementing the revisions toour pharmacy and professional practice evaluationprocedures.

4.0 Replace regular Policy Governance coaching withcoaching as needed.

5.0 Limited growth in number of members and phar-macies. Non-practising members support CPDPand the costs of operating, but not costs directlyassociated to licences such as the SaskatchewanDrug Information Service Grant, NAPRA assess-ments, Complaints and Discipline Committees andrelated legal costs.

6.0 Predicts no increase in interest rates, with infla-tionary increase in principal.

7.0 Continues fee payments using credit cards.

8.0 Participate in the RBSP conference (annual meet-ing, etc.) and joint conference with SRNA andCPSS.

9.0 All other programs are retained with increasedCommittee activity to ensure timely decisions.Two to four disciplinary hearings are anticipatedwith the costs allocated to practising membershipfees.

10.0 Revised NAPRA assessment.

11.0 Increase in per diem and meal and mileage allow-ances. Last increased in 2005.

12.0 Continues routine building repairs.

13.0 Includes the costs of our communication strategy,with district meetings, website development andnetwork improvements under PIP, plus additionalcosts to contribute data to the Sask. Health Pro-vider Registry and to the CIHI Pharmacist HumanResource Database.

14.0 Predicts inflationary increases in administrativecosts, with addition of administrative staff pluscasual staff for peak times. Continues a self-insured Health Spending Account for staff.

15.0 Includes a Capital Assets Budget to disclose thatdepreciation is not covered by the operating fundor operating surpluses. We will consult with theFinance Committee to develop a long term plan.

16.0 Implement Members Emeriti and Fellows.

17.0 Second of a three-year increase to the Sask. DrugInformation Services grant from $33,000 to$36,000.

18.0 President-elect to attend CPhA conference andPresident to attend one other conference as adelegate.

19.0 No internet pharmacy fee collected, but the regu-latory system is retained if needed.

20.0 Does NOT include a proposal to contribute addi-tional resources to the Prescription Review Pro-gram for a drug use evaluation capability usingADAPT data.

CEU Requirement Reminder

This is to remind members that the deadline forsubmission of the Continuing Education require-ment for renewal of your annual membership isJune 1, 2007.

Again this year we require only your signeddeclaration (on the renewal application) that youhave completed a minimum 15 CEUs in the pastyear. You are responsible to ensure a completedprofessional development log and backgroundmaterials are available for audit.

Do not submit your professional developmentlog or background information to the SCP officeunless you are specifically contacted to do so forauditing purposes.


Drug Schedule Bylaw Amendments

Clobetasone Butyrate0.05%

With the official amendment toSchedule F to deregulate the medi-cinal ingredient clobetasone buty-rate 0.05% in a cream formulationfor topical use on the skin, this drugis now in Schedule II.

Upon prior notification that thisdrug was to be deregulated, Councilhad pre-approved this Administra-tive Bylaw Amendment to becomeeffective when deregulated byHealth Canada.

What this means is that thefollowing schedule listing is now ineffect:

Clobetasone butyrate (whensold in a concentration of 0.05%clobetasone butyrate in creampreparations for topical use on theskin) — Schedule II

Schedule II products are phar-macy only “Non-Prescription Re-stricted Access Drugs” — whichcan be sold by a pharmacist to thepublic without a prescription.

These drugs must at all times, bekept or stored in a secure location inthe pharmacy that is not accessibleto the public. The pharmacist mustbe involved in the sale of thesedrugs, which includes arriving at

the decision to sell the drug.

FamotidineHealth Canada had previously

published notice to de-regulate thisdrug from prescription to non-prescription status. The NationalDrug Scheduling Advisory Commit-tee has recommended Schedule IIStatus based on package size.Council has approved amendingSchedule I and placing this drug list-ing in Schedule II upon de-regulationby Health Canada.

We have received notice thatsuch de-regulation was publishedin the Canada Gazette Part II onMarch 7, 2007 and therefore theseamendments are now in effect.

Schedule 1 – Prescription only

Famotidine and its salts, exceptwhen sold in concentrations of20 mg or less per oral dosage unitand indicated for the treatment ofheartburn.

Schedule II – Pharmacy only,

Non-Prescription Restricted

Access Drugs

Famotidine and its salts whensold in concentrations of 20 mg orless per oral dosage unit and indi-cated for the treatment of heart-burn, in package sizes containingmore than 600 mg of famotidine.

Unscheduled – can be sold

from any retail outlet

Famotidine and its salts whensold in concentration of 20 mg orless per oral dosage unit and indi-cated for the treatment of heart-burn, in package sizes containing600 mg or less.

RanitidineThe amendment is to become

effective when “Ranitidine and itssalts (except when sold in a dosageform containing mot more than theequivalent of 75 mg of ranitidine)” isreplaced by “Ranitidine and its salts,except when sold in concentrationsof 150 mg or less per oral dosageunit and indicated for the treatmentof heartburn” from Part I of Sched-ule F of the Food and Drugs Regula-tions.

Health Canada had previouslypublished notice to de-regulate thisranitidine in these strengths fromprescription to non-prescriptionstatus. The National Drug Schedul-ing Advisory Committee has recom-mended Schedule II Status basedon package size. Therefore, Councilhas approved amending Schedule Iand placing this drug listing inSchedule II once it has been de-regulated by Health Canada.

We have received notice thatsuch de-regulation was publishedin the Canada Gazette Part II onMarch 7, 2007 and therefore theseamendments are now in effect.

Schedule I – Prescription only

Ranitidine and its salts, exceptwhen sold in concentrations of150m mg or less per oral dosageunit and indicated for the treatmentof heartburn.

Schedule II – Pharmacy only,

Non-Prescription Restricted

Access Drugs

Ranitidine and its salts, whensold in concentrations of 150 mg orless per oral dosage unit and indi-cated for the treatment of heart-burn, in package sizes containingmore than 4500 mg of ranitidine.

Unscheduled – can be sold

from any retail outlet

Ranitidine and its salts, whensold in concentrations of 150 mg orless per oral dosage unit and indi-cated for the treatment of heart-burn, in package sizes containing4500 mg or less of ranitidine.


Notes from the Complaints CommitteeRecently the Complaints Com-

mittee investigated an allegation ofa medication error. We understandthat due to human error medicationerrors are inevitable. Therefore, pre-ventive measures can decrease theincidence of errors. It is most impor-tant to learn from the experience.

A complainant was prescribedZocor® but a generic substitute forZestril® was dispensed to the patienton three separate occasions. Theoriginal medication error occurredduring product selection and wasnot discovered on the final check ofthe prescription by the pharmacist.

The pharmacy technician madethe product selection and chose thewrong generic drug and selectedthat drug identification number(DIN). When the pharmacist wasconducting the final check of the

medication, the pharmacist com-pared the contents of the vial withthe contents of the stock bottle.Rather than comparing the vial withthe written prescription, the phar-macist checked the contents of thevial with the prescription labelthereby missing the opportunity tocatch the error. Since the wrong DINwas in the system with refills, theerror was repeated until the cus-tomer returned to her physician fora new prescription.

According to the patient medica-tion profile for this customer, shehad been receiving Zocor® in thatpharmacy for at least one year priorto this incident. A review of the pro-file should have raised a concern forthe pharmacist.

Lastly, had the patient been giventhe opportunity to see the medica-

From theDesk ofthe Dean

Dr. Dennis Gorecki

College of Pharmacy

and Nutrition

One hundred years ago, Sas-katchewan’s legislature passed theUniversity Act, breathing life intothe province’s dream of an instituteof higher learning. When the sodwas turned, on the site of thepresent College Building, there wasone clump of poplars on the openprairie. Today, there is a world-classuniversity. As the University ofSaskatchewan begins its centennialyear, events and projects have beenplanned to celebrate with students,alumni, faculty and staff, residentsof the city and province, and theentire country. The kickoff occurswith the official Birthday Party onApril 3, 2007, to which the Univer-sity welcomes everyone to comeout and take part in the excitement.

Canada Post is marking the cele-bration by issuing a commemorativestamp, available starting April 3.

A special centenary gift has alsobeen received. Donna Hay, PlantSciences research technician andpart-time lily breeder presented theUniversity with Lilium ‘Universityof Saskatchewan,’ an Asiatic lilybred for its white, gold and greencolours. It has been registered withThe Royal Horticultural Society inEngland and is being propagatedby Plant Sciences Department. Itwill grace campus flowerbeds thissummer and will be available to thepublic.

A major national event will show-case the University, city and prov-ince during the celebrations. The2007 Congress of the Humanities

and Social Sciences will take placeon campus from May 26 – June 3.“Bridging Communities: Makingpublic knowledge – Making knowl-edge public” is the theme of theCongress, which is expected toattract 5,000-6,000 delegates to par-ticipate in academic and culturalevents, with special emphasis onwomen, equity issues and partner-ships with Aboriginal Peoples.Another exciting development is theestablishment of three CentennialChairs – one each in environment,public health and public policy, to

respond to provincial and U of Spriorities.

September 14-16 will see thereturn of hundreds of alumni andfriends for the Centennial Home-

coming celebrations. The weekendof reminiscing and activities willinclude Dog Day Afternoon withU of S Football Huskies versusSimon Fraser University, the Presi-

dent’s Centennial Dinner and

Gala, and various academic lecturesand events. Our College will host anOpen House and grand unveiling ofa hallway display, made possiblethrough the generosity of UnitedPharmacists Enterprises, Ltd., toshowcase the history, contributionsand career paths of Pharmacists andDietitians. We invite all alumni andfriends to join us during this specialweekend.

The University has begun its Cen-tennial year with the promise of afuture bright with opportunity. Aswe look ahead, we ask you to joinus as we celebrate the past.

For more information aboutthe Centennial Celebrations, visitwww.usask.ca/100, and for Collegespecific activities please see www.usask.ca/pharmacy-nutrition/alumni.

tion during counseling, she mayhave noted the difference in themedication’s appearance.

Since this occurrence the phar-macy manager has instigated manychanges to the dispensing function.The pharmacy staff have imple-mented the following policychanges: whenever a brand changeis being contemplated the originalprescription is referenced; detailedcounseling sheets are given to eachpatient; if there is a price change of10% a flag is raised for the pharma-cist to conduct an additional check;and they conduct a ‘show and tell’process for the patient at the pointof sale.

The Complaints Committeereminds members that when work-ing with support personnel, theresponsibility for prescription accu-racy lies with the pharmacist.


Prescription Transfers and Privacy(circle of care). There are no fore-seeable reasons why this cannotinclude a request from a patient thatall of his/her prescriptions be trans-ferred whether or not refills remainif Pharmacist A has taken reason-able steps to satisfy him/herself thatthis is the true intention of thepatient. This may include a quickcheck of the PIP Viewer to ensurethat the whole profile is reviewed toensure safe, quality pharmaceuticalcare.

In addition, both pharmacistsmust comply with the various rulesregarding transferring prescriptionsas set out in the bylaws and theFood and Drug Act regulations.

The key question from a privacyperspective is whether it is properfor Pharmacist B to rely on therequest from a pharmacist at Phar-macy A without seeing somethingin writing signed by the patient orspeaking to the patient directly. Webelieve it is permissible under bothThe Health Information ProtectionAct (Saskatchewan), and the Per-sonal Information Protection andElectronic Documents Act (Canada)for Pharmacist B to rely upon therepresentation of Pharmacist A andproceed to transfer the prescrip-tion(s) without direct communica-

tion with the patient. However,Pharmacist B should take reason-able steps to confirm the identity ofPharmacist A, much in the sameway as a pharmacist is requiredto make such a confirmationwhen receiving a verbal prescriptionfrom a practitioner. As sectionC.01.041.2(a)(b) of The Food andDrug Regulations seems to specifi-cally contemplate a verbal transfer-ence of a prescription from onepharmacist to another, we recom-mend verbal pharmacist to pharma-cist communication. Other formsof communication, such as byfacsimile, can be used if Pharma-cist B can confirm the identity ofPharmacist A, and both pharmacistscan otherwise fulfill their legal obli-gations that constitute a propertransfer.

It would be prudent to obtainwritten direction and authorizationfrom the patient, especially wherethe whole file is being transferred.This would help ensure that thepatient’s wishes are being adheredto, which protects both PharmacistA and Pharmacist B. Also, if there isa competitive, or somewhat acrimo-nious relationship between the phar-macies, a written direction andauthorization signed by the patientmay help reduce the chances offurther conflict.

Ethical considerations also sup-port the ability of Pharmacist B torely on the representation of Phar-macist A that the patient wishes forthe prescription(s) to be transferred.If Pharmacist A misrepresents theintention of the patient to Pharma-cist B, this would seem to create anethical issue for Pharmacist A.

Pharmacist A must also be con-cerned about his/her own obliga-tions under HIPA/PIPEDA. Pharma-cist A must take reasonable steps tobe sure of the intentions of thepatient before making the request.Otherwise, Pharmacist A runs therisk of improperly collecting per-sonal health information if prescrip-tions for which the patient did notauthorize a transfer are transferredto Pharmacist A.

Members often inquire aboutlegal and ethical obligations to pro-tect the patient’s privacy whentransferring prescriptions. A typicalscenario:• A patient attends Pharmacy A

and asks that his prescriptionsdispensed at Pharmacy B betransferred to Pharmacy A. Thepharmacist at Pharmacy A con-tacts a pharmacist at Pharmacy Bto request that the informationbe transferred to him as permit-ted under section 14.13.4 of ourBylaws and sections C.01.041.1to C.01.041.4 of The Food andDrugs Regulations. Now thatPharmacy A is within the “circleof care”, does Pharmacy Brequire expressed consent fromthe patient, or can Pharmacy Brely upon deemed or implied con-sent, to disclose the pertinentpersonal health information toPharmacy A? Does it matter ifthe patient requests only onetransfer, or the transfer of all ofhis/her prescriptions?Based upon advice from our

Solicitor, we understand that in thescenario described above, that thepharmacist in Pharmacy B can trans-fer the prescription based on eitherimplied consent or deemed consent

Prescription Review Program Changes

Due to a bylaw amendment of the College of Physicians andSurgeons of Saskatchewan, effective February 2, 2007, physiciansare no longer required to include on prescriptions for drugs moni-tored under the Program “a statement that the prescription is onlyvalid for three days.” All other requirements of the Program remainunchanged.

We have sent a revised program summary to all pharmacy man-agers to replace the summary in the Pharmacy Reference manual.In particular, paragraph 4 states:

“A statement that the prescription is only valid for three days”has been deleted from bylaw 40 (3) of the College of Physicians andSurgeons and is no longer required on prescriptions. This meansthat the three day rule is eliminated and pharmacists may fill pre-scriptions at any time subject to professional judgment.”

For further details, please consult the revised summary in thePharmacy Reference Manual in the pharmacy, or at: http://www.napra .ca /pdfs /prov inces/sk /Prescr ipt ion_Rev iew_Program_revised_Feb2007.pdf


Insulin AbuseThe College has received reports

that body builders are obtaining fastacting insulin from pharmaciststo help them build body mass.In response, we have receivedthe following advisory from theSaskatchewan Drug InformationService:

Insulin FactsInsulin is being described as “the

most powerful anabolic hormone onthe planet.”1 Such articles candirectly have a negative impact onyoung adults. According to a studyin England, in 2005 there was a14% significant increase of insulinuse among male and female healthclub attendees.2 In U.S, about onemillion elite and recreational ath-letes use performance enhancingdrugs and as many as 25% of ana-bolic androgenic steroid abusersconcurrently abuse insulin.2,3

According to a representative fromthe Canadian Centre for Ethics inSports, they have not done anyresearch on this topic. Similarly, theSaskatchewan sports net repre-sentative wasn’t aware of any suchpractice either.

Insulin EffectInsulin works in synergy with

steroids, where the latter spawnsnew muscles while the formerinhibits catabolism of protein.3 Insu-lin use is intended to enhance per-formance and stamina. Insulin-likegrowth factors are critical modula-tors of skeletal muscle growth.Their local administration to skeletalmuscle results in significant in-

crease in total protein. Due to theirgrowth promoting properties, theyare highly desirable to athletes andthus, the World Anti-Doping agency(WADA) has placed them on its pro-hibited list.4 It includes brand nameslike Humalog, Humulin-N, NovolinGE NPH, Humulin-R, Novolin GEToronto, Lantus and Levemir.5 Thenormal practice among body build-ers is to inject 10 I.U. of regularinsulin and to combine it with a largeamount of sugary food. This tech-nique is called hyperinsulinaemicclamp.3 However; during compe-titions most athletes are on strictdiets thus hypoglycemia couldresult in serious complications suchas coma and even death. A 31 yearold body builder was found uncon-scious at home with a blood glucoseof 0.6 mmol/L, respiratory rate = 20and pulse of 100. Upon improve-ment, he stated that the previousday he had switched to a differentfast acting insulin.3,6,7

Role of the CommunityPharmacist in ControllingSale of Insulin

A source within the body buildingcommunity revealed that “at least10%” of his regular communityclients admitted to using insulin andmost of them obtained it from theirdiabetic friends. It is very hard toprevent diabetics from giving or sell-ing their insulin to body builders.3

Interestingly, authors of a letter inthe British Medical Journal wereable to buy insulin even though theywere not diabetic.1

Pharmacists in a variety of set-tings including community practicedispense medications and offeradvice on use of non-prescriptionproducts and dietary supplementsto athletes. The major role ofpharmacists in the use and abuse ofperformance-enhancing drugsincludes educating, counseling,monitoring and obtaining accuratedrug histories.8 Time permitting, thepharmacist or their supervisedintern can determine the conditionor symptoms to be treated (Type 1diabetes mellitus vs. Type 2 dia-betes mellitus), the patient’s self-diagnosis or practitioner diagnosisand assess patient’s self-care objec-tives i.e. target blood glucose levels.On a broader aspect, pharmacistscan question these patients as towhether they participate in any com-petitive sports because if they dothen they would be subject to drugtesting by numerous sports govern-ing bodies.9 Overall, if the pharma-cist suspects misuse/abuse, theycan refuse sale of the product. How-ever, in the course of fulfilling theirduty of care for the patient, thepharmacist can provide informationabout diet, training as well as non-judgmental advice about potentialrisks versus minimal (mostly un-proven) benefits of performance-en-hancing drugs including insulin. Forthose who continue to be intentupon using such performance en-hancing drugs, the pharmacist cantry to minimize risk of harm, for in-stance, by strongly discouragingreckless dosing practices, educatingabout risks associated with sharingneedles/ multi-dose vials and provid-ing information relating to access ofneedle-exchange facilities.10

Prepared by Grupreet Parmar,SPEP student

Saskatchewan Drug InformationService

January 25, 2007

References are available uponrequest to the SCP office.


Informing Drug Therapy Options for Osteoporosis in WomenThe drug alendronate is more

effective and less costly to thehealth care system than teriparatideor other bisphosphonates for theprevention of fracture in postmeno-pausal women, according to arecent health technology assess-ment by the Canadian Agency forDrugs and Technologies in Health(CADTH).

The CADTH report, “Teriparatideand Bisphosphonates for Treatmentof Osteoporosis in Women: AClinical and Economic Analysis,”compared the clinical and costeffectiveness of teriparatide to alen-dronate, etidronate, and risedronatefor the secondary prevention ofosteoporotic fractures in postmeno-pausal women. Preventing fracturesdue to osteoporosis is a publichealth priority, particularly as thepopulation ages. The medical com-plications of wrist, vertebral, andespecially, hip fractures can causesignificant morbidity and mortality.

The report found that alendronateor no drug therapy is the optimal

treatment option in 80-year oldwomen with previous fractures.Alendronate has been shown toreduce the risk of vertebral, non-vertebral, hip, and wrist fractures inthis population. Despite a loweryearly prescription cost, etidronate’sreduced effectiveness compared toother options, including no treat-ment, translated into higher healthcare system costs.

The report did not examine theuse of these drugs for primary pre-vention, as neither teriparatide norbisphosphonates have demon-strated a direct impact on clinicallyimportant fractures in these pa-tients. No trials studied teriparatidein the primary prevention of oste-oporotic fractures in women.

Because fracture rates are age-dependent, the cost effectivenessof bisphosphonates improves witholder patients. Compared with nodrug therapy, alendronate costs anadditional C$169,600 per quality-adjusted life year (QALY) for a 65-year-old woman. A QALY is a health

outcome measure that attempts tocapture net health impact by com-bining length of life and quality oflife. In a 90-year-old, alendronatetherapy is less costly and moreeffective than no drug therapy.

The report’s systematic review ofclinical literature found two relevantclinical trials on teriparatide. Thereport builds on a previous CADTHreview of 28 trials on bisphos-phonates.

An overview of CADTH’s clinicaland economic reviews on this topiccan be accessed through CADTH’swebsite at www.cadth.ca orthrough Brendalynn Ens, CADTH’sLiaison Officer for Saskatchewan.She can be reached at [email protected]. More detailed informa-tion about the range of servicesoffered by CADTH can also befound on the website.

The Canadian Agency for Drugsand Technologies in Health is anindependent, not-for-profit agencydedicated to supporting informeddecision making in health care.

Q and Afrom the

SPEP Rotations

QDuring a SPEP rotation, must a 4th year student who has been certified to prescribe emergency post-coital contraception be

supervised by the pharmacist?

AAlthough the student has successfully completed this portion of the curriculum leading to a degree in pharmacy, they are not a

licensed pharmacist.Bylaw 5.7 An intern under the immediate supervision and in the

presence of a licensed pharmacist may dispense any prescription,recipe or formula, or may compound any drug or medicine.

From this we would interpret the meaning to be that the internmay dispense ECP while under the direct and immediate super-vision of a pharmacist. Certified or not, the intern is not a pharma-cist and so cannot dispense/counsel independently. As with otherprescriptions, all responsibility and liability lies with the licensedpharmacist.

Farewell and BestWishes to NAPRA’sExecutive Director

The National Association ofPharmacy Regulatory Authorities(NAPRA) has announced the resig-nation of Executive Director KenPotvin effective March 16, 2007.

Ken has accepted the position ofDirector of Admissions, ProfessionalRelations and Undergraduate Affairsfor the new School of Pharmacy atthe University of Waterloo.

The Saskatchewan College ofPharmacists wishes to join with theNAPRA Board of Directors inextending our thanks and apprecia-tion to Ken for his dedication andleadership during his time with thenational organization. Our bestwishes go with Ken as he joins thisnew and exciting opportunity involv-ing the realization of a new phar-macy school in Canada.

Your health matters here.

Opportunities available for licensed pharmacists in Saskatchewan:

Estevan, Prince Albert, Tisdale and Weyburn

Please contact: DRUGStore Pharmacy National Recruitment CentrePhone 1-877 NATL JOB (1-877-628-5562)Fax 1-866 NATL FAX (1-866-628-5329)E-mail [email protected] www.drugstorepharmacy.ca

Advertise your

professional opportunity here!

Rate for ad space is $135per business card size block.

Call Pat at 306-584-2292or email [email protected]

for further information or to place an ad.

ADVICE FOR LIFE

Pharmacist Wanted

Full time or Part time

No evenings, Sundays or Stats

For more information on joining ourpatient oriented pharmacy team,

please contact

Yvonne LinnenPhone: (306) 338-2351 (work)

(306) 338-2903 (home)Fax: (306) 338-2421

Wadena DrugsP.O. Box 340;66 Main St. N.

Wadena, SK S0A 4J0

Email: [email protected]


P R O F E S S I O N A L O P P O R T U N I T I E S

FULL TIME PHARMACIST

Mitchell’s Drug Store, Roblin, MB

We are an independently family owned business thathas been in operation since 1907. We are offering:• Competitive Salary• Housing Package• License fees paid• Benefits package• Willing to provide 1/2 day / week protected non-

dispensing time to implement clinical programs

Position is Monday – Friday, an occasional Saturday.No evenings, Sundays or statutory holidays.Call Whitney Mitchell 204-937-3072 (home);

email: [email protected]

P R O F E S S I O N A L E N H A N C E M E N T O P P O R T U N I T I E S

Saskatchewan Institute of HealthLeadership (SIHL) – 2007 Program

The Saskatchewan Institute of Health Leadership(SIHL) 2007 program begins May 14-18, 2007, andends with a 2 day follow-up retreat November 15-16,2007 all to be held at the Hotel Saskatchewan Radis-son Plaza, Regina, Saskatchewan.

The seven-month program includes an initial andfollow-up retreats with SIHL Course Presenters andFacilitators conducting lectures and workshops;group projects focusing on six core competencyareas; teleconferences and access to coach/facilitators based in the healthcare system. Thisseven-month program concludes in November witha two-day follow-up retreat.

The Institute aims tobring together profes-sionals from all disci-plines and all levelswithin the healthcaresystem to foster lead-ership potential, skillsand the creation of aleadership commu-nity that works to-gether to promote,support and sustaingood health.

Participants who suc-cessfully complete the program will

receive a certificate that attests to mastery ofthe six core competencies:1) Life Balance and Personal Development2) Visioning and Planning3) Systems Thinking4) Conflict and Collaboration5) Policy and Politics6) Community and Culture

Program registration forms and information

are available at the University of Regina’s Centre forContinuing Education (306) 585-5739 or e-mail:[email protected]

Are You Interested inBeing a Part of a Movement

to Optimize the Pharmacists’ Rolein Primary Health Care?

CSHP and CPhA have launched an exciting newPharmacy Specialty Network (PSN) for pharmacistsinterested in primary health care practice. This PSNwill allow pharmacists practicing in settings such asprimary health centres, ambulatory care clinics, com-munity pharmacies, and other primary care venuesto discuss issues relevant to this emerging practice,to share great ideas and practice tools, and to getadvice on controversial or complex patient carescenarios. It offers access to an email newsgroup,a website with many resources to download,mentorship opportunities, and much more.

This PSN network is jointly hosted by CSHP andCPhA and is open to members of either organizationwho are currently working in primary care, are inter-ested in this type of practice site in the future, orwant to keep updated on what is happening thearea.

To sign up, contact CPhA or go to http://www.cshp. ca/cshpNetwork/psn/index_e.asp.

For addition information on this PSN contact Dr.Derek Jorgenson at: [email protected]

Take Advantage of the Best ProfessionalDevelopment Opportunity of Your Career!

The Canadian Council on Health Services Accredita-tion is recruiting clinical pharmacists who are prac-ticing in CCHSA accredited institutions, to becomesurveyors. The new accreditation standards useteams of clinical and administrative experts toreview client care. Pharmacists are needed to sharetheir clinical knowledge of medication administrationand reconciliation processes as well as their healthcare expertise in the review of organizational prac-tices.

As a surveyor with CCHSA you will be providedwith the opportunity to not only learn about goodpractices in other facilities but you will actually beable to see them at work, speak with the individualswho created and implemented them and expandyour network to a national level. Your organizationcan also benefit as you bring “home” the innova-tions and best practices you witness as a surveyor.

Interested pharmacists are asked to contactDonna Hutton, Senior Advisor, CCHSA Western/Northern Office at:

Suite 1414, 10235 – 101 StreetEdmonton, AB T5J 3G1Phone 1-866-452-3800Email: [email protected]


Prairie Health Information Privacy Day 2007Demystifying Health Information Privacy Challenges

April 16th, 2007 • Delta Regina • Regina, SK

PHIPD 2007 is an exciting new initiative for thoseorganizations affected by health information privacylaw across Canada’s three prairie provinces. HealthInformation Protection laws are intended to strike abalance between the legitimate need of health pro-fessionals to collect, use or disclose personal healthinformation and the need to maintain the confidenti-ality of such sensitive information. Agenda detailsand registration information are available at http://www.phipd2006.ca or call 613-226-8317.


Primary Health Care Conference“27/12 – Just Do It!

What’s Working and Why”

An interdisciplinary forum to share learning fromsuccessful experiences in primary care and team

development in Saskatchewan. Explore what worksand how this can be transformed and

implemented elsewhere across the province.

May 28, 2007

TCU Place35 – 22nd St ESaskatoon SK

S7K 0C8

Registration Deadline: May 1, 2007

27 health disciplines working together in 12 regionalhealth authorities to advance primary care.

Registration form enclosed with this issue.

Mark Your Calendars

Event Not to Be Missed

96th Annual General MeetingSaturday, April 28, 2007

9:30 – 10:30 amSheraton Cavalier Hotel

Saskatoon, Saskatchewan

SCP 50 & 25 Year Anniversary Recognition

Welcome Reception

(Dinner Buffet)Friday, April 27, 2007

7:00 pm

SCP President’s Luncheon & Awards

Sunday, April 29, 2007

Mark your calendars now!

Please contact the RBSP office at 306-359-7277for detailed Conference 2007 registration

and accommodation information.

2007Interdisciplinary

Conference“Collaborative Care Models

to Advance Patient Safety”

Sponsors

Saskatchewan Collegeof Pharmacists

(SCP)

Saskatchewan RegisteredNurses’ Association

(SRNA)

College of Physicians andSurgeons of Saskatchewan

(CPSS)

TCU Place, Saskatoon, SK

September 14 (evening)

and 15, 2007

Details in the next Newsletter

SCP Volume 26 - saskpharm.ca

Documents

Transcript of SCP Volume 26 - saskpharm.ca