April 2023 Florida Pharmacy Today

FLORIDA P H A R M A C Y

APRIL

USE DISORDER

Protect your Tomorrow with VISTA

FPA Leadership

Dan Buffington

Chairman of the Board

Carol Motycka President

Jeanette Connelly President Elect

Alex Pytlarz Speaker

Josh Pullo Vice Speaker

William Mincy Treasurer

Kathy Baldwin

FSHP President

Eric Larson Chairman, House of Delegates

Dustin Williams Director, House of Delegates

DeArcy Campbell Director, House of Delegates

Neil Barnett Director, House of Delegates

FPA Staff

Helen Sairany Executive Vice President & CEO

Maria Goodno

Executive Assistant

Jessica Lamb Manager of Education and Member Relations

Contents

The President’s Viewpoint.................................................4

Executive Insight...............................................................6

Speaker’s Report: House of Delegates...............................8

Legislative Update.............................................................9

FPA Upcoming Events.....................................................10

The Opioid Epidemic: Tools You Can Use.......................12

SUD Virtual Conference...................................................14

From the Desk of the Dean: Peter Swaan.......................15

Annual Meeting and Convention 2023.............................16

Naloxone: What You Need To Know..................................22

Pharmacy Spotlight: Thrive Pharmacy.............................24

Member Spotlight.............................................................26

Don’t Miss These Dates!

May 5 Last day of the 2023 Legislative Session

May 10 Last day to submit HOD Resolutions

May 17 HOD Board of Directors Via Zoom

Jun 7 Last Day to Submit New Business to the HOD & Last Day to Register as a Delegate

Jun 9 Last day to register for Convention Hotel Block

Jul 5-9 133rd Annual Meeting & Convention

Jul 30-Aug 2 40th Annual Southeastern Gatherin'

We Hit the Ground Running in 2023!

Carol Moytcka PharmD, BCACP

2023 has really started off with a bang! First and foremost, our members, staff, lobbyist, PR Firm, officers, and The FPA Pharmacy Independent Academy have been working extremely hard to work on advancing our profession while also protecting it through the legislative process. We have attended Board of Pharmacy meetings advocating on behalf of pharmacists throughout this great state of Florida.

In Tallahassee, efforts have been extensive including meeting with legislators, attending committee meetings, and testifying to both the House and Senate to advocate for pharmacy. Students from our great colleges of pharmacy around the state provided a health fair for legislators which was extremely well received and showcased the impact pharmacists have on the health of our community. Students also have been visiting Tallahassee throughout this committee season in their white coats in order to have a constant presence at the Capitol, helping keep our pharmacy legislative priorities at the front of legislators’ minds.

These efforts have really paid off as we see a bill regarding PrEP and PEP being considered and our long-fought efforts towards PBM reform becoming a reality! These are exciting times for Florida pharmacists and the effort by the Florida Pharmacy Association has been tremendous! I would like to thank everyone individually who has worked on these efforts, but the list is incredibly long which goes to show

the heart and dedication of our organization in advancing the profession forward.

Our committees have been hard at work supporting the organization through educational affairs, governmental affairs, professional affairs, and public affairs, student affairs, and organizational affairs efforts. I want to thank all of our chairs and council members for their hard work.

The Academy for The FPA Pharmacy Independent Academy have been a force this year in helping move our legislative efforts and advocate for independent pharmacists around the state. And finally, your elected officers have also been putting in many volunteer hours in order to move our organization forward and work on behalf of our members.

I am so proud and humble to be a part of this incredible team.

to bring new life to the Florida Pharmacy Association. We have a newly designed website with greater functionality and ease of use. On top of this, we have a new content management system which allows the user to register for meetings, attend the meetings, and receive their CE credits all in one space!

Don’t forget to follow our new podcast, Florida Rxperts, where you can hear from a wide range of guests discussing pharmacy issues that matter to our members. In regards to our educational efforts, it has already been a very exciting start to the year with our first conference being one of the best attended virtual conferences we have ever had! This February Clinical Conference was filled with a wide range of expertise starting with our keynote speaker Dr. Christopher Jones, Acting Director of the National Center for Injury Prevention and Control at the CDC. His presentation discussing the development of the new CDC guidelines provided attendees with tools they can use in any practice setting as we provide care for our patients suffering with pain. Additional presentations focused on cannabis and neurological disorders, autoimmune diseases, cardiovascular risk reduction, and opioid tapering. This

conference was an excellent to way start off the year!

I am thankful for all of you, our members, who have been on this journey with us and continue to support our FPA organization. We are excited about what our future holds as we continue to Lace Up and WON’T Stop!

We have several incredible conferences coming up including the Thrive Conference in April focusing on mental health and wellness, our May conference focusing on substance use disorders, and don’t forget our very popular SE Gatherin’ in August! Of course, we also can’t forget the Annual Convention in July at Marco Island where we have redesigned the program to allow for more time to mingle and confer with colleagues in this beautiful island setting. Be on the lookout for registration for all of these upcoming meetings and I look forward to seeing everyone!

The FPA staff, under the direction of our innovative CEO Helen Sairany, has been hard at work transforming our organization. Aside from the many visits to pharmacies and colleges of pharmacy around the state, staff has been toiling away behind the scenes

The Vulnerable Self: Trauma, Addiction, and the Pandemic Fallout

Helen Sairany, BA, PharmD, MBA, RPh, BCACP

This executive summary focuses on the alarming rise we have seen in substance use in Florida as well as the nation, a topic that could not be timelier. According to recent report by the U.S. Centers for Disease Control and prevention (CDC), more than 93,000 people died of a drug overdose in the United States in 2021 – the highest number of overdose deaths the country has ever recorded. Of these numbers, 7,579 people died from a drug overdose in Florida, making Florida number two in the nation for overdose deaths behind only California. This number is a 37% increase from 2019.

According to the National Survey on Drug Use and Health, 17 million U.S. adults experienced both mental health and substance use disorder in 2020. In 2019 alone, there were

49,860 opioid-related deaths. Though Florida has struggled with substance misuse crisis for years, the pandemic only exacerbated these effects. Many studies have shown that the pandemic contributed to increased alcohol and drug abuse, suicide attempts, and calls to mental health hotlines, because of the isolation, disruption to routines, economic uncertainty, and the anxiety it created. As a result, both alcohol and drug use are up. Approximately 8% of Florida citizens are using illicit drugs at any given point in time, which comes out to be approximately 1.5 million Floridians. Pasco County Sheriff’s Office reported a total of 1,491 overdoses in 2020 which was a 71% increase from 2019. The former Governor Rick Scott declared a state of emergency to authorize the state to draw the funding from the State Targeted Response to the Opioid Crisis Grants, a program that was established by the U.S. Department of Health and Human Services in April of 2017 and that was administered by the Substance Abuse and Mental Health Service Agency (SAMHSA).

Unfortunately, many of these problems were reaching epidemic proportions even before COVID-19. Consider that, pre-pandemic, President Trump declared the opioid epidemic a national emergency, relying on the following statistics:

Each day, 140 Americans die of an opioid-related overdose.

Drug overdoses are the leading causes of injury deaths in America, surpassing the totals for either firearm or vehicle traffic deaths. Shockingly enough, sustaining this death toll is the equivalent of experiencing an event like 9/11 every three weeks.

In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs. The staggering number of opioids prescribed in the U.S. in 2015 was enough for every American to be on medication around the clock for three weeks.

Americans are apparently in more pain than any other population in the world. At least, that is the conclusion that can be drawn from the startling findings from recent years: Approximately 80% of the global opioid supply is consumed in the United States, which accounts for only 5% of the world population. In the words of Vikesh Singh, assistant professor of medicine and director of the Pancreatitis Center at John Hopkins University, “If you include Canada and Western Europe [consumption of global opioid supply] increases to 95%, so the remaining countries only have access to about 5% of the opioid supply.”

The harsh reality that at least 140 people die from overdoses every day in the U.S. – two thirds of which are from opioids, isn’t new information, according to Dr. Gabor Maté, addiction expert and author of the book, The Myth of Normal. Dr. Maté says,

“We need to change the conversation to provide an effective response to the crisis. Dissuading people from taking drugs and treating addictive behavior isn’t the answer. Understanding and addressing the emotional pain and adverse conditions at the root of addiction would be significantly more effective.”

What do these scary statistics and findings mean for pharmacists, who are the most accessible providers in the country? It means we have a role to play, and as an association, we are obligated to provide our frontline heroes the tools and resources to fight this worthy fight. Here is what we have to share so far.

For the very first time, FPA is offering a live Summit on substance use Disorder, where we have selected sessions topics and recruited national experts in substance use disorder to tackle this timely topic. In addition, FPA’s Annual Convention Opening Keynote is dedicated to addressing this epidemic. We are honored to have the world renowned counselor, Jerry Moe, join us at FPA’s 133rd Annual Convention in Marco Island.

Make sure you mark your calendar so you can join us for FPA’s inaugural offering of FPA’s Summit on SUD from May 20 to May 21 and our Annual Meeting in Marco Island from July 5 to July 9. Registration to both events is live.

I look forward to seeing you soon!

Speakers Report

House of Delegates

In a few months, FPA’s 133rd Annual Meeting and Convention will take place July 5, 2023 – July 9, 2023 at the beautiful JW Marriott Marco Island.

Members, Local Unit Associations, and FPA House of Delegate members will gather to meet, learn, discuss, and advocate for the profession of pharmacy. I encourage all members to attend and be a part of the most important Florida pharmacy meeting of the year.

The House of Delegates will convene to discuss new business, and review submitted resolutions. Any member and/or local unit association should submit their resolution to the FPA offices as soon as possible.

I would like to recognize the members of the House of Delegate Board of Directors.

Chair of the House Board – Eric Larson

Speaker – Alexander Pytlarz

Vice Speaker – Josh Pullo

Director – Darcy Vaugh (term ends 2023)

Session Has Started!

Claudia

Davant, Adams

Street Advocates

Director – Dustin Williams (term ends 2024)

Director – Neil Barnett (term ends 2024)

In Florida, elected officials are predominantly Republican. The Cabinet, which includes the Governor, the Chief Financial Officer, the Attorney General, and the Florida Commissioner of Agriculture are all held by Republicans. In the Legislature both the House of Representatives and the Senate hold a Republican supermajority. This Republican supermajority in both chambers makes it challenging to pass legislation that could be seen as new or increased regulation over the private sector.

Prior to the House of Delegates meeting, please plan to attend and participate in the Annual Business meeting. FPA CEO Helen Sairany will be presenting to the membership new and exciting details about the future of the FPA.

Member Spotlight

It is shaping up to be one of the best FPA Meetings yet. I hope to see you in Marco! Thank you for allowing me to serve as your 2022-2023 House of Delegates Speaker.

It is an honor.

So our advocacy over the last few years has focused on educating legislators that the free market Republican philosophy does not apply to the PBM industry. When over 80% of the healthcare insurance market is controlled by only three companies, all 3 of whom are in the Fortune 15, there is no competition.

We have used FPA’s voice to share your stories with the Governor and legislators on the detrimental effects that the PBM industry using their monopoly-like leverage has had on your business, your families, and your ability to serve patients. And now we have been heard!

In July, 2022, Governor DeSantis issued an executive order regarding PBM reform initiatives and then expanded in a press conference in January 2023 his mission to reign in PBMs. The Legislature has also lasered in on real reform by adopting the Governor’s perspective and emphasizing in bills filed in the House and Senate that the anti-competitive, anti-patient behavior must stop in Florida.

HB 1509 sponsored by Representative Chaney and SB 1550 sponsored by Senator Brodeur would level the playing field for Florida-based community and independent pharmacies. These bills prohibit many of the practices PBMs use to discriminate against non- affiliated pharmacies and require rebates and access to the benefit of patients. PBM common business practices like clawbacks, steering patients to affiliated pharmacies, spread pricing, and mail-order pharmacy requirements would be prohibited! PBMs would no longer be allowed to remove a covered drug during the plan year. Language would also require 100% of rebates be distributed back to the health care plans to lower premiums and offset copays.

Please contact your legislators and demand they stand up to the PBM monopoly and support HB 1509 and SB 1550! Call the Governor’s office and commend him for putting Floridians before corporate profits! Get engaged with FPA and let your voice be heard!

Alexander Pytlarz, Speaker of the House

FPA Upcoming Events

April: Wellbeing Summit on Humanizing Work

The FPA Wellbeing Summit on Humanizing Work explores practice setting with cultures that allow pharmacists and their support staff use their talents and skills to serve patients, a culture that cares about them and what is important to them individually and collectively.

May: The FPA Summit on Substance Use Disorder

The FPA Summit on Substance Use Disorder explores the pharmacist’s role in addressing and preventing addiction in a healthy way. From recommending holistic approaches to cultivating an empathetic culture toward addiction, the education that participants receive here will equip them to provide effective and top of the line care for the patients in their community.

July: 133rd Annual Meeting & Convention

The FPA Annual Convention is the premiere event of the year and has a long history of drawing a wide variety of pharmacy professionals from all over Florida and the surrounding area. Pharmacists gather to learn from experts in the field, to view the latest products and services, and to network.

July/August: The FPA Annual Southeastern Gatherin’

The Southeastern Gatherin’ draws together a wide variety of Pharmacy professionals from the Panhandle of Florida as well as surrounding states such as Georgia, Alabama, Mississippi, Louisiana and more

The FPA Clinical Conference

The FPA Clinical Conference offers outstanding educational opportunities for every stage in your career— all in one place. This conference is your gateway to the latest clinical practice guidelines, practice tools, complex patient cases, and much more.

October: Nuclear Summit

The FPA Nuclear Summit explores a specialty area of pharmacy practice involved with the preparation of radioactive materials to improve and promote pharmacist patient care services.

November: Digital Summit

The FPA Digital Summit explores the rapid advances at the intersection of health care and technology (telehealth, digital medicine, digital therapeutics, and more) and consider how you can transform your practice and your role in digitallyenabled care.

December: Regulatory and Law Summit

The FPA Summit on Regulatory and Law is your gateway to the latest updates on pharmacy rules and regulations.

For more information, please visit the event page at FloridaPharmacy.org

Pharmacists and the Opioid Epidemic: Tools You Can Use

Trey Burry, PharmD

As essential members of the health care team, pharmacists are on the front lines of the opioid epidemic working to address prescription opioid abuse and overdose.

Pharmacists have multifaceted roles in dispensing opioid pain medications including evaluating new prescription orders with concurrent treatments, ensuring medications are appropriately prescribed, and assessing prescription orders for forgery or alteration. Pharmacists communicate with patients regarding proper use of medications, common side effects and potential risks, refill requirements, and how to safely store and dispose of unused medications to prevent diversion or misuse.

Dispensing opioid medications has become increasingly complex to navigate as pharmacists seek to provide optimal care to patients while safeguarding against liability. It is crucial that pharmacies perform their due diligence in carrying out opioid dispensing processes such as checking state prescription drug monitoring programs, identifying red flags, communicating with the prescriber or patient when concerned, and appropriately documenting provider or patient interactions. One tool that can be used to improve health care delivery and prevent opioid abuse is a safe opioid dispensing policy or opioid pledge.

The intent of an opioid pledge is to deliver upfront expectations around opioid prescriptions

to patients with the purpose of initiating a dialog between pharmacists and patients regarding opioid safety and stewardship. When pharmacies adopt and implement an opioid pledge it generates consistency, formalizes dispensing policies and practices, facilitates the training of pharmacy staff, eliminates confusion about early fills or refill dates, creates transparency for patients regarding the dispensing process, increases awareness for the actions the pharmacy is taking, and decreases the likelihood of meeting DEA quantity limits on controlled substances.

Opioid pledges can be formatted according to the needs and preferences of the pharmacy but should include the purpose of the pledge, what the pharmacy is committing to the patient, and expectations for the patient in the opioid dispensing process. A list of pharmacy responsibilities may include helping to ensure patient safety, communicating with prescribers, assessing treatment response, providing disposal resources, and offering and providing naloxone. Patient responsibilities may include using the medication as intended

and prescribed, being aware of risks, understanding limitations on early refills, proper storage and disposal of medication, and speaking to prescribers before making dosage or frequency changes.

Numerous independent community pharmacies across Florida implemented an opioid pledge in their dispensing process as a part of Flip the Pharmacy, a program coordinated and offered by the Community Enhanced Services Network (CPESN). Notably, a law was amended in July of 2022 that allows Florida pharmacists to dispense an emergency opioid antagonist without a prescription. Given the recent law amendment, pharmacies participating in the program last summer made educating patients on the availability of naloxone a major aspect of enacting the pledge.

Over a few months, every patient that picked up a chronic opioid prescription received an opioid pledge to review and sign before speaking to a pharmacist. The pharmacist discussed the opioid pledge with the patient in a private area, reviewed at least two to three points on the pledge, and signed the pledge to acknowledge their responsibilities. Every patient was offered naloxone during this conversation, regardless of MME or overdose risk, and told that they could receive the medication at any time in the future without a prescription. The pledge was then scanned into the patient’s profile before being given

to the patient to keep. The pledge received positive feedback among pharmacies and patients with dozens of patients receiving prescriptions and counseling for naloxone.

Pharmacists are on the front lines of the opioid epidemic engaging in prevention and treatment efforts to combat opioid use disorder and overdose. In an arsenal of weapons pharmacists may find the opioid pledge a formidable tool in dispensing opioid pain medications and providing medicationrelated services.

CPESN Florida is a statewide network of Florida community pharmacy practices dedicated to serving our patients with enhanced services and working collaboratively with other members of the healthcare team to improve patient health outcomes. For more information visit https:// cpesn.com/networks/cpesn-florida

Flip The Pharmacy is a program that is coordinated and offered by CPESN USA for member pharmacies. Information about this program can be found at www. flipthepharmacy.com. Resources related to creating and implementing an opioid pledge program are available at www. flipthepharmacy.com/opioid-focus.

1. “Drug Overdose Death Rates.” National Institutes of Health, U.S. Department of Health and Human Services, 9 Feb. 2023, https://nida.nih.gov/research-topics/trendsstatistics/overdose-death-rates.

National drug overdose deaths involving prescription opioids have more than quadrupled since 1999. 1

The FPA Institute on Substance Use Disorder explores the pharmacist’s role in addressing and preventing addiction in a healthy way

From recommending holist c approaches to cultivating an empathetic culture toward add ction the education that participants receive here will equip them to provide effective and top of the l ne care for the patients in their community

UF College of Pharmacy

Peter Swaan, PhD, MPharm

Anita Jacobson

8 00 am – 9 30 am May 20 2023

Communication is Key Talking to Patients with OUD

Improve communication with pat ents n order to overcome obstacles to optimal outcomes

9 30 am – 11:00 am May 20, 2023

Myths can Kill How to Approach Overdose and Mis nformation

Discover different discip ines and practices that can ass st in treat ng people w th OUD

Emily Leppien

11:00 am – 1 00 pm May 20 2023

Op oid Use D sorder: Beyond the Medicine

Educate pharmac sts about the different discip ines and practices that can ass st in treat ng people w th OUD

Jake Nichols

1:30pm – 3:00 pm May 20, 2023

The Self in Shame Heal ng the Wounds of Substance Use Disorders

The many types of shame, strategies to prevent unhealthy shame dur ng substance use disorder recovery, and how to apply th s knowledge for your patients

Dr. Thomas Franko

8:00 am – 9:30 am May 21, 2023

Advocacy Hour: Tools to change OUD treatment forever

Legislat ve actions that pharmac sts can take to advocate for their pat ents need for OUD treatment and expand the profess on of pharmacy so that pharmacists can continue to provide except onal pat ent care regardless of practice type

Jeffery Gold

10:00 am – 11:30 am May 21, 2023

Addiction and the Vulnerable Self Pract cing Self-Compass on n Recovery

Self-care sounds l ke an easy and s mple task but the reality is that most pharmacists struggle to find healthy ways to take care of themselves

Nancy Alvarez

12:00 pm – 1:30 pm May 21, 2023

Addressing Social Determinants of Health in Opioid Use Disorder

Learn about SDOH and ways to improve pat ent access to care despite the sign f cant barriers to care that some patients face

Scott Coon and Matthew Girard Hermenau

2 00 pm – 3:30 pm May 21, 2023

Creat ng a Culture of Trust; Harm Reduction in Marginalized Communities

Tools to mitigate r sk for patients m susing opioids and to communicate most effective y with providers in your area regarding prescrib ng these medications

Let me begin by first introducing myself to the Florida Pharmacy Association membership. My tenure as dean of the University of Florida College of Pharmacy began on Dec. 1, and I am thrilled to lead such an accomplished and well-respected pharmacy college. I spent the past two decades at the University of Maryland School of Pharmacy, where I held several leadership roles. Most recently, I served as the associate dean for research and advanced graduate education as well as a distinguished professor and chair in the department of pharmaceutical sciences. My academic and professional career includes stops at other premier pharmacy colleges, including the University of Michigan; the University of California, San Francisco; the Ohio State University; the University of Maryland; and now the University of Florida.

My arrival corresponds with a major milestone in the history of the UF College of Pharmacy, as our college celebrates its centennial in 2023. The Florida Pharmacy Association played an important role in the establishment of the UF College of Pharmacy. In the early 1920s, FPA members recognized the

need for a pharmacy school in Florida to provide advanced education and training to pharmacists in the state. There were no pharmacy schools in Florida at the time, and the existing pharmacy programs in other states were not easily accessible to Floridians. FPA leaders advocated for the creation of a pharmacy college at UF. They worked with university leaders and state legislators to secure funding for the new school, and in 1923, the UF College of Pharmacy was established.

Over the years, FPA has been an important partner of the UF College of Pharmacy. The organization has supported the college through scholarships, continuing education programs and other initiatives. FPA and the UF College of Pharmacy have worked together to advocate for the profession in Tallahassee and highlight the important role pharmacists play in providing health care to our state. UF College of Pharmacy faculty have also assumed various leadership roles in FPA and volunteered to advance the organization. Carol Motycka, Pharm.D., a clinical professor and assistant dean of our Jacksonville campus, is currently serving a one-year term as FPA president.

As the UF College of Pharmacy prepares to enter its second century, we owe a debt of gratitude to the Florida Pharmacy Association for its role in our founding and its continued support of pharmacy education in our state. Thank you to everyone at FPA who has helped the UF College of Pharmacy achieve 100 years of pharmacy greatness.

Thursday July 6, 2023

7:00am Registration Desk Opens

7:00-8:00 Breakfast

7:45am Welcome and Introductions

8:00am-10:00am Delegate Registration

8:00am-9:30am CE/RC

Leading in Times of Trauma: Helping Frontline Heroes Cope with Burnout with Helen Sairany

10:00am-12:00pm CE

To Fill or not to Fill: Addressing Addiction in Community Settings with Jake Nichols

11:00 am-11:30am

FPA Annual Business Meeting

Friday July 7, 2023

7:00am Registration Desk O

7:00-8:00 Breakfast

8:00am-9:30am CE/RC

s of CBD Products and with Steve Cutler

11:00am Pharmacy Car

Theresa Tolle

0:00am-11:30am CE/RC

ning Keynote with Jerry Mo

Family Matters: Helping Families through the Epidemic of Addiction

11:30am-1:30pm

Exhibit Hall Grand Opening

11:30am-1:30pm

Student Poster Presentations

12:00pm-1:00pm

Lunch in the Exhibit Hall

12:30pm-1:30pm

Local Unit Leaders Meeting

1:30pm-3:00pm CE/RC

The Community Champions: Inspire Your Team to Fill Unmet Needs in the Community with Annie Eisenbeis

2:15pm-3:45pm CE/RC

Dialing Down on Benzodiazepines with Sarah Melton

4:00pm-6:00pm

House of Delegates Reconvenes- if necessary

7:00pm-9:00pm FPPC Reception Presidents 250 Club Reception

3:30pm-5:00pm CE

NASPA/NMA Self-Care Bowl

Facilitated by Genevieve Hale

5:00pm-6:30pm

University Alumni Receptions

6:30pm- 8:00pm

Foundation Celebration

SNEAK PEEK AGENDA

Saturday July 8, 2023

6:30am 5K Fun and Walk

7:00am Florida Independent Pharmacy Owner Breakfast

7:00- 8:00am Breakfast

8:00am-9:30 am CE/RC

Collaborate for Success: The Ingredients of a Healthcare Dream Team with Amina Abubakar and Stephen Lewis

9:00am-11:00am Student Patient Counseling Competition

10:00am-11:30am CE/RC

Closing Keynote with Doug Hoey and Josh Lenchus

The Future of Pharmacy: Challenges and Opportunities

11:30am-1:30pm Exhibit Hall 12:00pm-1:00pm

Lunch in the Exhibit Hall

1:00-2:00pm Student Awards Event

1:30pm-3:00 pm CE/RC

Inspiring your Team in Times of Uncertainty with Amina Abubakar

1:30pm-3:00 pm CE

The Role of State Laws & Regulations in PBM Reform with Greg Reybold and Antonio Ciacca

3:30pm-4:30 pm CE

Your Annual Update to State and National Initiatives with Claudia Devant, Senator Jason Brodeur, Rep. Shane Abb Rep Gallop Franklin, and Rep Linda Chaney

3:30pm-4:30pm CE

Threats to Pharmacy Compounding Patients and Practic with Scott Brunner

7:00pm-10:00pm Banquet and Awards with Silent Auction Lace Up and Don't Stop:

Wear Your Formal with Statement Sneakers

Sunday July 9, 2023

7:00am- 8:00am Sunday Morning Worship

Theresa Tolle

7:20am

Registration Desk Opens

8:00am-10:00am CE

Mastering at Medication Error Prevention: A Practical Guide for Pharmacists with Michael Jackson

10:30am-11:30am CE

Hacked! Securing Your Pharmacy Data and Handling the Breach with Paige Clark

11:30am-12:00pm Installation of Officers

IMPORTANT CONFERENCE NOTES

A $20 daily resort fee and $100 daily incidental hold will be charged for your room on the personal credit card you check-in with.

FPA members will received a 50% discount on valet and self parking fees for the convention.

Our

List is

2022 Recipients of the “Bowl of Hygeia” Award

Make sure you are subscribed to FPA emails for the latest updates! We are making a playlist for convention and we need your jams. Email us your favorite tunes today at FPA@pharmview.com

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA History Hall located in Washington, DC.

Jennifer L. Keazer New Hampshire

Ronnie E. Opolka Sr. Alabama Kyla Newland Alaska Christina M. Madison Nevada Catherine Herbert Cary Virginia Ginger G. Scott West Virginia

Firlik Vermont

A. Clegg Washington William (Bill) Wenke Wyoming

Naxolone: What You Need to Know

Heather Taylor, PharmD, Consultant Pharmacist

Drug-related overdoses were the cause of 91,799 deaths in the Unites States in 2020. Of those, 68,630 were caused by opioids.1 Over 16,000 deaths were caused specifically by prescription opioids.2 In 2018, two million people were reported to have Opioid Use Disorder (OUD).3 The CDC defines OUD as “a problematic pattern of opioid use that causes significant impairment or distress. OUD is a treatable, chronic disease that can affect anyone – regardless of race, gender, income level, or social class. A diagnosis of OUD is based on specific criteria such as unsuccessful efforts to cut down or control use or use resulting in a failure to fulfill obligations at work, school, or home, among other criteria. It can even lead to overdose and death. In 2020, an estimated 2.7 million people ages 12 or older reported having an OUD”.4 Opioid use disorder is known to increase hospitalizations, and those with OUD who were hospitalized were more likely to die in the hospital or more likely to be readmitted within 30 days.5,6

In Florida, over 7,000 deaths reported were caused by a drug-related overdose in 2020.7 This was a 28% increase from years past.

Prescription drugs were more often the cause instead of illicit drugs. Fentanyl and benzodiazepines were the most found drugs, with fentanyl causing the most deaths.8 The increasing number of drug-related overdoses has prompted Florida leaders to take measures to ensure public safety. In 2016, House Bill 1241 was signed. It gave permission to pharmacists to dispense an emergency opioid antagonist with a non-patient specific standing order.9 Section 381.887 of the Florida Statutes allows pharmacists with a current active license who work in a pharmacy located in Florida to dispense Naloxone (IM, Sub Q and Nasal Spray) to emergency personnel without a prescription to be administered to persons exhibiting signs of opioid overdose.10 Senate Bill 544 amends 381.887 to allow Florida Pharmacists to dispense an emergency opioid antagonist without a prescription to patients and their caregivers who could use the treatment in a suspected overdose, and it was signed into law by Governor DeSantis in April 2022.11

Naloxone is an opioid antagonist. It works by attaching to opioid receptors and blocking and reversing the effects of opioids. Evidence suggests it works by competing with mu, kappa and sigma opiate receptor cites.12 Once administered, Naloxone works in the body for only 30-90 minutes. Because opioids remain in the body longer, multiple doses of Naloxone may need to be given. Withdrawal can occur after reversal in persons who are physically dependent on opioids, therefore 911 should be contacted immediately if an overdose is suspected and patients should be monitored after receiving Naloxone. Symptoms of withdrawal can include sweating, headache, nausea, vomiting, increased heart rate and changes in blood pressure. Naloxone will

have no effect if administered to a patient without opioids in their system. Naloxone formulations include a Nasal Spray (Narcan®, Kloxxado®) and an Intramuscular, Intravenous and Subcutaneous injection. Intramuscular administration has a longer duration of action than Intravenous, however the onset of action is faster with intravenous administration when compared to intramuscular and subcutaneous formulations.13 The recommended dose for Naloxone injection is 0.4-2mg initially in adults. Doses may be repeated in intervals of 2-3 minutes up to 10mg. The recommended dose of Naloxone Nasal Spray is 1 spray which can also be repeated every 2-3 minutes in alternating nostrils until EMS arrives.14

The availability of Narcan may become more accessible in 2023. Emergent BioSolutions, the manufacturer for Narcan is seeking FDA approval to sell Narcan over the counter. Currently the application is reported to be fast tracked and a response is expected at the end of March.15

Death rate maps and graphs. CDC.gov, 2, June 2022, https://www.cdc.gov/drugoverdose/deaths/index.html

Overdose Death Rates. NIH.com, 20, January 2022, https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

Substance Abuse and Mental Health Services Administration. 2018. https://www.samhsa.gov/sites/default/files/aatod_2018_final.pdf. Atlanta, GA: CDC; https://www.cdc.gov/drugoverdose/data/index.html. Accessed March 2019. [Google Scholar]

Opioid Use Disorder. CDC.gov, 30 August 2022, https://www.cdc.gov/dotw/opioid-use-disorder/index.html

, Ghertner R, Groves L. The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends, Assistant Secretary of Policy and Analysis. Washington, DC: ASPE; 2018. [Google Scholar] Weiss A, Heslin KL, Barrett ML, Izar R, Bierman AS. Opioid-Related Inpatient Stays and Emergency Department Visits Among Patients 65 Years and Older, 2010 and 2015. Statistical Brief #244 HCUP Rockville, MD: AHRQ; 2018. [Google Scholar]

McCarthy D., Johnson M, Audet AM. Recasting readmissions by placing the hospital role in community context. JAMA. 2013;309(4):351–352. [PubMed] [Google Scholar] Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2023, https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Florida Medical Examiners.(2020) Drugs Identified in Deceased Persons by Florida Medical Examiners. Florida Department of Law Enforcement. https://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-inDeceased-Persons/2020-Annual-Drug-Report-FINAL.aspx

HB 1241: Ordering of Medication. Flsenate.gov, 1 July 2016, https://www.flsenate.gov/Session/Bill/2016/1241

10 Statewide Standing Order for Naloxone. Fla Statute 381.887 (2022) https://www.floridahealth.gov/licensing-and-regulation/ems-system/_documents/ standing-order-naloxone.pdf

11 CS/SB 544-Drug-related Overdose Prevention. 2022. https://www.flsenate.gov/Committees/BillSummaries/2022/html/2727

12 Naloxone. Drugs.com, 1 May 2022, https://www.drugs.com/pro/naloxone.html

Thrive Pharmacy

Staff and Steven Mogeot, Owner Thrive Pharmacy

Thrive Pharmacy opened in Jacksonville, Florida, on September 11, 2018, to address the opiate crisis with a novel and compassionate approach. The opening day represented a day that someone experiencing SUD could now fight for themselves with the medical community’s support.

The owner/operator who chose this venture is Steven Mougeot, PharmD, a graduate of the University of Florida, class of 2008. Steven started his pharmacy journey in 1994 as a Navy Pharmacy Technician for eight years. With a degree in psychology already, he completed additional or pre-requisites and was admitted to Pharmacy School at UF Jacksonville.

Fresh out of school, he became the PDM at a CVS that was the worst-performing store in the district, as measured by corporate metrics. Within two years he turned that store around, making it the top performer and within budget. More success at corporate retail locations for various companies followed.

An opportunity opened up to be a pharmacist at his former Navy duty station, and he chose that for a few years. A gig as a contractlimited prior authorization pharmacist showed the underbelly of the insurance industry. Frustrated, Steven reached out to a friend who owned a pharmacy south of Jacksonville, requiring weekly commutes for five days living out of town, and returning on the weekends. But the opportunity presented the ability to work in both the sterile and non-sterile sides of compounding.

So it was here that Steven learned the art of making troches, something pharmacy school never offered but talked about. After almost one year of long-distance commuting (with a wife and two teenagers at home), Steven decided to open a pharmacy. Having seen the uglier side of compounding and the brighter side of compounding, he chose to specialize and fill a void he saw in the community.

Mouget’s experience in psychology, Pharmacy, faith, and sobriety (for 30 years!) has helped him create a pharmacy specializing in patients with substance use disorder.

Covid and a shifting world like any pharmacy. Overdoses hit an all-time high nationwide. And with fentanyl-animal tranquilizer (xylazine) laced products everywhere, the need has never been so great to help a struggling population. Thrive lost more than a handful of patients during and after this time to overdose/ poisonings. Poisoning here refers to when pills are “misbranded” as another product, and death occurs.

in all whole-numbered strengths from 1-12 and lower strengths in troche form. This form precludes diversion and inappropriate use (snorting or injecting) or selling on the street. Clinically, it is proven that traditional strips and tablets cannot be split for effective dosing. And with 1mg buprenorphine equal to 15-20mg morphine equivalents for effect, it should be readily apparent why macro dose changes (ex. 8 mg to 4mg) are not easily tolerated.

Too often at Thrive, Steven shares they see patients who felt maligned and ridiculed by their former pharmacy staff.

“Whereas we all should be celebrating therapeutic lifestyle changes, as we do with weight loss and dietary management with diabetics and cardiac patients, more often than not, when it comes to addiction, these patients are relegated to the bottom. How many diabetics did you discharge from your practice over the holidays when they overconsumed carbs? Or did you sneer at cardiac patients over Super Bowl weekend with the salty snack items they consumed? So why are there endless stories of patients who want to get off of opiates with buprenorphine-containing products having such a miserable time finding their medications? And yes, they, too, have their relapses. Misuse and diversion are always possible, but this is true for multiple pharmacy items, and Thrive Pharmacy is here for them in many ways.”

Furthermore, Big Pharma does not provide any actual taper or off-ramp when someone is ready to move off of buprenorphine, So Thrive provides a smooth off-ramp to minimize life disruption as individuals work their recovery programs and are prepared to move on. Yes, it is okay to lose patients as they get better. But too often, we all lose patients to overdoses, especially since 2020.

At Thrive, they encourage their customers to be their best selves. There are two comfortable couches to wait on in a warm, inviting environment. Pictures of sunrises cover the walls with steampunk lighting throughout, so the experience transforms and provides the community with care to help them thrive.

Almost five years in, Thrive Pharmacy endured

Thrive is an FDA-compliant compound pharmacy. The bulk majority of compounds provided are unlike any the DEA has seen in practice, as per a 2019 visit. Thrive provides buprenorphine with and without naloxone

Member Spotlight Member Spotlight

Lucas Zhou

Maryam Deravi

Aaron Emmel

Hobbies: Kayak fishing, coaching my daughters’ softball teams, reading, traveling, and finding great local coffee shops

Book: Hard to choose! It changes frequently so I’ll pick a recent read I enjoyed: Sapiens: A Brief History of Humankind

Quote: When you come to a fork in the road, take it - Yogi Berra

Movie/Show: Baseball by Ken Burns

Why are you proud to be in the Pharmacy Profession?

I’ve been fortunate to have a wonderful career in pharmacy. I’ve worked in retail and spent 10 years as a clinical pharmacist specializing primarily in critical care. I also worked as a hospital administrator, started several pharmacy and healthcare related businesses, and have volunteered for numerous organizations. One thing I haven’t done consistently is participate in professional pharmacy organizations. I’ve benefited from the hard work and advocacy of the professionals in organizations such as FPA, so hopefully I can commit to contributing from here on and help to advance our profession so future pharmacists have the same opportunities I have.

Where do you work and what is your title?

What college of pharmacy did you attend?

What are your favorite hobbies?

What is your favorite book?

What is your favorite quote?

What is your favorite Move/TV show?

Why are you proud to be in the Pharmacy Profession?

PharmD Candidate for 2024

College of Pharmacy, University of Florida

PharmD Candidate for 2023

College of Pharmacy, University of Florida