Bulletin Today
APhA Staff
Fatal drug overdoses in the United States soared 30% in 2020, the most recent CDC statistics show, but the burden on minority populations has grown much faster due to fewer treatment options.
According to the data, overdose deaths were up 22% from 2019 among whites but were up 39% for Native Americans and up 44% for Blacks. White individuals with substance abuse disorder were much more likely to have received treatment—nearly twice as likely, in fact, when compared with Blacks.
CDC researchers noted that overdose rates were higher in areas with more opioid treatment programs than average and in counties with greater income inequality. ■
Physicians continue to overprescribe fluoroquinolones
FDA has received reports of hundreds of thousands of serious adverse events associated with fluoroquinolones from more than 60,000 patients since the 1980s. The most frequent adverse effects include tendon rupture and neurological and psychiatric symptoms. However, experts estimate that only a small fraction of such events are reported to FDA.
Charles Bennett, MD, a hematologist at the University of South Carolina’s College of Pharmacy in Columbia, SC, believes fluoroquinolones may have injured hundreds of thousands of people nationwide. Despite FDA warnings and several patient reports about adverse effects, many health care providers continue to improperly prescribe fluoroquinolones for conditions such as simple UTIs, sinus infections, and respiratory issues.
FDA-approved fluroquinolones include ciprofloxacin, ciprofloxacin extended-release tablets, delafloxacin, gemifloxacin, levofloxacin, moxifloxacin, and ofloxacin. FDA regulators have not prohibited the use of fluoroquinolones for use in the treatment of bacterial infections in light of their benefit for certain conditions. However, the agency has required an escalating series of warnings and safety labeling changes, with the first black box warning added in 2008.
Former FDA Commissioner Scott Gottlieb, MD, noted that “for some patients, the benefits of fluoroquinolones may continue to outweigh the risks for treatment of serious bacterial infections, such as pneumonia or intra-abdominal infections, but there are other serious, known risks associated with these strong antibiotics that must be carefully weighed when considering their use.” ■
Study finds many older adults not getting medication reviews
Many older adults are not receiving comprehensive medication reviews (CMR), according to a report from University of Michigan researchers.
Their study, published in The Journals of Gerontology: Series A, found that fewer than 21% of people age 65 years and older received a CMR.
The study found that for older adults with health insurance, 77% were on two or more prescription medications. Of them, only one in five had received a CMR, while over one-third were interested in a medication review in the future.
Findings also revealed that most older adults—about 83%—were not aware that Medicare will cover a CMR.
For more than 15 years, Medicare Part D plans have included medication evaluations with a pharmacist who will take into account prescription medications as well as supplements and OTC medications.
The study found that older patients using two or more prescriptions and who were in good health or had low incomes were less likely to have a medication review. This was compared to older adults who took a similar number of medications but were less healthy or had higher incomes.
Researchers also found that older adults who take 5 or more prescription drugs were significantly more likely than those who take between two and four drugs to have had a CMR. ■
Gestational diabetes grows more common, pointing to need for more preventive care
A CDC analysis reveals that gestational diabetes has become a big problem over the last 30 years, especially as Americans became more sedentary during the COVID-19 pandemic. Longer-term trends, such as the climbing age of women giving birth and the shifting ethnic demographics of mothers, have also contributed to the growing prevalence of gestational diabetes, which can cause problems during delivery and create ongoing health complications for babies.
Experts say the research underscores a need for greater awareness, earlier diagnosis, and more providers trained to treat and manage the growing caseload.
Patient barriers to care, such as the cost of glucose test materials and insulin supplies, add another layer of challenge to the issue.
While dangerously high blood glucose levels are most common in the third trimester of pregnancy, specialists warn that gestational diabetes should not be dismissed as a short-term problem. As many as 70% of women who suffer from the condition develop type 2 diabetes within 20 years, and their children are more likely to develop type 2 diabetes as well. ■
Survey finds few parents intend to vaccinate their young children against COVID-19
According to a recent Kaiser Family Foundation survey, it does not appear that large numbers of parents will get their very young children vaccinated now that FDA has authorized COVID-19 vaccines for this age group. Most parents said they considered the vaccine a greater risk to their children than COVID-19.
Apprehension among parents of children aged 6 months to 4 years has so far resulted in only 2.8% of eligible children receiving COVID-19 vaccines since June 18, 2022 (which is when they became eligible), a separate analysis of federal vaccine data by the foundation revealed.
The survey found that 43% of parents with children younger than 5 years old said they would “definitely not” have their children vaccinated; about 27% said they would “wait and see;” and 13% said they would have their children vaccinated “only if required.”
Only 40% of children aged 5 to 11 years have been vaccinated to date. In the new Kaiser survey, 37% of parents of children in that age group said they would “definitely not” have their child vaccinated against COVID-19.
Parents’ primary concerns were about possible adverse effects, the vaccines’ comparative newness, and insufficient research. A majority of parents said they found information regarding the vaccine from the federal government confusing. However, 70% of respondents said they had not discussed the vaccines with a pediatrician yet. ■
Study shows widespread mislabeling of CBD OTC products
Labels of many cannabidiol (CBD) OTC products inaccurately list their CBD content, according to a study published in JAMA Network Open. Researchers at Johns Hopkins University School of Medicine tested more than 100 topical CBD products available online and at stores. They also found that some CBD products made therapeutic claims not approved by FDA.
The research team purchased 105 CBD topical products in the form of creams, lotions, and patches online and at brick-and-mortar sites in Baltimore in July and August 2020.
Only 89 (85%) of the 105 tested products listed their total amount of CBD in milligrams. Of these 89 products, 16 (18%) contained less CBD than stated on the label, 52 (58%) contained more than stated, and only 21 (24%) were correctly labeled.
In-store products overall contained 21% more CBD than stated on the label, while the online products contained 10% more than stated. Ryan Vandrey, PhD, the study’s senior author and a professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, said “The variability in the chemical content and labeling found in our study highlights the need for better regulatory oversight of CBD products to ensure consumer safety.”
The researchers also tested the products for their Δ-9-tetrahydrocannabinol (THC) content and found that THC was detected in 37 (35%) of the 105 products. These products were all within the legal limit of 0.3%, but 4 (11%) were labeled as “THC free,” 14 (38%) stated they contained less than 0.3% THC, and 19 (51%) did not cite THC on the label. ■
Older adults at risk of drug interactions with Paxlovid
A recent study suggests that some older adults may be taking medication that interacts with Pfizer’s nirmatrelvir/ritonavir (Paxlovid) COVID-19 antiviral. The drug has been approved for early outpatient treatment of COVID-19 to prevent severe disease.
Using national databases in Denmark, researchers estimated the share of older adults who were at risk of significant drug interactions if they were to use Paxlovid. According to the article in the International Journal of Infectious Diseases, they found that blood thinners that should not be taken with the antiviral were being used by 20% of people over the age of 65 years and by 30% of people over the age of 80 years.
Incompatible cholesterol-lowering statins were being used by up to 18% of people older than 65 years, and more than 20% of the study population were using drugs such as analgesics or heart medications that might require dose adjustments.
Prior to prescribing the antiviral, “the patient’s full medical history including herbals, [OTCs,] and recreational drugs must be known, and co-treatment carefully managed by the treating physician, or by a specialist, to avoid detrimental effects,” the researchers wrote. ■