Bulletin Today
Research finds patients who are more socially vulnerable live in pharmacy deserts
In a research letter published in JAMA Network Open, authors make a connection between pharmacy accessibility and social vulnerability.
Patients in higher social vulnerability index counties with a lower primary care practitioner density had a 30% to 40% higher likelihood to reside in regions with pharmacy deserts, according to the research letter, published August 23, 2024.
“These findings highlight how disparities compound to create barriers to access basic health care,” wrote the study authors.
Specifically, they found that, in a study of 3,143 counties, 46% had at least one pharmacy desert, of which 57% were categorized as having low and 44% as having high pharmacy desert density, respectively.
The findings are based on data from TelePharm Map through 2020, looking at communities located 10 or more miles from the nearest retail pharmacy.
Counties with a high versus low pharmacy desert density had a higher social vulnerability index.
Study authors go on to say that as pharmacies close, more and more individuals are left without easy access to medications, with disproportionate consequences for certain communities.
“There is an association between [social vulnerability index] and number of chronic conditions. For example, diabetes and hypertension tend to be more prevalent among Black patients living in rural areas,” said the study authors. ■
Pharmacists in NY allowed to administer RSV vaccines to older adults and pregnant individuals
The New York State Department of Health has announced a new statewide order allowing pharmacists in New York to administer the RSV vaccine to eligible patients.
According to New York’s Department of Health, people who should receive the one-time dose include adults who are 75 years and older, individuals aged 60 to 75 years old with underlying medical conditions, and pregnant women.
These groups of patients can walk into a participating pharmacy and receive the RSV vaccine without a separate prescription from a physician. ■
An OTC syphilis test will now be available
In August 2024, FDA authorized the first at-home OTC test for syphilis. The First To Know Syphilis Test, developed by NOWDiagnostics, allows patients to use a single drop of blood and determine if they have syphilis in 15 minutes. In a news release about the test, however, FDA noted that results from this type of test alone are insufficient to diagnose syphilis infection and should be followed by additional testing to confirm a diagnosis of syphilis.
“We continue to see advancements in tests, particularly tests for sexually transmitted infections, which can give patients more information about their health from the privacy of their own home,” said Michelle Tarver, MD, acting director of the FDA’s Center for Devices and Radiological Health. “Access to home tests may help increase initial screening for syphilis, including in individuals who may be reluctant to see their health care provider about possible sexually transmitted infection exposure. This can lead to increased lab testing to confirm diagnosis, which can result in increased treatment and reduction in the spread of infection.”
According to CDC, reported syphilis cases in the United States increased 80% between 2018 and 2022 (from 115,000 to more than 207,000). In response to this—as well as the surging number of congenital syphilis cases nationwide—HHS established the National Syphilis and Congenital Syphilis Syndemic Federal Task Force in early 2024. FDA said it views the authorization of this new OTC syphilis test as a direct contributor toward the goals of the department’s strategic plan to reverse the rise of STIs in the United States. ■
Federal agencies report progress on youth e-cigarette use
Based on data from the 2024 National Youth Tobacco Survey, FDA and CDC found that adolescent use of e-cigarettes is down from last year.
Findings showed there was a significant drop in the number of U.S. middle and high school students who reported current (past 30 days) e-cigarette use—a decrease from 7.7% of youth in 2023 to 5.9% of youth in 2024. FDA said this decline was largely driven by reduced e-cigarette use among high schoolers (1.56 million to 1.21 million), with no statistically significant change in current e-cigarette use among middle school students within the past year. The number of young adults who used e-cigarettes in 2024 is approximately one-third of what it was at its peak in 2019, when over 5 million youth reported current e-cigarette use.
Nearly 30,000 students in grades 6 to 12 were captured in the analysis.
The calculations also revealed that approximately 480,000 middle and high schoolers are current users of flavored nicotine pouches that dissolve when held between the lip and gum.
While the numbers from the current survey reflect a drop in current e-cigarette use and no change in the share of adolescents using nicotine pouches, at 1.8%, experts said the small victories are overshadowed by the bigger picture.
“The continued decline in e-cigarette use among our nation’s youth is a monumental public health win,” said Brian King, PhD, MPH, director of the FDA’s Center for Tobacco Products, in an FDA news release. “But we can’t rest on our laurels, as there’s still more work to do to further reduce youth e-cigarette use.”
In August 2024, FDA announced a final rule that raises the minimum age for certain restrictions on tobacco product sales. The requirements are in line with legislation signed in December 2019 that immediately raised the federal minimum age of sales of tobacco products in the United States from 18 to 21 years old.
Beginning on September 30, 2024, retailers were required to verify with photo identification the age of anyone younger than age 30 years who is trying to purchase tobacco products, including e-cigarettes. Previously, this requirement applied to anyone younger than age 27 years. ■
Buprenorphine plus naloxone could be safe alternative for OUD in pregnancy
Researchers of a recent study published in JAMA on August 12, 2024, sought to investigate the neonatal and maternal safety of buprenorphine plus naloxone compared with buprenorphine only in pregnant patients with OUD.
Outcomes comparisons revealed a reduced risk for neonatal abstinence syndrome in those receiving buprenorphine plus naloxone, which also demonstrated a modestly lower risk of small for gestational age and/or admission to a neonatal ICU.
The sample of patients included 8,695 Medicaid beneficiaries with live births between 2000 and 2018. A total of 3,369 patients received the combination treatment during the first 3 months of pregnancy, while 5,326 patients—some of whom switched from the two-drug approach—received buprenorphine alone in the first trimester.
The maternal morbidity rate among the pregnant patients who underwent combination therapy was 2.6% versus 2.9% for their counterparts who received buprenorphine alone. No between-group disparities were documented for major congenital malformations, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery.
The findings suggest that buprenorphine plus naloxone is a safe alternative OUD intervention for women in early pregnancy, although buprenorphine by itself is also safe. ■
What’s the latest with well-being for pharmacy staff?
According to the tenth installment of the Pharmacy Workplace and Well-being Reporting (PWWR) series, community pharmacists continue to suffer discrimination, harassment, and aggression on the job, but more are pushing back with legal action.
“The persistence of harassment, especially toward female pharmacy personnel, is alarming and underscores the necessity for robust policies to protect staff well-being,” said Krystalyn Weaver, PharmD, JD, executive vice president and CEO of the National Alliance of State Pharmacy Associations (NASPA).
APhA, along with NASPA, launched the PWWR in October 2021 to encourage pharmacy professionals to confidently share personal and detailed work experiences—both positive and negative.
Weaver said the ongoing challenges surrounding staffing and workload continue to be prominent themes in this latest report, with many submissions highlighting inadequate staffing and a mismatch between workload expectations and available resources. “What particularly stands out is the high recurrence rate of these issues across various practice settings, signaling the need for systemic change,” Weaver said.
She said she is struck by how the current business model exacerbates recurring issues such as inadequate staffing and workload pressure, which take an emotional and psychological toll on pharmacy personnel.
“Many services are provided for free, and pharmacies are often under pressure to focus on high-volume dispensing to sustain revenue, leading to a mismatch in staffing and workload. A shift to a care-based funding model could alleviate these issues by allowing pharmacies to be staffed according to the level of patient care they provide, which would not only improve working conditions but also better serve the community,” Weaver said.
A total of 108 reports informed this tenth iteration. The goal is to use insights from the reports to better support the profession. ■