Oregon Administrative Rules, Chapter 436 Summary of Public Testimony & Agency Responses be AWP minus 10% + $10.00. Consider payment for generics at a higher level to support their use. We suggest an AWP plus option: AWP + 5% plus $8.50. Regarding limitations affecting Oxycontin, Vioxx, Celebrex, and Neurontin, the rules need to address if the justification covers just the initial fill or multiple refills. If repeat justifications are needed, who is responsible to obtain or provide them, the patient, pharmacist, doctor? Any delay in obtaining pain medication needs to be avoided if at all possible. Within current rules payment will be based upon the lower of either the provider's usual and customary charge or the fee established by this rule. This provision gives the director authority to determine if a submitted U&C is excessive when compared to other providers. This provision is ambiguous and provides interpretation on a case-by-case basis as to what is reasonable for payment if not paid at established rates. In many states disputes have arisen over what constitutes usual & customary. We recommend deletion of the reference to usual & customary and make the rule reflect a true fee based system. Proposed amended language: "Payment will be the lower of either the provider's usual and customary charge or the fee established by this rule." See response to testimony below. Testimony: Exhibit #19 We participated in the Workers' Compensation Pharmacy Fee Advisory Task force, and the proposed rule appears to be consistent with the recommendations of the Task Force. By increasing the dispensing fee to a level that more appropriately reflects pharmacy dispensing costs, lowering the AWP rate, and requiring clinical justification for the use of certain drugs, the proposed rule provides appropriate incentives for pharmacists and pharmacies to encourage use of cost-effective drug therapies. We recommend you clarify the clinical justification process such that once submitted, the justification carries over to any refills authorized the prescribing practitioner. See response to testimony below. OAR 436-009-0090 1 ; Testimony: Exhibit #24 The Pharmacy Fee Advisory Taskforce made its final recommendation to the Department of Consumer and Business Services to modify the rules as follows: 1 ; If a brand medication has a generic equivalent, the pharmacist will dispense the generic; 2 ; If a brand drug has a therapeutic equivalent, the pharmacist would contact the physician to see if the therapeutic substitution could be made, and that a higher dispensing fee -- $10.00 would be appropriate in these instances, but not across the board; all other fills and refills of the therapeutic equivalent should remain at $6.70; and 3 ; See OAR 436-010-0230 6 ; for Exhibit #24. See response to testimony below. Preferred Formulary: fentanyl patch Duragesic ; [Janssen Pharmaceutica Products L.P.] hydromorphone tablet generic ; [various] levorphanol tablet generic ; [various] methadone tablet generic ; [various] morphine sulfate tablet generic ; [various] oxycodone tablet generic ; [various] morphine SR tablet generic ; [various] oxycodone SR tablet OxyContin ; [Purdue Pharma L.P.] Kadian morphine sulfate SR capsule ; [Alpharma].
The cause of chronic cough can be determined in most adult patients; specific therapy will be successful in the majority of patients when chronic cough is evaluated in a systematic manner. A diagnostic approach that systematically evaluates locations of the afferent limb of the cough reflex for diseases that might be causing cough has been utilized in one form or another in 11 published studies.3, 4, 115-121, 310, All studies were descriptive in nature; seven were prospective3, 4, 115-117, 310, Grade II-2 ; , and four were retrospective118-121 Grade II-3 ; . Ten primarily involved adults, and one118 focused on infants and children. In nine of the studies, the cause was determined from 88 to 100% of the time, leading to successful therapy in 84 to 98% of the patients. In two studies, the cause of cough was determined in 55%311 and 78%.310 Cough was eliminated in 68% in the latter study. It is not known why these latter two studies yielded results different from those of the other nine studies. Perhaps it was due to the different populations studied or to the use of different diagnostic311 and therapeutic310 protocols. A systematic, diagnostic approach to chronic cough has been validated in immunocompetent patients in multiple prospective and retrospective descriptive studies. No such approach has yet been studied in chronic cough in immunocompromised patients or for acute cough. Strengths and Limitations of the Anatomic Diagnostic Protocol: One prospective, descriptive study117 Grade II-2 ; has shown that the character eg, paroxysmal, loose and self-propagating, productive, brassy, honking, and barking ; and timing eg, nocturnal, with or after meals, associated with milk ingestion ; of cough was not helpful in predicting its cause. Two prospective, descriptive studies4, 115 Grade II-2 ; revealed the strengths and limitations of testing for diagnosing the cause of chronic cough in adults. The principal strength of diagnostic testing is in ruling out suspected possibilities Table 8 ; . The principal limitation is that a positive test cannot necessarily be relied upon to establish the diagnosis; a positive test has not been and paxil.
While improved dental hygiene can cure most problems, in some cases bad breath can signal an underlying medical condition.
Briggs GG, Freeman RK, Yaffe SJ. Drugs in lactation second edition. Williams & Wilkins, Baltimore, MD; 1997: 24. 533 USPDI. Drug information for the health care professional volume I. United States Pharmacopeial Convention, Inc., Rockville, MD; 1995: 1380. 534 Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994; 93: 137-150. Roche Pharmaceuticals, 340 Kingsland St., Nutley, NJ 07110-1199. Phone 800-526-6367. 536 Roche Pharmaceuticals, 340 Kingsland St., Nutley, NJ 07110-1199. Phone 800-526-6367. 537 Parke-Davis, 201 Tabor Rd., Morris Plains, NJ 07950. Phone 800-223-0432, 973-540-6089. Fax 973-540-2248. 538 Novak KK. Facts and comparisons drug information updated monthly. Facts and Comparisons, Inc., St. Louis, MO; 2000: 172i. 539 AstraZeneca, Zeneca Inc., Wilmington, DE 19850-5437. Phone 302-886-3000, 302-886-8000. 540 AstraZeneca, Zeneca Inc., Wilmington, DE 19850-5437. Phone 302-886-3000, 302-886-8000. 541 Drug Information Handbook, 6th ed.; 1998-1999: 602. 542 Little BB, Snell LM, Klein VR, Gilstrap LC 3d, Knoll KA, Breckenridge JD. Maternal and fetal effects of heroin addiction during pregnancy. J Reprod Med. 1990 Feb; 35 2 ; : 159-162. 543 Cunningham, FG, MacDonald PC, Leveno, KJ, Gant, NF, Gilstrap III, LC, eds. Williams Obstetrics, 19th edition. Appleton & Lange; 1993: 976. 544 Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994; 93: 137-150. Golding J. Unnatural constituents of breast milkmedication, lifestyle, pollutants, viruses. Early Hum Dev 1997 Oct 29; 49 Suppl: S29-43. 546 Novak KK, ed. Facts and comparisons drug information updated monthly. Facts and Comparisons, Inc., St. Louis, MO; 2000: 115s. 547 Novak KK, ed. Facts and comparisons drug information updated monthly. Facts and Comparisons, Inc., St. Louis, MO; 2000: 115s. 548 Briggs GG, Freeman RK, Yaffe SJ. A reference guide to fetal and neonatal risk drugs in pregnancy and lactation fourth edition. Williams & Wilkins, Baltimore, MD; 1994: 419. 549 Briggs GG, Freeman RK, Yaffe SJ. A reference guide to fetal and neonatal risk drugs in pregnancy and lactation fourth edition. Williams & Wilkins, Baltimore, MD; 1994: 422. 550 Briggs GG, Freeman RK, Yaffe SJ. A reference guide to fetal and neonatal risk drugs in pregnancy and lactation fourth edition. Williams & Wilkins, Baltimore, MD; 1994: 426. 551 USPDI. Drug information for the health care professional volume I. United States Pharmacopeial Convention, Inc., Rockville, MD; 1995: 2324. 552 Bristol-Myers Squibb Company, PO Box 4500, Princeton, NJ 08543-4500. Phone 800-321-1335, 609-818-3737. 553 Bristol-Myers Squibb Company, PO Box 4500, Princeton, NJ 08543-4500. Phone 800-321-1335, 609-818-3737. 554 Bristol-Myers Squibb Company, PO Box 4500, Princeton, NJ 08543-4500. Phone 800-321-1335, 609-818-3737. 555 Briggs GG, Freeman RK, Yaffe SJ. Drugs in lactation second edition. Williams & Wilkins, Baltimore, MD; 1997: 16-17. 556 McNeil Consumer Healthcare, Fort Washington, PA 19034. Phone 215-273-7000. 557 Briggs GG, Freeman RK, Yaffe SJ. A reference guide to fetal and neonatal risk drugs in pregnancy and lactation fourth edition. Williams & Wilkins, Baltimore, MD; 1994: 433-434. 558 Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994; 93: 137-150. Pharmacia & Upjohn, 100 Route 206 North, Peapack, NJ 07977. Phone 888-768-5501, 616-833-8244. 560 Pharmacia & Upjohn, 100 Route 206 North, Peapack, NJ 07977. Phone 888-768-5501, 616-833-8244. 561 Briggs GG, Freeman RK, Yaffe SJ. Drugs in lactation second edition. Williams & Wilkins, Baltimore, MD; 1997: 16-17. 562 Bristol-Myers Squibb Oncology Immunology Division, PO Box 4500, Princeton, NJ 08543-4500. Phone 800426-7644, 609-818-3737 and penicillin, for example, hydrocodone. Accepted into TRC vocational retraining programs. Due to his pathology, he will either need to return to modified work duties or obtain alternate work. Although the patient is able to reach heavy physical demand levels, it is uncertain if he will be able to maintain these duties for a sustained period of time without aggravation to his injury. References 1 ; Albright, et al including Philadelphia and Ottawa Panel Members ; . Philadelphia Panel Evidence-Based Clinical Practice Guideline on Selected Rehabilitation Interventions for Low Back Pain. Physical Therapy. 81 10 ; . Oct. 2001. 2 ; Effects of Noradrenergic and Serotonergic Antidepressants on Chronic Low Back Pain Intensity. Atkinson JH, Slater MA, Wahlgren DR, t al. Pain. 1999; 83 2 ; : 137-45. 3 ; Co morbid Psychiatric Disorders and Predictors of Pain Management Program Success in Patients with Chronic Pain. Workman EA, Hubbard JR, Felker BL. Records supplied by publisher ; . Aug 2002. 4 ; p. 137-140. 4 ; American Academy of Pain Management Guidelines. Specialty IRO has performed an independent review solely to determine the medical necessity of the health services that are the subject of the review. Specialty IRO has made no determinations regarding benefits available under the injured employee's policy. Specialty IRO believes it has made a reasonable attempt to obtain all medical records for this review and afforded the requestor, respondent and treating doctor an opportunity to provide additional information in a convenient and timely manner. As an officer of Specialty IRO, Inc, dba Specialty IRO, I certify that there is no known conflict between the reviewer, Specialty IRO and or any officer employee of the IRO with any person or entity that is a party to the dispute. Sincerely, Wendy Perelli, CEO YOUR RIGHT TO REQUEST A HEARING Either party to this medical dispute may disagree with all or part of the decision and has a right to request a hearing. The information gathered during the assessment. By keeping in mind the following highlights of the American Society of Addiction Medicine placement criteria, 51, 52 the clinician and the patient together can establish an appropriate treatment plan. Intoxication withdrawal. If the patient is in acute physical danger because he is experiencing acute withdrawal symptoms or life-threatening intoxication, he should be referred to a medically supervised setting usually inpatient ; . Biomedical conditions. Acute medical problems may require inpatient medical surgical services. Chronic medical problems, such as diabetes and hypertension, should be managed in an outpatient setting in which the patient can receive both medical and behavioral health services. The ideal setting would be a primary care clinic with access to psychiatric, addiction, and counseling services. Emotional behavioral conditions. If the patient is medically stable and receives a diagnosis of both a major psychiatric illness and a substance use disorder, then referral to a dual-diagnosis clinic is appropriate. Relapse continued-use potential.If the evaluation does not reveal any acute problems but identifies a propensity toward continued use of the problem substance, then referral can range from regular outpatient--relapse-prevention groups, 12-step programs--to intensive outpatient programs consisting of no less than 9 hours per week of full-spectrum treatment modalities, depending on the risk of relapse. CONCLUSION Evaluating the adult patient for a substance use disorder can be accomplished efficiently in the ED setting if the assessment is approached systematically. Clarifying personal values and views about substance use disorders, understanding cultural norms, screening for substance use and psychiatric disorders, enhancing motivation, and making an appropriate referral are essential steps in the evaluation process. Although there are no empiric data to support the effectiveness of the collective assessment approach presented in this article, each of its steps has been empirically tested or has had strong anecdotal support. Therefore, it is logical to integrate them into a comprehensive evaluation paradigm that may constitute the ED patient's first step toward recovery. When this article was written, Dr Maviglia was assistant professor and director of dual diagnosis services, department of psychiatry and behavioral medicine, Medical College of Wisconsin, Milwaukee. He is now medical director of ValueOptions and assistant professor of family and community medicine at the University of New Mexico in Albuquerque. He reports no conflicts of interest regarding the subject matter of this article. This article first appeared in Psychiatric Issues in Emergency Care Settings. Drugs Mentioned in This Article Alprazolam Xanax ; Clonazepam Klonopin ; Codeine Paverol, others ; Diazepam Valium ; Fentanyl Actia ; Flurazepam Delmane ; Lorazepam Ativan ; Methadone Methadose ; Methamphetamine Desoxyn, others ; Methylphenidate Concerta, Ritalin, others ; Oxycodone OxyContin, others ; Temazepam Restoril ; References: 1. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2003: Interim National Estimates of DrugRelated Emergency Department Visits. Rockville, Md: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2004. DAWN Series D and pepcid. 18 In or about January, 2001, in McLean, Virginia, at the home of HURWITZ, conspirators Kevin Fuller and Cindy Horn received prescriptions for OxyContin and other controlled substances. In or about January, 2001, in Fairfax, Virginia, HURWITZ and a pharmacist met with conspirators Kevin Fuller and Cindy Horn and encouraged her to consume more OxyContin pills, a portions of which they would distribute to others. On or about November 8, 2001, in or about Pikeville, Kentucky, conspirator Kathy Shortridge requested via facsimile that HURWITZ issue prescriptions for various controlled substances for FedEx delivery to her home. On or about November 9, 2001, within the Eastern District of Virginia, HURWITZ reviewed the medical laboratory report showing conspirator Robert Woodson' urine was positive s for cocaine. On or about March 1, 2002, in McLean, Virginia, HURWITZ prescribed excessive dosages of OxyContin after Rita Carlin had told him that she had previously injected her prescribed medications. Stem from the same criminal transaction. This Court will not upset a seemingly inconsistent verdict by speculation as to the jury's reasoning if we are satisfied that the evidence establishes guilt of the offense which the conviction was returned. State v. Wiggins, 498 S.W.2d 92, 93-94 Tenn.1973 ; . In examining whether the evidence is sufficient to support Defendant's conviction of aggravated child abuse, we must review the evidence in a light most favorable to the prosecution in determining whether a rational trier of fact could have found all the essential elements of the crime beyond a reasonable doubt. Jackson v. Virginia, 443 U.S.307, 319, 99 S. Ct. 2781, 2789, 61 L. Ed. 2d 560 1979 ; . Once a jury finds a defendant guilty, his or her presumption of innocence is removed and replaced with a presumption of guilt. State v. Black, 815 S.W.2d 166, 175 Tenn. 1991 ; . The defendant has the burden of overcoming this presumption, and the State is entitled to the strongest legitimate view of the evidence along with all reasonable inferences which may be drawn from that evidence. Id.; State v. Tuggle, 639 S.W.2d 913, 914 Tenn. 1982 ; . The jury is presumed to have resolved all conflicts and drawn any reasonable inferences in favor of the State. State v. Sheffield, 676 S.W.2d 542, 547 Tenn. 1984 ; . Questions concerning the credibility of witnesses, the weight and value to be given the evidence, and all factual issues raised by the evidence are resolved by the trier of fact and not this court. State v. Bland, 958 S.W.2d 651, 659 Tenn. 1997 ; . These rules are applicable to findings of guilt predicated upon direct evidence, circumstantial evidence, or a combination of both direct and circumstantial evidence. State v. Matthews, 805 S.W.2d 776, 779 Tenn. Crim. App. 1990 ; . The offense of aggravated child abuse is committed if a person commits the offense of child abuse or neglect and the "act of abuse or neglect results in seriously bodily injury to the child." Tenn. Code Ann. 39-15-402 a ; 1 ; . The offense of aggravated child abuse is a Class A felony if the victim is six years of age or less. Id. 39-15-402 b ; . The offense of child abuse or neglect is committed by "[a]ny person who knowingly, other than by accidental means, treats a child under eighteen 18 ; years of age in such a manner as to inflict injury or neglects such a child so as to adversely affect the child's health and welfare." Id. 39-15-401 a ; . Viewing the evidence in a light most favorable to the State, Defendant bought Oxyc9ntin pills on July 22, 2002. Mr. Kirk crushed the pills on top of the washing machine in the bathroom, and he and Defendant ingested the drug. The victim woke up and was fussy. Defendant rubbed his wet pacifier in the Oxycont8n crumbs and placed the pacifier back into the victim's mouth. The victim went to sleep. The next morning, the victim showed signs of respiratory distress and died two days later. The medical examiner noted severe damage to the victim's kidneys and brain which were consistent with the ingestion of Oxycontin. Based on the foregoing, a rational trier of fact could find beyond a reasonable doubt that Defendant was guilty of aggravated child abuse and phenergan. Clearance of oxycodone is impaired in the presence of liver disease, requiring a dose reduction. Patients with mild or moderate hepatic dysfunction exhibit accumulation of oxycodone: a 50% increase in peak blood levels and a 95% increase in overall blood concentrations AUC ; . For the oxymorphone metabolite, liver disease results in a 30% lower peak blood level and 40% lower AUC which is expected because metabolites are not being produced as efficiently ; [OxyContin PI 2007].
Alcohol Binge alcohol use1 Cigarettes Cigars, cigarillos, little cigars Smokeless Tobacco Marijuana Inhalants Cocaine Heroin Methamphetamines Steroids no prescription ; Ecstasy Oxycontn no prescription ; Other Illegal Drugs2 CURRENT any use in past 30 days ; Alcohol Binge alcohol use1 Cigarettes Cigars, cigarillos, little cigars Smokeless Tobacco Marijuana Inhalants Cocaine Heroin Methamphetamines Steroids no prescription ; Ecstasy Oxyc0ntin no prescription ; Other Illegal Drugs2 64.6% N A N A 13.9% N A N A 5.2% N A N A 42.9% 26.3% 20.5% N A 4.4% 27.9% N A N A 65.5% N A 47.6% 22.8% 3.3% N A 41.5% 19.8% 4.2% N A 62% N A N A 50% 12% 8% N A N A 53% 33% 26% N A N A 75% N A 53% N A N A 47% N A 8% 3% 6% N A 46% 27% 21% N A N A 76% N A 51% N A N A 45% N A 8% 2% 4% N A 48% 27% 21% N A N A 65.8% N A 43.0% 15.2% 1.3% 0.0% 0.4% 0.6% 1.7% N A 39.9% 25.4% 7.5% N A 35.3% 18.0% 5.3% 0.0% 0.4% N A 37.7% 17.9% 4.5% N A 43.6% 16.9% 3.9% N A 50.6% 25.6% 2.1% Respondents were asked about their use of "any other type of illegal drug such as LSD acid ; , PCP, mushrooms, Ketamine Special K ; , Rohypnol Roofies ; , or GHB and plavix.
2. Colorado Medicaid Prior Authorization Criteria for Oxycotin Oxycodone ER!
Oxycodone, including OxyContin, are Schedule II drugs under the Federal Comprehensive Drug Abuse Prevention and Control Act. Federal sentencing guidelines for diverted Schedule II pharmaceuticals are determined by the total weight of the tablets, not strength. Similar drugs of lower strength like Percocet and Tylox may weigh more than OxyContin, thus distributing the same quantities may result in stiffer penalties than for distributing OxyContin. Authorities in Maine, in conjunction with the U. S. Government, launched a new initiative in 2000 regarding OxyContin abuse. The Maine Attorney General's Office has proposed legislation seeking to make possession of a large number of OxyContin tablets a felony; such possession is currently a misdemeanor.
Table - 4 : Pharmacological agents with demonstrated efficacy in neuropathic pain.34 and prednisone and oxycontin, for instance, oxycobtin dose.
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The primary efficacy parameter was time to onset 1-mm ST-segment depression during ETT, comparing the treatment groups at eight weeks end of period 2 ; . Secondary efficacy parameters included time to onset of angina during exercise, exercise duration, number and duration of ischemic episodes during ambulatory ECG monitoring, ischemic burden product of ischemic episode number, duration, and magnitude of ischemic ST-segment depression during ambulatory ECG monitoring ; , and severity of angina by the Seattle Angina Questionnaire 38 ; . Other efficacy parameters included all these measures at 16 weeks end of period 3 ; . Assessment of transient ischemia. Ischemia during exercise stress was evaluated with treadmill testing using the ACIP protocol 37 ; for a ramp-like increase in work, avoiding the large step increases of the Bruce protocol 39 ; . Treadmill tests were done in the morning, in the same laboratories at each site, and at trough plasma levels for background anti-anginal medications. Before and during ETT, 12-lead ECGs, blood pressure, and pertinent exercise-related symptom data were recorded on standardized forms for interpretation by the Core Exercise Laboratory St. Louis University, St. Louis, Missouri ; , which was masked as to the clinical data and group assignment. Exercise-induced ECG ischemia was defined as the new development of ST-segment depression 1 mm over baseline. When baseline resting ST-segment depression 0.9 mm ; was present, an additional 1-mm ST-segment depression was required. Exercise ECGs were analyzed using customized software, as previously described 40 ; . Ischemia occurring spontaneously during daily life was assessed by ambulatory ECG recordings for 48 h by Rozinn Glendale, New York ; model 151 recorder 0.1 Hz frequency response ; with a C-120 cassette tape. After adequate skin preparation, leads were applied using V5 and either an "inferior-like" lead or a historically defined lead showing maximal ST-segment depression during ETT. Lead wires were stabilized; patient instruction was provided; and site personnel recorded approximately 8 min of 1-mV, 60-Hz, rectangular-caliber impulses at the beginning of each recording. Recordings were analyzed at the Ambulatory Electrocardiogram Core Laboratory eResearchTechnology, Inc., Philadelphia, Pennsylvania ; , which was masked as to the clinical data and treatment group assignment. ST-segment measurement. The technician set one marker at the mid-point of the PR segment and a second marker 20 ms to the right of the J point where the ST-segment measurement is made ; . A third marker was set 78 to 83 the right of the second marker for slope determination. The vertical difference between where the first and second calipers intersect the ECG was taken as the ST-segment measurement for that beat; this measurement was made for all normally conducted beats. Each measurement was then compared with measurements for the three preceding normally conducted beats to determine whether it was contaminated by artifact. If not, the measurement was included in the subsequent evaluation.
MOD6 5. Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid? 262 ; Yes No Don't know Not sure Refused Module 13: Tobacco Indicators If Q10.11, Go to MOD13 7 Previously you said you have smoked cigarettes. MOD13 1. How old were you the first time you smoked a cigarette, even one or two puffs? 347-348 ; Code age in years Don't know Not sure 77 Refused 99 How old were you when you first started smoking cigarettes regularly? 349-350 ; Code age in years Never smoked regularly Go to MOD13 6 88 Don't know Not sure 77 Refused 99 1 2 MOD13 4. In the past 12 months, have you seen a doctor, nurse, or other health professional to get any kind of care for yourself? 353 ; Yes No Go to MOD13 6 Don't know Not sure Go to MOD13 6 Refused Go to MOD13 6 1 2 MOD13 5. In the past 12 months, has a doctor, nurse, or other health professional advised you to quit smoking? Yes No Don't know Not sure Refused MOD13 6. 1 2 These next questions are about limitations you may have in your daily life." RI8 3. D ; Because of any impairment or health problem, do you have any trouble learning, remembering, or concentrating? 369 ; a. b. Yes No Don't know Not sure Refused 1 2 7 Q14.1 1, or if Q14.2 1, or if RI8 3 1 continue, else go to RI8 9. RI8 5. M ; What is your MAJOR impairment or health problem? 371-372 ; 43, for instance, oxycodone hydrocodone.
OxyContin pills or prescriptions at a crime scene, or a family member or witness merely mentions the presence of OxyContin, the death is also confirmed as "OxyContin-verified."51 Obviously the mere presence of OxyContin in the system of the deceased, or the mere mention of the drug by friends or family members is far from verification that OxyContin--either alone or in conjunction with other factors--actually caused a premature death. Third, overdose victims tend to have multiple drugs in their bodies.52 Approximately 40 percent of the autopsy reports of OxyContinrelated deaths showed the presence of Valiumlike drugs. Another 40 percent contained a second opiate such as Vicodan, Lortab, or Lorcet, in addition to oxycodone. Thirty percent showed an antidepressant such as Prozac, 15 percent showed cocaine, and 14 percent indicated the presence of over-the-counter antihistamines or cold medications. Deaths like those could be the result of any of the drugs present, drugs working in combination, or one or more drugs plus the effects of other conditions, such as illness or disease. Indeed, the March 2003 issue of the Journal of Analytical Toxicology found that of the 919 deaths related to oxycodone in 23 states over a three-year period, only 12 showed confirmed evidence of the presence of oxycodone alone in the system of the deceased.53 About 70 percent of the deaths were due to "multiple drug poisoning" of other oxycodone-containing drugs in combination with Valium-type tranquilizers, alcohol, cocaine, marijuana, and or other narcotics and anti-depressants.54 That is strong evidence that many of the deaths attributed to OxyContin by government officials are not the result of unknowing pain patients who grew addicted and overdosed, but of habitual drug users who may have used the drug with any number of other substances, any one of which could have contributed to overdose and death. In the absence of opioids like OxyContin, habitual users will, in all likelihood, merely switch to more available drugs. However, pain patients who rely on the drug for relief and paxil.
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Issue? If it is her position as opposed to the Society's, can she please say so? Tony Schofield South Shields, Tyne and Wear DOROTHY DRURY, Council election candidate, replies: I delighted to reply to Mr Schofield and, I hope, gain another vote in the coming election. In answer to all the questions in order, I stood for election last year because I wanted to be involved with the future of pharmacy. I was not reluctant to stand but did not expect to be voted onto the Council as there were existing Council members seeking reelection. However, the members of the Society did not re-elect some of the previous Council as they were obviously unhappy with their achievements. I standing again and it is a privilege to represent the members. My accomplishments on the Council include highlighting the day-to-day problems that pharmacists face, such as the new oxygen contract. I was involved in the devolved boards and I support the formation of the English board as this will give professional direction to pharmacists. I have attended all the regional meetings that have been allocated to me. I believe in getting to grips with the problems that face community and hospital pharmacists. I keep in touch with my former hospital colleagues and wish to unite all members, whatever their special area of work may be. I was pleased to attend the meeting in Sunderland with the Association of Pharmacy Technicians UK with some local pharmacists as well as technicians. I believe my position on skill mix to be similar to the Society's. I would like to point out that the tone of this meeting was not about skill mix but total withdrawal of the pharmacist from community pharmacies. Here is the proof. When I said that pharmacists were needed to screen prescriptions I was told this was not necessary as the computer did it.When I mentioned that the discussion at the Society was on-going and that certain issues such as the dispensing of Controlled Drugs were being looked at, I was told that there was no need for pharmacists to be present for this either. I not the one who is ignorant on POM-to-P changes or the "Ask your pharmacist" campaign. Indeed, how can you have an "Ask your pharmacist" campaign when you do not have.
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