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Saleh EA, Haddadin RN, Saleh B, Elayeh E. Changes in drug demand when a pandemic coincides with other outbreaks in a war zone country: a cross-sectional pilot study. J Pharm Policy Pract 2022; 15:89. [PMID: 36419090 PMCID: PMC9682693 DOI: 10.1186/s40545-022-00487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Yemen's health system has severely deteriorated due to the ongoing civil war accompanied by the COVID-19 pandemic which coincided with other outbreaks of endemic infections. Many health institutions closed due to insufficient equipment and supplies. Consequently, pharmacists became the available healthcare provider on the frontlines. This study aimed to evaluate the pattern of demand for prescription and nonprescription drugs during the pandemic based on the pharmacist's perspective in Yemen, a conflict zone country. METHODS An online survey was developed, validated, and distributed among pharmacists. The questionnaire was composed of two sections: (1) demographic characteristics of the participants and (2) changes in the demand for different drug categories. Chi-square test and Fisher's exact test were used to find statistical associations. RESULTS Responses (330) were received from pharmacists working in 12 out of 22 governorates in Yemen. During the pandemic, there was an increase in the demand for prescription drugs such as antibiotics, antimalarials, and sedatives (95%, 90%, and 71%, respectively) and an increase in the demand for nonprescription drugs such as vitamins (93%) and paracetamol (> 90%). Some of these drugs could have serious side effects if taken without medical advice, and others could result in severe effects if taken concomitantly. In addition, there was an increase in the demand for prescription drugs without a prescription, which was reported by 50% of the participants. No statistical difference was seen between the frontline districts and major cities in terms of requesting these drugs without a prescription. On the other hand, most participants (75.2%) did not attend any training or workshop during the last 6 months of conducting this survey. CONCLUSION COVID-19 has increased the demand for many prescription and nonprescription drugs, where the irrational use of these drugs may lead to devastating health effects. In war zone areas hit by a pandemic, policymakers and public health organizations should focus on training and educating pharmacists as important health care and medicine providers for the public.
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Affiliation(s)
- Ebtesam A. Saleh
- grid.411125.20000 0001 2181 7851Department of Pharmacology & Toxicology, School of Pharmacy, University of Aden, Aden, Yemen
| | - Randa N. Haddadin
- grid.9670.80000 0001 2174 4509Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Bassam Saleh
- Medical and Health Unit, International Organization of Migration (IOM), Aden, Yemen
| | - Eman Elayeh
- grid.9670.80000 0001 2174 4509Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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Cohen N, Mathew M, Davis A, Brent J, Wax P, Schuh S, Freedman SB, Froberg B, Schwarz E, Canning J, Tortora L, Hoyte C, Koons AL, Burns MM, McFalls J, Wiegand TJ, Hendrickson RG, Judge B, Quang LS, Hodgman M, Chenoweth JA, Algren DA, Carey J, Caravati EM, Akpunonu P, Geib AJ, Seifert SA, Kazzi Z, Othong R, Greene SC, Holstege C, Tweet MS, Vearrier D, Pizon AF, Campleman SL, Li S, Aldy K, Finkelstein Y. Predictors of severe outcome following opioid intoxication in children. Clin Toxicol (Phila) 2022; 60:702-707. [PMID: 35333145 DOI: 10.1080/15563650.2022.2038188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication. We explore predictors of severe outcome (i.e., intensive care unit [ICU] admission or in-hospital death) in children who presented to the Emergency Department with an opioid intoxication. METHODS In this prospective cohort study we collected data on all children (0-18 years) who presented with an opioid intoxication to the 50 medical centers in the US and two international centers affiliated with the Toxicology Investigators Consortium (ToxIC) of the American College of Medical Toxicology, from August 2017 through June 2020, and who received a bedside consultation by a medical toxicologist. We collected relevant demographic, clinical, management, disposition, and outcome data, and we conducted a multivariable logistic regression analysis to explore predictors of severe outcome. The primary outcome was a composite severe outcome endpoint, defined as ICU admission or in-hospital death. Covariates included sociodemographic, exposure and clinical characteristics. RESULTS Of the 165 (87 females, 52.7%) children with an opioid intoxication, 89 (53.9%) were admitted to ICU or died during hospitalization, and 76 did not meet these criteria. Seventy-four (44.8%) children were exposed to opioids prescribed to family members. Fentanyl exposure (adjusted OR [aOR] = 3.6, 95% CI: 1.0-11.6; p = 0.03) and age ≥10 years (aOR = 2.5, 95% CI: 1.2-4.8; p = 0.01) were independent predictors of severe outcome. CONCLUSIONS Children with an opioid toxicity that have been exposed to fentanyl and those aged ≥10 years had 3.6 and 2.5 higher odds of ICU admission or death, respectively, than those without these characteristics. Prevention efforts should target these risk factors to mitigate poor outcomes in children with an opioid intoxication.
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Affiliation(s)
- Neta Cohen
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Mathew Mathew
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Adrienne Davis
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Jeffrey Brent
- Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Paul Wax
- Southwestern School of Medicine, University of Texas, Dallas, TX, USA
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Stephen B Freedman
- Department of Paediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Blake Froberg
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Laura Tortora
- Banner - University Medical Centre, Phoenix, AZ, USA
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - Andrew L Koons
- Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | | | - Joshua McFalls
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Bryan Judge
- Spectrum Health - Michigan State University, Grand Rapids, MI, USA
| | - Lawrence S Quang
- Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Douglas A Algren
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jennifer Carey
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | - Ziad Kazzi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Rittirak Othong
- Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | | | | | - David Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anthony F Pizon
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Shao Li
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Kim Aldy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yaron Finkelstein
- Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada.,Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Chen JY, Chen GY, Wang SY, Fang CC, Chen LY, Weng TI. Development of an analytical method to detect simultaneously 219 new psychoactive substances and 65 other substances in urine specimens using LC-QqQ MS/MS with CriticalPairFinder and TransitionFinder. Talanta 2022; 238:122979. [PMID: 34857319 DOI: 10.1016/j.talanta.2021.122979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/12/2022]
Abstract
Emerging new psychoactive substances (NPS) poses a great risk to public health. Analyzing these large numbers of NPS and other associated substances often relies on liquid chromatography coupled to triple quadrupole mass spectrometry (LC-QqQ-MS) with multiple-reaction monitoring (MRM) mode. However, the differentiation of critical pairs, coeluted isobaric and/or isomeric species, is one of the challenges for this analytical platform. MRM transitions with poor selectivity can jeopardize accurate quantification and lead to biased interpretation. Herein, we refined a novel workflow for developing an MRM-based method with in-house CriticalPairFinder and TransitionFinder tools for the effective identification of unique and selective MRM transitions. Transitions selected by TransitionFinder showed much better accuracies than those selected only by fragment abundance in some mixtures of critical pairs. Using the proposed analytical strategy, a method that can simultaneously determine 219 NPS and 65 other substances across a variety of NPS classes in urine samples was developed, validated and applied to analyze clinical urine samples. This automated workflow is anticipated to facilitate method development for analyzing complex analytes while considering selectivity.
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Affiliation(s)
- Ju-Yu Chen
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guan-Yuan Chen
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - San-Yuan Wang
- Master Program in Clinical Genomics and Proteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chung Fang
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Chen
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Te-I Weng
- Forensic and Clinical Toxicology Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Mody S, Kirkdale CL, Thornley T, Dickinson A, Avery AJ, Knaggs R, Rann S, Bastable R. Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use? PHARMACY 2020; 8:pharmacy8040185. [PMID: 33049965 PMCID: PMC7712583 DOI: 10.3390/pharmacy8040185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 01/23/2023] Open
Abstract
The misuse of opioids, including codeine which is sold over-the-counter (OTC) in United Kingdom (UK) community pharmacies, is a growing public health concern. An educational Patient Safety Card was developed and piloted to see if it nudged customers into the safe and appropriate use of OTC codeine. Exploratory analysis was conducted by (i) recording quantitative interactions for people requesting OTC codeine in community pharmacies; and (ii) a web-based pharmacy staff survey. Twenty-four pharmacies submitted data on 3993 interactions using the Patient Safety Card. Staff found the majority of interactions (91.3%) to be very or quite easy. Following an interaction using the card, customers known to pharmacy staff as frequent purchasers of OTC codeine were more likely not to purchase a pain relief medicine compared to customers not known to staff (5.5% of known customers did not purchase any pain relief product versus 1.1% for unknown customers (χ2 = 41.73, df = 1, p < 0.001)). These results support both the use of a visual educational intervention to encourage appropriate use of OTC codeine in community pharmacy and the principles behind better self-care.
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Affiliation(s)
- Sapana Mody
- Boots UK, Thane Road, Nottingham NG90 1BS, UK
| | | | - Tracey Thornley
- Boots UK, Thane Road, Nottingham NG90 1BS, UK
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | | | - Anthony J Avery
- Division of Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Sarah Rann
- Formerly CDAO East of England, NHS, Medical Directorate, Victoria House, Capital Park, Cambridge CB21 5XE, UK
| | - Ruth Bastable
- HMP Littlehey, Huntingdon PE28 0SR, UK
- National Health Service, London SE1 6JW, UK
- Royal College of General Practitioners, London NW1 2FB, UK
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