Health care workers seeking pharmacy reforms to curb abuse
Dozens of young teenagers and pre-teen children in Vancouver Island's Cowichan Valley have ended up in the emergency room after overdosing on cold medications.
Dr. Valerie Cunningham, an emergency physician at the Cowichan District Hospital in Duncan, said she has seen children as young as 11 stunned after popping entire sheets of pills in the quest for a morphine-like high.
"The children that we're seeing are being picked off the street because they're wandering around in a trance-like state," Cunningham said. "So you can imagine how dangerous that would be if they wandered into the river."
The medications are pills containing a mix of acetaminophen, best known as the active ingredient in the pain killer Tylenol, and dextromethorphan, or "DM" or "DXM," a common cough-suppressant used in many cough medications such as Robitussin DM.
Cunningham said the Cowichan tribes have been speaking out about cough medicine abuse among youth, which makes her concerned that she has seen only a small fraction of the problem.
"I think for every one we see there may be dozens of other ones at home that are still abusing it," she said.
Doctors, youth workers and concerned parents are calling on the region's pharmacies to move the medications behind the counter, where pharmacists have greater control over dispensing them.
B.C.'s chief medical officer, Dr. Perry Kendall, said when used incorrectly, the medicines pose a real health risk. At high doses, the pills can cause loss of consciousness, liver damage and other serious complications, including death.
"If you take too much you can suppress respiration. It would be possible to have a respiratory arrest as a result of taking too much," Kendall said.
"So the issue of whether it should be behind the counter is probably a sensible question to look at. And certainly it would be concern about young people buying large quantities of it," he said.
"I think that's up to the pharmacist to kind of restrict the sale."
At the London Drugs in Duncan, a small town between Victoria and Nanaimo, pharmacy operations manager Shawn Sangha said he has done just that.
"At the Duncan branch we've removed all capsules and tablets containing the Tylenol and DM products off the floor so it's not accessible to the public, and moved it behind the pharmacy counter in the glass case," he said.
Removing the products from the floor will prevent shoplifting, Sangha said, and his pharmacy has undertaken further measures to track strange buying patterns.
"We have also take another step to program our tills where if multiple products are being purchased it will create a flag and then a pharmacist will intervene."
Marshall Moleschi, the registrar for the College of Pharmacists of British Columbia, said pharmacists are "very aware" of the potential for abuse with these products and have been asked to look out for unusual behaviour.
"The issue of using large quantities quantities of medication — way above the recommended dose — is not a new issue," he said.
And while pharmacists can try to act as sentinels against the abuse of over-the-counter drugs, it's a tough job, Moleschi said.
"It's difficult to detect something when they're only buying one package — and they're taking the whole package at once," he said.
On a periodic basis, Moleschi said, the idea of taking a lot of cold medicine takes hold in one or two high schools in the province and teenagers end up in the hospital after drinking a bottle of cough medicine.
In response to the latest rash of overdosing, the college sent an advisory notice to B.C. pharmacists on Friday.
"We have given directive to monitor the sales and asked for a voluntary 'put behind the counter' in this case. And we have done it a number — I guess, twice before."
Moleschi said there needs to be a public education program about the dangers of abusing any and all medications, not just the cold cocktails. He also said some of the cold medications that are being abused are sold in places where pharmacists aren't on staff.
March 20, 2011
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