Use, abuse of Internet pharmacies

first_imgEfforts to halt the growing abuse of prescription drugs must include addressing the availability of these drugs on the Internet and increasing physician awareness of the dangers posed by Internet pharmacies.In a commentary in the Dec. 20 Annals of Internal Medicine, investigators from Harvard-affiliated Massachusetts General Hospital (MGH), the Schaeffer Center for Health Policy and Economics at the University of Southern California (USC), and The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) describe the probable contribution of Internet pharmacies to the problem and outline potential strategies for addressing the problem.“Controlled prescription drugs like Oxycontin, Xanax, and Ritalin are easily purchased over the Internet without a prescription, yet physician awareness of this problem is low,” says Anupam B. Jena of the MGH Department of Medicine, lead author of the article, and a clinical fellow in medicine at Harvard Medical School.  “Abuse of medications purchased from websites can pose unique challenges to physicians because patients who abuse these medications may not fit clinical stereotypes of drug abusers.”The authors note that abuse of controlled prescription drugs now exceeds abuse of all illegal drugs combined, except marijuana. Some illegitimate online pharmacies sell drugs with no prescription or medical information at all while others ask for completion of a questionnaire before a prescription is issued by a physician who has never seen the patient. Studies from CASA Columbia have found that 85 percent of websites offering controlled prescription drugs do not require a prescription, and many that do allow the prescription to be faxed, increasing the risk of forgery or fraud.“The Internet serves as an open channel for distribution of controlled prescription drugs with no mechanisms to even block sales to children. This is particularly dangerous given that addiction is a disease that, in most cases, originates with substance use in adolescence,” says Susan Foster, vice president and director of Policy Research and Analysis at CASA Columbia.Additional investigations by U.S. agencies have verified the ease with which controlled drugs can be purchased online, but little information is available on how drugs acquired that way are used.  While some surveys suggest that as many as 10 percent of prescription drug abusers obtain their drugs online, the authors stress that such surveys probably underestimate the situation and would not reach individuals most likely to abuse prescription drugs purchased over the Internet.  They also note that surveys in drug treatment centers would totally miss local drug dealers, who are increasingly likely to access their supplies online.Earlier this year Jena and Dana Goldman, director of the Schaeffer Center at USC and also a co-author of the current article, published a study finding that the states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.  They estimated that for every 10 percent increase in high-speed Internet use during those years, admissions for prescription drug abuse increased 1 percent.  “Prescription use starts with the physician,” says Goldman, “and we need to more actively engage them to control illicit use.  Access to universal, electronic prescription records would be of great assistance in this regard.”Both federal and private agencies have taken measures to reduce the impact of illicit Internet pharmacies, including the 2008 passage of the Ryan Haight Online Pharmacy Consumer Protection Act, which specifically prohibits delivery of controlled substances prescribed by a physician who had never examined the patient.  But the success of that law and related efforts, such as FDA warning letters to Internet pharmacies and their service providers, is unknown.  The authors note that regulatory efforts also are “stymied by these pharmacies’ ability to appear, disappear, and reappear constantly,” and the reluctance of search engines to stop running ads for rogue online pharmacies.  The increasing online availability of prescription drugs may entice individuals believed to be at low risk for drug abuse to overuse controlled medications.The authors note that, while physicians and other health care providers should play a major part in addressing the challenges posed by Internet pharmacies, their awareness of the problem and ability to recognize and treat substance abuse of any kind is usually limited.  “Physicians need to educate patients about the risks of purchasing any medications over the Internet and should consider brief but routine questioning about Internet-based medication use,” says Jena, who is also a senior fellow at the Schaeffer Center at USC.  “Given the ability of illegal online pharmacies to evade law enforcement efforts, physician awareness and involvement will be crucial to reducing this problem.”last_img read more

Raptors star Kawhi Leonard played through sickness vs. Magic

first_imgThe Raptors are hoping to entice the California native into signing a long-term deal after the 2018-19 season. He was traded to Toronto by San Antonio this past offseason in a deal involving DeMar DeRozan, who was the face of the Raptors’ franchise.Losing Leonard could deal a huge blow to the team, but it risked everything to go for an NBA championship now. A successful postseason run could prove to be key in securing one of basketball’s better two-way players for years to come, so the Raptors will hope their go-to guy can get healthy for the challenges ahead. NBA playoffs 2019: ‘Hungry’ Derrick White sparks Spurs win over Nuggets NBA playoffs 2019: Kevin Durant’s Game 3 technical foul rescinded Kawhi Leonard played through some adversity in Friday’s win over the Magic.The Raptors star logged 37 minutes despite missing his team’s last two practices with an illness, coach Nick Nurse told reporters after Toronto’s 98-93 win over the Magic.center_img Nurse reveals Kawhi had not practised the past two days due to illness and basically gutted it out Friday night to give Raps 37 minutes.— Mike Ganter (@Mike_Ganter) April 20, 2019Leonard wasn’t at his best but was reasonably productive against Orlando. He recorded 16 points and 10 rebounds on just 5-of-19 shooting, which is far from his usual efficiency. He also forked over a game-high six turnovers, but appeared to be giving it everything he had in his off night.”That was a gutsy performance by him,” Nurse said after his team took a 2-1 series lead. Related News “He didn’t practice the last couple of days, he hadn’t been feeling that well and for him to go out there and fight through that and still play 37 minutes, I look down at this thing and I’m most proud of his 10 rebounds.”Only Pascal Siakam (42) and Kyle Lowry (40) surpassed Leonard’s time on the floor on Friday, and both of them recorded double-doubles as well.In Game 2, Leonard exploded for 37 points on 15-of-22 shooting in a dominant 111-82 victory in Toronto. He’ll have until Sunday to rest up for Game 4.last_img read more

President Trump to Sign Executive Order Protecting Monuments

first_imgPresident Trump will soon issue an executive order to protect public statues and monuments from being damaged or destroyed by far-left and anarchist protesters.“We are going to do an executive order and make the cities guard their monuments,” “This is a disgrace.” are Trump’s words. Monday night, hours after Arroyo interviewed Trump, a group of protesters attempted to pull down a statue of Andrew Jackson in Washington D.C.’s Lafayette Park before being pushed back by police. Protesters clashed with police on Monday in a park near the White House as they tried to tear down a statue of Andrew Jackson, the nation’s seventh president.Police moved into Lafayette Square with reports of pepper spray being used to clear the crowd.President Trump took to Twitter to say that “numerous people” had been arrested for what he called “disgraceful vandalism” of the “magnificent Statue of Andrew Jackson.” He suggested prison sentences of ten years. center_img It will be interesting to see how the federal branch can impose its will on these cities and municipalities. Far-left activist Shaun King on Monday said all images depicting Jesus as a “white European” should be torn down including stained glass adorning churches. last_img read more