Potency trends of delta9-THC and other cannabinoids in confiscated marijuana from 1980-1997.

The analysis of 35,312 cannabis preparations confiscated in the USA over a period of 18 years for delta-9-tetrahydrocannabinol (delta9-THC) and other major cannabinoids is reported. Samples were identified as cannabis, hashish, or hash oil. Cannabis samples were further subdivided into marijuana (loose material, kilobricks and buds), sinsemilla, Thai sticks and ditchweed. The data showed that more than 82% of all confiscated samples were in the marijuana category for every year except 1980 (61%) and 1981 (75%). The potency (concentration of delta9-THC) of marijuana samples rose from less than 1.5% in 1980 to approximately 3.3% in 1983 and 1984, then fluctuated around 3% till 1992. Since 1992, the potency of confiscated marijuana samples has continuously risen, going from 3.1% in 1992 to 4.2% in 1997. The average concentration of delta9-THC in all cannabis samples showed a gradual rise from 3% in 1991 to 4.47% in 1997. Hashish and hash oil, on the other hand, showed no specific potency trends. Other major cannabinoids [cannabidiol (CBD), cannabinol (CBN), and cannabichromene (CBC)] showed no significant change in their concentration over the years.

Sale of tobacco products in pharmacies: results and implications of an empirical study.

OBJECTIVE: To provide national-level data concerning the percentage of pharmacies selling tobacco products, examine relationships between selling practices and pharmacy characteristic variables, and explore perceptions of conflicts between tobacco-selling activity and professional and personal values and the potential effects of such conflicts. DESIGN, SETTING, PARTICIPANTS: Data were collected from a geographically stratified systematic random sample of 899 pharmacies. Multiple mailings were sent to the attention of the pharmacy manager. A random sample of nonrespondents was also contacted by telephone, urging participation. MAIN OUTCOME MEASURES: Whether the pharmacy currently sold cigarettes and/or smokeless tobacco products, and if so, whether these practices differed from what respondents' personal or professional values tell them to do. Scales designed to measure job satisfaction, job-induced tension, and propensity to leave were also included. RESULTS: Slightly more than half (50.5%) of the pharmacies sold cigarettes and 35.4% sold smokeless tobacco products. Independents were less likely than chain pharmacies to sell tobacco products. For those respondents working in pharmacies where tobacco products were sold, 47.6% responded that this practice differs from what their personal values tell them to do and 63.9% replied that this practice differs from what their professional values tell them to do. Even when controlling for pharmacy type, respondents working in pharmacies that sold tobacco products had significantly lower levels of global job satisfaction, higher levels of job-induced tension, and a higher propensity to leave than did respondents working in pharmacies that did not. CONCLUSION: Decision makers in pharmacies where tobacco products are still sold should take a serious look at the justification for the continued availability of tobacco products in an environment that has a goal of promoting health.

Quality of life assessment by community pharmacists: an exploratory study.

Implicit in the evolving role of pharmacy is that its practitioners embrace the concept of quality of life (QoL). In recent years there has been an increased interest in incorporating health-related quality of life (HRQoL) measures into clinical practice, primarily focusing on the physician as the user of this information. Pharmacists may be able to use these instruments in their practices to provide better pharmaceutical care. To explore the feasibility of such an undertaking, questionnaires were mailed to a national sample of community pharmacies. In addition to the questionnaire, the respondents were provided with examples of two instruments: the Duke Health Profile and the QOLIE-10. A definition of HRQoL was provided to the respondents. After two mailings and a reminder postcard, a usable response rate of 27.2% was achieved. The results revealed that over 80% of the respondents currently discuss HRQoL issues with their patients. In addition, 66% reported that they attempt to assess the HRQoL of their patients, albeit usually on a subjective, informal basis. After viewing examples of HRQoL instruments, over three-quarters of the respondents reported a willingness to use HRQoL assessment tools in their practices. However, only 53.7% of the respondents were familiar with the concept of HRQoL. Less than 5% reported familiarity with formal instruments. The self-reported knowledge of pharmacists concerning HRQoL was low and the respondents recognized a significant gap between their current knowledge and the level of knowledge needed to assess the HRQoL of their patients formally. The results suggest a possible role for the pharmacist in HRQoL assessment. However, the use of HRQoL instruments in community pharmacies will require further training and education on the part of pharmacists concerning the concept of HRQoL, the issues involved in its measurement and how they can use HRQoL information in their practices. In addition, a number of unanswered questions must be addressed through the research process in order for HRQoL questionnaires to become clinical tools in the practice of pharmacy.

The effects of acquisition cost and budget-based compensation on the attitudes of pharmacy directors toward the adoption of a cost-effective new drug.

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (p < 0.001). Respondents whose compensation was contingent on their control of the drug budget indicated a higher likelihood to resist the adoption of the new agent than did those whose salary was not so determined. These findings indicate that significant hurdles, psychological and organisational, still exist for the acceptance and use of pharmacoeconomic information in the hospital setting.

A physician survey on generic drugs and substitution of critical dose medications.

BACKGROUND: Generic substitution has become a common practice since the late 1970s. Because of the increased use of generic alternatives and concerns about the Food and Drug Administration standards for bioequivalency, especially with respect to narrow therapeutic index drugs, the awareness and attitudes of prescribing physicians to generic drugs and generic substitution are important. METHODS: A questionnaire designed to assess attitudes, beliefs, knowledge, and experiences with generic drugs and generic substitution was sent to 3639 physicians nationwide. Cluster analysis was used to identify attitudinal groups that were then analyzed with respect to differences in beliefs, knowledge, and experience with generic drugs. Perceptions of the therapeutic index for 15 branded drugs and comfort in substituting those products with generic alternatives were assessed. RESULTS: Physicians were classified into prosubstitution and antisubstitution groups, with a further division of antisubstitution physicians according to whether they felt influenced by outside pressures to substitute. Significant differences were found between the prosubstitution and antisubstitution groups with respect to beliefs about and experiences with generics and knowledge of the Food and Drug Administration bioequivalency standards. Of particular significance was the low percentage (17%) of physicians who correctly identified the Food and Drug Administration standards for bioequivalency. Prosubstitution physicians generally rated therapeutic indexes as wider than antisubstitution physicians. Physicians in all groups identified similar products they believed were not appropriate for substitution. CONCLUSIONS: Attitudes toward generic substitution are related to prescribing behaviors, beliefs about and experience with generic substitution, and perceptions of therapeutic index and comfort with substitution. Physicians need to understand the issues surrounding generic substitution and remain empowered to influence decisions to substitute.

Convenience or calamity? Pharmaceutical study explores the effects of sample frame error on research results.

Survey results of a nationwide sample frame did not differ from those of a statewide sample frame with respect to questions that were professional/procedural in nature or that dealt with putative industry knowledge. However, on questions that were attitudinal in nature, the sample frames differed significantly. Because of this, the authors conclude that using a geographically narrow convenience sample may or may not result in frame error, depending on the information being sought.

Tricyclic antidepressant overdose: conservative management in a community hospital with cost-saving implications.

Reports of late-onset cardiovascular complications following tricyclic antidepressant (TCA) overdose have led to a very conservative approach to these patients. Many patients have been hospitalized for continuous cardiac monitoring, regardless of the clinical presentation. Management algorithms based on clinical predictors of outcome have recently been proposed. We used the algorithm developed by Tokarski and Young to retrospectively evaluate the care of 33 TCA overdose patients admitted to our hospital over a 3-year period. We then identified 11 patients who could have been treated on an outpatient basis had the algorithm been employed. Ten were admitted to a monitored unit and spent a mean of 31.6 +/- 15.64 hours on the unit. None of the 11 patients developed complications during their hospital stay. Use of the algorithm would have resulted in an estimated cost savings of 13 hospital days and $14,000.

Selecting a computer system for a medical practice.

Although the risk will always exist that a computer system will be selected that does not adequately meet the needs of a practice, this risk may be minimized when the selection process is done properly. A seven-step approach for selecting an office management system is described, with discussion of major factors to consider and pitfalls to avoid.

Evaluation of the use of rural health clinics: attitudes and behaviors of primary care physicians in service areas of nurse practitioner clinics.

In response to concerns of the directors of Rural Health Initiative projects in Mississippi, a study was conducted to examine factors related to use of rural health clinics. This report focuses on attitudes and behaviors of primary care physicians in the service areas of four clinics staffed by nurse practitioners. Data for this evaluation were obtained via mail questionnaires sent to 41 primary care physicians in the service areas of the clinics. Usable responses were received from 25 (61.0 percent) of the physicians. The data indicate that a majority of these physicians approve of the nurse practitioner concept. Although there is evidence to support a positive correlation between previous experience and knowledge concerning nurse practitioners and physician acceptance of the nurse practitioner concept, only about half of the physicians reported that anyone had ever contacted them to talk about the clinic. Only about a quarter of the physicians had ever visited the rural health clinic, but 60 percent indicated that they would like to do so. These findings indicate a need to develop closer working relationships with all primary care physicians in the service area of a rural health clinic. The data indicate that when such a closer relationship existed, physicians were satisfied with the outcome of interactions. Twelve (48 percent) physicians stated that they had patient(s) referred to them by the clinic. Among these physicians 77.8 percent were satisfied with the information that they had received on the patient's condition. Fewer physicians (8 or 32.0 percent) reported that they had received a call from the nurse practitioner clinic to consult about one of the physician's patients. The physicians were satisfied with the outcome of the consultation in each instance that was reported.

Consumer expectations compared to the reported use of pharmacy services in rural areas.

Selected households in three northern Mississippi counties were surveyed to assess their primary medical care needs. Consumers' expectations concerning pharmaceutical services were analyzed. The results indicate that the surveyed population expects comprehensive pharmaceutical services. Patient profiles were the most desired service. Consumers were least interested in pharmacist counseling on health matters unrelated to drugs. Most services, however, are sought and/or delivered less frequently than expected. Pharmacists need to make consumers aware of available services.