Tuesday, December 2, 2014

Start Talking! program to reduce medication abuse.

     Start Talking! is a program from the State of Ohio to prevent over the counter and prescription medication abuse by children. It is aimed at reducing the misuse or abuse of these medications by informing the public and taking steps to ensure that parents and families are advised about these potential issues before filling a prescription. The website is here at Start Talking! Ohio.
     I think this program is terrific and it has a very real impact on our practice. When a prescription for an opioid is written for a child (often a prescription strength cough medication for pre-teens and teenagers), a form needs to be signed by the prescribing doctor and the parent. This form then is brought to the pharmacy where the prescription will be filled. We are required to do this step with the opioids now -- the doctor could lose their prescribing privileges for controlled medications if these steps are not followed.
     This above scenario most often applies to one of the hydrocodone-containing cough medications that are prescription-only, including Histussin, Hycodan, and generics (hydrocodone-homotropine). We used to be allowed to call the medication into the pharmacy. We cannot call this medication into the pharmacy any longer. If we do write the prescription in the office, it needs to be hand delivered by the parent to the pharmacy, along side the signed Start Talking! form stating that we have discussed the safe use of these medications as they can be misused and abused, and therefore are potentially dangerous. The forms are to be signed by the doctor and the parent dropping off the prescription.
     Although there are pain medications that contain the opioid hydrocodone (along with acetaminophen), such as Vicodin, it is very rare for pediatricians to prescribe these medications -- I can recall only prescribing them a handful of times in 21 years of being a pediatrician.
     I realize this is burden to families who "follow the rules" and the medications do not become misused or abused. However, the reality is we will need to follow these guidelines for the foreseeable future.

New Bacterial Meningitis Vaccine for Pre-Teens and Teens

     One of the scariest bacterial infections in children, adolescents, and young adults is bacterial meningitis. It can come on suddenly. It can quickly progress to a deadly infection. Our Menveo vaccine for bacterial meningitis helps prevent cases of Neisseria meningitis due to strains A, C, W, and Y. Approximately 30% of all Neisseria meningitis cases in the U.S. were due to strain B, which is not in the Menveo vaccine.
     The FDA has now approved a vaccine called Trumenba that helps prevent cases of meningitis due to this B strain. It is currently approved for 10-25 year olds. It is a three shot series given at a doctor's visit then 2 months and 6 months after the first. The side effects are similar to other vaccines given to adolescents: soreness of the arm, tiredness, and headache. Generally, the vaccine has been well tolerated. The Advisory Committee on Immunization Practices, the national committee of vaccine specialists that make the recommendations we follow, is going to make a further recommendation on the Trumenba's routine use in February of 2015.
     I anticipate that in 2015, we will start to routinely recommend the vaccine series. I will keep you updated. For now at least, we do not stock the vaccine. I will definitely want my three teenage sons to receive the vaccine.