Letters to the editor: September 3, 2007

September 3, 2007

Opinions are divided over how to dispose of unwanted drugs that minimize damage to the environment.

Publix Super Markets, a privately held grocer, said last month that it would give away seven generic antibiotics. The company, which has more than 900 stores in Alabama, Florida, Georgia, South Carolina, and Tennessee, runs a total of 684 pharmacies.

Publix, which is based in Lakeland, Fla., said it would give out amoxicillin, ampicillin, cephalexin, ciprofloxacin (excluding ciprofloxacin XR), erythromycin (excluding Ery-Tab), sulfamethoxazole/trimethoprim (or SMZ-TMP), and penicillin VK. Customers must bring in a prescription to get up to a 14-day supply at no charge.

This generic antibiotic dispensing comes on the heels of Wal-Mart's recent offering of certain drugs for $4 per prescription in Florida. The promotion was quite successful at the pharmacist's peril, since the volume of prescriptions doubled practically overnight but the support staff did not. The same would probably be expected of the Publix promotion, which in turn will strain the good patient-to-pharmacist relationship that currently exists.

Judicious use of antibiotics needs to be addressed from a holistic approach in light of the fact that manufacturers are not investing in antibiotic research and development, because antibiotics that are successful in the marketplace provide diminishing returns for the manufacturers due to resistance. Publix's action may begin an epidemic of antibiotic resistance in the southern United States (since that's where the majority of its stores are located) that can spread to the rest of the country due to the frequency and ease of travel.

In conclusion, I applaud Publix's efforts to offer free products to the uninsured. However, I believe that the selection of the product in question is inappropriate. Perhaps Publix should consider a different disease state, such as cardiovascular disease.

Angel J. Perez, Pharm.D.
Miami
angelpharmd@hotmail.com

We are not the police

With regard to your August Web survey on whether or not the sale of dextromethorphan (DXM)-containing products should be restricted-oh, come on, now, cough up the truth! There must be a move afoot to add still more bean-counting police work to pharmacy duties, isn't there? Pharmacy needs to veto this bad idea, and also the administrative treachery for which it stands.

We are pharmacists, not police officers! If certain medicinal substances are deemed to have a potential for abuse, they should be placed in one of the five federal controlled-substance schedules and also be made Rx-only. Do it with pseudoephedrine. Do it with dextromethorphan if you must. In this, I include the so-called "exempt narcotics," which should no longer be exempt from the prescriber's control. Put these drugs into the clinical arena. Put up or shut up. But don't deputize pharmacists and pharmacy technicians to maintain law and order for you. That's not our job.

If you think it is our job, please reread OBRA '90 and all the state counseling laws that are its children. [For more on DXM, see in this issue.]

Paul Trusten, R.Ph.
Midland, Texas trusten@grandecom.net

For the record: In an article appearing in Drug Topics, July 9, the cost of a ScriptPro robot was cited incorrectly. The cost of ownership for a robot is approximately $600 to $900 a week.