On to the main part of our trip, meetings. With the help of Dr. Andreia Bruno, we were able to book the “Hercules Room” at Monash University-Parkville Campus. Fully equipped with Zoom capable screens and secret cabinets of food and drinks, student leaders discussed not only different projects but also the sustainability and leadership of PharmAlliance student domain. UNC leaders (Clara Kim, Vraj Patel, Jenny Jin, Ember Lu) and Monash University leaders (Alisha Cloti, Kevin Wu, Brandon Pham) were in attendance, while Ruby Akkad from UCL called in from Toronto due to last minute visa issues.
This was the first time that student leaders were able to meet in person. We realized that the value of this face-to-face communication is vital, as the quality of the conversation was much higher and we were able to accomplish much more action items and structures. Ember and I had created meeting agenda templates beforehand, and each school was in charge of different sections of the meeting. Everyone created agendas before their meeting and came well prepared to host the meeting and guide discussions.
The first day was spent mostly discussing PharmAlliance student domain leadership so far. The leaders first drafted a mission statement of PharmAlliance student domain: While aligning with initiatives on the PharmAlliance level at the highest possible extent, collaborate on impactful and challenging pharmacy issues that are common between the US, Australia, and the UK. Then, students discussed about different issues with leadership that came up in effectively leading organizations. Students were able to share their experiences and also give advice on how to overcome obstacles.
The next day was spent on discussing the Medication Safety Comic series. We decided on logistics, themes, and different topics we want to be included in the comic series. While discussing all of the topics, we made sure that our end goal was having an element of collaboration in each step. Collaboration sometimes may be inefficient; In fact, there are tasks that could easily be done if it were just done within one campus group. However, the leaders were eager to implement collaborative portions across the project, as that is the main goal of PharmAlliance itself. Also, students and leaders in PharmAlliance truly value the unique international collaboration we are fortunate to be a part of, and wanted to take full advantage.
The last day was spent discussion the International Case Competition. Vraj Patel and Brandon Pham led the discussions on assessing what was good versus what could be better compared to last year. At the end of the meeting, the leadership team decided to make create interschool teams - i.e. each team will have students from two different countries! This was an exciting development compared to last year, where teams were composed of students in one school. This was again a decision made with the desire to increase collaboration among students across all three countries. We hope that the International Case Competition becomes a unique opportunity for students to learn about each others’ pharmacy practices.

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It’s no secret that the Opioid Crisis is here to stay. In the United States, over 115 people die from opioid overdose, including prescription opioids, heroin, and synthetic opiates like fentanyl. The Center for Disease Control and Prevention (CDC) estimates that the total cost of healthcare, loss of productivity, addiction treatment and criminal justice involvement totals to $78.5 billion a year in the US alone. Worldwide, it is estimated that 27 million people suffer from opioid use disorders but less than 10% of them who need treatment are receiving it. With opioid use and death from opiate use on the rise, how did we get here?
 
In later half of the 1990s, pharmaceutical companies had prescription opioid pain relievers on the market but there was concern for addiction. The companies reassured prescribers, pharmacists, and the medical community as a whole that patients would not become addicted to prescription opioid pain relievers. This led to an increase of opioid prescriptions, and widespread abuse of these medications before it was clear to the medical community that these were highly addictive. As addiction rose so did the rate of opioid overdose, by 2015 33,000 American had died from opioid overdose.
 
In present day, doctors are more reluctant to prescribe opioids and their costs on the black market have increased. This drives abusers to street drugs such as heroin. In order to keep up with demand, dealers and suppliers cut their heroin with high potency opioids acquired from overseas like fentanyl. Fentanyl is a synthetic opioid used in patients with severe pain needing long term pain management, and it is 50 to 100 times more potent than morphine. Most fentanyl-related harm come from illegally made fentanyl mixed into heroin, sometimes without the user’s knowledge.
 
The opioid epidemic has become a public health crisis with devastating consequences far beyond the users. There is a rising incidence of neonatal abstinence syndrome (infants born who suffer from opioid withdrawals), plus an increase in intravenous drug use increases the spread of HIV and hepatitis C. In order to combat this, some US states are offering safe needle programs and increasing overdose prevention intervention. One of these agents is known as naloxone. Naloxone is an inexpensive medication that can completely reverse the effects of opioid overdose and prevent death from opioid overdose. New opioid prescribing and dispensing programs have been started, along with continued education on safe opioid prescribing practices for prescribers.
 
The World Health Organization (WHO) recommends tackling the opioid crisis with a variety of treatment options, including psychological support, opioid maintenance treatments such as methadone and buprenorphine and supported detoxification and treatment with reversal agents such as naloxone. The WHO also supports countries where these treatment programs don’t already exist. The United States, and the world has acknowledged the opioid crisis, but we are a long way from solving it. 

A group of Pharm.D. students received a $10,000 PharmAlliance grant — the first of its kind to be awarded to Pharm.D. students — to support a project promoting medication safety.

The project is led by PY3 Clara Kim and PY2 Vraj Patel from the UNC Eshelman School of Pharmacy. It is co-authored by PY3 Ember Lu from the School and students from University College London and Monash University in Melbourne, Australia.
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Their initiative aims to promote safe use of the three medications most associated with drug errors — opioids, insulins and anticoagulants — through the creation of a comic series that promotes patient education. The comics will be distributed online through social media and offline as posters and fliers posted in community pharmacies in the U.S., England and Australia.

“This project will help patients, including those with low health literacy, understand how to take their medications correctly and acknowledge the importance of adherence, while making it fun in the process,” Kim said.

Established in 2015, PharmAlliance is an international partnership between the UNC Eshelman School of Pharmacy, University College London and Monash University. PharmAlliance has provided support for research initiatives developed by faculty and Ph.D. students from each of the three schools. This is the first PharmAlliance grant to be awarded to Pharm.D. students.

Along with Kim, Patel and Lu, the project’s co-authors include Monash University students Alisha Cloti and Emma Hatherley, and University College of London student Ruby Akkad.
“The student leaders of all three schools are very excited and thankful to be the first student group to have received this grant,” Kim said. “This is a very important step for the PharmAlliance student domain.”

The students will be mentored by faculty at each school: David Steeb, Pharm.D., M.P.H. at UNC-Chapel Hill, Andreia Bruno, Ph.D. at Monash University, and Oksana Pyzik, M.Pharm. at UCL.

The grant will allow the students to develop their project beyond the conceptual stage and travel to Melbourne to discuss their project, as well as ways PharmAlliance can support student initiatives and foster connections between students at each of the schools in the future.

​Original article found here, published on November 13, 2018 at the UNC Eshelman School of Pharmacy homepage:

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​Two PY2 students, Sue Liu and Clara Kim, had immersion experiences in Annie Penn Hospital.
Annie Penn hospital is a rural hospital under Cone Health system in Reidsville, North Carolina. It is a single inpatient hospital with services in pulmonology, cardiology, acute management and chronic disease control, with smaller outpatient fills.

The immersion itself lasts 2 months. According to Sue, her first month consisted of medication history review in the ER, while the second month was spent shadowing various health care professionals in different departments (e.g. cancer center, respiratory, surgery, and endoscopy), working in the IV room preparing IVs for patients, then later on working up patients, assessing them, and going on rounds with other pharmacists, nurses, case workers, and physicians in the mornings. “All these were valuable experiences for me because they allowed me to see the merit of interdisciplinary work that does on in hospital everyday,” Sue said about her experience. “I was able to see care delivery from one medical professional to another, which was one of the highlights of my rotation.”

However, working in the hospital as a PY1 student was not without its challenges. To Clara, who grew up in a city setting, transitioning to a small rural hospital was a surprising change. “I had to drive by cows and horses in the mornings, and once I even had to drive around a tractor that was going 5mph in a two-lane highway. I first felt like an oddball, also being one of the few minorities in the hospital,” she said.  However, she soon fell in love with her working environment. “My favorite part of the rotation was how warm the people were,” Clara commented, “Being in a small hospital you may be disappointed at not being able to see more ‘exciting’ medical situations, but the staff are very kind and they have a sense of community.”

Sue felt it was a little bit challenging to deal with many drugs and disease states which she had limited exposure to during her first-year training. For instance, community acquired pneumonia and other infectious diseases were a common indication for hospital admissions, but unfortunately were only superficially covered during the first year. It was a challenge that pushed Sue to learn more and faster. She became a self-directed learner, looking up new drugs that she had never encountered before on reputable drug information websites (such as Uptodate.com) and memorizing the brand name, generic name, and adverse effects. “I also asked many questions to people around me, as they had much more experience in working at a hospital,” Sue said. “My preceptor also gave me plenty of feedback to help me improve.”  

If you have any question about Clara and Sue’s experiences, feel free to email them or comment below!
Clara’s email: [email protected]
Sue’s email: [email protected]
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