Medical Marijuana and Student Life Student Health Services

So marijuana is now legal in the state of Ohio….what does that mean for me as a student here at The Ohio State University?

Can I get marijuana prescribed by a provider at the Student Life Student Health Center (SLSHS)?

I haven’t heard of anyone who has been prescribed medical marijuana yet.

As of September 8, state licensure, registration, and certification are required for Ohio’s Medical Marijuana Control Program. Ohio law requires the Ohio Medical Marijuana Control Program to be fully operational by this date.

 

Can I get a prescription from any doctor?

“The federal government prohibits doctors from being able to prescribe marijuana. Instead, patients must have a recommendation from a certified physician. Physicians interested in recommending the use of medical marijuana for patients must apply for a certificate to recommend from the State Medical Board of Ohio.” The Ohio Medical Marijuana Control Program

Many students will not qualify by age alone, as one must be at least 21 years old.

Physicians at the Wilce Student Health Center will not be certified. They will not be prescribing medical marijuana. That being said, it is very important that patients always disclose all supplements or other medications they are prescribed when seeking medical care. Be sure to let your SLSHS provider know if you are taking medical marijuana (or using recreational marijuana).

 

What kind of medical problems can be treated with marijuana?

The State of Ohio Medical Board has a defined list of medical diagnoses that qualify for treatment with medical marijuana.

The most common use is for pain control, especially nerve pain. Medical marijuana can also be helpful with certain types of nausea, muscle spasticity (as with multiple sclerosis and Parkinson’s disease), and glaucoma.

There are some initial studies that indicate marijuana may have a place in treating post traumatic stress disorder.

 

Keep in mind…

Marijuana is still illegal per federal law. The Federal Drug Free Schools and Community Act of 1989 prohibits the use of drugs (including marijuana) on campus if the school is receiving any federal funds.

We are in need of more medical research in the benefits and side effects/complications of marijuana use.

Just like with alcohol, one should not drive while using marijuana (medical or recreational).

The smoke from marijuana has toxic chemicals just like tobacco smoking.

In a student population already struggling with anxiety, depression and attention deficit disorders, the use of marijuana is likely to compound the issues. There is also increased risk of psychosis and impairments in learning, perception and judgement.

Kathryn McKee, M.D.

What’s in your work out supplements?

It’s the start of 2018, which means the “new year, new me” resolutions are picking up some good momentum by now. Hitting the gym more often is definitely one of my resolutions, and if our resolutions are on the same page, then this post can be of some help to you!

Work out supplements… we see them advertised all over our social media pages, and if you are walking into your local GNC, or Vitamin Shoppe the selection can be intimidating. What I’ve learned so far is that there are supplements that you take as a pre-workout, and supplements that do just as they are named, supplement.

Pre-workout Supplements:

What’s the scoop? Boosting your performance is all part of the plan. Growing bigger muscles, having quicker gains, and hoping for an easy solution is something we all strive for. Most of us understand that easy isn’t necessarily so, and may not entirely be the correct way in doing something. Unlike medications, workout supplements are not as strictly regulated by The Food and Drug Administration (FDA), which means dangerous ingredients may be incorporated without the knowledge of consumers. Some of the ingredients may actually have detrimental effects, and potentially cause death.

1, 3- dimethylamine, methylhexanamine or geranium extract—also known as DMAA is an ingredient that has been found illegally in some dietary supplements, where manufacturers mask the component as a “natural” stimulant. In 2013, a case report was published in the Clinical Journal of Sport Medicine, highlighting an incident where a 21- year old male suffered from cardiac arrest after ingesting a workout supplement containing DMAA. Structurally, DMAA is similarly related to amphetamine, methamphetamine, and MDMA. DMAA does not produce any type of stimulant similar to the mentioned substances, but if you are set to take a urine drug test for a new job, or professional program at The Ohio State University… heads up, you may fail.

Good news, DMAA has been banned by the FDA after the unfortunate incident that occurred in 2013, however, there are still some supplements through online purchase that may have the ingredient incorporated within the product, and I would recommend reading the back of the nutrition label before purchasing any type of supplement. The discontinued substance that contained DMAA was specifically the pre-workout supplement marketed as Jack3d made by USPLabs.

Regular Supplements:

First off, let me drink some protein.” Protein supplements are frequently consumed by athletes, as well as those who work out recreationally. There is much debate on the theory of amount of protein per day a person should intake and the timing of supplementation, and if you have any questions towards these matters PubMed.gov is a good source for you to do some more research about the topic.

Protein powders come in three common forms, those being—whey, soy and casein. A study by Kanda, A. et al in 2016, looked at the co-ingestion of all three substances and their effects on muscle protein synthesis after exercise in rats. The results of the study demonstrated a difference in peak time according to the type of protein ingestion, the authors concluded that whey protein was quicker to initiate the process compared to casein and soy.

Branched chained amino acids (BCAAs) especially leucine have been shown to increase muscle synthesis after exercise. Leucine is another component to keep an eye out for. Kanda, A et al. also noted that leucine displays a specific saturation point. The threshold described was around 43 mg of leucine, which means anything above this dose resulted in no further increase in the muscles anabolic response.

This is just the tip of the iceberg when it comes to the types of supplements that are available commercially, the big take away from this blog is to get you use to looking at the nutrition label located on the back of the products up for purchase. Speaking to your healthcare providers about any of your concerns is a good thing to do, especially if some of the components of your supplements seem a bit off.

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Kanda, A. et al. Effects of whey, caseinate, or milk protein ingestion on muscle protein synthesis after exercise. Nutrients. 2016 Jun; 8(6): 339.
  2. Lioudmila, K et al. Cardiac arrest in a 21-year old man after ingestion of 1,3 dmaa—containing workout supplement. Clin J Sport Med. 2015 Jan; 25 (1): 23-25

Can I drink this beer while on medication?

NFL playoffs and the OSU Spring Semester are in full swing, and this may mean an increase in alcohol consumption during the months to come. There are many drugs that interact with alcohol to some extent. These interactions can either metabolize medications and decrease the medications effectiveness, or can have the opposite additive effect and increase the risk of toxicity.

Here is a limited chart of studied alcohol-drug interactions and the risk/warnings of combining the two, be sure to ask your pharmacist about any drug-drug interactions before taking your medication:

Common OTC/Prescribed Medications Clinical Effects Recommendations
Pain Medications:
Acetaminophen (can be found in multiple OTC/prescribed drugs) Acute alcohol use in large amounts can increase risk of liver toxicity Do not consume >3 alcoholic drinks/day while taking this medication
Aspirin (Excedrin), ibuprofen (Motrin) and naproxen (Aleve) Increased risk of gastrointestinal bleeding Do not consume >3 alcoholic drinks/day while taking this medication
Codeine, hydrocodone + acetaminophen (Norco, Lortab, Lorcet, Vicodin), oxycodone + acetaminophen (Percocet, Endocet) and tramadol (Ultram) Co-ingestion may lead to respiratory failure, increased dizziness, sedation and can potentially be fatal Avoid alcohol consumption while on these medications
Antidepressants/Seizure medications:
Amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil); and bupropion (Wellbutrin/Zyban); phenytoin, perampanel (Fycompa) Increased risk of sedation, dizziness, fainting; may also increase risk of seizures; may cause psychiatric effects Minimize or avoid alcohol use, speak to your doctor/pharmacist about alternatives
Diabetic medications:
Glyburide (Diabeta), metformin (Glucophage) and insulin therapies May cause vomiting, nausea, headache, muscle or stomach pain and visual disturbance. Unpredictable effects while on insulin may occur Avoid heavy alcohol consumption (>3 drinks/day)
Antihistamines:
Diphenhydramine (Benadryl, ZZZquil) and doxylamine (Sleep Aids) Increased risk of sedation and dizziness Advise against alcohol consumption, speak to your doctor/pharmacist about alternatives
Antihypertensives:
Amlodipine (Norvasc), nicardipine (Cardene), nifedipine (Procardia), atenolol (Tenormin), and metoprolol (Lopressor, Toprol XL) Increased risk of dizziness and fainting

 

Advise against heavy alcohol consumption (>3 drinks/day)
Antimicrobials:
Doxycycline (Vibramycin), ketoconazole, metronidazole (Flagyl), and isoniazid May decrease effectiveness of medication, as well as increase risk of vomiting, nausea, stomach pain. Isoniazid and alcohol may cause liver damage Advise to avoid alcohol on all antimicrobial agents ask your pharmacist about interactions with your medications

 

Next time someone hands you an alcoholic drink and you are taking medication, ask yourself… is it worth the risk?

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Alcohol and Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. December 2015.

Prior Authorization

One of the most frustrating experiences as a patient is arriving at the pharmacy to pick up your medication and being told that a prior authorization is required. If you have never experienced this before the process can be especially confusing and aggravating. Unless you decide to pay cash for your medication or your doctor decides to change your therapy it can also involve a significant delay before you can actually get your medication.

Prior authorization is a process where the insurance provider wants more information from the doctor before they will pay for a medication. This process typically starts at the pharmacy when the staff there try to bill an insurance plan for a drug. The insurance will then send the pharmacy a rejection notifying them that a prior authorization needs to be completed. At this point the pharmacy will contact the doctor to let them know they must complete a prior authorization if they want the insurance company to cover the cost of the prescribed drug. The doctor must then answer some questions about the use of the prescribed medication and send those answers to the insurance provider. Finally, the insurance provider must review the doctor’s response and decide if they will pay for the medication or not. Thankfully this process is quicker than it used to be as many of these interactions are automated or electronic. Typically this process can take anywhere from a day to a week to complete, although times may vary. If a patient stays on their medication for an extended time it is likely that the prior authorization will need to be completed again at some point. Many plans require prior authorizations annually while some require them more often.

The main reason insurance plans institute prior authorization is cost savings. Plans want to review the use of high cost medications and make sure they are being utilized appropriately. A common way they do this is called step-therapy. Step therapy means that the insurance provider will require a trial of one or more lower cost medications before they will pay for a high cost drug. Many insurance providers require prior authorization for brand name drugs if a generic is available. Insurance plans often prefer a certain drug within a medication class due to cost and require providers to complete a prior authorization if they write a prescription for a different drug in the same class.

Prior authorization can be frustrating for both patients and healthcare workers. Despite that the practice isn’t going away anytime soon. If you want to be more informed about which drugs will require prior authorization on your health insurance you can request a copy of your insurance formulary which will show you which drugs your insurance plan prefers. Drugs on this list will be less likely to require a prior authorization.

Michael Kowalczyk

PharmD candidate 2018

Prescription Refills

Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?

In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.

You don’t have time to come in for an appointment right now?

Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.

How to avoid running out of medications?

Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.

Don’t see an appointment on-line that fits your schedule?

All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.

Ryan Hanson, M.D.

Medication Disposal Day – Don’t rush to flush!

The Student Health Services Pharmacy will be holding our 6th annual DEA-approved Medication Disposal Day Thursday, October 26th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication).

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets.

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health.
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America.
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet.

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 5th Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe!

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx.

Candace Haugtvedt, RPh, PhD
Student Health Services
The Ohio State University

My friend is hooked on painkillers, what should I do?

Addiction is a devastating disease that can have life-threatening consequences if not treated. It is important to know where to go on campus in case you or a friend is ever in need of help.

Counseling and Consultation Services

  • Location: Younkin Success Center (4th Floor), 1640 Neil Avenue, Columbus, OH 43201
  • Phone: 614-292-5766
  • About: Provide individual and group counseling, suicide prevention, mental health screenings and a variety of other mental health services to meet your needs.

The Ohio State Collegiate Recovery Community

  • Location: 1230 Lincoln Tower
  • Phone: 614-292-2094
  • About: The Collegiate Recovery Community is a program for students in or seeking recovery from drug or alcohol addiction. They provide many resources for students in recovery including the following:
    • Recovery House at Penn Place
    • Peer to peer support
    • Devoted recovery staff
    • Advocacy, information and referrals
    • On campus support group meetings
    • Monthly wellness workshops
    • Social events
    • CRC Student Leadership Board
    • Service opportunities
    • Recovery Scholarships
    • Annual CRC Program Orientation
    • Graduation Dinner
    • Individualized Recovery Plans
    • Ohio State alumni in recovery mentor program
    • Leadership and professional development
    • Scarlet, Gray & Sober Tailgates
    • Monthly community lunch
    • Designated CRC lounge on campus, 1230 Lincoln Tower

The Higher Education Center for Alcohol and Drug Misuse Prevention and Recovery

  • Location: 125 Stillman Hall, 1947 College Rd, Columbus, OH 43210
  • Phone: 614-292-5572
  • About: Can help students identify resources and answer their questions about drug and alcohol misuse. The center can also help identify the best way to talk to a friend who may be misusing drugs or alcohol.

Student Health Services

  • Location: 1875 Millikin Rd, Columbus, OH 43210
  • Phone: 614-292-4321
  • About: Student Health Services is dedicated to caring for students and families of those struggling with the disease of addiction. For those in long-term recovery, SHS can provide maintenance medication if certain expectations are met. Call a Care Manager at Counseling and Consultation Services to apply (614-292-5766). The SHS Pharmacy is also equipped to provide naloxone (Narcan), the overdose reversal medication, and overdose education. Call 614-292-0125 for more information.

It is important to speak up if you or a loved one is struggling with the disease of addiction. You could save a life! Be sure to check out my next post about naloxone, a drug that can reverse opioid overdose!

 

Kelsey Kresser Schmuhl, PharmD Candidate 2017

 

 

 

 

The Problem with Antibiotics

There are many types of antibiotics. The most commonly used antibiotics treat bacterial infections.  Penicillin was discovered in 1928.  It was first used on a patient in 1941.  It was mass produced by the end of World War II.  There are now dozens of antibiotics on the market.  These drugs have reduced illness and death from infectious diseases.  However, bacteria have adapted resulting in these drugs becoming less effective.

These antibacterials medicines do not work on all infections. They treat bacteria but not viral infections.  Common viral infections are colds, influenza, bronchitis, and most sore throats and sinus infections.

Overuse of antibiotics contributes to more serious drug-resistant bacteria. The CDC estimates that 23,000 people in this country die yearly from antibiotic-resistant bacteria.  Reasons for overuse include pressure on healthcare providers to prescribe these drugs, patients using leftover antibiotics, and patients using antibiotics purchased overseas.

What can we do? Do not expect antibiotics to cure every illness.  Please do not pressure your provider to prescribe an antibiotic.  Most colds and coughs will take two weeks or longer to resolve.  Complete the entire course when an antibiotic is prescribed,.  Also, never take someone else’s medication.

 

Dr. Matthew Peters, MD

Allergies versus colds – How to tell the difference?

Spring is in the air (although it’s snowing as I’m writing this blog), which means prime allergy season has begun! The common cold is also still prevalent in the ever-changing weather of Ohio.  Here are some facts about the differences between two similar presenting diseases and some tips on how to treat them! ALLERGIES Students may be more likely to develop allergies while attending college.  This could be due to living in a different region that has different pollens in the air and students may be exposed to different allergens.  Allergy symptoms occur quickly after exposure to an allergen and will last as long as you are exposed to the allergen.  Common symptoms include: runny or stuffy nose, sneezing, wheezing, and watery or itchy/dry eyes.

Common causes of seasonal allergies: pollen, dust, dust mites, food, animal dander, and mold

COLDS

Colds are caused by a virus, and very rarely are caused by bacteria. They mimic the same symptoms as allergies, but may also include fever, sore throat, and body aches.  Colds develop over several days and usually your body can clear the virus within several days to a week. Warning signs that you may have a bacterial infection (NOT the common cold) are vomiting or diarrhea along with fever and body aches and other common cold/allergy symptoms.  If you have these symptoms it’s important to see a doctor and stay hydrated!

Both allergies and the common cold have the same over-the-counter (OTC) treatment choices and non-medication related recommendations to help alleviate symptoms.

Common OTC Treatments:

  • Non-drowsy antihistamines – reduce symptoms of allergies like runny nose, itchy/watery eyes
    • Ex. Claritin (loratadine), Zyrtec (cetirizine), Allegra (fexofenadine)
    • Counseling tips: take daily during allergy season to prevent and reduce symptoms
  • Nasal steroids – helps reduce nasal inflammation, nasal congestion, runny nose and sneezing
    • Ex. Flonase (fluticasone), Nasacort (triamcinolone)
    • Counseling tips: requires a few days of treatment to notice effect on symptom improvement, and needs to be taken on a daily basis to continue to work
  • Nasal decongestants – helps reduce nasal congestion (stuffy nose)
    • Ex. Afrin nasal spray (oxymetazoline)
    • Counseling tips: should only be used for 3-4 days
  • Oral decongestants – helps reduce nasal and chest congestion
    • Ex. Sudafed (pseudoephedrine)
    • Counseling tips: do NOT use if you have high blood pressure without asking your doctor first
  • Artificial tears/saline solution – helps relieve dry or itchy eye irritation
    • Ex. Visine products, Artificial Tears
  • Pain relievers – reduce headaches associated with allergies or virus
    • Ex. Tylenol (acetaminophen), Advil (ibuprofen)
    • Counseling tips: don’t use more than the recommended dosing; be aware these ingredients may be in other OTC products and will count towards your maximum daily dose!
  • Cough drops – helps relieve cough associated with nasal drainage

 Non-Medicine Treatment:

  • Avoid allergens as much as possible!

 

  • Use a humidifier in your home to help with congestion
  • Wash hands/face often during pollen season
  • Avoid rubbing itchy eyes, try and use a cold compress instead to relieve symptoms
  • Avoid wearing contact lenses during pollen season to reduce eye irritation
  • Close windows/doors at home when pollen count is high

If you ever have questions about which OTC products can help your allergies or reduce the symptoms associated with a cold don’t hesitate to talk to your pharmacist or doctor!

Lindsey Glaze, PharmD Candidate 2016

The truth about antibiotics and birth control!

Q: I heard that antibiotics interfere with birth control pills, but I’m on the birth control that gets implanted under my skin – will antibiotics interfere with that too?

A: I’m so glad you asked this question!  This is one of the biggest medical myths of all time; one that gets propagated in doctors’ offices, health clinics, hospitals, blogs, magazines – and OK fine, student health centers – every day.  So now, for the first time ever… in print… online… on this blog… the TRUTH!

The only antibiotic that has ever been shown to interfere with birth control levels and effectiveness is a medicine called rifampin which is used to treat tuberculosis.  Rifampin may also interfere with the birth control patch and vaginal ring so if you are taking it, be sure to use a back-up, non-hormonal (i.e. condom) form of birth control.

There are some other medications that can interfere with your birth control, however, and if you are taking any of them you should always use back-up contraception.

  • Griseofulvin
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Phenobarbital
  • Topirimate (Topamax)
  • St. John’s Wort (herbal supplement)

But in general, your birth control will not be affected by any run-of-the-mill antibiotic that you might be taking for things like sinus infections, strep throat, urinary tract infections, skin infections, acne, etc.  Some people believe that because antibiotics disrupt the normal bacteria in the gastrointestinal tract, they will interfere with the absorption of the birth control pills from your stomach.  But this is not an issue, and even if it were, it wouldn’t apply to birth control methods that don’t involve swallowing pills like the skin patch or the vaginal ring or Implanon.

Now, there are enough women out there who swear that they have little antibiotic babies running around the house that your health care provider will probably still tell you to use back-up just in case.  And birth control doesn’t do anything to protect you against sexually transmitted infections, so using a condom is a good idea no matter what medications you’re taking.  But you can rest assured that your birth control is just as effective when you’re taking antibiotics as when you’re not.

More questions about your medicines?  Make an appointment to discuss them with a healthcare provider, or stop by and visit the SHS Pharmacy.  Our friendly Pharmacy staff will be happy to answer your questions.

John A. Vaughn, MD (OSU Student Health)