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Pharmacist reassures community in wake of tainted drug threat

November 9, 2012

Jeff Brown, Pharm.D., is on the job at Dwayne’s Friendly Pharmacy, where he uses his 10-plus-years of experience in compounding medications. Dwayne’s strictly follows Professional Compounding Centers of America’s high standards and guidelines. Photo by Marilyn Blake Philip

In the face of the recent nationwide compounded medication threat, a local pharmacist wants to reassure residents they are in safe hands with Inyo County’s only compounding pharmacy.
At last month’s Rotary Club luncheon, Jeff Brown, Pharm.D. of Dwayne’s Friendly Pharmacy, spoke about methylprednisolone, the contaminated compounded pain-relieving synthetic corticosteroid that has caused hundreds of cases of fungal meningitis and joint infections and dozens of deaths throughout the U.S. in recent months.
The tainted drug in question was made by The New England Compounding Center in Framingham, Mass., which even shipped some of it to a Lancaster pain management clinic, said Brown. Luckily, none of it was contaminated; in fact, California is one of four states with no cases of infection reported.
While Dwayne’s is Inyo County’s only compounding pharmacy, it does make high-risk compounds, said Brown, which usually involve preparing sterile product from non-sterile ingredients. The contaminated methylprednisolone is such a drug and is likely the result of “a failure on the part of NECC to follow proper technique in preparing the high-risk injectable drugs.”
While the drug is commonly used to treat pain caused by maladies such as asthma, cancers, arthritis and intestinal disorders, the batches that were produced at NECC brought many patients illness and death instead of relief.
NECC “saw a business opportunity,” said Brown and compounded in unsterile conditions using many short cuts, not the least of which was forgoing the required 14-week quarantine. It shipped more than 17,000 vials throughout the U.S. “in a rush to meet demand,” added Brown.
Patients had been receiving injections of the contaminated steroid for six months and all “cases of fungal meningitis were due to epidural administration of methylprednisolone,” said Brown. A 40-day incubation period makes it difficult to diagnose until it’s too late. The contamination was discovered when dozens of cases were reported, but the rate of fungal meningitis infection has been fairly low; Center for Disease Control feels pretty good about that, said Brown. Still, “this situation is disturbing, as a professional.”
Compounding pharmacies make custom-formulated drugs because of a legitimate demand: the national shortage of many low-cost, low-margin injectable meds produced by major pharmaceutical compa-
nies, said Brown. But he stressed that California is the most regulated state in the U.S. and Dwayne’s doesn’t compound sterile formulas from non-sterile intravenous products, said Brown. “It’s a very tricky process … Rest assured,” said Brown, Dwayne’s is not producing “the kinds of compounds you’re hearing about in the news.”
Dwayne’s mainly compounds four types of drugs: chemotherapy; liquid pediatric dosage forms for infants and children; hormone replacement therapy; and veterinary meds, explained Brown, who has more than 10 years’ experience compounding pharmacy. But “we try to do things differently than large chain store pharmacies … Dwayne’s is a very special place because of Dwayne and the community, who want a high level of service and product … You never want to take shortcuts in medicine. When it goes bad it can be very serious,” said Brown.

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