How to Spot Drug Diversion in Your Long-Term Care Facility

By holladay | August 4, 2015 | 0 Comments

“It’s estimated that over 6 million people in America use prescription drugs for non-medical purposes.” This transference of a controlled substance from a legal use to a use or channel that is illegal is referred to as diversion. The theft of another’s prescription drugs is an act many would not expect from health care professionals. Unfortunately, this act is common in the healthcare industry, including long-term care facilities. Because of the availability of prescription drugs in long-term care facilities, it’s important that all staff is aware of the hazards and consequences of diverting medication.

The three types of prescription drugs that are most commonly abused are: Opioids, Central Nervous System (CNS) Depressants, and Stimulants. These drugs are most commonly diverted due to the effects they may yield.

  • Opioids (Oxycodone, Hydrocodone, etc.): These medications are commonly prescribed to reduce pain and have a high risk for addiction and overdose. Opioid abuse can lead to respiratory distress and even death.
  • CNS Depressants (Mephobarbital-“Mebaral”, Diazepam – “Valium”, Alprazolam – “Xanax,” etc.): These are used to treat anxiety and sleep disorders. These addictive substances can lead to overdose, resulting in significant breathing problems or death.
  • Stimulants (Dextroamphetamine – “Adderall”, Methylphenidate – “Ritalin,” etc.) – are prescribed to treat sleep disorders and attention deficit hyperactivity disorder (ADHD) and can lead to severely high body temperatures, seizures, and cardiovascular distress. These drugs are less likely to be abused in long-term care facilities due to the fact that residents in long-term care are not often prescribed them.

“The Wisconsin Division of Quality Assurance estimates that oxycodone, morphine, fentanyl and hydrocodone products are the most often diverted medications in long-term care facilities.” Here are a few signs that an individual in your facility may be diverting a resident’s medications for personal use: (keep in mind these signs are just indicators and not absolute proof)

  1. Unwarranted and abundant absenteeism (especially last minute call-ins)
  2. Insistence on helping only specific residents who are prescribed controlled substances, (especially tenants with cognitive impairments)
  3. Disorderly documentation, repeatedly “forgetting” to chart medicine
  4. Offering to work night shifts or in settings with no (or few) other staff
  5. A steady decline in personal hygiene
  6. Temperament changes, behavioral mood swings, depression, lack of impulse control, etc.

As an employer, if you recognize any combination of these signs it is imperative to confront an employee suspected of diverting controlled substances. In some cases, the threat of employment loss can be enough inspiration for an abuser to seek treatment. Encourage your employee to seek assistance and provide them with information on available treatment programs in your area.


FDA gives Approval to New Insulin Pen Strength

By holladay | June 26, 2015 | 0 Comments

Diabetes affects approximately 380 million people world wide and this number is only increasing as the years progress. This metabolic disease causes elevated levels of glucose in the blood that must be regulated through means of insulin. Because those with diabetes do not have the ability to produce enough insulin it is imperative that they be able to self-administer this hormone into their systems through means of injection.

As reported by the Pharmacy Times,  “Last month the FDA (Food & Drug Administration) approved a new 200 unit/mL formulation of Eli Lilly and Company’s pre-filled pen containing insulin lispro (Humalog U-200 KwikPen).” This new insulin pen is for the enhancement of glycemic control in patients with type 1 and type 2 diabetes.


This new pen has benefits for its users that surpass that of its prior generation, the U-100 formulation:

  • The Humalog U-200 KwikPen delivers the same dose as Lilly’s Humalog U-100 KwikPen in half the volume, and is the fundamental concentrated mealtime insulin analog to receive FDA approval.
  • Another benefit of the U-200 formulation is that in comparison to the 300 units of insulin the U-100 formulation holds, the U-200 KwikPen holds 600 units. This allows diabetics to change their pens less frequently.


  • Users that are requiring smaller amounts of insulin to achieve glycemic control will have a larger amount of remaining unused insulin at the expiration date of the new pen. This new U-200 KwikPen continues to have the same storage and expiration dating requirements as the U-100 KwikPen. For these users, the U-200 KwikPen may not be the most cost effective product.
  • Like any drug, Humalog U-200 can have possible adverse effects. The adverse event most commonly associated with the use of Humalog is hypoglycemia, (which in severe cases may lead to unconsciousness, seizures, and death).
For further information about this new insulin pen or to see if this pen is a good option for your resident, please contact one of the Holladay pharmacists at 1-800-848-3446.


CMS Strives to Reduce Antipsychotic use in Nursing Facilities

By holladay | April 2, 2015 | 0 Comments

In late March of 2012, the Centers for Medicare & Medicaid Services (CMS) started the National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes. This organization has been commonly referred to as the Partnership to Improve Dementia Care in Nursing Homes. Antipsychotic drugs are those used to alleviate the behavioral and psychological symptoms of those with disorders of the mind, namely Alzheimer’s and dementia.


The goal of this Partnership is to enhance the quality of life of American residents in nursing homes. Previously, it has been common practice to use numerous types of psychopharmacological medications in nursing homes to address behaviors (without first determining the cause in which these behaviors developed.) These behaviors are commonly associated with symptoms of anxiety, depression, psychological distress, and insomnia all of which can be addressed without antipsychotic drugs, and their adverse effects (sedation, parkinsonism and increased risk of: infections, falls, strokes, etc.)


The primary concern with the use of medications, like antipsychotics, is that nursing homes and other medical facilities are using these drugs as a “quick fix” for behavioral symptoms. The Partnership to Improve Dementia Care in Nursing Homes recognizes that there are instances in which antipsychotic drugs are needed, but only after:

  • Specific and documented therapy
  • Ongoing examination of the resident to assess effectiveness and any development or presence of adverse effects from the medication


When a case for these drugs is concluded the medication should be administered only for the duration needed, and at the lowest effective dose. Often, these drugs are not necessary after using more holistic approaches to solving these behavioral issues – through a more thorough, individualized assessment of underlying sources.


The intolerance, hostility, delusions, apathy and sleep troubles these Alzheimer’s and dementia patients encounter can be solved with alternatives to antipsychotic prescriptions. Holladay suggests first trying non-drug treatments such as reminiscence therapy and social interaction. Research implies that various symptoms can be decreased by simply 10 minutes of individualized, daily talking therapy. Treatments including aromatherapy, animal therapy, music, dance, and massage therapy can also significantly lessen unfavorable behavior.


For more information on Alzheimer’s and dementia treatment options feel free to speak with a knowledgeable Holladay accociate at 336-760-3446.

Case Study: The Tramadol Transition

By holladay | January 28, 2015 | 0 Comments


Tramadol is a narcotic-like drug used to treat moderate to severe pain. Like many opioid analgesic based medications, tramadol has an increased abuse rate and as of August 18, 2014, the DEA has classified the medication as a schedule IV controlled substance.

In the past, it was widely believed that tramadol had a better safety profile than other opioid analgesics. Now that the drug has been deemed a Schedule IV substance, however, health care professionals may be less likely to prescribe it to patients for pain. In 2010 alone, more than 16,000 visits to the emergency room were documented as resulting from the use of tramadol for non-medial purposes.

“As confirmed by the association, current distributors of tramadol are DEA registrants with existing controlled substance storage that complies with DEA regulations,” the agency explained in its declaration. “The DEA understands that handlers of tramadol may need to make modifications to their current security procedures for compliance. These modifications necessary for security compliance will be a 1-time modification to provide for the appropriate storage, revision of operating procedures, training of staff, and amendments to suspicious order monitoring systems to include customer verifications.”

What does this mean for our clients?

At Holladay Pharmacy, we understand the guidelines set forth by the DEA. Our pharmacy in Winston-Salem, NC is designed to handle and store a variety of medications from over the counter drugs to schedule IV controlled substances like tramadol.

However, we also feel it is our duty to assist and guide our customers in the management process of the new controlled medication. Our pharmacists and other team member spent hours helping our customers understand the requirements and assisted in creating new processes to make sure that our customer’s were fully compliant with the new DEA guidelines before August 18, 2014. We feel that this personal touch and desire to serve our customers needs, even when it really isn’t “our problem” is what has made us successful over the years.

If your North Carolina based senior care facility has any questions about how to manage any type of medication, feel free to contact us. We would love to serve you.



By holladay | August 15, 2014 | 0 Comments

By G. Bryan

In December 2013, the Eight Joint National Committee (JNC8) released the latest Evidence Based Guidelines for the Management of High Blood Pressure in Adults.

One of the biggest changes in these updated guidelines is their commended BP goals. For the patient aged 60 years or older (who does NOT have diabetes or chronic kidney disease), the BP goal is now less than 150/90 mm Hg. Patients less than 60 years old OR over 60 years old with diabetes or kidney disease should maintain their BP at less than 140/90 mm Hg.

Another difference is in which classes of medications should be started first for HTN. For the African American population, a thiazide diuretic or calcium channel blocker (CCB) is now recommended as first-line treatment. In The non-African American population, treatment for HTN may be initiated with a thiazide diuretic, CCB, Angiotensin-
Converting Enzyme Inhibitor(ACEI), or Angiotensin Receptor Blocker(ARB).

Please contact your Holladay Consultant Pharmacist for more information.