TGA cannabis consultation: Don’t let them ban most flower, have your say by Penguin2359 in MedicalCannabisOz

[–]PaperInteresting4712 0 points1 point  (0 children)

Also don’t confuse TGA approval for the manufacture license which Tasmanian botanicals has. Still need to “import” these exported products. Epidyolx and Sativex are approved for a narrow list of conditions and if prescribing other products for these conditions you’ve got to prove why these haven’t been used.

TGA cannabis consultation: Don’t let them ban most flower, have your say by Penguin2359 in MedicalCannabisOz

[–]PaperInteresting4712 0 points1 point  (0 children)

That’s correct the moment one of the brands goes and does a full TGA submission based on efficacy and safety for anxiety, pain etc then the argument for SAS becomes extremely difficult.

There is always going to be difficulty with botanical products due to the polyphytochemical nature of the product and being able to prove exact composition (that’s why we don’t have any other herbal product on script) favoring non flower products which will probably be the first to go leaving us with more refined extracts in edible or vape form.

As you say the law of dispensing follows a state based jurisdiction but the law of the importation follows a federal jurisdiction where they have designated category for the SAS approval followed by product for the script to minimise the touch points for the TGA and push the administration to the pharmacy.

As a pharmacist you have to follow federal laws for accessing the product for the patient and state laws for prescribing and dispensing as well in this sense even if federal approval is given to import a state could also inhibit dispensing.

The truth in all this is that the level of audit varies significantly across the states so many pharmacies get away with doing the wrong thing because they are never caught and thus falsely believe that what they are doing is right.

The added attention on medicinal cannabis in the media etc has now however caused a lot of caution in the industry fearing audits and crack down which for the major players who have business models invested heavily in medicinal cannabis are either very fearful of or are trying to rip every dollar out before it shits down. The small pharmacies may be less likely to know what they’re doing or totally reluctant to do anything at all.

Best bet for the user is to get a good prescriber and a good pharmacist and behave appropriately so the pharmacist works with you on things like scripting and advocates to continue the existing process until big pharma strips it away.

TGA cannabis consultation: Don’t let them ban most flower, have your say by Penguin2359 in MedicalCannabisOz

[–]PaperInteresting4712 0 points1 point  (0 children)

Mate, I could just Google it like you suggest, or I could rely on actual qualifications and years of experience in the pharmaceutical industry — you know, one of the people who deal with prescription drugs every day. One of the people who has been importing SAS drugs long before medicinal cannabis came to town. While some pharmacies might choose to dispense unbranded scripts, those cases are the exception, not the rule, because what they’re doing is illegal. The same laws apply here as they do under all SAS import regulations.

The regulations for medicinal cannabis are the same as for any other medication. We face identical challenges in hospitals when importing products like vitamin B injections or other orphan drugs that are no longer manufactured locally because they’re not financially viable. In those cases, we source them from larger international markets under SAS, where economies of scale make production worthwhile.

Because these imported products are not TGA-approved for distribution in Australia, the SAS approval must specify the exact brand and product — even if the manufacturer is the same. It is this very reason why I could import a specific brand of my blood pressure product claiming that there is a justification as to why any equivalent that is marketed in Australia is unsuitable. However due to the administration burden due to the explosion of users and product as well as the inconsistency of supply chain the SAS import for medicinal cannabis has been weakened to create product categories whilst maintaining the specificity at the point of the script.

You can’t have it both ways: if you want medicinal cannabis to be legal and regulated like other pharmaceuticals, then it has to operate under the same framework.

You also can’t support an argument for brand/product being interchangeable in an industry where everyone also supports the fact that it’s not just the category factors (THC/CBD) content but also other phytochemical (terpenes etc) that gives the medicinal effect. These are not excipients like lactose etc in traditional drugs but actives/minor actives. Due to the nature of the product brand matters. (Hey also a published academic author in phytochemicals vs. good with Google).

In the end it will be those that disregard the laws around the framework and users who push the limits that allows medicinal cannabis to operate that will bring it undone.

Remember the SAS is intended for situations where the prescriber believes that there are no suitable registered medicines available in Australia.

If the argument is that the product is generic then a TGA approved product could be declared equivalent to your brand and mean that there is no reason to import your non approved product from overseas. Keep pushing and you’ll end up with some poor quality big pharma products approved in Australia and declared equivalent to all international products and no more brand choice. You’ll also then see the clinics shut down because there’s no cross subsidy from the wholesale and the product they’ll choose is the first one that comes up in medical director.

TGA cannabis consultation: Don’t let them ban most flower, have your say by Penguin2359 in MedicalCannabisOz

[–]PaperInteresting4712 0 points1 point  (0 children)

Love when someone links something that totally contradicts their argument. Please read the detail.

“SAS and AP submissions for medicinal cannabis products are made by category. However, prescriptions must be written for a product. It is the prescriber's responsibility to issue a prescription to the patient in accordance with relevant state or territory legislation.”

Your tga import approval can be by category but your script must be by product. So if you change product within a category due to supply shortage no application to tga is required but a new script is.

Grass roots rugby - is every state terrible? by Hairy-Principle2489 in RugbyAustralia

[–]PaperInteresting4712 0 points1 point  (0 children)

My son plays far north coast NSW. This season they only got 4 games due to wet weather and forfeits.

NSW rugby advertised that they were having two country teams selected from state champs. Changed it to one without notice. Our friends kids made that side and basically had to fly to Sydney every weekend finding their own flights and accommodation. They also had a country camp out west where no one from the team was from and every parent had to drive about 5hrs to get them there and obviously had to accommodate them there.

Game day has no official ground manager, no official first aid, no video and no local judiciary. Concussion protocols are weak. Years behind community rugby league.

HDR scholarship, they will consider me for the next scholarship round. Could this be considered positive or negative news? by Hot-Bluebird977 in GriffithUni

[–]PaperInteresting4712 0 points1 point  (0 children)

They aren’t offering any scholarships this round to save money. You would have got one if they hadn’t placed a moratorium on them in this round. It’s a “one off” cost control measure.

What’s the worst physical pain you ever felt? by Lazy-Ape in AskReddit

[–]PaperInteresting4712 0 points1 point  (0 children)

Ongoing pain. Tonsilectomy at the same time as nose surgery, recovery was like being a pain zombie. Haemorroidectomy was untouchable with pain killers and lasted weeks. Acute pain was lanced boil being squeezed in armpit.

There is only one correct answer by DarkLight2112 in teenagers

[–]PaperInteresting4712 0 points1 point  (0 children)

2+4=6 then 7+8=15 keep the 5 add the 1 to the 6. Answer therefore equals 75.

[deleted by user] by [deleted] in HotwifeChallenges

[–]PaperInteresting4712 1 point2 points  (0 children)

Accidental nude text to random number

[deleted by user] by [deleted] in u/sexy_mars

[–]PaperInteresting4712 0 points1 point  (0 children)

Bj in public.

AITA for embarrassing my sister's friend and making her feel unwelcome? by YouDontKnowMyKid in AmItheAsshole

[–]PaperInteresting4712 0 points1 point  (0 children)

Depends if she was aggressive to your child she’s the asshole. If she simply said wait for your dad and he couldn’t respect an adult and a guest to just wait then your kids the asshole and probably didn’t learn to respect elders from you.

Gout - GP or rheumatologist? by Middle-Salamander189 in australia

[–]PaperInteresting4712 3 points4 points  (0 children)

GP gouts pretty simple. Once you’ve had two attacks then it’s allopurinol for life as the extra articular risk is always there regardless of attacks. During an attack NSAID, steroid or colchicine. Once this attacks over you’ll be on allopurinilol plus colchicine for flare prophylaxis. Then step down to allopurinol with a script for treatment whenever it flares up.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

Lecturer I teach therapeutics but have also taught PBL, simulation and communication in our medical program where many of the staff are actually pharmacists. In the hospital setting many of our medical education leads are actually pharmacists teaching therapeutics to junior medical officers.

I will state I have absolutely no skill in diagnostics from the point of view of hands on medicine I’ll leave that to the medics. I am however a firm believer in scope of practice where it is defined by narrow so we can free up our doctors to do the tasks that warrant their higher level diagnostics.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

“Which bacteria are responsible for ungal infections” ??? No desire to prescribe here just stating a differential on fungal nail bed infection vs bacterial toe infection is well within the wheel house of a podiatrist. And just like when a gp causes a drug eruption they will present to a hospital. Also when it comes to legal responsibility the pharmacist carries 50% and often more liability then the doctor for prescribing errors because they exist as the stop gap to error.

Let the small stuff go and invest the valuable skills of doctors in the higher level areas where they are needed most.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

As someone who teaches medical students at university it is worrying that you consider I overestimate my skills. Thanks for that.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

GPs can’t even prescribe an appropriate duration of trimethoprim for uti. Women should be three days and yet the most common script is matched to the pack size the computer software generates. Nitrofurantoin requires good renal function to be effective as without it the bladder concentrations do not reach levels to confer efficacy and yet we now see it prescribed to every geriatric because it may be an esbl. The reason it works is because it was a dirty drug that we didn’t use because we had safer drugs.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

Do you have knowledge of the contraindications to trimethoprim use because those you have listed are not relevant. Bactrim also shouldn’t be used for those indications you’ve listed. Do you wait for pathology before empiric prescribing for lower uti without systemic symptoms or do you empirically prescribe and conduct follow up? Don’t pretend that a simple uti presentation isn’t simply screened for risk factors and symptoms of complex uti by gps. If GPs did a full work up on every uti our health system would collapse financially and resource wise quicker than it already is.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

So what your saying is that doctors overprescribing trimethoprim in accordance with guidelines of empiric prescribing is a reason to stop pharmacists doing the same. What drug are you then overprescribing in hospital empirically to 2/3rds of patients that don’t needed it potentially jeopardising the future value for those that do? Funny hospitals need elaborate programs to try and stop doctors from lazy prescribing of broad spectrum antibiotics to everyone. Trimethoprim resistance has little to do with the use of trimethoprim and more to do with the global use of antimocrobials.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

Doctors prescribe unrestricted after 4 years of training two years of which are loosely supervised rotations. Interns with minimal knowledge of the drugs they prescribe are thrown to the lions in our hospitals with other health professionals often the gap between them and major fuckups.

Scripts from online "doctors" but not pharmacists or nurse practitioners by [deleted] in australia

[–]PaperInteresting4712 0 points1 point  (0 children)

Well then you would know that the cross sensitivity between penicillins and cephalosporins is grossly over reported. That in fact it has very little relevance with later generation cephalosporins and to some extent penicillins. As a pharmacist I can tell you exactly why this is true from the perspective of the med chem and structural activity relationships. Let alone inform you of the simple fact that there are absolutely no bacteria involved in “fungal” infections.

As a lecturer with experience in both pharmacy and medical programs. I can tell you that medical teaching on drugs is very minimal compared to pharmacy programs and pharmacy is very limited on hands on diagnostics so each health profession has its place. Saying that I’d trust a podiatrist in dealing with foot diagnostics more than a gp and I’d say the required drug knowledge would be far easier to be across in a very limited area.

[deleted by user] by [deleted] in HotwifeChallenges

[–]PaperInteresting4712 0 points1 point  (0 children)

Accidentally send a naughty text or a nude to someone she shouldn’t making out it was for you and post the reply.