Why Only Your Farmacist Sells Marihuana in Canada.

It was a regular Thursday morning complete with my usual morning ritual

– Wake. Coffee. Journal. Read Bible. Pray. Meditate. Day Dream. Run. Shower. Eat –

– Business as usual –

….till these Texts…

Marijuana

…whence it was all up hill in my mind.

By noon, I had day dreamed myself to the very top of a Medical Marihuana distributing empire.

So, as any curious pharmacist would, I called the Alberta College of Pharmacists (ACP); where, after speculations if I was indeed a pharmacist, I was transferred to speak to an expert, who turned out to be my former teacher, and who also proceeded to recognize me as the recently awarded “Preceptor of the Year” recipient! This fact did not make this conversation awkward…at all.

From this conversation and after reading several other documents to determine how exactly I could hypothetically dispense Medical Marihuana in Canada, I found out several interesting facts.


1. I am as a matter of fact not allowed to produce Medical Marihuana on Pharmacy premises

2. I am strictly forbidden from possessing, producing, selling, providing, shipping, delivering, transporting and destroying marihuana.

3. As a licensed pharmacist and the proprietor of my pharmacy; I can not at the same time obtain a license from Health Canada to become a Licensed Producer or responsible person in charge of medical marihuana supply.

4. There is an explosion of medical marihuana shops in Vancouver City.

5. Dried marihuana is not an approved drug or medicine in Canada.


These facts were very confusing to me, because the Courts compelled a requirement to provide reasonable access to a legal source of marihuana when authorized by a physician for medical purposes. Despite medical use, it is not considered a medicine. It seems to me that a product intended for medical use should be subject to the same medication management that any product intended for medical purposes are subject to through pharmacist interventions. However, in this special case, we have a legal product ordered by a physician or nurse practitioner (the only two authorized healthcare professionals in Canada, Nurse practitioners are excluded in Alberta) and dispensed to patients by licensed producers (with no requirements for medical  or pharmaceutical background/ training), physicians, nurse practitioners or from Hospitals. In Alberta, physicians are definitely not authorized to dispense or become licensed producers of Marihuana.

Marihuana Question

According to the Alberta College of Pharmacists’ Policy statement   … “A licensed producer may only provide dried marihuana to a patient; it cannot be compounded or incorporated in any other vehicle or formulation.” Yet several of these “licensed producers” distribute in several different “formulations” (using that word very loosely). The closest medication I can think of that is manufactured in edible form is Actiq (Fentanyl in lollipops) a Schedule I Narcotic medication (in lay terms: You Must Be Very Ill to Get This Medication), which I’ve only heard of in pharmacy fairytales, but never dispensed, as it is not to my knowledge, available in Canada. In pharmacy land, one is very worried about poisoning children when one includes medical ingredients in delicious edible forms … so, naturally I was very curious about how these “lisensed farmacists” were getting away with this edible business. Turns out, it started from the shady sides of the previous law.

So…

Dispensaries and compassion clubs, which developed under a grey area of the previous federal legislation, are not legal under the current legislation.

Except…

A few days ago, in a historic move, council in Vancouver city voted to regulate about 100 “dispensaries“, charging retail dealers a whopping $30,000 license fee and compassion clubs a more gracious $1000 license fee while restricting available space for these shops through this new bylaw.

Marijuana Dispensaries  = #Truth

Still…

The bylaw does not allow the sale of edible products like pot brownies, with the exception of edible oils, which would include tinctures and capsules.

However…

The Supreme Court of Canada says medical marihuana must not be sold or provided with any additive, “additive” means anything other than dried marihuana but does not include any residue of a pest control product or its components.

So, we really do have a case in which a legally prescribed treatment is being supplied illegally (as edibles) to patients.

The Medical Product that is Not a Medicine

What is a Drug Product?
– Drug products include prescription and non-prescription pharmaceuticals, disinfectants and sanitizers with disinfectant claims.
– When a product is offered for sale in Canada to treat or prevent diseases or symptoms, it is regulated as a drug under the Food and Drugs Act.
– Prior to being given market authorization, a manufacturer must present substantive scientific evidence of a product’s safety, efficacy and quality as required by the Food and Drugs Act and Regulations.

In the case of Marihuana, it is prescribed, offered to treat diseases/ symptoms with limited or inconclusive efficacy evidence and has no market authorization under the Food & Drug Act…My (former) teacher also pointed out, when I called the ACP, that the quantity of the active ingredient is also very variable per unit dose. For these reasons, on the basis of limited efficacy data and variable content in unit doses, Health Canada has not in fact reviewed safety & efficacy data, and as a result, can not consider it a Drug Product. Because it isn’t a drug product, pharmacists can not dispense it.

hmmmmm….limited or inconclusive efficacy evidence and variable content in unit doses

You know what this sounds a lot like though?

Nutritional supplements.

Why has Health Canada reviewed and so provided market authorization for nutritional supplements, when there is limited to no evidence for their efficacy and many of these products have highly variable contents some containing <20% or sometimes none of the stated doses on the package? Despite the Canadian Medical Association’s concerns about safety of Marihuana treatment, it is yet to be reviewed for market authorization.

Nonetheless.

Medical cannabis is increasingly recognized as a valuable therapeutic option for the management of a variety of symptoms.1 As of April 1, 2014, patients are no longer allowed to grow their own cannabis. A court injunction allows individuals who had a license to grow cannabis under the former legislature to continue to do so until the court case is heard or the injunction is appealed.1

Currently, the dispensing Procedures for the non-medicine-medical-product:

Step 1: Physician or Nurse practitioner (Depending on Province) assesses the patient and determines there is a medically compelling need for the non-drug product A.K.A Marihuana. In Alberta, Physicians must register with the College as an authorizer of marihuana for medical purposes.

Step 2: Prescriber provides patient with a medical document (which looks a lot like a prescription in the detailed requirements for: patient specific information, marihuana dose, instruction for use and physician specific information).

Step 3 Patient presents document to a Farmacist (Licensed Producer) in any province across Canada.

Step 4: Farmacist registers the patient and sets her/ his price for the non-drug product.

Step 5: Farmacist ships non-drug product to patient with the label which includes the patient’s information and is thus proof of legal possession of the non-drug product.

Asides from Marihuana’s obviously illicit status, there are other factors which ought to be considered in its current medical distribution.

Clinical Considerations

Marihuana has an abuse potential – There is an addiction & dependence potential

There are 5 Randomized Controlled Trials lasting 3 to 15 days that support the use of smoked or vaporized cannabis for HIV/AIDS associated weight loss, multiple sclerosis related pain and spasticity, neuropathic pain & chronic pain

Potential risks of marihuana include: psychotic symptoms (dose dependent, age dependent, genetically influenced), impaired lung function, impaired cognition & potential interactions with psychoactive drugs, infertility, neurodevelopmental disorders following exposure of a fetus, impaired driving, impact on insurance and benefits coverage, unauthorized diversion.

Adverse Health Reactions: include dry mouth, red eye, reduction in blood pressure, increased or irregular heart rate, paranoia, hallucinations, derealization, increased anxiety, altered depth perception/ coordination, increased risks of lung disease & cancer, brain changes, lowers IQ (Irreversibly in those who initiate before 18 years old), reduces testosterone and the hormones that regulate ovulation, increased risks of addiction/ diversion.

Risk of Death

To give the controversy surrounding Medical Marihuana some perspective, I thought I’d compare relative risks of death of various drugs >>

Opioids: 14.7
Cocaine: 4.7 – 7.6
Amphetamines: 6.2
Cannabis: 1
Alcohol: 0.9 – 1.52
I am as a result inclined to believe the current controversies and hypersensitivity to Marihuana use may actually be a result of the dread factor which it poses.

I think it all comes down to the Sandman Equation:

Risk = Hazard + Outrage.

….And the outrage factor for Marihuana is high, so we are more likely going to over react to it’s use, and I do not say this to in any way discredit the very real hazard factor posed by Marihuana. It is a treatment for which there are still no high quality long term studies and for which we have no credible/ formal review of overall safety & efficacy. This fact makes many Physicians uncomfortable. A survey shows that only 19% of family physicians think physicians should recommend it1. I can only speculate about what sort of care patients could potentially receive with a Health Canada approved medical marihuana dispensed within all the proper checks and balances of a pharmacy dispensary model…

 How do these Farmacists get their licenses anyway?

To become a licensed producer/ person in charge of marihuana sale, all that is required is that you:


1. Must not be a regulated professional engaging in the practice of Pharmacy (may be unique to Alberta).

2. Notify a senior official of the local police, local fire authority and local government of the proposed activities to be conducted with cannabis and the address of the site(s) and of each building within the site(s).

3. Demonstrate compliance with regulatory requirements such as quality control standards, record-keeping, and security measures to protect against diversion, obtain necessary personal security clearances, and meet physical security requirements for cultivation and storage areas.

4. Send in an application to Health Canada.

5. An inspector may at a time during normal business hours and with the reasonable assistance of the applicant, inspect the site in respect of which the application was made.

Licences are issued only after it is determined:

  • there is no risk to public health, safety and security;
  • the applicant has met the security requirements outlined in the Marihuana for Medical Purposes Regulations (MMPR);
  • all the requisite security clearances have been obtained;
  • there are no other grounds for refusing the application; and,
  • The application otherwise satisfies the conditions for obtaining a licence outlined in the MMPR.

6. Within 30 days after the issuance, a licensed producer must provide a written notice to local authorities and licensing authorities (like the College of Physicians & Surgeons in Alberta) and provide a copy of the notice to the Minister.


For a medical product that is not designated as a drug or natural health product, Marihuana has several similarities to drugs we currently dispense:

It has known Indications, dispensing procedures, dosage forms, mode of administration, dose limits, quality control procedures, drug coverage and clinical considerations. Click Here for those juicy tidbits of info

The Role of a Pharmacist?

 We usually manage adverse effects, prevent interactions, counsel on administration techniques, provide harm reduction advice (in this case, we would promote vaporizer use, counsel not to mix with tobacco, counsel against breath holding, caution about edibles, counsel on dose titration, counsel about driving safely while on marihuana, caution alcohol/opioid/ other drugs/ interacting conditions), check appropriateness (be the final check to prevent use with contraindications like in pregnancy, cardiovascular disease, because we tend to know all the different specialists involved in a patient’s care when each don’t necessarily speak with each other), check safety and efficacy of various treatments….

Marijuana Musing

I agree

In Marihuana land,

A licensed producer who sells or provides dried marihuana must provide the Minister with a case report for each serious adverse reaction to the dried marihuana, within 15 days after the day on which the producer becomes aware of the reaction.

 A licensed producer who sells or provides dried marihuana must annually prepare and maintain a summary report that contains a concise and critical analysis of all adverse reactions to the dried marihuana that have occurred during the previous 12 months.

These farmacists are also expected to “refuse to fill” when minimum medical document (prescription) requirements aren’t met

So, these farmacists without minimum stated professional training (not to mention lack of any standards of practice) will critically analyze adverse reactions? How do they determine what to watch for? On the basis of which medical training do they establish causality? And despite obvious conflicts of interests, without any professional code of ethics, they’d set their own prices for each treatment yet refuse to fill when needed? How legal are the current sources of the product being distributed to patients? 

Currently…

The Pharmacist’s role is reduced to supporting patients by providing accurate information about the new regulatory changes, making them aware that they can contact their licensed producer for more information on processes and quality of their product, ensuring that patients report their adverse effects to their farmacists and perhaps counselling when appropriate during the comprehensive annual care plan process.

PS: I did not randomly misspell Marijuana 43 times; I have spelt it as such to align with Health Canada’s spelling in the new regulations.

Sources:

1. Danial Schecter, MA, MD, CCFP; Carlene Oleksyn, B.S.P. Pharm; Moe AbdallahBSc, BscPhm, R.Ph. Understanding Canada’s Medical Cannabis Regulations >> Studied on RxBriefCase

Authorizing Dried Cannabis for Chronic Pain & Anxiety Preliminary Guidance

Advice to the Profession

Policy Set for Marihuana for Medical Purposes

Medical Use of Marijuana

Medical Marihuana: What do you need to know before signing a medical document?

Alcohol Consumption Over Time and Risk of Death: A systematic Review and Meta-analysis

Marihuana for Medical Purposes Regulations

Responding to Community Outrage: Strategies for Effective Risk Communication by Peter M.Sandman, Ph.D.

CMA Medical Marihuana Policy Statement

CMA Policy – Medical Marijuana

Information for Health Care Professionals

Medical Marijuana – Flame-On! by Launette Reib MD, MSc, CCFP, FCFP, dip ABAM from the 26th Annual Best Science Medicine Course 2015.

Why are pharmacists so important when doctors can do their job?

Our pharmacy practice roles continues to expand, registered technicians are taking on technical roles, and we are focusing more on our cognitive responsibilities. Some of our patients don’t necessarily understand these changes. I’ve started to hear this question or various shades of it like … “Isn’t that my physician’s job?” “Shouldn’t that be my Physician’s problem?” “Why do you need to know that, you are just a pharmacist?”

In the epic battle of what a physician can do, a pharmacist can do too vs. what a pharmacist can do a physician can do better, neither profession wins. It is the very essence of division of labor for maximum productivity in our society that individuals specialize and cooperate for the synergistic benefit of all. Many smart people have recognized this, I think, after Plato who wrote in The Republic

“Well then, how will our state supply these needs? It will need a farmer, a builder, and a weaver, and also, I think a shoemaker and on or two others to provide for our bodily needs. So that the minimum state would consist of four or five men…”

We view things from different perspectives to improve the overall outcome for our patients, and neither profession bears any characterization of higher intellect/ morals. The truth is, pharmacists are trained to know a whole lot more about medications than physicians, and I certainly was not trained to complete physical assessments or diagnose complex care cases. Yet, it is fascinating to me how physicians and some patients get their panties in a bunch over this topic.

Case in point, is a letter I received from a physician 3 years ago, when I had merely pointed out that our mutual patient had a significantly elevated blood ethanol level (despite denying any alcohol consumption) and was experiencing several episodes of post prandial hypoglycemia (about 3 hours after several meals every week) despite several attempts at dose changes. I had merely suggested a switch from Insulin Toronto to a rapid acting insulin, and asked the physician if he could speak to the patient about alcohol consumption (because, the patient was obviously not being upfront with me; I had hoped both I and the physician could intervene).

Instead of collaboration, I received this letter>>
Ps: This letter is now a part of the tools used to prepare my students for the worst case scenarios in attempting to collaborate with other healthcare professionals as they go about caring for our patients.

Doctor's FaxThis patient spent another 2.5 years experiencing several bouts of hypoglycemia per week with hypoglycemic unawareness. At some point this year, another specialist recommended (as I had 2.5 years ago) rapid acting insulin with each meal. I am uncertain about his current alcohol consumption, but the number of hypoglycemic episodes dropped substantially.

As a side note about some of this particular physician’s comments:
On the comments about accessing Netcare: Our Standard of Pharmacist Practice actually requires that any reasonable Pharmacist would have, in this circumstance, considered appropriate information:
Standard 3.4 Appropriate information means the following information in relation to a patient: a) health condition to be treated and history of the condition; b) symptoms or signs to be treated; c) treatment history for the condition including drug therapy and outcomes; d) age; e) pregnancy or lactation status, if applicable; f) allergies or intolerances to drugs, excipients or other products that may affect drug therapy; g) other drugs or blood products being used; h) other health care products, aids and devices or other products being used that may affect the pharmacist’s decision; i) other health conditions that may affect the pharmacist’s decision; and j) any other information that a reasonable pharmacist would require to provide the pharmacist service.
Standard 3.6 When interaction with the patient or consideration of patient-specific information indicates that a pharmacist should review laboratory data and the data is not available, the pharmacist must:
a) order the appropriate laboratory test, or
b) contact an appropriate regulated health professional and request that the laboratory test be ordered.

On the comment about my inability to interpret lab data:
I am not entirely sure how else I could have interpreted a lab value of Blood Ethanol Level: 31 mmol/l and regular occurrences of FPG <4 several times in the week.

On the comment about Physician liability:
I am 100% liable for my decisions, actions, counseling, suggestions … etc. What I suspect is that many physicians do not recognize is that we are fully aware of the implications of our actions; we check and double check several studies and texts to back our suggestions up. The whole point of a pharmacist is essentially to mitigate medication risk to our patients and optimize pharmaceutical care, and we are fully aware about the implications of our interventions with regards to keeping our license.

Why are pharmacists so important?
Because, there is a good chance the pharmacist knows the time of onset, peak, duration and other such important pharmacokinetics as well as detailed mechanisms of action, interactions, clearance patterns etc about drugs. When pharmacists contribute such knowledge in their practice, it optimizes patient’s care for the best possible results. Pharmacists are here to provide great patient care in dispensing medications and optimizing pharmaceutical care through the various activities deemed now as our “expanded role” such as medication adaptations, prescribing, and medication assessments as advocates for our patients. This is our role: To dispense and manage medication use collaboratively for optimized patient care.

Can a physician do a pharmacists job?
First do no harm…

Asides from the obvious conflict of interests involved in having the diagnostician responsible for dispensing as well, pharmacists are the final check in the system to ensure that patients receive medications that are appropriate, safe and effective. We in addition, provide follow up counselling to ensure that medications are adhered to in order to reach treatment outcomes by monitoring our patients, and by being easily accessible to our patients. It is in fact impossible for physicians to do our jobs and ensure patient safety.

So, I thank you physicians who work with us collaboratively as we focus even more on our cognitive roles… and…

I beg the other physicians who currently do not understand us, do show us some love next time you receive our intentionally helpful messages. We really do not care for infringing on your territory, we just want to stay in our lane and optimize outcomes for our patients. Tis all!

He said, “AIDS and HIV Are FAKE Diseases Created By the Condom Industry To Sell Their Merchandise To The Unknowing Public.”

“Wise Words” by Jaden Smith …

Screenshot (6)

Believe it or not, this is actually a thing: HIV denialism. Reading these denialists’ blogs/ listening to them online just gives me the heebie-jeebies considering how devastating the effects of HIV  have actually been for patients who contract the virus. In addition,with new medical developments and decreased mortality rates, a new complacency has set in with condom use. Unfortunately, a lot of young adults seem to think it is “uncool” to use condoms or that it is a sign of “having something” when a partner advocates for condom use or the excuse of the weakest of all personalities, in my opinion, – it shows “lack of trust”. Besides the various significant social and mental health impacts of this disease, it costs approximately one million Canadian dollars to treat one patient through a life time of the disease, according to HIV Edmonton. Yet, 15605 people shared this apparently “ground breaking epiphany” by the then 14 year old Jaden Smith , 7351 people thought it was something they should recognize as one of their favorite tweets. Incredible!

*Sigh*

Let’s do a Risk Vs. Benefit analysis of Jaden’s “theory” just for shits and giggles.

Risk if you believe HIV is not real and you use male condoms anyway: You wasted <$2; may reduce sensation (perhaps last a little longer), interrupt foreplay in order to place the condom on penis properly AND make those awful Condom Manufacturers rich.

Benefit if you believe HIV is not real and you used male condoms anyway: You reduce your risk of: unplanned pregnancy, Gonorrhea,  Chlamydia, **Hepatitis B,  Lymphogranuloma Venereum, Trichomoniasis, *Herpes, *Syphilis, *Human Papilloma Virus, *Cervical Cancer, *Genital Warts. You may prevent premature ejaculation (in some men). You may reduce your risks for spontaneous abortions and infertility in the long run.

Don’t know about you, but it seems to me that the Benefits by far outweigh the Risk of being conned by those Condom Manufacturers.

My hope is that the kid was just being sarcastic..or thought he was just being a hilarious 14 year old… that being said.

…I’m seizing my Pharmacist Counselling Moment of Glory Here to Share Some #CondomPoints!

#POINT : HIV is real, as ~ 34,000,000 people living with HIV can attest to this point.

#POINT: We can get to Zero infections by sharing sound knowledge and actively participating in harm reduction efforts (BC has nearly eliminated cases of AIDS).

#POINT: When used consistently and correctly, there is evidence that, male condoms reduces unplanned pregnancy and reduces risk in both men and women of gonorrhea, chlamydia, trichomoniasis, syphilis, herpes, HIV and HPV.

#POINTCondom use does not undermine sexual risk reduction efforts by causing high-risk sexual activity or increasing the frequency of high risk behaviour – evidence from a systematic review of 174  sexual risk intervention studies.

#POINTThere is good evidence that when one partner in a couple has HIV and the other does not, consistent condom use reduces the risk of acquiring the infection by 80 to 95%

#POINT: Different sexual behavior & even positions may affect your risk of contracting a Sexually Transmitted Infections (STI) — More on this topic in upcoming post.

#POINT: STIs, if left undiagnosed could lead to infertility.

#POINT: Whipped cream, a Massage and your Tan might ruin your condoms… oil based products reduce latex condom integrity. Some topical medications, baby oil, suntan oils, vaseline, edible oils, massage oils etc are on this list.

#POINTCondoms are most effective when used with every act – Anal, Vaginal and Oral.

#POINT: New condoms should be used for prolonged sex; and for different types of sex within a single session (for example change after anal sex, before vaginal…)

#POINTThe condom should be used during the entire sexual act. That means, you shouldn’t put it on after genital contact or remove it prior to ejaculation… from beginning of genital contact to after ejaculation.

#POINTNot all condoms are created equal. Natural membrane condoms are made from lamb intestines, contain small pores and should not be recommended for STI protection.

#POINT:  CRAP happens! 2% of the time during vaginal intercourse (rates vary widely across studies and are a little higher during anal); the condom may slip &/or break….
A Back Up Plan? … have several more condoms available, gently wash your genitals with soap and water, though this practice has not been very well studied, washing may reduce your risk of acquiring an STI,  insert an applicator full of spermicide vaginally (to help prevent pregnancy). Note to Girls – Do Not Douche….it does more  harm than good.

#POINTIt is possible to contract an infection during foreplay and non-penetrative sex. A condom placed on the penis before any genital contact greatly reduces risks of infections

#POINTSome infections are transmitted primarily through skin surfaces like herpes, syphilis, chancroid and HPV when the condom completely covers the entire infected area, transmission risks are reduced as well….if the infected area is not covered by the condom then transmission is more likely.

#POINT: Next time your partner says condoms reduce the sensation/ are too sterile, remember that condoms come in a variety of shapes, sizes, colors, thickness, with or without lubricants/ spermicides, with or without reservoir-tip or nipple-ends. They can be straight-sided or tapered toward the closed end, textured (ribbed) or smooth, solid-colored/ nearly transparent, and odorless, scented or flavored — Perhaps this comment should simply be taken as a challenge to discover the “sensational” condom…I propose that all sexually active people should own Sex Kits containing one of each…(plus a travel sized kit… latex condoms can probably be carried, for convenience, for up to one month) 😉

#POINT: It is true that the odds of your partner having an STI in Canada are generally low — From the latest reports that I could find in 2010: 277.6 overall cases of Chlamydia per 100,000; 33.4 overall cases Gonorrhea per 100,000; 5.2 overall cases of Syphilis per 100,000; because HIV is not yet curable, I’d share the number of people living with the disease not the number of new cases/ year. In 2011, 71300 were estimated to be living with HIV in Canada plus 17,890 who were potentially unaware of it; meaning, 89280 people were likely carrying the virus out of 34.34 million Canadians that year.

These odds may increase significantly depending on various factors such as age, gender, race/ethnicity, sexual orientation, incarceration, intravenous drug use, number of sexual partners, marital status, residence in an urban area, new sex partner(s), history of prior STI, illicit drug use, contact with sex workers, intimate partner violence.

#POINT: Your knowledge of the low statistical odds, of meeting someone with these infections in Canada, is in fact meaningless to you, because you are not a science experiment, and as such, you are not the statistical average of 35 million people. You do not as a matter of fact know you & your partner’s status at every possible moment. You do not know the exact virulence factor of the bug(s) you may/ may not be exposing yourself to.You do not know how your odds of infection are skewed by the intersection of all the aforementioned factors in your particular case. For example, those odds of having Chlamydia in 2010 could shift from ~ 1 in 360 overall to closer to 1 in 50 if you were a 23 year old female living in Canada at the time.

… On The Twitter Philosopher….

This is the problem with everyone having a platform to share their thoughts, crazy ideas and pseudo-journalistic efforts, people use their influence to spread non-evidence based non-medicine nonsense about very important medical topics. Our patients are inundated with these messages, news and ideas daily. It is for this reason, I think it is crucial that we (actual Health Care Professionals) consider developing the skills required to engage with our patients through these new platforms of communication. A social media presence is becoming more crucial than ever imagined to share good quality messages with our patients. Our social capital as healthcare professionals place us in an ideal position to influence general thoughts and ideas about various topics and hopefully fix damaging content that sometimes end up forming general opinion. I wish there was a forum for our colleges and regulatory bodies to list advisories/ warnings about bogus sources of health information too. Bad information can be as bad for one’s health as administering an inappropriate medication.

There is a distinct dearth of engaging health media. It would be helpful if more critically evaluated evidence based medicine starts getting shared in patient friendly language online.

For now, I have created my tongue in cheek tool tip for my patients who show up at the pharmacy, having self-diagnosed via Oprah/ WebMd/ Dr. Oz. I plan to actually hand this out, the next time someone comes in with some absurd knowledge acquired from the internet or television; I’ll keep you all updated about how my first use of this card goes

Source Checker

…. Back to Jaden …

$2

vs

Reduce your risk (even when already low) for HIV &/or unplanned pregnancy  &/or Gonorrhea &/or Chlamydia  &/or Hepatitis B  &/or Hepatitis C &/or Lymphogranuloma Venereum  &/or  Trichomoniasis &/or *Herpes&/or  *Human Papilloma Virus &/or *Cervical Cancer &/or *Genital Warts &/or Syphilis .

???

It seems to me that if you are upset about condom companies getting rich, then you should buy stocks and get rich with the condom companies too! (May I suggest the Female Health Company Nasdaq: FHCO? They are doing particularly well…)

get tested and…

use the damn condom!

*Even with use of condoms, HPV (which could cause Cervical Cancer & Genital Warts), Herpes and Syphilis may still be contracted depending on what part of the genitals is infected. For the giver of oral sex, a condom may reduce risks of contracting HPV, Herpes & Syphilis as well.

**Hepatitis B is the smallest sexually transmitted pathogen; laboratory studies indicate male condoms are an effective barrier against this too.

I specifically referred only to male condoms in this post, because most of the efficacy data available are related to those more so than female condoms.

 

Sources:
Therapeutic Choices
UptoDate.com
5 years of great education at the University of Alberta.