The Global Impact of Drugs, Iowa City, Iowa, February 1, 2017

- I want to acknowledge our University and Community supporters, The University of Iowa's International Programs and the University of Iowa's Honors Programs. They contribute vital time, talent, and logistics to our organization. I also thank the Stanley-UI Foundation support organization for their financial support, and I thank today's special sponsors, Taxes Plus, and Adam and Brigette Ingersoll. It is my pleasure to introduce Don Letendre. Don Letendre is Dean and Professor at the University of Iowa College of Pharmacy. Following completion of his doctorate in Pharmacy and in clinical residency at the University of Kentucky, Don served as assistant director and assistant professor at the University of Kansas Medical Center. He spent nearly two decades on the staff of the American Society of Health Systems Pharmacists. Don was the dean and professor at the University of Rhode Island and executive secretary of the Rhode Island State Crime Laboratory Commission immediately prior to his responsibilities at Iowa. As a clinical professor, educator, associate staff member, and now academic administrator, Don is privileged to serve countless students and postgraduate residents throughout his career, and he has actively participated in the development and implementation of standards that have helped shape pharmacy practice and residency and technical training programs worldwide. I am very pleased to welcome Don Letendre. Okay. - Well, good afternoon. First thing I'd like to say is if my mom were alive and she were here today, she would be proud of me. What a wonderful audience and I'm so appreciative. I'll start to my left over here because, as my students will tell you, I'm extremely passionate about students, and for you to take time out of your schedules and open your minds to new conversation, I just want to credit you and certainly our honors program and the leadership we have there. To all of you, the work that you're doing in foreign relations, particularly in a point in time that we have right now cannot be underscored enough. So my complements and my, I just am privileged frankly to be with you here today because of the work that you do, which is so fundamentally important to all of us as Americans, and certainly, it's reflected in our own program in Pharmacy, which for an Iowa program represents a little bit more than 20% of diversity in our program and we're very very proud of the fact that we represent many countries from around the world in our professional PhD program. I have to fess up. Somewhat sadly the last time that I was in this facility right in this room, in fact, was for a funeral. That caused me to think about a little story that I wanna relay to you to sorta kick off today's event. This would be a curve ball for my students because I haven't done this before, but that's a good thing. So there's a professional couple here from Iowa City, husband and wife, and it was this time of year, only, it was bitterly cold. So the husband and wife decided, "You know, we really need a break from this cold. "So we're gonna go someplace warm." They decided upon a trek to southern Florida. Well as it turned out, the couple, they finished their workup separately. And so the gentleman finished first, but the wife hadn't finished up her work yet. So she said to her husband, "So listen, just go. "Get down there. "Get us settled. "Get the hotel room. "I'll join you as soon as I finish up my work," so he did. Well when he got there, he sent off a note to his wife, an email. Well, as luck would have it, in the email address he missed it by one character, and instead of the email going to his wife, it went to the window of a preacher who had died a couple of days earlier. Well, the widows went to the funeral, came home and started opening up her messages, and one caught her eye. She read it. She screamed, passed out on the floor. Her parent, pardon me, her children came to revive her. As they were reviving her, one of the children noticed the message up on the screen, and it said as follows: My dearest wife, I just arrived. Looking forward to your arrival tomorrow. P.S. Sure is hot down here. Communication, so fundamentally important in what we do in all aspects of our lives, either professional or personal, and this presentation here is no exception. Joining me today will be two of our stellar students, Alecia Rottinghaus and Kiley Bowding, Kiley Boeding, pardon me. Kiley and Alecia are P3 students, and I'll talk more a little bit about what that means in our professional degree development program, but suffice it to say, they're just a little over a year away from being pharmacists, license pharmacists. So the issues we're gonna speak about today are not only near and dear to their heart, but they're gonna live and breathe these things day in and day out. Obviously drugs are ubiquitous. It's a part of our life, both the yin and the yang, the good part of drugs, the bad part of drugs, and we hope today to try to cover a bit about that. Now as you can well imagine, trying to cover everything you need to know about drugs in a 45, 40, 45-minute presentation is virtually impossible. But we did try to identify some highlights and that's what I'm going to just quickly outline for you here today. As you can see here, one of the first things we're gonna just chat about briefly will be pandemics and the potential impact that drugs can or could have had on pandemics in the past. Then we're immediately going to move to revolutionary treatments, both vaccines and antibiotics. From there, we'll talk about the dangers of misusing medications with a particular focus on opioids, and Kiley and Alecia will take over at that point and handle that. And then I'll come back and wrap up and provide you a little bit of an overview of pharmacy education today because for most people that I ever have a chance to interact with in forums like this, their perception of pharmacy is largely shaped by either their local Walgreens or CVS or perhaps by their local community pharmacy. Hopefully it's more the latter than the former. But nonetheless, that interaction with pharmacist often times is their only, and I can just share with you up front that that's a very very small segment about what our profession represents. So let me first of all start out by talking about the Black Plague. In order to tee this up, I'm gonna ask Kiley to come up and show you a short video. Okay, so, just very quickly about the Plague itself, and we'll move very quickly through some of these early slides, which obviously you'll be able to see the correlation between some of these early diseases, and eventually the development of treatments for such ailments. The medieval thinking, of course, was what caused the Black Plague? Divine Punishment, retribution for sins against God. What our current knowledge as the gentleman did such a phenomenal job in articulating is due to a bacteria, and that bacteria was discovered by a French biologist back in the 19th century. How did the Black Plague end? Well, quite frankly, we don't know. I mean, we can reasonably postulate that the most popular theory is that eventually people learned to quarantine themselves from sick folks, and that's sad unto itself because obviously they just left sick people to die on their own because they knew if they came in contact, as was articulated, then they too would die. Certainly modern methods of hygiene, when you think about the septic systems that we have in place, when you think about our water systems, water treatment systems, so and so forth, all of those are actually an evolution of the things that we learned over the course of the centuries and the things that we take as commonplace today obviously did not exist then. By the way, one thing that I wanted to mention, I quickly went back from that slide, butone of the most common ways of disposing of bodies during that timeframe was burning them. Whoops. Okay, from there, I'd like to move to another pandemic, and this one's closer to home because in fact in presentations that I've given on similar topics, invariably, we've actually had folks that were quite aged and knew or perhaps some of you in this room have loved ones. For example, my own wife's, two of her grandparents actually died during the influenza pandemic. So the influenza pandemic of 1918, 1919, the global death toll estimated to be about 50 million deaths worldwide. Just here in the United States alone, over 600,000 people died which were more people than were killed in World War I totally. 1/4 of the U.S. and 1/5th of the world was infected with the influenza pandemic back at the start of the past century and the average U.S. lifespan during that timeframe because there was not an effective treatment actually decreased by 10 years because of the likelihood of infection. Prevention methods in the 1900s, quite frankly, weren't a heck of a lot different than what they would've been in the 14th century. Stay away. Stay home. Don't infect somebody else. The likelihood of you spreading the disease was increased. But then again, those loved ones who were responsible for treating you were putting themselves at risk in doing so. So you saw sanitariums grow up where they took infected people and tried to quarantine them off in certain locales because they didn't wanna try to infect other individuals. These are a couple of the slides that we put together that just represent the kind of prophylactic measures that one was trying to use at that time to help manage the disease. But as you can see, it includes no medications whatsoever because they did not exist. The impact of immunizations over the course of the last several years cannot be underscored enough. Back in 1796, a general by the name of Edward Jenner, he actually took small pox, cowpox rather. He scratched the sore of a little boy and then he went ahead later on and then after the boy had developed some immunities, he then purposely scratched that human smallpox into the little boy's sore. Interestingly enough, much to his delight, and much to what he was expecting would occur, the young boy did not contract smallpox. The fact of the matter is the work that was done in the late 18th century by Edward Jenner formed the basis for all of the vaccinations that we use today. Let's think about the impact of vaccinations and had they been in existence in the early part of last century when the pandemic occurred. In order to do that, what we decided to do was just pick yet another important element of human society that created tremendous adversity, and that was polio. Well in 20s, 30s, once again, even when I went to school in the 50s and then through the 60s, I had a classmate who actually had polio, and when I get to high school, another classmate who actually had contracted polio, and that could have been very easily treated, of course, with a vaccine as we know today. Jonas Salk had created the first effective polio vaccine. But the remarkable thing about that is in the late 1930s and 40s throughout World War II, people were suffering from polio. Let's just think about, again, we're picking on one element. Let's think about polio and the dramatic impact that the single discovery of a vaccine has had on the world. The fact of the matter is you can see up there that the fight to end polio, we're essentially 99% of the way towards eradication. If you look at the slide and look at, try, I know it's very difficult for those of you in the back, so I'll help you out. But just since 1988, we've gone from roughly 350,000 people who had contracted polio in 1998 to less than a couple hundred in 2011. The cost of treatment: about $.60 to treat someone, to vaccinate them against polio. Not surprisingly, the three epicenters, if you will, that continue to exist and harbor this disease are in three of the most poorest nations on the land: Nigeria, Afghanistan, and Pakistan, and so we're working very hard at trying to totally eradicate polio. Let's think about the overall impact of vaccinations in the United States. The very large picture there to the left looks like a bunch of balloons. Each of those represents, each of those balloons represents a different disease, and the largest one, by the way, just because you can't read it in the back there, that big yellow one is measles. Now you can imagine then that back in the early 1900s, this would've been a representation of the diseases that were very very common here in the United States, all of the various maladies that people would be suffering. Well over the course of the ensuing decades as a result of the work that was done in polio, let's take a look at where we are now in 2010. The one on the right-hand side is a reflection of where these same diseases are in 2010 as a result of vaccinations. So takeaway messages today, one takeaway message: If you've not been vaccinated against common maladies, get yourself vaccinated. There's a lot of misinformation out there about vaccines containing all kinds of harmful chemicals and so and so forth. The fact of the matter is it's not true. So get yourself vaccinated even each and every year. As I get older, ones of the things I'm mindful of is to make sure I get a flu vaccine because obviously the older you get, the more susceptible you are to contracting the flu, but dramatic, look at that. The picture itself is a wonderful depiction of the tremendous importance and impact that medications have had on the use of vaccines and treatment of common maladies. The cost of not getting vaccinated is just absolutely staggering. Look at vaccines alone, influenza alone, rather. You're talking billions of dollars. So vaccine-preventable diseases in the United States cost the U.S. almost $9 billion in 2015. Imagine if we could redirect $9 billion in other ways, much more beneficial ways, to help research and treat diseases as opposed to, in my opinion, wasting it needlessly on what otherwise would be preventable diseases. 80% of that cost or 7.1 billion can be blamed on un-vaccinated adults, not children, un-vaccinated adults. Staggering. Okay. Let's move very quickly towards just sharing with you that our students walk the talk. What I mean by that is, very quickly, look at the slide there. Look at the highlighted part. 73 student organization flu clinics just this past year were conducted by our College of Pharmacy alone in the greater Iowa City area. Over 6,300 immunizations were given, just incredible work. This is volunteer effort on the part of our students and our faculty to get out there and help treat individuals. We had campus-wide clinics, UHC, and you can see the list there, as well as community outreach, and local pharmacies, and Hills Bank, and several other local businesses in which these clinics were conducted. Great work by our students. With this knowledge, I just quickly like to move through antibiotics. I focus much on, we've gone through pandemics, then we've gone through diseases that occurred 14th century, early part of the century, the impact that vaccines would've had on the pandemic in the early part of the last century. But what about the Plague? Now the Plague, as the gentleman mentioned, would be treated with penicillin. Well penicillin's an antibiotic, not a vaccine. So let's just talk a little bit about antibiotics for just a moment. And with that, I'm gonna ask Kiley to come up again and just show you a quick little snip. So as you can see just by these billboards here, it is a good representation of some of the advertisements that would've occurred back around World War II that really highlighted the importance of penicillin at that time in sort of a sick-humor way. The one on the left hand corner I find especially amusing. Penicillin cures gonorrhea in four hours. It almost makes you wanna go out and get gonorrhea, right? I mean it's just like, "Well, what the heck. "You can get over it in four hours." But anyway, I just thought that was actually pretty humorous when I first saw that, but that was an actual billboard. I hope that was taken in the spirit in the right way, by the way. I know this is being taped, so. Okay. Now the good, the bad, and the ugly concerning antibiotics, and the good, very quickly in the spirit of time, is that this now made possible the treatment of diseases that previously were untreatable. And as we mentioned before in the 14th century, if we had these things, then we wouldn't had the Black Plague. It would've been addressed very quickly. Certainly many of the diseases that the young lady who was at the end of the tape there rattled off a whole bunch that are just easily banished with antibiotics today that previously would've cut life short. In fact, this audience of 50, well, 80 years ago would look very different than it does today because quite frankly, we can all thank much of our longevity, not only on better nutrition and hygiene, but certainly the introduction of drugs, and vaccines, and things that keep diseases at bay so that we can live longer. Well to every yin, there's a yang, and one of the yang is for every good thing, sometimes we overdo it, and when we overdo it, sometimes we mistreat. We mistreat by giving medications too often, and when we give medications too often, we develop resistance to the treatment of that disease, and in fact, that's what's happening in society today. The expectation all too often when mom brings her child to the physician's office or prescriber's office is that "Well my child has a cold," or they have the flu or whatever. Well, unfortunately, many of the times the malady that the child has is actually a virus, not a bacteria, but yet they expect to walk away with an antibiotic and then the thing runs its course, and you think the antibiotic is actually the thing that cured it when in fact it didn't cure it at all. But what's happened is over the course of time, especially in the last 20, 30 years, we have soaps with antibiotics in it. We give drugs willy-nilly. We have antibiotics in our food chain, so on, and so forth. So some of these things can be good, but overuse of these things can create resistance. So that's the yin and the yang, and the good, the bad, the ugly, as we say about antibiotics. Resistance has occurred, and I won't spend any time because again I would be taking up too much of our valuable time here, but just trust me when I say that overuse of antibiotics, as much as antibiotics are a powerful thing to treat disease, just like anything else in society, if we overdo it, we can create unintended consequences, and one of those unintended consequences is resistance, in which case then if you develop resistance, then some of these common things that antibiotics would cure are no longer curable by the drugs that they once cured so easily, which is the reason why we keep looking scientifically for the next bullet, if you will, to help us in beating back these organisms. They're smart little buggers. They will morph into something else that you cannot treat. Okay. Poor adherence can also lead to antibiotic resistance. So another takehome message for you: If you have been prescribed a medication, one of the things that is very very problematic in today's society, and this is 50%, keep this number in your head, 50% of the medications taken in the American system are not taken properly, and the largest problem is that people don't take their drugs the right way. So follow the instructions on your medication bottle and with respect to antibiotics, almost without exception, in fact I would say without exception, but I'm sure somebody's gonna come up with one, you take those medications until they're gone because otherwise the potential for reinfection occurs. Because you beat that down, you feel good, you stop taking your medication, then the the disease, the infection, recedes itself, if you will, and comes back with a vengeance. So take it until it's gone. Antibiotic resistance, 2 million people every year, and 23,000 people every year die from antibiotic-resistant infections. Now with that, I would like to now move on, if I could please, I'm gonna move very quickly to HIV and AIDS. This too, again, another modern-day malady that has been effectively treated. You can imagine, in the early 1980s, if somebody came up to you and said AIDS, what's the first thing you thought of? Death sentence. You're gonna die. Well it's just been remarkable how over the course of just a couple of decades, we have gone from a death sentence to people living virtually a normal life. Life expectancy here, life expectancy globally, 33.4 million people are living with AIDS, living with AIDS. 25 people, 25 million people have died since 1981, but the majority of people, once again, not unlike polio, that are dying are the people that don't have access to the medications. Of course an organization like this is dealing with formulations that would be near and dear to part of your central mission. 28.6 million people in poor and moderate countries should be on retroviral medication, but only 1/3 of these people are actually getting treatment. HIV medications and advancements, and this speaks to the point that I just mentioned a moment ago, a person without HIV today, we have a life expectancy of about 80 years old. If you are diagnosed at age 20 with HIV, you can still live into your 70s. The fact of the matter is medication treatment, so almost, almost the same as if you hadn't been treated, which is just extraordinary. But a person getting HIV and not being adequately treated, regrettably, their lifespan is cut short and the average lifespan is about 32 years of age. So a very powerful message, but also, a powerful message in terms of disease, but also the powerful message about the value of science and the work that we do. For example, in our College of Pharmacy and here on campus with our health science partners in discovering new drugs to treat these once untreatable maladies and beat these things back so that people can live normal lives, relatively normal lives. Of course, you're all well aware of the celebrities that have died as a result like Arthur Ashe, sadly, and then people who continue to live with HIV, such as Magic Johnson. And then, as I was mentioning, other vaccines in development for HIV infection alone, we have 25 antivirals, three gene cell therapy, and 16 vaccines. This is just for HIV. Cost of HIV treatments in the United States, obviously, very very expensive just like other diseases, so I'm not gonna spend a lot of time on that, but obviously the thing the message that we try to preach there when we do get and speak about this disease specifically are things that we can do in terms of treatment and prevention. But at the same time, make no mistake about it, we're working feverishly at continuing to hone treatment methods through advanced research. I wanted to pick HIV because it hits home. I could've pick a large number disease states, but it's something that everyone in this room is acutely aware of and what we're able to do in terms of research in a very short period of time is nothing short of astounding. Okay, with that, I would now like to turn things over to Kiley and Alecia. - Thank you, Dean Letendre. So for the next few minutes, Alecia and I are gonna talk about the current opioid epidemic. So recen or Dean Letendre just talked about kind of major pandemics that hit every corner of the world. Well this is an epidemic that hits closer to home, both geographically and probably personally for some people in the room, and that's America's opioid epidemic. So what exactly are opioids? I think what comes to mind for most people when they hear the word opioids are prescription pain relievers, so things like heroin, Percocet, morphine, but it's also the illegal drug heroin. Heroin is considered an opioid because it acts on opioid receptors in our body to produce a pain-relieving effect, just like the morphine, hydrocodone, the prescription pain relievers. So why is this becoming a problem? And in particular, just like with the antibiotics, overuse is a huge issue. So before we get started into kind of the dangers of the opioid epidemic, I just want to say the answer isn't to stop all opioid prescribing. There are people in the country who suffer from chronic pain conditions that need opioids to get through their day-to-day lives. Or if you were in a major car accident and you were in the hospital, I would hope you would get prescribed an opioid. With that being said, this is a huge problem that's really just in the U.S.. So why is this? The U.S. population makes up about 5% of the world's population, yet we use 99% of the world's hydrocodone. In fact, a few years ago, hydrocodone was the number one prescribed drug in the United States, not just the number one prescribed pain reliever, but the number one prescribed medication. It's gotten so bad in the United States that you are now more likely to die from an opioid overdose, then you are from a car accident. Opioid overdoses are the leading cause of injury death. That's passing motor vehicle accidents and firearm accidents. So why did this occur in the U.S.? Why is this such a problem here? There are multiple reasons, but today I'm just focus on two. The first one is pain became the fifth vital sign. So about 30 years ago, pain was actually undertreated in hospitals and clinics across the country. Patients felt like when they were going to the doctor, their pain wasn't being adequately assessed. So the American Society of Pain came up with pain as the fifth vital sign. That's why when you go to the doctor today, they might ask you, "On a scale of one to 10, what's your pain today?" The issue with this is that it's very very subjective. My seven out of 10 pain is gonna be very different than your seven out of 10 pain, and how does a doctor prescribe a medication based on that? Another reason is this under treatment of pain really put pressure on pharmaceutical companies to develop new medications to help treat pain. One in particular was Purdue Pharma and it made OxyContin. OxyContin was developed to be a long-acting opioid medication. So it was designed to deliver a short amount or small amount of medication about every hour for 12 hours. So you only have to take one pill a day. Great. However, Purdue Pharma advertised that OxyContin was non-addictive as long as you were taking it for a legitimate reason and they told this to patients, prescribers and medical students. Well the thing is, that's just not true. Even if you're taking an opioid for a legitimate medical reason, there's still a chance you could become addicted. Another issue with OxyContin, as it was designed to deliver short amount of medication every hour, it was not in what we call an abuse-deterrent formulation, so that medication could be crushed and then injected, snorted, or swallowed, and then in a few seconds, you would get 12 hours worth of medication. That's what we call dose dumping in the pharmacy world. So when that was happening, people were getting incredible highs and they were feeling good, and that's why many people got addicted off OxyContin in particular. So now I'm gonna talk about the link between these prescription opioids and heroin. So heroin, like I said, is an opioid because it acts on those opioid receptors in the body. So four out of five new heroin users started by misusing prescription opioids. They say that these are far less expensive and easier to obtain than a prescription from the doctor. So I think this picture is pretty powerful. People who are addicted to cocaine are 15 times more likely to be addicted to heroin, but if you are addicted to prescription painkillers, you are 40 times more likely to become addicted to heroin. So as a country, we're seeing a huge rise in the number of opioid users as well as a huge rise in the number of heroin users. So you might be sitting here thinking, "This is terrible, but it could never happen to me." Simply put, that's just not true. Substance use disorders are not a moral failing. They are a disease and I would argue that nearly everyone in this room has been affected by the opioid epidemic, whether they realize it or not. So if I could do a little exercise, if I could have everyone raise their hand if they've ever had their wisdom teeth removed or a major dental surgery, keep your hand raised if you were prescribed a prescription pain reliever. Keep your hand raised if you had any left. So majority of the people's hands are still raised. So majority of people start abusing prescription opioids obtain them from a family member or friend that are left over from a surgery or things like that. So what is an overdose look like? What happens when someone takes too much of a prescription pain reliever or too much heroin? The main kind of pinpoint sign is the pinpoint pupils. So as you can see there, the pupil gets incredibly incredibly small. That person is likely unconscious. They're experiencing respiratory depression or labored breathing. Labored breathing kinda sounds like someone snoring a little bit. Their skin is incredibly pale, and they have blue skin, fingertips, lips and nails. So with that, I'm gonna turn it over to Alecia and she's gonna go over how we can fight this opioid epidemic. Thank you. - Thank you. Okay so what we have now is Naloxone. Naloxone is an opioid antagonist, meaning that it can reverse the effects of an opioid. So it can reverse those effects of the extreme drowsiness, or the unconsciousness, the slowed breathing. So another important thing to know about Naloxone is that it only lasts for 30 to 90 minutes, whereas most opioids are going to last a lot longer. So people usually have to give more than one dose of Naloxone, and then the reason why I'm telling you this is because Naloxone just became available at a pharmacy. If, with a standing order, you can go in, I'll talk about it a little bit more, but go into a pharmacy and actually obtain this medication and use it in the community if you needed to. So it is important to know that the effects will only last 30 to 90 minutes and that you should call 911 and stay with that person because, like I said, the effects might not last as long as the opioid so they can go back into that respiratory depression and also to know that Naloxone will not harm someone. So even if you're not sure if they are going through an opioid overdose, it is okay to give it. It's safer to give it than to not give it. So ways to identify an overdose and treat someone with Naloxone is to remember the acronym I-CARE. So I would be to identify an overdose, so like the symptoms Kiley was saying: the pinpoint pupils, the respiratory depression, the slowed breathing. Those are things to always look for and then also to identify yourself that you're there, you're here to help. Make sure they are unconscious. Call 911 is the C. A would be administer rescue breathing. It is important to give them some air in their airway if they are having respiratory depression. Giving them Naloxone is not really gonna work if they don't have any air first. So you wanna make sure you do that first. And then after that, you can go ahead and administer the Naloxone. Actually we have three forms of Naloxone available. Each pharmacy might be a little different, but there is a nasal mist where it's just like a nasal spray. So you can just stick it in the nostril and spray, and I'll have these up here if anybody wants to look at 'em after the presentation. There's an autoinjector which is a lot like an epipen. You'll just take off the cap and put it in the upper outer thigh, and then there's also a kit which I won't open, but you can come see it up here. It's just, you put it together and it's like a nasal spray. There'll be a little spongy tip on the end and you can spray it into somebody's nose. So after that, then you can resume the rescue breathing, if that's not working, and then E would be ensure safety until EMS arrives. Like I said, it's really important to stay with that person until the medical attention arrives. So the new legislation, new legislation that's happened in 2016, prior to 2016, Naloxone was restricted just to paramedics, but now it has been expanded to first responders and police officers so that they are also allowed to carry it and administer it at their will. And then, also like I said, there is a new standing order. So that means it's a lot like a flu shot where if you go to the pharmacy, you don't need a prescription anymore. You can just ask the pharmacist for it. They will go through a screening with you. Make sure you're eligible or you can go for like a loved one that you feel is at risk as well. They will screen you for that as well and then talk you through each one of these to find out which one is your best option. And then we just wanted to point out that Iowa does not currently have a Good Samaritan Clause. There's 48 states that have the expanded Naloxone access, but only 35 of those have the Good Samaritan Clause. The Good Samaritan Clause states that if you call for 911 and are trying to save someone who is going through an opioid overdose, that you yourself are not going to get in trouble even if you are intoxicated with some substance or have some sort of paraphernalia around. That's important because 82.8% of the opioid overdoses have been reversed by drug users themselves and that drops down to 9.6 by family members and the 0.2% by public service providers. And then I just want to finish with just some proper medication storage and disposal. So a lot of people keep their medications in the bathroom because of convenience and they just, I don't know, they put 'em thereand it's a bad place for prescriptions, number one, because it's really humid in the bathroom and that can have an effect on your medications. And then number two, it's kind of a private area. So if someone were to be going through your medications, they could do it behind a closed door. So you wanna make sure you store them somewhere more public, somewhere like a kitchen and somewhere, if you are afraid that someone is, you do have a medication that is harmful to someone, lock it up in a lockbox which you can purchase at a hardware store or at a pharmacy and keep it away from people. And then also make sure you get rid of your medications when you're no longer using them. The Johnson County Police Departments actually have drop off boxes that you can take your medications to when you're done using them so that they're not at risk for you or anyone else. I just wanted to finish with this slide that addiction is causing us a lot of economic burden. There's over a hun or, sorry, $1 trillion every year spent on addiction, and that includes the crime and incidents, and also lost productivity as well as a few other things. So hopefully that's kind of a little just of what Kiley and I have been doing as students, and I'll have Dean Letendre close with some more things about the College of Pharmacy. - Thank you, Alecia. I just wanna close and just chat a moment about our educational process here in the United States because, as I mentioned in the outset, very few folks really know and understand the depth and breadth of our profession. If you see here, and not so surprisingly, the process of education here correlates very nicely with drug developments here in the United States. So if you look 1907, a two-year graduate in pharmacy degree is what was required. By the way, our program started in 1885. We are the, our program is the oldest public College of Pharmacy west of the Mississippi. We're the fourth oldest public in the nation, but the oldest west of the Mississippi, 1885. So back when we would've started, we would've been a two-year graduate in Pharmacy degree. By 1925, again, post-World War I, developments started to occur. We then moved. Our profession moved to a three-year graduate program, then known as a pharmaceutical chemist. By 1932, we had moved to a Bachelor of Science. Again, think about the things we talked about before in the work of science and the introduction of drugs and new science that would help treat individuals. We had moved to a four-year Bachelor of Science. 1960, we went through a five-year Bachelor of Science. In fact, I'm a product of a five-year Bachelor of Science and Pharmacy. In the 60, pardon me, in the 50s, there was a nationwide discussion about moving our profession to a professional doctorate such as Medicine and Dentistry. The compromise was not to do that and instead add an additional year, so that was the fifth year, and where are we today? Today it's a professional doctorate. Actually around 1999, 2000, we moved nationwide to a professional doctorate since 2004 because there were a couple of laggard programs, but 98% of the programs in the United States had moved to a professional doctoral degree, such as what we did in the late 1990s. So these young ladies over here, when you think about med school, you finish your Bachelor's Degree, our dentistry, you finish a Bachelor's Degree, then you go in four years of med school and four years of dental school. Same thing in Pharmacy. This young ladies right here, Alecia to my far right, your far left, she has a Bachelor of Science Degree here from Iowa and Kiley graduated from Luther College up in the northeast part of the state, Decorah, and then both of these women now joined 106 of their classmates. We take 108 per year in our professional doctoral program. Highly competitive program to get into and one of the most highly regarded programs in this nation, by the way, and you should all be proud of their designs. Separate from our professional doctoral programs, we have roughly 432, 108 times four, the four professional degrees, years rather. Then separate from that, we have a PhD program. At any point in time, we have typically 80 to 90 PhD students, a very robust graduate program. The former, when Kiley and Alecia graduate, they'll be pharmacists. They'll take their boards. The latter, we have some pharmacists who go on and get their PhD. Some even have completed their PharmD degree and gone on and get their PhD, but the vast majority of our PhD students have a Bachelor Science in Biology or Chemistry or whatever the case might be and they pursue a PhD in studies. Those are not pharmacists. They're pharmaceutical scientists, but not licensed practitioners in Pharmacy. So I hope today we've given you a bit of a glimpse, drugs, drugs global impact of drugs, a wide range. We started out with pandemics, and you could see the evolution started 14th century. We kinda talked Black Plague, influenza, polio, AIDS. We talked about antibiotics and vaccines, how we effectively treat large populations against these maladies. We then moved on to the opioid epidemic, something that we're living with, and as was pointed out, very staggering to think that such a high percentage of this is here in the United States, but quite frankly, is reaching globally, and it is a global epidemic costing billions and billions. When you think about the unintended consequences that Kiley and Alecia did such a wonderful job in presenting, and then just a quick wrap up on our education so that you're better informed about the high quality of education that's provided here at the University of Iowa and the stellar program that we have. So I want to extend our appreciation and I wanna now open it up to questions and answers, but thank you so much for your time. By the way, I just wanna give a shout out. These two young ladies are rock stars. These two young ladies are extraordinarily bright, talented individuals, but they are represent, yes thank you, yes let's give it up for them. - Why do pharmacists not discourage patients from using antibiotics to treat viral diseases? Please explain antibiotic resistance and as the result of mutation, selection, not smart little buggers - Okay. So the first one's, why do pharmacists not discourage patients from using antibiotics to treat viral diseases? We do We try to as much as we can. Unfortunately, a lot of times if you're in like a retail setting with like Don Letendre was saying like a Walgreens, a CVS, that kind of thing, a lot of times they're not given the indication for the drug. So, unfortunately, a lot of times it gets missed because a patient, a pharmacist doesn't have the time to go and ask, "Are you taking this for a virus or an antibiotic?" We're hoping that with awareness and providers awareness they are able to screen patients better and give them the information that an antibiotic's not used for everything, as well as patient awareness that when you go into the doctor's office not feeling well, that you shouldn't always be getting a medication for that. And then, antibiotic resistance as the result of mutation selection. So basically, antibiotic resistance happens when you are given an antibiotic and you a lot of times happens because they're not taken for the full course. So most of those bugs are killed, but not all of them, and so the ones that aren't killed can start growing and fighting back and becoming more dangerous because they can mutate and not be susceptible to that antibiotic anymore. - Actually there were quite a few very wonderful questions and hopefully the individuals that had them are able to stay a little bit and approach them with those questions. I wouldlike to, gonna be concluding our program at this time. Thank you so much to Don, and Alecia, and Kiley. It was absolutely wonderful. I also want to thank our sponsors: the University of Iowa's International Programs, the University of Iowa's Honors Programs, and the Stanley-UI Foundation support organization for their generous support, and we also thank today's special sponsors, Taxes Plus and Adam and Brigette Ingersoll, and we thank City Channel 4 for making our programs available and to viewing audiences. Don, Alecia, Kiley, at this time, you guys are not familiar with this tradition, but, we would like to present you with the very coveted Iowa City Foreign Relations Council mugs. Thank you, thank you, thank you. Thank you again everyone, and we are adjourned