Right Drug. Right Dose. Right Time. Mental Health Issues In Canada - - PowerPoint PPT Presentation

Right Drug. Right Dose. Right Time.

Mental Health Issues In Canada

• 1 in 5 people suffer from mental illness in Canada
• Study shows that workplace stress is one of the main causes of mental

health issues.

• 68 per cent of employees reported that they could only maintain

their optimal performance for less than 70 per cent of their workday.

• According to Stats Canada, in any given week:

ü Approx. 355,000 Canadians are unable to work due to disability (mental and/or behavioral disorders) ü Approx. 175,000 full-time workers absent from work due to mental illness.

• 1. Mental Health Commission 2. Globe and Mail and Morneau Shepell 3. Stats Canada

• The economic burden of mental illness in Canada is estimated at $51 billion per

year.

• With Bill 127 effect since Jan 1st 2018: Some workers with chronic mental stress

will be entitled to (WSIB) benefits.

• The cost of a disability leave for a mental illness is about double the cost of a

leave due to a physical illness.

• The burden to the employer-

ü Employees on disability ü Increased employee absenteeism ü Loss of employee productivity

Economic Burden of Mental Health Issues

• 1. Mental Health Commission 3. Stat Canada

• Not Effective?
• Toxic?
• Wrong Dosage?

Challenge with Mental Health Condition

Prescription Medication

Trial and Error Treatment for Patients with Mental Illness

• 40 percent of psychiatric medications fail the first

time

• Adverse reactions are common and can be severe

(e.g. obesity, suicidal tendencies etc.)

• It is hard to know if mental illness is under control

Medications should be helping not hurting

• In Canada, severe adverse drug reactions affect

200,000 patients annually causing10,000- 22,000 lives lost

• 1 out of 4 hospital admittances are drug related
• Costs us up to $17.7 billion per year

Personalized Prescribing Plan (P3): Part of XAP @ Beneplan

Prevent Drug-related Disability of Employees with Mental Health Issues!

P3 - Pharmacogenomic Test

• It is a genetic test to identify how a person will respond to medication
• Help to select the right drug an dose on the outset of condition without

trial and error

• This does not predict risks of developing diseases
• Simple saliva sample is used to conduct the analysis
• Test results are available within 5-7 business days

P3 - Pharmacogenomic Approach

Therapeutic effects Adverse effects

Pharmacogenomics

Clinical Factors Age Sex Liver function Renal function Genetic Factors Drug breakdown Drug response Environmental Factors Nutrition Smoking Alcohol Physical activity

P3 - Unique Feature

• Most extensive test panel in Canada-

ü > 50 genes ü >150 drugs ü proprietary

• Comprehensive Summary Report by in-house Pharmacist
• Employee education campaign ****
• Follow-up with employees **
• Continuous support for employees and physicians

P3 Implementation

• Employee Benefit Format (XAP):

Similar to EAP

• Pay-As-You-Go Format

Employee Eligibility

Employees and their dependents are eligible for a personalized drug evaluation if they are prescribed or currently are taking a medication that is included on our drug list.

The Process

Employee contacts P3 directly 1(844) 943 0210 Employees collect simple saliva sample and send to Laboratory Results are sent to employee and to employee’s doctor Pharmacist reviews the results and prepares Summary Report Consent form and DNA Kits sent to the employee Laboratory conducts the test and digital report is prepared

• Employees requisition the test voluntarily

with consent

• Solves the issues of privacy, confidentiality

and discrimination concerns stated in the Genetic Non-discrimination Act, 2017

• Protects the employer from potential

liability

No Employer Liability

• P3 keeps the employer at “arms-length”
• P3 assigns a “barcode” to the “name”
• Till the results are dispatched, the samples are kept

barcoded

• Only P3 can match “report” and “barcode” to identify the

employee

Employee Privacy & Confidentiality Assured

Benefit from P3 - Pharmacogenomic Test

• Saves money on medication waste
• Less employees on disability
• Less medication-related absenteeism
• Increased employee productivity and morale

Thank you

Sanjida Ahmed, PhD Email: Sanjida@personalizedprescribing.com

Per ersonalized ed Prescr cription Plan lan:

Consulting Pharmacist To help resolve medication issues:

• Side-effects
• Drug interactions
• Dosage optimization
• Medication Counselling
• Genetic Drug Compatibility Test

To Make Personalized Recommendations

Me Medication

• ns

Te Tested

• Cardiovascular Conditions (high blood

pressure, cholesterol, diabetes)

• Mental Health (depression, anxiety, ADHD,

schizophrenia)

• Pain (muscle or neuropathic)
• Immune Conditions (Psoriasis, Crohn's,

Rheumatoid arthritis)

• Oncology
• Smoking Cessation and Opioid Use Disorder

Privacy & Confidentiality

• All info discussed with pharmacist (including genetics)

is kept private

• NOT shared with:
• Employer
• Insurance company
• Government
• Doctor (unless consent provided)
• Info. sent to the lab is kept barcoded to maintain

privacy

• Illegal in Canada for insurance companies to ask for

your genetic information to determine coverage.

Case Study #1: RA

• Patient: 45 yr, female
• Conditions: Rheumatoid Arthritis, Chronic Pain
• Job function: Physician
• Coverage: CMA
• History: Prescribed Methotrexate for her RA and

developed bone fractures in her ankle. Medication was discontinued but patient still had persistent pain. The pain was so severe that the patient exclaimed: “I wish I can cut my leg off!”

• Test Process: Employee called PPI, pharmacist

gathered comprehensive history and ordered pharmacogenetic test.

Case Study: RA

• Test Result: Kiera has a rare genetic variation in

her MTHFR gene that leads her to a deficiency in the active form of folic acid.

Case Study: RA

• Pharmacist Interpretation: Methotrexate also

depletes folic acid levels, and though physicians generally prescribe a folic acid supplement, Kiera was not able to convert this supplement into a usable form. Thus, she suffered some of the symptoms of folic acid deficiency (i.e. bone fractures and heightened pain sensitivity).

• Recommendation: Supplementation with the

active form of folic acid (Leucovorin).

Case Study #2: Anxiety

• Patient: 30 yr., Female
• Conditions: Anxiety, Heart condition (enlarged

ventricles), Asthma, Tobacco Use Disorder

• Job function: Administrative Assistant
• History: As soon as she started medications

(Cipralex, Venlafaxine), she felt even more anxious and her heart condition worsened (i.e. dizziness and fainting spells that resulted in hospitalizations and days lost from work). Patient’s also uses her asthma rescue inhaler >3 time/week due to shortness of breath.

• Test Process: Employee called PPI, pharmacist

gathered comprehensive history and ordered pharmacogenetic test.

Case Study: Anxiety

Pharmacist Interpretation:

• Certain antidepressants (i.e. Venlafaxine and

Citalopram) can cause changes in electrical activity in the heart, which can increase risk of heart palpitations and heart malfunction

• Patient had genetic risk factors (HTR2A and

CYP2D6) and clinical risk factors (structural heart abnormality) for this side-effect as well

• The patients chronic use of Ventolin can further

increase adrenaline, heart palpitations and anxiety.

Result:

• When the pharmacist called Jane for a follow-

up discussion (a month later), Jane informed the pharmacist that the physician has discontinued the Venlafaxine and has started her on the Bupropion and Flovent inhaler.

• Jane experienced decreased anxiety and

increased motivation and she was able to reduce the number of cigarettes that she smoked/day.

• Though Jane still experienced bouts of dizziness,

she no longer had any fainting spells, and could function well at work.

• Jane was informed that the pharmacist is

available at any time, if she needed more help with smoking cessation.

Case Study: Anxiety

Case Study #3: ADHD

• Patient: 14 yr., Male
• Conditions: ADHD
• Coverage: Student (Dependent)
• History: Mark previously tried multiple

stimulants (i.e. Adderall and Concerta), and though there were slight improvements in impulsivity, he also had major side-effects (i.e. irritability, emotional inhibition, appetite loss and insomnia). The patient was currently on a combination of Concerta and Atomoxetine.

• Test Process: Employee (mother) called PPI,

pharmacist gathered comprehensive history and ordered pharmacogenetic test.

Case Study: ADHD

• Pharmacist Interpretation: Mark is a CYP2D6 poor metabolizer

which means he has a reduced ability to metabolize ADHD medications, and he is at high risk of dose-related side-effects (i.e. irritability, insomnia, appetite loss). In addition, there is a drug interaction between Strattera and Concerta.

• Pharmacist Recommendation:
• Discontinue Concerta and Strattera
• Consider Drug Holliday
• Supplementation with Omega-3 1000 mg once daily
• Consider Aerobic exercise (30 mins 2-3 x week)
• Try other alternatives not metabolized by CYP2D6 (i.e.

Desvenlafaxine)

Case Study: ADHD

• Result:
• Physician discontinued Concerta and Strattera
• Patient was on a drug holiday for the summer

and was able to start the school year without

• medications. The mother said that she noticed a

major improvement; Mark was not as irritable and was less moody after a good night’s sleep and weekly exercise at the local gym.

• After having a discussion with the physician, the

mother decided that medication alternatives will only be considered, if Mark is really not able to cope with his symptoms throughout the school year.

Viewing Test Results

The concern may not always be genetic.

Employee Education

• Medication Safety
• Medicinal Use of Cannabis
• Safe Opioid Use
• Medications for Anxiety and Sleep

Th Thank You!