My Commonplace Book

Want to distribute counterfeit drugs? Come to Maryland!

Maryland's Board of Pharmacy has no inspector, rarely does background checks, allows distributors to work out of their homes and hands out drug-distribution permits - 722 of them in total - after less scrutiny than that given when licensing beauticians.

But if you don't live here, don't feel smug.

Most states' laws governing who can buy and sell prescription drugs are lax, requiring little more than a filing fee and a promise to follow certain storage rules. And there's little oversight at the federal level, which has long delayed a program designed to track drugs through their sales channels. ...

"We have the most intense regulations for the manufacturing of drugs; every aspect is scrutinized," [investigative writer Katherine] Eban said. "Then the drug leaves the loading dock of the manufacturer and they just fall into the black hole. The [FDA] says, 'We don't regulate the supply chain.' That was incredible to me." ...

The previous guidelines and state laws, most of which are still in place today, are a "travesty," said Carmen A. Catizone, executive director of the [National Association of Boards of Pharmacies].

"The states licensed wholesale distributors, then relied upon the industry to self-regulate to a large extent," said Catizone .... "What ensued was a significant threat to basic safety. ... There were distributors that were counterfeiting and tampering with drugs and patients were actually killed because of this." ...

In 2002, [16-year-old liver transplant patient Timothy] Fagan was prescribed a drug meant to boost his red blood cell count, but wound up taking a fraudulently labeled one he bought from his local CVS pharmacy. The drug traveled through multiple hands, at one point being stored in paint cans and shuttled through a Miami strip club, before making it to Fagan's door [on Long Island] as part of the $32 billion counterfeit drug industry. ...

[A New York] bill, dubbed Tim Fagan's law, will likely face the same difficulties in becoming law that the FDA has faced in implementing portions of the Prescription Drug Marketing Act of 1988. That statute required the same "pedigree" that would show every move a drug made after it left the manufacturer. The drug industry complained that the requirement was burdensome and expensive, and the FDA has had a stay on the rule ever since it was introduced. ...

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Ambien, the nation's best-selling prescription sleeping pill, is showing up with regularity as a factor in traffic arrests, sometimes involving drivers who later say they were sleep-driving and have no memory of taking the wheel after taking the drug.

This doesn't surprise me in the least, but it does worry me. I rely on Ambien to manage the sleep problems caused by fibromyalgia, and I don't want this to spook anyone into banning or withdrawing it. Stronger warnings are fine -- I'm already very familiar with how it affects me -- as long as they don't start trying to withhold it in some way.

As it is I've been fighting with my insurance company for years to get them to approve it on a long-term basis -- I don't know where they get off thinking they know me and my medical needs better than my doctor does! I take other drugs that are much more expensive, and still others that are much more dangerous, but Ambien is the only one I've had such huge problems with.

Thank goodness I've never tried to drive while under the influence of Ambien -- probably because I rarely drink alcohol. But occasionally I used to do strange things I don't remember, mostly in the realm of eating.
I'd wake up and find a dish on the night table with a dried residue of rice pudding or ice cream, and have no idea where it came from -- obviously I'd decided to get some during the amnesiac period, brought it upstairs and ate it. When Ken and I were still together he'd tell me in the morning about odd things I'd said the night before -- the most common apparently being a demand for ice cream or rice pudding.

"You know I don't want to eat that!" I'd complain. "Why did you bring it to me?"

"I tried not to, but you insisted!" he'd say. "I told you that you said you didn't want me to listen to you if it was just because of the Ambien, but you said 'I don't care, just get it for me.' So I did!"

All I could do was shake my head. It didn't happen often, fortunately, and it doesn't seem to happen at all any more, kine ahora. He'd also tell me about strange conversations we had.

I've done other odd things, too. Once in awhile I find something in an odd place that I must have moved before going to sleep. And once I found a half-written letter on the computer that started perfectly normally and trailed off into hilarious gibberish as the Ambien took hold. It was obvious that I'd written it -- there was nobody else in the house -- but I had no memory whatever of it.

It works fast, too -- as little as 10 minutes and you're out like a light. Occasionally I've awakened to find myself half in pajamas and half clothed, and a number of times I've awakened a couple of hours later sitting up in bed with the light on and a book in my lap.

I always thought these things were humorous, but after reading this article it doesn't seem so funny any more. I just hope these people who drink too soon before taking Ambien, or who don't wait until they're completely ready to go to bed and to sleep before taking it don't kill anybody -- and don't mess things up for the rest of us!

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I take a drug called Ambien, which helps a great deal with the sleep disorder aspect of fibromyalgia. I'm usually careful to take it immediately before I go to bed, because it usually kicks in very quickly (within 15 minutes). But there's a very short period after it starts work but before you're fully asleep when very strange things can happen.

And one effect of the drug is amnesia -- once it begins working, you don't remember anything that happens. After you're asleep it's irrelevant, but it's disconcerting to discover in the morning that you said or did something silly in that period between swallowing the pill and actually falling asleep.

Last night I wanted to send an e-mail to a friend of mine, but decided -- for several good reasons -- to wait until today. But when I came in to the office this morning and jiggled the trackball to wake the computer up, I found an e-mail on the screen. 

As I read it, most of what had happened came back to me. As I was going to bed I had suddenly become worried that I'd forget to write to her and needed to do it right now! The first couple of paragraphs looked familiar, and as I read them I remembered writing them. Then I got to the third paragraph:

So anyway, what's going on with your life? How is everyone in the family doing? I wanted to ask how things are going for the two of you but my ambien just kicked in and I can barely type coherently as you will see when I stop fixing egery secondor thir letter and justtype more oroless

At least I didn't manage to push the Send button!