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Renewal — (growth hormone deficiency in children) only from a paediatric endocrinologist or endocrinologist cheap sildalis master card erectile dysfunction drugs in ayurveda. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 A current bone age is 14 years or under (female patients) or 16 years or under (male patients) generic 120 mg sildalis amex erectile dysfunction treatment las vegas; and 2 Height velocity is greater than or equal to 25th percentile for age (adjusted for bone age/pubertal status if appropriate) while on growth hormone treatment, as calculated over six months using the standards of Tanner and Davis (1985); and 3 Height velocity is greater than or equal to 2. Initial application — (Turner syndrome) only from a paediatric endocrinologist or endocrinologist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has a post-natal genotype confirming Turner Syndrome; and 2 Height velocity is < 25th percentile over 6-12 months using the standards of Tanner and Davies (1985); and 3 A current bone age is < 14 years. Renewal — (Turner syndrome) only from a paediatric endocrinologist or endocrinologist. Initial application — (short stature without growth hormone deficiency) only from a paediatric endocrinologist or endocrinologist. Renewal — (short stature without growth hormone deficiency) only from a paediatric endocrinologist or endocrinologist. Initial application — (short stature due to chronic renal insufficiency) only from a paediatric endocrinologist, endocrinologist or renal physician on the recommendation of a paediatric endocrinologist or endocrinologist. Renewal — (short stature due to chronic renal insufficiency) only from a paediatric endocrinologist, endocrinologist or renal physician on the recommendation of a paediatric endocrinologist or endocrinologist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 Height velocity is greater than or equal to 50th percentile (adjusted for bone age/pubertal status if appropriate) as calculated over 6 to 12 months using the standards of Tanner and Davies (1985); and 2 Height velocity is greater than or equal to 2 cm per year as calculated over six months; and continued… ‡ safety cap ▲ Three months supply may be dispensed at one time ❋Three months or six months, as applicable, dispensed all-at-once ifendorsed“certifiedexemption”bytheprescriberorpharmacist. Initial application — (Prader-Willi syndrome) only from a paediatric endocrinologist or endocrinologist. Renewal — (Prader-Willi syndrome) only from a paediatric endocrinologist or endocrinologist. Initial application — (adults and adolescents) only from a paediatric endocrinologist or endocrinologist. Approvals valid for 9 months for applications meeting the following criteria: All of the following: 1 The patient has a medical condition that is known to cause growth hormone deficiency (e. Patients with one or more additional anterior pituitary hormone deficiencies and a known structural pituitary lesion only require one test. Where an additional test is required, an arginine provocation test can be used with a peak serum growth hormone level of less than or equal to 0. At the commencement of treatment for hypopituitarism, patients must be monitored for any required adjustment in replacement doses of corticosteroid and levothyroxine. Renewal — (adults and adolescents) only from a paediatric endocrinologist or endocrinologist. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 The patient has primary nocturnal enuresis; and 2 The nasal forms of desmopressin are contraindicated; and 3 An enuresis alarm is contraindicated. Initial application — (Desmopressin tablets for Diabetes insipidus) from any relevant practitioner. Approvals valid for 12 months for applications meeting the following criteria: Both: 1 The patient has cranial diabetes insipidus; and 2 The nasal forms of desmopressin are contraindicated. Approvals valid for 12 months where the treatment remains appropriate and the patient is benefiting from the treatment. Approvals valid for 2 years where the patient cannot use desmopressin nasal spray or nasal drops. Approvals valid without further renewal unless notified for applications meeting the following criteria: Either: 1 pathological hyperprolactinemia; or 2 acromegaly*. Approvals valid without further renewal unless notified where the patient has previously held a valid Special Authority which has expired and the treatment remains appropriate and the patient is benefiting from treatment. Approvals valid for 6 months where the treatment remains appropriate and the patient is benefitting from the treatment. Approvals valid without further renewal unless notified for applications meeting the following criteria: Any of the following: 1 Patient has received a lung transplant, stem cell transplant, or bone marrow transplant and requires treatment for bronchiolitis obliterans syndrome*; or 2 Patient has received a lung transplant and requires prophylaxis for bronchiolitis obliterans syndrome*; or 3 Patient has cystic fibrosis and has chronic infection with Pseudomonas aeruginosa or Pseudomonas-related gram negative organisms*; or 4 Patient has an atypical Mycobacterium infection. Initial application — (non-cystic fibrosis bronchiectasis*) only from a respiratory specialist or paediatrician. Approvals valid for 12 months for applications meeting the following criteria: All of the following: 1 For prophylaxis of exacerbations of non-cystic fibrosis bronchiectasis*; and 2 Patient is aged 18 and under; and 3 Either: 3. Renewal — (non-cystic fibrosis bronchiectasis*) only from a respiratory specialist or paediatrician. A maximum of 24 months of azithromycin treatment for non-cystic fibrosis bronchiectasis will be subsidised. Approvals valid for 2 years for applications meeting the following criteria: Either: 1 Atypical mycobacterial infection; or 2 Mycobacterium tuberculosis infection where there is drug-resistance or intolerance to standard pharmaceutical agents. Renewal — (Mycobacterial infections) only from a respiratory specialist, infectious disease specialist or paediatrician. Approvals valid without further renewal unless notified where the patient has rosacea. Approvals valid for 3 months for applications meeting the following criteria: Both: 1 For the eradication of helicobacter pylori following unsuccessful treatment with appropriate first-line therapy; and 2 For use only in combination with bismuth as part of a quadruple therapy regimen. Approvals valid for 1 year for applications meeting the following criteria: Either: 1 Both: 1. Approvals valid for 1 month where the patient requires prophylaxis following a penetrating eye injury and treatment is for 5 days only. Renewal only from an infectious disease specialist, clinical microbiologist or gastroenterologist. Approvals valid for 1 month for applications meeting the following criteria: Either: 1 Patient has confirmed cryptosporidium infection; or 2 For the eradication of Entamoeba histolyica carriage. Approvals valid for 6 weeks for applications meeting the following criteria: Both: 1 Patient requires prophylaxis for, or treatment of systemic candidiasis; and 2 Patient is unable to swallow capsules. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient is immunocompromised; and 2 Patient is at moderate to high risk of invasive fungal infection; and 3 Patient is unable to swallow capsules. Approvals valid for 6 months for applications meeting the following criteria: All of the following: 1 Patient remains immunocompromised; and 2 Patient remains at moderate to high risk of invasive fungal infection; and 3 Patient is unable to swallow capsules. Can be waived by endorsement - Retail pharmacy - Specialist Specialist must be an infectious disease physician, clinical microbiologist, clinical immunologist or dermatologist. Approvals valid for 6 months where the patient has a congenital immune deficiency. Approvals valid for 6 weeks for applications meeting the following criteria: Either: 1 Patient has acute myeloid leukaemia and is to be treated with high dose remission induction, re-induction or consolidation chemotherapy; or 2 Patient has received a stem cell transplant and has graft versus host disease and is on significant immunosuppressive therapy*. Approvals valid for 6 weeks for applications meeting the following criteria: Either: 1 Patient has acute myeloid leukaemia and is to be treated with high dose remission induction, re-induction or consolidation therapy; or 2 Patient has received a stem cell transplant and has graft versus host disease and is on significant immunosuppression* and requires on going posaconazole treatment. Renewal — (invasive fungal infection) only from a haematologist, infectious disease specialist or clinical microbiologist. Approvals valid for 3 months for applications meeting the following criteria: All of the following: 1 Patient is immunocompromised; and 2 Applicant is part of a multidisciplinary team including an infectious disease specialist; and 3 Any of the following: 3.

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List prices for Rx products were obtained from the 2010 version of the Red Book: Pharmacy’s Fundamental Referencevi sildalis 120mg for sale erectile dysfunction when young. Ratios of generic-to- branded Rx sales were estimated based on the 2011-2012 Healthcare Distribution Management Association Factbook and Booz & Company analysis cheap sildalis 120 mg free shipping erectile dysfunction medicine with no side effects. Clinical Visit Cost Savings as healthcare provider visits would be Exhibit 2: required to secure prescriptions for Rx treatments Clinical Savings: Breakdown of Alternative Treatment Avoided Drug cost savings amount to $25 billion, which represents 25% of the total $102 billion in annual savings to the U. The majority of clinical cost savings result from avoided clinical visitsvii which are estimated at $66 billion or 65% of total savings. Physicians typically see patients during normal working hours and many individuals must miss work for physician visits. We assumed that each visit to a doctor to obtain a prescription results in, on average, two hours of lost work, which includes wait time, clinician interaction time in the physician’s offce, and travel time to and from the appointment. The frequency Allergy 14% of these conditions would drive a signifcant number Analgesics 13% of incremental doctor visits. Note: Sums to 100% before rounding The allergy category is the third largest source of savings. If we make a conservative assumption that each medical visit is 15 minutes in duration and that there are 2,000 working hours for a healthcare provider in a calendar year, these ~450 million incremental visits are the equivalent of over 56,000 medical practitioners working full-time on clinical care per year. This study was funded by the Consumer Healthcare Products Association and conducted by Booz & Co. Department of Health and Human Services, Centers for Disease Control and Prevention; National Health Statistics (2007). Reformed drug dealers have confessed they would have said anything to get others to buy drugs. You need facts to avoid becoming hooked on drugs and to help your friends stay off them. Popularized in the 1960s by music and mass media, they invade all aspects of society. In the United States, results from the 2007 National Survey on Drug Use and Health showed that 19. In Europe, recent studies among 15- and 16-year-olds suggest that use of marijuana The most commonly used illegal drug is varies from under 10% to over 40%, with the marijuana. According to the United Nations highest rates reported by teens in the Czech 2008 World Drug Report, about 3. Over the years, I turned to cocaine, marijuana and Malcohol under a false belief it would allow me to escape my problems. I prayed and cried for this feeling to go away, I had voices in my head, had the shakes and couldn’t leave home for six months. Here are some of the reasons young people Difficult as it may be to face one’s problems, have given for taking drugs: the consequences of drug use are always worse than the problem one is trying to • To fit in solve with them. The real answer is to • To escape or relax get the facts and not to take drugs in • To relieve boredom the first place. So, while providing short-term help in the relief of pain, they rugs are essentially poisons. A small amount acts as a stimulant Medicines are drugs that are intended to (speeds you up). A greater amount acts as speed up or slow down or change something a sedative (slows you down). An even larger about the way your body is working, to try amount poisons and can kill. So if you do not use medicines But many drugs have another liability: they as they are supposed to be used, they can directly affect the mind. As a result, the person’s actions may be odd, irrational, inappropriate and even destructive. And each time, the emotional And as he has more failures and life gets plunge is lower and lower. Eventually, drugs harder, he wants more drugs to help him will completely destroy all the creativity a deal with the problem. By the time I revolved around one thing: my realized I was addicted, snorting OxyContin was part plan for getting the money I of my daily routine. And amphetamine— it was the every time I tried to kick it, the physical craving only thing in my life. They are included here to provide you with the truth about what these drugs are and what they do. Page 30 11 Marijuana arijuana is usually rolled up in a cigarette to a National Household Survey on Drug Mcalled a joint or a nail. It can also be Abuse, kids who frequently use marijuana brewed as a tea or mixed with food, or are almost four times more likely to act smoked through a water pipe called a bong. They are five * times more likely to steal than those who Cannabis is number three of the top do not use the drug. Growing techniques and selective use of seeds have produced Street Names: a more powerful drug. As a result, there • eed • Smoke • Ganja has been a sharp increase in the number of marijuana-related emergency room visits • Blunt • Mary Jane • Super by young pot smokers. When the effects start to wear off, the person may turn to • Reefer • Chronic • Nederweed * cannabis: any of the different drugs that come from 12 Indian hemp, including marijuana and hashish. Marijuana Long‑term use can cause itself does not lead the person to the other psychotic symptoms. It can drugs: people take drugs to get rid of also damage the lungs and the unwanted situations or feelings. The drug heart, worsen the symptoms of (marijuana) masks the problem for a time bronchitis and cause coughing (while the user is high). It may reduce fades, the problem, unwanted condition the body’s ability to fight or situation returns more intensely than lung infections and illness. In fact, in the first hour of smoking marijuana, a user’s risk of a heart attack could increase fivefold. School performance is reduced through impaired memory and lessened ability to solve problems. Mixing alcohol with medications or Alcohol street drugs is extremely dangerous and can be fatal. Alcohol influences your brain Street Names: and leads to a loss of coordination, slowed • Booze reflexes, distorted vision, memory lapses and • Sauce blackouts. Teenage bodies are still growing • Brews and alcohol has a greater impact on young • Brewskis people’s physical and mental well-being than • Hooch on older people. Heavy drinking usually results in a “hangover,” headache, nausea, anxiety, weakness, shakiness and sometimes vomiting. Drinking effects of alcohol and a resulting ability to large amounts can lead to a coma and even drink more. Mixing alcohol with medications or physical condition that can include liver street drugs is extremely dangerous and damage and increases the risk of heart can be fatal. A pregnant woman may give and leads to a loss of coordination, slowed birth to a baby with defects that affect reflexes, distorted vision, memory lapses and the baby’s heart, brain and other major blackouts.

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In many cases buy discount sildalis 120mg online erectile dysfunction tips, given that the same drugs are being considered sildalis 120mg with amex erectile dysfunction garlic, production for non-medical use will merely require expansion of existing frameworks. The following consider- ation of existing legal and regulated production of opium/heroin, coca/ cocaine, and cannabis will help demonstrate how this could happen. Legal production of opium 140 A signifcant proportion, almost half, of global opium production is legally produced for processing into opiate based medicines. Any country can cultivate, produce and trade in licit opium, under the 140 Licit opium production accounted for more than half of global opium production until the recent bumper harvests in Afghanistan. As of 2001 there were eighteen countries that do; of these, four, (China, Korea, India and Japan) cultivate opium poppy for the production of raw opium, although only India exports it. Once harvested and collected, the pods and stalks are then sent to a factory to be chemically‘washed’. India is the exception to this rule: it is the only sanctioned exporter of opium gum. Whilst not without problems, this range of scenarios demonstrates that opium production is possible in a range of different environments. Iran and some Central Asian republics utilise confscated illicit opium for their domestic medical markets. Mansfeld notes that: Whilst previously, these countries had been satisfed with using seized opium for their domestic opiate needs, in recent years they have sought to sell seized opiates, or products derived from them internationally. Diversion to illicit market The levels of leakage into the illicit market vary greatly from country to country. Country quotas are set using offcial estimates of interna- tional demand using fgures from the past two years’ consumption. However, according to offcial fgures, ‘even in these countries only 24% of moderate to severe pain-relief 145 need was being met’. There is a real issue here regarding the access of pain relief by developing world countries that do not have a licence to grow poppies. International legal framework The international licensing control system seeks to permit and regulate legitimate production and use, while at the same time prevent diversion to the illicit market for non-medical use. Domestic legal framework arrangements Each of the countries that grows opium poppies for export has its own set of legal frameworks in order to prevent diversion into the illicit market. United Kingdom Farmers do not need a licence for poppy growing; however, the police must be informed of the location. The Home Offce confrms this: Although we do not licence growers, we do issue them with a letter confrming that we are aware that growing is taking place at their farm and detailing the locations. We advise each grower to produce a copy of this letter to their local police station in order that they may be aware of what is taking place. Anyone can grow opium poppies because the process itself is not controlled by the Misuse of Drugs Act 1971, but any processing of the plant to extract the opiates is controlled and can only be carried out 146 under licence. Farmers must also have obtained a security clearance from Tasmania Police and provided a detailed plan of the cultivation site. Licences are issued annually for a crop year which commences from 1st October and ends on 30th September of the following year. For this purpose, the central government announces a Minimum Qualifying Yield of a certain number of kilos of 150 opium per hectare. In 2001 there were only fve provinces in which opium poppies were licitly grown compared to 13 in 1933; the limit was reduced in order to manage the scale of production. Discussion Expanded production of opium and derived products under the existing framework is clearly both feasible and non-problematic. It is likely that the expansion of legally regulated opiate use would initially take place within existing medical prescription models—in- deed this process is already underway, albeit slowly. More signifcant shifts from illicit to licit production (be it via more substantial expan- sion of prescribing models, or some other appropriate form of licensed sales, see: page 25) would take place incrementally over a number of years allowing for a manageable transition period during which the relevant regulatory and enforcement infrastructure could be developed or expanded, with any emerging challenges responded to. As this phased process continues demand for illicit products will correspondingly diminish, and with it the economic incentives for diversion or illicit production to occur. This raises potentially signif- cant development issues for Afghanistan which currently produces an 151 D. Legal production of both does take place but, compared to the legal production of opium, it is on a much smaller scale and there is much less publicly available information— indeed the whole process is somewhat shrouded in secrecy. Coca leaves as a favouring agent The 1961 Convention specifcally allows for de-cocainised coca leaves to 154 be used as a favouring agent. In the case of Coca-Cola, coca leaves are purchased from South American suppliers by the American conglom- erate, Stepan Chemicals Company. Separation of the cocaine and favouring involves a fairly elab- orate process in which the leaf is ‘ground up, mixed with sawdust, soaked in bicarbonate of soda, percolated with toluene, steam blasted, mixed with 155 powdered Kola nuts, and then pasteurized’. A number of smaller product brands also use coca favouring, many (unlike Coca-Cola) specifcally building their marketing around the 156 coca leaf being an ingredient, despite their drinks having no active coca-derived content. Cocaine-based pharmaceuticals There is relatively little information in the public domain about the production and use of pharmaceutical cocaine for medical use. No fgures are available regarding the balance of global production (from the de-cocainised leaf based favourings process), or demand, or whether there is any leakage into the illicit market at any point during the coca/ cocaine production process. In practice, cocaine now has relatively few mainstream medical 155 ‘The Legal Importation of Coca Leaf’, University of Illinois, Class module 9. Its former role in anaesthesia has been progressively displaced by newer, more effective synthetically derived alternatives including Novocaine, Lidocaine and Xylocaine. Under the 1961 Single Convention, countries that legally produce coca and cocaine are expected to have established an agency to control and oversee the cultivation of coca and production of cocaine. Peru also manufactures a small amount of raw cocaine to 162 be exported to other countries for the production of medical cocaine. This statement understandably caused outrage in Bolivia and Peru where coca leaf chewing is a long established tradition amongst 159 The use of various coca preparations in South America as a traditional medicine in various forms remains widespread. The traditional use of coca leaf has increasingly become a political fashpoint in the international arena, as such long established cultural and traditional indigenous practices have collided with the prerogatives of Western governments determined to stamp out the source of illicit cocaine production that exists in parallel with sources for traditional use. To date, this report has never been offcially published although the relevant sections have subsequently 165 been leaked and made available online. Currently four countries (Bolivia, Peru, Argentina and Colombia) main- tain legislation permitting some form of protection of traditional use, to different extents. Bolivia and Peru allow the growing of the leaves for this use, limiting this to a certain amount of hectares. Argentina allows people to carry leaves for traditional chewing, as does Colombia and Chile for their indigenous peoples. Signifcant problems exist for the legal and quasi-legal markets in coca- based products in that they struggle to compete with the illegal coca production that supplies the illegal cocaine trade. Discussion Legal coca production for use in its raw leaf form, lightly processed products, or pharmaceutical cocaine does not present any signifcant problems in and of itself. Low potency coca products (leaf and tea) do not require any more controls than equivalent products such as coffee, whilst the processing of coca into pharmaceutical cocaine would take place at an industrial level for which any security and product regulation issues would operate within well established models.

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