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2/8/2002

Pharmacists Play Pivotal Roles at Olympic Games

Donna Young

Pharmacists are filling roles in Salt Lake City at the 2002 Olympic Winter Games that include everything from creating and maintaining a database of the types of drugs being dispensed to athletes and spectators to escorting athletes for the drug control program to running with the torch.

Ben Johnson, pharmacy contract manager for Intermountain Health Care (IHC) of Salt Lake City and pharmacy manager for the Games, said that, from a medical perspective, his city's event will be the "best organized" of any of the Olympic Games.

"We will be able to send on to Torino [Italy], where the next Winter Games will be held, information about how many of each type of drug was used," he said.

IHC and the University of Utah Hospitals and Clinics are the official medical providers for the 2002 Winter Games.

Pharmacy services. James Jorgenson, the university’s pharmacy services director, said the institution worked with health care information-systems manufacturer Cerner Corp. of Kansas City, Missouri, to design a computer system to track drug products dispensed for athletes and spectators from competition-venue medical stations, area hospitals, and the Olympic Village.

Pharmacists Volunteer for the Games

Several University of Utah Hospitals and Clinics pharmacists have volunteered to participate in various capacities at the 2002 Winter Olympics.

Carolyn Kowalchik, the university’s clinical inpatient services manager and pharmacy practice residency program director, is using eight days of her paid vacation time from work to volunteer as a doping-control escort for speed skaters at the Olympics.

An escort is the person who notifies an athlete of his or her selection for drug testing and remains with that person until he or she reports for sample collection. Part of an escort’s job is to remind the athlete to be aware of what he or she ingests before completing the drug test.

"It's more for their own safety, because sometimes people will try to hand them things to drink," Kowalchik said. "It's a good thing that we are there."

Michelle Wheeler, a pharmacist with the university hospital’s anticoagulation services, is acting as a language services volunteer for the Games. She speaks fluent Czech and is aiding the Czech Republic’s National Olympic Committee delegates in various capacities.

"Mostly I will be driving them all around town," she said.

Wheeler said she is also on-call to help the university’s drug information center interpret Czech drug names.

University of Utah pharmacy student and hospital intern Melanie Johnson was chosen by the Salt Lake Organizing Committee to be a torch runner, known as an "Olympic Guardian of the Flame." Guardians run alongside those people selected to carry the torch.

"Sometimes we carry the torch for them when they can't," she said.

Pharmacy Services Director James Jorgenson, a hockey coach for the university, is part of a USA Hockey research team evaluating Olympic teams’ styles of play. He said results of the study would help youth hockey teams in North America.

"We want to be able to provide a comprehensive profile of what sports and what countries used which types of drugs," Jorgenson said.

The university is operating the Olympic Village’s pharmacy, known as the Poly Clinic, where athletes’ prescriptions are filled. Corporate sponsors Pfizer Inc. and Cardinal Health Inc. donated drug products for the clinic, Jorgenson said.

Salt Lake City’s Olympic Village is located on a secured area of the University of Utah campus. The Poly Clinic is in a building next to the university’s student dormitories, which house the athletes during the Winter Games.

The university has closed its campus and dormitories during the Games, Jorgenson said. But some students, including pharmacy residents, have stayed in town to act as volunteers.

Pharmacists and technicians working in the Poly Clinic are paid for their services, Jorgenson said. But the pharmacists who are volunteering in other capacities are not paid and must use their vacation time to participate.

The university’s pharmacy residents developed the Salt Lake City Games’ drug formulary covering the athletes—a project completed well over a year ago, Jorgenson said.

"Doctors kept wanting to add more drugs to the list," said Linda Tyler, Drug Information Services pharmacy manager, "but we said ‘no.’"

She said the university is concerned about shortages of medications, such as tetanus toxoid, that might be in high demand to treat injuries sustained by athletes and spectators.

Tyler oversees the university’s Drug Information Center in Salt Lake City. The center has established a separate telephone line for the Winter Games.

Pharmacists working at the center answer questions—mostly from physicians treating spectators attending the Olympic Games—about drug products, including foreign substances, she said.

Tyler recruited pharmacy residents, in addition to pharmacists who are former University of Utah pharmacy residents, to work at the center during the Games.

She said two of the center’s drug information specialists also helped at the 1996 Atlanta Games.

Medical stations. At the 2002 Games, IHC is managing the medical stations located at each of the event venues.

IHC’s Johnson said there are 15 medical stations for athletes and 21 for spectators. Each medical station is staffed by at least one physician and one nurse who are also volunteers, he said.

Before the Winter Games, Johnson said, IHC pharmacists and technicians stocked hardware tool carts with an assortment of drug products for the medical stations.

The carts, he said, "have a wide range of things, such as antibiotics, injectables, cough and cold medicines, and gastrointestinal products."

Drugs that would disqualify an athlete from competition, Johnson said, were put in lock boxes that are kept on the bottom shelf of each cart and affixed with a warning sticker alerting the physician to complete a medical notification form before administering any of those drugs to an athlete.

Disaster Preparedness for the Games

The Public Health Service's Office of Emergency Preparedness (OEP) has 18 Disaster Medical Assistance Teams (DMATs) on-hand at the Winter Olympics to support local emergency medical services if necessary.

DMATs are groups of paid medical and support volunteers who provide emergency medical care during disasters or other events.

At the Olympics, these groups consist of five-member teams of physicians, nurses, pharmacists, paramedics, and emergency medical technicians, with each team in Salt Lake City for 10 days, said pharmacist Mark Gonitzke, a commissioned officer with OEP.

"There will always be 18 teams in town at all times," Gonitzke said. If a disaster occurs in another area of the country during the Olympics, OEP has "made sure there are enough teams" to cover all regions, including Alaska and Hawaii.

At least three DMATs from around the country are normally scheduled to be on-call every month. Gonitzke said each DMAT is sponsored by a local organization, such as a hospital, public health or safety agency, or private group, that recruits team members and arranges their training. The sponsoring organization also coordinates the dispatching of the team.

DMAT members must maintain appropriate certifications and licenses, according to OEP. When a DMAT is activated, members' licenses and certifications become temporarily recognized by all states. Members are considered federal employees and have protection under the Federal Tort Claims Act in the event of a malpractice claim, according to OEP.

DMAT members at the Olympics are not allowed to attend any of the events, Gonitzke said. "If a disaster strikes, we don't want our people caught up in it," he said.

Gonitzke said DMAT members use their "downtime" at the Olympics by networking and increasing their knowledge about weapons of mass destruction and other health care and disaster preparedness information.

He said the National Disaster Medical System (NDMS) is "always recruiting" volunteers to participate in the DMATs.

A special NDMS bioterrorism team is also in Salt Lake City for the Games in case a disaster occurs, Gonitzke said.

Prohibited substances. The International Olympic Committee (IOC), the governing body of the Games, maintains a list of prohibited classes, substances, and methods of doping.

Athletes must adhere to rules for restricted and banned drugs, or risk losing their medals, according to the World Anti-Doping Agency (WADA), an independent foundation that sets international standards for doping control.WADA was created in 1999 by an initiative led by IOC.

"Pseudoephedrine is the one that always gets people," IHC’s Johnson said. IOC has banned the use of the drug during competition.

Many cold medicines, weight-loss drugs, pain relievers, nasal sprays, and sleeping aids contain prohibited substances, according to the United States Anti-Doping Agency (USADA), which was established as an independent organization by the United States Olympic Committee (USOC) and began operations in October 2000.

"Any cold medicine that contains a decongestant and is taken orally is banned in competition, with no exceptions," warns USADA’s Guide to Prohibited Classes of Substances and Prohibited Methods of Doping. "Even when used for a legitimate medical treatment, the detected presence of a prohibited substance constitutes doping."

USADA’s guide alerts athletes to always know the exact name of the medication they are taking since many drug names may sound alike. The guide also cautions athletes that dietary supplement labels do not always list the exact ingredients and that many contain banned substances. Athletes must also ensure they do not ingest other common substances, such as caffeine, in amounts greater than allowed.

USADA offers a toll-free reference line to answer athletes’ questions about substances, drug products, and drug testing rules any time during the year, including during the 2002 Games.

Pharmacist Jeff J. Podraza manages and operates the drug reference line.

Podraza said he gets a "large number of calls on nutritional products and dietary supplements." But, he said, USADA makes "no guarantees" for the athletes about how the use of such products could affect drug tests. The use of supplements, herbals, and nutritional products are "completely at the athlete’s own risk," he said.

In 1993, Podraza was the first pharmacist to complete the USOC-cosponsored post-Pharm.D. residency program in sports pharmacology and doping control at the organization’s athlete training site in Colorado Springs, Colorado. The residency program, cosponsored by a predecessor of GlaxoSmithKline, ran for only a few years, Podraza said.

On completion of his residency, Podraza worked part time for USOC for seven years helping to educate athletes about drug products. He also participated in the 1996 Atlanta Summer Games as a doping control officer.

The newly formed USADA hired Podraza full time in 2000 to operate the reference line.

Doping-control personnel. Doping-control officers at the Olympics are responsible for obtaining medication histories and witnessing, collecting, and processing urine samples from the athletes, said Peter J. Ambrose, Pharmacokinetics Service director at Long Beach Memorial Medical Center in California.

Ambrose was a volunteer doping-control officer at the 1996 Atlanta and 2000 Sydney Games but turned down the opportunity for the 2002 Games.

He said that 50 U.S. pharmacists participated in Atlanta as doping-control officers and escorts. But in 2000, Ambrose said, he was the only U.S. pharmacist to act as a doping-control officer at the Sydney Games.

Because of his training in pharmacokinetics, Ambrose said, he was recruited by the National Collegiate Athlete Association in 1987 to act as a crew chief for its doping-control program and was the first pharmacist to serve in that position.

"Because of their knowledge of drug products," Ambrose said, "pharmacists are valuable volunteers for sports-related programs and should search out opportunities to participate in events like the Olympic Games."