How many times have you heard "We are going all-electronic"! We are getting rid of all the paper. Computers will eliminate the paper shuffle in our offices! Right? Not hardly! I have noticed that with computers and printers you can print paper a lot faster than the days before computers and high speed printers.

Why do we need paper copies? I guess an easy example is I use both a DayTimer and a PDA/Blackberry. I tried to go "all-electronic" but after losing everything a couple of times and being required to enter all the information back in again, I decided to keep both; it works out pretty well. Plus, I have written record of my activities over the past 20 years recorded in my DayTimers that are saved.

The use of "hard copies" has really been impressed upon me the past couple of years. We need hard copies for documentation and reference. I'll not discuss documentation in this issue but will say a few words about "references."

As many of you know, much of what I do involves providing information to all different individuals/professionals throughout the world on many topics relating to pharmacy. As an example, when working on law cases, one must use the literature and references appropriate for the time in question. So, if you need to know about Drug X that was available in 1975, then you look at the books and literature of that time period. Generally, if you either have in your possession or have access to the books and journals, it is not a problem. However, when the drug is from another country, then that can be quite difficult.

Now that we have the most fantastic search engines available on the Internet, we can search for information from all over the world...right? Not really. You see, most of the information available on the Internet is CURRENT information�not information that was available 25 or 50 years or more in the past. If one looks up the name of a drug at a website, you get the CURRENT information. How do you find something that was current even two or three years ago. We update our websites by putting in today's information and yesterday's information is gone, overwritten or archived and is no longer easily available. If all you need is current information for something you need to do today, then that is great. But, if you need information from "yesterday," then the Internet sites are often not the best resource.

Obviously, MEDLINE and all these indexing systems are extremely helpful in going into the past and they are adding more and more historical information all the time. But, if what you need is in a "reference book" or "book" and not in a "journal", then these indexing systems may not be of much help.

So, what is the answer to all this? Basically, paper can stay around a long time. I have books that are almost 200 years old and have been in libraries and seen books well over 1000 years old. When I think of how technology changes, I wonder what would have happened if we would have backed up all our data on 8-tracks (which were audio but the principal is the same), 8" floppy drives, 5" floppy drives, or even 3.5" floppies. You can have your data stored electronically, but years from now, you may or may not be able to retrieve it (I still have a lot of 8-track cartridges but no player). Paper will always be there to read. Think about it!

Just so you won't think that we waste a lot of paper at IJPC, the journal is produced electronically and it is possible to produce all the narrative content without printing a single sheet of paper until the journal is printed at the commercial printer. We do, however, print a copy of each article at least one time prior to layout and then print each of three separate layouts for proofing one time prior to printing. Compare this to when we started and were printing reams of paper for each issue for the different phases of editing, etc.

Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief

This week citations and abstracts related to palliative/supportive care were added to CompoundingToday.com's extensive literature search database. This database now searches 748 medical publications and has more than 2500 citations. Here is a sample of some of the articles added this week:

• Anwar D, Schaad N, Mazzocato C. Aerosolized vasopressin is a safe and effective treatment for mild to moderate recurrent hemoptysis in palliative care patients. J Pain Symptom Manage 2005; 29(5): 427-429.
• Goodlin SJ, Kutner JS, Connor SR et al. Hospice care for heart failure patients. J Pain Symptom Manage 2005; 29(5): 525-528.
• McNicol E, Horowicz-Mehler N, Fisk RA et al. Management of opioid side effects in cancer-related and chronic non-cancer pain: A systematic review. J Pain 2003; 4(5): 231-256.
• Shiaova L. The management of opioid-related sedation. Curr Pain Headache Rep 2005; 9(4): 239-242.
• Shiaova L, Lapin J, Manco LS et al. Tolerability and effects of two formulations of oral transmucosal fentanyl citrate in patients with radiation-induced oral mucositis. Support Care Cancer 2004; 12(4): 268-273.

In 1984, the opioid antagonist naltrexone was approved by the US Food and Drug Administration in a 50-mg dose for the treatment of addiction to heroin or opium. By blocking opioid receptors, naltrexone prevents the reception of beta-endorphin and met-enkephalin, which are endogenous hormones (endorphins) that exert an opioid-like analgesic effect. Many body tissues, including virtually every cell in the immune system, have receptors for those endorphins.

In 1985, Bernard Bihari, MD, discovered that about 3 mg of naltrexone (i.e., low-dose naltrexone, LDN) taken daily at bedtime seemed to enhance the response to infection in patients with the human immunodeficiency virus (HIV), the agent that causes the acquired immunodeficiency syndrome (AIDS). Bihari also found that his patients with cancer (such as lymphoma or pancreatic cancer) seemed to benefit from treatment with LDN. In addition, those with an autoimmune disease such as lupus often reported that LDN therapy resulted in prompt control of their disorder.

According to Dr. Bihari,¹ the brief blockade of opioid (endorphin) receptors caused by LDN may produce a prolonged upregulation of the immune system by causing an increase in the serum endorphin concentration. Bihari noted that healthy volunteers who have taken LDN as described above exhibit a higher level of beta-endorphins in their blood after treatment.

The adage "More isn't always better." applies to naltrexone therapy. Sometimes treatment with a low dose of a potent drug can be beneficial. Your local compounder has the materials and skills needed to customize naltrexone treatment according to the needs of individual patients.

1. [No author listed.] Low Dose Naltrexone. [Low Dose Naltrexone Website.] Available at: lowdosenaltrexone.org. Accessed January 30, 2005.

Protamine Sulfate Injection
Strength: 10 mg/mL

Protamine Sulfate Injection is in short supply with no alternative manufacturers. See www.ashp.org/shortage/availability-notices.cfm for more details.

The raw chemical is available from several chemical suppliers and a formula for compounding this preparation is available on CompoundingToday.com .

This week on IJPC's free list, pharmacists posted email discussing:

• Treatments for scleroderma needed.
• Crotamiton Compounding..is the API available?
• Need formula for phentermine PLO.
• Anyone making mesalamine suspension---formula came in from Belgium!
• Looking for a compounding pharmacist in Cape Town, South Africa�.have a patient moving there.
• Information needed on extended stability of IVIG after reconstitution

Join at IJPC.com and just read what others have to say or contribute and ask questions. It's easy, free and informative.

Junk Mail
Don't you just love junk mail. Ever wonder what to do with all the postage-paid return envelopes you get? Why not use them? Simply take any junk mail you have and place it in the envelopes and mail it back to the sender; it doesn't have to be theirs�mix it up a little. It costs them the price of the postage plus handling for these returned envelopes. Let the senders know you don't appreciate all the waste of paper, time and effort in their sending out indiscriminate and duplicative bulk mailings. There are more effective and targeted ways to advertise. Targeted bulk mailing is one thing and can be useful, but sometimes we get 3-5 copies of the same thing. Oh yes, since the post office says they are losing money due to e-mail advertising, using the postage-paid return envelopes and not wasting them will help out the post office; maybe(?) they won't have to raise the rates again!