The Anti-Lyme Crusader
By Carol McCarthy ’84
During the summer two Rhode Island pharmacies—Green Line Apothecary in Wakefield and Seaside Pharmacy in Westerly—became the first in the nation to dispense a single dose of antibiotics, on-site and without a doctor’s order, to potentially prevent Lyme disease in a person bitten by a tick. Anita Jacobson, clinical associate professor of pharmacy, had seen prior studies that showed a prophylactic dose could be effective, and worked for five years to bring the treatment to the public. Rhode Island residents and tourists—whose doctors at home may be less familiar with the disease—have used the service.
What made you pursue this project?
It’s a is a serious public health concern. Whenever I give a presentation and ask who has had Lyme disease or had a family member affected, every hand goes up. Rhode Island is one of 14 states with a high incidence of the disease. Timely treatment is important, but prevention is key.
How did the program start?
I collaborated with Kelly Orr and Jeff Bratberg (College of Pharmacy faculty members) as well as infectious disease specialist physician Fredric Silverblatt to develop the trial protocol in 2012. The only way to have pharmacists initiate antibiotic therapy was if we did it as a study, with a research exemption from the Rhode Island Board of Pharmacy. State law did not allow pharmacists to initiate new drug therapies—other than immunizations or naloxone (opioid overdose-reversal medication).
The trial was successful: No subjects developed Lyme disease or serious adverse effects, and the service was a seamless fit within pharmacy settings. The protocol—a 200-milligram dose of doxycycline—is proven effective as a prophylaxis against Lyme disease. But people should note that it protects against Lyme only, not other tick-borne illnesses.
What happened next?
It was 2014, everyone in the study was satisfied, but we couldn’t continue. We needed to change the law. I went to the state Department of Health, which was totally supportive, and we began working with the General Assembly. We collaborated with the Rhode Island Pharmacists Association and the Rhode Island Society of Health-System Pharmacists and passed legislation in 2016 expanding pharmacists’ role to include initiation of drug therapies under collaborative practice agreements with physicians. It’s exciting to wonder what other patient-friendly initiatives might come from that law—primary care for underserved populations comes to mind.
So how does it work?
It’s open to any pharmacist in the state—they simply have to be part of a collaborative practice agreement with a doctor and receive training at the URI College of Pharmacy. Pharmacists assess the customer and go through an eligibility checklist set by the U.S. Centers for Disease Control and Prevention: The person must be at least eight years old; the tick has to be attached for at least 36 hours; and it must have been removed within the last 72 hours. The customer cannot have Lyme disease at the time of treatment.
I would like to see this expand to the other states with endemic Lyme disease. They currently encompass New England, the Eastern Seaboard as far south as Delaware, Wisconsin and Minnesota.