When he was working as a pharmacist in Red Wing, Minn., Cody Wiberg always knew when one particular doctor was in town. It was a dermatologist who saw patients twice a month, and always prescribed a special skin cream that Wiberg had to mix up himself, special order.
So there's really nothing unusual about the idea of pharmacies "compounding" drugs, says Wiberg, who is now executive director of the Minnesota Board of Pharmacy.
But the national meningitis outbreak has cast the practice in a whole new light, now that more than 250 cases and 20 deaths in 16 states have been traced to tainted steroids from a compounding pharmacy in Massachusetts.
In Minnesota, about a dozen specialty pharmacies do most of their business compounding drugs, Wiberg says. They fill prescriptions for special situations -- say, for patients who are allergic to the red dye in a commercial medication.
They are not, he said, supposed to be acting like pharmaceutical companies. "We have taken great pains," he said, "to make it very clear to compounding pharmacies both inside and outside of the state what they can and can't do."
Minnesota, Wiberg said, has six inspectors to ensure that compounding pharmacies follow the rules, including the safety standards for making injectable drugs such as steroids. But those same inspectors also monitor 1,200 other pharmacies. "You can't be in every pharmacy every day," he said.
Whatever went wrong at the New England Compounding Center, the company appeared to be stretching the definition of a pharmacy. By law, it was only supposed to fill individual prescriptions for individual patients, yet clinics and hospitals say they were buying drugs in bulk.
Wiberg said he doesn't think that kind of thing would happen here. But he's leading a new effort to remind pharmacies and clinics where the lines are drawn.
"We're going to make it even more clear than we thought it was," he said.