The Brief

More than 3,000 California pharmacies earlier this month ended a service they long provided to help the medicine go down, and it’s unclear when they’ll restore it.

The pharmacies suspended their practice of flavoring medication because they’re awaiting rules from a state regulator charged with applying federal guidance that characterized the service as drug compounding, meaning the mixing of prescription medication.

Medicines that are commonly flavored include flu syrups, like Tamiflu, and various antibiotic prescriptions, including amoxicillin and Augmentin. Parents are worried about the change, especially as respiratory diseases and infections become more prevalent during the winter.

Brenda Alvarez of Anaheim said her four kids don’t like taking unflavored medication. “It’s harder for them to get the medication, especially when they’re sick, because the taste is just really bad,” she said.

The suspension of flavoring services by pharmacies follows new guidance from the United States Pharmacopeia, a nonprofit agency that advises the federal government.

It’s a shift from California’s past policy. In 2010, the California Board of Pharmacy explicitly stated in their lawbook that drug compounding does not include “the addition of flavoring agent(s) to enhance palatability.”

California’s Board of Pharmacy now is preparing rules that will adopt the federal guidance. While these rules will not ban flavoring, they would require pharmacists to comply with more stringent regulations when providing the service.

Chad Baker, senior vice president of marketing at flavoring manufacturer FLAVORx, said it is easier for California pharmacies to drop service than deal with potential costs and citations from the state regulator.

“It has been particularly rough because California has had a language in place at the Board of Pharmacy for the past 14 years that said flavoring is not compounding. And so that was what a lot of pharmacies base their investments on and what they wanted to provide to customers,” he said.

Pharmacist Sonya Frausto, who owns and runs Ten Acres Pharmacy in Sacramento, shows the process that she previously used to flavor children’s medication on Nov. 21, 2023.

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Fred Greaves

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CalMatters

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Pharmacists are also worried about losing customers.

“When we talk about flavoring we’re really talking about products that are manufactured, have expiration dates, and are quality controlled from the manufacturer themselves,” said Sonya Frausto, pharmacist and owner of a Sacramento pharmacy. “We’re not making a new compound.”

Assemblymember Tina McKinnor, an Inglewood Democrat, introduced a bill this year that would have prevented the confusion by excluding flavoring from being considered drug compounding. The bill passed overwhelmingly in the Legislature, but Gov. Gavin Newsom vetoed it.

“While I appreciate the author’s intention to maintain the current availability of flavored medication, this bill would create standards for California that do not meet the United States Pharmacopeia-National Formulary’s guidelines regarding compounding that have been put in place to minimize patients’ risk of harm,” Newsom wrote in his veto message.

The veto surprised some of the lawmakers who backed the bill.

“Anybody that’s been a parent knows that medication is only good when consumed, and when you have a child that is resisting taking the medication, that’s a big problem,” said Assemblymember Tom Lackey, a Republican from Palmdale who was a co-author of one of the versions of the bill.

Confusion over pharmacy rules

California is bound to the federal guidance because of a law Newsom signed in 2019 that requires the Board of Pharmacy to adopt regulations based on US Pharmacopeia standards.

US Pharmacopeia in late 2022 put forward an updated guidance on compounding that included stricter regulations, but was unclear on the issue of flavoring. Later, it released a supplement to the guidance saying that flavoring has been within the scope of drug compounding since 2004.

Pharmacists in April attended a Board of Pharmacy meeting where they urged regulators to exempt flavoring from the compounding rules. Board Vice President Maria Serpa told them “such action would run contrary to the board’s authority and would create conflict with federal law. California cannot adopt a lesser standard than those established” by US Pharmacopeia, according to meeting minutes.

Pharmacist Sonya Frausto, who owns and runs Ten Acres Pharmacy in Sacramento, shows the process that she previously used to flavor children’s medication. Nov. 21, 2023.

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Fred Greaves

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CalMatters

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Lobbyists representing pharmacies and flavoring manufacturers wrote several letters to the state board asking it to reconsider its position. “The board has treated medication flavoring as a pharmacy practice outside of the realm of compounding for decades,” they wrote in one letter.

But the board didn’t budge, and Newsom vetoed the bill that would have given the pharmacies more leeway.

Compliance, according to the US Pharmacopeia, would include stricter hygiene regulations as well as documentation of the compounding process. Some pharmacists are concerned the policies could drive up their costs.

According to a statement by the California Board of Pharmacy, “there are no provisions in pharmacy law that require a pharmacy to obtain a special or secondary license to compound nonsterile preparations,” which includes flavoring. “A pharmacy engaging in the practice of nonsterile compounding must comply with federal law, national standards and state law.”

California parents worry about kids’ medication

Parents are worried that the lack of flavors will deter their children from taking their medicine.

“Special needs parents like myself really struggle with children wanting to take their medication,” said Alvarez, whose oldest son, 9, was diagnosed with autism and sensory processing disorder.

Pharmacist Sonya Frausto, who owns and runs Ten Acres Pharmacy in Sacramento, helps a customer at the cash register on Nov. 21, 2023. Photo by Fred Greaves for CalMatters

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Fred Greaves

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CalMatters

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Frausto, the Sacramento pharmacist, also is a mother of two children. She said when medication is flavored, kids are more likely to take the full dose of the medication for the prescribed time.

“We want to make them feel comfortable,” she said. “Not doing flavoring sometimes can leave a lasting impression on the kids. They can say, ‘Oh I remember when I tasted that amoxicillin and it was disgusting,’ versus, ‘I remember taking that medication and it tasted like grape and I can continue to take the medication the next time I get prescribed the medication,’” she said.

Pharmacy chains including CVS and Rite Aid have stopped offering flavors in medications. Smaller pharmacies, like Frausto’s Ten Acres Pharmacy, an independent local pharmacy in Sacramento, are worried about the increased costs that could come with the federal guidance.

“I don’t have the capital to reinvest in new hoods or new types of ventilation systems based on what [the board’s] requirements are,” she said.

In California, the number of pharmacies that still offer flavoring fell to about 50, from more than 3,000 locations. This means families, especially those living in rural areas, could have to travel far to continue to get their kids’ medications flavored.

Alvarez said she would continue to give her children flavored medication, even if it means she has to drive a greater distance.

“It would be more of an inconvenience now,” she said. “But I think that would be the only way, just because I don’t see (my son) taking his medication otherwise.”

In the wake of the Eaton Fire, Altadena and Pasadena’s music community have really shown up to support fire survivors, especially fellow musicians who lost instruments and record collections.

That effort continues this weekend with a special donation concert at a Pasadena record store, with the aim of getting vinyl records back in the hands of survivors who lost their collections.

“You know, our name is Healing Force of the Universe, and I think that gives me a pretty clear direction… especially after the fires,” said Austin Manuel, founder of Pasadena record store, where Sunday’s show will be held.

The record donation effort is the brainchild of musician Brandon Jay, who founded the nonprofit Altadena Musicians after losing his home and almost all of his family’s instruments in the Eaton Fire. Through Altadena Musicians’s donation and registry platform, Jay said he and his partners have helped some 1,200 fire survivors get their music instruments back.

Brandon Jay.

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Robert Garrova

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LAist

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Now, that effort has fanned out to restoring vinyl record collections.

“All of that stuff evaporated for thousands of people,” Jay said. “Look at your own record collection and be like, ‘Wow, what if that whole thing disappeared?’”

You might know Jay from several bands over the years, including Lutefisk, a 1990s alt-rock band based in Los Angeles. He and his wife, Gwendolyn Sanford, composed music for TV shows, including Orange is the New Black and Weeds.

Jay plans to play some holiday tunes at Sunday's record donation show (which LAist is the media sponsor), along with fellow musician Daniel Brummel of Sanglorians. Brummel, who was also a founding member of Pasadena’s indie-rock sensation Ozma, said he was grateful to Jay for his fire recovery work and to Manuel for making Healing Force available for shows like this.

Brummel, who came close to losing his own home in the Eaton Fire, recalled a show he played at Healing Force back in March.

Ryen Slegr (left) and Daniel Brummel perform with their band, Ozma, on the 2014 Weezer Cruise.

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Even Keel Imagery

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“The trauma of the fires was still really fresh,” Brummel said. After playing a cover of Rufus Wainwright’s “Going to a Town,” that night — which includes the lyrics “I’m going to a town that has already been burnt down” — Brummel said his neighbors in the audience told him the rendition hit them hard. “It felt really powerful. And without that space, it just wouldn’t have occurred.”

Details

Healing Force of the Universe Record Donation Show
Featuring: Quasar (aka Brandon Jay), Sanglorians (Daniel Brummel) and The Acrylic.
Sunday, Dec. 14; 2 to 5 p.m.
1200 E. Walnut St., Pasadena
Tickets are $15 or you can donate 5 or more records at the door. More info here.

Topline:

The case: In September, the city settled a lawsuit brought forward by two brothers in their 70s who said they suffered serious injuries after an LAPD officer crashed into their car. Days before the $18 million settlement was reached, lawyers for the brothers said Feldstein Soto called an expert witness testifying for the plaintiffs and “attempted to ingratiate herself with him and asked him to make a contribution to her political campaign,” according to a sworn declaration to the court by the plaintiffs’ attorney, Robert Glassman.

The response: Feldstein Soto did not respond to an interview request. Her spokesperson said the settlement “had nothing to do” with the expert witness. Her campaign manager told LAist the city attorney had been making a routine fundraising call and did not know the person had a role in the case, nor that there were pending requests for her office to pay him fees.

What Jurado says: In a statement to LAist, Jurado said she wants to “make sure that the city’s legal leadership is guided by integrity and accountability, especially when their choices affect public trust, civic rights and the city’s limited resources."

What’s next: The motion needs to go through a few committees before reaching the full City Council. If it passes, the motion calls for the city attorney to “report to council in closed session within 45 days regarding the ethics breach violation and give updates to the City Council."

Every year in Santa Ana, Luis Cantabrana turns the front of his home into an elaborate altar in honor of La Virgen de Guadalupe that draws hundreds of visitors.

Along the front of the house, the multi-colored altar is filled with lights, flowers and a stained-glass tapestry behind a sculpture of the Lady of Guadalupe. Cantabrana’s roof also is lit up with the green, white and red lights that spell out “Virgen de Guadalupe” and a cross.

Visitors are welcomed with music and the smell of roses as they celebrate the saint, but this year’s gathering comes after a dark year for immigrant communities.

Luis Cantabrana stands in front of the stunning altar he built in front of his home in honor of La Virgen de Guadalupe. Every year, his display draws hundreds of visitors.

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Destiny Torres

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LAist

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Why do they celebrate? 

In 1513, the Virgin Mary appeared before St. Juan Diego between Dec. 9 and Dec. 12, asking him to build a church in her honor. Her image — a brown-skinned woman wearing a green veil with her hands together in prayer and an angel at her feet — miraculously appeared on his cloak.

To celebrate in Santa Ana, worshippers gathered late-night Wednesday and in the very early hours Dec. 12 to pray the rosary, sing hymns and celebrate the saint.

Cantabrana has hosted worshippers at his home for 27 years — 17 in Santa Ana.

The altar started out small, he said, and over the years, he added a fabric background, more lights and flowers (lots and lots of flowers).

“It started with me making a promise to la Virgen de Guadalupe that while I had life and a home to build an altar, that I would do it,” Cantabrana said. “Everything you see in photos and videos is pretty, but when you come and see it live, it's more than pretty. It's beautiful.”

The Santa Ana home's elaborate altar in honor of La Virgen de Guadalupe draws hundreds of visitors each year.

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Destiny Torres

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LAist

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Gathering in a time of turmoil 

Many also look to the Lady of Guadalupe for protection, especially at a time when federal enforcement has rattled immigrant communities.

“People don’t want to go to work, they don’t want to take their kids to school, but the love we have for our Virgen de Guadalupe,” Cantabrana said. “We see that la Virgen de Guadalupe has a lot of power, and so we know immigration [enforcement] won’t come here.”

Margarita Lopez of Garden Grove has been visiting the altar for three years with her husband. She’s been celebrating the Virgencita since she was a young girl. Honoring the saint is as important now as ever, she said.

“We ask, and she performs miracles,” Lopez said.

Claudia Tapia, a lifelong Santa Ana resident, said the Virgin Mary represents strength.

“Right now, with everything going on, a lot of our families [have] turned and prayed to the Virgen for strength during these times,” Tapia said. “She's a very strong symbol of Mexican culture, of unity, of faith and of resilience.”

See it for yourself

The shrine will stay up into the new year on the corner of Broadway and Camile Street.