When a medication doesn’t exist in the right dose, form or formulation, patients are left with few options – a challenge in rural areas like La Plata County.
That gap is filled by compounding pharmacies such as Rivergate Pharmacy and Compounding Center in Durango.
“Commercial products are made for the masses,” said Lori Kearney, pharmacist and owner of Rivergate. “But not everybody can take them. What we do is individualized.”
Located in the Animas Surgical Hospital complex, Rivergate has a small compounding lab behind the pharmacy counter.
There, stainless steel scales sit beneath a protective hood that pulls stray powder into HEPA filters. A planetary mixer spins creams until they reach a smooth, uniform texture, while an ointment mill presses medication through rollers so finished products don’t feel gritty on the skin.
This is the world of pharmaceutical compounding – the practice of combining, mixing or altering medications to meet the specific needs of a single patient or animal.
Unlike mass-produced drugs, compounded medications are prepared one prescription at a time. That can mean removing dyes or preservatives for someone with allergies, adjusting a dose that doesn’t exist commercially, or turning a pill into a flavored liquid for a cat that refuses tablets, Kearney said.
“It’s basically because everybody’s an individual,” she said. “I’m making drugs for that individual.”
For many La Plata County residents, that individualized care can be life-changing, and in some cases, the difference between being able to remain in a rural community.
April Stewart, a Bayfield resident of 25 years, said Rivergate’s services have been an integral part of her family’s life for more than a decade.
Stewart is the mother of seven adopted children. One of her sons is medically fragile and relies on a feeding tube, meaning he cannot take medication orally and requires compounded prescriptions every month.
“Rivergate has been compounding meds for him for over 10 years,” Stewart said. “Without a compounding pharmacy, it would be a lot more difficult for us to get him his medication.”
She said having a local compounding pharmacy makes it possible for families like her’s to live in Southwest Colorado.
“It offers high-needs kids access to a rural community,” she said. “If they weren’t here, I don’t know that we would truly be able to live here.”
Beyond the medications themselves, Stewart said the pharmacy’s reliability and responsiveness ease the stress of managing complex medical care.
“With a medically complex kiddo, we have medication changes, trial-and-error meds and insurance hurdles,” she said. “Having one part of his care network that’s local and trustworthy takes a lot of stress off.”
Compounding serves a wide range of purposes in medicine, from addressing unmet clinical needs to responding to emergencies and medication shortages.
Kearney recalled instances in which veterinarians contacted Rivergate after tourists’ dogs became seriously ill shortly after arriving at high altitude.
“We stop what we’re doing and get it done within hours,” she said. “Sometimes it’s lifesaving medication.”
In another case, Kearney said a patient came in requesting large amounts of topical pain medication for an infected, open wound. Instead of simply filling the request, she contacted the patient’s physician and helped develop a custom-compounded powder “bandage.”
The powder can be mixed with antibiotics, antifungals and pain relievers such as lidocaine and then applied in layers to a wet wound. It absorbs moisture and forms a dry, protective surface. Within a few weeks, the wound healed.
That kind of problem-solving, Kearney said, is what defines compounding.
“It’s equal parts science and problem-solving,” she said.
Rivergate is one of the only compounding pharmacies operating at this level in Southwest Colorado. The nearest comparable facilities are in Farmington or Grand Junction.
“Here in Durango, we’re pretty isolated compared to metropolitan areas,” Kearney said.
That isolation can make the pharmacy a critical backstop. During past medication shortages, including a year when children’s flu medicine was nearly impossible to find locally, Rivergate compounded medications to meet community demand.
Compounding medications that resemble commercially available drugs is a significant part of the practice and also a frequent source of controversy.
Drug manufacturers have argued in court filings that compounded versions of medications such as Ozempic are “unregulated” and unsafe. Kearney said that characterization misrepresents traditional compounding pharmacies.
“We are regulated,” she said. “The Board of Pharmacy inspects our lab, our records, our storage, everything we do.”
Compounded medications themselves are not FDA-approved products, but the ingredients used to make them must be FDA-approved. Unlike branded drugs that undergo large clinical trials, compounded medications are customized for individual patients and do not go through a separate multiyear approval process.
As a 503A pharmacy, Rivergate is legally limited to compounding medications for one single patient at a time and must avoid producing anything considered “essentially a copy” of a commercially available drug.
To do so legally, there must be a meaningful difference, such as a different dosage form, strength or formulation.
“It usually comes down to sensitivities,” Kearney said, “or a dosage form that doesn’t exist.”
When providers ask whether multiple drugs can safely be combined into a single cream, capsule or powder, the answer comes from research, not guesswork.
The pharmacy relies on pharmaceutical reference texts such as Remington’s Pharmaceutical Sciences, clinical literature and its membership in the Professional Compounding Centers of America, which conducts compatibility studies and publishes formulations.
“If we have compatibility issues, we’ve got our resources,” Kearney said. “We check the literature or tap into consultants. It’s all based on what’s gone before us – basically, research.”
She has considered expanding into sterile compounding, which includes injections and eye drops, but the investment and regulatory requirements are significant.
“That might be for the next generation,” she said, nodding to the young pharmacist filling a prescription.
jbowman@durangoherald.com
