Friday, January 20, 2023

Looks like the medication shortage is getting worse


In a blog post last September, I cited a news report that claimed the supply of vital US medications was getting worse.

As of Thursday, the Food and Drug Administration reported 184 drug shortages nationwide. The Association of Health-System Pharmacists put the figure higher, tracking a scarcity of 210 drugs.

U.S. drug shortages may be caused by a host of issues, including manufacturing and quality problems and delays and discontinuations, along with a regulatory system seen by many healthcare providers as more reactive than proactive in making fixes.

It's a long-standing problem worsened by supply chain issues and huge demands during the COVID-19 pandemic, with many drugs languishing on the shortage lists for months or years.

There's more at the link.

It seems the European Union is battling the same problem.

The European Commission (EC) has begun stockpiling drugs and organising joint procurement of pharmaceutical supplies following a Europe-wide medicines shortage.

A surge in demand for drugs across the European Union has pushed the European Medicines Agency to register shortages across drugs including penicillin and paracetamol. 

In response, the EC has started stockpiling drugs, obliging manufacturers to guarantee supplies, and organising joint procurements. Regulatory reform is also in the pipeline.

. . .

Greece banned the export of drugs earlier this month, after pharmaceutical companies were found to be importing drugs into the country at low prices before exporting them again with considerable mark-ups.

France has banned the sale of online paracetamol ... to ensure the availability of stock in shops.

The UK has enacted multiple Serious Shortage Protocols, allowing pharmacies to substitute prescriptions of drugs in high demand and low supply with alternatives under less pressure.

Again, more at the link.

A couple of weeks ago, while picking up a prescription for my latest medical misadventure, I asked the pharmacists what their recent experience has been.  They reported routine shortages of up to 150 medications, with some causing delays of one to two weeks in filling prescriptions - long enough to pose a serious health risk to people who really need their medications.  That's affected me personally on two occasions so far, although fortunately I've had reserves to cover the gap between prescribing and filling the prescription.

I've mentioned on several occasions in these pages that if you're reliant on prescription medications, it's a very smart move to build up reserve supplies of them for precisely this eventuality.  I've gotten my wife and myself to the point that we have 180 days (6 months) of reserves for every essential prescription medication we take.  It's not easy to do that legally, but if you have a sympathetic doctor who's willing to write a prescription for an extended supply, and your pharmacist is willing to accept payment in full, in cash, rather than bill it to a medical insurer (which obviously can't be expected to pay for such reserves), it can be done.  If those issues get in the way, there are alternatives.  It may not be legal, but I know a lot of people buy their medications outside the US, either by traveling to Mexico or ordering them from India or other countries.  The latter runs the risk of having them intercepted and confiscated by US customs authorities, but you pays your money and you takes your choice.

Another useful solution is to keep a basic supply of common antibiotics in reserve.  Obviously, if you don't know whether or not you're allergic to any of them, don't stock them:  but if you've taken them before and know your body won't react badly to them, I think you'd be silly not to have an emergency stash.  Many common antibiotics like amoxicillin, azithromycin (the so-called Z-Pac), bactrim (sulfamethoxazole/trimethoprim), cephalexin, ciprofloxacin, doxycycline and penicillin are available in the form of animal medications, manufactured in pill form to human standards of hygiene and purity, and can be purchased without a prescription, in person or online.  A surprising number of people take advantage of this loophole.  Again I stress, you can't just take them unless you know what you're doing, what your medical issue is, and what the correct antibiotic and dosage is to treat it:  but if you know all that, there's no reason not to have the necessary supplies on hand.  In many parts of the Third World you have no choice but to do so, because there's no doctor or nurse or clinic available for scores or hundreds of miles.  That's where I learned about such things.

Forewarned is forearmed.



Simeon said...

I'm T2D and on Metformin. I've been throwing myself into diet and exercise to try and reduce my medication. So far its working. I always pay cash for my medicine, even if part of it is taken care of by the insurer. I haven't had a problem doing this at my current pharmacy.

Jim said...

I've gradually built up a three month supply of my essentials except the most recent two. The one I have up to around two weeks extra and the other is a temporary so I won't worry about it.

Aesop said...

1) Tarascon Pocket Pharmacoepia 2020 (most recent ed. I could find)

2) Mosby's 2023 Nursing Drug Reference

That should be everything you need to help make your choices. The PDR isn't worth it for laymen unless you're going to med school, but will do in a pinch, and is better than nothing.

Greg said...

There is one other alternative when bucking the medical establishment: Concierge medicine. It's not cheap, and as you say, scripts are filled cash upfront, whether you use a local pharmacy or out of state. There are a number of them out there, the one I have experience with, getting Ivermectin and Hydroxychloroquine from is called Synergyhealthdpc(dot)com. It's telemedicine on a large scale, and with a membership, you can consult a nurse practicioner or doctor at any time.
I can also recommend Jasemedical(dot)com as a source of an antibiotic package originally intended for world travelers, that I obtained as a backup plan if ever needed.
There are likely other alternatives out there, but these have worked for me with very little difficulty. I have no other connection to them except as a client.

BadFrog said...

The UK is running out of basics like cough medicine and Lemsip, our equivalent of Tylenol cold and flu. I guess it's just part of making our new arrivals feel at home.

Old NFO said...

Have you looked at the cough drops aisle lately? Damned near empty, and good luck finding any kind of nasal spray lately... Grrr...

Jennifer said...

Ordering from overseas is still completely legal. I've done it 1-2x per year for over a decade using I have had one shipment confiscated by US Customs. I contacted ADC and they replaced it immediately, no questions asked.

Obviously, a person wouldn't stock any drug that he knows he's allergic to, but it bears keeping in mind that a person can develop an allergy to any thing at any time, including drugs that were previously used without issue.

Also, you don't have to know how to use them if you aren't comfortable with that, though it would be wise to learn everything you can about them and your conditions. A lot of antibiotics have interactions with food that can negate (or potentiate) their efficacy. A doctor or drug reference will help. Ideally, you would only be stocking these drugs so that you have them available when a doctor prescribes them for you. Look to Venezuela. They still have doctors who can prescribe essential medications. They just don't have the meds.

"Fish" antibiotics are still sold without a prescription in the US (until June 2023, when the FDA will remove them from the shelves) in the exact dosages as used for people.

There are a lot of articles on this very topic and on the individual antibiotics (as well as a lot of critical OTC medications to stock up on) at the Prep School Daily blog. Peter's got a link to it way down on this page under his "Reciprocal Blogroll" list.

Seal Of Lion said...

I'm on a injectable med in 'Glucagon-like peptide-1 receptor agonist' family for diabetes. So far mine hasn't had shortages but diabetics are starting see them in other types because the FDA authorized them to be used as weight loss drugs. And of course that has gotten people demanding they be prescribed to them.

Anonymous said...

Since i have had problems with recurrent infections in a wound that has reopened several times the providers seem to be willing to write me a script to keep on the shelf as long as I swear on my mothers grave that I will make an appointment ASAP if I start them. The problem with 90 day supply meds is that I believe the pharmacy can’t refill them by law until you are down to certain level. I think you could refill them at another pharmacy if the doctor will give you a different script. I did manage to get ahead on some of mine when I spent three months in a nursing home.

Cheri in the east said...

It is getting harder to get veterinary antibiotics. The USDA is putting pressure on supply stores to require a vet's prescription, even online. I'm not sure about fish or reptile antibiotics (the majority of veterinary tablet antibiotics) but any others are getting hammered hard. They say it is to limit the antibiotics in our food supply, but the outcome is that it is getting harder to do anything that doesn't have their sticky fingers in it.

RCPete said...

I'm not sure about animal meds being available without a prescription. Oregon (dominated by the Antifa/Nannys) seems to require a Vet's Rx. This seems to have been doubled down after Ivermectin got popular, but it was starting earlier.

I'm not sure if it's all meds, but you'd need to check.

I built up my stash by taking advantage of the lead time in refills. A 90 day supply could be refilled at 83 days, and my doctors have never noticed (or cared) that the interval between new prescriptions isn't a multiple of 90 days. For some meds, I've been on them a long time, and the backup supply is comfortable.

Heidi said...

Don’t forget Mark Cuban’s Cost Plus Drugs. My husband gets meds there if they are less than his co-pay. They have a limited number of medications, but their prices are incredible. You do need a doctor’s prescription.

Ritchie said...

I require B-12 injectable, which many weight loss clinics will supply in home do-it-yourself kits.