South Florida Sun-Sentinel (Sunday)
Ivermectin demand creating conflicts
Mail-order suppliers setting up waiting lists as some pharmacists refuse to fill prescriptions
As the delta variant of COVID burns through Florida, demand has soared for the controversial drug ivermectin.
Driven by suspicion of mainstream medicine, particularly among political conservatives, COVID patients are competing for scarce supplies of this once-obscure remedy for head lice and parasitic worms.
Large chain pharmacies are refusing to fill prescriptions for a drug that the Food and Drug
Administration says hasn’t been shown to be effective against COVID. Mail-order suppliers are running out of pills and setting up waiting lists. Even feed stores, where the veterinary version of the drug had been a risky choice of last resort, are exhausting their inventories.
“If I give you a prescription now, chances are much greater that you won’t get it,” said Dr. Bruce Boros, a Key West physician who claims success in treating more than 800 patients with the drug. “We are seeing nothing but fights and pushback.”
Dr. Lisbeth Roy, a Boca Raton physician, said her patients have been refused the drug by pharmacists, particularly at the big chains.
“They take it to the pharmacy and the pharmacist says I don’t feel comfortable filling this,” she said. “I was really quite angry. Never before have I had a pharmacist say
I’m not going to fill this.”
As the chains refused to fill prescriptions, patients turned to mail-order suppliers. But now even their inventories are running down.
“In order to fulfill the abundance of orders we have received, we are temporarily pausing sales of Ivermectin,” states the website for Seven Cells, a pharmaceutical
supplier in Stuart. “Please join our wait list - we will prioritize orders on a first come, first serve basis when we restart Ivermectin sales in the middle of next week.”
At Ravkoo, a supplier based in Auburndale in central Florida, a representative said the company was no longer accepting new prescriptions. “Refills only,” she said.
At Break Free Pharmacy in West Palm Beach, pharmacist Todd Logan was told his supplier would only send him 10 boxes a month, an equivalent of 200 pills. That’s not enough to satisfy the multiple daily requests he receives from customers.
So Logan ordered the ingredients for ivermectin and plans to compound his own version of the medication. “I just got the box now and I am planning to try making a batch tonight.”
How the drug is being abused
Created in the 1970s, ivermectin has been a highly effective drug against parasitic worms and insects in humans, particularly in tropical countries. Doctors use it to treat diseases caused by intestinal worms such as river blindness, as well as head lice and scabies. Ivermectin’s inventors, William Campbell and Satoshi Omura, won the 2015 Nobel Prize for Medicine for their achievement.
Trials are taking place now on the drug’s use against COVID. Although ivermectin can kill the virus in the laboratory, the effect on the disease in humans remains unclear. Also unknown are the risks of extended periods of regular doses, which many are using to prevent COVID.
Large doses are dangerous. The drug can cause stomach problems, low blood pressure, skin rashes, dizziness and seizures. This hazard applies particularly to people who resort to veterinary formulations of ivermectin, which are highly concentrated for use in large animals like horses and cows.
Dr. Larry Bush, an infectious disease specialist at JFK Medical Center in Wellington, said he often gets asked for ivermectin by hospitalized COVID patients. He won’t give it to them.
“When someone says ‘It can’t hurt’ I tell them I don’t practice medicine under the idea it can’t hurt. I practice under what’s beneficial. Studies show it doesn’t work and the mega doses needed to possibly work are harmful.”
Dr. Goar Alvarez, assistant dean for pharmacy services at Nova Southeastern University and director of its pharmacy clinic, said pharmacists have a professional right and obligation to question medications they think might be harmful to the patient.
“It’s our job to also protect them, regardless,” he said. “I would argue that we would look to science to say does this make sense?”
In a statement, CVS said it leaves the decision to individual pharmacists.
“While we do not have a policy that restricts our pharmacies from filling prescriptions for Ivermectin, the FDA has made it clear that people should not use this medication to treat or prevent COVID-19. Our pharmacists are empowered to use their professional judgment when reviewing a prescription and a prescriber’s diagnosis.”
Unable to get the drug from pharmacists, some consumers have turned to feed stores that sell high-dosage versions for horses, a risky step that could have catastrophic consequences.
Calls to the Florida Poison Information Center-Miami soared in August from people who took the veterinary version of the drug, said Wendy Blair Stephan, the center’s health education coordinator.
But even people willing to risk poisoning themselves may no longer have that opportunity, as feed stores supplies run down.
“We’ve been out of it for close to a month,” said Chase, an employee of Grifs Feed & Pet Supply in Davie. “We recently got in a few boxes but we sold out in 24 hours.”
Unlike the human version, which is given in pill form, the veterinary formula is sold as an injection for about
$25 or as a paste for about
$16.
“About two months ago the demand started kicking in. There were whispers that people were taking it for COVID but it sounded silly so we disregarded it. Now we have people calling every day asking for it and we are forced to say call back,” he said. “There’s someone here now asking for it.”
A conservative favorite
The drug, inexpensive and easy to take at home, has become popular on the political right, its very lack of mainstream support becoming a factor in its favor to those scornful of vaccines, masks, the medical establishment and the news media.
“The problem is you can’t get ivermectin in this country, even if a doctor prescribes it,” said Fox TV host Tucker Carlson on a recent show. “Pharmacies like CVS and Walgreen’s — they’re not scary or anything — reportedly are refusing to fill the prescriptions because — why? We reached out to both of those companies and neither one denied it…. It’s totally cool to give like opioids to drug addicts, but ivermectin? We can’t have that. CNN doesn’t want it.”
But it’s not CNN who objects to the use of ivermectin to treat COVID, it’s the Food and Drug Administration and organizations of medical professionals.
“Ivermectin is approved for human use to treat infections caused by some parasitic worms and head lice and skin conditions like rosacea,” the FDA said in a statement. “Currently available data do not show ivermectin is effective against COVID-19.”
A statement from several medical professional associations called for an end to the use of the drug against COVID until studies could be completed.
“We are alarmed by reports that outpatient prescribing for and dispensing of ivermectin have increased 24-fold since before the pandemic and increased exponentially over the past few months,” read a Sept. 1 statement from the American Medical Association, American Pharmacists Association and American Society of Health-System Pharmacists. “As such, we are calling for an immediate end to the prescribing, dispensing, and use of ivermectin for the prevention and treatment of COVID-19 outside of a clinical trial.”
Opposition from the medical establishment has not stopped efforts to win support for the drug in Florida. In conservative Polk County, which lies between Tampa and Orlando, a Republican county commissioner attempted to get his colleagues to vote to send a letter to the governor urging support for ivermectin.
“I am trying to see that people get access to the human form so they don’t have to run and get the horse dewormer,” Polk County Commissioner Neil Combee said in an interview. “They are taking the animal version because don’t know how to get human form and that’s the wrong thing to do. We need to make sure people who want to use it at least have a doctor they can ask and a pharmacy that will fill it if a doctor prescribes it.”
Although he couldn’t win support from a majority of the Polk County Commission, he and a colleague sent the letter anyway.
Christina Pushaw, press secretary for DeSantis, said he has not been asked to get involved.
“As far as I am aware, Governor DeSantis has not received any formal requests from Florida elected officials to endorse ivermectin or use it alongside monoclonal antibody treatment,” she said. “In Florida, there is no regulation that would prevent pharmacists from filling valid prescriptions written by physicians.”
The scenario could change with the new Florida surgeon general, Dr. Joseph Ladapo, who assumed the role this week and praised ivermectin in a Wall Street Journal column last year called “Too Much Caution Is Killing COVID Patients.”
Combee said he plans to send a letter to the new surgeon general. “He seems open to doing things differently.”
Broward one of the first
Early in the pandemic, when doctors were desperate for weapons against the disease, many turned to ivermectin for its anti-viral effects. One of the first to try it was Dr. Jean Jacques Rajter, a lung specialist at Broward Health, after a patient’s son begged him to administer it to his mother. He did, and within days, he said, she recovered.
Rajter would go on to promote the drug at the health system’s four hospitals, where 173 COVID patients were treated with ivermectin. In a paper published in a medical journal, Rajter said his observational study, while small, found “ivermectin was associated with lower mortality during treatment of COVID19, especially in patients with severe pulmonary involvement.”
But as the pandemic continued and other medications became available, Broward Health physicians steered away from ivermectin.
“There was not enough data to support its effectiveness in comparison to other proven therapeutics,” spokeswoman Jennifer Smith said.
Doctors refuse to give it out
Dr. Larry Bush, the infectious disease specialist at JFK Medical Center in Palm Beach County, is one of the many doctors who refuse patient requests to prescribe ivermectin.
Bush hopes ivermectin loses popularity with the introduction of a new pill to be used to treat COVID, molnupiravir, which is in clinical trials and could be available by the end of the year. Bush says it could become a “proven” alternate for ivermectin.
With many pharmacists and doctors refusing to dispense the drug, people seeking ivermectin turn to online databases and social media sites that list doctors willing to prescribe the drug.
Jim Sidel of Ocala said he and his wife both took ivermectin after Dr. Boros, the Key West physician, prescribed it. His wife had COVID symptoms, he did not. At the time, he was able to fill the prescription at Publix. “My wife took a large dose and within 24 hours she no longer had a fever. It seemed to stop COVID in its tracks. At the time the standard of care was ‘do nothing until you get critical.’ “
Another physician willing to prescribe it is Dr. Nabeel Kouka of Aventura, who estimates he prescribed ivermectin for 250 to 300 patients, achieving what he believes to have been excellent results. But now it’s become harder for patients to fill prescriptions.
After Kouka prescribed the drug to one patient recently, he received a notice from a Hollywood CVS headed “Script Clarification” and stating “NOT APPROVED FOR COVID BY FDA.”
He said his prescriptions have helped severely ill patients beat the disease and helped those who had been exposed to it escape with only mild cases. He says patients should have the freedom to take the medications they and their doctors think will help them.
The shortage and crackdowns by chain pharmacies have driven people to desperate ends, he said.
“People are afraid now. Before I was writing for one month and with two refills to cover them for three months. Now they are asking me please give us the three months together because we don’t know if it will be still available tomorrow.”
“Now the problem is they’re getting the medicine from the horses. People are buying it from India. I have patients asking me is the Indian medicine good? I say I don’t know. I doubt it. I’m not against India, but people are selling it online. How do you know if it’s legit?”