Medicines shortag e hits critical point
Supplies of more than 160 vital drugs are dangerously low as pharmacy union voices ‘increasing concern’ that dearth poses serious health risk to elderly and psychotic patients forced to switch or even come off their meds
A SEVERE shortage of drugs commonly used to treat the elderly and psychotic patients is having a serious impact on hospital care, the Irish Mail on Sunday can reveal.
The Health Products Regulatory Authority (HPRA) confirmed that, as of this summer, more than 160 medicines are in short supply. These include paracetamol, EpiPens to treat life-threatening anaphylaxis, as well as forms of hormone replacement therapy (HRT).
However, vital anti-psychotic drugs, commonly used to treat dementia, and tranquillisers are also either in very low supply or cannot be sourced at all. It means many elderly and psychiatric patients have to ‘abruptly come off one medication and start another’, according to one medical source at a Dublin facility.
The source told the MoS: ‘While the shortage continues, doctors have been asked not to initiate any new prescriptions of some drugs. But for existing prescriptions, it can be very hard for the patient to come off a drug if it’s not available, particularly because of the nature of the drugs which control mood and behaviour.
‘On same drug for years so switching can be harmful’
‘Doctors have been trying to get around it, prescribing higher or lower strength doses of the tablet but then when it’s not available altogether it’s difficult.’
The Irish Pharmacy Union (IPU) this weekend said medicine shortages are causing undue stress, fear and anxiety for patients, and in some instances is putting their health at risk. Patients in nursing homes and psychiatric facilities are particularly impacted by the shortages of certain drugs.
The MoS spoke this week to staff and family members at two Dublin facilities where patients’ medications have been switched because their usually prescribed drugs are no longer available. One healthcare worker said the altered medication can have a ‘dramatic’ impact on patient care and that the drug shortages are of ‘increasing concern’.
The source said: ‘I think there’s just this attitude now that if we can’t get that drug, we’ll switch to that one.
‘But some clients have been on the same drug for years and switching can be harmful.
‘Especially with dementia, the way a person behaves can alter dramatically depending on what meds they are on. The changes can be dramatic.’
The family of one elderly parent at a nursing home in the capital said he became distressed after his medication was ‘chopped and changed’ due to supply shortages this year. The man’s son said: ‘You wonder how much of his agitation was due to the drugs changing.’
The IPU confirmed there has been a ‘nationwide shortage of critical prescription medicines’. And it urged the authorities to take ‘immediate steps’ to address the supply problem. A spokesman said: ‘On a regular basis there is a shortage of one medicine or another and in many cases a nationwide shortage of critical prescription medicines. It is imperative that immediate steps are now taken by the relevant authorities to ensure that there is a continuous supply of medicines available to pharmacies, and in turn their patients.’
Medicines for Ireland, an umbrella organisation representing pharmaceutical companies, said the Government needs to undertake ‘a fundamental reform of medicine policy in Ireland’.
The group warned that, in the absence of critical reforms and a long-term strategy for medicine procurement, Irish patients will find it increasingly difficult to access affordable life-saving medicines. Longstanding supplychain problems, the impact of Brexit and the pandemic, and high levels of demand have all contributed to medicine shortages.
Sandra Gannon, chief executive of Irish pharmaceutical firm Azure, said Brexit will continue to have a ‘profound effect’ on the supply of drugs into the country. She said that Ireland’s position as a small island on the edge of Europe with a relatively small market means it will continue to be overlooked by the big pharmaceutical companies.
Alarmingly, she said prescribing doctors often rely on unlicensed drugs to fill the shortfall.
Ms Gannon told the MoS: ‘Unlicensed drugs are supposed to be used in exceptional cases and on a person-by-person basis.
‘You’re not supposed to have thousands of people using unlicensed drugs at any one time; it’s not supposed to be the norm.
‘Take, for instance, paracetamol. It went short in May, June and July.
There are just two suppliers in the market. The price for a 100-pack of paracetamol at 500mg, standard strength, is reimbursed here at €1.60. The average in the rest of Europe is €3.51. In Finland, it’s €3 and in the UK it’s €2.80.
‘Where a medicine is in short supply, companies will allocate available stock to markets that pay the most. Our position on the edge of Europe isn’t helping. Big pharmaceutical companies might send a consignment into Europe, might send it to Belgium for example and then distribute by road from there.
‘But we’re a sea trip away. When the UK was in the EU it might have been worth it, but increasingly it seems less so.’
The HPRA said the response to the drugs shortage must be a ‘multifaceted’ one involving the Department of Health and other agencies
A spokesman said: ‘Medicine shortages can originate at any point in the supply chain and can involve and impact many different stakeholders. Medicine shortages require a multi-faceted, multi-stakeholder response to ensure patient safety, continuity of care and protection of public health.
‘To that end, at the request of the Department of Health, the Health Products Regulatory Authority assumed a coordinating function in Ireland’s response to the manage
‘Our position on the edge of Europe isn’t helping’
ment of medicine shortages.’ The HPRA admitted that, ‘in some cases’, doctors are accessing medicines licensed abroad but not here, to fill the shortfall.
In response to queries about the shortage of licensed medicines, a spokeswoman said: ‘In the case of medicines used most often in Ireland there are typically multiple forms, strengths, brands and generic medicines from various sources.’
She added: ‘In the event [of] short supply issues for individual medicines, alternative options such as alternative strengths, brands and generic medicines will usually be available to ensure continuity of treatment.’
Medicines for Ireland (MFI) chair Padraic O’Brien warned Ireland would continue to suffer from supply issues. He said: ‘Global supply chain bottlenecks, soaring energy costs and rising inflation are causing major disruption to the supply of medicines in Ireland. As a smaller market, Ireland is more likely to be badly impacted by inflationary pressure and as costs continue to rise, market conditions are becoming increasingly unviable for companies supplying generic medicines to Irish hospitals and pharmacies. This could potentially lead to critical shortages across our healthcare system with health implications for Irish patients.
‘MFI believes supply security can be dramatically enhanced by the implementation of targeted pricing adjustments. In some cases, our reimbursement prices for certain medicines are too low compared to other countries across the EU and price adjustments in Ireland are historically downward only.
‘As the largest supplier of medicines to the HSE and patients directly, Medicines
For Ireland is willing to work with Government to modify current drug pricing policies in order to protect patient access to high-quality affordable treatments.’
Irish Patients’ Association co-founder Stephen McMahon said the medicine shortage is ‘worrying’. He said: ‘It’s particularly so for patients with chronic illness.
One thing we’re always told as patients is to take your medicine regularly, don’t skip it – and with good reason. But here are patients who are having to do that very thing.’ Mr McMahon also pointed to price differences between branded and generic drugs as a possible cause why some facilities, particularly private facilities, might not be accessing certain drugs.
‘You could have a station where the bean counters are saying, “not those brand drugs”, [because they] are too expensive.’ In response to queries from the MoS, the department said medicine shortages are ‘increasingly prevalent worldwide over the past decade’. The department said it requested the HPRA to co-ordinate ‘Ireland’s response to the management of medicine shortage’.
A spokesman added: ‘In the case of medicines used most often in Ireland, there are typically multiple forms, strengths, brands, and generic medicines available from various sources. In the event that there are some supply issues for individual medicines, alternative options such as alternative strengths, brands, and generic medicines will usually be available to ensure continuity of treatment.
‘In some cases where the medicine originally prescribed for the patient is unavailable, patients may be switched to a suitable therapeutic alternative following appropriate consultation with a healthcare professional.’