MEDICAL MATTERS:We're in the grip of a drugs supply crisis, writes MUIRIS HOUSTON
IF I told you there was a country where it is not possible to buy over 50 essential prescription medicines and asked you to guess which country that might be, what would your answer be? Perhaps somewhere like Afghanistan, with its ongoing war? Or maybe an impoverished African nation with a poorly developed health service? At a push you might suggest a former Soviet Republic.
Welcome to our very own “Banana Republic”: as of May 1st there are over 50 licensed drugs I can legally prescribe for you but which you will be unable to source in a pharmacy in Ireland. The list includes a number of vital medicines, without which your health will deteriorate, perhaps to the point of requiring hospital admission, within weeks of you being forced to stop taking them.
A bad news story about our benighted health service is hardly new. But this is one of the most dangerous situations I have come across in over a decade of writing about medical matters. Yet it is something the authorities have known about for some time but have chosen not to tackle definitively.
Pharmacists have attempted to have the situation remedied. I understand they have had some support from the Irish Medicines Board but, despite repeated warnings of the danger to patients’ safety, the Department of Health has remained largely unresponsive to the issue. At its national conference last week, the Irish Pharmacy Union (IPU) again called on the department to do something.
Speaking at the conference, president of the IPU, Rory O’Donnell, said, “For a number of years, pharmacists and patients have had to put up with medicine shortages, causing significant distress all round. The latest example is the shortage of Eltroxin, a drug used to treat thyroid problems, a common disorder. It is not acceptable in this day and age that the health of some patients is compromised due to a shortage of medicines.”
Eltroxin is widely prescribed for people with an underactive thyroid. It is an essential medicine that replaces a hormone the body no longer manufactures. Once diagnosed with hypothyroidism, the patient can expect to take Eltroxin for the rest of their lives.
That is, if they can find a pharmacist with enough supplies to dispense the correct dosage. According to the IPU, it is not uncommon for pharmacies to be left without the drug for up to four weeks at a time. It is a fluctuating situation: they may have adequate supplies for a couple of weeks, followed by periods completely without the drug.
So what happens to patients when they are left without this essential medicine? Not surprisingly, it varies from person to person but, as a minimum, after about 21 days, they will experience fatigue and dry eyes, and their mood will dip noticeably.
There are isolated case reports of patients suddenly denied their Eltroxin who have become acutely psychotic and who have needed involuntary admission to a psychiatric hospital. Negative cardiac effects have also been shown to occur after the acute withdrawal of thyroid hormone, leading to higher blood pressure and possible heart failure, especially in older people. In addition, there is research demonstrating a worsening of cognitive function following acute hypothyroidism.
Why is there a drug supply problem? No one seems sure but it often involves established medications with a low unit price. Could it be part of an international price-gouging racket, which is the subject of a current investigation and a legislative proposal in the US senate?
What is abundantly clear is the need for urgent legislation here to ensure we have an adequate supply of vital medicines.
It must become the number one priority for the new secretary general of the Department of Health. In his previous post as chief of the Pharmaceutical Society of Ireland, Ambrose McLoughlin acted to strengthen patient safety in the sector: the same patients need him to act immediately on this issue to avoid serious harm.