Here is a bitter pill to swallow. In January, according to the Therapeutic Goods Administration, 261 drugs were affected by shortages.
Some of these shortages, according to a report by NewsGPwere due to an unexpected increase in consumer demand – and perhaps tellingly these included diazepam (used to treat anxiety, alcohol withdrawal and seizures), gabapentin (an anticonvulsant) and l omeprazole (heartburn and indigestion).
If that’s not a portrait of a nail-biting nation, then what is?
Of the 31 critical shortages cited by the TGA – meaning they were not available – most were of injectable steroids, antibiotics and anesthetic agents.
Too dependent on offshore manufacturers
NewsGP noted that these shortages were similar to shortages seen overseas, which is particularly troubling as Australia imports 90% of its pharmaceuticals from overseas.
What’s going on? Australia has always been vulnerable to shortages, but that vulnerability has been put to the test by the COVID-19 pandemic.
The severity of China’s manufacturing lockdowns and disruptions is just one factor.
And, of course, there is the fucking war.
But there are also bizarre factors at play.
So we reported in June that the diabetes drug Semaglutide, marketed under the brand name Ozempic, was running out as it became a popular treatment for weight loss.
The TGA has quietly issued a statement, addressed to GPs, urging them to stop prescribing the drug for obesity management.
The story only broke because hundreds of people were taking to TikTok not just to show off their slimming bodies, but to inject the drug as a form of pulp Fiction– performance art.
So how are we doing now?
On Thursday, the TGA listed 340 medicines we are short of – significantly more than in January – and included 39 critical shortages.
On top of that, the TGA said shortages of 83 more drugs were expected.
Shortages are largely managed by doctors prescribing similar drugs – which is not always satisfactory and can be problematic – or where regulated substitutes are not available, the TGA has approved “unregistered” products under of Section 19A, a decision made ”in the interest of public health”.
Last month, NewsGP released another report, calling the situation “unsustainable.”
RACGP Victoria President Dr Anita Muñoz told the site that “switching medications increases the risk of errors and urged doing as much as possible to mitigate disruption”.
She said: ”Cutting, switching and making last minute changes can confuse patients and only increases the chances of a medication mishap happening.
“We really can’t rely on that as a strategy.”
Sometimes there’s no substitute
Thursday I called a friend who works as a country doctor. I often call him for information on a story and he asks me not to use his name.
About two weeks ago, this GP received an email telling him that Ritalin, an ADHD medication, was not available.
“We get these kinds of emails all the time… from the TGA or the National Prescribing Service, but this one was the biggest,” he said.
“Almost all children with Attention Deficit/Hyperactivity Disorder take Ritalin. ”
The email advised doctors “to try to find a substitute”.
But Ritalin is a unique drug. There’s no real substitute, and ADHD children are “very hard to control behaviorally anyway.”
He said Ritalin was the most effective drug for the disease “and anything you give them, which is usually an antidepressant or a behavior modification drug, is never so good”.
This doctor works in Ballarat. When parents come to see him and have accurately discerned that their child has ADHD, he informs them that ADHD can only be formally diagnosed by a pediatrician or psychiatrist and that there is a six month wait for everything kind of specialist.
“On top of that, I’m now saying, well, yes, your child needs Ritalin, but GPs aren’t allowed to prescribe Ritalin – and there’s none available at the moment in any way.”