Managing drug shortages – pharmacists can help

DR SATISH JANKIE and

PROF LEXLEY PINTO PEREIRA

WITH reference to the report “Medical drug supply shortage hits Trinidad and Tobago” in the Sunday Newsday of January 16, this is neither a new phenomenon, nor is it surprising.

The global pandemic has put health systems under significant pressure and stretched some to capacity. The pandemic has tested the supply chain of drugs not just in TT but also in Europe, the US, China, India and several other countries, exposing cracks in the supply chain, with unprecedented demand caused by the large numbers of critically ill covid19 patients.

Two publications from the Faculty of Medical Sciences have highlighted the situation: "SARS-Cov-2 and drug shortages – Trends and lessons from a Caribbean perspective," published in the Caribbean Medical Journal in October 2020, and "Covid19 causes price increases and reduced stocks of drugs in Trinidad, West Indies," published in Academia Letters in 2021.

The pandemic disrupted the supply chain right from India and China, which are the main sources for active pharmaceutical ingredients. Manufacturing plants were affected as staff fell ill or were contact-isolated, impacting capacity to meet global demands.

The shortage of methylprednisolone mentioned, if accurate, is disturbing but not unexpected. Shortage of emergency medications became a major concern early in the pandemic.

In the US, low supplies of sedatives and painkillers forced clinical pharmacists to allocate much of their time to drug acquisition and conservation.

COVID WORSENED DRUG SHORTAGES

Drug shortages are not new, but the tsunamic impact of covid19 pushed first-line drugs to exhaustion with reliance on second/third line drugs. This occurred for corticosteroids, analgesics, neuromuscular blockers (paralytics for the many ventilated patients), and antimicrobials.

Europe was not spared this onslaught and experienced scarcities of critical drugs to manage covid19 patients. In the US, the American Society of Health-System Pharmacists (ASHP) conducted weekly reports on drug availability.

Clinical pharmacists spent considerable time identifying drug shortages, considered alternatives, assessed possible risks involved and critically monitored drug use and wastage.

This kind of approach could be adopted in the current scenario by local pharmacists, whose role should be expanded to clinical pharmacy on the wards.

The potential of drug shortages provoking the entry of counterfeit medications cannot be ignored. Medications are prepared for a particular zonal climate and our country falls into zone 4.

So medications coming in surreptitiously through the “suitcase trade” may not be designed for the specificities of our zone, so that the shelf life may be shorter than the stated expiry date. This danger is an alert for community pharmacies to discourage this practice, which could result in adverse drug effects within our population.

PHARMACISTS CAN HELP Only 16 per cent of pharmacists in Trinidad and Tobago reported "good" or "very good" stock levels six months into the pandemic. Most pharmacists received drugs less frequently and the stock was often rationed by pharmaceutical distributors to ensure equity across the country’s pharmacies.

As the pandemic progressed, price increases were exponential. The Chronic Disease Assistance Programme (C-DAP) was negatively affected and pharmacists reported items being unavailable from contracted state suppliers.

The profession of pharmacy in more developed nations embraces many additional responsibilities that are not available to our local pharmacists. The role of the pharmacist extends beyond dispensing of medications and pharmacists in TT can provide a greater service than they currently perform.

The profession is evolving to encompass specialty areas, such as clinical pharmacy, chronic disease prevention and management, pharmacovigilance and drug safety.

Pharmacists are easily accessible health care providers, who can be seen without an appointment and with short waiting time. The fact that pharmacies in the country remained open throughout the pandemic signals the importance of this group of health care givers.

Dr Satish Jankie and Professor Lexley Pinto Pereira work in the Faculty of Medical Sciences, UWI, St Augustine campus.