Which medicines could be in short supply in 2022?

Toilet paper aside, COVID-19 has severely impacted global medicine supply chains.
 
When the pandemic first unfolded, stockpiling and wholesaler restrictions saw temporary localised shortages of salbutamol (Ventolin) despite no issues with supply at the manufacturer level. Certain antidepressants, contraceptives, hormonal replacement therapies and antihypertensives were also temporarily affected.
 
Even a run on over-the-counter medicines saw items such as children’s liquid paracetamol being placed temporarily ‘behind-the-counter’ to control supply.
 
Overall, the number of medicine shortages in Australia reportedly rose by 300% between 2019 and 2020.
 
To curb ongoing shortages, three main strategies have since come into effect.
 
Midway through 2020, the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia, in consultation with the Department of Health, enforced limits on pharmacist dispensing and sales of certain prescription and over-the-counter medicines.
 
New legislation was also passed in August 2021 allowing pharmacists to substitute a different PBS-listed medicine when a patient’s usual medicine had been deemed to be in ‘serious scarcity’ under the Serious Shortage Substitution Notice (SSSN) scheme.
 
Finally, a new initiative called the Medicines Supply Security Guarantee was announced by Federal Health Minister Greg Hunt at the end of last year as part of a deal with the pharmaceuticals industry, which will see generic medicines companies hold a minimum of 4–6 months of onshore stocks of critical medicines.
 
These strategies have helped, but Australia remains vulnerable to shortages given we import much of our pharmaceutical goods from overseas.
 
‘Restrictions are still in place and they have prevented an already dire situation getting worse,’ Sydney pharmacist Dany Mikhail told newsGP.
 
‘There are numerous products in short supply to the point where it would nearly be impossible to list from memory.’
 
The latest medicines to see shortages offshore are antidepressants in the UK, and antivirals, potassium chloride and anaesthetic agents in the US. Inhaled budesonide, recommended as a potential treatment option for mild-to-moderate COVID by the National COVID-19 Clinical Evidence Taskforce in Australia, also saw a recent temporary shortage due to increased demand in Canada.
 
Such shortages are proving to be a difficult pill to swallow not just for patients, but for doctors and pharmacists as well.
 
A poll of UK GPs in June 2021 revealed growing medicine shortages have forced more than four in five GPs to prescribe second choice drugs, driving up workload and sometimes placing patients at risk.
 
With an ever-growing Omicron crisis, it is likely we will see further shortages locally which will have a flow on effect for GPs.
 
When asked specifically about the supply of COVID-19 medicines for the treatment of mild-to-moderate disease, a TGA spokesperson told newsGP that the regulator has been working closely with medicine sponsors to monitor supply.
 
‘There was an increase in demand of inhaled budesonide medicines in October 2021, following its recommendation by the National COVID-19 Clinical Evidence Taskforce as a COVID-19 treatment,’ the spokesperson said.
 
‘The TGA worked with the sponsor, AstraZeneca, and state and territory health department representatives to manage current and anticipated demand, including for off-label use for COVID-19. The TGA has not received any shortage notifications [since] for inhaled budesonide.
 
‘The supply of sotrovimab [sold as Xevudy] and casirivimab/imdevimab [sold as Ronapreve] is distributed through the National Medicines Stockpile and the TGA has not received [any] shortage notifications for these medicines.’
 
The TGA continues to closely monitor medicine shortages in Australia and if needed, can also place restrictions on prescribing as it did for Ivermectin in September 2021.
 
Its online medicine shortage reports database provides health professionals with a quick and easy way to search for current, anticipated and resolved medicine shortages in Australia.
 
Currently, there are 261 medicines affected by shortages. Among those in short supply due to an unexpected increase in consumer demand are diazepam, gabapentin and omeprazole. Of the 31 critical shortages, most are injectable steroids, antibiotics and anaesthetic agents which is similar to the shortages seen overseas.
 
According to NPS MedicineWise medical advisor Dr Caroline West, it is important that GPs continue to ask their patients about medicines regularly.
 
‘While working as a GP during this pandemic, I discovered some patients would deliberately stockpile or use medicines off label as a way to feel control over an otherwise difficult situation,’ she told newsGP.
 
‘Some even shared medicines with their whole family or bought medicines for conditions they didn’t have because of something they heard or read on social media.’
 
Dr West also encourages GPs and pharmacists to be proactive about giving sensible medicines advice at every opportunity to reduce unnecessary patient demand.
 
‘Panic buying or stockpiling of medicines is possible during surges of COVID. People are naturally worried about the potential of further lockdowns and restricted access to medicines,’ she said.
 
‘GPs and pharmacists play a central role in reassuring patients that while it’s wise to keep enough of their regular medicine for the short term, say a month or so, stockpiling is definitely not recommended.
 
‘The more people stockpile and access multiple prescribers and suppliers, the more likely they are to experience inadvertent dose mistakes, double dosing due to brand and generic name confusion, expired medicines or have medicines fall into the wrong hands such as small children.
 
‘We all have a role to play in ensuring ongoing supply’.
 
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COVID-19 medicines shortage pandemic supply chain