In early January I went into a panic when a medicine called Colazide suddenly disappeared from pharmacy shelves. It is the only medicine that provides some measure of control over my ulcerative colitis. All of Wangaratta's pharmacies had run completely dry, so I rang my specialist, but he didn't keep a supply on hand either and suggested I try pharmacies in Yarrawonga. I rang all of them, but had no luck. I then (unsuccessfully) tried pharmacies further away.
Angry and frustrated, I rang the medication wholesaler who, in turn, blamed the manufacturer's inability to source the medicines raw ingredients. I was advised that they were 'hopeful' that Colazide might be back in supply sometime in February. That was four to eight weeks away! When you have ulcerative colitis, going without medication for weeks might as well be going without for an eternity.
Buying medicines online
I had been told there was a nationwide shortage of Colazide, but that wasn't going to stop me from searching for it online. On one online forum, a person said he had tried to get Colazide from every pharmacy in Adelaide - with no luck. During my search, I found one online seller whose website said they had some in stock and rang to check, only to find that they had run out too.
Overseas websites listed Colazide as in stock, but when I got into the fine print, it became apparent that it would take up to ten days to process my order after they received my prescription. It could then take a couple of weeks to get to Australia via mail, not to mention the added potential barrier of being stopped at customs. I figured it would take at least a month for an overseas order to arrive – and that wasn't going to help my soon-to-be-raging colon!
Australia's Therapeutic Goods Administration (TGA) regulates medical drugs and devices in Australia and warns against buying prescription medicine from overseas suppliers. The TGA website makes it clear that an overseas medicine with the same name as one purchased in Australia might have completely different ingredients. It also warns that the medicine could:
- Be fake
- Be a stronger or weaker dose that you are used to
- Contain undisclosed, contaminated or dangerous ingredients
- Be past its use-by date
In other words, don't use these dodgy imports! It's pretty clear that the risks outweigh the benefits, even when you're desperate.
Other medicine shortages
In 2012 several notable online medical publications reported on other medications being in short supply in Australia, including one of the most popular anti-diabetic drugs, Diabex. The cancer drug Caelyx was also been reported as being in short supply, as well as injectable morphine and benzylpenicillin.
Causes of shortages
At the time of writing, Australia only manufactures around five per cent of its prescribed medicines. The global nature of the pharmaceutical industry means many drugs are manufactured by only one or two large overseas companies. If something goes wrong at one of these overseas manufacturing plants, shortages will occur. If a medicine is subsequently in short supply on a world-wide basis, then a small and geographically remote market like Australia might find it very hard to acquire an uninterrupted and reliable supply.
Not to be alarmist, but a manufacturing plant could burn down, or be closed down for maintenance or an upgrade. Manufacturers of cheap generic medicine may also not find it profitable to invest in new equipment, resulting in breakdowns. The Diabex shortages were caused by problems in manufacturing its active ingredient metformin. The injectable morphine shortage was due to overseas packaging delays.
Other causes of medicine shortages include increased demand. The increased demand for benzylpenicillin, caused by floods and other disasters, caused a shortage.
I decided against risking overseas medicines, and went back to my doctor and got a prescription for an alternative medication. I had used it before, but it had not seemed to work as well as Colazide and had made me overly tired.
Other people who are forced off a particular medicine due to its unavailability also risk side-effects that range from the unpleasant to the downright nasty. People can suffer from withdrawal from a prescription drug just as much as they can from an illegal one. Similarly they can take time to adjust to the effects of taking another drug. Swapping drugs of different dosages may cause overdoses or under-doses and these can have serious consequences for your health in both the short and long term. This was seen as a major potential problem with substitutes for Diabex.
Fortunately, Colazide became available again in early February. My ulcerative colitis did not flare up while I was on the alternative medicine, but I did have to cope with excessive tiredness.
Australian wholesalers should act now
Having dealt with the fallout of medicine shortage and seen first hand the difficulties people could face if contingencies aren't put in place, it is my opinion that Australian wholesalers should consider keeping at least a couple of months supply of non-perishable medicines in reserve at all times. Another solution could be more Australian manufacturing of medicines, so at least our transport links and manufacturing standards can be reasonably assured. However, Australia's small market, high dollar and complex free-trade agreements will make it hard for any manufacturing expansion or renegotiation.
Either way, I have decided to always ensure I always have at least a month's supply of my medicine stacked away in the cupboard. Just in case.