Jack London is an incredible Alaskan Husky dog that suffers from a form of autoimmune disease, which results in his body attacking the skin of his nose. The condition can be difficult to manage in some dogs, but Jack responds well to a combination of tetracycline and a vitamin called niacinamide. As long has he gets these medications he does well and lives without a care. His guardians are happy because this treatment is relatively safe and well tolerated, and the drug is not particularly expensive. But Jack's "mom" recently suffered a big scare when she learned that tetracycline is on a list of drugs that are in short supply in our country.
She was stunned and upset that her dog's health might suffer due to such a shortage. Jack's case is a complex one and he is very sensitive to many medications. She just did not want to face the potential difficulties this shortage might create.
When she called our office I explained the situation. She was even more surprised to learn that there were large shortages of very important drugs which were affecting doctors, veterinarians and most importantly patients of all species here in the United States of America.
"I felt like I was living in some backward third-world country," she said.
And the more she thought about it, the more uneasy she felt. She wondered about her own medications and those needed by her friends and family.
In veterinary medicine, we are seeing difficulty in obtaining drugs that kill adult heartworms and prevent juvenile heartworms from growing to adulthood. This has important ramifications for people who live in areas where heartworms are a risk factor for their dogs and cats. There are also scarcities of drugs used for chemotherapy, pain and cardiac conditions. The problem exists for some prescriptions for humans, too, and is bad enough that the president recently issued an executive order addressing the need to resolve or improve these circumstances.
We have also seen the prices of many simple and formally inexpensive generic drugs skyrocket in the last year and this also drives up the costs of services for consumers.
As with all things, knowledge is power and so there are several proactive things you can do to find out if these shortages will affect you, your family or the animals in your life:
- As a first step, make a list of all drugs and medications used in your home.
- Go to the FDA Web site to see if your drugs are listed there. The website of the American Society of Health-Systems Pharmacists (ASHSP) is a private site that is easier to use.
- Check the sites monthly so you can be properly informed. Since pharmacy companies do not usually notify doctors about upcoming shortages, it is best if you take this personal step yourself.
If your drugs are not listed there is nothing more to worry about, but you might want to check with your pharmacist and see if you would save money if you purchased a larger supply of medication. If that is the case then ask your doctor for a larger prescription. This is a good practice for drugs that are needed long-term. It helps us prepare for a disaster and might save you money in the process. One warning applies here and that is to be sure that you do not buy more drugs than you can use before their expiration dates. Using expired drugs is not safe and should not be done. Pharmacy laws require that the expiration be listed on the bottle, so just look there and verify that the drugs will be used before the expiration date is reached.
In the event that a shortage occurs, do not panic. Take the following steps:
- Ask your physician or veterinarian about the importance of the specific drug to your case. Is there a substitute drug or alternative modality like herbal medicine that might suffice? Is the substitute effective and safe in comparison to the short supplied drug? Is the substitute drug available? In Jack's case we have the option of using topical 0.1 percent tacrolimus ointment which as limited study showed being beneficial as sole agent in about 60 percent of the dogs tested. Since no one treatment works or is tolerated well by all patients, we need to have options to consider.
- Contact various pharmacies in your area to see if they have stock. If you find a pharmacy with the medication, verify the price to be sure there is no price gouging going on and then call your doctor to ask for a prescription as soon as possible.
- Sometimes online pharmacies will be able to supply drugs, but be sure you are dealing with a reputable one as some online suppliers have been found to deliver improper product. If possible, deal with suppliers within the continental U.S. that have good reputations. The FDA "A.W.A.R.E." program has good advice for consumers.
- If no options exist, ask your doctor about any trials that may be going on for your condition. In some cases you may be able to enroll in a research project to obtain treatment for your condition.
In this case Jack got what he needed from a local pharmacy, but that is just the beginning of that story. We have become a very drug-dependent society. As always, it is best to take responsibility for our own health and to take steps to prevent and postpone disease. Perhaps scarcities like these present issues will drive some of us to live healthier lives, but as a veterinarian I certainly hope that we can resolve these issues and return to a more stable production atmosphere where we can get the health care items we need and we have the freedom to choose the best products available for our needs.
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Corrigan M, Kirby DF. Impact of a National Shortage of Sterile Ethanol on a Home Parenteral Nutrition Practice: A Case Series. JPEN J Parenter Enteral Nutr. 2012 Jan 12.
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White SD, Rosychuk RA, Reinke SI, Paradis M. Use of tetracycline and niacinamide for treatment of autoimmune skin disease in 31 dogs. J Am Vet Med Assoc 1992;200:1497-1500.