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Patients in England ration drugs as supply crisis hits

Patients in England are being forced to ration life-saving drugs as a supply crisis hits availability of at least 30 different types of medication, an analysis of official data has shown.

Drug shortages, defined as when a pharmacy or hospital orders a medicine but cannot receive it, are double the level of two and half years ago, according to official data collated by the British Generic Manufacturers Association, a trade body.

There were 101 supply shortfalls recorded in April, compared with 45 in November 2021, their lowest point in the past three years.

The situation has left many patients suffering without treatment as pharmacists struggle to get hold of stock and spend an increasing amount of time searching for replacement therapies.

The data, shared with the Financial Times, showed that 30 common drugs, from diabetes treatment metformin to painkillers such as paracetamol suppositories, have been in short supply for at least six months over the past two years.

The analysis of figures from NHS England and the Department of Health and Social Care, the first of its kind by the BGMA, reveal the extent of drug scarcity across the country. The Nuffield Trust think-tank recently warned that shortages had become a “new normal”.

The shortfalls come as drug shortages reach new highs across Europe and a 10-year peak in the US.

The causes vary for each drug but manufacturers warn that prices for off-patent, generic medicines, which represent the majority of drugs used globally, are too low to make them attractive to make. This is partly due to a squeeze on pricing from manufacturers in Asia and from procurement practices.

Brexit has “exacerbated” the problem in the UK by increasing checks on imports and leading companies to exclude the country from their supply chains, according to the Nuffield Trust.

“There’s an extra burden to get drugs into the UK but we’d still have big medicine problems if we were still in the EU,” said Mark Dayan, Brexit programme lead and author of the think-tank report.

The shortages are taking a toll on patients, with one in four members of the public in England having experienced medicine shortages in 2023, according to polling by Healthwatch England, an affiliate of the health and social care regulator the Care Quality Commission.

Column chart of Total shortage incidents  showing Medicines shortages are double 2021 rates

Recent acute shortages include drugs used by cystic fibrosis and pancreatic cancer sufferers to aid digestion and epilepsy drugs that prevent seizures.

Lucy Baxter has cystic fibrosis, a disease that affects 11,000 people in the UK, and causes the build-up of thick mucus in the lungs, pancreas and other organs.

The 26-year-old relies on an enzyme supplement called Creon to digest food. She was already taking recently out-of-date Creon when she went to pick up a new prescription, only to be told the drug was unavailable.

Creon distributor Viatris said its manufacturing partner was unable to meet high global demand for the drug.

Earlier this month, the government issued guidance to clinicians asking them to limit patients to one month’s supply of the medicine. Supplies will be limited until 2026, with a knock-on effect for alternative products. Creon is also in shortage in sixteen EU member states.

Anil Sharma in one of his pharmacies
Anil Sharma owns eight pharmacies across Cambridgeshire and Suffolk. ‘I’ve had bottles of shampoo thrown at me because patients are so angry,’ he said © Tom Pilston/FT

“It’s really quite scary,” Baxter said from her home in Preston. “I rely on this drug to have basic meals and keep my weight on. It feels like we have gone back in time to when CF sufferers didn’t have these enzymes to just eat normally.”

Meanwhile, the charity Epilepsy Action was contacted by epilepsy patients 3,500 times this year, four times as much as the same period last year, owing to shortages of two key drugs, carbamazepine and lamotrigine.

The problem is also taking its toll on pharmacists. Data from Community Pharmacy England, a trade body, found almost three-quarters of pharmacy staff are spending one to two hours a day dealing with shortages, by phoning GP surgeries and checking stocks at alternative distributors.

Janet Morrison, CPA chief executive, said pharmacists “absolutely face more aggression and frustration” and that the problem was widespread.

Anil Sharma, who owns eight pharmacies across Cambridgeshire and Suffolk, said his staff had faced abuse and threats of violence from patients struggling to secure drug supplies.

In recent weeks, one patient who had struggled to obtain hormone replacement therapy patches to treat her menopause “started shouting and swearing at staff . . . and hurling abuse”, he said.

“I’ve had bottles of shampoo thrown at me because patients are so angry. We have perspex screens because of Covid, but it’s pretty scary,” he added.

Mark Samuels, BGMA chief executive, said the association was in talks with the government over “immediate actions” to address shortages. The trade body’s suggestions include making it easier to transfer drug supplies from one hospital trust to another but policy work will be delayed by the general election in July.

“Sometimes there’s a genuine shortage where there’s not enough stock full-stop. Sometimes there may be plenty of stock in a warehouse in Manchester but not London,” he said. “The only thing that matters to patients is whether they can get their medicines.”

DHSC did not respond to a request for comment.

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